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London Med. and Surg. Journ. Aug. 1830,
TREATISE
ON
SPECIAL AND GENERAL
ANATOMY.
BY WILLIAM E. HORNER, M. D.
PROFESSOR OF ANATOMY IN THE UNIVERSITY OP PENNSYLVANIA— MEMBER OF THB IMPERIAL
MKDICO-OHIRURQICAL ACADEMY OF ST. PETERSBURG— OF THE
AMERICAN PHILOSOPHICAL SOCIETY, &C.
Multum adhuc restat operis, multumque restabit, nee ulli nato, post mille ssecula
pnecluditur occasio aliquid adjiciendi.
SENECA, EPIST.
IN TWO VOLUMES.
VOL. I.
FIFTH EDITION, REVISED AND IMPROVED.
LEA & BLANCHARD,
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1840,
BIOLOGY
LIBRARY
G
Eastern District of Pennsylvania, to wit: —
BE IT REMEMBERED, that, on the seventeenth day of October, in the
fifty-first year of the Independence of the United States of America, A. D.
1826 — William E. Homer, of the. said district, hath deposited in this office the
title of a book, the right whereof he claims as Author, in the words following-,
to wit: —
" A Treatise on Special and General Anatomy. By William E. Homer, M. D.
Adjunct Professor of Anatomy in the University of Pennsylvania, Member of
the American Philosophical Society — Surgeon at the Philadelphia Alms
House, &c. ' ' Multum adhuc restat operis, multumque restabit, nee ulli nato,
post mille saecula prsecluditur occasio aliquid adjiciendi.' Seneca, Epist. In
two volumes.' Vol. II.
In conformity to the Act of the Congress of the United States, entitled, " An
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tary to an Act, entitled, ' An Act for the Encouragement of Learning, by se-
curing the Copies of Maps, Charts, and Books, to the Authors and Proprietors
of such Copies, during the times therein mentioned,' and extending the bene-
fits thereof to the arts of designing, engraving, and etching Historical and other
Prints."
D. CALDWELL,
CJerk of the Eastern District of Pennsylvania.
& CO., PIUJTTEnS.
PREFACE
To the First Edition, published in 1826.
THE many additions that, of late years, have been
made to Descriptive or Special Anatomy; the improved
views on the collocation of its objects; the alterations and
amendments in the method of description; and the non-
urgent call for some greater information on General Ana-
tomy than what is commonly introduced into the scho-
lastic systems; require in the English language, for the
benefit of the medical student and of the practitioner, a
new work on the structure of the body, executed by one
who is in the habit of pursuing anatomical inquiries by
constant dissection. It would have been pleasant to me
if some gentleman, whose time, opportunities, qualifica-
tions, and spirit ofresearch were better suited to the en-
terprise, had stepped forward for its accomplishment.
While meditating on this subject, I had a strong desire
to remodel the excellent work of Dr. Wistar,* on a plan
more suited to the actual state of the science ; but, upon
reflecting that it was a justly celebrated monument to
his reputation, I became dissatisfied with the project of
cutting and carving it into a more modern figure. In
addition to which consideration, having frequently de-
parted from his authority, the alternative was presented
either of suppressing his ideas to substitute my own, or
of giving currency to opinions differing from my own
convictions, neither of which was agreeable. The la-
* A system of Anatomy for the use of Students of Medicine. —
Philadelphia, 1817.
IV PREFACE.
hour, moreover, of remodelling would have been almost
equal to the writing cf a new book.
Neither is there any work extant from the British
press, which presents a good model for a body of Ana-
tomy. This assertion may surprise some, and yet it
is entirely true, and especially so in regard to the
British publications most circulated in this country :
I allude to the Anatomy of Mr. Fyfe,* and to that of
Mr. Bell.f The first, from being unpretending, good
in its way, and having accomplished the object for which
it was intended; to wit, as a general outline of anatomi-
cal objects, requires for the present no farther comment.
But the second, being presented to us in the imposing
form of four octavo volumes ; illustrated by numerous
diagrams and plates; abounding in strictures upon the
opinions of others, and written in a fanciful pleasant
manner; has had a much more powerful influence on
the taste of the American student, and is, therefore, a
very proper subject for a short analysis. It is not going
beyond bounds, when I say, that there is no work which
affords more amusement to the young student on the
first perusal, or whose authority is viewed by him with
more deference. Its sprightly style; its confident man^
ner of address; the many exploded, antiquated errors
which have been disentombed from absolute oblivion,
in order to make the reader laugh at them; the gro-
tesque dress put upon the valuable opinions of others;
and their travestied doctrines; all contribute to make it
read like a production of the imagination, and to have
* A Compendium of the Anatomy of the Human Body, intended
principally for the use of Students. Philad. Ed. 1802.
t The Anatomy of the Human Body, illustrated with one hundred
and twenty-six engravings. By John Bell, Surgeon.
PREFACE. V
the same sort of popularity which works of the latter
kind frequently enjoy. As the real importance, how-
ever, of a work upon an exact science does not exist in
its wit and "bizarreries" but upon the wholesomeness
of its truths, and the accuracy with which they are
stated; it is fair to expect that the writer should himself
be faultless, who thus uses the weakness of others as
the foil upon which to display, most advantageously,
his own presumed brilliancy and perfection. It does
not require much scrutiny to ascertain whether the ex-
pectation is realized, and whether this author does not
abound in inaccuracies, in exaggeration, in obscurities,
and in irrelative matter.
In regard to the inaccuracies of Mr. Bell, we give the
following as specimens, which we have got without far-
ther trouble than that of thumbing his pages. " This
membrane (the Mediastinum) passes directly across the
breast from the sternum before, till it fixes itself in the
spine behind. It is on the left side of this membrane, in
the left cavity of the breast, that the heart is placed."
" The Eustachian Valve is in general thick and fleshy "
"The Pericardium is formed, like the Pleura and Me-
diastinum, of the cellular substance" " The Perioste-
um is merely a condensation of the common cellular sub-
stance, formed in successive layers." "The perioste-
um, tendons, fasciae and burses mucosce, are all of one
substance and of one common nature." " The socket,
(i. e. theacetabulum) is deepened by its cartilage, which
tips the edge of the socket, and stands up to a conside-
rable height." Some of these mistakes are glaring blun-
ders; others may perhaps be referred to the faulty phra-
Vlll PREFACE.
another, like vitriol upon tartar, and thereby ejecting
itself through the aorta. — Of side passages in the heart
through the septum of the ventricles. — Of the cele-
brated general of the Messenians, Aristomenes, known
equally well for his devotion and constancy to the cause
of his countrymen, having his heart filled with hair, a
proof of his invincible courage and daring. Of the eel
which was found in the heart of a patient of Dr. May.
These matters may possibly be excused on the footing
of episodes, intended to diminish the tediousness of a
long story.
The oddities of this writer are likewise entirely cha-
racteristic : thus, we have in his Principles of Surgery
a regular diagram of the resemblance between the thigh
bone and a chariot with dished wheels. "Polonius.
Very like a whale."
The last comment which we have to make touching
this " popular writer" is on his anatomical illustrations.
I cannot enter into an analysis of them, but have only
time to say, that if ever a simple matter was perplexed
by illustrations, we have this feat to perfection in the
account of the Circulation, of Respiration^ and of the
round of blood in the Foetus.*
The character of the preceding vagaries may suit a
writer on common literary subjects, where amusement
only is intended ; but is totally unfitted to an instructor
in an exact science, where words should be used only
according to their technical meaning, and where patient
observation is the only guaranty from ridiculous mis-
* The preceding observations are principally applicable to the first
and second volumes of the Anatomy of the Human Body ; the third
and fourth have been executed in much better taste by Mr. Charles
Bell.
PREFACE. IX
takes. But I must here stop^ for I have never aspired
to the reputation of a critic, and to the equivocal friend-
ship with the rest of the world which such commenta-
tors generally have. I have only been induced to point
out these faults, because it appeared to me that the
writer alluded to/though now numbered with the dead,
has left a reputation tending to deprave the scientific
habits of such medical students, and they, I believe,
are not a few, as read his works. I am also checked
by the hint of Le Sage : "En verite sil y a bien de mau-
vais auteurs, il faut convenir q'il y a encore plus de
mauvais critiques."* I, therefore, conclude by sug-
gesting, that if an exact science require for the relief of
its student some dilution with the works of the imagi-
nation ; instead of corrupting it with mere notions and
exaggerations, it would be much better for the student
to resort to productions of the fif st merit, and to hold in
one hand his System of Anatomy, and in the other a
Milton, or a Waverly Novel.
I should be extremely sorry to be understood as doubt-
ing the capability of the British anatomists to write a
good treatise on this subject. I indeed feel persuaded
of the contrary; and, therefore, only mean that as yet
they have not, in this particular, done justice to them-
selves, or to the literary reputation of their country.
Any other opinion w^ould be great injustice to them, 'and
would also be ingratitude for acts of friendship and civi-
lity received from many illustrious and enlightened in-
dividuals whom the profession is proud to own; and al-
* In truth, if there are many wretched authors, one must confess
that there are many more wretched critics. — Gil Bias.
X PREFACE.
legiance to whose doctrines has, moreover, been freely
avowed, in the present work, on proper occasions.
To the profound anatomist, whose inclinations lead
him to study every fasciculus of fibres composing a mus-
cle or a ligament, and every minute nervous or arterial
ramification, the. present Treatise on Anatomy will of
course, be a mere outline of the science. But to the stu-
dent of medicine and to the practitioner, who have only
time to dwell upon prominent and useful points, I trust
that it will appear sufficiently full for most professional
objects. The anatomy of the human body is of an ex-
tent much beyond the common conceptions of it, and is
rather a generic than a specific term. A full treatise
on it would contain matter to twice or three times the ex-
tent of the present work, and would even then be in
many respects deficient; for it must not only give a full
description of parts in the adult body, but their first ap-
pearance in foetal life, and their gradual development
into the perfect or adult state. It must also contain a
complete account of the properties of each kind of struc-
ture composing the human body, called, in technical lan-
guage, General Anatomy; also morbid alterations of
structure, and finally varieties in shape, position, &c.
It is here proper to remark, that though every hu-
man body be formed on the same general mould, yet,
in examining the details of structure in an individual,
varieties will be met with causing a difference from
all other individuals. For as no two leaves or two hu-
man countenances are precisely alike, so the interior
organs of individuals differ in their phases, though the
same end is obtained. Hence, it becomes necessary
PREFACE. XI
for a system of anatomy to show rather what is of the
most frequent occurrence, than to pretend to universal
correctness; because, by the latter test, many of its ac-
counts are inexact. Some of these departures from the
general rule are so infrequent as to deserve the name
of anomalies: in some cases, there is, indeed, only one
or two recorded instances; but, in others, the variation
is so frequent as to leave the anatomist in doubt, about
what mode of description is applicable to the majority
of cases. From this latter cause, we, in consulting
different writers, sometimes find their opinions much
opposed ; and to our surprise, the adage of quot homines
tot sententics, as applicable to the science of anatomy,
as it is to one of an abstract and confessedly disputable
kind. Anatomy, however, in its great outlines, is a
science surprisingly and sufficiently exact; the excep-
tions are too few to admit of hesitation about what is
right and what wrong : it is, therefore, perhaps, next to
mathematics in the precision of its indications, and in
the value and certainty of its rules. It is, for these
reasons, in every way suitable, that in an operation, or
in the treatment of a disease, where the condition of
organs is to be considered ; that we should look with
full assurance for what is most common, rather than to
hesitate and vibrate between two opinions; to balk
about mere varieties. Otherwise, a knowledge of the
possibility of the latter will rather injure than assist
our exertions, and our inefficiency will have the ap-
pearance and effect of ignorance.
Sensible of the importance of reflecting upon, and
of observing maturely the matters treated of, I have
Xll PREFACE.
done my best to be accurately informed by repeated
dissections, and .by reference to the highest authorities.
The latter was happily put into my power, by the
well-furnished library of the Alms House and of the
Pennsylvania Hospital; and by a private collection,
containing many of the most approved productions.
This balancing of the opinions of others with one's
own dissections, is, unquestionably, best suited to cor-
rect inferences : to follow exclusively the one- or the
other, is attended with great liability to error. An un-
due deference to approved authorities makes our opi-
nions habitually wavering and uncertain, from the
discrepance of writers among themselves; while an in-
sufficient attention to such means of information pro-
duces very serious mistakes in correctness of descrip-
tion, and very false ideas of scientific acquirements.
If we presume on our own infallibility and originali-
ty, we are apt to suppose ourselves possessed of sur-
passing skill, as floating triumphantly on an ocean of
discovery, as extending in every direction the bounda-
ries of the science and giving a new impulse to it ;
while, on the contrary, our faulty modes of examina-
tion, and neglect of competent writers, have caused us
to flounder ridiculously on common-place and well
settled points. It is thus that imaginary originality is
not unfrequently in an inverse proportion to the recent-
ness of one's induction into the science, and to the ex-
actness with which it has been studied.
In the absence of knowledge, the young and enthu-
siastic, but heedless anatomist, is frequently prolific,
from the commencement, in discoveries : he makes
PREFACE. Xlll
them in such numbers, with such facility, and under
such unpremeditated circumstances, that he is filled
with admiration at his own abilities in such matters,
and at the ignorance and inattention *of his predeces-
sors and cotemporaries. In the ready communication
of the result of his labours, he is disposed to use the
language of high attainment and of advanced reputa-
tion. He hints at his anticipations of the jealousy and
malice which are known to follow greatness and excel-
lence; not considering that there is quite as much
proneness in an individual to overrate himself from
self-love, as there is in others to decry him unjustly.
He feels mortified at the supposed apathy of some per-
sons, and indignant at others for not placing him at
once, on the pinnacle of fame. After waiting in vain
for such homage, he, at length, finds out that the mat-
ters treated of have all the triteness of being very well
known; or, if they be novelties, they are the offspring
of hasty and imperfect observation, and were rather
leading into error than conducting to, the truth. An
inattention to the writings of others has also the incon-
venience of exposing us justly to the raillery and cri-
ticism of persons, who, not reflecting that it is scarcely
possible to bring new truths into vogue, much less er-
rors, and that such mistakes carry with them their own
seal of death, they drag them to the block, there to die
by the hand of the public executioner. Dr. W. Hun-
ter* has justly remarked, that " He that is in a hurry
to publish his discoveries, will often have occasion to
repent his haste. Reflection, and more favourable op-
* Med. Comment, p. 57. Lond. 1777.
VOL. L— 2
XIV PREFACE.
port unities of making inquiries, will at length bring:
us back to the truth, if we have been misled, and will
confirm and improve our inventions, if they be right."
The preceding^observations are not intended to re-
press the spirit of generous enterprise, but rather to
assist it, by giving it a proper direction. There are,
unquestionably, many things yet to be discovered in
anatomy, as proved by the continued contributions of
its cultivators. For, in the language of the motto,
" Multum adhuc restat operis, multumque restabit,
nee ulli nato, post mille ssecula prsecluditur occasio
aliquid adjiciendi." These remarks are only intended
as a salutary warning to the young votary of anatomy,
not rashly to promulgate, by boastful writing or lan-
guage, that he considers his own acquisitions as the
standard of the science, and every thing beyond them
as in the region of discovery. Because, if he does, he
is sure to meet with the most mortifying convictions
to the contrary; and sometimes to find himself placed
below the degree of his actual acquirements, for mani-
festing a want of acquaintance with topics common to
others. The rule is undoubtedly a good one: " Let
not him that putteth on his harness boast himself, as
he that putteth it off."
^
Nonthinking that the present treatise is a proper
field for discussion on controverted points, I have pur-
posely, excepting on a few occasions, avoided it, by
simply giving an opinion after my own views of cor-
rectness, without pretending to infallibility, or being
disposed to reject better information when offered. I
cannot, however, but feel the strongest diffidence of
PREFACE. XV
my powers to execute, in a moderately satisfactory,
not to say a proper manner, the enterprise of writing
a treatise on anatomy. There are not many persons,
who, as they advance in the study of the science, by
dissections and by reading, do not, after awhile, as in
the cultivation of high religious and moral attainments,
mistrust their acquirements; and find, that whatever
may have been the fancied perfection of their know-
ledge during the infancy of their studies, they were
then only on the threshold of the temple. In begin-
ning the career of anatomical inquiries, as an almost
exclusive profession, we have yet to appreciate the la-
bours; I may, indeed, say to read the writings of the
eminent men who have gone before us. We have yet
to learn the infhiense multitude of observations by
which we are surrounded, and the great labour that it
requires to master them all. The fact is well esta-
blished, that it requires some years of hard study be-
fore the anatomist becomes aware of his own weak-
ness, and of the many things that he has yet to do in
order to be brought up to the actual state of the sci-
ence.
Impressed by these convictions, I have constantly
endeavoured to ascertain and present the science of
Descriptive or Special Anatomy, as it stands at the
present day, \vithout entering into all the minutiae of
details of which it is susceptible. I have, therefore,
neglected no fact bearing on the subject, which seemed
to be sufficiently authenticated or important to deserve
notice. Owing, however, to the expanded field in
which I have worked, and the many pressing engage-
ments which drew my attention from it, it is not im-
PREFACE.
probable that I may have omitted some things worthy
of remark, which I may have subsequent reason to re-
pent my neglect of.
By far the greater part of this work has been
wrought up in regular manuscript; on several occa-
sions, however, not wishing to make the text more pro-
lix, I have incorporated with it literal extracts from my
" Lessons in Practical Anatomy." This is especially
the case in regard to the nerves of the extremities and
to the muscles. The two works harmonize; yet some
unimportant differences may, in a few places, be ob-
served by the attentive reader, owing to improved
views in the present. Simple typographical mistakes
have also given rise to discrepancies ; but it is almost
impossible to avoid a contingency of this kind, owing,
sometimes, to the inevitable hurry in which a proof-
sheet is corrected, and, at others, to the mechanical
derangements, to which the press is subject.
The great deficiency of the English language in
terms suited to anatomical description and nomencla-
ture, and the difficulty of forming suitable compound
words from-it, have induced me to take some liberties
which I would gladly have dispensed with, under
other circumstances. To avoid periphrasis, and the
inconvenient repetition of sentences, I have, therefore,
frequently adopted French terminations, and sometimes
formed a word upon a Greek, a Latin, or a French
root; following, in these respects, the authority of the
Continental Anatomists. But it is still a great deside-
ratum, for anatomy to be rather more algebraical in its
characters and language, than it is at present.
PREFACE
To the Fifth Edition,
THE present state of Anatomy exhibits the propriety
of the motto adopted for the title of this work, at its
first edition in 1826, for on whatever side our attention
may be directed to the nations of the earth, most en-
gaged in the cultivation of human sciences and arts,
we find that Anatomy is still in progress, and will pro-
bably continue so to the end of time. Contributions
of the most valuable kind have been made in France,
in Germany, in Italy, and in England, not only in re-
gard to new observations, but in giving a greater perfec-
tion to modes of elucidation by plates — models — draw-
ings and injections. In all of these states, improved
systematic treatises have appeared, besides numerous
monographs of an instructive kind. In England the
science has taken on an aspect signally amended within
the last twenty years, so that the disparity once exist-
ing between her and the states of the continent, strikes
the eye of the inquirer much less than it did at a former
period ; in fact several works of a high order of merit
have made their appearance. Our own country has
manifested the same spirit of advancement in the in-
crease of medical schools, and in the multiplication of
highly instructed teachers of anatomy, and expert prac-
tical anatomists. Though possessing less literary and
scientific leisure than any other of the polished and
2*
XV111 PREFACE.
instructed quarters of the world ; yet those limited op-
portunities have been fruitful in original observations,
in translations, in papers, in monographs, and in im-
proved editions of preceding works.
The several productions alluded to in the above
sketch, are too numerous for distinct or individual no-
tice on the present occasion, they have, however, been
freely canvassed for the composition of this work, and
their contribution to the general cause of anatomy
claimed, to the extent that it could be, keeping at the
same time this work within the precincts of what it is
intended for, to wit, a Text Book to the course of Lec-
tures on Anatomy in the University of Pennsylvania.
Some things may, however, be omitted as useless, which
strike the understanding of others as too important for
neglect; and other things on the ground of having a tes-
timony too defective, at present, of their real existence,
to justify their being introduced into a code of De-
scriptive Anatomy.
W. E. HORNER, M. D., Univ. Penn.
Philadelphia, Oct. 1839.
INTRODUCTION.
THE Science of Anatomy has, of late years, been di-
vided into Descriptive and General. This distinction,
though faintly traced by preceding anatomists, owes its
present prominence to the labours of the celebrated Bi-
chat; and the daily observations of physiologists and pa-
thologists, are only renewed and concurrent evidences
of its importance and value in the practice of medicine.
Although the distinction is only coming into vogue in
this country, the tendency to it is so great that in a
few years more, medical language and ideas will be
universally tinged with it; it is proper, therefore, that
it should be defined in such a manner, that it may be
perfectly intelligible to the student.
Descriptive Anatomy teaches the exterior form of or-
gans, their magnitude, their position, their connexions
with adjacent parts ; and their intimate texture or or-
ganization. As in this way every individual part is
brought under a strict review, it is this division of the
science which gives skill to the surgeon. The term is
not entirely appropriate, because description means any
account whatever ; the substitution of the phrase Special
Anatomy is, therefore, one of the improvements of the
present day, and is very much resorted to.
General Anatomy may be explained, as its great
XX INTRODUCTION.
founder, Bichat, himself has done it, by the following
comparison. Chemistry has its simple bodies, as heat,
light, hydrogen, oxygen, nitrogen, carbon, and so on,
whose several combinations form all the composite bo-
dies on the face of the globe. In the same way anatomy
has its simple tissues, whose varied combinations form-
all the organs of the human body and of animals.
These tissues are,*
1. The Cellular, Vol. I. p. 317
2. The Adipose, or Medullary, 325
3. Vascular, II. p. 153, 280
4. Nervous, 313
5. Osseous, I. p. 56
6. Fibrous, or Desmoid, - 257
7. Cartilaginous, 351
8. The Fibro-Cartilaginous, 256
9. Muscular, - 351
10. Erectile, or Spongy, as Penis, &c. II. p. 85
11. Mucous, 50
12. Serous, 10
13. Dermoid, or Skin, I. p. 328
14. Glandular, as Liver, Kidneys, &c. &c. II. p. 56
The distinctions of tissue do not rest upon an imagi-
nary basis, but have nature for their foundation. The
organization of each has well marked, and characteristic
* Bichat admits twenty-one elementary tissues, but several of them
are but modifications of one and the same. For example, the arterial,
the venous, and the absorbent, belong all to the vascular, and I have
thought it useful to concentrate them under one head; and so of some
others, where the analogy is equally evident. As the nature of the
work did not admit of the consecutive description of these tissues, re-
ference is made to the pages in which they are discussed. With this
guide they may be studied in immediate succession, by the person
desirous of an outline of General Anatomy.
INTRODUCTION. XXI
peculiarities, which may be ascertained by their dis-
eases, and by the influence of different agents, as heat,
air, water, acids, alkalis, neutral salts, and putrefaction.
Each tissue has its particular strength, and its particular
mode of sensibility, upon which repose all its vital phe-
nomena, and the blood is but a common reservoir, where
each chooses what is in relation to itself. An example,
however, will serve better for illustrating these several
points. The stomach is composed of four laminae, one
is serous, another muscular, a third cellular, and a fourth
mucous. Each of these laminse has its appropriate sen-
sibilities and mode of life, which may cause it to be dis-
eased, while all the others are healthy. Peritoneal in-
flammation may invade the first, the cramps of colic the
second or muscular, the infiltration of dropsy the third
or cellular, and dyspepsia the fourth or mucous.
It thus happens, that the diversity of the tissue of an
affected organ modifies the symptoms of its diseases, and
especially their duration. Hence, nothing is more vague
in medicine, in regard to duration, than the terms chronic
and acute. An inflammation in one tissue will go na-
turally through its stages in a few days, as, for exam-
ple, in the skin, cellular substance, mucous membranes;
while in the bones and ligaments, on a natural progress
being also observed, weeks and months are required for
its accomplishment. It is evident, therefore, that a
time which is chronic in the first three tissues, is acute
in the lagt two.
A chemical analysis of the body demonstrates only a
few elementary principles; and they are varied in their
combinations by a greater or less proportion of one or
the other. Calcareous matter, the neutral salts, carbon,
hydrogen, oxygen, nitrogen, sulphur, iron, wrought up
by the powers of animalization into gelatine, albumen,
and fibrine, which again are elaborated into the fibrous
and laminated tissue, constitute about the sum total of
XX11 INTRODUCTION.
the results of the experiments of animal chemistry. It
has yet to find out the laws of the phenomena which
give to these elementary atoms the condition of blood,
and afterwards change this blood into muscles, nerves,
and other things.
The whole body is formed of solid sand of fluids. The
former, when unravelled, consist of fibres, of laminae,
and of molecules; their mechanical division does not ad-
mit of any greater separation. Many of the laminae are
arranged into membranes, thus forming hollow viscera,
for containing either articles of food or the excretions;
others surround the different solid viscera and separate
them from the contiguous parts. Other laminae pene-
trate through the most compact structure, and indeed
form the nidus in which its atoms or particles are de-
posited. Many of these laminae consist of several thin-
ner laminae, placed together and united by filaments ar-
ranged into cells, which cells receive the ultimate par-
ticles of the whole fabric, and constitute its base. The
lamhue also, by being wrought into cylinders, constitute
vessels of different kinds, which are distributed in such
numbers through the body, that by far the greater part
of its structure seems to be formed of them. In regard
to the fluids, they are extremely abundant in number
and in quantity, and are found in the cells of the lami-
nated tissue, and in the several vessels. One not accus-
tomed to the process^ would be astonished to see, when
these fluids evaporate by exposure to the air, that near-
ly all parts of the body, except the skeleton, lose from
one-half to two-thirds of their original bulk, and some
parts even more. The several solid parts of the body
are then literally kept soaked during life in the fluids ;
which have for a principal constituent, simply water.
There are some animals whose organization is so sim-
ple that they possess only the power of sensation; and
of motion in one part upon another. This is perhaps
INTRODUCTION. XXiii
the lowest degree in which, animal life does exist, or
possibly can exist, without a new order of things.
These qualities, sensation and motion, are of necessity
combined always; they constitute the first ingredients
in the composition of life, both in vegetables and ani-
mals, and by being modified in various ways by their
application to different organs, may be traced up to the
perfect animal, man.
Nutrition is the first want of every being, and is one
of the modes of sensation; therefore, before any other ap-
paratus is provided for animal life, means are resorted to
to carry it on. Vegetables are fixed to the soil, and are
furnished with great numbers of porous roots, which by
spreading in different directions, come in contact with
the moisture of the ground and by simple absorption
conduct it as the aliment of the plant. There are many
animals which have a vegetative life almost as simple
as this, are fixed permanently to the spot where they
came into existence; others are permitted to change
their places of abode, and a provision for nourishment
by roots would not answer; hence comes the necessity
of a stomach, or reservoir in the interior of the body,
into which aliment may be introduced, and transported
along with the animal. In many instances this stomach
seems to constitute the whole animal, as in a hydatid :
it receives such simple fluids as compose the medium in
which it resides, and carries on its digestion, with so
little change of the alimentary matter, that there seems
to be nothing of an excrernentitious kind, as commonly
understood, thrown off. These animals are found abun-
dantly in the waters of tropical regions, exist sometimes
in the brain of man, and of sheep, in the uterus, and in
almost every part of the body. But, again, there are
stomachs of a more complex kind, which have opening
into them a great number of absorbing orifices, called,
in the striking language of Boerhaave, " genuine inter-
XXIV INTRODUCTION.
nal roots." These stomachs may admit fluids only, or
they may be large enough to receive considerable mass-
es of solid aliment. In the latter case exists the neces-
sity of teeth, or some mechanical means of triturating
the solid food into such fine pieces, as will admit of its
being exposed by an extensive surface to the action of
the stomach. But as much of the matter thus carried
in is unfit for assimilation, and there may be even more
of it than is required, an intestinal canal is provided,
by which it is carried oat again. Here then commence
the phenomena of a true digestion, with all its modifi-
cations and stages.
The very simple structure of a plant, and its perma-
nent locality is attended with a circulation of its juices
equally simple ; which is performed and maintained by
the capillary attraction of its pores, and by evaporation
from its higher and more exposed parts. This circulation
is the more rapid as the evaporation becomes greater :
but the latter may become changed into absorption by
the humidity of the atmosphere ; and the circulation be as
a consequence reversed from the branches to the roots.
But it is evident that such animals as possess extensively
the powers of locomotion, besides having organs more
numerous and more complex than the parallel fibrillse of
vegetables, will frequently find themselves in such con-
ditions of temperature and locality, that a similar circu-
lation of the nutritious fiuid in them could not be main-
tained. Hence it is necessary to have more powerful
and regular agents for carrying on the circulation.
They, therefore, are furnished with innumerable blood
vessels, called arteries and veins, which have a common
centre, the heart, for propelling through them the blood
or nutritive fluid to all parts of the system. From the
heart being furnished with valves, which are all in one
direction, the blood can flow only in a corresponding
course; thus it is forced by the heart into the arteries,
INTRODUCTION. XXV
and after moistening the most minute fibres it is received
into the capillary extremities of the veins and brought
back to the heart, where it receives another impulse, and
performs again the round of the body, and so on in suc-
cession. This phenomenon is called the circulation.
When it exists in animals, blood is always to be found;
for the most part red, but in many species white or trans-
parent. The use of the blood in them is to receive from
the alimentary canal, from the skin and lungs, such
matter as has been assimilated, and to convey it to eve-
ry part of the body, for the purpose of repairing its
waste, or providing for its growth. It is at the very
extremities of the arteries that this deposite occurs, and
the blood getting into the veins loses its bright vermi-
lion colour, becomes of a modena or dark blue, and is
no longer fit for the purposes of life till some of the prin-
ciples which it has lost by this passage are restored to
it. This restoration takes place in the lungs> where a
sort of combustion is performed by^ the absorption of
oxygen, This process is called respiration, and it ex-
ists in all things that live, under various modifications
of the apparatus performing it. In man it is performed
in two cellular air bags, which have a heart indepen-
dent of the one just mentioned, for propelling the blood
through the ramifications of their vessels. In fish there
are gills, which have their surfaces exposed to the wa-
ter, and are aerated by the air contained in the water,
and the same heart which supplies the general circu-
lation, also fills a large artery, that is distributed very
minutely through the gills. But in insects, where
there are no blood vessels, and the nutritious fluid is
contained in cells, there are, distributed over their bo-
dies, air tubes, which transmit atmospheric influence.
The blood vessels, iu addition to the function of car-
rying nutritious matter, perform an essential part of a
very different character. All the atoms of which the
VoL.L— 3
XXVI INTRODUCTION.
body is composed, after residing in it for a time, be-
come no longer fit for use; their farther residence is, in
fact, injurious, and it is necessary to remove them. A
system of vessels is provided for this purpose, called
the absorbents, which are the scavengers of the body.
Taking up, therefore, these eifete atoms, they convey
them into the blood vessels, where they are mixed with
the common mass of blood. Several organs are pro-
vided, as the liver, the kidneys, the surface of the body,
and the lungs, through which these effete particles are
discharged from the blood in the form of excretions;
as the bile, the urine, perspiration, and pulmonary ex-
halation.
We have now sketched the human machine as far as
its internal existence, or self-preservation, is concerned
in the functions of digestion, circulation, respiration,
and excretion. Let us proceed in the inquiry by a
rapid glance at those organs by which it is put into a
relation with surrounding objects, and on which it de-
pends for the sublime operations of the understanding.
Sensation is derived from the nervous system, com-
posed of the brain, the spinal marrow and the nerves.
The latter may be traced to many parts of the body,
and are supposed to be distributed to all. They main-
tain its different sympathies, keep the several organs
in one harmonious course of action, and, in some in-
stances at least, are indispensable to the performance
of their functions. In addition to these, many of the
nerves have at their extremities organs of a particular
construction, each fashioned in the best manner for the
performance of its functions, in making us acquainted
with exterior objects. The interior extremities of all
these nerves terminate either in the brain or spinal
marrow ; the external are the points intended by nature
to be affected by the objects around us; but it is indis-
pensable to consciousness, that their line of communi-
INTRODUCTION. XXvii
»
cation with the brain be not interrupted. The sense
most extended is that of the touch, which is enjoyed
by all parts of the surface of the body ; the others are
thought, by very respectable physiologists, to be only
more exalted modifications of it, and are susceptible of
more delicate impressions. It is scarcely necessary to
mention that the other sensations are executed by the
eye, the ear, the tongue, and the nose.
The Sense of Touch is the most important of all, and
the least liable to error in its reports. To exercise it,
it is necessary for the body, under examination, to come
into contact with ours: hence, its operations are so me-
chanical, that but little is left to the imagination, and
they, therefore, serve to verify and to correct the im-
pressions on the other senses, more particularly those
on the eye. It is the sense of touch by which we learn
accurately the dimensions of bodies, and the figures of
such as are hard. The hand, or any other part, by be-
ing applied to them in various directions, informs us
whether they are flat, round or angular. A greater or
less degree of pressure informs us whether they are
soft or hard, and by rubbing, we ascertain whether
they are rough or polished. The resistance they make
to motion, teaches us whether they can or cannot be
moved, and their being impelled against us shows the
momentum with which they act, as well as its direc-
tion. Our ideas of heat and of cold are also derived
from this source. It is not asserted that all parts of
the surface of the body enjoy equally the sense of touch ;
on the contrary, this sensibility is more or less active,
according to the organization of the part, and as its
nerves are more or less numerous and exposed ; hence
we find it most exquisite and perfect in the ends of
the fingers. This, therefore, being the most import-
ant of the senses, the magnitude of its influence on
the habits and intelligence of different animals is im-
Man, from the nudity and the delicacy of the tex-
ture of his skin, derives* from this source, a discrimi-
nation and refinement* in_ regaid to the natme of
bodies, much superior to what many other
The Sight enables us to distinguish
quantity, and the direction of the rays .of light which
proceed from a luminous body; or, in other words, to
ever, of the latter we are exposed to great deception;
lor the lays of light, by Mling on a- minor, or any
other plane reflecting .surface* before they reach the
eye, will induce us to believe the body to be in that
direction. Bodies which are near, reflect more rays
of light than such as are distant: we thus estimate dis-
tance by the eye; but it happens continually, that
some bodies naturally reflect more rays than others;
in consequence of which a rery luminous body, at a
great distance, wffl frequently be thought to be much
nearer to us, than such as are more within our reach.
Mistakes of this kind can only be corrected by the
sense of touch, and our habitual reference to it, and
us to fora
•tens the touch in die rapidity with which it
in the extensiveness of its ap-
in a single moment. It is* therefore* an oigan
of the first utility in 1l*3>fc™g us acquainted with s«p-
lounding objects. Man does not possess it to that
ther see as far as the Tuhure or eagle, nor so minutely
as die fly; yet his ingenuity has t u»iifc.d him to
both. Fur,withthetefaH»pe,he
INTRODUCTION.
the immensitity of space, which, under common <
munition, are either invisible, or form mere points in
the heavens. And with the microscope he sees the
texture of the most minute atom.
The Ear, along with the powers of articulation, ena-
bles the whole human family to make a common stock
of the knowledge which each individual may possess.
As connected with the preservation of the individual,
it is much less important than the eye or the touch;
yet, considering it as a means by which we receive
knowledge and impart it to others, the aggregate of
human intellect depends for its present state and future
improvement, essentially upon it. In its acuteness,
we are much inferior to many other animals; neither
have we, by instruments, been able to do much in im-
proving it : yet, by cultivation and by studying its most
minute and delicate impressions, an endless source of
instruction and amusement has been opened to us, in
the intonations of language, and in the enrapturing
strains of harmony. It eminently qualifies man for
the social state, occasionally warns him of danger, and
allures him to such things as are useful to his sub-
sistence.
In regard to the Taste and to the Smell, they make
us acquainted only with such objects as are necessary
to our subsistence. They are enjoyed too imperfectly
by man, for them to become a fruitful source of his
intelligence. As they principally lead us to filling the
stomach, and to debasing the intellectual man into the
beast, that eats and dies; the wisdom of nature is as
fully demonstrated in the imperfection which she has
put upon these senses, and our inability to improve
them, as in the exalted and varied degrees to which
3*
XXX INTRODUCTION.
she has carried the others. The keenness of the scent
of the hound, and the discriminating nicety of the bee,
in opening sources of enjoyment merely physical,
would have degraded, instead of elevating us; by en-
grossing our time and ingenuity, in the development
of pleasures incompatible with our constitutions and
destinies.
Man being thus constituted, it is worthy of inquiry
in what his life consists. According to the celebrated
Bichat, it is " the aggregate of those functions by
which death is resisted. For such, indeed, is the con-
dition on which we live, that every thing surrounding
us has a tendency to produce our dissolution, by the
affinities existing between their atoms, and the atoms
of which a living body is composed. It is plain, there-
fore, that the principle of life, like all other principles
in nature, incomprehensible in itself, must be- studied
by its phenomena."*
There are two remarkable modifications of life : one
is common to the vegetable and to the animal, the other
is the exclusive attribute of the latter. Under the first
modification, are included assimilation and excretion,
which, though exercised under apparently different
circumstances in animals and in plants, are probably
essentially the same in both. This modification is
termed by Bichat, Organic Life. By the second mo-
dification of life, the animal has a more extended
sphere of existence than the vegetable, is put into a
certain relation with all the objects that surround him,
is made the inhabitant of the whole world, and not,
like the vegetable, confined for ever to the place of its
birth. By it the animal feels, and is conscious of ex-
ternal objects, reflects upon them, moves voluntarily,.
*• Recherches sur la vie et La Mort.
or r
•or J
V^
INTRODUCTION. XXXI
and can communicate, by the voice, his wants and ap-
prehensions, his pleasures and his pains. The func-
tions included under the second modification, are
termed, by Bichat, Animal Life.
Each of these lives has two orders of functions, keep-
ing up its connexion with the objects destined for its
existence. In animal life, one of these orders may be
said to commence at the surface of the body, and to be
extended towards the centre, the impression of exterior
objects affecting- first the senses, then the trunks of
nerves, and lastly, the brain. A second movement,
constituting the second order of functions, is afterwards
made from the centre to the circumference, by which
the influence of the brain is exercised on the organs of
locomotion and of voice. These two functions, in ani-
mal life, are perfectly equivalent in their operations.
He who feels the most, will also act the most. Early
life is the period of quick and multiplied sensations, so
is it the period of quick and multiplied movements.
A partial, or a total privation of the sense of sight,.
causes us to move cautiously and slowly onwards.
The suspension of our communicatiori, through sleep,
with exterior objects, causes also a suspension of the
faculties of locomotion and of voice.. In organic life,,
the first order of functions assimilates to the animal
the substances which must nourish him, and includes
digestion, circulation, respiration, and nutrition; under
the influence of which four functions, every thing must
pass before it can be assimilated. But, after a temporary
residence, the assimilated particles becoming effete and
noxious, have to be carried away out of the body : by
which means the second order of functions in organic
life is established, consisting of absorption, circulation,
exhalation, and secretion.
The two functions of organic life differ, however,
from those of animal life, in not observing, on all occa-
XXX11 INTRODUCTION.
sions, an equivalence of action : the diminution of assi-
milation does not involve a corresponding diminution
in excretion ; hence, follow emaciation and marasmus,
conditions in which, assimilation ceasing in part, dis-
assimilation is exercised to the usual extent, or near it.
From this sketch, it is seen that the circulation of the
blood is the connecting link of the two orders of func-
tions in organic life, as the brain is the connecting link
of the two orders of functions in animal life. The blood
is, therefore, in fact, composed of two parts or descrip-
tions of matter : one is recrementitial, derived from the
aliment, and subservient to the renovation and growth
of parts ; the other is excrementitial, derived from the
wrecks of all our organs, and under the necessity of
being cast away as useless.
M. Bichat thinks the division of life into animal and
organic, fully warranted by their . differing much from
each other in the exterior shape of their respective or-
gans,— in their mode of action, — in the duration of their
action, — in the effects of custom or habit on them, — in
their relation to the moral part of man, and in their vi-
tal force.
One of the most prominent differences in the two
lives, is the symmetry and duplicity of the Organs of
Animal Life, and the irregularity in shape of those be-
longing to Organic Life. The impression of Light is
received by two organs exactly alike. Hearing —
Smelling — Touching — are likewise performed by or-
gans having their congeners on the opposite sides of the
body; and even Tasting, though apparently performed
by one organ, has that organ divided into two equal
and symmetrical parts, thus making it like the other
organs. The whole exterior surface of the body is, in-
deed, manifestly divided into two equal parts, marked
off from each other by the fissure in the nose, the upper
lip, the chin, the raphe of the scrotum and perineum,.
INTRODUCTION. XXX111
the spinous processes, and the depression in the supe-
rior posterior part of the neck. The Brain and Spinal
Marrow, as belonging to animal life, consist of two
halves, presenting corresponding arrangements in the
development of cavities and prominences, and so on,
and in sending similar nerves to the organs of locomo-
tion and of voice.
The organs of organic life are marked, on the contra-
ry, by the character of striking dissimilitude in their
two halves, as manifested in the liver, the spleen, the
stomach, the intestines, the heart, and the great vessels
belonging to it. There are, however, some organs of
organic life in which the difference is less prominent,
as the lungs of the two sides, the pulmonary arteries,
the veins, the trachea, the kidneys, the capsulse renales,
and the salivary glands.
From what has been said, we are, perhaps, prepared
to admit with M. Bichat, that animal life is double; that
its phenomena being executed after the same manner on
both sides of the body, it is very possible for the actions
of one side to be suspended or destroyed while those of
the other go on. This, in fact, happens in certain pal-
sies, where the sensibility and motion of one side are so
completely suspended, that it resembles a vegetable; all
relation with exterior objects being cut off, and nothing
but the function of nutrition being preserved ; whereas
the other side retains all its animal properties. For
these reasons Bichat has very quaintly observed that we
have a right life and a left life. In organic life, on the
contrary, the functions of the two halves of any organ
are so allied, that the lesion of one affects the other.
The liver, in a disease on one side, has its functions im-
paired throughout : it is the same with the intestinal ca-
nal, and with the heart.
Congenital deformities are said to be more frequent in
the organs of organic life than in those of animal life.
XXXIV INTRODUCTION. *
Several cases have occurred, and Bichat relates one
which happened in his own amphitheatre, where there
was a general displacement of the digestive, the circu-
latory, the respiratory, and the secretory viscera. The
stomach, the spleen, the sigmoid flexure of the colon,
the point of the heart, the aorta, and the lung with two
lobes, were all on the right side. But the liver, the
coecum, the base of the heart, the vense cavse, the vena
azygos, and the lung with three lobes were on the left
side. All the organs placed beneath the middle line,
as the mediastinum, the mesentery, the duodenum, the
pancreas, the division of the trachea, were reversed.
Latterly I have had occasion to observe, in our own
dissecting rooms, two cases of the caput coli removed
from the ri^ht iliac into the left iliac region; the colon
O O *
\vas of the common size and length, and being confined
to the left side of the abdomen, formed there a loop,
which ascended into the left hypochondriac region, and
then descended as usual. In these cases, as there was
no transverse mesocolon, the duodenum had all the
coats of the other intestines; and was not attached to
the front of the right kidney and to the spine. One of
these was an adult female subject of considerable cor-
pulency, the other a corpulent male.
Another difference between organic and animal life
exists in the mode of action of their respective organs.
Each of the organs of animal life being double, our sen-
sations are the more exact, as there exists between the
two impressions, from which they result, a more perfect
correspondence. We see badly when the images trans-
mitted to the brain are derived through eyes of unequal
strength. Without knowing this law as theorists, we
instinctively show its influence in shutting one eye
while looking through a convex glass; whereby we pre-
vent a confusion of images arising from two impres-
sions of unequal force, concerning the same body : when
INTRODUCTION. XXXV
one eye is weaker than the other, we squint involun-
tarily, and it finally becomes a habit, in order to avoid
the confusion of perception from two unequal images
on the brain. This accounts for squinting, both in early
life, from some congenital cause, and for that squinting
which is the result of inflammation, in more advanced
life. A little reflection on this head will satisfy us; for
as a single judgment or perception is, for the most part,
formed from the two impressions, one on each eye, how
is it possible that this judgment can be accurate, when
the same body is presented at the same moment with
vivid or faint colours, accordingly as it was painted on
the strong or weak eye?
The Ear is subjected to the same law as the eye. If,
in the two sensations composing the act of hearing, one
is received upon an organ better developed than the
other, and more discriminating in its functions, it will
leave an impression more clear and distinct; but the
brain being affected simultaneously by the unequal im-
pressions, will be the seat of an imperfect conception.
This case constitutes a false ear in music, and from the
impressions being continually confused, prevents the
individual from judging rightly between harmony and
dissonance.
A similar reasoning has been founded by Bichat upon
the structure of the Nose, Mouth, and Organs of Touch.
He believes also that the brain itself, as the seat of the
mind, may become the cause of error in our ideas, when
the two halves of it are not perfectly alike; for example,
if one of the hemispheres be more strongly organized
than the other, better developed every where, and more
susceptible of a vivid impression. The brain transmits
to the soul the impression or impulse derived from the
senses, as the latter transmit to the brain their impres-
sions; it is, therefore, to be believed that the soul will
perceive confusedly, when the hemispheres, being une-
XXXVI INTRODUCTION.
qual in force, do not blend into one, the double impres-
sion upon them. In proof of this, it is common to see
mental derangements depending on the compression of
-a hemisphere by effused blood, by pus, by depressed
bone, and by an exostosis from the internal face of the
cranium. Even where every sign of compression is
removed, the hemisphere occasionally takes a long time
to regain its action, so as to recover from the alienation.
This harmony of action exists also in the organs of
locomotion, and of voice; and any thing which inter-
rupts their symmetry destroys the precision with which
their functions are executed.
Opposed to this harmony in the shape and functions
of the organs of animal life, the most striking differ-
ences may take • place between the organs of organic
life, without much disturbance in the general result.
For example, in disparities of the kidneys, of the lungs,
of the salivary glands, &c., their functions are not, by
any means, the less perfectly performed. The circu-
lation remains the same in the midst of the frequent
varieties of the vascular system on the two sides of the
body, whether those varieties exist naturally, or whe-
ther they depend upon artificial obliterations of the
large vessels, as in aneurism.
Another very striking difference in the two lives may
be observed in the duration of their action. All the ex-
cretions proceed uninterruptedly, though not uniformly.
Exhalation and absorption succeed each other incessant-
ly; assimilation and dissimilation follow the same rule.
On the other hand, every organ of animal life, in the ex-
ercise of its functions, has alterations of activity and of
complete repose. The senses, fatigued by long appli-
cation, are, for the time, disqualified from farther action.
— The Ear is no longer sensible of sounds : — The Eye
is closed to Light ; — Sapid bodies no longer excite the
INTRODUCTION. XXXV11
Tongue ; — The Nose is insensible to odours ; — And the
Touch becomes obtuse. Fatigued by the continued ex-
ercise of perception, of imagination, and of memory,
the brain has to recruit its strength, by a state of com-
plete inactivity for some time. The muscles, relaxed
by fatigue, are incapable of farther contraction, till they
have been permitted to rest; hence the necessary inter-
mission, in every individual, of locomotion and of voice.
This intermission of action is sometimes extended to
all the organs of animal life at the same time ; on other
occasions, only a part of them is affected by it. It is
in this way that the brain frequently continues in the
active exercise of thought, while the senses, as well as
the powers of locomotion and of voice are suspended.
In addition to the foregoing views, it has also been
•suggested by Bichat, that another striking difference
between organic and animal life, is found in the epoch
and mode of their origin. Organic life exists from the
first moments of conception ; but animal life does not
commence till after birth, when exterior objects are es-
tablished in a certain relation with the individual. It
is more than probable, that the function of the Eye, the
Ear, the Tongue, and the Nose, does not exist in such
manner as to communicate their several sensations in
the foetus; and that the enjoyment of a sort of indistinct
sense of touch, arising from its striking against the pa-
rietes of the womb, is the only circumstance which can
give the latter any idea of its existence; it is, however,
doubtful whether it has even a consciousness on that
point. The organic life, on the contrary, of a fetus,
though not so complicated as afterwards is still re-
markable for the promptitude and vigour of some of its
functions, particularly of assimilation; and in a very
short time after birth, all the organs which it employs
reach their highest degree of perfection, and thus pre-
VOL. I.— 4
XXXV111 INTRODUCTION.
sent a very different case from the organs of animal
life.
The distinction of the two lives is farther kept up in
their manner of ceasing in old age. Natural death, says
Bichat, is remarkable, in terminating animal life almost
entirely, a long time before it does organic life. The
functions of the first cease successively. The Sight be-
comes dim, confused, and finally is extinguished. The
Ear receives the impression of sounds indistinctly, then
faintly, and afterwards they are entirely lost upon it.
The skin becomes shrivelled, hardened, loses many of
its vessels, by their obliteration, and is only the seat of
an obscure and indistinct touch; the hair and beard be-
come white, and fall from it. The Nose loses its sen-
sibility to odours. Of all the senses, it has been often
remarked, that the Taste remains the longest, and ex-
hibits the last efforts of animal life.
The powers of the mind disappear along with those
of the senses. The imagination and the memory are ex-
tinguished ; the latter, however, under striking circum-
stances. The old man forgets, in an instant, what was
said to him, because, his external senses being weak-
ened, do not confirm sufficiently the impressions on his
mind : he is, however, able to recollect the transactions ,
of early life, and sometimes retains a vivid impression
of them. He differs from the infant in this, that the
latter forms his judgments from what is passing, where-
as, the former forms his from what has already past.
Both are, therefore, liable to great errors ; for, the ac-
curacy of knowledge, in regard to things present, can
only be obtained by comparing them with other things.
Locomotion and voice also participate in the decline of
the other organs of animal life; their powers are intrin-
sically weakened ; besides which, a certain degree of
inactivity is imposed on them, by the previous decline
of the brain and senses.
INTRODUCTION. XXXIX
If we now consider, that sleep retrenches about one-
third of the whole duration of animal life ; that nine
months of it are first lost in gestation ; and that the ex-
tinction of our senses is the inheritance of old age ; it
will be seen how great is the difference between, the
whole duration of animal, and of organic life.
It has been remarked by Bichat, that the idea of death
is painful to us only because it terminates our animal
life, or those functions which put us in relation with sur-
rounding objects. This is the privation which plants
terror and dismay on the borders of the tomb. It is
not the pain of death that we fear, for many dying per-
sons would willingly commute death for an uninter-
rupted series of bodily suffering. But if it were possi-
ble for a man to exist whose death would only effect
the functions of organic life, as the circulation, diges-
tion, and secretions, allowing the exercise of the senses
and the mind to continue, this man would view with
indifference the extinction of organic life, because he
knows that the happiness of living is not attached to it,,
and that he would remain after this partial death, still
in a condition to appreciate all the delightful ties of ex-
istence.
TABLE OF CONTENTS.
VOLUME I.
BOOK I.— SKELETON,
Page
PART I. — General Anatomy of Natural Skeleton, - 49
CHAP. I. — General Anatomy of Bones, • 50
Sect. 1. — Number and Texture of Bones, - 50
2. — Composition of Bones, - - 56
CHAP. II. — Sect. 1. Periosteum, - - - -63
2.— Medulla, 65
CHAP. III. — Osteogeny, - - 67
Sect 1. — Development of Bones, - - - 67
2.— Growth of Bones, - - 71
3. — Formation of Callus, - ^ 74
PART II. — Bones, individually,
CHAP. I.— Trunk, 78
Sect. 1. —Spine, - 78
2. — Development of Spine,
3.— Uses of Spine, • 90
4. — Qssa Innominata, - 97
5. — Pelvis, generally, - - 102
6. — Development of Pelvis, - 105
7.— Mechanism of Pelvis, - - 106
8.— Thorax, 107
9.— Cartilages of Ribs, - - 112
10.— Development of Thorax, - 115
11.— Mechanism of Thorax, • 116
CHAP. II.— Head, 121
Sect. 1.— Cranium, - - 122
2. — Individual Bones of Cranium, - 124
3,— Face, - 138
4*
Xlii CONTENTS*
Page
CHAP. III. — General Considerations on Head, - - 149
Sect. 1. — Sutures, 149
2. — Diploic Structure of Cranium, - - 156
3. — Internal Surface of Crsuiium, • 158
4. — External Surface of Head,. - - 161
&.— Nasal Cavities, - - 165
6.— Orbits of the Eyes, - - 167
7.— National Peculiarities of Face, - 169
8. — Development of Foetal Head, - - 177
CHAP. IV.— Os Hyoides, 181
V. — Upper Extremities, - 182
Sect. 1.— Shoulder, -, 182
2.— Arm, - 187
3. — Fore Arm, 189
4. — Hand, - 193
5. — Development of Upper Extremities, • 201
6. — Mechanism of Upper Extremities, - - 202
7. — Motions of Shoulder, 204
8. — Motions of Shoulder Joint, - - 205
9. — Motions of Fore Arm. -.. 207
10 — Motions of Hand, - - 210
CHAP. VI. — Inferior Extremities, 213
Sect. 1. — Thigh Bone, - - 213
2.— Leg, - - - - 217
3.— Foot, - 223
4 — Development of Inferior Extremities, 234
5. — Standing, - ... 235
6. — Locomotion, 241
PART III. — Articulations, - - - 251
CHAP. I. — Cartilaginous System, ... 251,
Accidental Development of Cartilages, - - - 253
Perichondrium, - - . . 254
Articular Cartilages, - . 255
CHAP. II. — Fibro-Cartilaginous System, -. 256
III. — Ligamentous Tissue, - . . 257
Sect. 1.— - 257
2. — Ligaments of Joints, - . 260
3 — Synovial Articular Capsules, 261
CHAP. IV. — Articulations of Lower Jaw, - - - 263
V. — Ligaments of Spine, . 266
VI, — Ligaments of Pelvis, -.. ._ --274
CONTENTS. Xliii
Page
CHAP. VII. — Articulations of Thorax, - - 278
VIII. — Articulations of Upper Extremities, - - 283
IX. — Articulations of Lower Extremities, - 299
BOOK II,
PART I.— Integuments of the Body, •- -317
CHAP. I. — Cellular Substance, - 317
II.— Adeps, - - 325
PART II. — Dermoid Covering, -- -- 328
CHAP. I.— Of the Skin, generally, - - 328
SECT. 1. — Cutis Vera, - 330
2. — Rete Mucosum, - 332
3.._Cuticula, - 336
CHAP. II. — Of the Sebaceous Organs, - - 340
HI.— Of the Nails, 342
IV. — Of the Hairs, - -- -. - - 344
BOOK III.
PART I. — Muscles, -. -„ - 349
CHAP. I. — General Anatomy of Muscles, - - 349
II. — Muscular Motion, - - ... - 355
III. — Shape of Muscles, - _ 359
IV. — Tendons, - - 360
PART II. — Special Anatomy of Muscles, - -- - 363
CHAP. I. — Muscles of Head and Neck, -- 363
SECT. 1. — Muscles of Face, ... . 363
2. — Muscles of Neck, - - 371
CHAP. II. — Muscles of Trunk, - . . 390
SECT. 1. — Muscles on Front of Thorax, -./ - 380
2. — Muscles and Fasciae of Abdomen, - - 383
3. — Muscles of Upper and Posterior part of Abdo-
men, .. 394
4. — Muscles on Posterior Face of Trunk, -. 400
CHAP. III. — Of the Fasciae and Muscles of the Upper Extre-
mities, -. -. .. . 4U
SECT. 1.— Fascia, ... .. - 411
2. — Muscles of Shoulder, .. ... 414
3. — Muscles of Aim, - .. -416
4. — Muscles of Fore Arm, ... 420
§.-— Muscles of Hand, - - - . 439
Xliv CONTENTS.
Page
CHAP. IV. — Of the Fascirc and Muscles of the Lower Extre-
mities, - - 436
Sect. 1.— Fascia* - 436
2.— Muscles of Thigh, 442
8. — Muscles of Leg, - - 452
4.— Muscles of Foot, - 460
BOOK IV.
ORGANS OF DIGESTION, • 467
PART I. — Organs of Mastication and Deglutition, 469
CHAP. I.— Mouth, - - 469
II.— Teeth, - . 471
Sect. 1. — Number of Teeth, and Subdivision, - -471
2.— Of the Texture and Organization of the Teeth, 474
3.— Gums, - 478
4.— Formation of Teeth, 479
5.— Dentition, - - 484
6. — Irregularities in Dentition, •' 490
CHAP. III.— Tongue, - 493
Sect. 1. — Muscles of Tongue, 493
2. — Mucous Covering of Tongue, - 495
CHAP. IV.— Palate, 498
V.— Glands of Mouth, • 500
Sect. 1. — Muciparous Glands, • 500
2. — Salivary Glands, - 501
CHAP. VI. — Pharynx and (Esophagus, - 504
Sect. 1.— Pharynx, - - 504
2.- — (Esophagus, 507.
VOLUME II.
BOOK IV.
CONTINUES.
Page
PART II. — Organs of Assimilation, - 5
CHAP. I. — Abdomen, generally, - 5
II. — Of the Peritoneum and Serous Membranes, gene-
rally, - 10
Sect. 1. — Peritoneum, - - 10
2.— Omenta, 13
3.— General Anatomy of Serous Membranes, - 18
€HAP. III.— Chylopoietic Viscera, 22
Sect. 1.— Stomach, - 22
'2.— Intestinal Canal, - 28
3. — Minute Anatomy of the Mucous Coat of the
Alimentary Canal, 41
4. — General Anatomy of Mucous Membranes, - 50
CHAP. IV. — Assistant Chylopoietic Viscera, - 56
Sect. 1.— Liver, - - 56
2. —Spleen, - 64
3.— Pancreas, - - - - - 68
BOOK V.
OF THE URINARY ORGANS, - 71
BOOK VI.
ORGANS OF GENERATION, - 85
CHAP. 1. — Male Organs of Generation, - - - 85
Sect. 1.— Penis, - 85
2. — Mucous Glands and Apparatus, - 90
3.— Testicles, - 93
4. — Muscles and Fasciae of Perineum, - • 100
. CONTENTS.
Page
CHAP. II. — Female Organs of Generation, 106
Sect. 1.— Vulva, -. 106
2.— Vagina, -. 110
3. — Uterus, audits Appendages, - - 112
CHAP. III.— Breasts, - - - - 120
BOOK VII.
ORGANS OF RESPIRATION, • 125
CHAP. I. — Larynx, ^ - 12fr
II. — Of the Trachea and Glands bordering upon it, - 135
Sect. 1.— Trachea, 135
2.— Thyroid Gland, . - 139
3. Thymus Gland, -, 141
CHAP. III.— Lunsrs, - - - «, - 143
BOOK VIII.
CIRCULATORY SYSTEM, 153
PART I.— General Anatomy of Circulatory System, - - 153
CHAP. I. — General Considerations, -. 153-
II.— Arteries/ - - 16fr
III.— Veins, 171
IV.— Blood, - - 175
Sect. 1.— Serum, - 177
2. — Coagulating Lymph, - - 179
3.— Red Globules, - 180.
PART II.— Special Anatomy of Circulatory System, - - 181
CHAP. I. — Heart, 181
II.— Arteries, - - 195
Sect. 1.— Of the Aorta and the Branches from its Cur-
vature, - 195
2. — The Carotids and their Branches, 198
3. — Subclavian and Branches, - 207
4. — Branches of Descending Thoracic Aorta, - - 220
5r.— Branches of Abdominal Aorta, - 222
6. — Common Iliacs, - 230
7.— Internal Iliacs, - 230
8.— External Iliacs, -, 235
CHAP. III.— Of the Veins, - - 249
$ect. 1.— Veins of Head and Neck, 249
2. — Veins of Upper Extremities, - - 258
CONTENTS. Xlvii
Page
Sect. 3 — Veins of Lower Extremities, - 261
4. — Veins of Abdomen, - 26$
5.— Vena Portarum, . 268
CHAP. IV. — Peculiarities of the Circulatory System in the
Foetus, - 270
Sect. 1. — Peculiarities of Foetus, - . 271
2. — Peculiarities of Circulation of Foetus, - 275
CHAP. V. — General Anatomy of Absorbent System, - 280
VI. — Special Anatomy of Absorbent System, - - 289
Sect. 1. — Absorbents of Head and Neck, - 289
2. — Absorbents of Upper Extremities, - - 291
3.— Absorbents of Inferior Extremities, 293
4. — Deep Absorbents of Pelvis, - - 296
5. — Absorbents of Organs of Digestion, 298
6. — Absorbents of Viscera of Thorax, - - 303
7. — Absorbents of Parietes of Trunk, 300
8. — Thoracic Ducts-, v - 309
BOOK IX.
OF THE NERVOUS SYSTEM, - - 313
PARTI. — General Anatomy of the Nervous System, - 313
II. — On the Special Anatomy of the Central Portion of
the Nervous System, - - 3^7
CHAP. I. — Medulla Spinalis, and its Membranes, 327
Sect. 1. — Medulla Spinalis, - - 327
2. — Membranes of Spinal Marrow, - - 333
3. — Blood Vessels of Medulla Spinalis, - - 337
CHAP. II. — Encephalon, - 338
Sect. 1. — Membranes of Brain, - - 339
2. — Medulla Oblongata, - 349
3. — Protuberantia Annularis, - 353
4. — Cerebellum, - 354
5. — Cerebrum, - - 357
6. — Nerves of Encephalon, - 373
7. — Arteries of Brain, - . - 382
PART III. — Senses, - - 387
CHAP. I. — Nose, - ... 337
II.— Eye, 397
Sect. I. — Auxilliary parts of Eye, - 398
2.— Eyeball, - 413
xlviii CONTENTS.
CHAP. III.— Ear, - - - 433
Sect. 1.— -External Ear, - 433-
2. — Tympanum, - 438
3.— Labyrinth, 444
4. — Nerves, - 450
PART IV. — Special Anatomy of Nerves, 453
CHAP. I. — Nerves of Encephalon, - 453
Sect. 1. — Nervus Olfactorius, 453
2. — Nervus Opticus, - - 453
3. — Nervus Motor Oculi, 454
4. — Nervus Trochlearis, - 454
5. — Nervus Motor Externus, - 455
6. — Nervus Trigeminus, - ... 455
7. — Nervus Facialis, - 465
8. — Nervus Hypoglossus, - 468
9. — Nervus Accessorius, 469
10. — Nervus Glosso-Pharyngeus, - - 470
1 1 — Nervus Pneumogastricus, 472
CHAP. II. — Sympathetic Nerve, - 477
III. — Nerves of Medulla Spinalis, 489
Sect. 1. — Upper Nine Spinal Nerves, - - 489
2. — Thoracic Spinal Nerves, - 500
3 1 — -Abdominal Spinal Nerves, ... 503
TREATISE ON ANATOMY,
BOOK I.
PART I.
On the Anatomy of the Skeleton.
THE skeleton is the bony frame- work of the human body;
and, by its hardness and form, retains in proper shape the
whole fabric ; affords points for the attachment of muscles ; and
protects many of the viscera. Anatomists call the bones, along
with their natural connexions of ligaments, cartilages, and sy-
novial membranes, a natural skeleton ; and the bones only, but
kept together by artificial means, an artificial skeleton.
The bones are inflexible, and in a recent state are of a dull
white colour, familiar to most persons from its being the same
in animals; but they may be made of an ivory whiteness by
being properly macerated and prepared.
The regional division of the skeleton is into Head, Trunk,
Superior or Thoracic, and Inferior or Abdominal Extremi-
ties.
If a vertical plane be passed from the top of the head down-
wards, through the middle of the skeleton, this plane will divide
the latter into bilateral, or two equal portions, called, in com-
mon language, the right and the left side of the body. These
VOL. I.— 5
50 SKELETON.
two sides are perfectly alike in shape and size.* Some of the
bones are found in this plane, being intersected by it into two
equal parts or halves : others are somewhat removed from it,
and are in pairs. This arrangement antagonizes the two sides
of the body, and qualifies it for all its motions.
CHAPTER I.
OF THE BONES, GENERALLY,
SECT. I. NUMBER, TEXTURE.
THE number of the bones is commonly the same in every
person of middle age ; but they are less numerous then, than in
infancy, from several of them having been originally formed in
pieces which coalesce. The farther fusion in advanced life, of
contiguous bones into each other, diminishes still more their
number. It is, however, generally agreed to view the follow-
ing as distinct : —
For the Head — An occipital bone, a frontal, a sphenoidal, an
ethmoidal, two parietal; two temporal, each containing the
small bones of the tympanum ; two superior maxillary, two
palate, two malar or zygomatic, two nasal, two unguiform or
lachrymal bones, two inferior turbinated, a vomer, and an in-
ferior maxillary : ? .-^\,
* The exact harmony or symmetry of form and size, between the two sides of
the body, as a general rule, is rather hypothetical than real in nature. It is a
point of general notoriety, that the right side enjoys more force than the left, and
this will "be found attended with greater development. There are few persons
that have not the face and the spine somewhat out of shape from the bones on
one side growing larger than on the other, the right, commonly, prevailing over
the left : hence we sec a nose somewhat turned; and a spine curved, the convexity
of which is to the right side, with the attendant consequences on the position of
the ribs— the scapula) and the sternvm. This condition of false growth is exhi-
bited, in all degrees, from a deviation almost imperceptible to one amounting to
deformity. The left side is said, also, to be more liable to diseases. Copious re-
ports on these several subjects as well as on human stature, generally, at all
ages, have been made by the French Anatomists : for a summary exposition of
which, see Malgaigne, Anat. Chirurg. Vol. I. Chap. 1. Paris, 1838.
SITUATION OF BONES. 51
For the Trunk — Twenty-four true or moveable vertebrae, one
sacrum, four caudal vertebra? or bones of the coccyx, two inno-
minata, twelve ribs on each side ; a sternum, in three pieces,
however, in the youthful adult:
One hyoid, in three pieces, sometimes five in the adult, and
situated in the throat: ^ *^
The remaining bones compose the limbs, and are, therefore,
in pairs, or correspond exactly on the two sides of the body.
They are,
For the upper Extremities — The clavicle, the scapula, the os
humeri, the radius, the ulna, the eight bones of the carpus, the
five bones of the metacarpus, the two phalanges of the thumb,
the three phalanges of each of the fingers, the two, and some-
times more, sesamoid bones:
For the lower Extremities — The os femoris, the tibia, the fibula,
the patella, the seven bones of the tarsus, the five of the meta-
tarsus, the two phalanges of the big toe, the three phalanges of
each of the smaller toes, and the two, sometimes more, sesa-
moids.
There are, therefore, twenty-two bones to the head, not in-
cluding those of the tympanum; fifty-six to the trunk of the
body ; one insulated bone to the throat; sixty-eight to the two
upper limbs; and sixty-four to the two lower limbs. In all, two
hundred and eleven. The redundancy or the deficiency of the
sesamoid bones, in a subject, may cause this number to be
slightly increased or diminished.
The situation of the bones varies; some are profound, while
others approach very near to the surface of the body. They
are, as stated, either symmetrical, — that is, consist of two late-
ral portions precisely alike, — or else in pairs, having a perfect
correspondence with each other. The symmetrical or bilateral
bones are the frontal, the occipital, the sphenoidal, the ethmoidal,
the vomer, the inferior maxillary, the hyoid, the spinal, and the
sternal ; and they are situated under the middle vertical line of
the body. The pairs are on the sides of the middle line, more
or less removed from it.
The long bones (ossalonga) are generally cylindrical or pris-
matic, and have their extremities enlarged for the purpose of
articulating with adjoining bones. The broad bones (ossa lata)
52 SKELETON.
have their shapes diversified by muscular connexion and by the
forms of the viscera they contain. The thick bones (ossa
crassa) are situated in the vertebral column ; and in the hands
and feet ; and have their surfaces very irregular.
The bones present, on their periphery, eminences and cavi-
ties, a proper knowledge of which, is of the greatest importance
to the surgeon. The former are called apophyses or processes,
and are extremely numerous and diversified: they serve for the
origin and insertion of muscles, and for furnishing articular
faces. The cavities are also numerous : some of them are su-
perficial, and serve for articular surfaces; others for the origin
of muscles; for the enlargement of other cavities, as that of the
nose and ear ; and for purposes which will be mentioned else-
where.
The articular ends of the long bones are called epiphyses,
from their being formed from distinct points of ossification,
whereas, the shaft of the bone is its diaphysis or body, being
the part first formed. The epiphysis, therefore, as its name
implies, grows upon the other. Many processes grow after
the manner of epiphyses, from distinct points of ossification,
though they are seldom called by the same appellation. This
is the case with the trochanters of the os femoris, with the pro-
cesses of the vertebra, the crista of the ilium, and the tuber of
the ischium.
Near the centre of some bones a canal is formed which passes
in an oblique direction, and transmits blood vessels to their in-
terior. There are also, at the extremities of the long bones, at
the different points of the thick ones, and near the margins of
the flat ones, a great many large orifices, which principally
transmit veins: in addition to which, a minute inspection of any
bone whatever, will show its whole surface studded with still
smaller foramina, also for the purpose of transmitting blood
vessels.
The density of bones is always well marked, and exceeds
much that of other parts of the body. It is, however, variable
in different bones, and in different places of the same bone:
hence their substance has been divided into compact and .eel*
lular, of which the former is external and the latter internal.
The cellular structure, or substance, grows from the internal
TEXTURE OF BONES. 53
surface of the other, and is composed of filaments and small
lamina?, which pass in every direction, by crossing, uniting, and
separating. The cells, resulting from this arrangement, pre-
sent a great diversity of form, size, and completion. They are
all filled with marrow, and communicate very freely with each
other. The latter may be proved in the boiled bone, by the
practicability of filling them all with quicksilver from any given
point ; and, indeed, by the injection of any matter sufficiently
fluid to run. The communications between them are formed
by deficiencies in their parietes, after the same manner that the
cells of sponge open into each other. This structure does not
exist in the earliest periods of ossification, when the bones are
cartilaginous almost entirely, but developes itself during the
deposite of calcareous matter. The manner of its formation
is imperfectly understood, though it may possibly be the result
of absorption, and it is not completed in the bones, originally
consisting of several pieces, till they are consolidated into one.
The compact substance is also formed of filaments arid lami-
nae, which we find to be so closely in contact with each other,
that the intervals between them are merely microscopical in
the greater part of their extent: they become, however, more
and more distinct, and larger, near the internal surface; and at
the extremities of the long bones. The compact tissue is gra-
dually blended with the cellular structure, or lost in it. Its
filaments are directed longitudinally it) the cylindrical bones,
radiate from the centres of the fiat ones, and are blended so as
to render it impossible to trace them in the thick ones. This
disposition in the flat bones is much better seen in early life;
subsequently, it becomes indistinct. The compact tissue, par-
ticularly in the cylindrical bones, has in it a multitude of lon-
gitudinal canals, visible to the microscope, and some of them
to the naked eye, which contain vessels and medullary matter.
Those canals, originally described by Havers, are, according
to the estimate of M. Beclard, about one-twentieth of a line in
diameter, on an average; but they are, generally larger near
the interior than the exterior surface of the bones, and have
frequent lateral communications with the cellular structure, and
with the external surface.
The compact and the cellular structures present themselves
5*
54 SKELETON.
under different circumstances in the three species of bones. The
compact has an unusual thickness in the bodies or diaphyses of
the long bones, and is accumulated in quantities particularly
great in their middle, which, from its position, is more exposed
than their extremities, to fracture from falls, blows, and violent
muscular efforts. But as this texture approaches the extremi-
ties of the bones it is reduced to a very thin lamina, merely suf-
ficient to enclose the cellular structure and to furnish a smooth
articular face for the joints. The cellular structure, on the con-
trary, in the long bones, is most abundant in their extremities,
constituting their bulk there, and is least so in their bodies. It
is so scattered at the latter place as to leave a cylindrical canal
in their middle, almost uninterrupted for some inches. This
canal, cellular in its periphery, has its more interior parts tra-
versed in every direction by an extremely delicate filamentous
bony matter, which, from the fineness of its threads and the
wide intervals between them, has been, not unaptly, compared
to the meshes of a net, and is, therefore, spoken of especially
under the name of the reticulated structure or tissue of the bones,
in contra-distinction to the cellular. It is formed on the same
principle with the latter; and though the term, from that circum-
stance, has been rejected, upon high authority, as superfluous, it
appears worthy of retention, as it expresses a fact of some im-
portance, Too weak to contribute in an appreciable degree to
the strength of the bone, the reticulated tissue seems principally
useful in supporting the marrow and in giving attachinent to its
membrane. The extremities of this cylindrical canal gradually
disappear by becoming more and more cellular.
In the fiat bones, the compact structure forms only their sur*
face or periphery, and is of inconsiderable but generally uniform
thickness; the space within is filled up with the cellular struc?
ture, which is rather more laminated than it is in the long
bones.
In the thick or round bones, the compact structure forms their
periphery also; but, generally, it is thinner than in the flat: their
interior is likewise filled up by the cellular structure, and does
not present differences of importance, from the ends of the long
bones.
A simple experiment on any of the cylindrical bones will prove
that the tumefaction of their extremities does not add proporr
TEXTURE OF BONES. 55
tionately to their weight, as one inch or any other given section
of the compact part weighs very nearly the same with a section
of equal length from the cellular extremities. The swelling at
the ends of the bones adds much to the safety of their articular
union, as the extent of the surfaces is thereby much increased,
and, consequently, they are less liable to displacement. The cy-
lindrical and the cellular cavities, thus formed in the long bones,
by increasing the volume of the latter, add greatly to their
strength beyond what would have occurred, had the same quan-
tity of material been solid. The late Dr. P. S. Physick demon-
strated this most satisfactorily by a scroll of paper, which, on
being rolled up successively, into cylinders of various sizes, has,
like a lever, its power of sustaining lateral pressure on one of its
extremities, continually increased as its volume or diameter is
augmented, until the latter reaches a certain extent. The same
highly distinguished teacher also pointed out another very im-
portant advantage of the cellular structure. It is that of serving
to diminish, and in many cases to prevent concussion of the
brain, and of the other viscera, in falls and in blows. The opi-
nion was verified by his demonstrating the momentum, which is
communicated through a series of five ivory balls suspended by
threads, when one of them is withdrawn from the others, and
allowed to impel them by its fall. This momentum is so com-
pletely transmitted through the series, that the ball at the far-
thest end is impelled almost to the distance, from which the first
one fell. This familiar experiment, used as a preliminary test
to the accuracy of his views, was immediately succeeded by his
substituting for the middle one of ivory, a ball made of the cel-
lular structure of bone. The same degree of impulsion now
communicated at one end of the series, is almost lost, or rather
neutralized, in the meanderings of the cellular structure of the
substitute; and particularly if the latter be previously filled with
tallow or well soaked in water, so as to bring it to a condition
of elasticity resembling the living state.
In persons of advanced age, the marrow of the bones becomes
more abundant, and their parietes thinner; and we also observe
then, that the bones break more readily, and are more crum-
bling, rotten, or soft, than during the anterior periods of life.
In women, after the critical period is passed, these traits are
especially developed, and the compact centres of the long bones
56 SKELETON.
have their texture more or less approximated to the spongy tis-
sue. Mr. Velpeau (Anat. Chirurg.) says, that in the amphithe-
atres of Paris, he has often cut easily with a scalpel, the ends of
the femur, tibia, humerus, the bodies of the vertebrae and the
tarsal bones, when there was apparently no morbid lesion in the
skeleton.
SECT. II. COMPOSITION OF BONES.
The bones under every modification of shape and mechanical
arrangement, are constituted by precisely the same elementary
matters : the principal of which are an animal and an earthy
substance, in intimate combination. Their minute analysis,
according to Berzelius, when they are deprived of water and
of marrow, affords 32 parts of gelatine, completely soluble in
water; 1 part of insoluble animal matter; 51 parts phosphate
of lime; 11 carbonate of lime; 2 fluate of lime; 1 phosphate
of magnesia; 1 soda and muriate of soda. There are some
other ingredients manifested in the analysis of Fourcroy and
Vauquelin, as iron, manganese, silex, alumine, and phosphate
of ammonia. The relative proportion of the above ingredients
is not uniformly the same, as the bones of the cranium, and the
petrous portion of the temporal, in a remarkable degree, have
more calcareous matter in them, than the other bones of the
same skeleton. There is also a considerable diversity in indi-
viduals, according to their age and to certain morbid affections.
The earthy matter gives to bones their hardness and want
of flexibility, and is easily insulated from the other by combus-
tion; which, in destroying the animal part, leaves the earthy
in a white friable state, but preserving the original form of the
bone. If the heat be of a high degree, the calcareous part
becomes vitrified, and its cells are blended by fusion. The
action of the atmosphere, long continued, also divests the bones
of their animal matter, and the calcareous then falls into a
powder. If the bones be kept beneath the surface of the
ground, by which they are less affected by changes in tempe-
rature and moisture, the animal matter remains for an immense
number of years. I have seen in the Hunterian Museum of
London, preparations of the teeth of the Mastodon or Mam-
moth, in which the animal matter was exhibited entire, notr
COMPOSITION OF BONES. 57
withstanding the great lapse of years since it was in a living
state : and a repetition here of the same experiments on the
teeth and bones of the same animal has exhibited the same
result. I was also informed by the late Mr. Say, a distin-
guished naturalist, that animal matter has been detected in
fossil shells, the existence of which was probably anterior to
that of the human family.
The phosphoric acid of bones gives them a luminous appear-
ance at night. Bichat says, that in these cases he has found
an oily exudation on the luminous points, probably from the
marrow or contiguous soft parts. This phenomenon will
account for many of the superstitions which in all ages have
affected ignorant minds, on the subject of burying grounds.
The immersion of a bone in diluted muriatic acid is the best
method of demonstrating the animal part in a separate state.
The strong affinity of the acid for the earthy part, and the
soluble nature of the salt thus formed, leave the animal matter
insulated. In this state it preserves the original form of the
bone, is cartilaginous, flexible, and elastic. The action of hot
water alone, upon a bone, by continued boiling, will, from the
soluble nature of the cartilage, separate the latter from the
earthy part, and convert it into gelatine. " The gelatine may
be precipitated afterwards from the water by tannin. The
mode of this combination of animal and of earthy matter is
not understood, but it is generally supposed to exist by the ex-
tremely small cavities of the former receiving earthy particles,
in the same way that sponge holds water.*
There are no means for investigating the minute anatomy
of the bones more favourable than the removal of the earthy
* If we conceive the phosphate of lime and the other earthy materials of bone
to be in a state of solution in the blood and serum with which the cartilaginous
rudiment of the bone is impregnated, any action which would precipitate the
earthy materials, would also, of course, impregnate the cartilage with them, and
this process may be considered as completed when the bone acquires its proper
consistence.
Considering cellular substance as the parenchyma or primordium of all other
parts, it is probably a speculation not entirely groundless, that every peculiar
tissue or glandular texture has its elements precipitated from the circulating
fluid in a manner analagous to that of the calcareous part of bone. This idea
also affords a clue to a result almost uniform in protracted macerations of all
tissues, to wit, the parts being brought back to the primordial state, by the pe,
puliar depositee in them being dissolved in the water and removed,
58 SKELETON.
part by an acid. The cartilage thus left is the complete
mould, in every particular of form, into which the particles of
calcareous matter were deposited. In this state, the compact
part of the bodies of the cylindrical bones may be separated
into laminae ; and these laminae, by the aid of a pin or fine-
pointed instrument, may be subdivided into filaments or threads.
The laminae, though enclosing one another, are not exactly
concentric. I have observed, that the more superficial come
off with great uniformity and ease in the adult bone, but the
intertexture continually increases towards the centre. Bichat
has objected to this dissection of the bones, that the laminae
are not formed in nature, but factitiously, by the art of the
anatomist, and that their thickness depends entirely on the
point at which one chooses to separate them ; they, therefore,
may be made thick or thin at pleasure. It does not appear to
me difficult to account for the manner in which this laminated
arrangement is produced. The longitudinal filaments of the*
bones adhere with more strength to each other at their sides
than they do to those above or below, in consequence of which
a plane of these filaments may be raised at any place and of
any thickness. This fact does not involve the inference that
the bones are formed by a successive deposite of one lamina
over another; it merely inculcates the mode of union between
the filaments or threads. I am, however, inclined to the opi-
nion that the periosteum secretes the externaF laminaB in the
adult bone, inasmuch as they separate with unusual facility
from the subjacent one. We know that the periosteum has
the power of this secretion, as a laminated deposite of bone on
the roots of the adult teeth frequently met with, proves without
doubt, as also the phenomena of necrosis.
The disposition of the cylindrical bones to separate into
laminae, is constantly manifested in such as are simply exposed
to the atmosphere.
The opinion of the laminated and filamentous arrangement
of bones has been very generally adopted by anatomists.
Malpighi, whose name is inseparably connected with minute
investigations in anatomy, taught it. Gagliardi, also, in ad-
mitting it, thought he saw pins of different forms for holding
the laminae together. Havers also saw the laminated and
thread-like structure. In short, there are few of the older
COMPOSITION OF BONES. 59
anatomists who have not adopted fully the opinion. Among
the moderns, the late M. Beclard, the distinguished and able
Professor of Anatomy in the School of Medicine in Paris, says,
that when the earth is removed from bones by an acid, if they
be softened by maceration in water, the compact substance,
which previously offered no apparent texture, is separated into
laminae, united by filaments; the laminae themselves, at a later
period, separate themselves into filaments; which, by a farther
continuation of the process swell, and become areolar arid soft.
A long bone examined after this process, divides its body into
several laminae, the most external of which envelops the rest;
and the remainder, by rarefying themselves towards the extre-
mities, are continuous with the cellular structure there.
J. F. Meckel, of the University of Halle, has furnished the
following account in his General Anatomy of the Bones : —
" The filaments and the laminae which constitute the bones
are not simply applied one against the other, so as to extend
the whole length, breadth, or thickness of a bone, or to go from
its centre to the circumference. They lean in so many differ-
ent ways, one against another, arid unite so frequently by
transverse and oblique appendages or processes, that some
great anatomists, deceived by this arrangement, have doubted
the fibrous structure of bones. Nevertheless, their opinion is
not perfectly correct. In spite of those inflections and anasto-
moses of fibres, the fibrous. structure always remains very ap-
parent; and one is warranted in saying, that the dimension of
length exceeds the two others, in the texture of many bones.
This predominance is chiefly well marked in the first periods
of osteogeny ; for, at a later time, the fibres are so applied
against each other, as scarcely to be distinguished. But these
longitudinal fibres never exist alone; there are many oblique
or transverse ones from the first periods of ossification; and
they are even from the beginning so multiplied, that the num-
ber of longitudinal fibres does not prevail over them so much
as at a subsequent period, when the fibres approach nearer, in
such way that the transverse become oblique; until at last,
from the increase of the bone, the latter, at first view, seems to
be composed only of longitudinal fibres. The transverse and
oblique fibres do not form a separate system; but continue un-
60 SKELETON.
interruptedly with the longitudinal, which they unite to each
other."*
The venerable Scarpa, some years ago, advanced opinions
adverse to the laminated and fibrous or filamentous tissue of
bones :f the latter doctrine he was induced to think a mere
mistake, arising from careless observation. Founding his own
views upon what he had seen in the growing bone, — in the
adult bone when its earthy parts were removed by an acid, —
and upon certain cases of disease attended with inflammation
of the bone; he denied, without reservation, the existence of la-
minae and fibres in bones, declaring that even the hardest of
them were cellular or reticulated. It appears to me, in look-
ing over his paper, that a desire to overthrow old doctrines and
to establish new ones, has induced him to make one omission in
the report of his experiments, otherwise unaccountable in a man
of his general intelligence and candour. Having softened the
cylindrical bones in an acid, he next proceeds to a long conti-
nued maceration of them ; he finds, as other persons have done,
the animal part of the bone finally resolving itself into a soft cot-
tony tissue. He has made but one jump from the immersion in
the acid to the last stage of the process of maceration. Now, if
in a short time after the bone had been softened in the acid, he
had admitted an intermediate observation, he would no doubt,
like all other inquirers, have found that the animal part of the cy-
lindrical bones was readily separable into laminae ; and that by a
pin or needle these laminae could be split into fibres, the greater
part of which are longitudinal; and that pounding the ends of
these fibres with a hammer would resolve them into a very fine
penicillous or pencil-like structure. There is no objection to
theuconclusion, that these laminae and filaments, as a final con-
dition, produce a very fine microscopical cellular arrangement,
which may be made more apparent in being distended by the de-
velopment of gaseous substances, arising from putrefaction or
maceration; but there is reason for a decided opposition to the
assertion of there being no fibres in bones, when we have daily
* Manuel D'Anat. Gen. Descr. et Path, traduit dc L'Allemand par Jourdan et
Breschet. Paris, 1825.
t A Scarpa. De penitiori ossium structura cornrncntarius. Leipp. 1795. See
also Anatomical Investigations, Philadelphia, 1824, by the late J. D. God-man,
M. D., for an English translation of the same.
COMPOSITION OF BONES, 61
under our eyes preparations showing them; some of which de-
monstrate the fibres running principally longitudinally, others
spirally, like the grain of a twisted tree, and others having a
mixed course. Upon the whole, the description cited from
Meckel, exhibits this subject in a just and accurate manner.
The more obvious arrangement of the cellular and compact
structures of the bones* indicates a considerable difference in
their intimate texture: they are, nevertheless, closely allied;
for one structure is converted, alternately, into another by dis-
ease, of which specimens abound in. the Wistar Museum. In
both cases, from the fibres or filaments are formed cells which
exist every where, and are only larger and more distinct in
what we call the cellular structure; but the compact part has
also its cells, though they are smaller, more flattened, and for
the most part microscopical*
Organization of Bones. — The blood vessels of the bones,
though small, are very numerous. This is well established, by
the success of fine injections, which in the young bone commu-
nicate a general tinge; and by scraping the periosteum from
living bones, whereby their surface in a little time becomes co-
vered with blood, effused from the ruptured vessels. In those
operations for exfoliation from the internal surfaces of the cy-
lindrical bones, where it is necessary to excavate the bone ex-
tensively, in order to remove all the detached pieces; unless the
general circulation of the limb be previously arrested by the
tourniquet, the cavity of the bone is flooded with blood. Bi-
chat has also remarked, that the blood vessels of the bones be-
come unusually turgid and congested, in cases of drowning and
strangulation. The observations in 1832, on cholera in Paris,
showed the same congestion of black blood, to have been pro-
duced by that disease.
The arteries which supply the bones, from their mode of dis-
tribution, are referred to three classes. The most numerous
and the smallest, are those which penetrate from the periosteum,
by the capillary pores found over the whole surface of the
bones. The next are those which penetrate the larger forami-
na at the extremities of the long bones, and at different points
of the surface of others. And the third class, called nourish-
ing, amounts to but one artery for each of the cylindrical bones
VOL. L— 6
62 SKELETON.
which penetrates by an appropriate canal, as mentioned, com-
monly near the centre of the bone.
The arteries of the first two classes are generally extremely
small. They ramify upon the compact and cellular structure,
penetrating it in every direction. At death, they are common-
ly filled with blood, which renders the injection of them diffi-
cult. The third, or, as commonly called, the nutritious artery,
is of a magnitude proportioned to the bone to be supplied. Be-
ing single in every instance, it passes through the compact tis-
sue, and having reached the medullary cavity, it divides imme-
diately into two branches; each of which in diverging from its
fellow, goes towards its respective extremity of the bone. These
branches ramify into countless capillary vessels upon the mem-
brane containing the marrow,* and finally terminate by free
anastomoses with the extreme branches of the two other sys-
tems.
The veins of the bones are very abundant : they are uniform-
ly found in company with the branches of the third, or nutri-
tious arteries, and their common trunk goes out at the nutri-
tious foramen into the general circulation. These ramifications
have been long known, and bring back the blood from the me-
dullary membrane only. The veins which receive the blood of
the other arteries do not attend them, and were first of all found
in the diploic structure of the cranium, which led to the disco-
very of them in all the other bones. The honour of the ori-
ginal observation has been claimed respectively by two very
distinguished men of Paris, MM. Dupuytrent and Chaussier.J
These veins issue from the bones by numerous openings dis-
tinct from those furnishing a passage to the arteries. This cir-
cumstance is remarkably well seen in the flat and thick bones,
and at the extremities of the cylindrical ones. Having left the
bone, they terminate, after a short course, in the common ve-
nous system. They arise exclusively from the spongy and com-
pact structure, by extremely fine arborescent branches, which,
uniting successively, form trunks; these trunks penetrate the
compact tissue, and escape from the bone by orifices which are
* Would not this furnish a hint, that the arteries which secrete fat are diffe-
rent from other arteries, and that this distinction may prevail generally ?
t Propositions sur quelques points d' Anatomic, de Physiologic, &c. Paris, 1803.
} Exposition de la Structure de 1'Enccphale. Paris., 1807.
OF THE PERIOSTEUM. 63
uniformly smaller than the bony canals, of which they are the
terminations. The canals are formed of compact substance,
continued from the external surface of the bone, and are lined
by the contained veins. The parietes of the canals are pene-
trated by smaller veins entering into the larger. M. Dupuy-
tren is of opinion, that only the internal membrane of the ve-
nous system exists in this set of veins; that it. adheres closely to
the bone, so as to be incapable of exerting any action upon the
blood ; that it is very thin, weak, transparent, and is thrown
into numerous valves.
Lymphatic vessels are generally seen only on the surface of
the bones. Mr. Cruikshank, however, on one occasion, while
injecting the intercostal lymphatics, passed his mercury into the
absorbents of a vertebra, and afterwards saw them ramifying
through its substance;* a fact which, along with what is known
of the power of exfoliation in bones, proves sufficisntly the ex-
istence of such vessels in them. Nerves have also been traced
into them, accompanying the nutritious arteries.t
CHAPTER IL
SECT. I. OF THE PERIOSTEUM.
THE membrane which surrounds the bones is called perios-
teum, and is extended over their whole surface, excepting that
covered by the articular cartilages. As this membrane ap-
proaches the extremities of the bones, it is blended with the li-
gaments uniting them to each other, from which the ancients
adopted the opinion, that the ligaments and periosteum were
the same. Many fibres pass from the periosteum to the bone,
by which it is caused to adhere. These fibres are more nume-
rous and stronger at the extremities than in the middle of the
cylindrical bones ; also upon the thick bones, than upon the flat
ones. The blood vessels of the bones accompany these fibres
* Anatomy of Absorbing Vessels, p. 98. London, 1790.
f Beclard, Elemens d'Anatomie Generale. Paris, 1823.
64 SKELETON.
and contribute to the adhesion. The periosteum is united to
the muscles and to the parts lying upon it, by cellular substance.
The adhesion of the periosteum to the bones varies in the se-
veral periods of life. In infancy it may be separated from them
with great facility: in the adult it adheres more strongly in con-
sequence of its internal face having taken on a secretion of bone,
by which it is blended intimately with the bone it surrounds ;
and in old age it is still more adherent, from the progress of its
ossification. It is thick and soft in the infant, and becomes
ihinner and more compact as life advances.
The organization of the periosteum is fibrous, and the fibres
pass very much in the same direction with the fibres of the
bones ; excepting the flat bones, on which it is not radiated.
These fibres have different lengths, the more superficial are
longer, while the more deeply seated extend but a small dis-
tance. Inflammation developes the fibres in a striking manner,
by occasionally making the membrane as thick as an aponeuro-
tic expansion.
The blood vessels of the periosteum are numerous, and can
be easily injected. They come from the contiguous trunks,
and ramify minutely, into a vascular net-work, many of whose
branches penetrate into the bone, and have the distribution al-
ready mentioned. A few lymphatic vessels have been observed
in it. Its nerves have not been clearly discovered, though the
sensation of extreme pain, when violence is done to it in an in-
flamed state, may be thought a proof of their existence. In
health its sensations are null, or extremely obscure.
The periosteum receives the insertion of tendons, of liga-
ments, and of the aponeuroses. In early life, owing to the
slight attachment of this membrane to the bones, all these parts
may be torn from them, with but comparatively little force.
Bichat* having advocated the opinion, that the internal laminas
of the periosteum become ossified in the adult, considered that
as a means by which all the afore-mentioned insertions into it
were identified with the bones. This will account for the great
degree of tenacity with which they adhere, and the immense
force they are capable of sustaining, without being detached
from their insertions. In this tendency to ossify, the periosteum
* Anatomic Generale.
MEDULLA, AND ITS MEMBRANE. 65
manifests a great similitude to other fibrous membranes, as the
dura mater, the sclerotica, and the tendons.
The use of the periosteum is to conduct the blood vessels to
the bones, to protect the latter from the impression of the mus-
cles, and other organs, which come in contact with them, to
keep the ossification of the bones within its proper boundaries,
to give shape to them, and to secrete bone in the growing state
or in fractures; and, finally, as has been suggested by the late
Dr. Physick, it exerts a very happy influence in turning from
the bones suppurations in their vicinity, which would otherwise
be pernicious to them.
SECT. II. OF THE MEDULLA, AND ITS MEMBRANE, CALLED THE IV-
TERNAL PERIOSTEUM.
A greasy substance, as already stated, fills the cells of the
bones : it does not, in its composition, differ from common fat :
its granules, however, seem to be somewhat finer. From its re-
semblance in position to the pith of vegetables, it has obtained
the name of medulla or marrow. It is contained in a very fine
cellular and vascular membrane, lining the internal cavities of
the bones, and sending into their compact substance very deli-
cate filaments. The existence of this membrane has been de-
nied, but it may be established by sawing a bone in two, and
approaching the cut end to the fire, so as to melt out the mar-
row, or by immersing it in an acid, in which case the mem-
brane becomes crisp and distinct. Its delicacy is so extreme,
that it can only be compared to a spider's web. In this state it
may be traced, lining the whole cylindrical cavity of the long
bones, and extending itself to their extremities. It also exists
in the diploic or cellular structure of all the other bones ; but it
is scarcely possible to demonstrate it there in a very distinct
manner, owing to its extreme tenuity.
The medullary membrane is composed principally of the mi-
nute and numerous blood vessels spent upon the internal sur-
face of the bones, aided by a very fine, soft, cellular tissue,
merely sufficient in quantity to fill up the meshes between the
frequent anastomoses of the vessels. From the latter cause, it
is compared to the pia mater and to the omentum. It has been
stated, that its blood was derived from the nutritious artery,
6*
66 SKELETON.
which communicates freely with the other arteries of the bones.
This membrane is so arranged as to form along the course of
the blood vessels small vesicular appendages which contain the
marrow, and bear some analogy to a thick bunch of grapes*
hanging from the several pedicles of the stem.
Its nerves are extremely small; they enter by the nutritious
foramen, and have been particularly observed by Wrisberg and
Klint* They have not been traced ramifying in the substance
of the bone, but follow for some distance the course of the prin-
cipal arteries.
With the exception of Mr. Cruikshank's solitary injection of
a vertebra, no lymphatics have been observed satisfactorily on
this medullary membrane; and such trunks of the external peri-
osteum as are supposed to arise from the medullary membrane,
have not been traced nearer to it, than the orifice of the nutri-
tious canal.
Some differences exist in the nature of the contents of the
medullary membrane; for example, that part of it which is re-
flected over the cells in the extremities of the long bones, and
in the whole interior of the flat, and of the thick ones, contains
a much more bloody and watery marrow, than what is found in
the cylindrical cavities of the long bones: the latter, indeed, re-
sembles closely, as just stated, common adeps, presenting no es-
sential differences from it. These circumstances have given
occasion, without a material distinction of texture, to divide the
medullary membrane into two varieties.
That variety contained in the cellular extremities of the long
bones, and in the spongy bones generally, is in a superior degree
vascular. The part within the meshes of its vessels is, however,
so imperfect, that Bichat declared his inability to find it, and
that the number of the fine vessels was what gave, fallaciously,
the appearance of a membrane; while, in fact, the intervals be-
tween them were large, to allow the fat to come into contact
with the naked bone. The probability of this deficiency is con-
firmed by the circumstance, that no one pretends to have found
a membrane in the microscopical pores of the compact substance,
yet the existence of fat in it is proved by its becoming greasy
when insulated and exposed to heat. It is from the great abun-
dance of blood in this variety of the medullary tissue, that the
proportion of its adeps is small.
* Beclard, loc.. ciU
DEVELOPMENT OF BONES. 67
The second variety of medullary membrane is displayed in
the cells and cylindrical cavity of the diaphysis or body of the
long bones. Its membranous cells communicate freely with one
another when the membrane is entire; but, according to the ob-
servations of Bichat, not with such as are in the epiphyses of the
bones; and the line of demarkation is abrupt and well defined.
This is proved by attempts to inflate the one from the other; the
air, in such cases, passes with great difficulty. The texture of
this medullary membrane, from its extreme delicacy in a natural
state, is rather obscure, but it is occasionally well developed in
disease. Its sensibility has not been very apparent in such
cases of amputation as I have seen, though it is said, by some,
to be extremely exquisite. In whatever degree its sensibility
exists in different subjects, it is always more apparent in the
middle than near the extremities of the long bones; which may
be accounted for by its nerves always entering at the nutritious
foramen, and extending from thence towards the extremities.
The medullary membrane, besides its use in secreting the
marrow, is highly serviceable to the nutrition of the bones, as
proved in the experiments of Trojat, who, by destroying it,
produced their death, and an artificial necrosis, which was cured
in the usual way by a new secretion of bone from the perios-
teum. The marrow which it contains in the adult is not per-
ceptible in the foetus. Moreover, the quality of this marrow is
varied by disease; in consumption, dropsy, and other ailments
attended with great emaciation, a considerable part of it is ab-
sorbed, and a serous fluid deposited in its place; a circumstance
well known to those who clean skeletons.
CHAPTER III. ;
ON OSTEOGENY.
SECT. I. OF THE DEVELOPMENT OF THE BONES.
AT birth, though the skeleton is sufficiently solid to preserve
the shape of the individual, yet it is very imperfect in many
68 SKELETON.
particulars, which will be pointed out more in detail hereafter.
At present it may be stated, that the ends of all the long bones
are cartilaginous — the carpus and tarsus are nearly in the same
state — the vertebrae, true and false, have their processes very
imperfect; and consist, each, in several distinct pieces, united by
the remains of the cartilaginous state. Several of the bones of
the head are in the latter condition; and the sutures are so im-
perfect that the flat bones readily ride over each other from the
thinness of their edges, and also have the angles rounded, which
occasions the vacancies called fontanels.
From the early embryo .state to the completion of the skele-
ton, three stages are observable in the progress of ossification;
the first is mucous or pulpy, the second cartilaginous, and the
third osseous.
I. The mucous stage is observable at a very early period after
the embryo has been received into the womb, and presents
itself under two modifications. In the one, from the general
softness of the whole structure of the embryo, and from the
apparently homogeneous nature of its constituents, the mucous
rudiments do not distinguish themselves from the other parts:
This condition, however, is soon changed into one, and that be-
fore the expiration of the first month of gestation, in which they
assume a solidity and colour, which mark them off, both to
the eye and to the touch, from the still softer parts surrounding
them.
II. About the expiration of the first month the mucous stage
is converted into the cartilaginous, and the consistence of the
bones then increases continually by the accumulation of gela-
tine. Bichat makes a remark on this subject which has been
confirmed by the experiments of Scarpa, though erroneous de-
ductions have been made by the latter: that we do not see,
during the formation of the cartilages, those longitudinal striae
in the long bones, radiated in the flat, and mixed in the thick
bones, which distinguish the osseous state. The cartilaginous
state presents another peculiarity worthy of observation: all the
bones which in a more advanced stage are to be united by carti-
lage, as the vertebrae, those of the pelvis, and of the head, make,
DEVELOPMENT OF BONES. 69
in their groups, respectively, but one piece; while those which
are to be united by ligament, and consequently to be moveable,
as the femur, the tibia, the clavicle, and so on, are respectively
insulated. In the cartilaginous state the bones have neither cells
nor medullary cavities, and consist in a solid, homogeneous mass,
the form of which is sufficiently definite; and has its surface
covered by periosteum.
The flat bones of the cranium seem to be an exception to the
general rule of a preliminary cartilaginous state, and are com-
monly thought to be such. Their appearance is delusive, from
the cartilage being extremely soft and thin, and concealed by
the pericranium on the one side, and the dura mater on the
other; but a careful dissection enables one to distinguish it from
this double envelope.*
III. The osseous matter begins to be deposed when the rudi-
ments of the bone have become entirely cartilaginous, with the
exception of a few mucous points. In certain bones this change
is observable about the commencement of the second montht
after conception: J. F. Meckel has placed it about the eighth
week. The colour of the cartilage first becomes deeper; and,
in the region where ossification is to commence, is of a well
marked yellow. The blood vessels, which before this carried
only the transparent part of the blood, now dilate, so as to admit
the red particles, and a red point is perceived, called the punc-
tum ossificationis, from its receiving the first calcareous deposite.
This deposite is always near the very centre of the cartilaginous
rudiment, and not at its surface: the portion of cartilage nearest
to it is of a red colour; but, a little farther off, opaque and hol-
lowed into canals. The ossification increases on the surface of
the cartilage, and in its interstices, by continual deposites, which
are always preceded by that condition just mentioned. The
canals of the cartilage transmit the blood vessels, and are large
at the beginning of ossification; but, as the process advances and
is completed, they diminish gradually, and finally disappear.
The progress of ossification is somewhat modified in the three
classes of bones.
* Bichat, loc. cit. t Beclard, loc. cit. Bichat, loc. cit.
70 SKELETON.
In the long bones a small ring is observed to form early near
their centre, and to be perforated on one side by the nutritious
artery. This ring has its parietes thin, but broad, and its cavi-
ty is the beginning of the medullary canal. It is formed of
very delicate fibres which advance towards the extremities of
the bone,* and at the same time increase in thickness; so that
at birth, the body or diaphysis is generally finished. Common-
ly, at a period subsequent to birth, but differing in the several
bones, their cartilaginous epiphyses also begin to ossify, by the
development in their centre of points of ossification, which pre-
sent the phenomena mentioned in the last paragraph but one.
The cartilaginous state of the epiphysis gradually disappears
by retiring from the articular end of the bone towards its dia-
physis; and, just before its complete removal, it appears as a
thin lamina, gluing the end or epiphysis of the bone to its body.
Several of the apophyses of the long bones are also formed from
distinct points of ossification.
The ossification of the flat or broad bones begins by one or
more points, according to the bone being of a simple shape as
the parietal; of a double shape or symmetrical, as the frontal,
where there are two points of ossification ; or of a compound
shape, as the occipital and temporal, where there are several
points. The commencement of ossification in them, is also
manifested by the appearance of a red vascular spot in the
cartilaginous rudiment, in which the osseous matter is depo-
sited, and from which it progresses in radiated lines. The
periphery of this circle of rays presents intervals between the
fibres, giving it the appearance of the teeth of a fine comb:
these intervals are subsequently filled up by the sections of radii
starting from them, and so on successively till the bone is
finished. In the infantile head the several radii grow with a
pace nearly equal ; so that where the bones are angular, the
angles being most distant from the centre of ossification are
finished last of all, from which result the fontanels. Where the
bones are intended to be kept distinct from each other, their
fusion is prevented by a membranous partition; but when they
are to coalesce into one piece, only cartilage is found, which is
subsequently ossified.
* Bichat, loc. cit.
GROWTH OF BONES. 71
In some of the flat bones, as the sternum and the sacrum,
there are, first of all, a great many distinct points of ossification,
which quickly unite into a smaller number ; they then remain
stationary for a number of years, but finally all unite into but
one piece.
The ossification of the thick bones begins by one or more
points, according to the simplicity or complexity of their figures.
The bones of the tarsus and of the carpus, have each but one
point, while those of the spine have several. The two former,
as stated, are almost entirely cartilaginous at birth. The re-
maining phenomena of ossification in these several bones are the
same as has been mentioned.
SECT. II. ON THE MANNER IN WHICH BONES GROW.
After the cartilaginous condition of the bones has been sup-
plied by the complete deposite of osseous matter, and they are
finished, with the exception of the epiphyses being fused into the
respective bodies, the bones still continue to grow till the indi-
vidual has reached a full stature. This is effected by the succes-
sive addition of new matter to the old. The long bones lengthen
at their extremities; this is proved by the following experiment
of Mr. John Hunter.* Having exposed the tibia of a pig, he
bored a hole into each extremity of the diaphysis, and inserted
a shot; the distance between the two shots was then accurately
taken. Some months afterwards, when the animal had increased
considerably in size, the same bone was examined, and the shots
were found precisely at their original distance from each other,
but the extremities of the bone had extended themselves much
beyond their first distance from the shots. The flat bones in-
crease in breadth by a deposite at their margins, a circumstance
which has been known a long time, but it required the ingenui-
ty of Mr. Hunter to prove conclusively that the long bones in-
crease in length by a similar process, and not by interstitial de-
posite, as Duhamel thought. This observation explains most
satisfactorily the use of the cartilage between the diaphysis and
the epiphysis in all bones ; that it is merely interposed for the
* Transactions of a Society for Improvement, vol. ii. London, 1800. Experi-
ments and Observations on the Growth of Bones.
72 SKELETON.
purpose of offering the least possible resistance to the new os-
seous fibres, which grow from the epiphyses and from the dia-
physes: and that it is kept for this end, without any material
change in thickness, from the fourth or fifth year to the six-
teenth or eighteenth, when it disappears, because there is no
longer any use for it, in consequence of the bones having at-
tained their full length.
The epiphyses are then manifestly intended to favour the
elongation of the bodies and the development of the extremities
of the long bones, to suit the same purposes in some of the flat
bones, as those of the pelvis, and to permit the general deve-
lopement of the bodies of the vertebras. The ossification of the
epiphyses commences in some bones about fifteen days before
birth, as in the inferior extremity of the thigh bone, and in
others, as those of the ossa innominata, not till the fifteenth
year or thereabouts. Many of the processes from the bones,
are also epiphyses, as the trochanters of the os femoris, the
tuber of the ischium, the acromion scapulae, the seven processes
of a vertebra, and so on, and are developed in the same way.
The time at which they all are thoroughly fused into the bones
to which they belong, extends from the fifteenth to the twenty-
fifth year; depending upon the individual bone, and upon vari-
eties of constitution in different persons : though this process
may be considered as completed, generally, in the female at
the age of eighteen, and in the male at twenty-one.
The increase in thickness of every bone depends upon a
continued secretion from the internal surface of the periosteum,
at first soft and mucous, then osseous : when this secretion is
arrested, the bones cease to grow in thickness, which com-
monly occurs some time after they have attained their full
length. The changes which subsequently take place in them
are those of interstitial deposite and absorption : the former is
well exemplified in inflammation of the bones, and in spina
ventosa ; the latter in the diminution of the bones in extreme
old age, and in the loss of the alveolar processes.
There is no period of life in which this interstitial absorption
and deposite is not continually occurring, but it is much more
rapid in young and growing animals than in the adult and old.
The experiments of Mr. Hunter and of Duhamel, show, that
when a growing animal is fed upon madder, (rubia tinctorum,)
GROWTH OF BONES. 73
the bones are quickly coloured by it; when the madder is
withheld, the bones become again white; and that the first
appearance of the restoration of the latter is manifested by a
white lamina being deposited on their surface. The madder,
under such circumstances, is a long time in getting out of the
bones. I fed a young pig for one month on it, mixed with
other food. At the expiration of the succeeding five months,
the animal, having grown very considerably, was killed. The
interior lamince of all the bones continued to be deeply tinged,
while their surface from the deposite of new bone had become
white. From this it would appear that deposite is a very per-
manent thing in bones : it, of course, must prevail much over
absorption, else their growth would be arrested.
At the same time that the periphery of each bone is increas-
ing in its dimensions, the medullary canal is also augmenting :
this arises from an absorption going on internally, while the
deposite is making externally. Duhamel* proved this by a cu-
rious experiment. He surrounded a cylindrical bone of a
young animal with a metallic ring; on killing the animal some
time afterwards, he found the ring covered externally by a se-
cretion of bone,f owing to the growth of the latter, and the
medullary canal as large as the ring itself. Notwithstanding
the obvious conclusion from this experiment, he made the mis-
take of supposing that the bone had enlarged by expansion, and
not by a deposite externally with an absorption internally.
As the individual advances in life, the cylindrical canal, in
the centre of the long bones, continues to enlarge in size by the
internal absorption : so that the parietes of the bones, which in
early life were much thicker than the canal, and in the adult
about the same diameter, become exceedingly thin in old age;
resembling thereby a stalk of Indian corn, with the pith scoop-
ed out.J The cells of the cellular structure in the several
bones also enlarge, whereby the whole weight of the bones is
much decreased in the very aged. In the parietes of the cra-
* Mem. de 1'Acad. Roy. des Sciences, an. 1739-41-43-46.
t If a string be tied around a growing tree, the same thing takes place, and it
is finally shut up in the ligneous part.
t There are several examples of this in the Anatomical Museum. More rarely
the reverse takes place, and the cavity is filled up : of this there are also speci-
mens.
VOL. I.-7
74 SKELETON.
nium there is rather a tendency to the absorption of the diploe,
and the approximation of their tables.
The bones, also, become more brittle in old age, in conse-
qneuce of the increase of calcareous, with a diminution of
gelatinous matter. The reverse being the case in infancy,
they are more flexible than in the adult, and can even bear to
be twisted or bent without breaking.*
SECT. III. — ON THE FORMATION OF CALLUS.
As this is a consequence of bones being fractured, and a mode
that nature takes to repair the accident, there is some resem-
blance between it and the primitive formation of bone. Owing
to the rupture of the blood vessels of the bone; of those of the pe-
riosteum, and of the medullary membrane; and frequently of the
vessels of contiguous parts, the first effect of the accident is an
effusion of blood into the cavity of the fracture. The several
contiguous soft parts then swell, become hardened and inflamed;
and, in the mean time, an absorption of the blood is proceeding,
while an effusion of coagulating lymph from the ruptured ves-
sels occurs in the cavity of the fracture. A ring, the thickest
part of which is precisely over the seat of the fracture, is formed
by the lacerated parts ossifying: there is also formed in the in-
terior of the bone a sort of osseous pin. Till this moment the
bone itself remains unchanged, with the exception of a coating
of coagulating lymph on its broken faces; but now its extremi-
ties begin to coalesce or fuse themselves into each other, the su-
*The reported instances are now numerous, where, from a defective organiza-
tion of bone, fracture is produced from very trivial causes; and this state is not
confined to any particular age, for it extends from infancy to advanced life. I
have attended a fractured os femoris in a child of two years, from a stumble in
walking across a carpeted floor. In another child the os femoris was broken, so
far as could be learned, by the nurse stooping to reach something from the floor:
the same child had both clavicles broken, without any one knowing when or
where: the left side was flattened, from the fracture, probably a partial one, of
several ribs, equally inexplicable. In a third child the tibia was broken from a
trifling fall on the floor, and the clavicle from striking the shoulder moderately
against the rounded back of a chair.
In these several instances the fragility may arise cither from a defective rela-
tion of the constituents of the bone to each other, by a deficiency of animal mat-
ter, which diminishes the tenacity of the bone, or it may arise from attenuation
merely of the bone, leaving its points too thin for ordinary accidents.
FORMATION OF CALLUS. 75
perfluous bony matter (the ring and the pin) being no longer
necessary, 'is absorbed, and the cavity of the bone with the
membranes of the latter is re-established.* In this case it will
be seen that the deposite of coagulating lymph into the cavity
of the fracture, corresponds with the mucous rudiments of the
foetal bone, and that the remaining phenomena of ossification are
the same.
Some physiologists have attempted to give to the periosteum
the exclusive credit of the formation of callus: the view is erro-
neous, because experiments show, that even where the perios-
teum is stripped designedly from the fractured ends of bones,
they, nevertheless, unite, and the periosteum is restored when
the callus is formed. The probability then is, that all the blood
vessels (from whatever source they come) which penetrate the
organized coagulating lymph secreted between the fractured ex-
tremities, convey and deposite calcareous matter.
The celebrated Bichat and some others, were of opinion, that
in every case of fracture where the ends of the bones are not
kept in contact, granulations spring up from the ruptured sur-
faces of the bone, and of its membranes; that these granulations
first receive into their interstices a soft gelatinous deposite, then
a cartilaginous one, and, finally, a calcareous one, by which the
bone is united. This process, however, is much more common
in compound fractures which suppurate, and may be considered
rare in simple ones.
When the calcareous matter begins to take a place in a form-
ing callus, if the part be much moved, the process is arrested,
the blood vessels no longer deposite even if they carry calca-
reous materials, and an artificial joint is formed. The proper
period of restoration being once passed, the vessels sink into an
inactive state from which they have little or no disposition to
rouse themselves. Under these circumstances, Dr. Physick
proposed, many years ago, the introduction of a seton through
the cavity of the fracture, and the retaining of it there for a long
time, for the purpose of stimulating the vessels. The plan has
* J. Hunter, paper by Mr. Home, in Trans, of Society for Improvement. Lon-
don, 1800.
76 SKELETON.
now been repeatedly tried, with complete success, on the cylin-
drical bones, and, in one instance, upon the lower jaw.*
Callus is formed much more speedily in young persons than
in old: occasionally, however, we meet with cases in which the
rapidity of its deposite in the latter is remarkable. I, for ex-
ample, treated, in 1826, a female of ninety, for a simple frac-
ture of the os humeri, which was cured at the end of five
weeks.
* Dorsey's Elements of Surgery. Philadelphia Med. and Phys, Jour. &c.
There is now in the possession of Dr. J. Randolph, the son-in-law of the late
Dr. Physick, the os humeri upon which this experiment was first tried, and
which shows, very satisfactorily, the state of union : a hole is still left which
the seton occupied,
BOOK I.
PART If.
Of the Bones, individually.
THE several textures of the body are so intermixed, that the
consideration of one alone, pursued through all its applications,
excludes for the time, rather artificially, some one or more of
the others. This circumstance, inseparable from a clear ac-
count, has always perplexed writers on anatomy, and left them
under various impressions concerning the best point of depar-
ture and method for pursuing. their descriptions. Reasons of
value may be urged for almost any arrangement : each one
will have some peculiar advantages that the others have not,
and which will cause it to appear to the understandings of its
advocates, superior to the rest. For a course of study which
is intended to be physiological and surgical in its combinations,
the usual practice of beginning with the skeleton is, perhaps,
the most advantageous; the young student will, however, un-
derstand that if the skeleton have any natural claim to this
precedence, it is principally from its furnishing those land-
marks, as it were, to which we refer the situation of other
parts, and that it is only conceded, for the purpose of laying a
foundation for their more easy and intelligible description sub-
sequently. The human frame may be compared to an extend-
ed landscape, the multiplicity of whose features and the variety
of objects spread over whose surface, collectively, bewilder the
beholder; but by seizing first on its prominent outlines, marking
the course of its mountains and ridges, and determining the
bearings of the several objects according to them, we become
able, at length, to define not only to ourselves, but to others,
the precise position of each point, or each object which may
become the subject of inspection.
78 SKELETON.
Unfortunately, ' the minuteness with which the skeleton is
described has been decried as useless, but the zealous and rea-
sonable student ought to bear in mind — that the only-rational
plan of reducing a dislocated joint must depend upon a proper
knowledge of its articular faces; that many of the great phe-
nomena of life depend essentially upon the arrangement of the
skeleton; that locomotion is inseparably connected with it;
and that, in short, it has a bearing upon almost every animal
operation. With these facts impressed upon him, he will be
prepared to give the history of the skeleton a full and perfect
attention.
CHAPTER J.
THE TRUNK.
THE trunk is constituted by the Spine, the Thorax, and the
Pelvis.
SECT. I. THE SPIKE.
The spine, (Columna Vertebralis, Rachis,) is placed at the
posterior part of the trunk, and extends from the head to the
inferior opening of the pelvis. It consists of twenty-eight or
nine distinct pieces, of which the upper twenty-four are true,
or moveable vertebrae. The twenty-fifth is the sacrum, or the
pelvic vertebra, which is fixed; and the remainder are the
caudal vertebrae or the coccyx.
On the posterior face of the spine, each of the true vertebrae
is seen to contribute, by a long process, to that ridge which is
so readily felt beneath the skin, and from which, probably, the
name of spine was derived. The spine increases gradually in
size from the first to the last true vertebra. The upper part
of the sacrum is extended laterally much beyond the latter,
afterwards the spine diminishes abruptly to the extremity of
the coccyx. The spine has several curvatures, which are best
marked in the erect position. For example, the lower part of
the cervical portion is convex anteriorly, and concave behind —
the thoracic part is concave in front,, and convex behind — the
THE SPINE. 79
lumbar portion is convex in front, and concave behind — the
pelvic and caudal portion is concave in front, and convex be-
hind. This arrangement is the result of the different degrees
of thickness in the bodies of the vertebrse, and especially in the
fibro-cartilages which unite them to each other. Wherever
these cartilages are thin at their anterior margin, there is a
concavity ; but where they are thick at the same point, there
is a convexity.
There are seven vertebrae to the neck, called cervical;
twelve to the thorax, called dorsal; and five to the loins,
called lumbar. In reckoning the number of the vertebrae, the
one next to the occiput is always the first; and so on, succes-
sively, to the last. Albinus, however, has departed from this
rule, and counts them from below, upwards.
General Characters of a Vertebra.
A vertebra (verttbre) consists in a body, in seven processes
or extremities, and in a canal or foramen for lodging the spinal
marrow.
The body of a vertebra is at its fore part ; it is somewhat cy-
lindroid or oval, but varies considerably from these figures ac-
cording to its position in the spine. The anterior part of the
body is convex ; but the posterior part is concave, where it con-
tributes to the spinal canal. The superior and inferior surfaces
are fiat, with the exception of a ridge of hard bone at the cir-
cumference, more elevated, and not so extended in some bones
as in others. These ridges are, in young subjects, epiphyses.
There are many foramina, large and small, to be seen on the
front and back surfaces of the bodies. They transmit arteries
and veins, and some of them are used for fastening the liga-
ments of the spine. On the posterior face of the body there
are two foramina larger than the others, occupied by veins
coming from the interior of the vertebra. These veins corre-
spond with the diploic sinuses in the head, and have been parti-
cularly described by M. Breschet, of Paris, in a thesis present-
ed to the School of Medicine in 1819.
The processes are placed a.t the posterior part of the vertebra.
80 SKELETON.
Of these there are four oblique or articulating processes, which
articulate with the corresponding ones of the bones, above and
below; two transverse processes, which project, one on either
side, from between the oblique processes; and one spinous pro-
cess, which is placed on the middle of the bone behind. The
two oblique, and the transverse process on each side, come from
a common base or root that arises from the lateral posterior part
of the body, and present collectively a very irregular appear-
ance. Their faces and inclinations are much modified in the
several vertebrae. The spinous process is also much modified
in regard to size, shape, and inclination.
The body and processes form the periphery of the foramen
for the spinal marrow, and, by their thickness and strength,
afford an excellent protection to the latter. This spinal fora-
men is of a triangular shape, presenting its base in front and its
apex behind. It is considerably larger than the spinal marrow
of the part, including its vessels, membranes, and the nerves
that proceed from it; in this respect the foramen differs very
materially from the cavity of the cranium, which is exactly
filled by the brain.
At the upper part of the spinal foramen of a vertebra, between
the body and the upper articulating, or oblique process, is a
groove. There is another groove between the lower oblique
process and the body. These grooves, by the approximation of
the contiguous vertebrae, are converted into perfect holes, called
inter-vertebral foramina, and are for the transmission of the
spinal nerves and blood vessels.
The bodies of the vertebrae are extremely light and spongy,
being formed principally of the cellular matter of bone, and are
covered, with the exception of their upper and lower surfaces,
with a very thin lamella of compact substance. The processes,
for the most part, have a thick and compact structure, enabling
them to sustain conveniently the weight of the body and the ac-
tion of the different muscles, as applied to them.
Of the Cervical Vertebra, generally.
The cervical vertebrae differ among themselves, but are dis-
tinguished by certain common properties from the other bones,
THE SPINE. 81
of the spine. Their bodies and processes are small, but the
spinal foramen is large, so as to admit of much motion, without
pressing on the spinal marrow. The fore and back parts of the
body are more flattened. The upper face is concave transverse-
ly, being bounded on each side by a ridge of bone; the lower
face is concave from before backwards, and is bounded by a
ridge before and behind. This arrangement permits the bodies
of adjoining vertebrae to embrace each other in the dried bones,
and grants great facility of motion, in the living body, by the
interposition of the intervertebral substance, as well as securi-
ty in the attachment of the latter.
The oblique processes have their articular faces at an angle
of about forty-five degrees. The superior face upwards and
backwards, the inferior downwards and forwards. The spinous
process is short, triangular, nearly horizontal, and bifurcated at
its posterior extremity, where it terminates in two tubercles.
The transverse processes are short, and perforated by a large
canal for the transmission of the vertebral artery and vein ; they
are concave above, somewhat convex below, and present two
points at their external extremities for the origin and insertion
of muscles. The inter- vertebral foramen is formed principally
by the lower of the contiguous vertebrae.
Of the Cervical Vertebra, individually.
•The first cervical vertebra, commonly called the Atlas, from
its supporting the head, presents the appearance of a large ir-
regular ring, much thicker at its sides than elsewhere. It is
deficient in body, owing to the space allotted to that part in the
other vertebrae being occupied by the processus dentatus of the
second vertebra. The place of body is supplied by an arch of
bone.
Its oblique processes are peculiar, both in shape and position.
The upper ones are concave and horizontal, their long diameters
being extended from within outwards and backwards, so as to
suit the direction of the condyles of the occipital bone with
which they articulate; the greatest depth of their concavity is,
therefore, internal. The inferior oblique processes are smaller,
slightly concave, and circular; they rest upon the shoulders of
the second vertebra. At the internal margin of the oblique pro-
82. SKELETON.
cesses a rounded tubercle is found on either side of the bone.
The transverse ligament of the neck is extended between the
two tubercles, and keeps the processus dentatus in its place.
The short thin bridge at the fore part of the bone, is marked
in front by a tubercle, and behind by an articular face which
touches the processus dentatus. The bridge or section of the
ring forming the posterior part of the bone, is much longer and
more arched than the anterior. It also has in its centre a tu-
bercle, occupying the position of a spinous process. At the
anterior extremity of this bridge, just behind the upper oblique
process, there is a groove, and sometimes a canal, made by the
vertebral vessels, just before they enter the foramen magnum
oecipitis.
The transverse processes of this vertebra are at the sides of
the thick part of the ring. From their greater length, they pro-
ject considerably beyond the transverse processes below, and
are also perforated at their bases by the vertebral vessels, which
have a very winding course from them into the cranium.
The spinal canal of the first vertebra, excluding the space for
the processus dentatus and transverse ligament, is the largest in
the spine: by which ample provision is made against injuries of
the medulla spinalis, notwithstanding the great latitude of the
rotation of this bone upon the second vertebra. A considera-
ble vacuity is left between the upper posterior margin of the
atlas and the contiguous surface of the os oecipitis, for the gin-
glymoid motion of the head upon the atlas,
The second vertebra of the neck is particularly remarkable
for the elongation of its body above into the processus dentatus
or tooth-like process. This process rises as high as the superior
margin of the atlas, and almost touches the anterior margin of
the foramen magnum oecipitis.* It presents an articular face
in front, where it touches the first vertebra. It presents also a
smooth face behind, W7here it touches the transverse ligament
Above the latter face, on each side, is a flat surface for the ori-
gin of the moderator ligaments, and the very point above pre-
sents a small rough surface for the vertical ligament going to
the margin of the foramen magnum.
* Sometimes it even forms a joint with itt
THE SPINE. 83
On each side of the tooth-like process, this bone presents its
superior oblique process, as a shoulder, nearly horizontal, circu-
lar, and somewhat convex. The inferior oblique process has
nothing peculiar either in its position or direction. The fora-
men of the transverse process is directed upwards and outwards.
The interior part of the body, like that of the other vertebrae,
is cellular.
The posterior part of the second vertebra is strong and broad.
The spinous process is longer than any other except the seventh,
and sometimes the sixth; it is also much larger, is triangular,
presents a ridge above and a fossa below, and is bifurcated at
its extremity. Just behind the upper oblique process there is
a very superficial notch, scarcely discernible, for the inter-
vertebral foramen. The processus dentatus is the pivot or axle
upon which the head revolves, and is stationary while such
motions are going on.
The vertebrae of the neck increase gradually in the size of
their bodies from the second to the seventh; and there is suffi-
cient uniformity between them, wth the exception of the last,
to render the general Inscription applicable, though it is not
difficult to observe some minute and unimportant points of dif-
ference.
The spinous process of the sixth vertebra is long, and termi-
nates in a sharp point. •
The seventh cervical looks like a dorsal vertebra, and has
some peculiarities which are well marked. Its body is larger,
its superior face is less concave than in the others, and its infe-
rior face is flat. Its spinous process is the longest of all, is not
bifurcated, but terminates by a rounded tubercle easily felt be-
neath the skin. Its transverse processes are thrown somewhat
backwards, and though there is a small foramen in them, it is
not large enough to receive the vertebral vessels. Sometimes
on. the side of its body, at the lower margin, is a small face, by
which it partially articulates with the head of the first rib.
M. Portal* reports, that in some rare cases he has seen only
six, and in others, eight cervical vertebrae, with neither of which
deviations have 1 ever met.
* Anat. Medicale. Paris, 1803.
84 SKELETON.
Of the Dorsal Vertebra.
General or Common Characters. — The dorsal vertebrae,
amounting to twelve, being intermediate in position to those of
the neck and loins, are also intermediate in size. They diminish
in the transverse diameter of their bodies from the first to the
third: afterwards, they increase regularly in size to the last.
Their bodies are more cylindroid than those of the neck, and
the most of them are marked laterally on the upper, and also on
the lower margins, near the base of the processes, with a small
articular face, which receives one-half of the head of a rib. The
adjoining fossa of the contiguous vertebra, receives the other
half of the head of the same rib. The superior of these articu-
lar faces is larger than the inferior. The superior oblique pro-
cesses are flat, and present almost backwards; the inferior are
also flat and present as directly forwards. The transverse pro-
cesses are directed obliquely backwards: they are long, termi-
nate in an enlarged extremity, which presents an articular face
in front for the tubercle of the contiguous rib. The transverse
processes as they descend are directed more backwards, and di-
minish in length. The spinal processes are long, triangular, with
a broad base, and an extremity somewhat rough, swollen, and
sharp-pointed, except in the upper and lower vertebrae: they
have a ridge above and a fossa below; are directed obliquely
downwards, and overlap each other.
The spinal foramen is small and round. The notch for the
inter-vertebral foramen is formed principally by the vertebra
above.
Of the Dorsal Vertebra — individually.
These vertebrae, though they have many common points of
resemblance, yet some of them present distinguishing peculiari-
ties. Of these, the first and the two or three last, are the most
remarkable.
The first has a complete articular face on the side of its body
for the head of the first rib, and a partial surface at its lower
margin for the head of the second rib. Its spinous process is
projecting and not so oblique as some of the others: the flat-
ness of its body makes it look much like a cervical vertebra.
THE SPINE. 85
The three lower dorsal vertebrae approach in the form of their
bodies to those of the loins. Frequently, but- not always, the
tenth has the articular face for the head of the rib, equi- distant
from its upper and lower margins, and its transverse process so
short, and inclined backwards, that the tubercle of the tenth rib
does not form an articulation with it. The eleventh and twelfth
vertebras have also the fossae for the heads of the ribs, in their
middle, at the sides of the roots of the processes; instead of a
partial pit at their upper and lower margins. Their transverse
processes are remarkably short, are directed almost backwards,
and do not touch the ribs, and have therefore no articular marks.
The spinous process departs from the triangular shape, becomes
flattened and vertical at its sides, is not far from being horizon-
tal, and has a tubercle at its extremity.
The middle vertebrae of the back have some minute points of
difference among themselves, the most of which it would be
useless to study. They increase, as stated, gradually in size as
they descend, and their spinous processes are very near to, and
overlap each other, like shingles on the roof of a house.
Of the Lumbar Vertebra.
Common Characters. — Their number has been stated at five.
Their bodies are larger than those of the other true vertebrae,
and are oval on the upper and lower surfaces, with the long di-
ameter transverse. The epiphyses at the margins of these
faces, are larger and more elevated. The spinal foramen is
triangular and more capacious than in the dorsal vertebrae.
The inter-vertebral notches for the nerves to pass out, are much
larger than elsewhere in the spine, and are formed principally
by the upper of the two contiguous vertebrae, though the diffe-
rence is not very remarkable.
The transverse processes are very long, and stand out at right
angles. The articular faces of the upper oblique processes are
concave and vertical, being directed very much inwards, or
looking towards each other; the lower oblique processes are
convex, and have the articular faces directed very much out-
wardly. The spinous process is short, thick, and horizontal;
having broad, flat sides, and terminating by an oblong tubercle.
VOL. I.— 8
86 SKELETON.
Of the Individual Lumbar Vertebra.
These bones are not so well marked among themselves as the
other vertebrae. They may be distinguished in a single set, by
the successive increase in the size of their bodies. The first,
therefore, is known by its smallness; by the comparative short-
ness of its transverse process, and by the deep concavity between
the superior oblique processes.
The transverse and spinous processes of the three middle
vertebrae are rather longer than those of the others; the third
has them the longest of all. The last lumbar vertebra may be
recognised by its greater size; by its body being flat, and deeper
in front than behind, so as to give it somewhat of a wedge shape;
by the greater size of its spinal foramen; by the obliquity back-
wards of the transverse process; and by the wide interval be-
tween the oblique processes, as well as by the lower of the lat-
ter facing almost directly forwards.
Of the Pelvic Vertebrae.
The os sacrum, (sacrum,) the largest by much of any of the
bones in the spinal column, has obtained its name from the sup-
position of its having been offered in sacrifice by the ancients.*
It forms the posterior and superior boundary of the pelvis, as
well as the pedestal of the spine, and may therefore be properly
studied along with either of them, though its association with
the spine seems more natural. In its lateral boundaries it is tri-
angular: it is also regularly concave before, and very irregularly
convex behind.
In its forming state this bone consists of five pieces, separated
by long narrow interstices filled with cartilage. It is in this
condition that its pieces bear a very strong resemblance to the
true vertebra, and therefore have obtained the name of false
vertebrae. They are all fused into one by the progress and de-
velopment of the bone; but the marks of the original separation
remain, particularly on its front surface.
Though the anterior face of the sacrum presents generally a
* Portal. Anal. Med. vol. i. 345.
THE SPINE. 87
regular concavity; in some subjects, nevertheless, it is flat. This
surface is pierced on each side by four holes, which communi-
cate with the spinal cavity and transmit the anterior nerves of
the cauda equina. Beneath each range of holes is a notch, which
by the corresponding one of the* coccyx, is converted occasion-
ally into a perfect foramen for the thirtieth spinal nerve, or for
the fifth of the sacrum. These foramina diminish in size, from
the higher to the lower: their orifices are funnel-shaped, and di-
rected obliquely outwards. Horizontal ridges of bone, marking
the original separation of the false vertebrae, connect the holes
of the two sides.
The false vertebrae decrease in size from above, which is ma-
nifested by the successive approach of the foramina, and of the
horizontal ridges. The first of them has almost the same verti-
cal diameter as the last of the loins, besides its great increase of
magnitude by the lateral extension of its base.
The posterior face of the sacrum is very convex and rough,
and is equally divided by its spinous processes. The processes
belonging to its three upper sections or bones, are for the most
part well marked, and decrease in length from the first. The
fourth spinous process is resolved into two tubercles, and the
fifth is fairly separated also into two tubercles, by an angular
fissure, with its base downwards and open. This fissure, it may
be remarked, sometimes invades the fourth spinous process, and
even the third, and in some rare eases runs the whole length of
the posterior surface of the bone, leaving a gap from one end to
the other. The upper margin of the posterior face of the sacrum
presents on each side an oblique process for articulating with
the lower oblique processes of the last lumbar vertebra. Just
above the upper spinous process is a deep notch, between which,
and the last lumbar vertebra, is a very large vacuity, or gap, ex-
posing the spinal canal.
On each side of the spinous processes are also four foramina,
smaller and thinner than those in front, and for the passing of
the posterior nervous cords from the cauda equina. At their in-
ternal margins some small and obscure risings of bone are per-
ceptible, which may be considered the rudiments of oblique pro-
cesses. On the outer side of these foramina, there are several
more strongly marked tubercles, from which the sacro-iliac liga-
88 SKELETON.
ments arise. After these the posterior surface of the bone slants
very considerably to its lateral margin.
The base of the sacrum presents in its middle an oval surface
for articulating with the last lumbar vertebra. Between this
surface and the oblique process, may be remarked the groove
for the fifth lumbar nerve. The base of the sacrum continually
thickens, from the side of the oval surface to the place of junc-
tion with the ilium. The anterior margin of this expansion is
continuous with the linea ilio-pectinea; the posterior margin is
elevated at its extremity, is a substitute for a transverse process,
and is placed immediately below the transverse of the last lum-
bar vertebra. The point of the sacrum is truncated where it
articulates with the os coccygis. The lateral face of the sacrum
is thicker above than below; its upper two-thirds present an ir-
regular, and somewhat triangular face for joining the ilium; the
lower third is very thin, and contributes to form the sacro-scia-
tic notch of the pelvis.
The spinal canal of the sacrum is triangular, and diminishes
continually to its lower extremity, where it terminates by a
small orifice, notched behind, as mentioned, and exposing the
last piece of the bone. The foramina on the anterior and pos-
terior surface of the sacrum, communicating with this canal, cor-
respond strictly in their uses and positions with the inter-verte-
bral foramina of other parts of the spine.
The sacrum is extremely light for its size, and its texture is
in a high degree spongy; but its processes and articular faces
are quite as compact as they are in other parts of the spine.
Of the Coccyx or Caudal Vertebra.
The os coccygis (coccyx) resembles the sacrum in shape and
texture, and is so placed as to continue forwards the line of the
curvature of the sacrum. It consists in four pieces, sometimes
only three, united to one another by fibro-cartilaginous matter,
and it corresponds with the tails of animals. These pieces in
the progress of life, are not only anchylosed together, but also
with the sacrum; so that all the false vertebrae, from the base of
the sacrum to the point of the coccyx, are joined into a single
bone.
THE SPINE. 89
The upper bone of the coccyx is the largest, and is the base
of this little pyramidal pile; it is united, by its middle, to the
truncated apex of the sacrum ; and its sides, moreover, are, in
the perfect specimen, elongated several lines beyond this sur-
face of contact. From the posterior surface of the first bone,
of the perfect coccyx, a tubercle arises on either side, which is
curved upwards, and joins the bifurcated termination of the last
spinous process of the sacrum: between the two bones an inter-
vertebral foramen is thus left for the passage of the fifth sa-
cral nerve from the canal of the sacrum. Immediately below
this tubercle is a notch, made by the sixth sacral nerve.
The remaining bones of the coccyx are much smaller than
the first, and diminish successively. The surfaces which they
all present to each other are somewhat concave in the centre.
The lower end of the last bone terminates in a rough point, to
which a cartilage is appended. These bones are very spongy
and light: their principal strength is derived from a ligamentous
covering. To them are attached the sacro-sciatic ligaments, the
coccygrei, levatores ani, and the glutaei magni muscles.
SECT. II. — DEVELOPMENT OF THE VERTEBRAL COLUMN,
This column is much longer, in proportion to the limbs, at
birth, than it is in adult life, and upon it depends the principal
length of the individual at this period. The head is always in
proportion to the length of the spine. This predominance in
the head and spine is,, no doubt, connected with the necessity
of an early development in the nervous, respiratory, and ali-
mentary systems, in order to maintain the life of the individual;
whereas, the use of the upper and lower extremities being called
for only at a more advanced period, their development is not
in proportion. It is remarked, that in adult life the principal
difference in the stature of individuals depends upon the length
of the lower extremities; (he trunk, including the head, being
of nearly the same length in all. This rule, however, like most
others, has numerous exceptions. The spinal canal and the inter-
vertebral foramina are, also, proportionably larger in the foetus.
The spine of the foetus is but badly suited to the purposes of
standing and walking. Its spinous processes are deficient, in
consequence of which, the muscles which are intended to keep
8*
90 SKELETON
it erect, have their insertion so much in the line of motion, that
they perform their part very imperfectly, and the spine is con-
tinually bending forwards, from the erect position. All the
transverse processes are also imperfectly developed, those of
the loins are particularly deficient; those of the thorax and neck
are less deficient; as in the one case they have to form an arti-
cular surface for the ribs, and in the other to allow passage to
the vertebral artery. The bodies of the vertebrae are. imper-
fectly ossified, and are separated by cartilage from the processes.
The epiphyses, or upper and lower surfaces of the bodies, are
in the state of cartilage: the bodies, therefore, are rounded both
above and below, whereby their surfaces of contact are much
reduced in extent, and the line of support to the trunk rendered
much less firm. When, at this age, the vertebras are macerated,
their bodies present themselves as small rounded tubercles; and
very nearly one-half the whole length of the spine is made up
of the cartilaginous epiphyses and the inter-vertebral cartilages-
The spine, in the foetus, is almost straight, and scarcely presents
at all those curvatures, for which it is so remarkable in adult
life. This depends upon the rounded form of the bodies of the
vertebra3, and the sameness of thickness in the inter-vertebral
matter at its anterior and posterior edge.
SECT. III.— ON THE USES OF THE VERTEBRAL COLUMN..
The vertebral column performs three important offices in the
animal economy. It affords a secure lodgement to the spinal
marrow; is a line of support to the trunk, in every variety of
position;'and is the centre of all its movements.
In standing, the spine also supports the head, which it can
do very conveniently, from the horizontal direction of the con-
dyles and their nearly central position on the occiput, and from
the head being almost in equilibrium when we stand erect. The
volume of the head is so much greater before the condyles than
behind them, that upon a superficial view one would suppose its
preponderance in front to be very considerable. This is, how-
ever, less than it might seem to be, for two reasons: one is, that
the diameters of the head are augmented behind the condyles,
and, secondly, it is formed of solid matter; whereas, in front
a great deal of it is hollow, for the construction of the nose and
VERTEBRAL COLUMN. 91
the sinuses bordering upon it. The head, though nearly ba-
lanced, has some preponderance in front, which is manifested
by its falling forwards whenever we sleep in the erect position,
or when the sudden suspension of life destroys the contraction
of the muscles on the back of the neck.
In the lower orders of animals, the obliquity of the condyles,
their situation at one end of the head, and the great length of
the face, acting as a weight upon a long lever, have a continual
tendency to incline the head downwards ; which is only par-
tially counteracted by the largeness of the muscles and liga-
ments on the back of the neck.
The horizontal direction of the condyles, and their location
near the centre of the base of the head, have arrested the atten-
tion of naturalists, and established for man characters distin-
guishing him, from all other animals, for facility in maintaining
the erect attitude. Bichat happily observes, that from this con-
formation result the following peculiarities in his organization :
1. Less strength in the muscles of the neck than in quadrupeds;
2. Less projection in the occipital bone, where the muscles are
inserted ; and, 3. An imperfect development of the ligamentum
nuchae.
The thoracic and abdominal viscera, by being placed in front
of the spine, and having no counterpoise behind, have a conti-
nued tendency to bend it. This is only resisted by the mus-
cles which fill up the long gutter on either side of the spinous
processes, and are inserted into the ribs, the spinous and the
transverse processes. The lumbar vertebrae and the appertain-
ing muscles and ligaments, having an increased duty to per-
form, from the lowness of their position, and the variety of their
movements, become the soonest affecteM by fatigue and bodily
weakness; and therefore manifest sooner the' sensation of las-
situde, notwithstanding the augmented volume of the bodies
and processes of the vertebra), and of the muscular masses in-
serted into them.
The mechanical arrangement of the spine permits it to per-
form the motions of flexion, extension, lateral bending, circum-
duction, and rotation.
1. Flexion, or that posture in which the spine is bent for-
wards, is the most extensive of its movements : the general me-
92 SKELETON.
chanism of the human body disposes us to approach surround-
ing objects in that direction; and the musdes of the abdomen,
besides their intrinsic strength, act most advantageously in pro-
ducing it, by being removed to a great distance from the centre
or line of motion. In this position the inter-vertebral carti-
lages are diminished or compressed in front, and thickened be-
hind, the anterior vertebral ligament is in a state of relaxation,
while the posterior vertebral ligament and those which connect
the spinous processes are in a state of proportionate tension.
2. The motion of extension, on the contrary, is much more
limited from several causes. The muscles which act in this
case, by arising either from the posterior face of the pelvis, or
from the transverse processes, and going upwards to be insert-
ed either into the ribs, the transverse or the spinous processes,
are much less advantageously placed than the abdominal mus-
cles, in regard to the length of the lever which they employ.
Moreover, mechanical obstruction is opposed to this motion by
the spinous processes of the back and neck, being very near to,
and overlapping each other. The abdominal muscles also af-
ford a strong resistance to its being carried beyond a certain
point as any one may assure himself of, by the tension commu-
nicated to these muscles from placing a large billet of wood un-
der the loins of a subject; and, when they are cut through tran-
versely, the immediate consequence is, a great increase in the
posterior flexion of the spine, through the agency of the lower
dorsal and the lumbar vertebras. The anterior vertebral and
the inter-vertebral ligaments, likewise, oppose the extension of
the spine, much more than the elastic and the inter-spinous li-
gaments do its flexion.*
3. The lateral inclination of the spine is a motion of consi-
derable extent, and is obtained both by the very advantageous
position of the muscles on the side of the trunk and neck, and
by the little mechanical resistance to it from the shape and ar-
rangement of the parts concerned. A principal impediment to
this motion being carried beyond a* certain point, is presented
by the ribs striking against each other. The transverse pro-
cesses of all the vertebrae are so far apart, particularly in the
loins, that they scarcely deserve to enter into the estimate of
VERTEBRAL COLUMN. 93
resistances. As the muscles of the one side produce the late-
ral curvature, so their resistance on the other limit it to a cer-
tain extent, as may be readily ascertained by cutting them
through.
4. The circumduction of the spine is that motion in which
the trunk is caused to describe a cone, the base of which is
above, and the apex below. It is performed on the lower dor-
sal and the lumbar vertebrae, and is a succession of the move-
ments already described.
5. The rotation of the spine is a very limited motion. It is
performed almost entirely on the lower dorsal and the upper
lumbar vertebrae, and presents in its analysis a series of minute
and oblique slidings of the body of one vertebra upon another,
the pivot being the oblique processes. The action occurs by
the lateral yielding of the inter-vertebral substance; it must,
therefore, be almost inconceivably small in any individual sub-
stance, particularly when the latter has been hardened and ren-
dered more fibrous by old age. In the very young subject it
is more appreciable.
Of the Motions peculiar to each Class of Vertebra.
1. The cervical vertebrae, as a whole, enjoy a considerable
share of flexion, extension, lateral inclination: and of circumduc-
tion, as the result of the other motions. Their rotation, or the
oblique sliding of one vertebra upon the other, is very limited.
The apparent facility with which they are twisted upon each
other, when the face is turned to the shoulders alternately, is
almost wholly the motion of the first vertebra upon the second,
the participation of the other vertebrae being very inconsidera-
ble. The possibility of the dislocation of these vertebrae, with
the exception of the first, is very stoutly denied by authorities
of the first standing in anatomy, on the score that too great a
resistance to this accident is afforded by the inter-vertebral and
yellow ligaments, by the inter-spinal and inter- transverse mus-
cles, by the inter-locking of the bodies of the vertebrae through
their reciprocal concavities and convexities, and by the shape
and extent of their oblique processes.
94 SKELETON.
Some years ago, I met with a case in which there was every
reason to believe that a partial displacement or dislocation had
occurred about the fourth vertebra, in a boy of eight or ten years.
It rose from his struggling to extricate himself from the grasp
of a school-mate, who held him near the ground by the back of
the head, with the spine bent forwards. This position, it is
evident, was calculated to lift the oblique processes of the verte-
brae over each other; and an oblique force applied at the same time
consummated the accident, by twirling the lower oblique process
over the upper margin, and in front of the one with which it
was articulated below. The displacement was manifested by
inability to move the neck; by a permanent inclination and turn
of the head to the side opposed to the injured one; and by an
inequality in the range of the anterior points of the transverse
processes of the side affected. I succeeded in replacing the bone
by lifting its dislocated side over the lower oblique process,
communicating at the same moment a rotatory motion, the re-
verse of that by which the accident had happened. In an in-
stant, the patient was relieved; from extreme pain, fixed defor-
mity, and inability to move the neck, he performed with freedom
all the motions natural to the part.
The principal motions of the head upon the first vertebra are
those of flexion and extension: the power of the condyles to
slide horizontally from one side to the other in the cavities
formed in the atlas, is excessively restricted, both by the shape
of the proximate articular surfaces, and by the arrangement of
the ligaments: this motion is, in fact, so inconsiderable as scarce-
ly to deserve notice. Even flexion and extension appear greater
than they actually are, in consequence of the lower vertebrae
most commonly concurring in these motions. When simply
the head is flexed upon the atlas, while the other vertebrae are
kept erect, the chin approaches the sternum, and the skin of the
neck is thrown into folds; but when all the bones are flexed,
the head is thrown forwards and the skin is kept tense. The
flexion of the head upon the atlas is restricted by the ligamen-
tum nuchae, and by the ligament passing from the posterior
margin of the occipital foramen to the posterior bridge of the
atlas. The extension of the head is restricted by the vertical,
moderator, and anterior vertebral ligaments.
The motion of the atlas upon the axis is limited strictly to
VERTEBRAL COLUMN. 95
rotation. The confinement of the processus dentatus by the
transverse ligament behind, and by the anterior bridge of the
first vertebra in front, prevents thoroughly both flexion and ex-
tension. The horizontal direction and the flatness of the cor-
responding articular faces of these two vertebrae, also prevent
any lateral inclination. In compensation for these restrictions,
the rotatory motion is enjoyed to great extent, and is amply
provided for, by the extreme looseness and thinness of the cap-
sular ligament of the oblique processes. In this motion the arch
of the atlas and the transverse ligament rotate on the tooth-like
process to the right and left alternately; at the same time the
inferior oblique process of the atlas is slid either forwards or
backwards, according to the general movement upon the upper
oblique process of the dentata. This movement is checked, at
a certain point, by the moderator ligaments, which, by the close
connexion of the head and first vertebra, answer the same pur-
pose as if they were inserted into the latter. It is also checked
by the capsular ligament, notwithstanding the general laxity of
the latter. But still it is not difficult for it to exceed its natu-
ral bounds, and for the oblique process of the atlas to pass com-
pletely beyond the margin of that of the dentata, and in return-
ing to lock against it. This, in fact, happens, in the great majo-
rity of instances, where violence from falls, and so on, has been
applied to the body, and results in injury to the neck, particularly;
and when, in the abrupt turning of the head, produced by the
action of the muscles, the individual finds himself incapable of
bringing it back. This articulation is, unquestionably, less pro-
tected, and more exposed to accident, than any other in the
spine; and, as just stated, is therefore supposed, by some, to be
the only one in the neck admitting of luxation.
Most frequently, in this luxation, when it is produced by ex-
ternal violence, death is the immediate result, from the spinal
marrow being pressed upon and disorganized above the origin
of the phrenic nerve. The seat of the principle of respiration
is in the medulla oblongata, and its agents are the phrenic and
the intercostal nerves; the communication with which being
thus cut off, respiration, and consequently circulation, stop im-
mediately. Bichat thinks, that, when death is thus suddenly
produced, the processus dentatus, by rupturing its own ligaments
connecting it to the occiput, slides by the falling of the head
96 SKELETON.
forwards, beneath the transverse ligament, and presses upon the
spinal marrow. On the contrary, when it is a simple displace-
ment of the oblique processes, as the odontoid process remains
within its boundaries, and its ligaments are only stretched, there
is no danger of death. Fatal accidents have happened to this
articulation, by holding an infant from the ground, by the two
hands applied to the head, from his struggles to disengage him-
self. A posture-maker is said to have died on the spot, from
communicating a rotatory motion to his trunk, while its weight
was sustained by inverting his head, and making the latter the
base of support. When the vertebras are displaced in such per-
sons, as well as in those hung by the neck, it is supposed that
this sliding of the processus dentatus from beneath the trans-
verse ligament takes place; as, by experiments on the dead
body, it is found that such displacement occurs much more rea-
dily than the rupture of the transverse ligament.
2. The dorsal vertebrae are capable of but very little motion
in any direction. The rigidity and length of the sternum pre-
vent them from flexion, the overlapping and obliquity of their
spinous processes prevent them from extension, and the ribs pre-
vent them from lateral inclinations. It is, however, to be ob-
served, that as those obstacles are diminished, successively, in
the five lower dorsal vertebrae, consequently they become more
and more capable of motion upon each other. Luxation among
them, at any point, is thought to be impossible, from the strength
of their ligamentous attachments, and from the arrangement of
their articular faces.
3. The lumbar vertebrae move with great comparative free-
dom upon one another; admitting, as stated, of flexion, exten-
sion, and lateral inclination. Below, however, they are much
more restrained than they are above; hence, it results, that the
principal seat of the motions of the trunk upon the spine, is
about the connexion of the lumbar and dorsal vertebrae. Dis-
location is here, also, thought to be impossible, from the
strength of their ligamentous attachments, from the great dia-
meters of their bodies, and from the deep interlocking of the
oblique processes.
OSSA INNOMINATA. 97
SECT. IV. - OF THE OSSA INNOMINATA.
(Os Cozauz, ou des Isles.)— These bones, two in number, are
situated one at either side of the sacrum, and constitute the la-
teral and anterior parietes of the pelvis; forming, along with the
sacrum and coccyx, the whole of this latter cavity.
The os innominatum, from having been, in its original state,
in three pieces, notwithstanding they subsequently coalesce firm-
ly in the adult, and preserve scarcely any vestige of their pri-
mitive distinction, is divided by anatomists into ilium, ischium,
and pubes.
Os lliumj (Ilion.) — This, the largest of the three portions,
forms all the upper rounded part of the os innominatum, and is
the haunch bone of common language. Its superior margin is
a semicircle, rather thicker towards the extremities than in the
middle. The inequality, when viewed from above, is very ap-
parent, as well as a slight curvature resembling the letter S.
This margin of the bone is called its crest or spine, presents an
internal lip for the origin of the transversalis abdominis muscle,
an external one for the insertion of the obliquus externus, and
an intermediate edge for the origin of the obliquus internus.
The anterior extremity of the spine is terminated by a project-
ing point, called the anterior superior spinous process, from
which arise the tensor vaginas femoris, the sartorius, and the
beginning of Poupart's ligament. The posterior extremity of
the crest is also projecting and pointed, but less so than the
other, and obtains the appellation of the posterior superior spi-
nous process.
The anterior margin of the os ilium is unequal, and divided
into two portions, of nearly the same length, by a strong, well-
marked projection, the anterior inferior spinous process, which
is placed an inch and a half below the anterior superior, and
gives origin to the rectus femoris. This margin joins with the
pubes by a large flattened elevation, called the ilio pectineal pro-
tuberance. Between the latter and the anterior inferior spinous
process, a concavity exists which is occupied by the junction of
the psoas magnus and iliacus internus muscles, where they pass
under Poupart's ligament. Between the two anterior spinous
VOL. L— 9
98 SKELETON.
processes is another concavity, from which the anterior edge of
the gluteus medius arises.
The posterior margin of the ilium is also very unequal, both
in its direction and thickness. The posterior inferior spinous
process is about sixteen lines below the posterior superior, and
terminates a cutting edge running between these two processes.
Just below it we find the d*eep excavation called the sciatic
notch, through which pass out the pyriform muscle, the sciatic
nerve, and several blood vessels.
The exterior face of the ilium, called its dorsum, is generally
convex and rounded; its margins, however, are so elevated, that
partial depressions, or sinkings below the general surface, may
be remarked, especially at its back part. Just above the two
posterior spinous processes, a flatness is observable, from which
a part of the gluteus magnus arises. A semicircular rough
ridge begins at or near the anterior superior spinous process,
and may be traced on this surface of the bone to the sciatic
notch. All that portion of the dorsum between this ridge and
the spine, with the exception of the little flat surface just above
the posterior spinous processes, gives origin to the gluteus me-
dius. The dorsum terminates below at the acetabulum, and be-
tween the latter and the semicircular ridge is the surface for the
origin of the gluteus minimus.
The internal face of the ilium, or that which looks towards
the belly, is called its costa or venter. Its superior part, amount-
ing to about two-thirds of the whole surface, is very concave,
and is the iliac fossa, which is occupied by the iliacus internus
muscle. The fossa is continued forwards into the hollow below
the anterior inferior spinous process, and over the acetabulum.
The iliac fossa is terminated below by a rounded ridge, a part of
the linea ilio-pectinea that separates the greater from the lesser
pelvis. The remaining third of the costa of the ilium is very
rough and unequal, and is appropriated to the articulation with
the sacrum, and to the origin of some of the muscles of the back.
Immediately posterior to the sciatic notch is the surface for the
sacrum, which is somewhat triangular, but irregularly so, and
extends from the iliac fossa to the posterior inferior spinous
process. Behind the sacral surface is another, twice as large,
strongly marked by its roughness, and elevated into a vertical
ridge at its middle. Anterior to this ridge arise many of the
OSSA INNOMINATA. 99
ligamentous fibres, fastening the ilium to the sacrum; but pos-
terior to it is the surface of origin to the multifidus spinae, and
the sacro-lumbalis muscles.
Os Pubis, (Pubis.) — This bone constitutes the fore part of
the innominatum, and is much the smallest of the three. It is
composed by a body and two large branches from it, one run-
ning downwards to join the ischium, and the other backwards
and upwards to join the ilium.
The body of the pubes is joined to its fellow on the opposite
side by a flat surface, called the symphysis, which is eighteen
or twenty lines in its long diameter. The superior part of the
body also presents a flat surface, called its horizontal portion,
which is bounded outwardly by the spinous process about an
inch from the symphysis. The horizontal portion and the sym-
physis form a right angle. From the exterior face of the spine
two ridges proceed outwardly; the posterior is the crista; it is
sharp, elevated, and makes the anterior half of the linea ilio-
pectinea; the anterior ridge is lower down, increases in its
elevation as it goes along, is rounded, and runs nearly horizon-
tally to terminate in the anterior upper margin of the acetabu-
lum. Between the two ridges is a superficial triangular con-
cavity occupied by the origin of the pectineus muscle; the base
of the triangle is bounded by the protuberance formed at the
junction of the pubes and ilium, and it is exactly over this
part that the femoral vessels pass; its apex is the spine or spi-
nous process of the pubes. The extremity of the upper branch
of the pubes is triangular, and much enlarged where it contri-
butes to the acetabulum.
The inferior branch of the pubes, technically called its
ramus, is a flattened process about an inch in length, and, as
mentioned, descends to join the ischium. Its exterior is plain,
and has no mark deserving of attention ; but the internal face,
near the anterior margin, is concave for attaching the crus of
the penis or of the clitoris.
The body of the pubes in front is concave, and gives origin
to the adductor longus and brevis muscles; behind, it is only
sufficiently concave to participate in the general concavity of
the pelvis.
100 SKELETON.
Os Ischium, (Ischion.) — This bone forms the posterior infe-
rior portion of the os innominatum, and is the next in size to
the ilium. It is of a triangular form, and has the anterior
extremity bent upwards to join with the pubes. The latter
part is its crus or rarnus, and the remainder is its body.
The body of the ischium is a triangular pyramid, the inter-
nal side of which is smooth and uniform, but the posterior and
the external sides are very unequal. The internal side is broad
above and narrow below ; at the middle of its posterior margin
is the spinous process, a projection of considerable magnitude,
and sharp-pointed, for attaching the lesser sacro-sciatic liga-
ment. Immediately below the spinous process is a smooth
concave surface, forming a trochlea, over which the obturator
interims muscle plays. Below this trochlea, and forming the
most inferior internal margin of the bone, is a long ridge,
somewhat more elevated behind than in front, into which the
great sacro-sciatic ligament is inserted. The internal face of
the ischium, though technically called its plane, departs from
the perfect regularity implied in that name, by participating in
the general concavity of the pelvis.
The posterior face of the ischium is swollen out, above, into
a rounded surface, for the strengthening the posterior parietes
of the acetabulum. This swell is bounded, below, by a trans-
verse depression or fossa; immediately below which, is the
tuberosity of the ischium, a large rough surface extending
from the fossa to the beginning of the crus. This rough sur-
face is subdivided into four, two above, and two below. The
one above, which is external, and nearest to the acetabulum,
gives origin to the semi-membranosus muscle; the other,
which is internal, gives origin to the semi-tendinosus, and to
the long head of the biceps flexor cruris. Of the two flat sur-
faces below, the one which borders on the ridge for the inser-
tion of the great sacro-sciatic ligament, is the part on which
we sit, and the last surface, which is exterior again to this,
gives origin to a part of the adductor magnus muscle.
The exterior face of the ischium, above, forms the lower part
of the acetabulum, and is, therefore, very much excavated;
below this the surface is flat, and sufficiently uniform to dis-
pense with a particular description.
The crus of the ischium is flattened internally and externally,
OSS A 1NNOMINATA. 101
and in the adult it is fused completely into the crus of the
pubes, so that very faint marks of their primitive separation
are left. The anterior margin of the crus has, for the origin
of the crus penis and the erector penis muscle, an excavation
continuous with that on the crus of the pubes.
In examining the general features of the os innominatum, it
will be observed, that its outline is in some degree like the
figure 8; the narrowing in its centre being produced by the
sciatic notch below, and by the deep concavity above, between
the anterior superior spinous process and the symphysis of the
pubes. The regularly rounded margin of the ilium above, and
of the ischium below, contribute to the resemblance, but the
angle of the pu-bes interrupts it. The narrowest part of the
bone, or its neck, is between the top of the sciatic notch and
the fossa below the anterior inferior spinous process. It will
also be remarked, that the posterior margin of the sciatic notch
is formed by the ilium, and the anterior by the ischium.
The acetabulurn, or the cotyloid cavity, (camli cotyloide,) is
placed immediately on the outside of the neck of the os inno-
minatum. In infancy one-fifth of it is seen to be made by the
pubes, two-fifths by the ilium, and two-fifths by the ischium.
It is a very deep hemispherical depression, having a sharp ele-
vated margin all around, particularly at its superior part.
The inferior margin, amounting to one-eighth of the whole
circumference, is comparatively shallow, and is, indeed, con-
verted into a notch, sunk much below the general surface of
the brim. The greater part of the acctabulum is smooth, and
incrusted with cartilage wherever the head of the os femoris
is applied to the support of the trunk; but the very bottom,
with the intervening surface continuous with the notch,
amounting to rather more than one-fourth of the whole cavity,
is rough, sunk below the general concavity, and is occupied
by a soft vascular fat.
In the fore part of the innominatum a large deficiency, called
the thyroid foramen, (foramen thyroideum,) exists between the
pubes and ischium. In the male subject it is triangular, with
the angles rounded ; but in the female it is rather oval. Lead-
ing from the plane of the ischium is a groove, which goes
along the superior end of the foramen, and appears externally
9*
102 SKELETON.
under the anterior ridge of the pubes. It conducts the obtura-
tor vessels and nerve to the inner side of the thigh.
The texture of the os innominatum is cellular internally,
with a condensed lamella externally. It is of very various
thickness. The ilium, in its centre, has the external and
internal sides so near one another, that in most adults the light
will shine through it. A large foramen is seen on the venter
of the ilium, and another on its dorsum, for the transmission of
nutritious arteries. There are several others, smaller, at va-
rious points of the os innominatum, for the same purpose, and
for the adhesion of ligamentous fibres.
SECT. V. — OF THE PELVIS, GENERALLY.
The sacrum and coccyx behind, and the ossa innominata at
the sides and in front, constitute, as observed, the whole cavity
called pelvis, (bassin.) Its position is such, that, in the adult,
it divides the entire length of the body into two parts nearly
equal, the head and trunk forming one part, and the lower ex-
tremities the other. Generally, the former are somewhat the
longest ; but in cases of unusual corporeal stature, the excess
depends upon an undue length of the inferior extremities. On
the contrary, in persons of little height, the latter have not been
developed in proportion to the trunk of the body.
The pelvis, as a whole, is a conoidal cavity, having its base
upwards, and the summit below. Its internal surface forms an
irregular floor, on which the viscera of the abdomen are sus-
tained in the erect position; and its external surface, by pro-
jecting considerably at various places, establishes very favour-
able points for the origin of muscles.
The internal surface of the pelvis is divided by the projection
of the anterior margin of the base of the sacrum, and by the li-
nea ilio-pectinea, into two cavities; the upper one is the great
pelvis, and the lower one, the little pelvis. The great pelvis is
the base of the cone, and presents at its anterior part a large de-
ficiency, which is supplied in the fresh subject by the abdominal
muscles. The little pelvis is a complete bony canal, much
deeper behind and at the sides, than in front. Its depth, behind,
is formed by the whole length of the sacrum and coccyx ; at the
THE PELVIS. 103
sides, by the bodies of the ischia and a small part of the ilia ;
and, in front, only by the length of the bodies of the pubes.
The upper orifice of the lesser pelvis is called its superior
strait: it is somewhat oval, and looks obliquely forwards and
upwards. Its axis may be indicated by a line drawn from the
extremity of the coccyx to a point an inch, or thereabouts, be-
low the umbilicus. The inferior orifice of the lesser pelvis is
called the inferior strait. Its margins in the naked skeleton are
very unequal, for it presents three very deep notches, two late-
rally, and one in front. The first are formed by the external
margins of the sacrum and coccyx, contributing to deepen the
sciatic notch, which already is formed in each os innominatum-
The third one is formed by the convergence of the rami of
the pubes and ischia of the opposite sides, and constitutes the
arch of the pelvis of authors, sometimes called the arch of the
pubes. The axis of the lower strait, it is clear, must have
a very different direction from the axis of the superior, and
is indicated by a line drawn from the lower part of the first
bone of the sacrum, through the centre of this opening. The
cavity of the lesser pelvis is increased considerably behind, by
the curvature of the sacrum; this, however, is not uniform, as
the sacrum is much more curved, as well as longer in some indi-
viduals than in others. The planes of the ischia are not paral-
lel with one another, but converge slightly from above, in con-
sequence of which the transverse diameter of the lower strait is
rather smaller than the transverse diameter of the superior strait.
Difference of the Pelvis in the Male and Female.
There are several well marked peculiarities in the fully de-
veloped pelvis of either sex.
The ossa ilia are larger, less concave, and more horizontal in
the female. The superior strait is also larger, and more round:
its transverse diameter always exceeds the antero-posterior;
whereas, the latter, in the male, frequently is found the longest.
The lesser pelvis is also more capacious in women. The crura
of the pubes and ischia, are not so long as in men; but they di-
verge more, and join at the under part of the symphysis pubis
by a large, regularly rounded arch; whereas, in men, the arch
as it is called, is merely an acute angle.
104 SKELETON.
The os sacrum in women is shorter, more concave, and is
also broader in proportion to its length. The spaces, vertically,
between its foramina in front are very small, forming a sort of
ridges, which give to the bone the appearance of having been
compressed in its length.
The distance between the upper and lower straits, or in other
words, the depth of the small pelvis in women, is not so great
as in men: this arises from the comparative shortness in the
length of the pubes, of the ischia, and of the sacrum, as just
mentioned. The cartilaginous joining of the pubes is thicker
in women. The diameters of the inferior strait, like those of
the superior, are longer in females.
Accoucheurs have attached much importance to the direction
and length of the diameters of the small pelvis in well formed
women. At an average they are as follow. The superior strait
presents three diameters: The first or antero-posterior extends
from the upper extremity of the symphysis pubis, to the mid-
dle of the projection of the sacrum at its superior margin, and
measures four inches : The second diameter, or the transverse,
crosses the first at right angles, and extends from the middle of
one side of the strait to the corresponding point on the other;
it measures five inches: The oblique diameter extends from
the sacro-iliac junction of one side to the linea ilio-pectiniaover
the acetabulum of the other, and measures four inches and a
half, sometimes more.*
At the inferior strait, the antero-posterior diameter is from
the lower part of the symphysis pubis to the lower end of the
sacrum, and measures five inches.! As the coccyx, in child-
bearing women, is moveable, its projection forwards is not
taken into the account, because it recedes by the pressure of
the child's head, and does not resist its passage: in some cases,
however, it is unfortunately fused into the sacrum, and there-
fore perfectly rigid, which will diminish this diameter at least
an inch. The transverse diameter of the inferior strait is
drawn from the middle of the internal margin of the tuberosity
of one ischium, to the corresponding point on the other, and
measures four inches.
* See Dewees' System of Midwifery, 7th edition, 1835, p. 28,
t Dr. Dewees says four. Loc. cit.
THE PELVIS. 105
The depth of the little pelvis, in the female, at the symphysis
pubis, is an inch and a half; at the posterior part four inches,
or five if we include the coccyx ; and at the side three inches
and a half. There are many other details connected with the
measurements of the pelvis, which are mentioned by systematic
writers on midwifery.
SECT. VI. DEVELOPMENT OF THE PELVIS.
Three points of ossification are observable in the os innomi-
natum of the early foetus : one is at the superior part of the
ilium, another is at the tuberosity of the ischium, and the third
is at the angle of the pubes. The radii of ossification from
these centres, have extended themselves considerably at birth,
so as to sketch out the forms of the bones to which they re-
spectively belong. But these bones are separated from one
another by cartilage, and do not coalesce till years afterwards.
The union or fusion of the ilium and pubes then occurs at the
ilio-pectineal eminence, over the acetabulum, and partly in this
cavity; the ilium and ischium join in the acetabulum princi-
pally, and the ischium and pubes unite by their respective
erura at the middle of the internal side of the foramen ovale.
All the points of the os innominatum, most remote from the
primitive centres of ossification, are cartilaginous at birth: as,
for example, the crest, the spinous processes, the tuberosity,
and even the component parts of the acetabulum. The latter
cavity has then a triangular shape, and from its very flexible
and yielding condition, is incapable of affording a strong point
of support to the trunk in the erect position.
At birth, the middle parts of the os sacrum, which are em-
ployed in protecting the spinal marrow, are more advanced in
their ossification than its lateral parts. The five pieces which
compose it, are, like the bodies of the true vertebrae, of a
rounded shape. The processes behind are cartilaginous. The
coccyx is extremely small, and scarcely presents any ossifica-
tion whatever.
The pelvis of the foetus, at birth, is smaller in proportion than
the superior portions of the trunk; this is one of the reasons
why the abdomen is so projecting. The lesser pelvis is so
106
SKELETON.
small and shallow, that the bladder, even in the undistended
state, cannot be accommodated by it, but is contained princi-
pally by the abdomen. Its transverse diameter is much short-
er than the others. The superior strait faces much more
forwards than in the adult.
SECT. VII. ON THE MECHANISM OF THE PELVIS.
The pelvis has an important part in the several actions of
standing and of locomotion; besides its usefulness in giving a
support to the viscera of the abdomen, and in having attached
to, and contained within it, the organs of generation.
In standing, the pelvis is impelled by two opposing forces, in
consequence of the attachment of the vertebral column at its
hind part, and of the ossa femorum at its anterior lateral parts.
The weight of the head and of the upper parts of the body,
falling upon the sacrum, acts upon a lever, which is represent-
ed by the distance between the acetabula and the sacro-iliac
junction, and has a tendency to depress the posterior part of
the pelvis, by rotating it upon the heads of the thigh bones.
This movement is obviated by the iliacus internus, psoas mag-
nus, and some other muscles, which keep the front of the pelvis
from rising up. It is also prevented by the principal weight
of the trunk being in front of the spine, and therefore inclining
forwards, so that the centre of gravity, in the erect position,
gives a continual tendency to fall forwards instead of back-
wards.
The wedge-like shape of the sacrum is highly favourable to
the erect position: from having it's base upwards, whenever
the weight of the trunk is thrown upon it, it is driven down
between the ossa innominata, and has the tightness of its arti-
cular connexion, therefore, muc«h increased by the position
which it is intended to sustain. In illustration of the. usefulness
of the triangular or wedge-like shape of the sacrum, it may be
observed, that it is much less so in animals which are intended
to go upon all fours than in the human subject.
The articulation of the several bones of the pelvis with each
other, is so close as not to admit of any motion between them,
with the exception of the os coccygis, and of the relaxation
THE THORAX. 107
peculiar to pregnancy. The pelvis, however, has upon the
spine, flexion, extension, lateral inclination, and rotation ; the
latter being performed by a series of very slight twists of the
lumbar vertebra upon each other. Like all other motions, it
is much extended by habit in early life. Of this I have seen
an instance, in an adult Indian, who, from infancy, had been
deprived entirely of the use of the lower extremities; but who,
by being seated in a large wooden bowl, with a round bottom,
and having his legs drawn up in a squatting position, could, by
alternate twists of the spine, with the assistance of a short staff
in each hand, move with surprising speed over a plain surface.
SECT. VIII. — OF THE THORAX.
The thorax is the upper part of the trunk, and is formed by
the dorsal vertebra? behind, by the sternum in front, and by the
ribs with their cartilages at the intermediate spaces. It is of
a conoidal figure, flattened in front, somewhat concave behind,
and semi-cylindrical on the sides. The interior circumference
corresponds with the exterior, with the exception of the poste-
rior part, where, owing to the projection of the column of dor-
sal vertebra?, a partial septum exists which has a tendency to
divide it into two chambers. The superior part of the cone,
or its summit, is much smaller than the inferior part or the
base, and presents a very oblique cordiform foramen, much
lower in front than behind, owing to the superior margin of the
sternum being lower than the first dorsal vertebra. The base
of the thorax is a very large opening: its lateral and posterior
margins, formed by the ribs and their cartilages, present a
convexity downwards; but, in front, where the latter run up to
join the sternum, a large notch is formed between the carti-
lages of the opposite sides, into the apex of which notch the
third bone of the sternum projects.
Of the Ribs.
The ribs, costae, (cotes,) are twenty-four in number, twelve
on either side. Of the latter, the upper seven, in consequence
108 SKELETON.
of their cartilages joining the sternum, are called the sternal
or true ribs, and the lower five, from their cartilages stopping
short of the sternum, are called the false or asternal ribs.
Cases are recorded by several anatomists of there being eleven
or thirteen ribs on a side : the latter I have seen several times,
and the former but once or twice. In such cases, the dorsal
vertebrae correspond in number with the ribs. In the instances
of redundance which have come under my notice, the last rib
looked like a transverse process of unusual length, belonging to
a lumbar vertebra. The superabundant vertebra constituted
the thirteenth dorsal ; but was formed like the first lumbar as
it commonly exists, arid the last lumbar vertebra was entirely
anomalous in its shape, being intermediate in form to a lumbar
vertebra, and to the first bone of the sacrum.
All of the ribs are so placed, that they run very obliquely
downwards and forwards from their posterior extremities.
This obliquity becomes the more striking as the ribs increase
successively in length. The first rib, for example, articulating
by its posterior extremity with the first vertebra of the back,
has its anterior extremity nearly on a horizontal line with the
lower part of the third dorsal vertebra. The seventh rib has
its anterior extremity on a horizontal line with the lower mar-
gin of the last dorsal vertebra, notwithstanding its posterior
extremity articulates with the seventh vertebra. The same
sort of comparison might be usefully instituted in regard to all
the ribs, in which case the rule will be found closely applicable,
with the slight exception of the two or three last ribs. The
ribs are nearly parallel to each other in this obliquity, allowance
being made for the effect which the obliquity of the sternum
has in causing a greater separation of their anterior extremities
from each other, than exists at their posterior extremities.
Common points of resemblance between the Ribs. — Each rib
is paraboloid ; presents an external and an internal surface ; an
upper and a lower margin; a sternal and a vertebral extre-
mity.
The external surface of each rib is convex, while its internal
surface is concave. The former presents, not far from the ver-
tebral extremity, an oblique ridge, occasioned by the insertion
of the sacro-lumbalis muscle. It is precisely at this line that a
THE THORAX. 109
curvature somewhat abrupt, takes place, which is the angle of
the rib. Between the angle and the transverse process of the
vertebra, each rib is rather more narrow and cylindrical than it
is in advance of the angle. The superior margin of the rib is
rounded and somewhat rough, for the insertion of the intercostal
muscles, while the inferior margin is brought to a thin, cutting
edge. Just within, and above 'the latter, is a fossa beginning
somewhat nearer to the spine than the angle of the rib, and
ceasing about one-third of the whole length of the rib, short of
its anterior extremity. It contains the intercostal vessels and
nerve. From the upper margin of this fossa arises the internal
intercostal muscle, and from the lower the external.
The anterior extremities of the ribs are thin and flattened,
in the upper eight there is some increase in their breadth at
this point, and in all there is an oblong pit for receiving the end
of the corresponding cartilage. The vertebral extremity of the
rib is its head, and presents two flat articular surfaces, separated
by a ridge. This head is received into the inter-vertebral mat-
ter, and upon the articular faces of the adjoining margins of the
vertebrae. A small depression exists upon the posterior face of
the rib bordering on its head, for containing a little fatty mass.
About an inch beyond the head, at the posterior under surface
of the rib, is a tubercle, presenting a smooth articular face, for
connecting itself with the transverse process of the vertebra.
Just beyond this, but bordering on it, is a much smaller tuber-
cle, not unfrequently indistinct, for the insertion of the exter-
nal transverse ligament, and below it is a small pit for the lodge-
ment of fatty matter near the joint. The space between the
greater tubercle and the head of the rib is its neck, which is in
contact with the antero-superior face of the transverse process
of the vertebra, and has a sharp ridge on its upper margin, for the
insertion of the internal transverse ligament.
The most of the ribs have a very sensible twist in them, by
which their spinal extremity is directed upwards, and the ster-
nal extremity downwards; from which it results, that the whole
length of the rib cannot be brought into contact with a hori-
zontal plane.
Differences in Ribs. — Though there are many common points
VOL. I.— 10
110 SKELETON.
of resemblance among the ribs, yet there are, also, some well
marked peculiarities. The ribs increase successively in length
from the first to the seventh inclusively ; they then decrease :
the last is not only the smallest, but not unfrequently the shortest.
The angles of the ribs increase in their distance from the spine,
from the first to the last rib. The angle, however, of the first
rib, is not well marked, from its being so near the tubercle;
neither is the angle of the last, from its being so near the ante-
rior extremity. The oblique ridges constituting or marking
off the angles, are placed one above the other, in the same line.
This gives to the back of the thorax a triangular flatness, the
base of which is below. The projection backwards of the angles
of the ribs, along with that of the spinous processes of the ver-
tebrae, forms on each side of the latter the gutter, which is filled
up by the large muscles that keep the trunk erect. This gutter
is, of course, broader below.
The first rib is more circular than the others. Its head is
spherical, instead of presenting two articular surfaces. This
rib is flat above and below ; its margins are internal and exter-
nal. It has no groove for the intercostal vessels and nerve.
About the middle, the upper surface is marked by a superficial
oblique fossa, made by the subclavian artery ; in front of, and
behind which is a small rising, marking the insertion of the sea-
leni muscles. The second rib is considerably longer than the
first, and has its flat surfaces obliquely upwards and down-
wards, so as to round off that part of the thorax. The four in-
ferior ribs decrease at their anterior extremities, or become
somewhat tapering. The last two ribs do not articulate with
the transverse processes, and, consequently, have no corre-
sponding tubercles. As their heads articulate with the middle
of the bodies of their respective vertebrae, instead of with the
margins, they present only a single and somewhat convex sur-
face. The eleventh rib is marked only for a short distance in
its middle by the fossa, for the intercostal vessels. The twelfth
rib has no mark of the kind.
There is an augmentation in volume from the second to the
eighth rib, inclusively; afterwards they decrease. The angles
of the ribs are, successively, more and more obtuse.
The structure of the rib is spongy, covered with a lamella of
THE THORAX. ill
compact bone. The spongy structure predominates at the an-
terior extremity, for there the rib is comparatively soft.
Of the Sternum.
This bone constitutes the middle front part of the thorax,
and, owing to the obliquity of the ribs, has its superior end on
a horizontal line with the third vertebra of the back, while its
inferior extremity is on a horizontal line with the eleventh dor-
sal vertebra. It is also placed in a slanting direction, so that
the lower part recedes from the spine much farther than the
upper.
The sternum is oblong, somewhat curved, like a bow, so as
to be convex in front, and concave behind. It is divided, in
the adult, into three distinct pieces; an upper, middle, and
lower, which are held together by cartilage and by ligament ;
but not unfrequently in advanced life these pieces are all fused
into one, by bony union. The first and middle parts join where
the second rib is articulated, and the middle and lower where
the seventh rib articulates. At these points there is a well
marked transverse ridge, both anteriorly and posteriorly, and
between them on the front of the bone, there are other ridges
not so strong, indicating the original separation of the bone into
several other distinct pieces. The lateral margins of the ster-
num are somewhat elevated where the ribs articulate.
The upper end of the sternum is both thicker and broader
than the lower end. Where tke first and second parts join,
there is a narrowing of the two : the same occurs where the se-
cond and third pieces unite.
The first or upper bone of the sternum, has an irregular
square figure ; it projects somewhat above, and is slightly hol-
low below. It is scooped out at the superior margin, and pre-
sents a point at each end of the scoop. At the side of the lat-
ter is a concave and rounded surface, for articulating with the
clavicle ; just below which is a rough surface, for the cartilage of
the first rib. The bone diminishes much in breadth from this
point, and terminates by a narrow oblong face, joining it to the
second piece. At each side of this junction both pieces con-
tribute to a fossa for the cartilage of the second rib.
112 SKELETON.
The second bone of the sternum is longer and narrower than
the first. At its lower part it increases somewhat in breadth,
and then terminates by being rounded ofFon either side, so that
its margins converge towards each other. The sides of this
piece afford complete pits for the third, fourth, fifth, and sixth
ribs; the pit for the seventh is common to it and the third bone,
as the pit for the second rib is common to it and the first bone.
The sixth and seventh pits are in contact, the fifth is very near
the sixth, the fourth is about half an inch above the fifth. On
viewing the whole side of the -sternum, it will be observed that
the distances between the pits decrease, successively, from the
first to the last.
The third bone of the sternum, in the young adult, is fre-
quently in a great degree or wholly cartilaginous, hence, the
name of xyphoid cartilage (cartilago xyphoides or ensiformis)
has been applied to it. It is thin, varies remarkably in its
breadth in different individuals, and has the lower extremity
sometimes turned forwards and sometimes backwards, but most
frequently it is inclined or>ly slightly forwards. The base of
this piece presents a narrow oblong surface for articulating with
the second bone, at each end of which is the half fossa for the
seventh rib. The margins of the ensiform cartilage are thin,
and have the transverse muscles of the abdomen inserted into
them. Sometimes the lower extremity, instead of being point-
ed, is bifurcated.
The sternum is composed of a spongy texture, enveloped by
a thin layer of compact substance. Its strength depends, in a
great degree, on its ligamentous covering.
SECT. IX. OF THE CARTILAGES OF THE RIBS.
These are placed at the anterior extremities of all the ribs,
the seven superior of which they unite to the sternum by the
sychondrosis articulation. The length, breadth, and direction
of these cartilages are far from being uniform.
The first costal cartilage is short; the following ones increase
in length, successively, to the seventh, inclusively. The carti-
CARTILAGES OF THE RIBS. 113
lages of the false or abdominal decrease, successively, in length
from the eighth to the twelfth, inclusively; the last is a mere
tip to the end of the rib. The breadth of the first cartilage is
considerable near the sternum; the succeeding ones are not so
large at this point. With the exception of the first three, the
costal extremities of the cartilages are larger than the sternal;
and they become more rounded as they advance to the latter.
The cartilages, in point of magnitude, generally, will be found
in proportion to the size of the ribs with which they articulate.
The sixth and seventh are joined together, and are spread ouc
at their middle, which gives there an increase of breadth, and
permits them to touch, and sometimes to coalesce.
The first cartilage goes obliquely downwards in the direction
of the rib to which it belongs, in order to join the sternum.
The second and the third cartilages are nearly horizontal, but
inclining a little upwards in their progress; the fourth, fifth,
sixth, and seventh, pass, successively, more and more obliquely
upwards to the sternum, in consequence of the increasing length
of the ribs requiring them to traverse a longer space to reach
this bone. From the direction of tlae cartilages being oblique-
ly upwards, while that of the ribs is obliquely downwards, the
angle formed near the rib at the base of the c.irtilage, where the
latter begins first to turn upwards, is less obtuse in the lower
cartilages than in the upper. The obliquity of these cartilages
is also very manifest, by comparing them with the side of the
sternum: with it they form a very acute angle below, and a very
obtuse one above.
The cartilages of the false ribs, successively, decrease in
length, to terminate in front by small tapering extremities.
The first is united by ligaments, somewhat closely, to the last
true or sternal, and is occasionally sent forwards fully to the
sternum. The others are united more loosely, in such a way
that the anterior extremity of the one lies agains^ the inferior
margin of that which is above. The eleventh and twelfth car-
tilages are generally too short to touch the ones above, they
therefore are fixed principally by a connexion with the abdomi-
nal muscles. Their ribs are much more moveable than any
others, and have been called floating, from that cause.
There is some difference between the two extremities of the
cartilages; the posterior or costal is a small, convex, unequal
10*
114 SKELETON.
surface, very closely united to the anterior extremity of the cor-
responding rib. The other or sternal extremity in the sternal
cartilages, offers a smooth articular face, which is angular or
convex, according to the shape of the cavity in the sternum with
which it has to articulate. The three first ahsternal, and the
last sternal cartilage, make, to the lower part of the thorax, a
broad and well marked margin, convex in front and concave
behind.
The cartilages of the ribs are, in persons of middle age, white,
flexible, and very elastic. They are dissolved very slowly in
boiling water; by which they, if young, are reduced to gelatine,
otherwise their solubility is very imperfect. They have a
structure differing, in some respects, from other cartilages; when
dried, and exposed to the action of the atmosphere, they are^,
seen to consist of an immense number of small thin plates, placed
end to end, and separated by deep fissures. M. Herissant de-
scribes these plates as interlaced one with another, and forming
a kind of spiral, the regularity of which is interrupted by small
cartilaginous projections, uniting the plates to each other.*
These cartilages have a gres»t disposition to ossify, which is ma-
nifested in most individuals somewhat advanced in life. The
ossification begins in their centre, and advances to the circum-
ference, and is always preceded by a yellowish tinge. When
they are fully ossified, like the ribs, they are cellular within,
and compact externally, and are continuous with the ribs, there
being no interval: in such cases, the distinction from the ster-
num is generally kept up by the preservation of the joint, with
the exception of the first, which is fused into it. The complete
ossification of the first cartilage is not uncommon; the others,
though there is generally in old persons a considerable deposite
of bone in them, are seldom fully ossified. In neither case,
however, is it common to see such a perfect continuity of bone
between the rib and sternum, that the junction may not be dis-
solved at one point or another of this space by the action of
boiling water: at least, after very numerous observations on this
subject, I. do not remember to have met with a single instance
of it.
* Acad. des Sciences, an. 1748.
DEVELOPMENT OF THE THORAX. 115
SECT. X. — OF THE DEVELOPMENT OP THE THORAX.
In the foetus the shape of the thorax differs much from that
of the adult, in the greater comparative extent of its antero-pos-
terior diameter, and in the projection of the sternum. The state
of the thoracic viscera, at this period, calls for such an arrange-
ment; as the heart and thymus gland, which are in the middle,
have a considerable extent, whereas, the lungs are still collapsed
from the emptiness of their air cells. The ribs are but little
curved at their posterior parts, the angle being by no means
well formed, in consequence of which, the fossa on each side of
the bodies of the vertebrae, in the thorax, is not so deep; neither
is the fossa behind, on each side of the spinous processes, so
fully marked. The superior opening of the thorax is more
round from the increase of the antero-posterior diameter. The
inferior opening is extremely large, both from the elevation of
the sternum, and from the pressure of the abdominal viscera, of
which the liver, from its great extent, is a principal agent. The
vertical diameter of the thorax is %small, from the ribs, particu-
larly the lower ones, being pressed up one against the other, by
the diaphragm, acted on by the abdominal viscera.
The bones individually are in the following state at birth.
The ribs are almost completed, the heads, where they join the
spine, being in a state nearly as perfect as at any subsequent pe-
riod of life, and not by any means in the condition of a cartila-
ginous epiphysis, as is presented in the extremities of the cy-
lindrical bones generally. These bones, as Bichat very justly
observes, are destined to a function which commences imme-
diately upon birth, and which requires in them as much perfec-
tion then, as they have in the adult. For respiration is different
from locomotion, the latter requires a species of education, which
may be given gradually, whereas one respires from the begin-
ning as he will respire always. The sternum, which is less im-
mediately connected with breathing, and only contributes to
the general solidity of the thorax by completing its circumfe-
rence, is in a state almost cartilaginous, and presents only nuclei
of ossification in its several pieces.
At the instant of birth, a great change is produced in the di-
116 SKELETON.
mensions of the thorax. The lungs, from being in a collapsed
and solid state, suddenly suffer an expansion of their cells by
the introduction of air into them, and increase twice or three
times in magnitude. This is accomplished by the elevation
of the ribs, and the consequent increase in the transverse dia-
meter of the thorax: it becomes a condition that for ever after-
wards remains, so that the lungs, even upon death, continue to
have their air cells distended, and do not return to a perfectly
collapsed state. The action of the diaphragm is but small in
the earliest periods of life, owing to the size and pressure of the
abdominal viscera against it; respiration is then principally car-
ried on by the elevation and depression of the ribs, and by their
being rolled outwards, a motion which the flexibility of their
cartilages and the looseness of their articulating surfaces favour
very much.
At the age of puberty the thorax experiences a remarkable
augmentation. Its transverse diameter is sensibly increased,
and there is a general expansion of its volume, indicative of a
healthy and vigorous constitution. Should this not take place,
and the sternum be projected, it is supposed to mark a disposi-
tion to consumption. The enlargement of the thorax is un-
doubtedly also connected with a development of the organs of
generation at the same time. The exercise of the latter re-
quires greater vital powers than exist in early life, and the pro-
vision for it is manifested by the general increase of vigour and
firmness in the human frame; but it is not possible to point out
in what manner the sympathy exists, which, on the develop-
ment of the organs of generation, extends their influence to the
bony structure of the thorax.
SECT. XI. OF THE MECHANISM OF THE THORAX.
The thorax performs two very important offices in the ani-
mal machine: the first is to contain and protect the organs of
circulation and respiration, the second to assist in the function
of respiration, and perhaps that of circulation.*
The mechanism of the thorax is such that the solidity of its
* A very interesting paper, on this subject, lias lately been presented to the
French Institute by M . Barry.
MECHANISM OF THE THORAX. 117
materials, and its rounded shape, present a very efficacious de-
fence to its viscera from the influence of blows on its outside.
The effects of the latter are also materially diminished by the
thickness and contraction of the several large muscles which are
placed on its surface. On its back part the thick longitudinal
muscles of the spine, as well as those running to the superior
extremities, fill up the gutters on each side of the spinous pro-
cesses, and make a fleshy protuberance, divided into two by the
raphe which extends the length of the back over the spinous
processes. In front it is less protected, owing to the sternum
being immediately under the skin. Nevertheless, when blows
are inflicted on this part, their effects are much diminished by
the elasticity of the cartilages of the ribs, and by the direction,
obliquely downwards, of the ribs themselves; both of which
dispose the sternum to retreat backwards, and to yield to the
impelling force. The recession will take place more readily at
the moment of expiration; and when the muscles which elevate
the ribs are not on their guard. In those deliberate exertions
of the strength of the thorax, exhibited by individuals lying
down on their backs, and sustaining a heavy weight on the ster-
num, the ribs are saved from injury by different means. The
arched form, itself, of the front of the thorax, is of considerable
service in the resistance under such circumstances ; this, how-
ever, would be easily overcome, and the ribs would break, if
the arch were not sustained in its elevation by the contraction
of the large muscles on its sides ; as the serratus major, the pec-
toralis major and minor, each of which, by acting on the de-
pressed anterior extremities of the ribs and their cartilages, has
a tendency to keep them elevated. Fractures of the ribs, from
blows or force applied in front, are not so liable to occur in the
part stricken as in the point feeling the greatest momentum,
which from the semicircular form of the ribs is in or near their
middle : this exhibits a true example of what the French writers
call the contre-coup. Bichat says, that the fracture by contre-
coup is much more common when the individual being struck
unexpectedly, has not had time to throw his muscles into a state
of contraction, for the protection of the ribs.
The lateral convexity of the thorax being greater than that
in front or behind, and having the same assistance from the
muscles mentioned, presents a stronger resistance when blows
118 SKELETON.
are inflicted directly on it. Each rib represents an arch, the
summit of which is its centre, and the base its two extremities.
The abutments of the base are, the sternum at one end and the
spine at the other : a displacement from them is completely pre-
vented by the strength of the ligamentous attachments, as well
as by the form of the surfaces. Under these circumstances, as
fracture occurs preferably to dislocation, it is generally at the
point stricken.
The abdominal or false ribs, from their want of attachment
to the sternum, present a very different condition. Their an-
terior extremities, therefore, yield readily, and are driven in-
wards towards the abdomen.
The second function of the thorax, relating to its influence on
respiration, is executed by its dilating and contracting, whereby
the air is received into, and expelled from it. The spine is the
fixed point for the motions of the ribs in respiration. In the act
of dilatation, the capacity of the thorax is augmented in three
directions, vertically, transversely, and antero-posteriorly, or
from the sternum to the spine. The vertical augmentation is ac-
complished by the diaphragm ; and, as mentioned, is much great-
er proportionally in the adult than in the infant, from the greater
comparative size of the abdominal viscera in the latter. The
transverse augmentation is produced by the successive contrac-
tion of the intercostal muscles, which raise the ribs upwards.
The first rib is moved inconsiderably, in consequence of its short-
ness and of its continuity with the sternum. The attachment of
the scaleni muscles to its upper surface, serves rather to give a
fixation to it, and to prevent it from being drawn down by the
other ribs, than to produce by their contraction an elevation of
it. The first rib may, therefore, be considered as a fixed point.
The first intercostal muscles contracting from it, draw up the se-
cond rib, which, in its turn, becoming a fixed point for the second
intercostal muscles, they contract and draw up the third rib, and
so on successively to the last. It is the obliquity of the ribs from
behind, downwards and forwards, which enables this elevation of
them to produce an increase in the lateral diameter of the thorax:
without such obliquity, their elevation would not have the ef-
fect. But the obliquity alone could be of but little service, if
MECHANISM OF THE THORAX. 119
the anterior extremities of the ribs were not attached to the
sternum by cartilages, which have to ascend in order to reach
it; for it is obvious that the angle of the cartilage and rib, during
their elevation by the intercostal muscles, has a tendency to en-
large itself; and will, in doing so, increase the horizontal dis-
tance between the anterior end of the rib and the sternum, and
consequently increase the transverse diameter of the thorax.
The upper ribs, from the shortness as well as direction of their
cartilages, can do little or nothing in increasing this diameter.
According to some anatomists, the capacity of the thorax is
also augmented by a rocking motion of the rib, in which, the
two extremities being stationary, the middle is drawn upward
and outward. It is not, however, very clear, that this motion
exists to much extent, in the adult, as the posterior articulations
of the thorax are opposed to it.
While the transverse enlargement of the thorax is going on,
a simultaneous motion occurs in the sternum, and in consequence
of the oblique direction in which the ribs run to it, the sternum
is caused, by the elevation of their bodies, to recede from the
spine. But, as the ribs increase successively in length from the
first to the seventh, each lower one, in its elevation from the
oblique towards the horizontal line, has its anterior extremity
carried proporlionably farther off from the spine ; hence, the
sternum has a combined movement resulting from its several
attachments to the ribs: one motion elevates it as a whole, ano-
ther causes it to recede from the spine as a whole: and the
third causes its lower end, from the increased length of the ribs
there, to be pushed farther from the spine than the upper; giving
it, thereby, during respiration, a slight motion backwards and
forwards, resembling that of a pendulum. This latter motion,
however, though its existence is clear, is riot very considerable,
from the sternum being kept in check by the tendinous centre
of the diaphragm, as one may prove by examining his own
body. The enlargement of the thorax, in its antero-posterior
diameter, is much more considerable at the anterior extremi-
ties of the ribs, because there they are comparatively free. In
this case, the cartilages of the ribs are bent forwards, besides
being elevated.
In expiration, the movements of the thorax are exactly the
reverse of what they are in inspiration, and alUts diameters are,
120 SKELETON.
consequently, diminished. Whatever may be said of muscular
influence in producing this change, it is much exaggerated. It
is true, that there are certain muscles which may be applied to
this end, as the abdominal, and also some on the back, as the
longissimi dorsi and sacro lumbales; but that they are actually
so engaged, under ordinary circumstances, is rather questiona-
ble. In observing the phenomena of natural respiration, when,
by position, all these muscles are put into a state of relaxation,
it does not appear that the process is at all impaired by their
being thrown out of action. The only muscles, therefore, that
seem to be especially appropriated to produce expiration, are
few and small: they are the serrati inferiores postici, one on
either side of the spine. But, when the lower ribs are fixed by
the several muscles inserted into them, they become points of
support to the upper ones ; and then the intercostal muscles may
officiate in expiration, by drawing the ribs successively down-
wards, as they do, in inspiration, by drawing the ribs succes-
sively upwards.
The elasticity of the cartilages, by which these bodies are en-
abled to return from the constrained state in which they were
placed by inspiration, has also been supposed important to ex-
piration, by Haller, and others. The power thus derived is
certainly of some value; but has much less than has been at-
tached to it. It unquestionably exists in early and middle life,"
but is lost in old age, when the cartilages ossify, and, therefore,
are deprived of elasticity. The true and efficient cause of expi-
ration appears to be atmospheric pressure, upon the external
parietes of the thorax, acting along with the natural elasticity
of the lungs. The lungs, it is well known, when in a state of
repose, and removed from the thorax, are much smaller than
the cavities which they fill during life. They have, therefore, a
continual disposition, in the living state, to return to the size
which is most easy to them; and, when they are dilated by
inspiration, they subsequently contra<*t. These positions are
proved conclusively, by the condition of the inferior surface of
the diaphragm, in a healthy and entire thorax: where this mus-
cle, in consequence of atmospheric pressure from without, is
driven high up into its cavity. Its contraction in inspiration
draws it down, and the instant that the contraction ceases, it is
impelled upwards again. Now, the same power is applied to
, THE CRANIUM. 121
the whole periphery of the thorax: and its cavity being enlarged
by the contraction of the several muscles appropriated to the
elevation of the ribs; the moment this contraction ceases, the
latter are impelled downwards. From all this it will be under-
stood that the muscles, by creating a vacuum in the lungs, cause
the vacuum to be filled by the introduction of air through the
trachea; and upon their ceasing to contract, the several agents
mentioned cause the expulsion of the same air. It is generally
believed, that the surface of the lung is every where in contact
with the thorax; it appears, however, doubtful, whether there
is not a space between the pleura pulmonalis and diaphragmalis,
particularly at the most posterior and inferior part of the dia-
phragm. Certain it is, that adhesions there, are much less com-
mon than in other parts of the thorax.
The ligaments at the spinal extremities of the ribs, by being
put on the stretch in inspiration, have also some tendency to
throw down the ribs in expiration. In short, the contraction
of the thorax may be set down as the result of the joint action
of the atmosphere, the cartilages of the ribs, the ligaments, the
contraction of the lungs, and the muscles. When the structure
of the lung is so altered that its elasticity is impaired or de-
stroyed, expiration becomes then much more difficult.
CHAPTER II.
OF THE HEAD.
THE head is placed upon the upper extremity of the verte-
bral column, and consists in a considerable number of bones,
which are either in pairs, or, if single, have the two sides sym-
metrical. Some of these bones form a large cavity, the cranium,
for containing the brain; the others are employed in the forma-
tion of the nose; of the orbit for the eye-ball; and of the mouth.
The head, for the most part ovoidal, presents very striking va-
rieties of form between different individuals and different na-
tions. It is thought by physiologists, that the moral or intel-
lectual condition of a people, their habits, climate, and food,
VOL. I.— 11
122 SKELETON,
have a powerful influence in producing these diversities. The
head is divided into cranium and face.
SECT. I. OF THE CRANIUM.
The Cranium is composed of eight bones. The Os Frontis,
the Os Occipitis, two Ossa Parietalia, two Ossa Temporum, the
Os S.phenoides, and the Os Ethmoides, The Os Frontis is at
the front of the cranium; the Os Occipitis is at its hind part; the
Ossa Parietalia, one on each side, form its superior lateral parts;
the Ossa Temporum, also one on each side, form its inferior la-
teral parietes; the Os Sphenoides is in the middle of its bottom
part; and the Os Ethmoides is at the fore part of the centre or
body of the last bone.
The cavity thus formed for the brain, has three diameters,
which may be learned by sawing vertically through the middle
line of one skull, and horizontally through the cavity of another.
The first diameter is the longest, and extends from the lower
part of the frontal bone to the protuberance on the middle of the
Interior surface of the os occipitis; it is commonly about six
inches and a half long. The second diameter includes the space
between the superior margins of the temporal bones, where they
are most distant from each other, and passing over the middle of
the great occipital foramen, is about five inches. The third di-
ameter is taken from the centre of the large hole in the occipital
bone, to the centre of the suture between the parietal bones; it is
about five inches, also. Rather more than one-third of the ca-
vity of the cranium is placed behind the second diameter, and it
diminishes somewhat abruptly; but in front of this diameter the
cavity is finished more gradually.
When the face is separated from the cranium, the exterior
surface of the latter, excepting its base, represents tolerably ac-
curately the form and proportions of its cavity: allowance being
made for the large sinuses in the lower part of the frontal bone,
and for the thinness of the upper parts of the temporal bones.
The diameters mentioned, can only represent what most fre-
quently happens, for daily observation proves remarkable de-
partures from them. Sometimes the transverse diameter is in-
creased at the expense of the longest, which gives to the head a
flatness before and behind. On other occasions, the vertical di-
THE CRANIUM. 123
ameter is increased, whereby the head receives a conical form.
In many individuals the first diameter is increased, which makes
the two sides of the cranium more parallel and flat than usual.
The elongation of the transverse diameter is the most common,
and that of the vertical the least so. The capaciousness of the
cranium is much the same in adult individuals of the same sex;
from which it may be inferred that the excess of one diameter
is obtained generally at the expense of the other. The male
cranium is more capacious and thick than the female.
The female sex is less liable to variations in these proportionate
diameters than the male. Stature has but little influence on the
capaciousness of the cranium, as giants and dwarfs have it of the
same size; hence, the former seem to have very small heads,
while the latter appear to have very large ones, the eye being
deceived by the relative magnitude of their bodies.
The fact seems to be now well ascertained, that continued
pressure, or rather, resistance in a fixed direction, made upon
the cranium of a growing infant will change its natural form.
Peculiar ideas of beauty have induced certain tribes of savages
to adopt this barbarous and unnatural practice. The late Pro-
fessor Wistar* showed to his class, in 1796, a Choctaw Indian
having this peculiarity; and a tribe now existing near the sources
of the Missouri, continues the practice of flattening both the oc-
ciput and the os frontis.
In the Wistar Museum we have ten headst of Peruvian In-
dians, brought from the Pacific Ocean, nine of which bear the
strongest evidence of having been flattened by pressure, on the
os frontis and on the os occipitis. The possibility of effecting
such a change in the form of the cranium has been strongly con-
tested; and Biehat, who admits it, acknowledges that he was
unable to produce like modifications in puppies, kittens, and
India pigs. The singular change, however, which is wrought
upon the feet of Chinese ladies, strongly corroborates the opi-
nion of the head being also susceptible of artificial modifications
in its form.J
* System of Anat. 3d edit. vol. i, p. 73, 1824,
t Presented by Dr. James Corneck, U. S. Navy, to the late Dr. Physick.
t In an examination of an adult female of this nation, Among Foy, the mea-
surements were two inches and one-eighth from the heel to the end of the small
toe ; four inches and three-quarters from the heel to the end of the great toe; and
the circumference of the ankle six inches and six-tenths.
124 SKELETON.
SECT. II. OP THE INDIVIDUAL BONES OP THE CRANIUM.
1. Frontal Bone, (Os Frontis, Frontal)
The frontal bone forms the whole anterior, and a portion of
the superior, lateral and inferior parietes of the cranium. It is
symmetrical, and, occasionally, is completely divided into two
bones by the continuation of the suture between the parietal
bones.
Its external face is convex, and the internal concave. On the
former may be observed a line, or slightly raised ridge, running,
on the middle of the bone from above downwards, which is ex-
pressive of the original separation between its two halves. The
front surface of the bone is terminated on either side, below, by
the orbitary or superciliary ridge, a sharp and arched elevation,
forming the upper anterior boundary to the orbit of the eye.
This ridge terminates outwardly by the external angular pro-
cess, and inwardly, by the internal angular process. Just above
the internal half of the orbitary ridge the bone is raised, by the
separation of its tables, into the superciliary or nasal protube-
rance or boss. Between the internal angular processes a broad
serrated surface exists, by which the frontal bone is united to the
nasal bones, and to the nasal processes of the superior maxil-
lary bones. The centre of this surface is elevated into the
nasal spine, which serves as an abutment to the nasal bones,
and resists any force which might tend to drive {hem inwards.
On its exterior lateral surface, behind the external angular
process, the frontal bone presents a concavity, bounded above
by a well marked semi-circular ridge, and intended for the
lodgement of a part of the temporal muscle.
On each side of the front of the bone near its middle a promi-
nence exists, most frequently better marked in infancy than in
advanced life, and called by the French the frontal protube-
rance.
Proceeding backwards from the inferior part of the bone are
the two orbitar processes, concave below and convex above.
They are much thinner than other parts of the bone, and are
separated by an oblong opening which receives the ethmoidal
bone. A depression, large enough to receive the end of a fin-
ger, is at the exterior anterior part of the orbitar process, be-
THE CRANIUM. 125
ing protected by the external angular process: this depression
contains the lachrymal gland. Half an inch above the lower
margin of the internal angular process, a much smaller depres-
sion exists, occasioned by the tendon of the superior oblique
muscle where it plays upon its trochlea. In the orbitary ridge,
just without the latter depression, is the supra-orbitary foramen
or notch, for the passage of the frontal artery and nerve.
The internal margins of the orbitar processes are broad and
cellular, where they join the ethmoid bone; and at their fore
part is seen a large opening on each side leading into the
frontal sinus. These margins, in common with the ethmoid
bone, form two foramina, one anterior, another posterior, and
called internal orbitary; the first transmits the internal nasal
branch of the ophthalmic nerve and the anterior ethmoidal
artery and vein, the latter transmits the posterior ethmoidal
artery and vein. Externally and behind, the orbitar process
presents a broad triangular serrated surface for articulating
with the sphenoid bone.
The interior or cerebral face of the os frontis is strongly
marked by depressions corresponding with the convolutions of
the brain; on its middle exists a vertical ridge, becoming more
elevated as it approaches the ethmoidal bone. This ridge is
situated below, extends about one-half of the length of the
bone, and terminates, above, in a superficial fossa, made by
the longitudinal sinus of the dura mater; at its lower extremity
is the foramen caecum, common to it and the ethmoid bone,
and which is occupied by a process from the great falx of the
dura mater, and also affords passage to some very small veins,
which go from the nostrils to the commencement of the longi-
tudinal sinus.*
The frontal sinuses consist in one or more large cells, placed
beneath the nasal protuberances. There is a very great
variety in their magnitude and extent; sometimes they proceed
as far outwards as the external angular process, and back-
wards for half an inch into the orbitar plates. In a few
instances in the adult they do not exist, but the cases are very
uncommon. The cells of the opposite sides have a complete
* Portal. Anat. Medicalo.
11*
126 SKELETON.
partition. They communicate with the cavity of the nose
through the anterior ethmoidal cells.
With the exception of the inferior part, where the processes
and sinuses exist, the os frontis is of a very uniform thickness,
and the diploic or cellular structure is found constantly be-
tween its external and internal faces.
This bone is united to the parietal, ethmoidal, and sphenoi-
dal of the cranium; and to several bones of the face.
2. Parietal Bones, (Ossa Parietalia, Os Parietaux.)
These bones, it has been stated, form the superior and lateral
parts of the middle of the cranium. They are quadrilateral,
convex externally, and concave internally. Their external and
internal tables are uniformly separated by a diploic structure,
which, from being more abundant at the superior part of the
bones, occasions there an increased thickness.
The external surface of the parietal bone is raised about its
middle into the parietal protuberance. Just below this protu-
berance is an arched, rough, broad, but slightly elevated ridge,
marking the origin of the temporal fascia and muscle, and
continuous with the ridge on the side of the frontal bone.
The internal surface of the bone is marked by the convolutions
of the brain ; there are also a number of furrows upon it, hav-
ing an arborescent arrangement, and produced by the ramifi-
cations of the middle artery of the dura mater. These furrows
all proceed from two large ones at the anterior arid at the infe-
rior part of the bone: not unfrequently at the latter point these
furrows are converted into perfect tubes, by the deposition of
bone all around the arteries. Of these furrows, the foremost
may be traced from the greater wing of the sphenoidal bone,
and running somewhat parallel with the anterior margin of the
parietal; and the other passing from the squamous portion of
the temporal, is a little behind the middle of the parietal, and
inclines towards its posterior superior angle. The internal
face of the parietal bone also presents an imperfect fossa at its
superior margin, which is completed by junction with its fel-
low, and accommodates the longitudinal sinus of the dura ma-
ter. Near this edge it is not uncommon to see one or more
THE CRANIUM. 127
small irregular pits through the internal table, and looking
somewhat ulcerated : these are formed by the glands of Pac-
chioni, in the dura mater. At the inferior posterior corner of
the bone, there is also a fossa, which is made by the lateral
sinus of the dura mater.
The superior, posterior, and anterior margins of the parietal
bone are regularly serrated, and nearly straight. The inferior
margin is concave, presenting a thin, bevelled, radiated surface
before, for articulating with the squamous portion of the tem-
poral bone: behind this concavity, the angle of the bone is
truncated and serrated, for articulating with the angular por-
tion of the os temporis. The anterior inferior angle is the
most remarkable, from its being elongated so as to join the
sphenoid bone in the temporal fossa.
A foramen, called parietal, is found at the superior margin
of this bone, nearer to its posterior than to the anterior edge;
it transmits an artery between the integuments and dura mater,
and also a vein from the integuments to the longitudinal sinus.
M. Portal says, that in some protracted headaches this vein
swells considerably; and that he has seen much good in such
cases, arise from the application of leeches to the part : he has
also seen, in a child, its tumefaction the precursor of the pa-
roxysms of epilepsy.
The parietal bone articulates with its fellow, with the fron-
tal, the sphenoid, the temporal, and the occipital bones.
3. Occipital Bone, (Os Occipitis, Occipital)
This bone is quadrilateral, resembling a trapezium. It is
convex externally, and concave internally; but both of these
surfaces are much modified by ridges and processes. Its
thickness is also very unequal; though, Hke the other bones, it
has two tables, with an intermediate diploe. It is so placed as
to form a considerable share of the posterior and inferior pa-
rietes of the cranium.
The foramen magnum is found in the lower section of this
bone, and constitutes a very conspicuous feature in it. This
128 SKELETON.
hole is oval, the long diameter extending from before back-
wards. Its anterior inferior margin, on either side, is furnished
with a condyle,- for articulating with the first vertebra of
the neck. These condyles are long eminences tipped with
cartilage, which converge forwards, so that lines drawn
through their length would meet an inch in front of the fora-
men magnum; they recede behind: their internal margins are
deeper than their external. The condition of their articular
surfaces is therefore such, that they permit flexion and exten-
sion of the head, but not rotation. The anterior edge of the
foramen is thicker than the posterior. This foramen transmits
the medulla oblongata, the vertebral arteries and veins, and
the spinal accessory nerves.
The external surface of the occiput presents, half way be-
tween the foramen magnum and the upper angle of the bone,
the occipital protuberance, from the lower part of which a
small vertical ridge is extended in the middle line to that
foramen. Into the ridge is inserted the Ligamentum Nuchae.
From either side of the protuberance an arched ridge is ex-
tended to the lateral angle of the bone ; it is the superior semi-
circular ridge or line, from which arise the occipito frontalis
and the trapezius muscles, and into it is inserted a part of the
sterno cleido-mastoideus. Below this about an inch is the in-
ferior semicircular ridge, more protuberant, but not so dis-
tinctly marked in its whole course. Into the inner space,
between the upper and lower ridges, is inserted the complexus
muscle, and into the outer space between the same, the sple-
nms muscle. The lower ridge is principally occupied by the
origin of the superior oblique muscle of the neck.
The inner space between this ridge and the great foramen,
gives origin to the rectus posticus minor, and the outer space to
the rectus posticus major. Into a small elevation, leading from
the outside of the condyle directly to the margin of the bone,
is inserted the rectus capitis lateralis.
In a depression behind each condyle is the posterior condy-
loid foramen, which conducts a cervical vein to the lateral sinus.
Passing through the base of the condyle, and having its orifice
in front, is the anterior condyloid foramen for conducting the
hypoglossal nerve to the toncm*.
THE CRANIUM. 129
That part of the bone before the condyles is the cuneiform or
basilar process: the base of which is marked by depressions for
the insertion of the recti muscles, which are situated on the
front of the cervical vertebrae; and its fore part, which is trun-
cated at the end, overhangs the pharynx, and is placed against
the body of the sphenoid bone. The superior external part of
the os occipitis is uniformly convex, being covered by the oc-
cipito frontalis.
The internal surface' of the os occipitis is strongly impressed
by ridges and depressions. On that portion of it behind the
great foramen, is a rectangular cross, forming at its centre a
large internal protuberance. The upper limb of the cross is
marked by a fossa for the longitudinal sinus; the two horizon-
tal limbs are also marked, each by its respective fossa, which
receives the corresponding lateral sinus. The right fossa is fre-
quently the largest. The inferior vertical limb of the cross has
attached to it the small falx of the dura mater, and is slightly
depressed by a small sinus. The spaces between the limbs of
the cross are much thinner than other parts of the bone, and
present broad concavities, the two superior of which receive
the posterior lobes of the cerebrum, and the two inferior, the
lobes of the cerebellum.
The superior face of the cuneiform process is excavated, lon-
gitudinally, to receive the medulla oblongata. On each side of
the foramen magnum, a short curved fossa is observed, which
receives the lateral sinus just before its exit from the cranium.
The two superior margins of the occipital bone are regularly
serrated. The inferior margins have each, in their centre, a
process termed the jugular eminence, in front of which is a
rounded notch, forming a part of the jugular fossa, which trans-
mits the internal jugular vein and the eighth pair of nerves.
The edge of the bone above this eminence is serrated, but be-
low it is rather smooth and rounded, being parallel with the
temporal bone, and having an imperfect adhesion to the petrous
part of it, before the jugular fossa. •
The occipital bone articulates above with the parietal, lateral-
ly with the temporal; and in front with the sphenoid.
130 SKELETON.
4. Temporal Bones, (Ossa Temporum, Temporaux.)
These bones form portions of the inferior lateral parietes, and
of the base of the cranium.
Their figure is very irregular. Their circular anterior por-
tion is called squamous : behind it is the mastoid, and between
the others is the petrous.
The squamous portion is thinner than the other bones of the
cranium that have been described, from the temporal muscle and
its fascia covering it, so as to afford sufficient protection to the
brain. Its exterior surface is smooth and slightly convex. The
interior surface is formed into fossa? by the convolutions of the
brain. At the anterior inferior part of the latter surface, a
groove is made by the middle artery of the dura mater, imme-
diately after it gets from the foramen spinale of the sphenoid
bone on its way to the parietal. This groove bifurcates, one
branch runs backwards to join the posterior groove of the pa-
rietal bone; and the other ascends to join the anterior groove
of the same, frequently, however, impressing the top of the
great wing of the sphenoid, just before it reaches the parietal.
The greater part of the circumference of this portion is sloped
to a sharp edge, but at the anterior inferior part it is serrated
and thicker. On the outside of the latter is the glenoid cavity,
for articulating with the lower jaw: the length of it is trans-
verse, with a slight inclination backwards, so that a line drawn
through it would strike the foramen magnum occipitis. The
anterior margin of this cavity is formed by a tubercle, on which
the condyle of the lower jaw rises when the mouth is widely
opened. The outer margin of the glenoid cavity is formed by
the root of the zygomatic process. The zygomatic process has
a broad horizontal root, from which it extends outwardly, and
then diminishing, runs forwards to join the malar bone. Pos-
terior to the root of the zygomatic process, a small vertical
groove may be seen occasionally, made by the middle tempo-
ral artery.
The mastoid portion of the temporal bone, is thick and cel-
lular. Its upper part forms an angle, which is received between
the parietal and occipital bones: both margins of this angle are
THE CRANIUM. 131
serrated. Below, is the mastoid process, a large conical pro-
jection eight lines long, into which are inserted the sterno-mas-
toid, and trachelo-mastoid muscles. At the inner side of its
base is a fossa affording origin to the digastric muscle. The
inner face of the mastoid portion is marked by a deep large fossa
for the lateral sinus of the dura mater. In the posterior part of
the suture, uniting the mastoid portion and the occipital hone,
or in the former bone near the suture, is the mastoid foramen,
for conducting a vein from the integuments into the lateral
sinus.
The cells in the mastoid bone are large and numerous, and
obtain the name of sinuses; they communicate with the tym-
panum by one large orifice. On the outer side of these sinuses
a thin diploic structure is observable in some heads.
The petrous portion of the temporal bone is a triangular py-
ramid, arising by a broad base from the inner side of the mas-
toid and squamous portions. It is fixed obliquely forwards, be-
tween the sphenoid and occipital bones. Its anterior surface is
marked by the convolutions of the brain. Near the centre of
this surface, and having a little superficial furrow leading to
it, is a small foramen called the Hiatus Fallopii, through which
passes the Vidian nerve. The posterior surface of the petrous
portion presents a large foramen, the meatus auditorius internus,
through which pass the seventh or the auditory and the facial
nerve. Half an inch behind this orifice, is a very small one,
overhung by a flat shelf of bone; this is said to be the aqueduct
of the vestibule. Just above the meatus auditorius internus is
a foramen more patulous than the aqueduct, for transmitting
small blood vessels.
In the base of the petrous portion, between the mastoid and
zygomatic processes, is the meatus auditorius externus, a large
opening conducting to the tympanum. It is oval, about half an
inch deep, and varies much in its size in different subjects: its
margin is called the auditory process, the lower part of which
is very rough, for attaching the cartilage of the external ear.
The lower surface of the petrous bone is exceedingly irregu-
lar. Immediately below the meatus externus, is a depression
1 32 SKELETON.
which seems like a part of the glenoid cavity, and is improper-
ly considered as such by anatomists, inasmuch as it does not
form a portion of the articular surface for the lower jaw, but
simply allows room for its motions, the parts which it contains
(consisting of vessels, and a portion of the parotid gland) being
pressed back when the jaw opens. Between this cavity and
the glenoid is the glenoidal fissure, separating the petrous from
the squamous bone. In this fissure, leading to the tympanum,
is a foramen which contains the processus gracilis of the mal-
leus with its muscle, and the chorda tympani. The posterior
margin of the depression just alluded to in the petrous bone, is
made by a long rough ridge, called processus vaginalis; just
behind which, and partially surrounded by it, is the styloid pro-
cess. The styloid process is round, tapering, and an inch and
a half long ; but frequently absent in prepared skulls, from acci-
dental fracture and from being in a cartilaginous state. From
it arise the styloid muscles.
Behind the root of the styloid process, is the stylo mastoid
foramen, which transmits the portio dura or facial nerve to the
face. Just within the styloid process and the foramen is a deep
depression, called jugular fossa, large enough to receive the
tip of the little finger. The fossa, along with a corresponding
one in the os occipitis, is occupied by the internal jugular vein
and the eighth pair of nerves. Immediately before the lower
end of this fossa is the foramen caroticum, being the lower ori-
fice of a crooked canal, which terminates at the apex of the
petrous bone, and transmits the carotid artery and the upper
extremity of the sympathetic nerve. At the inner side of the
carotid canal, a superficial serrated groove is perceived, which
receives the adjoining edge of the occipital bone. Just in ad-
vance of the inner part of the jugular fossa is a small spine of
bone, at the foot of which is a pit, containing the orifice of the
supposed aqueduct of the cochlea. The spine separates the
eighth pair of nerves from the internal jugular vein.
In the angle between the squamous and petrous bones, within
the glenoid foramen, is the orifice of the Eustachian tube. The
tube is divided longitudinally, by a bony partition. The upper
division contains the tensor tympani muscle.
A small groove exists along the superior angle of the petrous
THE CRANIUM. • 1 33
bone, and another along the inferior angle, adjoining the basilar
process of the occipital bone, and formed in part by it : they
are made by the superior and inferior petrous sinuses.
The temporal bone articulates with the occipital, the parie-
tal, the sphenoid, and the malar.
5. Sphenoid Bone, (Os Sphenoides, Sphenoide.)
The sphenoid is a symmetrical, but very irregular bone,
placed transversely in the middle of the base of the cranium.
It consists of a cuboidal body in the centre, of a very large
process called the great wing, and spreading laterally to a con-
siderable distance on either side of the body, and it has, also,
a number of angular margins and additional processes about it.
In regard to the body of the sphenoid bone, from its upper
anterior part arise, one on each side, the apophyses of Ingras-
sias, or the little wings. These wings have a broad horizontal
base, and extending themselves outwardly, terminate in a sharp
point. Their anterior edge is serrated for articulating with
the os frontis : the posterior edge is smooth. Between the two
wings, in front, is a prominence united to the ethmoid bone.
The base of the wing is perforated by the foramen opticum,
for transmitting the optic nerve with the ophthalmic artery.
Below and behind this foramen, the little wing terminates in a
point, called the anterior clinoid process. Between the fora-
mina optica is a ridge of bone, sometimes called processus oli-
varis, and just above the ridge a groove, made by the optic
nerves where they unite. Behind the ridge is a depression,
the Sella Turcica, for containing the pituitary gland. This
depression is bounded behind by a very elevated transverse
ridge, called the posterior clinoid process. At either extremi-
ty of the base of the latter, a groove (sulcus caroticus) is made
by the carotid artery, which groove may be traced indistinctly
under the anterior clinoid process, where it forms a notch, and
sometimes a foramen.
The posterior face of the body of the sphenoid bone, presents
a flat surface for articulating with the cuneiform process of the
occipital. Most frequently, in the adult, the bones are anchy-
losed at this junction. The inferior part of the body of the
sphenoid presents a rising, in its middle, called the sphenoidal
VOL. I.— 12
1 34 SKELETON.
or azygous process, for articulation with the vomer, and with
the nasal septum of the ethmoid. On each side of this process,
in front, is the orifice of the sphenoidal cell. These cells con-
sist, most commonly, of one on each side, and are separated
by a bony partition. In the very young bone they are not
formed. The body of the sphenoid undergoes so many changes
between early infancy and adult life, by the conversion of its
diploic structure into sinuses or cells, and is also so much mo-
dified in different individuals, that a general description of it
will not answer for all specimens.
The two great wings arise from the sides of the body of the
sphenoid, by a small irregular base. From their lower part pro-
ject downvvards,on either side, the two pterygoid processes called
external and internal. These processes have a common base,
are partially separated behind by a groove called pterygoid fossa,
and below by a notch. The internal is the longest, and is termi-
nated by a hook, on the outer side of which is a trochlea made
by the tendon of the circumflexus muscle. The external ptery-
goid process is the broadest. By applying together the temporal
and sphenoid bones, a groove, common to the two, leading to
the Eustachian tube, will be seen. This groove is continued
obliquely across the root of the internal pterygoid process, and
indicates the course of the cartilaginous portion of the Eusta-
chian tube. The internal pterygoid process sends out from its
base a small shelf of bone, separated by a fissure from the un-
der part of the body of the sphenoid. The posterior edge of
the vomer rests against this projection. The fissure is filled up
in advanced life.
The great wings of the sphenoid bone present three faces.
One is anterior, and called orbital, from its forming a part of the
orbit; another is external, and called temporal; and the third is
towards the brain, and forms a considerable part of the fossa
for containing its middle lobe. The orbital face is square and
slightly concave. The temporal face is an oblong concavity, at
the lower part of which is a triangular process, giving an origin
to the external pterygoid muscle. The cerebral face is concave
and marked by the convolutions of the brain, as well as by a
furrow made by the principal trunk of the great artery of the
dura mater as it passes from the temporal bone to the temporal
angle of the parietal. The inferior portion of the great wing is
THE CRANIUM. 135
elongated backwards into a horizontal angle, called the spinous
process, which is fixed between the petrous and squamous portions
of the temporal bone. From the point of the spinous process pro-
jects downwards the styloid process. The great wing presents
a triangular serrated surface above, at its outer end, by which
it articulates with the osfrontis; just below this, in front, is a short
serrated edge, by which it articulates with the malar bone; and
externally, is a semicircular serrated edge, by which it articulates
with the squamous portion of the temporal bone. The tip of the
large wing generally articulates also with the parietal bone.
Between the apophysis of Ingrassias and the greater wing is
the foramen sphenoidale, called also foramen lacerum superius of
the orbit. It is broad near the body of the bone, and becomes a
mere slit at the extremity of the little wing. Through it pass
the third, fourth, the first branch of the fifth, and the sixth pair
of nerves. Two lines below the base of this hole is the foramen
rotundum, for transmitting the second branch of the fifth pair of
nerves. Eight lines, or thereabouts, behind the foramen rotun-
dum, is the foramen ovale, for transmitting the third branch of
the fifth pair of nerves. Two lines behind the foramen ovale is
the foramen spinaie, for transmitting the middle artery of the
dura mater. In the under part of the bone, and passing through
the root of the pterygoid processes, is the foramen pterygoideum,
for transmitting the pterygoid nerve; it being a recurrent branch
of the second branch of the fifth pair of nerves.
The sphenoid* bone articulates above and in front with the
vomer, the frontal, ethtnoidal, malar, and parietal bones : late-
rally with the temporal, behind with the occipital, and by its
pterygoid processes with the palate bones.
6. Ethmoid Bone, (Os Elhmoides, Ethmoide.)
This bone is placed between the orbitar processes of the os
frontis, and, as has been stated, fills the vacuity between them.
It is cuboidal, extremely cellular, and light.
The horizontal portion between the orbitar processes is the
* This bone is, by some anatomists, described in common with the os occipitis,
& the osbasilare, in consequence of their early junction into a single piece.
136 SKELETON.
cribriform plate called so from its numerous perforations. This
is divided, longitudinally, above and below, by a vertical pro-
cess ; and from the under surface on each side, is suspended the
cellular portion.
The vertical process on the superior face of the cribriform
plate is the crista galli, which extends sometimes from the back
to the front of this plate, and is thickest in the middle. The com-
mencement of the great falx arises from it, and occasionally it
contains a cell or sinus opening into the nose. Between the front
of the crista galli and ihe os frontis, is the foramen crecum, al-
ready described. On either side of the crista galli the cribriform
plate is depressed into a gutter for holding the bulb of the olfac-
tory nerve, and is perforated with many holes for transmitting
its ramifications. The most anterior foramen on each side is
oval, and transmits to the nose the internal nasal nerve, after it
has got into the cranium through the anterior internal orbitar
foramen. The margins of the cribriform plate show many im-
perfect cells, which are completed by joining their congeners
in the margins of the orbitar processes of the os frontis.
The vertical process below the cribriform plate is called
nasal lamella. It generally divides the nostrils equally, but is
occasionally inclined to one side. It joins below, to the vomer
and the cartilaginous septum of the nose ; in front is in contact
with the nasal spine of the frontal bone and with the nasal
bones; and behind, with the azygous process of the sphenoid.
Each cellular portion of the ethmoid forms, by its exterior, a
part of the orbit of the eye, which surface is called os planum.
The internal or nasal face forms part of the nostril. The fore
part of this face is flat, but, posteriorly, in its middle, is a deep
sulcus, called the superior meatus of the nose. The upper tur-
binated bone, a small scroll, constitutes the upper margin of
this meatus. The inferior internal margin of the cellular por-
tion of the ethmoid, is formed by another scroll of bone, run-
ning its whole length. This is the middle turbinated bone.
Moreover, from the inferior margin of the cellular portion, one
or more laminse, of an irregular form, project so as to diminish
the opening into the upper maxillary sinus.
THE CRANIUM. 137
The cells in the ethmoid bone are numerous and large, the
posterior ones discharge, by one or more orifices, into the upper
meatus. The anterior discharge into the middle meatus of the
nose by several orifices, concealed by the middle turbinated
bone. The most anterior of these cells is funnel-shaped, and
joining the frontal sinus, conducts the discharge of the latter
into the nose.
In children of from three to eight years of age, there is at-
tached to the posterior part of each cellular portion of the eth-
moid, a triangular hollow pyramid, consisting of a single cell.
This pyramid arises, not only from the cellular portion, but also
from the posterior margin of the cribriform plate, and of the
nasal lamella, by which it gains a large and secure base. The
processus azygos of the sphenoid bone is received between the
two pyramids. In the base of the pyramid, communicating
with the nose, is a foramen, which is known in adult life as the
orifice of the sphenoidal sinus. The pyramid, towards puberty,
becomes a part of the sphenoidal bone, and then detaches it-
self, by a suture at its base, from the ethmoidal. As life ad-
vances it is greatly developed, no indication of its original
condition remains, and it becomes fairly the sphenoidal cell;
singularly differing in shape from what it was in the begin-
ning.*
Being put upon the investigation of this pyramid by the late
Professor Wistar, with the view of ascertaining its different
phases of development, it has occurred to me to see it in every
stage, from that of a simple triangular lamina, arising from
the posterior margin of the cribriform plate, to the perfect hol-
low pyramidal slate. The preceding anatomists describe it
but imperfectly; it remained for that distinguished individual
to elucidate its real history.
Several of the articulations of the ethmoid have been men-
tioned; the remainder will be introduced with the bones of the
face.
* Wistar's Anatomy, vol. i. p. 31, 3d edit.
136 SKELETON.
cribriform plate called so from its numerous perforations. This
is divided, longitudinally, above and below, by a vertical pro-
cess ; and from the under surface on each side, is suspended the
cellular portion.
The vertical process on the superior face of the cribriform
plate is the crista galli, which extends sometimes from the back
to the front of this plate, and is thickest in the middle. The com-
mencement of the great falx arises from it, and occasionally it
contains a cell or sinus opening into the nose. Between the front
of the crista galli and ihe os frontis, is the foramen ccecum, al-
ready described. On either side of the crista galli the cribriform
plate is depressed into a gutter for holding the bulb of the olfac-
tory nerve, and is perforated with many holes for transmitting
its ramifications. The most anterior foramen on each side is
oval, and transmits to the nose the internal nasal nerve, after it
has got into the cranium through the anterior internal orbitar
foramen. The margins of the cribriform plate show many im-
perfect cells, which are completed by joining their congeners
in the margins of the orbitar processes of the os frontis.
The vertical process below the cribriform plate is called
nasal lamella. It generally divides the nostrils equally, but is
occasionally inclined to one side. It joins below, to the vomer
and the cartilaginous septum of the nose; in front is in contact
with the nasal spine of the frontal bone and with the nasal
bones; and behind, with the azygous process of the sphenoid.
Each cellular portion of the ethmoid forms, by its exterior, a
part of the orbit of the eye, which surface is called os planum.
The internal or nasal face forms part of the nostril. The fore
part of this face is flat, but, posteriorly, in its middle, is a deep
sulcus, called the superior mealus of the nose. The upper tur-
binated bone, a small scroll, constitutes the upper margin of
this meatus. The inferior internal margin of the cellular por-
tion of the ethmoid, is formed by another scroll of bone, run-
ning its whole length. This is the middle turbinated bone.
Moreover, from the inferior margin of the cellular portion, one
or more laminae, of an irregular form, project so as to diminish
the opening into the upper maxillary sinus.
THE CRANIUM. 137
The cells in the ethmoid bone are numerous and large, the
posterior ones discharge, by one or more orifices, into the upper
nveatus. The anterior discharge into the middle meatus of the
nose by several orifices, concealed by the middle turbinated
bone. The most anterior of these cells is funnel-shaped, and
joining the frontal sinus, conducts the discharge of the latter
into the nose.
In children of from three to eight years of age, there is at-
tached to the posterior part of each cellular portion of the eth-
moid, a triangular hollow pyramid, consisting of a single cell.
This pyramid arises, not only from the cellular portion, but also
from the posterior margin of the cribriform plate, and of the
nasal lamella, by which it gains a large and secure base. The
processus azygos of the sphenoid bone is received between the
two pyramids. In the base of the pyramid, communicating
with the nose, is a foramen, which is known in adult life as the
orifice of the sphenoidal sinus. The pyramid, towards puberty,
becomes a part of the sphenoidal bone, and then detaches it-
self, by a suture at its base, from the ethmoidal. As life ad-
vances it is greatly developed, no indication of its original
condition remains, and it becomes fairly the sphenoidal cell;
singularly differing in shape from what it was in the begin-
ning.*
Being put upon the investigation of this pyramid by the late
Professor Wistar, with the view of ascertaining its different
phases of development, it has occurred to me to see it in every
stage, from that of a sample triangular lamina, arising from
the posterior margin of the cribriform plate, to the perfect hol-
low pyramidal state. The preceding anatomists describe it
but imperfectly; it remained for that distinguished individual
to elucidate its real history.
Several of the articulations of the ethmoid have been men-
tioned; the remainder will be introduced with the bones of the
face.
* Wistar's Anatomy, vol. i. p. 31, 3d edit.
ft*
140 SKELETON.
the nerve of the molar teeth to their roots, and a similar canal is
seen in front of the antrum, for the nerves of the front teeth.
The nerves, in both instances, come from the infra orbitary.
The nerves, till they begin to divide into filaments, are between
the lining membrane and the antrum, but afterwards they make
complete canals in the alveolar processes. The antrum fre-
quently communicates with the frontal sinus, through the ante-
rior ethmoidal cells, which circumstance is omitted by most
anatomists.
This bone is articulated with the frontal, nasal, unguiform,
malar, and. ethmoid, above; to the palate bone behind; to its
fellow, and to the vomer, at its middle; and to the inferior
spongy bone by its nasal surface.
2. Palate Bones, (Ossa Palati, Palatins.)
The palate bones, two in number, are placed at the back
part of the superior maxillary, between them and the pterygoid
processes of the sphenoid.
For descriptive purposes they may be divided into three
portions — the horizontal or palate plate, the vertical or nasal
plate, and the orbitar or oblique plate, placed at the upper ex-
tremity of the latter.
The palate plate is in the same line with the palate process
of the superior maxillary bone, and supplies the deficiency
caused by its abrupt termination. It is square. The inferior
surface is flat, but rough for the attachment of the lining mem-
brane of the mouth. The superior surface is concave, and
forms about one-third of the bottom of the nose. The anterior
margin is serrated where it articulates with the palate process
of the maxillare superius. The posterior margin is thin and
crescentic. The internal extremity of the crescent is elon-
gated into a point, from which arises the azygos uvulae muscle.
The internal margin of the palate plate is thick and serrated
for articulating with its fellow, the upper edge of it being turn-
ed upwards to join the vomer. The exterior edge touches the
internal side of the maxillare superius, and from it arises the
nasal plate.
THE FACE. 141
The nasal plate forms the posterior external part of the nos-
tril, and is much .thinner than the palate plate. Its side next
the nose is slightly concave, and is divided into two unequal
surfaces, of which the lower is the smallest, by a transverse
ridge, that receives the posterior extremity of the lower turbi-
nated or spongy bone. The external face is in contact with
the internal face of the maxillary bone, and presents a surface
corresponding with it. The nasal plate of the palate bone
diminishes the opening into the Antrum Highmorianum by
overlapping it behind. Backwards it joins the pterygoid pro-
cess of the sphenoid bone, and overlaps its anterior internal
surface.
At the inferior and posterior part of the nasal plate, where
the crescentic edge of the palate plate joins it, the palate bone
is extended into a triangular process, called the pterygoid.
This process, on its posterior surface, presents three grooves,
the internal of which receives the internal pterygoid process
of the sphenoid bone, and the external groove receives the ex-
ternal pterygoid process of the same bone. The middle fossa
has its surface continuous with the pterygoid fossa of the sphe-
noid bone, and may be seen, in the articulated head, to contri-
bute to this fossa. The anterior surface of the pterygoid
process of the palate bone presents a small serrated tuberosity,
which is received into a corresponding concavity on the pos-
terior surface of the maxillary bone, and contributes to the
firmer junction of the two.
On the external surface of the nasal plate, between it and
the base of the pterygoid process, a vertical groove is formed,
which is converted into a complete canal by the maxillary
bone. The lower orifice of this canal is near the posterior
margin of the palate. It is called the posterior palatine fora-
men, and transmits the palatine nerve and artery to the soft
palate. Immediately behind this canal there is, not unfre-
quently, a smaller one, running through the base of the ptery-
goid process of the palate bone, and transmitting a filament of
the same nerve to the palate.
The upper extremity of the nasal plate is formed by two
processes, one in front and the other behind, separated either
14» SKELETON.
by a round notch or a foramen. The posterior of the two,
called also pterygoid apophysis, is inclined over towards the
cavity of the nose. It is thin, and fits upon the under surface
of the body of the sphenoid bone, and upon the inner surface
of the internal base of the pterygoid process of the same. Its
upper edge touches the base of the vomer. The anterior pro-
cess is the orbitar portion of the palate bone.
The orbitar portion or plate is longer than the pterygoid
apophysis, and is hollow and very irregular. It may be seen
in the posterior part of the orbit wedged in between the eth-
moid and maxillary bone. The portion of it which is there
seen, is the orbital face, and is triangular. On the side of the
ethmoid bone its cells are seen, which are completed by their
contiguity to the ethmoid and sphenoid. The cells, in young
subjects, are not always to be met with. The posterior face
of the orbitar portion is winding and looks towards the zygo-
matic fossa.
The notch between the orbitar portion and the pterygoid
apophysis is converted into a foramen, by that part of the
body of the sphenoid bone which is immediately below the
opening of the sphenoid cell. Through this foramen, called
spheno-palatine, pass the lateral nasal nerve, the spheno-pala-
tine artery and vein.
This bone can scarcely be studied advantageously except in
the separated head. A single application of it to the maxillary,
will then show how it extends from the palate of the mouth to
the orbit of the eye; and how it is the connecting bone be-
tween the maxillary bone and the pterygoid process of the
sphenoid.
The palate bone articulates with six others. With the up-
per maxillary, the sphenoid, the ethmoid, the inferior spongy,
the vomer, and with its fellow. The places of junction have
been pointed out in the description of the bone.
3. Nasal Bones, (Ossa Nasi, Os du Nez.)
The ossa nasi, two in number, fill up the vacancy between
THE FACE. 143
the nasal processes of the superior maxillary bones. They are
oblong and of a dense compact structure, being so applied to
each other as to form a strong arch called the bridge of the
nose, which is farther sustained by the nasal spine and the
continuous oblique serrated surface of the os frontis.
The ossa nasi are thick and serrated at their upper margins;
below, they are thin and irregular. The surfaces by which
they unite with each other are broad, having their edges raised
where they join the nasal lamella of the ethmoid bone. The
edge by which they join the nasal process of the upper maxil-
lary bone is concave; the upper part of this edge is overlapped
bv the nasal process, but the lower part of it overlaps the na-
sal process.
On the posterior face of the os nasi is to be seen a small
longitudinal groove, formed by the internal nasal branch of the
ophthalmic nerve, which nerve penetrates the foramen orbitale
anterius and the cribriform plate of the ethmoid bone.
The ossa nasi articulate with each other in front, with the
nasal processes of the upper maxillary behind, with the septum
narium where they are in contact with one another, and with
the os frontis above.
4. Unguiform Bones, (Ossa Ungues, Os Lacrymaux.)
The unguiforrn is a very small thin bone, "placed at the in-
ternal side of the orbit, between the nasal process of the upper
maxillary and the os planum of the ethmoid. Its orbitar sur-
face is divided into a face which is in a line with that of the
os planum, and into an oblong vertical concavity, continuous
with the concavity on the posterior surface of the nasal pro-
cess, for lodging the lachrymal sac. Its inferior anterior cor-
ner is elongated into the nose, so as to join with a process of
the inferior turbinated bone, whereby the ductus ad nasum is
rendered a complete bony canal.
This bone lies on the orbitar side of the most anterior eth-
moid cells, and completes them in that direction.
An important variety in the structure of this part of the or-
bit occasionally occurs, in which the whole fossa for lodging
1 44 SKELETON.
the lachrymal sac, is formed by the unusual breadth of the na-
sal process of the upper maxillary bone. In this case, the
only part of the os unguis which exists, is that in the same line
with the os planum. Several examples have come under my
own notice. Duverney has also mentioned it. Sometimes it
is entirely wanting, in which case the os planum joins the na-
sal process.* A variety still more uncommon is mentioned by
Verheyen, where the lachrymal fossa is formed exclusively by
the os unguis.
This bone articulates very loosely with the adjoining bones,
so that it is frequently lost from the skeleton. It joins the os
frontis above, the os maxillare superius before and below, the
os planum behind, and the inferior spongy bone in the nose.
5. Cheek Bones, (Ossa Malarum, Jugalia, Os de la Pommette.)
These bones, two in number, are also called zygomatic by
many anatomists* They are situated at the external part of the
orbit of the eye, and form the middle external part of the face.
The cheek bone is quadrangular, and has irregular margins.
It consists of two compact tables with but little intermediate
diploic structure.
There are three surfaces to it.. That which contributes to
the orbit is crescentic, and is called the internal orbitar process.
The one in front is convex, and forms part of the face ; and be-
hind the latter is a third surface, which is concave, and forms a
part of the zygomatic fossa. Of the four margins, two are su-
perior, and two inferior. The anterior of the first two is con-
cave, and rounded off, to form the external and one-half of the
lower edge of the orbit. The posterior upper border above,
is thin and irregular, and to it is attached the temporal fascia: it
terminates behind by a short serrated margin, for articulating
with the zygomatic process of the temporal bone. The ante-
rior inferior margin, is serrated its whole length, for articulating
with the superior maxillary bone. The posterior inferior mar-
gin gives origin to part, of the masseter muscle. Some anato-
mists admit, also, a fifth margin to this bone, which is towards
the bottom of the orbit, and articulates above with the great
wing of the sphenoid bone, and below with the superior maxil-
* Berlin, Traite D'Oatcol. vol. ii. p. 143. Paris, 1751.
THE FACE. 145
lary. Between these two parts is a notch, forming the outer
extremity of the spheno-maxillary slit.
The angles of this bone are called processes. The upper one,
which is continuous with the external angle of the os frontis, is
the superior orbitar, or angular process. The orbitar margin
terminates below, in the inferior orbitar, or angular process.
That portion of the bone which joins with the zygoma of the tem-
poral, is the zygomatic process; and the fourth angle is the max-
illary process.
The os malae articulates with four bones ; to wit, with the
maxillary, frontal, sphenoidal, and temporal.
There are some few small foramina in this bone, which trans-
mit nerves and blood vessels.
6. Inferior Spongy Bones, (Ossa Spongiosa ant Ttirbinata Infe-
rior a, Cornets Inferieurs.)
This pair of bones is situated at the inferior lateral parts of
the nose, just below the opening into the antrurn Highmorianum.
They are very thin and porous, and their substance is extreme-
ly light and spongy.
The internal face of the spongy bone is towards the septum
of the nose, and presents an oblong rough convexity. The ex-
ternal face has a corresponding concavity towards the maxillary
bone. The superior margin presents, in front, an upright pro-
cess, which joins with the anterior inferior angle of the ungui-
form bone, to form the nasal duct. Just behind this, the margin
of the bone is turned over towards the antrum, forming a broad
hook, which rests upon the lower margin of the orifice of the
antrum, and diminishes its size. From the superior margin, also,
one or two processes not unfrequently arise, whereby this bone
joins the ethmoid. The inferior margin is somewhat thicker
than the superior.
The anterior extremity of this bone rests upon the ridge
across the root of the nasal process of the upper maxillary. The
posterior extremity rests, in like manner, upon the ridge across
the nasal plate of the palate bone.*
* In some rare cases this bone adheres to the ethmoid, so as to become a part
of it.
VOL. I.— 13
146 SKELETON.
The Ploughshare, (Vomer.)
This single bone is placed between the nostrils, and forms a
considerable part of their septum. It is frequently more in-
clined to one side than to the other. It is formed of two laminae,
between which there is a very thin diploic structure.
The sides of the vomer are smooth and parallel. It has four
margins. The superior is the broadest, and has a furrow in it
for receiving the azygous process of the sphenoid bone. The
anterior margin being directed obliquely downwards and for-
wards, its front half joins the cartilaginous septum of the nose,
and the posterior half receives, in a narrow groove, the nasal
plate of the ethmoid.
The posterior margin of the vomer is smooth and rounded,
making the partition of the nostrils behind. The inferior mar-
gin articulates with the spine or ridge of the superior maxillary
and palate bones, which exist at their internal border.
(Lower Jaw, Os Maxillare Inferius, Maxittaire Inferieur.)
This bone forms the lower boundary of the face, and is the
only one in the head capable of motion. In early life, its two
halves are separable, being joined at the middle line only by
cartilage; but, in the course of two or three years after birth,
they are consolidated, and the original cartilage disappears,
It consists of a body or region which corresponds with the
teeth, and two extremities or branches.
The inferior part of the body presents a thick and rounded
edge, which is the base. The upper part of the body is formed
by the alveolar cavities for receiving the teeth. The line of
union between the halves, being called the symphysis, is marked
in front by an elevated ridge, terminated below by the ante-
rior mental tubercle a triangular rising. In many subjects
this tubercle is bounded on each side by a rounded prominence
of bone, which gives to the forepart of the jaw an unusual
squareness in the living subject. Just above the latter promi-
nence, there is, on each side, a transverse depression, from
which arises the levator muscle of the lower lip. On a line
with this depression, and removed a little distance from its ex-
THE FACE. 147
ternal extremity, under the interstice between the second small
and the first large molar tooth, is the anterior mental or maxil-
lary foramen, the termination of a large canal in either side of
the bone, and which conducts the inferior maxillary blood ves-
sels and nerve to the teeth. The foramen is directed obliquely
upwards and backwards, and transmits the remains of these
blood vessels and the nerve to the face. The chin is that part
of the bone between the anterior mental foramina. As the al-
veolar processes do not exist in early life, and in very advanced
age when the teeth are lost, the anterior mental foramen in
such cases is very near the superior margin of the bone. At
it an obtuse ridge of bone commences, and which ends in the
root or anterior edge of the coronoid process. The alveolar
processes of the last three molar teeth are placed within this
ridge, and project over the internal face of the bone.
The internal or posterior face of the lower jaw is also marked
at the symphysis by a ridge passing from the superior to the in-
ferior margin. At the lower part of this ridge is a cleft pro-
cess, the posterior mental tubercle. Below this tubercle, on ei-
ther side, is a shallow fossa, for receiving the digastric muscle.
Between the lower margin of the bone and the protuberance
occasioned by the alveolar processes of the larger molar teeth,
is an oblong large fossa, made by the pressure of the sub-max-
illary gland.
The alveolar processes form a semicircle, the extremities of
which are carried backwards with a slight divergence. The
parietes of the processes are thin, and present cutting edges.
They of course correspond, vin number and shape, with the roots
of the teeth which they have to accommodate. The anterior
ones are longer than the posterior. As a general rule, the alve-
olar processes may be said to come and depart with the teeth*,
but, when a single tooth is extracted, the alveolar cavity not
unfrequently is filled up with osseous matter, the edge of it alone
being removed. This occurs more frequently in the lower than
in the upper jaw.
The base of the lower jaw does not present many marks
worthy of attention. It should be observed, that its anterior
part is thicker than the posterior; and that sometimes, just be-
148 SKELETON.
fore the angle of the bone, we see a concavity of this edge, but
generally it is straight, or nearly so.
The extremities or rami of the lower jaw are quadrilateral,
and rise up much above the level of the body. The superior
margin presents a thin concave edge, bounded in front by the
coronoid, and behind by the condyloid process. The coronoid
process is triangular, and receives the insertion of the temporal
muscle; its base is thick, but its apex is a thin rounded point.
The condyloid process is a transverse cylindrical ridge, directed
inwards, with a slight inclination backwards, its middle being
somewhat more elevated than the extremities. It springs from
the ramus by a narrow neck. There is a concavity at the
inner fore part of its neck for the insertion of the pterygoideus
externus, and a convexity behind.
The external face of the ramus is flat, but marked by the in-
sertion of the masseter muscle. The internal face, at its lower
part, is flat and rough, for the insertion of the pterygoideus in-
ternus. At the upper part of this roughness is the posterior
mental or maxillary foramen, through which the inferior maxil-
lary vessels and nerve pass. It is partially concealed by a spine
of bone, into which a ligament from the os temporis is inserted.
Leading from this foramen is a small superficial groove, made
by a filament of the inferior maxillary nerve.
The angle of the inferior maxillary bone, formed by the
meeting of the'base and the posterior margin of the ramus, pre-
sents diversities well worth attention, at .different epochs of life,
and in different individuals. In very early life, and in very
advanced, when the alveoli are absorbed, it is remarkably ob-
tuse. In most middle-aged individuals it is nearly rectangular.
Besides which, its corner is sometimes bent outwards and some-
times inwards, increasing or diminishing thereby the breadth
of the face at its lower part.
The substance of this bone, externally, is hard and compact.
Internally there is a cellular structure, through the centre of
which runs the canal for the nerves and blood vessels. From
this canal smaller ones are detached, containing the vascular and
nervous filaments which go to the roots of the teeth. The max-
illare inferius articulates with the temporal bones, by means of
their glenoid cavities.
'THE SUTURES. 149
Remarks. — The maxillare inferius has a greater influence on the
form of the face than any other bone entering into its composi-
tion. Sometimes it is much smaller in proportion in certain in-
dividuals than in others. Sometimes its sides, being widely se-
parated, cause a great shortening to the chin, and breadth to the
lower hind part of the face. In many instances, the alveolar
processes, in front, incline obliquely over the outer circumfe-
rence of the bone, and thereby give to the chin the appearance
of receding considerably. In others, the alveoli incline over
the inner circumference, which causes the chin to project unu-
sually.
CHAPTER III.
GENERAL CONSIDERATIONS ON THE HEAD.
HAVING described the individual bones of the head, it will
now be proper to consider it as a whole.
SECT. I. — OF THE SUTURES.
Except in advanced age, the bones of the cranium and of the
face are very distinctly marked off and united by sutures.
The latter are formed by the proximate edges of the bones,
presenting a multitude of sharp serrated points, and of deep
narrow pits, by which they are brought into accurate and firm
contact. Here and there, in the sutures which unite the flat
bones of the cranium, we find not only sharp points, but com-
plete dove-tail processes of the one bone received into corre-
sponding cavities of the other. The denticulation of the sutures
is much more common, and much better marked, on the exter-
nal than on the internal surface of the cranium. On the latter,
the union of the bones is, in several instances, by a joint nearly
straight; in which case, the denticulation is almost exclusively
confined to the external table and to the diploic structure.
The Coronal Suture, (Sutura Coronalis,) so named from its
13*
150
SKELETON.
corresponding in situation with the garlands worn by the an-
cients, begins at the sphenoid bone, about an inch and a quarter
behind the external angular process of the os frontis. It in-
clines so much backwards in its ascent, that when we stand
erect, with the head in its easiest position, a vertical line,
dropped from its point of union with the sagittal suture, would
pass through the centre of the base of the cranium, and would
cut another line drawn from one meatus auditorius externus to
the other. It unites the frontal bone to the two parietal.
The Sagittal Suture (Sutura Sagiltalis) unites the upper mar-
gins of the two parietal bones, and is immediately over the divi-
sion between the hemispheres of the cerebrum. It has been
stated in the account of the os frontis, that sometimes it is con-
tinued through the middle of this bone down to the root of the
nose.
The Lambdoidal Suture (Sutura Lambdaformis) is named
from its resemblance to the Greek letter lambda, and consists
of two long legs united angularly. It begins at the posterior
termination of the sagittal suture, and continues down to the
base of the cranium, as far as the jugular eminences of the occi-
pital bone. Its upper half unites the occipital to the parietal
bones, and the lower half the occipital to the temporal bones.
The latter half is sometimes called the Additamentum Suturae
Lambdoides,
The Squamous Suture (Sutura Squamosa] is placed on the
side of the head, and unites the parietal to the temporal bone.
The convex semicircular edge of the latter overlaps the concave
edge of the former. The squamous suture is converted into the
common serrated one, where the upper edge of the angle of the
temporal bone joins the parietal. This portion is called the Ad-
ditamentum Suturse Squamosae.
The squamous mode of suture unites, likewise, the great wing
of the sphenoidal to the temporal angle of the parietal.
In the upper part of the lambdoidal suture, particularly, we
find in many skulls one or more small bones, connected to the
parietal and occipital hones by serrated margins. They are
THE SUTURES. 151
called the ossa Wormiana or Triquetra. They vary very much
in their magnitude, being in different subjects from a line to one
inch, or an inch and a half in diameter. I have seen them of
the latter size, and even larger, occupying entirely the place of
the superior angle of the os occipitis. Most commonly, but not
always, when one of these bones exists on one side of the body,
a corresponding one exists on the other. A congeries of these
bones, united successively, is sometimes found in the lambdoidal
suture; in such cases they are, for the most part, small. Com-
monly these bones consist, like the other bones of the cranium,
of two tables and an intermediate diploe, and form an integral
portion of the thickness of the cranium; sometimes, however,
they compose only the external table. M. Bertin says, that
he has seen them, also, composing only the internal table of the
cranium.
All the sutures mentioned besides the lambdoid, may exhibit,
at any of their points, the ossa Triquetra or Wormiana. I have
seen them in the coronal, the sagittal, and the squamous, but in
such cases they are small. The lambdoid unquestionably has
them most frequently. M. Bertin has seen a large square bone
at the fore part of the sagittal suture, occupying the place, and
presenting the form, of what was once the anterior fontanel: he
has also seen triquetral bones in the articulations of the bones of
the face.*
The sutures described belong exclusively to the cranium, but
there are others common to it and to the face~. The sphenoidal
suture surrounds the bone from which its name comes; the eth-
moidal suture surrounds the ethmoidal bone; the zygomatic su-
ture unites the temporal and malar bones; the transverse suture
runs across the root of the nose, and also unites the malar bones
to the os frontis. The other articular surfaces of the face de-
rive their names from the bones they unite, and do not merit a
particular attention at this time, as enough has been said in the
description of the bones themselves.
The base of the cranium is remarkably different, in the man-
ner of its articulations, from the upper part. The surface, in
the first place, is very rugged, and much diversified by its con-
* Berlin, loc. cit.
152 SKELETON.
nexion with muscles and bones: besides which, there is a con-
siderable number of large foramina and fissures in it for the
blood vessels and nerves. To guard against the weakness
arising from the latter arrangement, nature has given a very in-
creased thickness to the base, particularly where much pressure
from the weight of the head exists, and has applied unusually
broad surfaces of bone to each other to secure them from dis-
placement by concussion, and different kinds of violence. These
arrangements are particularly manifest at the junction of the
cuneiform process of the occipital bone with the body of the
sphenoid, which, in middle age, is anchylosed; — at the lower
part of the lambdoidal suture; — and at the margins of the pe-
trous portions of the temporal bones where they touch the con-
tiguous bones. Whence it results that the several fastenings of
the base of the cranium, and also of the upper maxilla, are so
complete and strong, that they are most generally perfectly ex-
empt from dislocation; and when the violence offered to them
is sufficiently great, the bones, in place thereof, are fractured.
The use of the sutures, in the cranium and upper maxilla, is
somewhat problematical; for as none of the bones move, the
head might have been equally well arranged by being made of
a single piece. In proof of which it is only necessary to recol-
lect, that in the very aged there is frequently not a bone of the
cranium and upper maxilla to be found in an insulated state:
they are all fused into the adjoining bones, by the obliteration
of their sutures. The old notion that sutures existed for the
purpose of arresting the course of fractures, and for opening in
some diseased conditions of the brain, has been very justly ex-
ploded. We know lhat a fracture will traverse a suture readily,
and that the opening of the sutures from hydrocephalus is an
occurrence only of very early infancy, where the sutures have
not arrived at the serrated and dove-tail arrangement, by which
they are subsequently secured. It is much more probable that
the true reason for the existence of sutures, is found among the
laws peculiar to the growing state; and which most commonly
are suspended after the several developments have been accom-
plished. Thus, the head, in consequence of being separated by
sutures into many pieces, is more readily wrought from its form
and size in the embryo state, to the form and size required by
THE SUTURES. 153
adult life. This necessity of subdivision into many pieces, does
not depend so much on the size, as on the shape of the head.
For we find the largest animal, as the elephant, having no
more sutures than the smallest, as the mouse. This opinion is
also sustained by what we see in other bones. Bones of a
very simple shape, as those of the tarsus and carpus, consist
from the very beginning of but one piece. But where the
shape of a bone is complicated, we find it, while growing,
submitted to the same law as the head at large, and consisting
of many pieces. In such cases these pieces are united by a
species of suture corresponding precisely with the form of su-
ture observed between some of the bones of the cranium; as,
for example, between the occipital and the sphenoid. Thus,
the os femoris, till adult age, consists of five pieces: its two ar-
ticular extremities, its body, its trochanter major, and its tro-
chanter minor. The cranium itself, before birth, and for some
time after, has several of its individual bones consisting each
of two or more pieces, which favours still more the idea.
Some persons think that the sutures of the adult are only re-
mains of an arrangement intended exclusively for the benefit»of
the partarient state, by maintaining a plasticity of the head of
the foetus, which admits of its diameters accommodating them-
selves to the diameters of the pelvis of the mother. This the-
ory is rather too exclusive, though it may be admitted that the
sutures in a foetal head have that use, and are in some cases of
parturition a most fortunate coincidence, by which the lives of
both parties are saved. But it should be observed that in a
great number of cases, the head of the foetus never changes its
form in passing through the pelvis, because the passage is quite
large enough without it; and, again, if the sutures were intend-
ed expressly for the parturient state, we ought not to find them
in birds, and in such animals as are hatched, because the ne-
cessity for them there does not exist.*
Upon the whole we may safely conclude, that the sutures of
the cranium and face are simply a provision for the growing
state, and that, like all other provisions for this state, it also
ceases at its appropriate period, and sometimes leaves not a ves-
* A gentleman whose anatomical writings have some vogue in this country,
has cut the Gordian knot, by telling us that they are " accidental merely, and of
little use!! "—Anat. of the Human Body, by John Bell, Surgeon, Edinburgh.
154 SKELETON.
tige of its existence. Occasionally, indeed, we find the latter
to have occurred in one or more sutures, even before the age
of puberty, as I have repeatedly witnessed of the sagittal, the
squamous, and the lambdoidal sutures.
The manner in which the sutures are formed is sufficiently
interesting: they are generally said to be made by the radii of
ossification, from the opposite bones meeting and passing each
other, so as to form a serrated edge. This explanation may
account partially for the shape of the edge of the sutures, but
not for their invariable position; inasmuch as we always find
the sutures in the same relative situation, and having the same
course. If they depended exclusively on so mechanical a pro-
cess, as the rays of one bone shooting across the rays of ano-
ther by their own force, we ought to find, occasionally, the sa-
gittal suture more on one side of the head than on the other,
and not straight, because in some instances ossification is a
more rapid process on one side than on the other. Moreover,
in all cases where bones arise from different points of ossifica-
tion, and meet, the serrated edge should be formed; and parti-
cularly in the flat bones. Observation, however, proves that
the os occipitis, which is formed originally from four points of
ossification, and therefore has as many bones composing it in
early life, does not present these bones afterwards united by the
serrated edge. The acromion process of the scapula, though
originally distinct from the spinous, never unites to it by suture,
but always by fusion. The mode of junction in the three bones
of the sternum is always by fusion. In short, the observation
holds good in numerous other instances.
Berlin and Bichat, reject fully the mechanical doctrine con-
cerning the sutures, and present one founded upon reason and
observation, and susceptible of confirmation by any accurate
observer. The dura mater and the pericranium, before, ossifica-
tion commences, form one membrane consisting of two laminas.
Partitions pass from one of these laminae to the other, which
mark off the shape, or constitute the mould of the bones long
before they are perfected. The peculiar shape of the bony
junction, or, in other words, of the sutures or edges of the bones
in adult life, depends, therefore, exclusively upon the original
shape of the partitions. When the latter are serrated, the points
THE SUTURES. 155
of ossification will fill up these serrse; but when they are oblique,
the squamous suture will be subsequently formed.
This theory also accounts for modes of junction intermediate
to the squamous and serrated suture ; for the formation of the
ossa Triquetra or Wormiana ; for their existence, form, size, and
number, in some skulls, and their total absence in others. The
inference will also be obvious, that in all ossifications from dif-
ferent nuclei, a suture will not be formed, where the membra-
nous partitions do not exist ; but that the bones will unite after
the manner of such as are fractured. We shall also understand,
that when these partitions are weak and imperfect, either from
their congenital condition, or from advanced age, as happens in
all sutures, but with some differences of time, the bones of the
opposite sides are fused together completely.
The partitions which determine the places of the sutures, may
be demonstrated in a young adult skull by removing with mu-
riatic acid the calcareous portion of the bones, so as to leave
only the animal part. On opening the sutu/e after this process,
it will be seen, that the pericranium sends in its partition, which
is met by the partition coming from the dura mater. Or, if
either of these membranes be peeled off, its contribution of par-
tition will appear very plainly projecting from its surface, in
the form of a ridge.
Owing to congenital hydrocephalus, the sutures of the vault
of the cranium have been known to remain open for years after
birth, from the continued augmentation of the volume of the
brain. In such cases additional bones are sometimes formed,
manifesting a strong attempt, on the part of nature, to cover the
brain with bone. I obtained, some years ago, a specimen of
this kind belonging to a foetus of nine months, whose head was
as large as it is commonly in adult life, and in whom there were
two ossa parietalia on one side. Morgagni,* whose authority
is proverbial in morbid anatomy, states, that a learned colleague
and intimate friend of his, Bernardin Rammazzani, aged seven-
ty, had the sutures open at that period of life. He does not say
at what time this condition of them appeared. I think it more
probable that they had never been closed, though Morgagni
* Causes and Seats of Disease, Letter 3d, Art. 8th.
156 SKELETON.
leaves the reader to infer, that it was a circumstance which had
arisen from a violent hemicrania, with which the patient had
been seized when he was advanced in life. Diemerbroek found,
in a woman of forty, the anterior fontanel not ossified. Bauhius'
wife, aged twenty-six, had the sutures not yet closed. Indeed,
there is no deficiency of well authenticated similar instances,
more of which it will be unnecessary to adduce. It may be ob-
served here, that when from congenital hydrocephalus, attended
with much extension of the brain, the bones of the cranium are
compelled to grow beyond their usual diameters, they are un-
commonly thin, and the diploic structure is very imperfectly
developed : which will account for their separation at any period
of life, from the fastening being so slight.
SECT. II. OF THE DIPLOIC STRUCTURE OF THE CRANIUM.
The bones of the cranium, in the adult, consist of an external
and of an internal table; united by a bony reticulated or cellu-
lar substance, which does not manifest itself very distinctly till
two, three, or even more years are passed, by the infant. The
internal table of the skull is thinner and more brittle than the
external, and has obtained, from that cause, the name of vitreous
table.
The cells of the diploic structure are not to be confounded
with the large sinuses that exist in the frontal, the temporal, and
the sphenoidal bones. They are formed under different circum-
stances, and do not communicate with them. The sinuses are
lined by a mucous membrane, whereas the lining membrane of
the cells of the diploe corresponds with the internal periosteum
of other bones. I have a preparation now before me, in which
the diploic structure of the os frontis exists between its sinuses
and the external table of the bone: in the same head, a similar
circumstance existed in regard to the temporal bone; from which
we infer that the diploic structure, in these places, is caused to
recede, and even to be partially obliterated, when the develop-
ment of the sinus commences, which is not until some time af-
ter the evolution of the diploic structure. The sphenoidal bone,
when fully evolved in its body, is a remarkable instance of the
recession of diploic structure for the purpose of forming a sinus.
STRUCTURE OF THE CRANIUM. 157
In the diploe of the dried bones, several arborescent channels*
may be seen by the removal of the external table. They were
discovered about the year 1805, by M. Fleury, while he was
Prosecteur at the School of Medicine in Paris: and engaged, at
the instigation of the venerable Chaussier, in some inquiries re-
lative to the structure of the cranium. The account given by
the latter is, that these channels are occupied in the recent sub-
ject, by veins, which, like all others, are intended to return the
blood to the heart. These veins are furnished with small
valves, have extremely thin and delicate parietes, and commence
by capillary ramifications, coming from the different points of
the vascular membrane, which lines the cells of the diploe.
Their roots are at first extremely fine and numerous, form by
their frequent anastomoses a kind of net-work, and produce by
their successive junction, ramuscules, branches, and large trunks,
which, becoming still more voluminous, are directed towards
the base of the cranium. Some variations exist in regard to the
number, size, and disposition of these trunks; but generally one
or two of them are found on either side of the frontal bone, two
in the parietal bone, and one on either side of the occipital bone.
Anastomoses exist between these several trunks> by which the
veins In the parietal bone are joined to those in the frontal and
in the occipital. Branches from the right side of the head also
anastomose with some from the left side. Besides the branches
already mentioned, one or two smaller than the others are di-
rected towards the top of the head, and terminate in the longi-
tudinal sinus.
The descending veins of the diploe communicate in their pas-
sage with the contiguous superficial veins, and empty into them
the blood which they receive from the several points of the di-
ploe. These communications are passed through small fora-
mina, which penetrate from the surface of the bone to the diploe.
The trunks of such diploic veins as are continued to the base of
the cranium, open partly into the sinuses of the dura mater, and
partly into the venous plexus at the base of the pterygoid apo-
physes of the sphenoid bone, and form there the venous commu-
nications through the foramina of the base of the cranium, called
* Chaussier, Exposition de la Structure de 1'Encephale. Paris, 1807.
VOL. I.— 14
158 SKELETON.
the emissaries of Santorini. Moreover, there are communica- ,
tions sent from the diploic veins, through the porosities of the
internal table of the skull, to the veins of the dura mater. This
fact is rendered very evident by tearing off the skull-cap, when
the surface of the dura mater will be found studded with dots of
blood, and the internal face of the bone also, particularly in apo-
plectic subjects. It appears, indeed, that the arteries of the
cranium are principally distributed on its external surface, and
the veins on its internal surface and diplo£.
In the infant, the diploic veins are small, straight, and have
but few branches: in the adult, they correspond with the descrip-
tion just given, and, in old age, they are still more considerable,
forming nodes and seeming varicose. In children, when the bones
are diseased, they partake of the latter character. In order to
see them fully, the external table of the skull must be removed,
both from its vault and base, with a chisel and mallet. This
operation will be much facilitated by soaking the head pre-
viously in water for two days.
SECT. IIT. THE INTERNAL SURFACE OF THE CRANIUM.
The points for study in viewing the cranium as a whole, are
generally the same as have been presented in the detail of each
bone. It is, nevertheless, useful to regard the structure in its
connected state, as new views are thus presented of the rela-
tive situation of parts, and of the formation of the several fossae
and cavities.
The cavity for containing the brain is regularly concave
above, and is there called the arch or vault; but below, it is di-
vided into several fossae, and is called the base.
The whole cavity is lined by the dura mater, and, in the adult,
presents round superficial depressions made by the convolutions
of the brain. These depressions are seldom deep enough to pre-
vent the internal periphery of the vault and sides of the crani-
um, from being nearly parallel with their external surface.
On the Vault, or arch, are to be seen, on the middle line, the
frontal spine, extending from the ethmoid bone halfway or more
up the os frontis: also, the gutter for the longitudinal sinus lead-
ing from this spine along the sagittal suture, and terminating at
SURFACE OF THE CRANIUM. 159
the internal occipital protuberance. On either side of this gut-
ter are the arborescent channels, made by the great middle ar-
tery of the dura mater. In this section, we also see the inter-
nal face of the os fronlis, excepting its orbitar processes; the
parietal bones; and the superior fossae in the occipital bone, for
the posterior lobes of the cerebrum.
The Base of the cranium internally presents a very unequal
surface, abounding in deep depressions, processes, and foramina.
On its middle line, extending from before backwards, the follow-
ing objects should be remarked. The foramen coscum at the
front of the crista galli; and, at either side of the latter, the eth-
rnoidal gutter, perforated with holes. These gutters are bound-
ed, laterally, by the internal margin of the orbitar processes of
the os frontis, and behind by the sphenoid bone. At the fore
part of the gutter is the oblong foramen for transmitting to the
nose the internal nasal nerve, and about half an inch behind this
foramen, in the suture, with the os frontis, is the inner orifice
of the foramen, called the anterior internal orbitar, which leads
the same nerve from the orbit. Immediately behind the ethmoi-
dal fossae the sphenoid bone presents a plane surface, upon which
are placed the olfactory nerves and the contiguous part of the
brain. Behind this plane is the fossa, running from one optic
foramen to the other, for lodging the optic nerves. Behind this,
again, is the sella turcica or pituitary fossa, bounded at its two
anterior angles by the anterior clinoid processes, and behind by
the posterior clinoid process. Posterior to the latter is a plane
square surface of the sphenoid bone, continuous with the inter-
nal surface of the cuneiform process of the os occipitis. On
the latter is the depression called basilar gutter, for receiving the
medulla oblongata, and which is bounded below by the great
occipital foramen. From this foramen to the internal occipital
protuberance, proceeds the inferior limb of the occipital cross.
On both sides of the ethmoidal bone is a convex surface ; called,
however, the anterior fossae of the base of the cranium, and
formed by the orbitar processes of the os frontis and the little
wings of the sphenoid bone, for lodging the anterior lobes of the
brain. This surface is terminated behind by the rounded edge
of the little wings, which is received into the fissure between the
160 SKELETON.
anterior and middle lobes of the brain. Just anterior to this edge
is the fronto-sphenoidal suture.
On the sides of the sella turcica are the middle fossae of the
base of the cranium. They are very wide externally, where
they are bounded by the squamous portions of the temporal bones,
but narrow internally, where they are bounded by the Sella
Turcica. The little wings of the sphenoidal bone terminate
them in front, and form there a crescentic edge hanging over
their cavity. Their posterior margin is the superior ridge of
the petrous bone. This bone is placed very obliquely, inwards
and forwards, and its point almost reaches the posterior clinoid
process. At the anterior part of the fossa is the sphenoidal
fissure or foramen, of the sphenoidal bone. Just above the
base of this fissure is the foramen opticum, partially concealed
by the anterior clinoid process. Just below the base of the fis-
sure is the foramen rotundum. At the point of the petrous
bone, by the side of the posterior clinoid process, is the in-
ternal orifice of the carotid canal. On a line with the latter,
exteriorly, is the foramen ovale. Two lines behind the latter
is the foramen spinale. The groove formed by the middle arte-
ry of the dura mater, may be traced from the foramen spinale
along the anterior margin of the squamous bone. Near the
upper part of this bone the groove bifurcates; the larger chan-
nel runs upwards into a groove on the tip of the great sphe-
noidal wing, into the principal groove of the parietal bone,
which commences at the temporal angle of the latter. The
smaller groove runs horizontally backwards, and just above
the base of the petrous bone is continued also into the parietal
bone. On the front of the petrous portion may be seen the
hiatus Fallopii. The sphenoidal suture runs through these fossae,
in the examination of which, the reception of the spinous pro-
cess of the sphenoid bone, between the squamous and petrous
portions of the temporal, will be readily understood.
On each side of the foramen magnum occipitis are the two pos-
terior fossas of the base of the cranium, formed by the posterior
faces of the petrous bones, the angles of the mastoid portions of
the temporal bones and by that surface of the occipital bone be-
low its horizontal ridges. These two fossae are very partially se-
SURFACE OF THE HEAD. 161
parated by the inferior ridge of the occipital cross. The lambdoi-
dal suture traverses these fossae. At the junction between the
petrous bone and the basilar process of the occipital, in the course
of the suture, is a groove for the inferior petrous sinus. The
groove conducts to the posterior foramen lacerum, which has a
small part separated from it by the little spine of the petrous bone,
which, with the assistance of the dura mater," forms a distinct
foramen for the eighth pair of nerves. The posterior foramen
lacerum beingcommon to the temporal and occipital bones, is oc-
casionally much larger on the right than on the left side: in
which case, the groove that leads from it along the angle of the
temporal bone, the inferior corner of the parietal, and the hori-
zontal limb of the occipital cross, is also larger. Above the fo-
ramen lacerum are the meatus auditorius internus and the inter-
nal orifice of the aqueduct of the vestibule. Between the foramen
lacerum and foramen magnmn occipitis is the anterior condyloid
foramen. The two posterior fossae of the base of the cranium
contain the cerebellum.
SKCT. IV. — OF THE EXTERNAL SURFACE OF THE HEADi
Anatomists, of modern times, consider the external surface
of the head as forming or representing three ovals and two
triangles each of which constitutes a region. The first oval is
the whole superior convex part of the cranium ; or, in other
words, the external surface of its vault. The second oval is
formed by the inferior surface of the cranium, and of the face.
The third oval -is formed by the lower front part of the os fron-
tis, and by the face. Each side of the head forms one of the
triangular regions.
The superior region is so simple, and its parts have been so
closely sketched, that it is unnecessary to repeat the descrip-
tion.
The inferior region or oval, extends from the chin to the oc-
cipital protuberance, and is bounded in its transverse diameter
by the superior semicircular ridges of the os occipitis, by the
mastoid processes, and by the rami and base of the lower jaw.
This surface is subdivided into Palatine, Guttural, and Occipital
sections or regions.
The Palatine region or section, is formed by the superior
14*
162 SKELETON.
maxillary and palate bones, above, and by the inferior maxil-
lary bone, laterally and below. It is a deep fossa, the circum-
ference of which is represented by the letter U, the open part
being behind. The whole upper surface of the palatine region,
presents a number of small rough elevations and fossa?, for the
attachment of the lining membrane of the mouth. The surface
is divided into two equal parts by the long or middle palate su-
ture, which is crossed at its posterior part by the transverse
palate suture. The posterior margin of the hard palate is con-
cave on each side of the mouth; and from it is suspended the
soft palate. The point in the centre of this margin gives ori-
gin to the azygos uvula? muscle.
The foramina on this surface, are the anterior palatine or
foramen incisivum, in the long palate suture just behind the in-
cisor teeth, and on either side, behind, between the palate and
pterygoid process of the palate bone,, bounded exteriorly by the
upper maxillary, is .the posterior palatine foramen. About one
or two lines behind this, is another foramen, in the base of the
pterygoid process of the palate bone, through which pass fibril-
la?, of the same nerve that occupies the posterior palatine fora-
men. The posterior palatine foramen also transmits an artery
to the soft palate, the mark of whose course may be seen at the
base of the alveolar processes for the molar teeth.
The depth of the palatine fossa depends on the state of the
teeth. When they are removed by old age, and the alveolar
processes also, what wras palatine fossa is almost a plane sur-
face; and in many instances of extreme old age, entirely so,
excepting the part formed by what remains of the lower jaw.
The separation from the nose is, also extremely thin, and not
unfrequently imperfect. The transverse diameter of the mouth
is much decreased, in consequence of the absorption of the al-
veolar processes taking place, from the outside towards the in-
side.
The internal surface of the lower jaw has been sufficiently
described in the account of that bone.
The Guttural, Region of the base of the head is formed by the
cuneiform process of the os.occipitis, in the centre; by the infe-.
rior face of the petrous bones, laterally and behind; by the body
and great wing of the sphenoid bone, laterally and in front;
nnd by the several bones contributing to the orifice of the pos-
terior narcs.
SURFACE OF THE HEAD. 163
It is bounded anteriorly by the pterygoid fossae and openings
of the nose, and behind by the mastoid and condyloid processes.
It consists, consequently, in one part, which is horizontal, and in
another, which is vertical. In regard to the horizontal portion,
its inequalities, processes, and fossae, have been already stated.
The relative position of its foramina, cannot, however, be studied
except in the united bone. The following rules will afford
some assistance in determining their position, even on the liv-
ing body.
A line passing from the anterior margin of one mastoid pro-
cess to the corresponding point of the other, will subtend the
stylo-mastoid foramina, and the posterior margin of the foramina
lac-era; it will also touch the base of the styloid processes, and
cut into halves the condyl.es of the occiput. A line, three-eighths
of an inch in advance of this, run through the middle of the
meatus auditorius externus, will indicate the posterior margins
of theglenoid cavities,* and cut in half the inferior end of the ca-
rotid orifices or foramina, and touch the anterior margins of the
anterior condyloid foramina. Another line, one fourth of an inch
in advance of the latter, will cut through the centre of the gle-
noid cavity, and subtend the styloid process of the sphenoid
bone, and the bony orifice of the Eustachian tube in the tempo-
ral bone. A line passing between the external ends of the tuber-
cles of the temporal bones, will subtend the foramina ovalia and
the foramina lacera anteriora. The foramen spinale is about
equi-distant from the last two lines.
The foramen lacerum anterius, being at the point of the pe-
trous bone, is occasioned by the latter not filling up the space
between it and the sphenoidal and occipital bones. The de-
ficiency is supplied, in the recent state, by cartilage. Precisely
opposite to the point of the petrous bone, is the posterior orifice
of the foramen pterygoideum, from which emerges the pterygoid
nerve, and penetrating this cartilage immediately divides into
two branches: one going to the carotid canal, and being one of
the roots of the Sympathetic nerve; and the other, ascending
into the cranium, becomes the Vidian nerve or superficial pe-
trous.
The vertical portion of the Guttural Region presents the pos-
* By glenoid cavity is here meant the whole of the depression in the temporal
bone, and not merely the surface for the contlyle of the lower jaw.
164 SKELETON.
terior orifices of the nostrils, separated from each other by the
vomer. On each side are the pterygoid processes of the sphe-
noid bone, and above is its body. The pterygoid fossa, formed
between the external and internal process, and the long unci-
form termination of the latter with the broader and shorter ter-
mination of the former, will also be observed.
The Occipital region of the base of the head, placed imme-
diately behind the other, may be considered to include the mas-
toid processes, and the foramen magnum occipitis, and to be
bounded behind by the tuber of the occiput and its superior
transverse ridges. Its marks have been sufficiently dwelt upon,
in the description of the os occipitis.
The third oval will be described in detail in a short time.
On the side of the head, where we consider the triangular
region to exist, the arch formed by the malar bone and the zy-
gomatic process of the temporal, forms a very conspicuous
feature. The anterior abutment of this arch is formed by the
greater part of the malar bone, and a considerable portion of
the malar process of the superior maxillary. The posterior
abutment is formed by the root of the zygomatic process of the
temporal bone. Its superior margin is thin, for the insertion
of the temporal aponeurosis : the inferior margin is thick, and
is divided, by a projection in its middle, into an anterior and a
posterior surface, marking the origins of the two portions of the
masseter muscle. There is a very considerable vacancy be-
tween the zygoma and the side of the head, occupied by the
coronoid process of the lower jaw, the temporal and the exter-
nal pterygoid muscles. The coronoid process is just within
the zygomatic arch, and the tip rises three or four lines above
its inferior margin.
The large depression within the zygoma is the temporal fossa.
All that portion of the side of the head beneath the ridge lead-
ing from the external angular process of the os frontis, and run-
ning along the surface of the parietal bone, is tributary to the
temporal fossa. The bones, therefore, which form it, are the
frontal, the parietal, the temporal, the great wing and the ex-
ternal pterygoid process of the sphenoid bone, and the posterior
face of the superior maxillary and malar bones. The arrange-
NASAL CAVITIES. 165
ment of the squamous suture is well seen in this fossa, also the
junction of the pterygoid bone with the parietal and frontal, by
the overlapping of the great wing of the former. At the inferior
part of the latter, is the pointed process, from which one head
of the external pterygoid muscle arises.
At the bottom of the temporal fossa there is a narrow slit
partitioned from the nose by the nasal plate of the palate bone.
This slit, from its position, is called the Pterygo-maxillary fossa.
It is triangular, the base being upwards and the point down-
wards. The base reaches to the bottom of the orbit. From
the base there leads into the nose the spheno-palatine foramen
for transmitting the lateral nasal nerve and blood vessels. Ex-
ternally to this foramen, and somewhat above it, is the foramen
rotundum for the upper maxillary nerve. On a level with the
spheno-palatine foramen, and running horizontally through the
base of the pterygoid process, is the pterygoid foramen for the
nerve of the same name. Running vertically downwards from
the point of the pterygo-maxillary fossa, is the posterior pala-
tine canal for transmitting the nerve and artery of the same
name. The upper part or base of the pterygo-maxillary fossa,
is continuous with a large fissure in the bottom of the orbit
called the spheno-maxillary.
SECT. V. OF THE NASAL CAVITIES.
The nose consists of two large cavities or fossae, in the mid-
dle of the bones of the upper jaw, and has a very irregular sur-
face. Its cavities are separated from one another by a vertical
septum, consisting in the vomer and in the nasal lamella of the
ethmoid bone. This septum presents a surface which is per-
fectly prlane, with the exception, that in some subjects it is
slightly convex on one side, and concave on the other. It is
deficient in front.
The upper part of either nostril is formed by the cribriform
plate of the ethmoid bone ; in front of this the surface is very
oblique, being made by the os nasi; posteriorly there is a ver-
tical gutter on the body of the sphenoid bone, in the middle of
which is the orifice of the sphenoidal cell. The distance be-
tween the cellular part of the ethmoid and the septum nasi is
106 SKELETON.
not more than three lines. The double row of foramina in the
cribriform plate is very well seen, also the foramen at its ante-
rior part for transmitting the nasal branch of the ophthalmic
nerve; the groove formed by the latter on the posterior face of
the os nasi is also very distinct.
The bottom of either nostril, called its floor, is formed by the
palate process of the superior maxillary and palate bones; it is
somewhat concave, and about half an inch wide; its width, how-
ever, is not uniform, as it is sometimes wider or narrower in
front than it is in the middle. In it is seen the upper orifice of
the foramen incisivum at the anterior point of the vomer.
The external or orbitar surface of the nasal cavity is very ir-
regular, presenting a number of projections and fossoe3 over
which the Schneiderian membrane is displayed. It is formed
by the upper maxillary, the ethmoid, the unguiform, the palate,
the nasal, the lower spongy, and the sphenoid bones. In the
middle of the posterior part of the ethmoid is the upper meatus
of the nose, a deep fossa, bounded above by the cornet of Mor-
gagni, and receiving the contents of the posterior ethmoidal
cells, by one or more orifices. At the posterior termination of
this fossa is the spheno-palatine foramen. The middle spongy
bone forms the lower boundary of the ethmoid ; between it and
the lower spongy or turbinated bone, is the middle meatus of
the nose, a fossa of considerable size, but of unequal surface.
At the fore part of the middle meatus is a vertical projection,
formed by the ductus ad nasum and lachrymal fossa. Just
behind this ridge, is an interval between it and the anterior
part of the ethmoid, through which the os uriguis may be seen.
When the middle spongy bone is broken off, immediately be-
neath its anterior part a channel obliquely vertical, is seen in
the ethmoid, which leads to the frontal sinus, through the an-
terior ethmoidal cell. This cell, from its peculiar shape and
function, is called infundibulum. Behind this oblique channel
is another oblique channel, parallel, but smaller; in which seve-
ral orifices may be found of the anterior ethmoidal cells. The
anterior channel has, indeed, for the ethmoidal cells other ori-
fices besides the infundibulum, which are smaller, and below
the latter. It is bounded, in front, by a sharp, thin ridge of the
ethmoid, the lower extremity of which contributes to close the
large opening into the sinus maxillare.
ORBITS OF THE EYES. . 167
Commonly about the middle of the middle meatus of the nose,
but varying very much in different subjects, is the orifice of the
sinus maxillare, or antrum Highmorianum. Its precise situa-
tion and direction are so very uncertain, that its orifice is found
with some difficulty in the fresh state, in great numbers of per-
sons. Not unfrequently I have seen this orifice high up, under
the anterior extremity of the middle spongy bone.
The inferior meatus of the nose is bounded above by the
lower spongy bone, and below by the palate processes. It ex-
tends the whole length of the nostril. At the anterior part of4
this meatus above, is the orifice of the ductus ad nasum, which
communicates with the orbit of the eye.
The nostril presents an increased width, anterior to the points,
where the spongy bones cease: this space is bounded on the
orbitar side by the nasal bone, and the nasal process of the
upper maxillary. There is an increase of transverse diameter
also at the posterior part of the nostril, behind the points where
the spongy or turbinated bones cease. This space is bounded
externally by the nasal plate of the palate bone, and by the in-
ternal pterygoid process.
The posterior nares, or orifices of the nostrils, are oval, and
are completely separated by the posterior margin of the vomer.
In the dried skeleton, on the contrary, the anterior nares have
a common orifice, from the deficiency of the bony septum be-
tween them.
SECT. VI. ORBITS OF THE EYES.
The orbits of the eyes are the conoidal cavities in the face,
presenting their bases outwards and forwards, and their apices
backwards; so that the diameter of either orbit, if continued,
would decussate that of its fellow in the pituitary fossa or sella
turcica. Seven bones form the orbit, the os frontis, the os
malse, the os maxillare superius, the os planum, the os un-
guis, the os sphenoides, and the os palati. Its cavity is some-
what quadrangular, besides being conoidal. The angles are
particularly well marked, in most subjects, at its base or ori-
fice; which resembles an oblong, having its long diameter in
some persons placed almost horizontally, and in others oblique-
168 SKELETON.
ly downwards and outwards. Immediately within the orifice
the cavity is enlarged, owing to the projection of the orbitary
ridge of the os frontis, and the elevation of the anterior inferior
margin of the orbit, so that the greatest diameter is there ra-
ther vertical than horizontal. From this point the orbit de-
creases gradually in size to the sphenoidal fissure, or the supe-
rior foramen lacerum of the orbit which forms its apex. The
internal walls of the two orbits are nearly parallel, in conse-
quence of the cuboidal figure of the os ethmoides, which is
placed between them.
The superior face or roof of the orbit is triangular and con-
cave : it is very thin, and presents but a slight septum between
the eye and the brain. Almost the whole of it is formed by the
orbitar process of the os frontis, its point only being made by
the little sphenoidal wing. The depression for the lachrymal
gland, at its external anterior part, is very perceptible. The
trochlea for the superior oblique muscle of the eye, is also well
seen about three-quarters of an inch above the point of the in-
ternal angular process of the os frontis. Just at the outer side
of this depression is the foramen or notch for the frontal artery
and nerve. The optic foramen may be seen, very readily, pass-
ing through the little wing of the sphenoid bone.
The inferior face, or the floor of the orbit, is also triangular
and concave, and is formed by the orbitar process of the upper
maxillary bone principally; being assisted, however, at its an-
terior external margin, by a portion of the malar bone; and, at
its point behind, by the orbitar process of the palate bone. The
latter cannot be seen very distinctly in the articulated bones,
owing to its great depth in the orbit; but, when the external
side of the orbit is removed with a saw, its position is placed in
an interesting light. The floor of the orbit is thinner than its
roof, and forms a very slight separation from the maxillary sinus.
It is terminated behind by the spheno-maxillary fissure, or in-
ferior foramen lacerum of the orbit; a large slit, which, com-
mencing at the base of the sphenoidal fissure, separates the great
wing of the sphenoidal bone from the ethmoidal, the palate, and
the upper maxillary bones. This fissure runs obliquely out-
wards, so as to have its external extremity terminated by the
malar bone. Near the external extremity is seen the com*
THE FACE. 169
mencement of the infra-orbitar canal, for transmitting the su-
perior maxillary nerve and artery.
The external face of the orbit is also triangular, and very ob-
lique. It is formed by the malar bone, and by the orbitar face
of the great sphenoidal wing. It is defined below by the spheno-
maxillary fissure, and above by the suture which unites the
frontal to the malar, and to the great wing of the sphenoidal
bone. It is terminated, at the apex of the orbit, by the sphe-
noidal fissure.
The internal face of the orbit is an oblong square, nearly
parallel, as mentioned, with the corresponding face of the other
orbit. It is formed principally by the orbitar face of the eth-
moid, called the os planum, but at the apex of the orbit a small
portion of the body of the sphenoid bone contributes to it, and
anteriorly is the os unguis. It is bounded behind by the sphe-
noidal fissure, in front by the lachrymal ridge on the nasal pro-
cess of the os maxillare superius, and above and below by the
upper and lower ethmoidal sutures. In the upper of these su-
tures there are generally two, sometimes three, foramina, the
anterior of which transmits an artery, a vein, and a nerve, to
the nose ; the posterior transmits, also, an artery and a vein to
the same.
The lachrymal fossa is well worthy of attention: it is seen to
commence small at the upper part of the os unguis, and to in-
crease in size till it is formed into a complete canal, the ductus
ad nasum, leading to the nose, by the upper maxillary and the
inferior spongy bones. The direction of the canal is almost ver-
tically downwards, inclining very slightly backwards. It was
stated, that the fossa in the fore part of the os unguis is some-
times supplanted by the increased breadth of the nasal process, a
fact of some importance to an operator for fistula lachrymalis.
SECT. VII. OF THE FACE, TOGETHER WITH SOME REMARKS ON THE
FACIAL ANGLE, AND ON NATIONAL PECULIARITIES.
The anterior oval of the head extends from the frontal pro-
tuberances to the base of the lower jaw, and from the malar
bone of one side to the malar of the other inclusively. This
oval is divided into two symmetrical or equal halves, by the
VOL. I.— 15
170 SKELETON.
vertical suture, which unites the bones of the opposite sides of
the face.
In the infant, the frontal protuberances are always well
marked, from their being the centres of ossification for the two
halves of the os frontis ; in the adult, they are frequently not
raised above the common level of the bone. The superciliary
protuberances just above the internal half of the orbitary or su-
perciliary ridges, are generally somewhat prominent, but they
vary very much in this respect in different individuals. Between
these ridges the frontal bone is sometimes raised into a vertical
elevation, continuous with the dorsum of the nose, as is more
frequently seen in young persons.
The nose, or pyramidal convexity, formed by the nasal pro-
cesses of the superior maxillary, and by the nasal bones, is con-
cave above, and extremely prominent below. The prominence
of it depends upon the development of the ossa nasi. I have
frequently seen the latter curtailed to about one-half, and even
one-third of their usual breadth, and also diminished in length;
which is followed by an unusual flatness of the nose : the pecu-
liarity had been presented to me till lately only in negroes; but,
since then, I have also met with it in the skulls of white sub-
jects: it is., however, much more uncommon in the latter. The
anterior orifice of the nose is cordiform, the base being below:
the centre of the base is marked by a rough point, called the
anterior nasal spine.
The cheek bones form, on either side of the face, a conside-
rable prominence, depending much upon the length of the ma-
lar process of the upper maxillary bones. In savage tribes, this
prominence is frequently a characteristic trait, and may depend
upon the greater development of the upper maxillary sinuses,
probably from the more frequent or more intense employment
of the organ of smelling. The elevation of the cheek bone is
always conspicuous in emaciated subjects, from the fat around
its base being absorbed.
The alveolar processes with the teeth produce, in certain sub-
jects, a very conspicuous projection in the face ; varying, how-
ever, considerably in different individuals, and in different tribes
of human beings. There is but little doubt of the organization
of some men being more coarse and animal than that of others,
THE FACE. 171
even in members of the same family. The circumstance occa-
sionally manifests itself by unusually large and long teeth, and
by alveolar processes of corresponding dimensions. Savage
nations have almost invariably this peculiarity, which is kept
up among them, not only by hereditary influence from father
to son, but also by the actual habits of the individual being pro-
ductive of, and favourable to this arrangement. It would be
interesting to know whether from their articles of food general-
ly being harder to masticate than such as are used by civilized
people, they do not contribute to, or even produce a greater de-
velopment in the organs of mastication. Analogy is in favour
of the opinion, because the arms or the legs ar6 always developed
in proportion to the vigour and frequency of the exercise to
which they are put. Ploughmen have large legs. Blacksmiths
have large arms. Persons whose habits of exercise do not call
into action any part of the body, to the exclusion of other parts,
have finer and more graceful forms than labourers. It is there-
fore, probable, that the ease and gracefulness of movement, said
to mark the polished and accomplished man of fashion, depend
upon the harmonious action of his whole frame, derived from
this proportionate development of all its parts. Besides the in-
fluence of exercise upon the organs of mastication, the passions
or faculties of the mind not unfrequently manifest themselves
there. Individuals of unusual ferocity and savageness, have
frequently large teeth and alveolar processes. The gnashing
of the teeth has, in all ages, been considered one of the most
striking signs of anger.
While speaking of these indications of man in a savage and
uncultivated state, it will be understood that I allude to such
tribes as are engaged in the chase, and in other active modes of
subsistence, and whose habits are not settled down into the agri-
cultural or pastoral condition. It is quite possible for one in the
latter situation to be equally uninstructed, on every point of
mental improvement, and to be much inferior in capacity, to one
of the former ; yet his articles of food, and the sensations and
passions in which he indulges, will give no very prominent out-
line to his face, but only mark it by the general expression of
dulness and ignorance.
The outline of the face is marked also by depressions or fossae.
172 SKELETON.
Those for the eyes and for the nose have been studied, and ar-
rest at once the attention of the most superficial inquirer. Im-
mediately below the orbits are the canine fossa3 formed in the
centre of the front of the upper maxillas. Just above the incisor
teeth of these bones are the superior incisive fossae. Below the
inferior incisor teeth, on each side, also, is the inferior incisive
fossa.
In most adults the face projects somewhat beyond the crani-
um, but there is a considerable diversity in this respect between
different tribes of human beings. Camper,* who has paid much
attention to this arrangement, has designated it under the term
of the facial angle, which he marks off by two straight lines.
One is drawn from the lower front part of the frontal bone to
the point called the anterior nasal spine at the orifice of the
nose, and between the ends of the roots of the incisor teeth of
the upper jaw; the other, from this latter point to the middle of
the rneatus auditorius externus, or thereabouts. The facial
angle is. included between these two lines. In Caucasian, or
European heads, this angle is about eighty degrees. In the
negro, or Ethiopian, it is about seventy degrees; and in the
Mongolian or copper-coloured man, about seventy-five de-
grees.
An invariable relation is established between the extent of
the facial angle, the capaciousness of the cranium, and the size
of the nasal and palatine cavities. The nearer the approach is
to a rectangle, the smaller is the cavity of the nose, and qf the
mouth, and the greater is that of the cranium, thereby mani-
festing a more voluminous and intellectual brain. On the con-
trary, the more acute that the facial angle is, the smaller is the
volume of brain, and the larger are the nose and mouth. This
is so frequently the case, that Bichat considers it almost a rule
in our organization, that the development of the organs of taste
and smell, is in an inverse ratio to that of the brain, and con-
sequently to the degree of intelligence. \
This, like other general rules, is subject to exceptions, in con-
sequence of the facial angle varying in its size, from causes
which have no connexion with the degree of development of
the brain. Thus an unusual prominence and thickness in the
* Dissertation sur les Differences du Visage chez les Hommes. Utrecht, 179L
THE FACE. 173
lower part of the os frontis, from an increased capaciousness
of the sinuses, will make the facial angle appear less acute.
The absorption of the alveolar processes, after the loss of the
teeth, will produce the same result in our measurements of the
facial angle. The heads of infants, previously to the appear-
ance and full growth of the teeth, have always the facial angle
less acute than the heads of adults: in some cases an angle of
ninety degrees is presented in them. On the contrary, a growth
of teeth, and consequently of the alveolar processes, dispropor-
tionate to the size of the body of the upper jaw, will cause the
facial angle to project very considerably even in an individual
of the Caucasian race. Similar objections may be brought
against the indications of the inferior line. The fair state of
this argument appears then to be, that the doctrine of the facial
angle, though correct in a majority of instances, has numerous
exceptions from individual peculiarities, and that there is no
race of human beings which does not present the facial angle
in all its ranges from seventy to ninety degrees,
With the view to meet such objections and establish a rule
of more uniformity, M. Cuvier has proposed to ascertain re-
sults from a vertical section, by which it appears that the Cau-
casian cranium is four times the area of the face; whereas in
the negro the face is a fifth larger in proportion.
In regard to the various configurations of the human face
and stature, depending upon habits and circumstances conti-
nued through a long succession of ages and generations, the
following views of one,* pre-eminently qualified to judge, will
not be uninstructive.
"• Although there appears to be but one human species, since
all its individuals can couple promiscuously, so as to produce a
prolific offspring, we yet remark in it certain hereditary con-
formations, which constitute what arc called races. Of them
there are three which are eminently distinct in appearance:
they are, the white or Caucasian; the yellow or Mongolian;
the negro or Ethiopian.
* Rcgne Animal, par M. Ic Chcv. Cuvier, torn, 1, p, 94. Pari^ 1817,
174 SKELETON.
" The Caucasian race, to which we belong, is distinguished
by the beautiful oval form of the head ; and it is this which has
given birth to the most civilized nations, and to those which
have generally ruled over the others. It has some differences
in the shade of the complexion, and in the colour of the hair.
" The Mongolian is known by its prominent cheek bones,
flat face, narrow and oblique eyes, straight and black hair, thin
beard, and olive complexion. It has formed vast empires in
China and Japan, and has sometimes extended its conquests on
this side of the Great Desert ; but its civilization has always
remained stationary.
The Negro race is confined to the south of Mount Atlas; its
complexion is black, its hair woolly, its skull compressed, nose
flattish ; its prominent mouth and thick lips make it manifestly
approach the monkey tribe ; the people which compose this
race have always remained in a state of barbarism.
" The race from which we are descended is called Caucasian,
because tradition and also the lineage of nations, would appear
to trace it to the group of mountains situated between the Cas-
pian and the Black seas, (on the borders of Europe,) from whence
it has radiated in every direction. The people of Caucasus, as
also the Georgians and Circassians, are considered, even at
the present day, the handsomest in the world. The principal
branches of this race are distinguishable by the analogies .of
language. The Armenian or Syrian division, directed its course
towards the south,, and has given birth to the Assyrians, the
Chaldeans, and the untameable Arabs, who, after Mahomet,
(werd very near becoming masters of the world; to the Pheni-
cians, the Jews, and the Abyssinians, which were Arabian colo-
nies; and it is very probable that the Egyptians also are de-
scended from the same source. It is from this branch, (the
Syrian,) always inclined to mysticism, that the most widely
extended religions have sprung. Science and literature have
flourished among them occasionally, but always under fantas-
tic forms, and with a figurative style.
" The Indian, German, and Pelasgic branch, is infinitely more
extended, and was divided at a much earlier period ; we, never-
THE FACE. 175
theless, recognise the greatest resemblance between its four
principal languages; which are, the Sanscrit, at present the
sacred language of the Hindoos, and mother of all the dialects
of Hindostan ; the ancient language of the Pelasgi, which is the
common mother of the Greek, the Latin, of many tongues
which are now extinct, and of almost every language spoken
in the south of Europe ; the Gothic or Teutonic, from which
are derived the languages of the North and North West, such
as the German, Dutch, English, Danish, Swedish, and their dia-
lects ; and lastly, the language called Sclavonian, from which
come those of the north-east, as the Russian, Polish, Bohe-
mian, &c.
" It is this great and respectable branch of the Caucasian
race, which has carried farthest Philosophy, the Arts and Sci-
ences, and which has been for ages the depository of them.
" This branch was preceded in Europe by the Celts, who
came from the north, and were formerly very much extended,
but are now confined to the most western parts; and by the
Cantabrians, who passed from Africa into Spain, and are, at
present, almost confounded with the numerous nations whose
posterity has been blended in this peninsula.
" The ancient Persians have the same origin with the Indian
branch; and their descendants, even at the present day, bear
the strongest marks of affinity to the European nations.
" The Scythian or Tartarian branch, first directing their
course to the north and north-east, always led erratic lives in
the vast plains of those countries: and they have only left them
to return and destroy the more comfortable establishments
of their brethren. The Scythians, who, at so remote a period
of antiquity, made irruptions into Upper Asia; the Parthians,
who destroyed there the power of the Greeks and Romans; the
Turks, who overthrew there that of the Arabs, and subjugated
in Europe the unhappy remnant of the Greek nation, were
swarms of this stock; the Philanders and the Hungarians are
colonies of it, in some measure astray among the Sclavonian
and Teutonic nations. The north and east of the Caspian Sea,
their original country, are still inhabited by people of the same
origin, and speaking similar languages; but they are there in-
termixed with an infinity of other petty nations, of different
origins and languages. The Tartar nation has always re-
176 SKELETON.
mained more unmixed in all that tract of country, extending
from the mouth of the Danube, to beyond the Irtisch, from
which they so long threatened Russia, and where they have at
last been subdued by her. The Mongolians, however, in their
conquests have blended their blood with these people, and many
traces of this intermixture are discovered, principally among
the Western Tartars."
" The Mongolian race commences to the east of this Tartar
branch of the Caucasian, and prevails thence to the Eastern
Ocean. Its branches, the Calmucks and Halkas, still nomadic
or unsettled, occupy the Great Desert. Thence have their an-
cestors, under Attila, under Genghis, and under Tamerlane,
spread far and wide the terror of their name. The Chinese
come from this race, and are not only the most anciently
civilized of it, but, indeed, of any nation yet known. A third
branch, (the Montchoux) has recently conquered China, and
continues to govern it. The Japanese and Coreans, and al-
most all the hordes which extend to the north-east of Siberia,
under the domination of Russia, belong also to it in a great
measure. If we except a few Chinese literati, the whole Mon-
golian race is universally addicted to the different sects of the
worship of Fo.
" The origin of this great race appears to have been in the
Altay Mountains,* as ours was in the Caucasian; but it is impos-
sible to follow so well the clue of its different branches. The
history of these wandering people, is as fugitive as their establish-
ments; and the records of the Chinese, from being confined to
their own empire, afford us but short and vague accounts of their
neighbouring nations. The affinities of their languages are also
but too little known to guide through this labyrinth.
te The languages of the north of the peninsula beyond the
Ganges, and also that of Thibet, bear some affinity to the Chinese,
at least, in their monosyllabic nature, and the people who speak
them are not without traits of resemblance to the other Mongo-
lian nations; but the south of this peninsula is inhabited by the
Malays, a much handsomer people, whose race and language arc
spread over the coasts of all the islands of the Indian Archipe-
* A range in the north of Asia, about 5000 miles long..
FCETAL HEAD. 177
lago, and have occupied almost all those of the Southern Ocean.
On the largest of the former, especially in the uncultivated and
savage parts, we find other men, who have woolly hair, black
complexion, and negro visage, and who are all extremely bar-
barous. The most known are the Papuas, a name by which
they may be generally denominated.
" It is not easy to refer either the Malays or Papuas, to any
one of the three great races; but can the former be plainly dis-
tinguished from their neighbours, the Caucasian Hindoos on one
side, and the Mongolian Chinese on the other? We must con-
fess that we do not find them to possess sufficient characteris-
tics to enable us to answer this question. Are the Papuas ne-
groes, who formerly straggled along the Indian Ocean? We
have neither drawings nor descriptions sufficiently clear to re-
ply to this question.
" The inhabitants of the north of the two continents, the
Samoiedes, the Laplander^, and the Esquimaux, sprung, ac-
cording to some authorities, from the Mongolian race. Agree-
ably to others, they are but a degenerate offspring of the Scy-
thian and Tartarian branches of the Caucasian race.
" It is impossible to refer, satisfactorily, the Americans them-
selves to either of our races of the old continent; and yet they
have not characteristics precise and constant enough to con-
stitute a distinct race. Their copper-coloured complexion is
not sufficient; their hair, which is generally black, and their
scanty beard, would lead us to refer them to the Mongolians,
did not their well marked features, and their moderately pro-
minent noses, oppose such an arrangement; their languages
are as innumerable as their tribes, and we have yet been un-
able to discover either any analogies among them, or with
those of the ancient world."*
SECT. VIII. OF THE DEVELOPMENT OF THE FCETAL HEAD.
The foetal head, in the very early stages of gestation, forms
an oval vesicle, constituting the greater part of the bulk of the
* On this subject, see also Lectures on the Physiology, Zoology, and Natural
History of Man, by W. Lawrence. London, 1822.
Dictionnaire des Sciences Med. tome XXI. Paris, 1817.
Histoire Naturelle de L'Homme, par Lacapede. Paris, 1821.
Blumenbach de Variet. Gen. Hum. Nat. 1794— abo Decades, 1790—1814.
178 SKELETON.
embryo, and at this period has the face scarcely visible. The
parietes of this vesicle are formed by a thin membrane, con-
sisting of two layers, the external of which is the pericranium,
and the internal layer is the dura mater. These layers adhere
so closely that they cannot be accurately separated by the
knife.
About the third month of the embryo, or even earlier, ossifi-
cation may be seen at several points of the cranium, but more
extensively about its base. These points are the centres of os-
sification, which progressively increase towards their respec-
tive circumferences, by the deposite of new bony matter.
Generally the base of the cranium begins to ossify before the
vault, and is entirely ossified at birth, with the exception of a
few parts, as the clinoid processes and the ethmoid bone.
The following nuclei of ossification show themselves between
the laminae of the foetal cranium, from the third to the fourth
month. One at the anterior part, for the centre of either side
of the os frontis; one for the centre of each parietal bone, on
the upper side of the head; one on the side of the head below,
for the squamous portion of the temporal bone; and there are
several for the occipital bone. These points extend themselves
in radii; and, as the intervals between the latter become wider
by their divergence, new radii, as observed elsewhere, are de-
posited between them. In some of the bones, the radii, from
opposite points, in the progress of ossification before and after
birth, meet and coalesce : this occurs in the os frontis and in
the os occipitis.
At birth the contiguous margins of the flat bones simply ap-
proach each other, but have not interlocked. These bones con-
sist then of but one table, the edges of which are very finely ser-
ratedj and thereby show the radii of ossification. The edges are
held together by the dura mater, internally, and the pericranium,
externally; but the fissure between them is very obvious, and so
large that it allows very readily considerable motion and the
mounting of one bone upon the other by slight pressure. It is
always to be observed that the base of the cranium is an ex-
ception to the latter rule, both from the breadth of its articulating
surfaces, and from its comparatively advanced ossification. In
parturition, therefore, the vault of the cranium, by its mobility,
is adjusted to the contoar of the pelvis, but the base does not
FCETAL HEAD. 179
yield in either of its diameters to the expulsive powers of the ute-
rus. The latter provision, however inconvenient in parturition,
is of the greatest consequence immediately afterwards; for with-
out this immobility in the base of the cranium, whenever the
weight of the head was thrown upon it, the pressure of the ver-
tebral column would drive it upwards, to the injury of the brain
and of the nerves proceeding from it. This resistance, it may
be added, is still farther assisted by the arched figure of the base
of the cranium. On this subject, it is not a little remarkable,
that even the heads of hydrocephalic foetuses have the bones
of the base fully ossified, and in contact, so as to support the
weight of the head in the vertical position.
Fontanels. — In consequence of the flat bones of the cranium
ossifying always towards the circumference, their angles, as ob-
served, being the longest radii from their centres, are the last in
ossifying. These angles are commonly incomplete at birth, and
the membranous spaces which represent them are the Fontanels.
Of these there are six, two on the middle line of the head, above,
and two on either side. The former afford highly important
indications to the midwife.
The anterior fontanel is the largest of all. It is at the fore
part of the sagittal suture, and is produced by a deficiency in
the angles of the parietal bones, and of the contiguous angles of
the os frontis. It is quadrangular or lozenge-shaped; and the
anterior angle is generally longer than the others. This is re-
markably the case, when the sagittal suture is continued down
to the root of the nose. The posterior fontanel is at the other
extremity of the sagittal suture, and as there are only three
points of bone defective there, two for the parietal bones, and
one for the occipital, this suture is triangular. In many chil-
dren, at birth, it is so far filled up as to be scarcely visible; the
three membranous sutures, however, which run into it, make
its position sufficiently discernible by the finger.
Of the two fontanels, on either side, one is placed at the an-
gle of the temporal bone where it runs up between the occipital
and the parietal. The other is in the temporal fossa, under the
temporal muscle, at the junction between the parietal and the
sphenoidal bones. These two fontanels are but little referred
to by the accoucheur in delivery, as they are irregular and in-
distinct. The pulsations of the brain may be readily felt through
180 SKELETON.
the fontanels. They ossify rapidly after birth, and are fre-
quently closed completely by the end of the first year ; but if
there be an accumulation of water in the ventricles of the brain,
they remain open for an indefinite period.
The longest diameter of a child's head is from the vertex or
posterior extremity of the sagittal suture to the chin, and mea-
sures five inches and a quarter. From the middle of the frontal
bone to the tubercle of the occipital is four inches, from one
parietal protuberance to the other is about three inches and a
half.
At birth the os frontis consists, most commonly, of two pieces,
united by the sagittal suture. The parietal bone is a single
piece, incomplete at its angles. The temporal bone consists of
three pieces: one is the squamous, the other is the petrous, and
the third is a small ring which afterwards constitutes the meatus
externus; it is deficient in styloid and mastoid processes. The
os occipitis is in four pieces: one extends from the angle of the
lambdoidal suture to the upper edge of the foramen magnum;
on either side of the foramen magnum is another, with the con-
dyle growing on it, and the cuneiform process is the fourth. The
ethmoid bone is cartilaginous. The sphenoidal bone is in three
pieces. The body and little wings, being united, form one ; the
great wing and the pterygoid process, being also united, form
on either side of the body another piece.
At birth there is a great disproportion in size between the cra-
nium and face. This disproportion diminishes in the progress
of life, by the development of the sinuses and of the alveolar
processes in the latter. At birth, indeed, there is no cavity ei-
ther in the sphenoidal, the frontal, or the upper maxillary bones;
the orbitar and the palate plates are very near each other, and
the rudiments of the teeth are hidden in the bodies of the up-
per and lower jaw bone. The latter consists of two pieces,
united by cartilage at the chin, and its angle is very obtuse.
HYOID BONE. 18 i
CHAPTER IV.
THE HYOID BONE, (OS HYOIDES, HYOIDE.)
THE Os Hyoides is placed at the root of the tongue, within
the circle of the lower jaw. It is ah insulated bone, having no
connexion with any other, except by muscles and ligaments.
It is said, very properly, to resemble the letter U, and consists
of a body and two cornua.
The body is in the middle; it is the largest part of the bone,
and forms nearly a semicircle. Its anterior face is convex, and
its upper part is flattened by the insertion of the muscles from
the lower jaw. The posterior face is concave.
The cornua, one on either side, are about an inch long, and
are placed at the extremities of the body, being united to it by
the interposition of cartilage and ligamentous fibres. They are
somewhat flattened rather than cylindrical, and diminish to-
wards the posterior extremities, where they terminate in a
round enlargement like a head.
At the cartilaginous junction of the cornu and body, on each
side, there is a small cartilaginous body three or four lines long,
fastened by ligamentous fibres. It is frequently found ossified.
This is the appendix or lesser cornu. A round ligament passes
from it to the extremity of the styloid process of the temporal
bone.
The texture of this bone is cellular, with a thin compact la-
mina externally. M. Portal says, that he has found it carious
from venereal contamination; in which case, the patient had
been afflicted with violent sore throat and purulent expectora-
tion. Sauvages and Valsalva have met with a case, where,
from luxation of the cornu, the patient spoke with great diffi-
culty. The ligament to the styloid process is, in some rare in-
stances, ossified to a considerable extent, which produces diffi-
culty in swallowing and in talking.
VOL. I.— 16
182 SKELETON.
CHAPTER V.
OF THE UPPER EXTREMITIES.
THIS portion of the skeleton is divided on either side of the
body, into shoulder, arm, fore arm, and hand.
SECT. I. OF THE SHOULDER,
The shoulder consists of-two bones, the clavicle and the sca-
pula, and occupies the superior, lateral, and posterior part of the
thorax. Its shape and position are such, that it augments con-
siderably the transverse diameter of the upper part of the trunk,
taken as a whole: while the thorax alone, at this place, is actu-
ally smaller than it is below. The clavicle is longer, in pro-
portion, in the female than in the male, which increases the
transverse extent of the shoulder, and gives a greater space on
the front of the thorax for the development of the mammas.
This coincidence between the length of the shoulder and the
development of the mamma, has been particularly noticed by
Bichat, who says that it is almost always well marked, that very
rarely a voluminous bosom reposes on a small pectoral space,
or a small bosom is found upon a large pectoral space. In the
male, on the contrary, this diameter of the trunk is increased
principally by the breadth of the scapula, which, from its posi-
tion on the thorax, and its great size, gives the bulky appear-
ance to this part. It is evident that these modifications in the
frame-work of the shoulders, are connected with the natural des-
tinations of the two sexes. In woman the length of the clavi-
cle is adverse to its strength, and it is indistinctly marked by
muscular connexions; whereas, in man it is short, strongly
marked, and large. Anatomists who are fond of extending
such comparisons, say, also, very justly, that the pubes, which
perform the same office for the lower extremities that the cla-
vicles do for the upper, that of keeping the two apart, are, in
the female, both smaller and longer than in the male; that their
shape is not so favourable to strength or locomotion, and has a
special view towards the lodgement of the genital organs, and
THE SHOULDERS. 183
to the passage of the child. In man the increased size of the
whole skeleton, and the greater development of the muscular
system, indicate that he was intended for more laborious exer-
tion than the female.
The thorax and the shoulder are connected by a reciprocal
development, both being indicative, when large, of a robust and
vigorous constitution, and when small, of a weakly one. As
both of these parts are acted on by the same muscles, the ne-
cessity of this coincidence is sufficiently apparent The height
of the shoulder depends upon the scapula alone; its elevation,
therefore, is greater in males and in vigorous persons generally,
than in females and in weakly individuals. The direction of
the shoulder is such, that the articular face of the scapula for
the os humeri, looks outwards, thereby proving that the quad-
ruped position in man is unnatural; for by it, the weight of the
fore part of the trunk is directed upon the back part of the cap-
sular ligament of the joint instead of upon the glenoid cavity,
as in quadrupeds. This, and many other circumstances, prove
that the natural intention of the upper extremities in the human
subject, is to seize upon objects, and not to maintain the hori-
zontal position.
Of the Shoulder Blade, (Scapula, Omoplate.)
The Scapula is placed upon the posterior superior part of the
thorax, and extends from the second to the seventh rib inclu-
sively; its posterior edge is nearly parallel with the spinous pro-
cesses of the vertebrae, and not far from them.
Its general form is triangular. It therefore presents two
faces, of which one is anterior, and the other posterior, — three
edges, of which one is superior, another external, and the third
internal or posterior — and three angles, of which one is supe-
rior, another inferior, and the third exterior or anterior.
The posterior face of the scapula, or its dorsum, is somewhat
convex, when taken as a whole; and is unequally divided by its
spine into two surfaces or cavities, of which the lower is twice
or three times as large as the upper. The spine is a very large
process that begins at the posterior edge of the bone, by a smal
triangular face; rapidly increases in its elevation, and running
184 SKELETON.
obliquely towards the anterior angle, ceases somewhat short of
it; it is then elongated forwards and upwards, so as to overhang
the shoulder joint, and to form the acromion process. The ca-
vity above the spine is owing principally to the elevation of
the latter, and is called the fossa supra-spinata; it is occupied
by the supra-spinatus muscle. The cavity below the spine is
the fossa infra-spinata, and is for the infra-spinatus muscle: it is
bounded below by a rising of the external margin of the bone.
The middle of this fossa presents a swell or convexity, which
is a portion of the general convexity presented by the posterior
face of the bone. The spine of the scapula is always promi-
nent in the outline of the shoulder, and has a well secured base
along the whole of its attachment to the bone, to where it ter-
minates in the acromion process. It leans upwards, and from
the increased breadth of its summit, is concave both above and
below. The summit itself is somewhat rough, and has inserted
into its superior margin the trapezius muscle, while the infe-
rior margin gives origin to the deltoid. The little triangular
face at the commencement of the spine is made by the tendon
of the trapezius muscle gliding over it. The acromion process
arises from the spine by a narrow neck, is triangular, nearly
horizontal, and overhangs the glenoid cavity, being elevated
about one inch above it. It is slightly convex above and con-
cave below: the external and the internal margins are the long-
est. The posterior margin is continuous with the inferior edge
of the spine of the scapula; and the internal is on a level with
the clavicle. At the fore extremity of the internal margin, is a
small, oval, articular face, by which the acromion unites with
the clavicle. The margins of the' acromion, with the excep-
tion of the internal, are rough, and give origin to the deltoid
muscle.
The anterior or costal face of the scapula is concave, and
obtains the name of the sub-scapular fossa or venter. It is oc-
cupied by the sub-scapular muscle; the divisions of which, by
leaving deep interstices between them, produce corresponding
ridges upon the bone, that run obliquely upwards and outwards.
Along the whole posterior margin of this face of the scapula,
is inserted the serralus major anticus.
THE SHOULDERS. 185
The posterior or vertebral margin of the scapula is the long-
est of the three, and is called the base. It is not perfectly
straight, but somewhat rounded, especially above the spinous
process; and has there varied degrees of obliquity in different
persons. This margin, below the spine, receives the rhomboi-
deus major muscle, and above the spine, the levator scapulae;
at the part between the other two, the rhomboideus minor is
inserted.
The external or axillary margin of the scapula, also called
the inferior costa, is much the thickest of the three. A superfi-
cial fossa placed somewhat posteriorly, forming the inferior
boundary of the fossa infra-spinata, begins about two inches
from its inferior extremity, and running up to the neck of the
bone, lodges the teres minor muscle. On the exterior face of
the inferior angle is a flat surface, from which the teres major
muscle and a slip of the latissimus dorsi arise. At the fore
part of this surface the inferior costa is elongated into a kind
of process. Just below the glenoid cavity is a small ridge for
the origin of the long hea,d of the triceps muscle.
The superior margin or costa of the scapula, is the shortest
and thinnest of the three, and is terminated in front by the co-
racoid notch between it and the coracoid process. The notch
is converted into a hole by a ligament, in the living state, and
through it pass the upper scapular nerve and blood vessels.
The glenoid cavity for articulating with the os humeri, sup-
plies the place of the anterior angle of the scapula. It is very
superficial, and ovoidal, with the small end upwards. Just at
the upper end is a small flat surface, from which the long head
of the biceps arises. The glenoid cavity is fixed on the cervix,
as it is called, at which a general increase in the thickness of the
bone occurs, in order to give a strong foundation to this cavity.
From the superior part of the cervix arises the coracoid pro-
cess, the base of it being bounded in front by the glenoid cavi-
ty, and behind by the coracoid notch. The base rises upwards
and inwards for half an inch, and what remains of the process,
then, runs horizontally inwards and forwards, to become small-
er, and terminate in a point. This point is advanced beyond
16*
186 SKELETON.
the glenoid cavity, about an inch from its internal margin. The
upper surface of the coracoid process is rough and undulated;
below it is concave, forming an arch under which passes the
sub-scapularis muscle. On the clavicular side of its base is a
tuberosity, from which arises the conoidal ligament. The ex-
tremity is marked by three surfaces : the interior is for the in-
sertion of the pectoralis minor, the middle for the origin of the
coraco-brachialis, and the external for that of the short head of
the biceps. The acromial margin of the coracoid process gives
origin to the triangular ligament of the scapula, which is in-
serted into the acromion just below the face for the clavicle.
The scapula is composed of cellular and compact substance.
The two laminae of the latter are in contact in the fossa supra-
spinata, and infra-spinata; from which cause the bone is diapha-
nous at these points*
Of the Clavicle, (Clamcula, Clavicule.)
The Clavicle is a long bone, situated transversely at the up-
per front part of the thorax, and extends from the superior ex-
tremity of the sternum to the acromion of the scapula. It is
cylindrical in its middle third, flattened at its external, and
prismatic or triangular at its sternal extremity. Besides being
shorter, it is more crooked and robust in man than in woman,
and different individuals present it under considerable varieties
of curvature. The sternal two-thirds of it are convex in front,
and concave behind, while the humeral third is concave in
front, and convex behind: this double curvature induces anato-
mists to compare it with the letter S, though it is by no means
so crooked.
We have to consider its superior and inferior face, its ante-
rior and posterior edge, and the two extremities. The superior
face is smooth, and does not present any marks of importance
excepting a depression near the sternum, for the origin of the
sterno-cleido mastoid muscle. The inferior face, near the ster-
nal end, has a rough surface, to which is attached the costo-
clavicular or rhomboid ligament: about fifteen lines from the
humeral extremity is a rough tubercle for the attachment of the
coraco-clavicular or conoid ligament. Between the two ends,
THE ARM. 187
a superficial fossa is extended for lodging the sub-clavius mus-
cle. The sternal two-thirds of the anterior margin are marked
by the origin of the pectoralis major; it is there thick: the other
part of this margin is thinner, and gives origin to the deltoid
muscle. The posterior margin presents, near its middle, one or
more foramina for the nutritious vessels. The triangular inter-
nal end of the clavicle is unequal where it joins the sternum,
and is elongated considerably at its posterior inferior corner.
The external flat end presents at its extremity a small oval face,
corresponding with that on the acromion scapulae.
This bone is very strong from the abundance of its condensed
lamellated structure; but, like other round bones, the cellular
matter predominates at its extremities.
SECT. n. — OF THE ARM, (Os Humeri, ISHumerus.)
The arm extends from the shoulder to the elbow, and has but
one bone in it, the os humeri. The latter, in its general ap-
pearance, is cylindrical, with an enlargement of both extremi-
ties; the superior end presents a general swell, while the infe-
rior is flattened out.
The superior extremity of the os humeri, which is also called
its head, is very regularly hemispherical, and has its axis di-
rected obliquely upwards and backwards, to apply itself with
more facility to the glenoid cavity of the scapula. The base on
which the head reposes is termed neck, it is riot more than four
or five lines long, and is marked off by a superficial furrow,
surrounding the bone. This furrow is more conspicuous above,
where it separates the head from two knobs called the tubero-
sities.
One of these tuberosities, the external, being placed beneath
the acromion scapulae, is much larger than the other, and bears
on its upper face the marks of the tendinous insertion of three
muscles. The most internal mark is for the supra-spinatus
scapulae, the middle for the infra-spinatus, and the external, or
posterior, for the teres minor. The smaller tuberosity is inter-
nal, and placed on a line with the coracoid process; it has but
one mark, and that is on its upper face, for the tendinous inser-
tion of the sub-scapularis muscle. The two tuberosities are
188 SKELETON.
separated by a deep fossa, named bicipital, from its lodging the
tendon of the long head of the biceps muscle. This fossa is
continued, faintly, for some inches down the os humeri; its
lower part being bounded, externally, by a rough ridge, indi-
cating the insertion of the pectoralis major, and internally by
another ridge, not quite so strong or rough, indicating the in-
sertion of the teres major and latissimus dorsi.
The body of the os humeri is the part extended between its
extremities. The superior half presents a more cylindrical ap-
pearance than the inferior, which is rather triangular. On the
middle of the bone, externally, two inches below the insertion
of the pectoralis major, exists a triangular elevation into which
the deltoid muscle is inserted. At the internal margin of the
bone, and on a line with the latter, is the insertion of the coraco-
brachialis muscle; and between the two is the orifice of the canal
for the nutritious artery. The front of the os humeri, in its
lower half, is flattened on each side down to its inferior end; on
these surfaces is placed the brachialis internus muscle. On a
line with the posterior end of the greater tuberosity, and a lit-
tle below it, an elevation is formed for the origin of the second
head of the triceps extensor cubiti. The posterior face of the
bone is flattened from this point down to its lower extremity,
and accommodates the last named muscle.
The articular surface for the elbow joint is very irregularly
cylindrical. The part that joins the radius, presents itself as a
small hemispherical head, placed on the front of the bone, and
with its axis looking forwards. Just above it, in front, is a
small depression for the head of the radius in its flexions. The
surface which is in contact with the ulna, is more cylindrical,
but still irregularly so ; for its middle is depressed, wrhile the
sides are elevated: the internal side is much broader and more
elevated than the external. The lesser sigmoid cavity is just
above the front of the ulnar articular surface, and receives the
coronoid process. The greater sigmoid cavity is in a corre-
sponding place behind, and receives the olecranon process: the
bone where it separates these cavities is very thin; sometimes
it is even deficient.
THE FORE ARM. 189
The external condyle is just above the radial articular surface ;
it is continuous with a ridge of three or four inches long, form-
ing the external margin of the bone, and from it, and the ridge
together, arise the extensor muscles of the fore arm and hand.
The ridge, itself, is bounded, above, by a small spiral fossa, de-
scending downwards and forwards, made by the spiral artery
and the muscular spiral nerve. The internal condyle is placed
just above the internal margin of the ulnar articular surface : it
is much more prominent and distinct than the external, and may
be readily felt beneath the skin. A ridge also leads from it,
and extends upwards as high as the insertion of the coraco-
brachialis, but it is by no means so elevated as the external
ridge, though it is much longer. From the internal condyle,
and the adjoining part of the ridge, arise the flexor muscles of
the hand and fore arm.
The os humeri is composed of compact and cancellated sub-
stance; the latter predominates at the extremities, and the former
in the body.
SECT. III. OF THE FORE ARM.
The fore arm is placed between the arm and the hand, and
consists in two straight bones, the Ulna and the Radius, of
which the former is on the same side with the little finger, and
the latter on that of the thumb.
Of the Ulna, (Cubitus.}
The ulna, though nearly strait, is not wholly so. It is
much larger at the upper than at the lower extremity, and in its
general features is triangular. It has to be considered in its
humeral and carpal extremities, and in its body.
The humeral, or upper extremity, presents the olecranon pro-
cess at its termination ; the coronoid a little below and in front;
the greater sigmoid cavity between the two; and the lesser sig-
moid on the radial surface of the coronoid.
The olecranon process is rough on its upper face, for the in-
190
SKELETON.
sertion of the triceps muscle, and terminates in front in a sharp
edge and point, which are received into the greater sigmoid ca-
vity of the os humeri. The coronoid process is a triangular
sharp ridge, much elevated, and having a large base ; on the
lower front of the latter is a roughness for the insertion of the
brachialis internus muscle. The greater sigmoid cavity forms
all the articular surface between the margins of the two pro-
cesses. It is divided, transversely, at its bottom, by a superfi-
cial roughness, which distinguishes the olecranon from the co-
ronoid portion of it. Besides which, a rising exists in its verti-
cal length, which is received into the corresponding depression
of the os hurneri. The lesser sigmoid cavity has its surface
continuous with that of the greater, and presents itself as a small
semi-cylindrical concavity, for articulating with the side of the
head of the radius. A small fossa, for fatty matter, exists just
above it.
The carpal, or lower extremity of the ulna, presents, on the
side of the little finger, a process of variable length, the sty-
loid, from which arises the internal lateral ligament of the wrist.
At the radial side of this process is an articular face or small
head, one" surface of which looks towards the wrist, and the
other is in contact with the radius, being semi-cylindrical. On
the back of the ulna, between the styloid process and this head,
is a groove for a passage of the extensor carpi ulnaris.
The body of the ulna is triangular, in consequence of three
ridges, which extend from the brachial to the carpal extremity.
The most prominent of these ridges is on its radial side, and,
beginning al the posterior end of the lesser sigmoid cavity, con-
tinues very distinct almost to the lower end; it then, however,
gradually subsides. From it arises the interosseal ligament.
Within this ridge, on the anterior or palmar face of the bone,
is another, more rounded, which, beginning at the internal mar-
gin of the coronoid process, extends down to the styloid pro-
cess. For the greater part of its length it gives origin to the
flexor profundus digitorum, but just above the carpus, the pro-
nator quadratus arises from it. The third ridge begins at the
external margin of the olecranon, and runs in a serpentine way
to the inferior end of the ulna, but becomes almost indistinct at
THE FORE ARM. 191
its lower part. To the upper fourth of this ridge, is attached
the anconeus muscle, which reposes in a hollow between it and
the beginning of the first or outer ridge. To the beginning of
this latter ridge, is attached the supinator radii brevis muscle.
On the posterior surface of the bone, just below the olecranon,
is a long sub-cutaneous triangular face on which we. lean.
The three ridges of the ulna divide it into as many surfaces,
which are each modified by the muscles lying upon them. The
anterior surface presents, just above the middle of the bone, the
canal for the nutritious artery, running obliquely upwards.
The body of the ulna is compact, the extremities, and more
abundantly the upper, are cellular.
Of the Radius, (Radius.)
The radius is shorter than the ulna, is placed on its external
side, and extends from the os humeri to the wrist. It is smaller
at the humeral than at the carpal extremity, and though nearly
straight is somewhat convex outwardly. It is to be considered
in its extremities and body.
The superior or humeral extremity presents a cylindrical
head, which bears all around it the marks of a cartilaginous in-
crustation, broader on the cubital than on the other side. The
broader part plays in the lesser sigmoid cavity of the ulna, while
the other is in contact with the annular ligament. A superficial
fossa also exists on the upper surface of this head, which re-
ceives the convexity of the articular face of the external con-
dyle of the os humeri. The head of the radius is placed upon
a narrow part called the neck, of about half an inch in length.
Immediately below the neck, on the ulnar side, is a rough pro-
. tuberance or tubercle, the bicipital, for the insertion of the bi-
ceps flexor cubiti.
The lower or carpal extremity of the bone, is augmented con-
siderably in volume, and is flattened out transversely. The
carpal surface presents a long superficial cavity, bounded ex-
ternally by the styloid process, from which proceeds the exter-
nal lateral ligament; and ending on its ulnar side, by a small
192 SKELETON.
cylindrical concavity, for receiving the lower end of the ulna.
The former or superficial cavity is divided into two by a slight
ridge in its short diameter ; the division next the styloid pro-
cess receives the scaphoid l?one, and the other the os lunare.
At this extremity also a ridge exists on the front of the bone
for forming the margin of the articular face, and giving origin
to the capsular ligament. The posterior and external faces of
the bone., here, are rendered irregular by several grooves and
ridges. The large groove next to the cylindrical concavity for
the ulna, transmits the tendons of the extensor communis digi-
torum and indicator, also the tendon of the extensor major pol-
licis, which forms a channel somewhat distinct, and on the sty-
loid side of the groove. Next to this is another large groove for
the tendons of the extensor carpi radialis brevior and loagior ;
and on the styloid side of the radius is the third groove for
transmitting the tendon of the extensor minor pollicis, and of
the extensor ossis metacarpi pollicis. The anterior margin of
this groove is formed by a small spine or ridge, into which is
inserted the tendon of the supinator radii longus.
The body of the radius is somewhat triangular, and therefore
presents three ridges. One, on its ulnar side, extends from the
bicipital protuberance to the lower end, and gives origin to the
interosseous ligament: it is sharp and well marked. Another,
on the outer or styloid margin of the bone, also begins at the
bicipital protuberance, and terminates in the styloid process.
The upper part of this ridge is curved, has the supinator brevis
inserted into it, and a portion of the flexor digitorum sublimis
arising from it ; at its lower part the pronator quadratus is in-
serted. The third ridge is on the posterior- face of the radius,
and, arising insensibly from below its neck, is principally con-
spicuous in the middle third of the bone: it runs down, however,
to the carpal extremity, and, becoming more prominent there,
separates the two larger grooves from each other. This ridge
is shorter, and not so elevated as the other two.
These three ridges form as many surfaces to the radius, of
which the anterior augmenting gradually in its descent, affords
attachment to the flexor longus pollicis above, and to the pro-
nator quadratus below; at its upper part is a canal, slanting up-
wards, for the nutritious artery. The posterior surface has the
THE HAND. 193
extensor muscles of the thumb and the indicator lying upon it.
The external surface presents a roughness, just above its mid-
dle, for the insertion of the pronator teres ; and below it is co-
vered by the radial extensors, which are crossed by the exten-
sor metacarpi pollicis and the extensor minor.
The body of the radius is compact ; its extremities are cel-
lular.
SECT. IV. OF THE HAND.
The. hand consists of carpus, metacarpus, and phalanges, and
has in its composition twenty-seven bones, to which number
may be added the two sesamoids.
Of the Carpus, (Carpe.)
The carpus, or wrist, is next to the bones of the fore arm.
Eight bones compose it, which are arranged into two rows, one
adjoining the fore arm, and the other the metacarpus : — they
are called first and second rows. These bones present very
diversified forms, and a number of articular faces, which ren-
der them difficult to be distinguished from each other.
The first or antibrachial row has in it the os scaphoides, lu-
nare, cuneiforme, pisiforme. The second or metacarpal row
has in it the os trapezium, trapezoides, magnum, and unci-
forme.
Of the Scaphoides, (Scaphoide,)
This bone is on the styloid half of the end of the radius, and
is distinguishable in a set by its greater length. It is convex
above and concave below. The convexity forms only a half
of its upper surface, the other half being rough, and making a
knob at its extremity. The concavity on the lower surface is
large enough to receive the end of a finger. Between the
concavity and the convexity, and on the dorsal surface of the
bone, at its outer end, is a second convexity, of an oblong shape.
Between the two convexities is a small fossa for the capsular
ligament. The palmar, or anterior face, shows a crook in the
VOL. L— 17
194 SKELETON. -
bone. The knobbed extremity projects beyond the styloid pro-
cess of the radius. The other extremity, which is narrow, joins
the os lunare.
Of the Lunare, (Semilunare.)
This bone is at the ulnar side of the preceding, and may be
distinguished by the semi-lunated shape of the surface joining
the scaphoides. Its upper surface is convex where it articulates
with the radius; the lower face is concavely cylindrical. The
ulnar side is a plain surface which joins the os cuneiforme. Its
dorsal side is rather thinner than its palmar.
Of the Cuneiforme or Pyramidale, (Pyramidal.)
This bone is placed at the ulnar side of the last, and may be
distinguished by its representing somewhat a triangular pyra-
mid. The surface next the lunare is plane, but the other ex-
tremity, being the boundary of the wrist in that direction, is
rough. Above, it presents a small convexity, adjoining the
surface for the lunare, whereby it enters partially into the upper
wrist joint. Its inferior surface is concavo-convex, the con-
vexity being towards the ulnar end. On its palmar side it pre-
sents a circular plane surface for the os pisiforme.
Of the Pisiforme, (Pisiforme.)
This bone is placed on the front or palmar surface of the last,
and may be distinguished by its being smaller than any other
in the carpus, by its spheroidal shape, and by its presenting but
one articular face, which corresponds with one on the cunei-
forme. It is always so prominent as to be felt, without difficulty,
at the ulnar extremity of the wrist, and is very moveable.
Of the Trapezium, (Trapeze.)
This bone is placed at the radial end of the second row; its
shape is exceedingly irregular, but it may be generally distin-
guished by being a bone of the third magnitude as regards the
second row. It is better for the student to find out first the
THE HAND. 195
surface by which it articulates with the metacarpal bone of the
thumb, which he can do in a short time by a comparison of the
surfaces of the two bones. This being successful, will estab-
lish a clew to the other surfaces, and to the relative position of
the bone. The thumb surface is a concave cylindrical trochlea,
placed on the radial side of the trapezium, and looking down-
wards and outwards. On the reversed or upper side is a small
concavity, which receives the dorsal convexity of the scaphoid
bone. Continuous with this concavity is another on the ulnar
side, which receives a corresponding convexity of the trape-
zoides. Between this concavity and the one for the thumb is
a small plane surface, by which the trapezium articulates par-
tially with the metacarpal bone of the fore finger. The dorsal
face is rough and unequal. The palmar face is unequally di-
vided by a high ridge or process, at the ulnar side of whose
root is a deep fossa for the tendon of the flexor carpi radialis.
Of the Trapezoides, (Trapezoide.)
It is placed at the ulnar side of the last bone, and is the
smallest in the second row. There is no liability of confound-
ing it with any other bone of the carpus, as it is the least of
any, excepting the pisiforme. The greater difficulty is the ad-
justment of it in the separated bones: the following rule, how-
ever, will serve. It is surrounded by articular faces on its sides,
but the dorsal surface presents a broad base, while the palmar
extremity is reduced in siz.e. Holding the bone with a refe-
rence to these, it will be observed that one side is very crook-
ed and concave, while the reversed or opposite one is convex.
The latter fits against the surface of the trapezium which has
been indicated, while the former embraces the side of the os
magnum just below its head. The metacarpal surface of the
trapezoides is long and elevated in its middle for being received
into the root of the metacarpal bone of the fore finger, while
the upper surface presents a long concavity for receiving a part
of the dorsal convexity of the scaphoides.
Of the Magnum, (Grand Os.)
It is placed at the ulnar side of the trapezoides, and, from its
being larger than any other bone in the carpus, will scarcely
196 SKELETON.
be mistaken. Its ulnar side is flat, and presents a plane surface
for articulating with the unciforme. The radial side is uneven
and rather indistinctly marked where it joins the trapezoides,
but the latter surface will be found near the middle of this side
just below the head. The upper surface of the magnum is
formed into a spherical head, the radial side of which reposes
in the concavity of the scaphoides, while the ulnar side is in the
concavity of the lunare. Its metacarpal surface is triangular,
convex, and winding, by which it joins the metacarpal bone of
the middle finger. On the radial side of this surface is a small
one continuous with it, whereby the magnum articulates par-
tially with the metacarpal bone of the fore finger. The poste-
rior or dorsal face is broad, while the palmar is more narrow.
Of the Unciforme, (Os Crochu.)
It is placed at the ulnar side of the magnum, is nearly of the
same size, but readily distinguishable from it by its long crooked
process as well as by its peculiar shape. Its radial side is plane
where it joins the magnum; the reversed or ulnar side is brought
to a thin edge. The metacarpal surface presents two distinct
concavities ; the one next to the ulnar edge is for the metacarpal
bone of the little finger, and the other for that of the ring finger.
The upper surface is convex and winding, having its ulnar mar-
gin almost touching the surface of the metacarpal bone of the
little finger. The most considerable portion of the upper sur-
face reposes upon the cuneiform, and the remainder upon a
part of the concavity of the lunare. The posterior face is broad
and rough, while the palmar is narrower. From the ulnar side
of the latter, projects the unciforme process already alluded to.
The two ranges of carpal bones, thus shaped, present, when
articulated or united together, an oblong body, the greatest dia-
meter of which is transverse. Its posterior face is semi-cylin-
drical and arched, while the anterior face is concave for the
passing of the flexor tendons. Two protuberances are found on
each extremity of the palmar surface. Those at the ulnar end
are the pisiforme, and the unciform process of the unciforme;
those at the radial end are the protuberance at the radial end of
THE HAND. 197
the scaphoides and the sort of unciform process from the trape-
zium bounding the radial margin of its groove. These several
prominences may, with a little attention., be readily distinguished
beneath the skin. The superior face of the carpus, which ar-
ticulates with the lower end of the radius and ulna, presents an
oblong convex head formed by the scaphoides, the lunare, and
very partially by the cuneiforme. The inferior face of the car-
pus presents a very diversified surface, subdivided into five dis-
tinct ones, each of which is fashioned according to the shape
of the metacarpal bone with which it has to articulate.
The central joint of the wrist, formed between the two rows
of bones, is very deserving of attention. The first row is con-
vex on its radial end, the convexity being formed on one half
of the scaphoides: to the ulnar side of this there is a deep con-
cavity formed by the other half of the scaphoides, — by the lu-
nare and the cuneiforme. The upper surface of the second row
fits very accurately upon the lower surface of the first: its ra-
dial end is, therefore, a concavity formed by the trapezium and
trapezoides, which receives the convexity of the scaphoid; then
a very large prominent head is formed by the magnum and
unciforme, and received into the concavity of the first row.
The magnum reposes upon the scaphoides and part of the lu-
nare, the unciforme upon the remainder of the lunare, and the
whole of the cuneiforme. The carpal bones consist of cellular,
matter enclosed by condensed lamellated substance.
Of the Metacarpus-.,
The metacarpus, is situated between the carpus and the pha-
langes of the fingers and thumb. It consists of five bones, one
for the thumb and one for each finger. The latter are parallel
or nearly so with each other; but the first diverges considerably,
and is so placed as to traverse the others in front during its
motions. These bones are rounded in their middle, and enlarged
at their extremities. That of the thumb is the shortest, the
others decrease successively in length from the fore to the lit-
tle finger*
17*
198 SKELETON.
Of the First Metacarpal Bone, or that of the Thumb. — It is
placed upon the trapezium: and besides being the shortest, is
also the thickest of any. Its upper end is cylindrical and
slightly concave from side to side, to present a fit surface to
the trapezium. Its lower end is slightly convex, and elongated
in front into a trochlea, on either side of which reposes a sesa-
moid bone. The posterior face of its body is flat and straight;
the anterior is concave in its length, and is divided into two
surfaces by a middle ridge. A roughness exists on either side,
at its lower end, for the attachment of the lateral ligament.
Of the Second Metacarpal Bone, or that of the Fore Finger. —
The greater length of this bone gives it a distinctive character.
It is placed upon the trapezoides, and articulates laterally also
with the trapezium, and the magnum. Its carpal or upper end
presents, in the middle, a deep concavity for receiving the tra-
pezoides, at the radial side of which is a small plane face for
articulating with the trapezium, and at the ulnar side an oblong
surface, the upper margin of which joins the magnum, and the
remainder is in contact with the third metacarpal bone. The
lower end presents a convex head extended in front to concur
in the flexion of the finger, on each side of which head is a
concave rough surface for the lateral ligament. The poste-
rior face of the bone presents a triangular flat surface, the base
of which is towards the finger or phalangial end. The palmar
face is concave, longitudinally, and divided by a middle ridge,
into two surfaces, each of which is compressed by the interos-
seous muscles. A tubercle exists on the back of the bone just
below its carpal end for the insertion of the tendon of the ex-
tensor carpi longior, and another in front for that of the flexor
radiali?.
Of the Third Metacarpal Bone. — This is a little shorter than
the last, and is nearly of the same size, but its carpal extremity
is very different. The latter is triangular, and is bounded on
its radial side by a sort of styloid process, with a tubercle on
the posterior face of it, into which the tendon of the extensor
radialis brevior is inserted. It is placed upon the magnum, to
which it joins by a slighlly concave, winding surface. It also
presents, continuous with the same surface, an oblong face
THE HAND. 199
which joins the second metacarpal bone, and, on the reversed
side, two round facets, which are contiguous to the fourth me-
tacarpal bone. In regard to its lower or phalangial extremity
and body, this bone resembles closely the one last described.
Of the Fourth Metacarpal Bone.— This bone is placed upon
the unciforme, and has a very small articulating surface with
the magnum: it is much smaller and shorter than the third
metacarpal, and readily distinguishable by these circumstances.
The carpal surface, by which it joins the unciforme, is trian-
gular and slightly convex; its radial edge touches the magnum.
Continuous with this edge are two small faces, slightly convex,
which join the contiguous faces of the third metacarpal bone.
On the reversed side of the fourth metacarpal is an oblong face
which joins the carpal end of the fifth metacarpal bone. In
regard to its body and phalangial extremity, this bone resem-
bles the two preceding, and therefore does not require a parti-
cular description.
Of the Fifth Metacarpal Bone. — It is placed upon the unci-
forme exterior to the last, and is both smaller and shorter than
the fourth. The carpal extremity presents a cylindroid and
slightly convex face, for articulating with the unciforme, at the
radial margin of which is an oblong facet, for joining the fourth
metacarpal: just below the outer margin is a small tuberosity,
into which is inserted the tendon of the extensor ulnaris. The
lower or phalangial extremity, like that of the others, presents
a convex articular face, extended in front for the flexion of the
first phalanx. The body also corresponds with that of the
others, excepting that it is more flat in front.
Of the Phalanges.
The fingers are named numerically, beginning at the fore
finger; they are also named from their functions, as Indicator,
Impudicus, Annularis, and Auricularis.
Each finger has three bones in it, called its phalanges: the
bone adjoining the metacarpus is the first phalanx, the middle
bone is the second, and the other the third.
200 SKELETON.
The first phalanx is the largest. Its posterior face is semi-
cylindrical, the anterior face is flattened, and concave in its
length. The two surfaces run into each other by forming a
ridge on either side, from which arises the theca of the flexor
tendons. The metacarpal extremity is enlarged, and presents
a superficial cavity, which receives the end of the metacarpal
bone. On either side of this end of the bone is a small tuber
for the lateral ligament. The lower extremity is also enlarged
and flattened at its sides. Its articular face is extended in
front, and presents two condyles, or small heads, for joining
the second phalanx.
The second phalanx is likewise second in size and length. It
is semi-cylindrical on its posterior face, flattened on its ante-
rior, which is somewhat concave in its length, and the two sur-
faces form a ridge, on either side, into which the tendon of the
flexor sublimis is inserted, and from which arises the theca of
the flexor tendons. Its extremities are slightly enlarged : the
articular face of the upper presents two superficial cavities for
the condyles of the first phalanx : the articular face of the lower
extremity presents a trochlea, with a slight elevation at each
side.
The third phalanx is the smallest of the three, and is very
different from the others. Its superior extremity being en-
larged, presents an articular face, having two superficial cavities,
which adjust themselves to the corresponding face of the last
described bone. The inferior extremity is semicircular, thin,
and flattened, its margin being very rough, and somewhat ex-
panded. The posterior face of the body is convex, and the an-
terior flat.
The phalanges of the middle finger (Impudicus) are larger
and longer than the others. The phalanges of the fore finger
(Indicator) are next in size, but not in length, as the ring finger
is rather longer than it. The phalanges of the ring finger (An-
nularis) are next in size, and those of the little finger (Auricula-
ris) the smallest and shortest of any.
The thumb (Pollex) having but two phalanges, the first cor-
responds sufficiently in its general form with the first one of
DEVELOPMENT OF THE UPPER EXTREMITIES. 201
the fingers: it may be distinguished, however, by its shortness
and additional size. The second phalanx of the thumb, corre-
sponding with the third of the fingers, is only to be distinguished
by its additional bulk and length.
All the metacarpal and phalangial bones have condensed la-
mellated structure externally, and a cancellated one internally:
and, like other bones, are more compact in their bodies than at
their extremities.
There are two small hemispherical bones, called sesamoid,
placed upon the trochlea, at the lower extremity of the meta-
carpal bone of the thumb. They answer the purposes of pa-
tellss, and facilitate the action of the short flexor muscle. The
metacarpal bones of some of the fingers are, in robust indivi-
duals, occasionally furnished in the same way.
SECT. V. OF THE DEVELOPMENT OF THE UPPER EXTREMITIES.
At birth the upper extremities are larger in proportion to the
lower .than they are at any subsequent period of life, owing,
perhaps, to the umbilical arteries, which carry off to the placenta
of the mother the greater part of the blood which afterwards
goes to the lower extremities. The nearer a foetus may be to
the embryo state, the more marked is this relative size of the
extremities, which becomes gradually less obvious till the age
of puberty, when'it almost entirely disappears.
At birth, the ends of the clavicles are, in consequence of their
advanced ossification, much less cartilaginous than those of the
other cylindrical bones. Its shape, also, approaches nearly to
that of the adult state.
The scapula is also in an advanced stage of ossification, and
large. The glenoid cavity, though still cartilaginous, is well
sustained by a bony basement coming from the central point of
ossification of the scapula, and is much farther ossified than the
acetabulum. The acromion, the coracoid process, and the an-
gles, are still cartilaginous.
The osjiumeri is cartilaginous at both extremities, which are
also larger, proportionally, in consequence of this state. Its
inferior extremity is remarkable for the size of that portion of
it which articulates with the radius.
202 SKELETON.
In the fore arm the extremities of its bones are cartilaginous.
The ulna has the olecranon large, while its coronoid process is'
comparatively small ; the greater sigmoid cavity is, consequent-
ly, not so concave as in the adult. The position of the radius,
at its upper end, is somewhat peculiar, for it is much more an-
terior than in the adult; a circumstance depending upon the
greater size of the little head of the humerus, upon which it
rests. This arrangement renders pronation more extended in
the fo3tus, as the radius always crosses the ulna with additional
facility., by being placed more anterior to it. This fact is strong-
ly exemplified in the bones of a fore extremity of animals. Bi-
chat observes, that this greater extent of pronation exposes the
annular ligament to being stretched considerably behind, and,
consequently, the radius to luxations at its head ; an accident by
no means unfrequent among children. The late Dr. Physick
says, that he has often seen it in consequence of nurses incau-
tiously seizing them by the fore arm to help them over gutters,
or to render them other assistance. It happens while the arm
is in a state of pronation; for the weight of the body, by hang-
ing from it, increases, the position distends the ligaments, and
produces luxation. As the bones of the fore arm in the foetus
are nearly straight, the interosseal space decreases gradually
from above downwards.
The carpus is entirely cartilaginous at birth, and consists in
the same number of pieces that it does in the adult. Its arti-
cular cavities are well formed. Its size is proportionate to what
it is in the adult : in this respect it differs from the cartilaginous
extremities of the round bones, which are always larger from
being in this state. The carpus, therefore, appears small in the
foetus.
The metacarpus is cartilaginous at its extremities, but ossified
in the middle. The phalanges are in the same state.
SECT. VI. OF THE MECHANISM OF THE UPPER EXTREMITIES.
The scapula and clavicle are for the superior extremity what
the os innominatum is for the inferior; in consequence^f which,
some anatomists consider them as .a part of the trunk of the
body. Though the convenience of anatomical description ge-
nerally requires them to be associated with the upper extremi-
MECHANISM OF THE UPPER EXTREMITIES. 203
ty, I shall depart from the rule on the present occasion, and
view them only as the basis of the attachments and motions of
the os humeri, and of the remaining parts of the superior ex-
tremity.
The upper extremities, considering them as commencing with
the os humeri, differ materially in their position from the
lower. They are placed much farther behind ; of which one
may be satisfied fully by drawing a line from the middle of the
glenoid cavity, to the middle of the acetabulum of the same
side; the body being perfectly erect at the time, the line will
be found oblique. The advantage of this arrangement is to
give greater latitude of motion to the upper extremity than if
it had been placed more in front. Another important benefit
is, that by the bulk of the shoulder being placed behind the
centre of gravity, the erect position is more easily preserved ;
a different position of it, by throwing its weight forwards, would
have had a continually tendency to produce falls, and to effect
somewhat, in man, the same inconvenience which is felt by the
quadruped in the erect position. Another point, also of some
interest in the position of the upper extremities, is the distance
to which they are separated from each other by the lateral pro-
jection of the scapulae, and, consequently, of the glenoid cavi-
ties. A distance owing to the length of the clavicles, and which
considerably exceeds the distance between the heads of the ossa
femorum.
When the whole length of the superior is compared with that
of the inferior extremities, the difference is not so great as one
may suppose. The former is ascertained by a line drawn from
the head of the os humeri to the end of the middle finger : as the
hand is parallel with the bones of the fore arm, its length is also
included, which amounts to a considerable portion of the whole.
On the contrary, from the foot being articulated at right angles
with the leg, only its thickness contributes to the length of the
lower extremity. As far, however, as individual bones are con-
cerned, those of the upper extremity, with the exception of its
phalanges, are uniformly shorter than the corresponding bones
of the lower extremity. The os humeri is much shorter than
the os femoris — the bones of the fore arm than the bones of the
leg — the carpal and metacarpal bones than the tarsal and me-
tatarsal.
204 SKELETON.
The bones of the upper extremity are much less robust than
those of the lower, a very certain indication of the difference of
the uses for which they were intended. Their articular surfaces
are arranged for great variety and extent of motion, in the
seizing and handling of bodies; whereas in the lower extremity,
they are fashioned so as to suit the comparatively limited num-
ber of motions requisite to progression, and to sustain the body
firmly in the upright position. The carpus and metacarpus are
much smaller than the tarsus and the metatarsus, because the
latter are intended to support a great weight. On the contrary,
the phalanges of the fingers are much better developed than the
phalanges of the toes, because the latter are not destined to hold
bodies and to examine them, and may be dispensed with both
in standing and in progression.
The motions of the upper extremity are immensely varied,
and by a short attention to them, some useful hints may be ob-
tained in regard to dislocations.
SECT. VII. OF THE MOTIONS OF THE SHOULDER.
The clavicle performs a very important office in the actions
of the shoulder, by preserving it in a fit attitude for the motions
of the upper extremity. The simple movements of the clavicle,
of which the sterno-clavicular articulation is the centre, are
those of elevation, depression, advancing, and retreating, and a
rapid succession of these produces circumduction. The weight
of the shoulder is also sustained by the clavicle, by the latter
being fastened at the extremity next to the sternum, and having
in the cartilage of the first rib a fulcrum, intermediate to this
attachment and to the weight at its other end. This is proved
conclusively by its fracture; for in that case the shoulder inva-
riably falls down, from the lever being broken which kept
it up.
The clavicle, also, by keeping the glenoid cavity at a dis-
tance from the side of the thorax, and directed outwards, gives
great facility and latitude to certain motions in the human sub-
ject; and which are performed with difficulty, and very imper-
fectly, in animals not having a clavicle. A principal one of
these motions is circumduction, manifested by the elbow being
MOTIONS OF THE SHOULDER JOINT. 205
turned inwards or outwards, and in most persons extends to
three-fourths or even an entire circle. This motion concurs in
the action which brings the hand to the mouth, in consequence
of which such an action is performed with difficulty when the
clavicle is broken. After an accident of the kind, the head, in-
stead of remaining stationary as usual, is advanced towards the
hand, without which the act cannot be accomplished. A cer-
tain length in the clavicle seems indispensable to the vigorous
and perfect action of the shoulder in particular movements; if
the clavicle be disproportionately long, as in females, these
movements are executed with inevitable awkwardness and im-
becility; as, for example, in throwing a stone.
The scapula presents a moveable basis, on which the mo-
tions of the arm are accomplished. Its primary motions are
such as have been assigned to the clavicle, in consequence of
the connexion between these bones; besides which, in all the
extreme motions of the humerus, backwards or forwards, the
scapula is caused to perform a partial rotation, the axis of
which is indicated by a line drawn from the end of the acro-
mion to the inferior angle. When the arm is brought very far
forwards, the inferior angle of the scapula is carried outwards,
and somewhat elevated, while the superior angle is directed
towards the spine, and somewhat depressed. But, when the
arm is carried very far backwards, the inferior angle is direct-
ed towards the spine, and the superior angle looks forwards
and upwards. The clavicle in these cases moves inconsidera-
bly, as the scapula enjoys a pendulous motion, and its point of
suspension is the outer end of the clavicle; at which place the
oblong articular surfaces slide laterally upon each other and
decussate. The extreme degrees of these motions tend to dis-
locate this articulation, but the accident is prevented by the
strong coraco-clavicular ligament, which, by its peculiar posi-
tion and conformation, resists firmly at a certain point. In the
abduction and adduction of the arm the scapula is motionless.
SECT. VIII. OF THE MOTIONS OF THE SHOULDER JOINT.
The os humeri is susceptible of elevation, depression, ad-
vancing, retreating, circumduction, and rotation.
VOL I.— 18
206 SKELETON.
In elevation, the head of the os humeri slides downwards in
the glenoid cavity, and distends the lower part of the capsular
ligament. In this motion the scapula is apt to follow it ; in
which case there will be a less degree of distention in the cap-
sular ligament. If the os humeri be carried forwards, its ele-
vation is performed with much more ease, from the readiness
with which the scapula follows it; but if it be carried backwards,
this facility is much diminished. It is in the latter position,
therefore, that dislocations downwards are most disposed to oc-
cur when violence is offered to the joint. If in every case the
scapula could follow the motions of the os humeri, so as to pre-
sent fairly its glenoid cavity, luxations would be comparatively
rare; but generally the violence offered transmits its momentum
so speedily to the joint, that the muscles of the scapula are
taken by surprise, and have not time to adjust properly the gle-
noid cavity.
In the depression of the os humeri, the parts constituting the
shoulder joint are in their most natural and easy position. The
capsular ligament becomes very loose below, and is somewhat
stretched above. Any degree of force which might be. applied
to the member, is warded off and its direction changed by the
intervention of the trunk of the body. Should, however, the
force be applied directly in the axis of the bone*, the projection
of the aeromion process, and the strength of the triangular liga-
ment of the scapula, would arrest the dislocation.
When the os humeri is advanced, the posterior part of the
eapsular ligament is put upon the stretch; but the form and ar-
rangement of the articular surfaces are somewhat favourable to
this position, and accordingly it is one of but little inconve-
nience. When the os humeri is retracted, its head, by being
directed forwards, exercises considerable force upon the fore
part of the' capsular ligament, and when assisted by an exter-
nal momentum is disposed to dislocation, forwards and in-
wards.
The motion of circumduction is very extensive in the shoul-
der joint; and by it the os humeri describes a cone, of which
the glenoid cavity is the apex. It is a regular succession of
the movements already mentioned, and in consequence of all
the motions forwards of the os humeri being more easy and
MOTIONS OF THE FORE ARM. 207
natural, the axis of the cone, instead of being directly outwards,
is somewhat forwards.
By rotation, is meant the revolving of the os humeri upon
itself. The centre of this movement is not the axis of the bone5
but is removed to one side of it, by the lateral projection of the
head. The neck, however, is too short and thick to permit
any great extent to this motion; it, accordingly, is limited in
such a way as never to amount to luxation. Its greatest ex-
tent, in most persons, does not exceed the describing of half a
circle, which may be ascertained by applying a finger upon
the internal condyle of the os humeri. By it the capsular liga-
ment is rendered, alternately, loose and tense on its front and
back parts. Bichat observes, that in the anchylosis of the
elbow joint, this motion, by habit, is much augmented, so as to
supply the want of rotation of the head of the radius upon the
ulna. The scapula and the clavicle do not vary their position
in rotation.
SECT. IX. OF THE MOTIONS OF THE FORE ARM.
There are two kinds of motion in the fore arm. In the one,
the fore arm is flexed, or extended upon the arm, and in the
other, the radius only changes its position in regard to the
ulna.
1. The ulna is the essential agent of the first, in consequence
of its manner of articulation with the os humeri ; the radius is
only accessory, and is drawn by the ulna into a participation in
its motions. These two bones, it will be recollected, are dis-
posed of in an inverse manner, the larger part of the ulna being
above, while the larger part of the radius is below. This ar-
rangement causes the ulna to present the principal articular
surface for union with the os humeri, while the radius affords
the principal surface to the carpus; it also gives to the whole
fore arm a great uniformity in its transverse diameter. The
fore arm executes, upon the arm, flexion, extension, and lateral
inclination.
Where the flexion is complete, the coronoid process is re-
ceived into its cavity, on the front of the os humeri; and the ole-
208 SKELETON.
cranon, having left its cavity, is placed below the condyles.
In this state the capsular ligament is stretched at its posterior
part, while the anterior is thrown into folds, and is relaxed
along with the lateral ligaments. In the demi-flexion of the
arm, there is a more equal degree of tension of the several li-
gaments. When the os humeri is reposing in its most easy at-
titude, at the side of the body, if the fore arm be flexed, its line
of motion directs the hand towards the mouth; a circumstance
which is accounted for by the peculiar obliquity of the troch-
lea, on the lower part of the os humeri, upon which the ulna
revolves, and is independent of any special act of volition. It
is said that man, above all other animals, has the mechanism
of the upper extremity most particularly addressed to the latter
motion, to the perfection of which the clavicle is indispensable.
It is in consequence of this application of the clavicle, that if it
be broken, man, like animals which are entirely deprived of it,
will, in the flexions of the fore arm, more easily carry the hand
to the opposite shoulder than to the mouth.
In. the full extension of the fore arm, the olecranon process
being received into its cavity, is much above the condyles of
the os humeri. The lateral ligaments, as well as that part of
the capsule on the front of the joint, are in a state of tension.
When the extremity is in this position, a fall upon the hand
may produce a dislocation backwards. In this case the fore
arm being fixed, the coronoid process affords the surface upon
which the principal momentum of the fall is felt. If the liga-
ments on the front of the joint be not strong enough to with-
stand the force, they are lacerated, and the articular surfaces,
passing each other, the upper parts of the ulna and radius are
driven behind the os humeri. Bichat asserts, that nothing is
more easy than to produce such a luxation on the dead body by
a similar proceeding, and that he has repeatedly done it — that
it is about as easy to produce this dislocation, as it is difficult to
effect one at the scapulo-humeral articulation. In a moderate
extension of the fore arm, produced by a small weight suspend-
ed on the hand at arm's length, there is a well marked pressure
of the inferior extremity of the os humeri against the ligaments
in front of the articulation, which is augmented by a tendency
of the ulna to describe the arc of a circle, from above down-
wards, and to separate itself from the os humeri. In this case
MOTIONS OF THE FORE ARM. 209
the muscles which flex the fore arm are kept so much in the
line in which they contract, or are so little removed from the
axis of their own motion, that they contribute but little to sus-
tain the fore arm in situ; the weight is, therefore, actually sus-
tained by the ligaments in front of the articulation. But they
being pressed and drawn in the manner mentioned, such great
pain and weariness are produced as to render a continued sus-
pension of the weight insupportable, the experimenter is, there-
fore, in a short time, under the necessity either of casting off
the weight or of giving such a degree of flexion to the fore arm
as will allow the muscles to contract more advantageously.
Besides flexion and extension, the ulna has a sort of rocking
motion when the fore arm is only half bent; but when the lat-
ter is at either extreme of the former positions, this motion is
imperceptible, owing to the nature of the articular surfaces and
the resistance of the ligaments.
2. In the rotations of the radius upon the ulna, the latter is
almost motionless, excepting the case specified in the last para^
graph. The position of the radius on a plane somewhat ante-
rior to the ulna, its small cylindrical upper extremity, and its
broad lower one, all concur in facilitating rotations forwards
and backwards. It is owing to the hand following these mo-
tions that the first is expressed by the term pronation, in which
the palm of the hand is directed downwards ; and the second,
supination, in which the palm is upwards and the back of the
hand downwards.
Pronation is the most common, and, consequently, the easiest
position to the fore arm, when not carried to an extreme: it is
adopted involuntarily, simply by the action of the ligaments and
the particular shape of the articulating surfaces of the bones.
It is the posture most generally suited to the examination and
grasping of surrounding bodies. In order that it may be ac-
complished fully, the superior extremity of the radius rolls on
its own axis, in the loop formed by the annular ligament and
the lesser sigmoid cavity of the ulna; while the lower extremi-
ty revolves around the little head of the ulna below. The mid-
dle part of the radius crosses that of the ulna, and the interos-
seous space is diminished. An excess of this motion will pro*
duce luxation either above or below, but more easily at tha
18*
210 SKELETON.
latter place ; both on account of the greater extent of motion
there, and of the comparative weakness of the ligaments.
In supination, a movement the reverse of what is described,
takes place ; the radius revolves outwardly, and is brought pa-
rallel with the ulna. If by any force it be carried beyond this
line, a dislocation may occur, in which the little head of the
ulna, abandoning the sigmoid cavity of the radius, will be thrown
in front of it. An accident, however, said to be very unusual.
Bichat considers the cartilage between the ulna and the cu-
neiforme as a principal obstacle to these luxations; but when it
is insulated or separated from the cartilage of the radius, as
sometimes occurs, the joint is very much weakened thereby,
and more exposed to dislocations.
SECT. X. — OF THE MOTIONS OF THE HAND.
The hand, as a whole, performs upon the forearm, flexion,
extension, lateral inclination, and circumduction. As it only
follows the motion of the radius in pronation and supination,
and does not contribute in the slightest degree to either, its ap-
propriate motions can all be performed independently of them.
In flexion the convex head, formed by the first range of car-
pal bones, slides from before backwards in the concavity which
receives it. The posterior part of the capsufor ligament is
stretched, and the anterior thrown into folds, while the lateral
ligaments remain at their ease. In extension, with the excep-
tion of the lateral ligaments, the phenomena are reversed. This
extension, as is well known, not only brings the hand into the
same line with the bones of the fore arm, but carries it beyond
that line till it forms almost a right angle with it. The wrist
joint, in this respect, differs from the other ginglymous articu-
lations; but what it gains in extension it loses in flexion, as it
cannot be bent so much as either the elbow or knee. The ar-
rangement, however, gives great facility to the use of the hand.
In the lateral inclinations of the hand, the capsule in front of
and behind the wrist, is but little affected, but the lateral liga-
ments are alternately relaxed and lightened. As the articular
surfaces are extensive in the line of these motions, dislocations
in the direction of either of them are very uncommon, and
when they do occur they are for the most part incomplete.
MOTIONS OF THE HAND. 211
Circumduction is produced by a regular succession of the
motions described; it, therefore, does not require a specific no-
tice.
Of the Partial Motions of the Hand.-~We\\ marked changes
of position occur between the first and second rows of the car-
pus: these are principally flexion and extension. Lateral in-
clination or abduction and adduction are extremely limited, and
circumduction does not exist. The motions, such as they are,
are confined within much narrower limits than those of the ra-
dio-carpal articulation, and have for their main fulcrum the
head of the magnum.
The lateral articular surfaces of the several bones of the car-
pus, though they present the arrangement of joints, have not an
appreciable motion upon each other. Whatever changes of po-
sition happen among them, are probably so obscure that they
never appear, except under the influence of great and sudden
violence. The complexity of the mechanism of the wrist,
seems to have a double object in view : for ordinary circum-
stances of impulse and motion, the flexion and extension of the
first row upon the second, as a whole, is sufficient; but when a
great momentum is communicated to the structure, the number
of pieces which form it, and the variety of their shapes and mode
of attachment, diffuse the violence throughout the whole wrist,
and generaHy save it from dislocation or fracture. The fracture
of a single bone, excepting from gun-shot wounds, is a very un-
usual circumstance: I have, however, in possession a scaphoides
which was broken through transversely, and had probably been
in that state for a long time; as all appearance of inflammation,
at the period of my finding it, was absent, and as the fractured
surfaces had become highly polished by rubbing against one an-
other.
-The pisiform bone moves with much freedom inwardly and
outwardly on the cuneiform, but its motion up and down is re-
sisted by the muscles which are attached to it. Owing to its
articular cavity being insulated, and to its own remoteness, a
dislocation of it, if it did occur, would interfere but little with
the general uses of the hand.
The metacarpal bone of the thumb has a very free motion on
SKELETON.
the trapezium, in flexion, extension, adduction, abduction: and
circumduction is the result of the other four. In consequence
of this variety of movement in it, of its position on a plane an-
terior to that of the fingers, and of a corresponding obliquity
of the trapezium, the thumb can, in all cases of grasping and
examining bodies, antagonize the fingers. The circumduction
of the thumb resembles very much that of the wrist, or shoul-
der joint, though the mechanism of the articular surfaces is dif-
ferent. In this motion, it describes a cone or circle, the ante-
rior segment of which is larger, and performed with more fa-
cility than the posterior.
The second and third metacarpal bones are so closely bound
to the carpus, that their motion above is almost imperceptible;
in consequence of their length, the motion is more appreciable
below, but even there it is very much restricted. The fourth
metacarpal bone has a limited ginglymous movement, which is
sufficiently demonstrable, and the fifth has it in a considerable
degree; it also admits of a sort of adduction, by which it is
brought nearer to the other bone.
The first phalanges admit of flexion, extension, adduction, ab-
duction; and circumduction, by the successive performance of
the others. The first phalanx of the thumb has the three last
motions very much curtailed, in consequence of the necessity
of great strength and stability in this joint, so as to antagonize
firmly the fingers. The remaining phalanges perform, simply,
flexion and extension. The latter, as in the knee and elbow,
rarely goes beyond the axis of the limb, whereas the former,
from the extent of the articular surfaces and the particular me-
chanism of the joint, permits the hand to be closed and dou-
bled.
From what has been said, it will not be difficult to form $
general conception of the great variety of motions resulting
from the number and arrangement of the pieces constituting
the upper extremity. The os humeri being the basis of them,
may be presented in any direction; the bones of the fore arm
may be alternately retracted or protruded, and by the revolving
of the radius, will permit the palm of the hand to apply itself at
THIGH BONE. 213
any point ; and, again, the multiplicity of simple motions of the
hand, and the exhaustless variety of their compounds, contri-
bute to give to the upper extremity, in man, a perfection of me-
chanism infinitely beyond any thing which can be devised by
the powers of art: a sentiment cogently expressed by the late
Professor Wistar: who remarked, that " The human hand, di-
rected by the human mind, is the most perfect instrument that
man ever saw or ever will see."
CHAPTER VI.
OF THE INFERIOR EXTREMITIES.
THE bones of the inferior extremities are the os femoris, the
tibia, fibula, patella, and a large number which enter into the
composition of the foot.
SECT. i. — OF THE THIGH BONE, — (Os Femoris, Femur.)
This is the only bone in the thigh, and extends from the trunk
to the leg. It is considerably the longest and largest bone in the
skeleton, and presents a conformation entirely peculiar. For
the purposes of description, it is divided into the two extremities
and the body.
The superior or iliac extremity presents three well marked
eminences, the head, the great and the little trochanter. The
head is the articular surface above, and forms rather more than
one-half of a perfect sphere. Its smoothness indicates the exist-
ence of a cartilaginous crust on it during life, and is only inter-
rupted by a small pit a little below its centre, which gives at-
tachment to the round ligament of the hip joint. Its articular
surface is?more extensive above than below, as that part is chief-
ly employed in sustaining the trunk, and comes in contact with
a corresponding surface of the os innominatum. The head is sup-
ported on a branch of the os femoris called the neck, which, pro-
214 SKELETON.
jecting from the internal face of the bone between the trochan-
ters, is directed inwards and upwards at an angle of about thirty-
five degrees, but varying in different subjects. The neck is two
inches in length, oval, or resembling a flattened cylinder, the
greater diameter of which is vertical ; and arises by an exten-
sive base along the upper end of the os femoris. It has a great
multitude of foramina dispersed over it, which penetrate to its
interior, and give passage to blood vessels; the largest of them
are on its posterior surface. Some of these foramina are also
occupied by fibres. A superficial horizontal fossa, formed by
the tendon of the obturator externus, may be seen crossing the
posterior face of the base of the neck.
The great trochanter is situated at the superior part of the
base of the neck, and though presenting a well marked, elevated
summit, rising straight upwards, does not reach the altitude of
the head, but falls short of it half an inch. The trochanter
major rests upon a broad base, has its surface much diversified,
is somewhat prominent in front and externally; but presents on
the side which is next to the head of the bone a deep rough con-
cavity, which is occupied by the insertion of the small rotatory
muscles on the back of the pelvis. On its summit is a small
smooth spot, marked by the insertion of the pyriformis muscle;
below this, and also externally, is a broad surface, slightly con-
vex, into which the gluteus medius is inserted; below this, again,
is a second prominent and rounded surface, over which a part
of the tendon of the gluteus magnus plays. On the front of
the trochanter, and just in advance of the insertion of the glu-
teus medius, is an oblong surface, proceeding obliquely down-
wards and outwards, into which is inserted the gluteus mini-
mus.
The trochanter minor is much smaller than the other, and is
a conical process, placed on the internal posterior face of the
bone, at the lower end of the root of the neck. It receives the
common tendon of the iliacus internus and psoas magnus mus-
cles. A broad elevated ridge joins the two trochanters on the
posterior face of the bone, and from its middle half arises the
quadratus femoris muscle. A much smaller ridge, and by no
THIGH BONE. 215
means so elevated, runs in front, from the one process to the
other, and indicates the line of attachment of the capsular liga-
ment of the hip joint.
The inferior extremity of the os femoris is much more volu-
minous than the superior, and is divided into two parts, called
the internal and the external condyle. These condyles are of
very nearly the same size, but, being separated by a notch be-
hind, they are placed somewhat obliquely in regard to each
other; and the internal, from being the most oblique, and, con-
sequently, the most protuberant, also seems to be the larger.
If the os femoris be placed exactly vertical, the internal con-
dyle has the appearance of being the longest; but, if it be placed
in its natural obliquity, the lower face of the condyles is on the
same plane. In front, the condyles unite to form an articular
trochlea, on which the patella plays : this trochlea is unequally di-
vided by a vertical depression, so as to have its more extensive
surface externally. This latter surface is the anterior part of
the external condyle, and is much more elevated than the in-
ternal part of the trochlea, which belongs to the internal con-
dyle. Posteriorly, the internal condyle projects more than the
external, and both have the articular surfaces, there, so much
elongated backwards and upwards, as to admit of a very great
flexion of the leg.
Each condyle presents an internal and an external face. The
internal condyle has on its internal face a tuberosity, from which
proceeds the internal lateral ligament of the knee; on its exter-
nal face it forms one-half of the notch which separates it from
the other condyle, and at its anterior part in the notch may be
observed a small depression, from which proceeds the poste-
rior crucial ligament. The external condyle, also, has on its
external face a tuberosity, from which proceeds the external
lateral ligament of the knee, and just below it a depression for
the origin of the popliteus muscle. Its internal face forms the
other half of the notch just mentioned, and on the posterior part
of this face is a small depression for the attachment of the an-
terior crucial ligament. The inferior face of the condyles is
somewhat flattened, the transverse diameter of that of the ex-
ternal being rather longer than the other. The inferior extre-
216 SKELETON.
mity of the os femoris is beset with foramina, large and small,
for the passage of vessels and the attachment of fibres.
The body of the os femoris begins at the trochanters, and
terminates in the condyles. It is slightly bent, so as to present
the convexity of the curve forwards. Its size is gradually di-
minished to the middle; it then begins to enlarge, and continues
to augment till it terminates in the large inferior extremity.
The body is very nearly round, and departs from that figure
only on its posterior face, where an elevated rough ridge is
found, occupying the superior two>thirds of the bone, and called
the linea aspera. The linea aspera begins broad, rough, and
flat, on a level with the trochanter minor; it narrows as it de-
scends, and becomes, at the same time, more elevated. Its
lower extremity bifurcates into two superficial, slightly marked
ridges, one on ea'ch side, which may be traced into the poste-
rior extremity of its corresponding condyle. Between these
ridges the surface of the bone is flattened. In the whole course
of the linea aspera, an internal and an external margin is very
obvious. The superior half of the latter is occupied by the in-
sertion of the gluteus magnus, and the remainder by the origin
of the biceps flexor cruris. This margin also gives origin to
the vastus externus. The internal margin of the linea aspera
is mostly occupied by the insertion of the triceps adductor, and
by the origin of the vastus internus.
In the linea aspera, near the middle of the bone, is the canal
for the nutritious artery, which slants upwards : occasionally
one or more canals, besides, are found in it for the same pur-
pose.
The texture of the os femoris is compact in its body. Its
extremities are cellular, with the exception of a thin lamina
forming their periphery : the cylindrical cavity in its middle,
like that in all the other long bones, is reticulated. The ossa
femorum approach each other very closely at their inferior ex-
tremities, but are widely separated at their superior, in conse-
quence of the length of their necks, and of the distance of the
acetabula from one another.
THE LEG. 217
SECT. II. — OF THE LEG.
Two bones form the leg, the tibia and the fibula, to which
may be added the patella, from its attachment to the tibia.
Of the Tibia, (Tibia.)
The tibia is placed at the internal side of the leg, and extends
from the thigh to the foot. After the os femoris, it is the long-
est and the largest bone in the skeleton. It is divided into the
body and the two extremities.
The superior extremity of the tibia is oval, transversely, and
presents an extent of surface suited to the articular face of the
two condyles of the os femoris, to which it is joined. It has
here two superficial cavities for receiving the ends of the con-
dyles; one of them is internal and the other external. The in-
ternal is the deeper and more extensive of the two, and, being
oval, has its long diameter in an antero-posterior direction.
The external, besides being smaller and more superficial, is
more circular; and, from the want of elevation in its margins,
scarcely presents at all the appearance of a cavity. These
two cavities, which approach to within half an inch of each
other, are kept entirely separated by an elevated triangular
ridge, with a broad base, called the spinous process of the tibia.
The summit of the ridge presents two tubercles, one at each
end, separated by a pit, which serves to attach the posterior
end of the external semi-lunar cartilage. The ridge is placed
nearer the posterior than the anterior margin of the tibia. Its
base, in front, is depressed by the attachment of the anterior
crucial ligament, and just before this is a rough, triangular
space, extending to the anterior margin of the bone, and co-
vered by fat in the recent subject. Between the ridge and
the posterior margin of the bone is a deep depression for the
attachment of the posterior crucial ligament.
The circumference of the superior part of the tibia, just be-
low its articular surface, is flat before, somewhat flat and con-
VOL. I.— 19
218 SKELETON.
cave behind, and bulging at the sides. The flatness, in front, is
triangular, having its base upwards and the apex downwards,
the latter terminates in a well marked, broad, rough rising,
which is the tubercle of the tibia, and serves for the insertion
of the tendon of the patella. The concavity behind is made
by the popliteus muscle, and slopes from above obliquely in-
wards and downwards. The projection is great on the inter-
nal side of the upper extremity of the tibia, and at its posterior
part has a depression made by the insertion of the semi-mem-
branosus tendon. The external projection is thicker in front
than behind; at the latter point it has a small articular face,
looking downwards, for the head of the fibula.
The inferior extremity of the tibia is much smaller than the
superior. It is terminated by a transverse quadrilateral cylin-
drical concavity, by which it articulates \vith the astragalus.
This concavity is narrower and deeper internally than external-
ly, and is traversed from before backwards by a low broad ridge.
It is bounded internally by the internal malleolus, a large pro-
cess of half an inch in length, the external side of which is a con-
tinuous surface with the cylindrical concavity, and forms part
of the joint. The other side of the malleolus is superficial, being
just beneath the skin. A shallow groove exists in its posterior
part, which transmits the tendons of the tibialis posticus and of
the flexor longus digitorum pedis. Inferiorly, the malleolus is
notched, or presents a depression, for the origin of the internal
lateral ligament, and just before the depression it is elongated
into a point. The lower end of the tibia presents, before and
behind, a slight swell, running transversely just above the arti-
cular surface. The posterior swell is occasionally slightly
marked by the tendon of the flexor longus pollicis pedis.
Externally, the circumference of the lower end of the tibia
presents, longitudinally, a concavity which is in contact with
the lower end of the fibula. This concavity .terminates insen-
sibly above, but is deep below, where it is bounded before and
behind by an elevated point of bone, of which the posterior is
the highest. The concavity is placed nearly in the vertical line
of the little articular face for the fibula, on the head of the tibia;
and at its lower margin, there is frequently a small lunated sur-
THE LEG. 219
face, which is continuous with the articular surface for the as-
tragalus, and is consequently a part of the cavity of the ankle
joint. Just above this lunated surface the bone is rough for the
origin of short ligamentous fibres, which unite it to the fibula.
The body of the tibia commences just below the enlarged up-
per extremity, and terminates near the ankle. In the front view
of it, it diminishes continually in descending, in its superior two-
thirds: afterwards it enlarges gradually to the lower extremity;
in the lateral view it diminishes downwards almost to the lower
extremity. It is slightly bent forwards, and is generally prisma-
tic, more particularly above: one of its faces is internal, another
external, and the third posterior. The internal face is rounded,
and, with the exception of its upper part, where the flexor ten-
dons are inserted, it is only covered by the skin. Its external
face is flat, excepting below, where it is rounded and is covered
by the muscles on the front of the leg. The posterior face is
slightly rounded, except at its upper part where it is crossed by
a line running obliquely from the articular surface for the fibula,
downwards and inwards : above which line, is the superficial
triangular depression for the popliteus muscle.
The three sides of the tibia are marked off from each other
by ridges of bone. The anterior ridge, called the spine or crest,
begins at the external margin of the tubercle for the insertion
of the tendon of the patella, and may be traced very distinctly,
in the form of an S very slightly curved, almost to the malleo-
lusinternus: it is more elevated in its middle. The external
ridge is a straight line running from one extremity of the bone
to the other; to it is attached one edge of the interosseous liga-
ment. The internal ridge is rounded, but also runs the whole
length of the body of the bone, being more distinct below. The
internal lateral ligament of the knee and the soleus muscle are
attached to it, above; and below, the flexor longus digitorum
pedis.
Foramina large and small, for blood vessels and fibres, are
found on the circumference of both extremities of the tibia. On
its posterior face, about one-fourth of its length from the head,
is a large canal sloping downwards, through which passes the
nutritious artery. Its structure, like that of the other long bones,
220 SKELETON.
is cellular at its extremities ; but compact in the body, where it
presents a cavity occupied by cancellated matter. It will now
be understood how it articulates with the fibula, externally, at
both ends; with the os femoris above; and with the astragalus
below.
Of the Fibula, (Ptront.)
The fibula is placed at the external side of the tibia, and ex-
tends from the head of the latter to the foot : it is much smaller,
and not quite so long as the tibia, and is so articulated with it
as to be on a line with its posterior face. It is to be studied in
its two extremities and in its body.
The upper extremity of the fibula is considerably enlarged
and irregular. It presents, above, a small articular face di-
rected upwards and very slightly concave, by which it joins the
corresponding face of the tibia. This surface is bounded be-
hind by a sort of styloid process, into which is inserted the ten-
don of the biceps flexor cruris. The circumference of the bone,
in advance of this, furnishes attachment to the external lateral
ligament of the knee.
The inferior extremity of the fibula is also enlarged, being
flattened on its tibial side, but more rounded externally. This
part of the fibula is called the malleolus externus. It descends
lower than the internal ankle,, and is also more prominent and
large. Its tibial side presents, below, a small triangular slightly
convex articulating surface, which reposes against the side of
the astragalus ; behind, and somewhat below it, is a small rough
depression, which, with the adjoining inferior margin of the bone,
gives origin to the three fasciculi of the external lateral ligament
of the ankle. Above the articular surface, the bone is rough
and slightly rounded where it is received into the side of the
tibia, and sends oft' many short ligamentous fibres to it. The
anterior margin of this extremity of the fibula is thin and pro-
jecting, the posterior surface is flat and broad, and is slightly
scooped out into a longitudinal groove, which transmits the
tendons of two peronei muscles. The pointed termination
below, of the malleolus externus, is sometimes called the coro-
noid process.
THE LEG. 221
The body of the fibula extends between its extremities. It is
irregularly triangular, somewhat smaller above than below,
thick posteriorly, thin anteriorly, and slightly convex in its
length behind.
There are three faces to the fibula, one is external, another
internal, and the third posterior. The first is semi-spiral, and
turned forwards above; its superior third gives origin to the pe-
roneus longus muscle, .and the middle third to the peroneus se-
cundus: its lower third exhibits the semi-spiral arrangement
which may be traced into the groove on the posterior part of the
malleolus externus, and thereby indicates the course of the ten-
dons of these peronei muscles. The internal face is directed to-
wards the tibia ; it is divided by a low longitudinal ridge into
two parts, of which the anterior is the more narrow. The ridge
itself, well marked in the middle two-fourths of the bone, is in-
distinct above and below; and furnishes attachment to the inter-
osseous ligament. The space in front gives origin to the exten-
sor proprius pollicis, and the extensor communis digitorum : and
the space behind gives origin to the tibialis posticus. The pos-
terior face is also somewhat semi-spiral, its superior end being
outwards, and the inferior end inwards. The superior third gives
origin to the soleus muscle, and the remainder to the flexor lon-
pollicis pedis.
The angles of the fibula which are formed by the junction of
the three surfaces described, differ somewhat among themselves.
The anterior angle is frequently very sharp and elevated in its
middle half, and below it bifurcates into two ridges, including
between them a triangular space, which is only covered by the
integuments. The posterior angle is well marked, and winds
so as to be external above, and posterior near the foot. The
internal angle, formed by the union of the internal and the pos-
terior surfaces, is only very well marked in its middle half.
The projection of this angle gives to the bone the appearance
of inclining inwards towards the tibia, besides which it has ac-
tually a little bend in that direction.
Near the middle of the posterior face of the fibula, a canal,
sloping downwards, conducts the nutritious artery. The circum-
19*
222 SKELETON.
ference of the extremities, like that of the other long bones, pre-
sents a multitude of foramina for vessels and the filaments of
fibres to pass. It is composed in its extremities of cellular or
spongy structure, and in its body of compact matter, enclosing
a cavity occupied by cancellated structure.
Of the Patella (Rotule.)
The patella is a small bone, intermediate to the thigh and to
the leg, and placed on the fore part of the knee joint ; it is
smaller in proportion in females than in males.
Its anterior face is uniformly convex and rough, and is studded
with a considerable number of foramina for the passage of ves-
sels, and for the attachment of fibres. The course of the longi-
tudinal fibres composing the front of the bone, is also well marked.
The posterior face of the patella is an extensive articular sur-
face, divided unequally by a broad longitudinal elevation, which
runs from the superior to the inferior margin of the bone. The
part of this surface external to the ridge, is the largest and the
most concave, and is applied to the trochlea, in front of the ex-
ternal condyle of the os femoris ; while the smaller surface is
on the internal side of the ridge, and is applied, to the trochlea,
of the internal condyle.
The circumference of the patella is nearly oval, the long di-
ameter being transverse. Its thickness is much augmented
above, where it presents a rough, and somewhat unequal flatness
for the insertion of the tendon of the rectus femoris. Below,
the bone is thinner, and elongated into a conical point, from
which proceeds the tendon of the patella to be inserted into the
tibia. Laterally, the margins are thinner still.
The texture of the patella is cellular, covered by a lamina of
condensed bony matter. It is developed in the tendon of the
extensors of the thigh, and with the exception of its posterior
face remains in a state almost entirely cartilaginous, for a year
or two after birth. Its base is, therefore, fibrous, in which is
deposited, subsequently, the calcareous matter. In its fracture
union is effected more frequently by the fibrous base alone,
than by perfect ossification. In order to put it into its proper
THE FOOT. 223
position, turn the point downwards, and apply the greater sur-
face behind, to the trochlea of the external condyle. The pa-
tella is said to be to the tibia, what the olecranon is to the
ulna; and is, therefore, a sort of appendage to it, united by
ligament instead of being continuous with it, as is the case with
the olecranon.
SECT. 111.: — OF THE FOOT.
The foot forms the third section of the inferior extremity, and
is placed at a right angle to the bones of the leg. The size of
its bones varies much in different individuals, depending much
upon their modes of life, and dress : it also varies much in the
two sexes, being, for the most part, smaller in the female.
The foot is oblong, narrower behind than before ; presents one
surface above, which is its back, and another below, which
is the sole; a posterior extremity called the heel, and an ante-
rior extremity called the point; also its internal margin is much
thicker, longer and more concave, than the external margin.
The foot is divided into Tarsus, Metatarsus, and Toes or
Phalanges.
o
Of the Tarsus, (Tar se.)
The tarsus forms the posterior half of the foot, and is com-
posed of seven distinct bones, which are arranged on a plan,
and present features having scarcely a single point of resem-
blance with the carpus. These bones are,, the Os Calcis, the
Astragalus, the Naviculare, the Cuboides, the Cuneiforme Ex-
ternum, Cuneiforme Medium, and Cuneiforme Internum.
Of the Os Calcis, (Cakaneum.)
The calcaneum, or heel bone, forms, almost exclusively, the
posterior half of the tarsus, and may be readily distinguished
by its greater magnitude. Its shape is very irregular. Its
greatest diameter is in the length of the foot; it is also thicker
vertically than transversely.
224 SKELETON. »
The superior face is deeply scooped out, at its fore part, and
is formed there into two articular surfaces, for joining with the
astragalus: these faces are separated from each other by a rough
fossa, which runs from within obliquely forwards and outwards.
The anterior external part of this fossa is deep, broad, and tri-
angular; the posterior part is narrow, is occupied by a ligament,
and allows the two articular surfaces to come nearer. Just
behind the fossa is the first articulating surface, lying parallel
with it; being oblong, convex, semi-cylindrical, and looking
obliquely upwards and forwards. Before the fossa is the se-
cond surface: it is oblong, much smaller than the first, and is
very frequently divided into two by a transverse notch, and is
concave. The part of the bone upon which this face is wrought,
is called, by the French, the little apophysis. I have frequent-
ly remarked, that the face posterior to the first mentioned fossa
is smaller and more vertical in the African than in the Eu-
ropean; the os calcis, behind it, is also smaller and longer.
The upper posterior face of the bone is somewhat concave.
The under surface of the os calcis is slightly concave, longi-
tudinally. It is bounded, behind, by two tuberosities, of which
the internal is larger than the external; they both give origin
to muscles of the sole of the foot and to the aponeurosis
plantaris. There is also a tuberosity bounding the same sur-
face in front, from which arise the ligaments that connect this
bone with the adjoining ones. .
The anterior extremity of the os calcis forms the greater
apophysis, and is terminated in front by a triangular and slight-
ly concave surface, by which it articulates with the os cu-
boides. The posterior extremity is convex and rough : con-
stitutes the heel, and near its middle receives the tendo-achillis;
the upper part is sloping and more smooth, in order to accom-
modate this tendon in the flexions of the foot.
The external surface of the os calcis is flat, with the excep-
tion of a gentle rising in its middle; it is marked, occasionally,
by a superficial groove, indicating the course of the peronei
muscles. The internal surface is very concave, and obtains the
name of sinuosity; along it pass the tendons of several muscles
THE FOOT. 225
from the back of the leg, of which that of the flexor longus pol-
iicis pedis makes a conspicuous groove on the under surface of
the little aphophysis.
Of the Astragalus, (UJlstragah.)
This is the next in size to the os calcis, and is placed on the
superior part of the latter, between it and the bones of the leg,
The astragalus presents, above, a semi-cylindrical surface,
by which it is put in contact with the tibia. This surface is
narrower, and continued farther behind than it is before; is
slightly depressed, longitudinally, in its middle, and, conse-
quently, presents an elevated margin on either side, of which
the external is the broadest and highest. This articular face
continues on each side of the bone, and is more extensive ex-
ternally, where it comes in contact with the fibula or malleolus
externus, than internally, where it touches the 'malleolus in-
ternus.
The inferior face of the astragalus is traversed by an oblique
rough fossa, going from within outwards and forwards, and
corresponding in size with that on the upper face of the os cal-
cis. Behind the fossa, and parallel to it, is a deep oblique se-
mi-cylindrical concavity, suited to the adjoining face of the os
calcis; and before the fossa is a narrow oblong convexity,
suited to the corresponding articular concavity of the same
bone. When the latter is divided into two facets, the concavi-
ty of the astragalus presents also two facets, separated by a
small ridge.
The anterior extremity of this bone is terminated by a con-
vex head, the horizontal diameter of which is the greatest.
This head articulates with the scaphoides, and is continuous
with the surface that rests upon the little apophysis of the os
calcis. On the internal side of the head is a small triangular
surface, continuous with the others, that rests upon a strong
ligament going from the os calcis to the scaphoides. Above,
immediately before the surface for the tibia, is a small depres-
sion, which, in the flexions of the foot, receives the anterior
226 SKELETON.
margin of the articular surface of that bone. The posterior
extremity of the astragalus is thin, and has a notch, or groove,
formed in it by the tendon of the flexor longus pollicis.
Of the Naviculare, or Scaphoides, (Scaphoide.)
It is situated at the internal side of the tarsus, between the
astragalus and the cuneiform bones, and has its greatest dia-
meter transverse. Its circumference is oval, thicker above
than below, and at its internal side presents a large tuberosity;
into which is inserted the tendon of the tibialis posticus. Some-
times the external margin has a small articular face, where it
comes in contact with the cuboides.
The scaphoides presents, behind, a deep concavity, which
receives the head of the astragalus; anteriorly, it is somewhat
convex, but this surface is divided by small ridges into three
triangular faces, for the three cuneiform bones. Of these faces
the internal is broader below than above; the others are broader
above than below.
Of the Cuboides, (Cuboide.)
It is situated at the external side of the tarsus, between the
os calcis and the metatarsal bones. Its figure is irregular; but,
perhaps, sufficiently indicated by its name. It is narrower
externally than internally, and has the posterior extremity
oblique.
The superior face of the cuboides is rounded, but rough.
The inferior face has in its middle a broad elevated ridge run-
ning almost transversely, but somewhat forwards. The exter-
nal extremity of this ridge is marked by a trochlea, on which
plays the tendon of the peroneus- longus; the tendon is then con-
ducted along a groove between the ridge and the anterior mar-
gin of the bone.
The internal face is flat, and has in its middle a circular
facet where it comes in contact with the cuneiforme externum.
THE FOOT. 227
The posterior face joins the os calcis, is triangular, and semi-
spiral. The anterior face is oblong, transversely, and is di-
vided by a slight vertical rising into two, for articulating with
the last two metatarsal bones.
Of the Qunerforme Internum, (Premier Cuneiforme.)
It is placed at the internal anterior extremity of the tarsus?
between the scaphoides and the first metatarsal bone, and may
be distinguished from the other cuneiforms by its greater size.
Its thickest part is below.
The anterior face presents a long vertical convexity, which
joins the first metatarsal bone. The posterior face is not so
extensive, and is formed into a triangular concavity, having
the broadest part below, which joins the internal facet of the
scaphoides. The internal side is semi-cylindrical and rough;
it is marked, anteriorly, near its middle, by the tendon of the
tibialis anticus. The external side is somewhat concave, and
generally rough, and is marked just below its superior margin
by two articular facets, of which the anterior is the smaller,
and comes in contact with the second metatarsal bone; the
posterior, from its concave obliquity, gives a slope to the upper
margin of the bone, and is in contact with the cuneiforme me-
dium.
Of the Cuneiforme Medium, (Second Cuneiforme.)
The middle or second cuneiform bone is placed upon the
scaphoides, immediately on the outside of the cuneiforme in-
ternum. It may be distinguished by being the smallest bone of
the tarsus. Its figure resembles sufficiently well a wedge; the
base of which is above, and the edge below.
Its posterior face is slightly concave where it joins the sca-
phoides; the anterior face is slightly convex, and articulates
with the second metatarsal bone. The internal face presents,
superiorly, an oblong, slightly convex, and oblique articular
facet, which touches the cuneiforme internum: what remains
of this side is rough, for the origin of Jigamentous fibres. The
228 SKELETON.
external face is somewhat concave, and presents, at its poste-
rior part, a vertical articular face for joining the cuneiforme
externum ; but anteriorly, it is rough for the origin of ligamen-
tous fibres.
In the articulated foot the lower part of this bone is almost
concealed between the other two cuneiforms.
Of the Cuneiforme Externum, (Troisieme Cuneiforme.')
The external or third cuneiform bone is placed upon the sca-
phoides, between the second cuneiform and the cuboides. Of
the three bones it is the second in size, and is also appropriate-
ly named from its shape. The base is upwards.
The posterior face furnishes, on its superior half to join the
scaphoides, a quadrangular articular facet, sloping outwardly,
below which the bone projects into the sole of the foot. The
anterior face is flat, and articulates with the third metatarsal
bone. The internal face presents, above, two articular facets,
of which the one at the posterior corner is larger than the other,
and joins the second cuneiform; the other, at the anterior cor-
ner, is very small, and touches the second metatarsal bone.
Below these facets the bone is rough, and gives origin to liga-
mentous matter. The external face, at the middle of the base,
forms an angular projection, behind which is a small oval arti-
cular surface that joins the cuboides. The remainder of this
face is rough, for the origin of the ligaments, with the excep-
tion of a very small articular facet at the anterior superior cor-
ner, which joins the fourth metatarsal bone.
The structure of the bones of the Tarsus is uniformly cellu-
lar within, the cells being enclosed by a thin lamina of con-
densed matter. The astragalus is rather stronger and more
compact than any of the others. I have seen one instance,
however, in which it had been separated into two pieces by a
transverse vertical fracture, going from the ankle joint to the
articulation with the os calcis. The observation was made
after it had been boiled: the callus had completely united the
two fragments, and no displacement had occurred.
THE TOOT,
If a vertical section of the os calcis and of the astragalus be
made, the parietes of these cells are found to radiate from the
upper articular surfaces like columns, so as to prevent the
bones from being crushed by the vertical weight of the body.
Of the Metatarsus, (Metatarse.)
The metatarsus succeeds to tho tarsus, and is formed by five
long parallel bones. They are called numerically, beginning
on the inner side, or that of the great toe. There are four in-
tervals between them, which are filled up by the inter osseous
'muscles.
Of the First Metatarsal Bone.
Placed at the inner side of the foot upon the cuneiforme ifi-
ternum, and forming the base of the great toe, it may be readi-
ly distinguished in the separated bones by its greater size and
shortness.
The posterior -extremity presents an oblong articular conca-
vity, the greatest length of which is vertical, for joining the cu-
neiforme internum. The internal semi-circumference of this
extremity is convex, while the external is slightly concave or
flat; below, it presents a prominent tubercle, into which is in-
serted the tendon of the peroneus longus.
The anterior extremity, also called the head, is rounded and
convex, forming an articular surface for the first phalanx of the
great toe. This surface is continued far back below, and pre-
sents there, for the sesamoid bones, a trochlea with a longitu-
dinal ridge in its middle. The lateral surfaces of the head arc
rough and concave, for the origin of the lateral ligaments.
The body is much smaller than the extremities, and is pris-
matic. Its internal side is rounded, the external side flattened,
and the inferior side concave, longitudinally, for lodging the
muscles of the great toe.
VOL. I.— 20
230 SKELETON.
Of the Second Metatarsal Bone.
This is the longest of any, and may be distinguished from the
others principally by that circumstance.
The posterior extremity is triangular, the broadest part being
above. It presents a surface very slightly concave, almost flat,
which rests upon the cuneiforme medium. The sides of this
extremity being flattened, laterally, it is locked in between the
internal and external cuneiforms ; on its internal side, above, is
an articular facet, where it comes in contact with the cunei-
forme intemum, and, externally, it has two articular facets. The
posterior one of the latter touches the cuneiforme externum,
and the anterior, which is smaller, comes in contact wi'th the
third metatarsal bone. These two facets run into each other
by an angular rising.
The anterior extremity is convex and rounded; its vertical
diameter is more considerable than its transverse, and the arti-
cular face which it furnishes to the second toe is continued con-
siderably below, in order to assist the flexion of the first phalanx.
Its circumference is rough and flattened laterally, for the origin
of the capsular ligament.
The body is smaller than either of the extremities, and de-
creases gradually from behind forwards. It is flattened on each
side, and elevated longitudinally above and below, into a ridge.
There is a curvature in its length, which makes it convex above,
and concave below, for the lodgement of muscles.
Of the Third Mvtalarsal Bone.
This is rather shorter than the second, but has very much
the same shape.
Its posterior extremity, or base, is triangular, has the broad-
est part above, and articulates with the third cuneiform; the
surface for the latter, slopes outwardly. Its circumference is
flattened laterally, and presents, internally, at its superior cor-
THE FOOT. 231
ner, a small face, which articulates with the second metatar-
aal; externally, it also presents, at its superior corner, an arti-
cular facet, which joins the fourth metatarsal.
Its body and anterior extremity, do not present any essen-
tial points of difference from the second metatarsal.
Of the Fourth Metatarsal Bone.
It is somewhat shorter than the third, and is placed upon the
internal of the two anterior faces of the cuboides.
The posterior extremity, or base, is more quadrangular than
the base of the preceding bones. It presents an articular face
to the cuboides, which is also square or nearly so, flat, and slopes
outwardly. On its sides it is irregular ; internally, at the superior
margin, it has two articular facets, continuous with each other,
but forming thereby an obtuse angle; the anterior joins the third
metatarsal; and the posterior, which is much the smaller, touches
the cuneiforme externum. Below these, the surface is rough.
The articulation with the cuneiforme externum is occasionally
deficient. I have observed the latter, particularly in the negro,
and it seems to arise from the unusual development of the cu-
boides. The external surface of the base has at its superior
corner an articular facet for the fifth metatarsal bone, and be-
lo\v it an oblique deep fossa, before which is a tubercle.
The anterior extremity and the body of this bone, though
smaller than those of the preceding, do not present any essen-
tial points of difference.
Of the Fifth Metatarsal Bone.
.This is shorter than any of the others, excepting the first, and
is placed on the front of the cuboides, externally.
Its base is remarkable, and distinguishes it strongly, by being
projected considerably beyond the external margin of the cu-
boides, and forming there a large tubercle, into the superior part
SKELETOX.
of which is inserted the tendon of the peroneus tertius, and into
the posterior part, the tendon of the peroneus secundus. The
base, also, has a triangular flat surface, sloping considerably
outwards, which articulates with the cuboides. On the inter-
nal side is the articular facet, whereby it joins the base of the
fourth rnetatarsal bon-e. The base is flattened below, rough,
and somewhat convex above. N
The anterior extremity is more rounded than that of the other
metatarsal bones, but in other respects similar. The body is
prismatic ; being flat below, flat internally, and slightly rounded
externally.
Of the Toes.
The toes are five in number, and named numerically, by be-
ginning at the great one. They each are formed by three bones
called the phalanges, with the exception of the great toe, which
has but two of them. The phalanges are distinguished into first,
second, and third. In. these several respects the toes correspond
with the fingers.
Of the First, or Great Toe.
The first phalanx of the great toe is longer and much larger
than any other. Its base is large, and forms a deep concavity
for receiving the end of tke metatarsal bone. Its anterior ex-
tremity is formed into two small condyles, for being received
into the second phalanx. This bone is broad and strong, being
semicylindrical above, and flat below.
The second phalanx corresponds in its appearance with the
third of the other toes, but is much larger than any of them. Its
base is broad and flat, and has two superficial cavities for the
condyles of the first phalanx. The anterior extremity is ex-
panded semicircularly, and converted into a very scabrous sur-
face, for the firmer attachment of the soft parts about it. The
body of this phalanx is constricted in the middle, rounded
above, and flat below.
Connected with the great toe, are two small hemispherical
bones, lying upon the trochlea of its metatarsal bone, and im-
THE FOOT. 233
bedded in the tendons of the small muscles which move the first
phalanx. They are the sesamoids, and present, superiorly, an
articular surface, covered with cartilage, which enters into the
composition of the joint; and below, a rounded surface, which
has nothing remarkable.
The sesamoid bones, though generally appropriated solely to
this joint, are yet frequently found elsewhere. For example, in the
second joint of the same toe — in the first joint of the other toes
—in the articulation of the first phalanx of the thumb, with its
metacarpal bone— in the first joint of the fingers— in the knee
joint, behind each condyle — and, in advanced life, in tendons
where they slide upon bones. Ancient luxations give a dispo-
sition to their development in the capsular ligaments of the gin-
glymous joints, of which a very interesting specimen may be
seen in the Anatomical Museum, occasioned by an external la-
teral dislocation of the elbow.
Of the Smaller Toes.
Their phalanges bear a general resemblance with those of the
fingers, but are neither so large nor so long.
The first phalanges are successively diminished to that of the
little toe, and are almost precisely like each other. Their pos-
terior extremities, or bases, form a cavity deeper in proportion
than in the fingers, for receiving the ends of the metatarsal
bones. The anterior extremities are fashioned into two small
condyles forforming a hinge-like joint with the second phalanges.
The bodies are smaller than the extremities, more rounded and
narrower than in the fingers.
The second phalanges are very short, the extremities being
so near each other that the body is of inconsiderable length, par-
ticularly as regards the last two, where it forms a mere line of
separation. The posterior end has two superficial cavities for
receiving the first phalanx; the anterior end is imperfectly fa-
shioned into two little condyles for joining the third phalanx.
The third phalanges have a well-formed articular surface for
20*
234 SKELETON.
joining the second. The anterior extremity is rough, for the at*
tachment of the adjoining soft structure. This phalanx of the
fourth and fifth toe is frequently very imperfectly developed, be-
ing a mere tubercle with an articular face at one end.
The structure of the metatarsal and phalangial bones resem-
bles that of other long bones. Porous and cellular at the ex-
tremities, their bodies are composed of compact lamellated mat-
ter, enclosing a cancellated texture.
SECT. IV. OF THE DEVELOPMENT OF THE INFERIOR EXTREMITIES.
The comparatively small quantity of blood which is sent to the
lower extremities of the foetus, is the cause of their not being so
large in proportion to the upper, at the time of birth, as they are
subsequently. Our wants immediately after birth, and during
the first months of life, are naturally such as to require but little
service from the lower extremities, in which is seen a striking
correspondence between the internal arrangements of the animal
economy and its actual necessities; or, in other words, a conti-
nued and rigid adaptation of means to produce a certain effect.
The os femoris at birth presents several peculiarities. The su-
perior extremity being in a cartilaginous state, is placed more at
:«. right angle to the body of the bone than it is in the adult. The
neck is short, which by diminishing the base of support to the'
trunk, makes the progression of infants more tottering and infirm.
The lower extremity is also cartilaginous and large. The body
of the bone has but a very slight degree of curvature, which like-
wise increases the difficulty of standing and walking in very
young subjects. The patella is cartilaginous.
In the leg the bodies of the tibia and fibula are ossified, but
their extremities are cartilaginous. The bones of the tarsus,
with the exception of parts of the os calcis and of the astragalus
are cartilaginous. The metatarsus and the phalanges are ossi-
fied in their middle, but cartilaginous at their extremities: their
development is not so complete as that of the corresponding
bones of the hand.
MECHANISM OF THE INFERIOR EXTREMITIES. 235
About the fifteenth year, the bones of the lower extremities
have very nearly the same forms as in the adult: they are all fully
ossified, with the exception of their extremities not being fused
or joined to their bodies; but still in the state of epiphyses, and,
therefore, separable either by boiling or long-continued macera-
tion.' Exclusively of this condition, which sometimes remains to
the twentieth or tWenty-fifth year, the epiphyses are as fully os-
sified as at any subsequent period of life.
SECT. V. ON THE MECHANISM OF THE INFERIOR EXTREMITIES IN
REGARD TO STANDING.
The os femoris is well adapted by its shape and position to
the erect attitude. The curvature which its body makes in
front has the effect of advancing the lower part of it, and there-
by keeping it in a line with the centre of the trunk; but if it had
been perfectly straight, the erect position would have been main-
tained with great difficulty, owing to the centre of the trunk
being in advance of this bone. Under the latter circumstancea,
an incessant tendency to fall forwards would have manifested
itself, which could have been obviated only by flexing the ossa
femorurn very much at the hip joint, or by keeping one foot al-
ways in front of the other. Even under the actual arrangement
of the skeleton, when muscular support is withdrawn from it sud-
denly, it falls forwards, owing to the weight of the parts anterior
10 the spine being greater than that of the parts posterior to it.
When muscular action is weakened or badly regulated, the same
tendency to fall forwards is manifested : children continually
tumble in that direction: a person in a state of intoxication,
somewnat short of the entire loss of locomotion, not being able
to sustain the trunk of the body erect by the muscles of the
back, inclines forwards, and would be precipitated to the ground,
were it not that at this crisis one leg is involuntarily advanced,
so that the base of support is much augmented. But if the in-
dividual attempt to walk, the continued necessity of keeping a
large basis of support to prevent the body from falling forwards,
urges him into a slow7 running or trotting gait.
The arrangement of the whole upper extremity of the os fe-
236 SKELETON.
moris is also highly favourable to the erect attitude and to loco-
motion. The neck of the bone, by its length and oblique posi-
tion in regard to its body, enlarges transversely the base of its
support, and gives great stability in preventing the trunk from
falling either to the right or left; while it contributes at the same
time to the facility of progression, in permitting the os femoris to
bend forwards and backwards. The laterat or transverse extent
of the base, thus obtained, cannot be supplied with equal effect
in any other way, as a certain proportion between the diameters
of the pelvis and the length of the neck of the thigh bone is in-
dispensable. In females, where the transverse diameter of the
pelvis is greater than in males, though standing is equally secure
as in the latter, yet their progression is always marked by a
want of firmness strongly characteristic of the sex. The strength
of articular connexion of the os femoris with the innominatum is
confirmed by the acetabulum being placed where the latter is
re-enforced by the linea ilio pectinea, and by the anterior infe-
rior spinous process; and as the principal weight of the trunk is
sustained by the acetabulum, immediately below the latter pro-
cess, we accordingly find it at this point of the greatest depth.
It is also to be stated, that the capsular ligament at this part is
stronger than elsewhere, thereby conforming strictly to the gene-
ral purposes of the articular connexion. The capsular ligament
is assisted by the ligamentum teres, which, by arising from the
lower margin of the acetabulum and passing upwards to the
head of the os femoris, prevents the head from sliding upwards,
while it permits it to swing freely backwards and forwards in
its socket.
In erection, the bones of the leg are in a line with the vertical
diameter of the trunk: in this "respect they differ very materially
from the os femoris, which not only inclines forwards in its de-
scent, but also leans towards its fellow internally, and almost
touches it at the knee. This relative position of the leg and
thigh is obtained by the greater length of the internal condyle of
the os femoris, and also by the other peculiarities of form in the
latter; \\hereas the tibia is nearly straight in the direction of its
long diameter, and has a horizontal articular surface above,
whereby it and the os femoris make an entering angle externally
and a salient one internally. Under common circumstances, the
MECHANISM OP THE INFERIOR EXTREMITIES. 237
weight of the trunk is transmitted to the foot exclusively through
the tibia, owing to^the fibula not entering into the composition of
the knee joint, and not being sustained by any bony basement at
its inferior part. The fibula is principally intended for the origin
of muscles, and for the lateral security of the ankle joint ; and
may be broken without the'accident suspending either erection
or locomotion.
The position and shape of the foot concur largely in the gene-
ral object of maintaining the human being in the erect attitude.
Fixed at right angles to the leg, and articulated by a surface in
the centre of its most solid structure, the tarsus, it receives the
weight of the body perpendicularly upon the astragalus. The
latter being the key-stone .to the arch, diffuses the pressure
through the remainder of the structure, so that the whole foot is
planted against the ground, an attitude more fully executed by
man than by any other animal. The tendency of the body to
fall forwards, requires a very considerable elongation of the foot
in front of the tarsus, in order to increase the extent of the base
of support in that direction, We accordingly find the metatarsal
bones not only forming bases for the flexion of the phalanges; but
also by their great length, by the flatness of the articular faces
which they present to the tarsus, and by their consequent im-
mobility at these points, extending and securing the base of the
body in that direction to which its gravitation most inclines
it. The first metatarsal bone, though corresponding in place
with the first metacarpal, is very unlike it in other respects.
Of predominating magnitude, but parallel with the other bones
and immoveable at its base, it is obviously intended for sustain-
ing the body, and least of all for prehension and for antago-
nizing the other bones, as is the case with the thumb.
The points on which the foot is particularly pressed when we
stand, are the tuberosity of the os calcis, the tuber of the base
of the last metatarsal bone, with the under surface of the cuboi-
des, and the anterior extremity of the first metatarsal bone.
The arch of the foot, upon which this depends, may be considered
in two ways: one is in the longitudinal direction, and has its abut-
ments in the os calcis behind, and in the ends of the metatarsal
bones in front, the other is transverse, is but slightly elevated
238 SKELETON.
externally, indeed almost flat, while it is raised to a considerable
height internally. This double arrangement is eminently ser-
viceable in many respects : it permits a concavity in which the
muscles of the toes may repose and act without being pressed
upon by the superincumbent weight of the body — it also per-
mits a free flow of blood and of nervous energy to this struc-
ture, gives a very elastic base to the whole body, and allows
itself to be applied to such inequalities of surface as it meets
with.
It has been agitated, by some ingenious inquirers into the
original condition of man, whether the erect attitude is natural
to him and not the result of an advancement in civilization.
Independently of the proofs derived from the authentic reports
of travellers concerning the varieties of the human family, from
none of whom have we rea'son to believe that the latter have
any where been found adopting habitually the attitude of quad-
rupeds ; there are evidences derived from the general mechan-
ism of the skeleton, still more conclusive, that standing is fully
natural to us. For example, 1st, The position of the foramen
magnum occipitis, evidently farther forwards in man than in
animals, indicates that his voluminous head is to be kept in equi-
librium by a vertical line of support near the centre of its base.
2d. The ligamentum nuchae, weak in man, is strong in quadru-
peds. 3d. The curvatures of the spine are so varied as to di-
minish the tendency to fall forward when we are erect. 4th.
The direction of the orbits of the eyes, which looking for-
wards, when we stand, and enabling the eye to apply itself to
a vast circumference, would, in the quadruped position, be di-
rected towards the ground, and thereby have the sphere of ob-
servation reduced to a few yards. 5th. The opening of the
nostrils, when we stand, permits odours to ascend easily into
the nose ; in the other attitude this opening would be directed
backwards. Such are the circumstances, in connexion with
the head only, which indicate the necessity of the biped posi-
tion for the full enjoyment of the functions which the Creator
has given to us. But there are, also, others equally evident
in the mechanism of the extremities, and of the parts of the
trunk to which they are attached. Thus, 1st, The breadth of
the pelvis, and the slight obliquity of its superior strait, in re-
MECHANISM OF THE INFERIOR EXTREMITIES. 239
gard to the spine, prevents us from falling to one side, and, at
the same time, brings the lower extremities immediately in a
line with the spine. 2d. The length of the neck of the os fe-
moris, and the size of its condyles. 3. The articulation of the
knee, which permits the leg to be brought into a line with the
os femoris, a position impracticable in quadrupeds. 4th. The
foot being articulated at a right angle with the leg, and having
its tarsus and metatarsus so well developed. 5th. The predo-
minance of the transverse diameter of the thorax over the ver-
tical, which, with the great length of the clavicle, and the
shape of the scapula, unfit the latter for assisting much in pro-
gression. 6th. The shape of the hand, calculated to seize upon
objects, but from the length of its phalanges not suited to sus-
tain the body. 7th. The mode of articulation at the wrist,
which, from its mobility and weakness in the direction to which
the weight of the body would be applied to it, could not be
brought to support it advantageously. And, lastly, the great
disproportion of length, in the adult, between the upper and
lower extremities, when an attempt is made to walk like the
quadruped.
In considering the skeleton of the very young child, it is
worthy of remark how closely its mechanism, with the excep-
tion of the head, corresponds with the habits of early life.
A spine, nearly straight, and a pelvis, the lateral diameter
of whose cavity is so small that the transverse base of
support is much diminished, render erection inconvenient.
LowTer extremities shorter in proportion than the upper ones,
having thigh bones nearly straight; also, the articulations
of the knee not admitting of a full extension of the leg.
All these circumstances prove that the quadruped position,
inconvenient and intolerably irksome when continued for a
length of time in the adult, is natural to the young infant.
The space between the ossa femorum, produced by the breadth
of the pelvis and the length of their necks, and, therefore, always
considerable above, varies below in different individuals. A cer-
tain distance at the latter point seems to be indispensable to con-
venient and graceful progression. Thus, when it is in excess, it
produces the deformity called bandy legs, and causes a totter-
240 SKELETON.
ing gait, such as may be mimicked, at any time, by walking
with the legs in a state of abduction: but, when diminished, it
is called knocked knees, and interferes with the firmness of the
step by causing the centre of gravity to pass, alternately, through
the internal condyles of the ossa femorum, instead of falling ex-
actly between them.
The firmest position in which we can stand is that in which
the feet are perfectly straight and parallel with each other, so as
to form a square base for the support of the trunk. If from this
position the toes be turned either inwards or outwards, the con-
sequent reduction of the antero-posterior diameter of the base,
causes' less resistance to the natural inclination of the trunk for-
wards. Whatever may be the grace and the ultimate intention
of the first position in dancing, to wit, that of having the feet
nearly in the same line, with the heels touching and the toes out-
wards, it is certainly the most unfavourable attitude for ease in
keeping the body erect that can be adopted; for the base of sup-
port being diminished, both by the length of the body of the os
calcis, and by that of the foot, anterior to the ankle joint, the
trunk is continually inclining either forwards or backwards, and
is prevented from falling only by the alternate action of the
muscles behind and in front.
When we are upon the knees, the base of support for the
trunk being entirely withdrawn in front, it is necessary, in order
to maintain the position, and to prevent falling forwards, that
the hip joint be flexed so as to throw the weight of the body en-
tirely behind the thigh bones. The position is one of so much
restraint and fatigue upon the muscles, that it can be maintained
for a long time, only by some artificial support in front, or by
the buttocks falling down upon the legs, and resting against them.
The position we assume on being seated in a chair, is the
easiest of any of those in which the trunk is kept erect, or nearly
so. The length of the lever, represented by the whols length of
the skeleton, is then diminished one-half; consequently, any pre-
ponderance of it at particular points, above, bears with less force
upon the base. The base itself is much augmented by the ampli-
tude of the buttocks, and by the horizontal position of the thigh
MECHANISM OP THE INFERIOR EXTREMITIES. 241
bones in front; and may be also increased, at pleasure, by the
extension of the legs. If, under such circumstances, the trunk
of the body be slightly advanced, its equilibrium is so easily main-
tained as to require but a very little muscular action to continue
it. The most exposed part of the base is backwards; and, if the
trunk be kept perfectly erect, there is some tendency of it to fall
in that direction. Hence, the utility of backs to seats, and the
fatigue from such as have not.
SECT. VI. ON THE MECHANISM OF THE INFERIOR EXTREMITIES IN
REGARD TO LOCOMOTION.
1. Of the Motions of the Thigh.
These, like the motions of the os humeri, upon the scapula?
consist in extension, flexion, abduction, adduction, rotation, and
circumduction; but, in consequence of being performed upon an
immoveable basis, the acetabulum, they are much less extensive.
In order that they may be understood well, it will be useful to
assume certain points of reference in the os innominatum and
femoris. These are the trochanter major, the pubes, and the
anterior superior spinous process of the ilium. In standing;, the
lower external part of the trochanter major, where it forms a
bulge on the side of the thigh bone, is on a horizontal line with
the upper part of the symphysis pubis. A triangle, described by
lines drawn from the anterior superior spinous process to the
symphysis pubis — from the latter to the point mentioned of the
trochanter, and from the latter to the anterior superior spinous
process, will be nearly a rectangle, of which the base is above,
and the shortest side behind.
The flexion of the os femoris is that motion in which its lower
extremity is carried forwards. It is performed with great ease
and freedom, in consequence of the arrangement of the articu-
lar surfaces of the bones, and of the capsular ligament. The
head revolves freely in the acetabulum, the ligamentum teres
is put into a slight tension, and the end of the trochanter major
VOL. I.— 21
242 SKELETON.
approaches the sciatic notch. The extreme point of this mo-
tion is the one preserved by the os femoris of the foetus utero.
Extension is the reverse of flexion. When the latter has
been performed, extension restores the thigh bone to its verti-
cal position, and carries it some degrees farther, but cannot be
executed to the same extent behind, that flexion is in front.
When pushed to an extreme, it brings the trochanter major
under the inferior anterior spinous process of the ilium, and the
round ligament is put very much upon the stretch; it is, finally,
arrested by the lower part of the neck of the os femoris lodging
against the posterior elevated margin of the acetabulum, and
by the thickened part of the capsule, in front and above, being
so much distended as not to yield farther without laceration.
Abduction is the act by which the thigh bones are separated.
When carried to an extreme, the under part of the head of the
os femoris leaves the acetabulum, and distends very forcibly
the capsular ligament at this point. The superior fasciculus
of the round ligament is strongly extended; but the inferior
fasciculus is kept easy, and, indeed, somewhat relaxed. This
motion is arrested by the trochanter major striking against the
ilium; without which it would be much more extensive, as the
capsular ligament is strained at its weakest point, and relaxed
at the strongest.
Adduction is the reverse of the last. The muscles which
produce it, the adductors, from their situation and course, are
unable to give an extent to this motion much beyond the act of
reinstating the thigh when it has been abducted. In this re-
spect they are much less influential than the great pectoral
muscle which adducts the os humeri. The articular sur-
faces of the bones are suited to a much greater latitude of this
movement, but it is arrested both by a deficient power in the
muscles, and by the strong upper part of the capsular ligament
being put upon the stretch.
Circumduction is the regular succession in a circle of the four
preceding motions, and is much less extensive in the os femoris
than in the os humeri, for the reasons stated. The centre of
the circle, or cone, thus described, is the head of the bone, and
MECHANISM OF THE INFERIOR EXTREMITIES. 243
it is much more extensive anteriorly and externally than pos-
teriorly and internally.
Rotation, owing to the length of the neck of the os femoris,
is extremely well marked, and is indicated by the trochanter
major moving backwards and forwards. The radius of the
circle thus described, is the distance between the centre of the
head of the os femoris and the bulging external part of the tro-
chanter major. The rotation outwards or backwards is more
fully and easily performed than the reverse, owing to the num-
ber and favourable position of the muscles causing it, many of
which are specially appropriated to its production, and some
others partially so. This movement is arrested by the neck of
the bone striking against the acetabulum behind, and by the
tension of the capsular ligament in front. Rotation, forwards,
having but few muscles to produce it, and they neither special-
ly devoted to it, nor acting very advantageously for the pur-
pose, is arrested by the neck of the bone striking against the
fore part of the acetabulum, by the tension, behind, of the cap-
sular ligament, and also, by that of the ligamenturn teres.
When the convexity and the neck of the os femoris look di-
rectly forwards, it is indicated by the great toe pointing in the
same direction.
2. Of the Motions of the Leg.
The movement of the leg upon the thigh is that of flexion,
of extension, and a very partial degree of rotation.
In flexion, the head of the tibia slides backwards upon the
condyles of the os femoris, which are prolonged behind, for the
purpose of extending this motion. It is checked, when carried
to an extreme, by the posterior margin of the tibia striking
against the os femoris, and by the tension of the ligament of
the patella. In the mean time, the lateral, the crucial, and the
posterior ligaments are relaxed. The patella, always station-
ary, and at the same relative distance in regard to the head of
the tibia, slides downwards upon the trochlea of the os femo-
ris, and in the flexed position sinks between the condyles, so as
to come in contact with the ligamentum mucosum.
244 SKELETON.
In extension, the patella rises upon the condyles, and becomes
prominent; the lateral ligaments are rendered somewhat tense,
and the motion is finally checked, by the resistance of the cru-
cial and of the posterior ligaments of the articulation.
The rotation of the bones of the leg can only be performed
when they are flexed, and the ligaments, generally, thereby re-
laxed, in which position a very limited motion, inwards and
outwards, is perceptible. The motion, outwards, is the more
extensive of the two, in consequence of the arrangement of the
crucial ligaments, which are separated from each other by it.
The motion, inwards, is limited by these ligaments being
brought immediately by it into close and resisting contact with
each other. In either case, however, the posterior and the la-
teral ligaments all contribute, ultimately, to arrest the motion.
In all these conditions of the leg, the semi-lunar cartilages
slide somewhat upon the head of the tibia.
The articulation between the tibia and the fibula is such as
to admit of no motion whatever below; but, above, a limited
sliding backwards and forwards is performed by the fibula
upon the tibia. This movement is made more perceptible in
cases of extreme emaciation, and in general relaxation of the
muscular system.
3. Of the Motions of the Foot.
The general motions of the foot upon the bones of the leg
are flexion, extension, and an inconsiderable inclination inwards
and outwards.
In flexion, the astragalus rolls backwards in the articular
cavity formed by the tibia and the fibula, and is arrested by the
anterior upper part of the astragalus coming in contact with
the articular margin of the tibia. The ligamentous fibres and
the synovial membrane, in front of the articulation, are re-
laxed; those behind are in a state of tension, as well as the
tendo-achillis, and the other tendons there. Luxation from an
excess of this motion is impossible.
MECHANISM OF THE INFERIOR EXTREMITIES. 245
In extension, the foot is brought with the point downwards,
so as to have its upper surface almost on a line with the bones
of the leg. The astragalus glides forwards; the tendons, on the
back of the joint, are very much relaxed. The joint itself is in
a state the reverse of the preceding.
In the lateral motions, the sole of the foot is caused to pre-
sent itself either obliquely inwards or outwards, whereby it
may be accommodated to any inclined surface on which we
walk. The first position is checked by the internal malleolus,
and the tension of the external lateral ligaments; the second,
by the external malleolus, and by the tension of the internal
lateral ligament. These motions constitute the adduction and
the abduction of the foot; and by a regular succession with its
flexion and extension, communicate a very limited and embar-
rassed species of circumduction.
The bones of the tarsus, for the most part, have a very ob-
scure motion upon each other, with the exception of the arti-
culation between the astragalus and the scaphoides, and be-
tween the os calcis and cuboides. At these points the move-
ment upwards and downwards, makes a sort of flexion and
extension of the fore part of the foot, which is very distinct.
A species of twisting, or oblique gliding, is also slightly percep-
tible there.
The bones of the metatarsus are susceptible of a slight eleva-
tion and depression, which, almost imperceptible at their bases,
become sufficiently obvious at their anterior extremities. They
also may be slightly approximated, at their fore parts, by the
action of muscles, and by external compression. When the
weight of the body is thrown upon them, they separate from
each other, and the metatarsus loses, in some degree, the arched
form of its anterior extremity below.
The phalanges of the toes have the same motions with those
of the fingers, except that they are more restricted. The first
ones, therefore, perform flexion, extension, adduction, abduction,
and circumdaction ; the last two have only flexion and exten-
sion. The extension of the first phalanges is more extensive
21*
246 SKELETON.
than their flexion, from whence results an important advantage
in walking or in standing upon the toes. The shortness of the
second and third phalanges of the small toes, together with the
thickness of the sole of the foot contiguous to them in their ex-
treme flexion, causes them rather to be doubled up on them-
selves, than on the sole of the foot.
On the General Motions of the Lower Extremities.
These may be resolved into three; walking, running, and
leaping.
In walking, though the first step may be taken in a variety
of relative positions of the lower extremities to each other, yet
it will make the investigation more clear to suppose the indivi-
dual standing erect, with the two feet precisely on the same
plane, and giving equal support to the trunk. The first step is
then taken, by detaching the foot of one side from the ground ;
in order to do which, the thigh is bent upon the trunk, the leg
upon the thigh, and the limb by being thus elevated becomes
shorter. At this period the ankle joint remains at rest, with a
slight inclination of the toes downwards. By the subsequent
relaxation of the muscles of the limb advanced, with an incli-
nation of the trunk to the same side, the limb is caused to de-
scend upon the ground. These are the only motions when the
step is short and easy; but, when a long stride is taken, by which
the limb is put very much in advance of its fellow, in order to
bring it to the ground, the pelvis is caused to rotate forwards
on the head of the stationary thigh bone, whereby the trunk of
the body, instead of presenting the sternum forwards, has it
turned to one side.
When a step has been taken so as to leave one inferior extre-
mity advanced before the other, for example the left, the limb
behind is brought forward by .the following mechanism: — The
left foot, remaining fixed, becomes the point of support to the
trunk; and the right, which is behind, is elevated successively,
from the heel to the toes, by the action of the muscles on the back
of the leg, and rests, upon the phalanges. The effect of this po-
sition is to elongate the right inferior extremity to the amount
of the distance between the fore part of the ankle joint and the
MECHANISM OF THE INFERIOR EXTREMITIES. 247
anterior extremity of the metatarsus, whereby that side of the
pelvis is pushed forwards, and a rotation in advance impressed
upon it. By the latter impulse, the foot of that side is wholly
detached from the ground, the thigh being flexed at the same
moment at the hip joint, and the leg flexed at the knee, the
whole extremity is carried forward and fixed upon the ground,
after the manner described in the first step. Ordinary progres-
sion results, then, from the regular succession of the last mo-
tion in the two extremities. In regard to the impulsion of the
pelvis from the foot behind, this will probably take place in
every case, more or less; it may however, be reduced very
much by a certain extent of flexion at the knee joint; and the
want of it not be felt, because other powers concur to produce
the same impulsion; as certain muscles, and also the momen-
tum of swinging the lower extremity forward.
An equality of length in the lower extremities is indispensa-
ble to graceful and regular progression. If one of them be
shortened from any cause whatever, it is manifested in the gait,
by an unusual sinking of the pelvis on the defective side, at the
moment the foot is brought to the ground, and from the conti-
nuity of the pelvis with the upper parts of the body, a conside-
rable lateral inclination is communicated to the latter in the
same instant. The pains frequently taken to conceal this de-
fect, disguise it very imperfectly, unless the shortness be only
such as may be supplied by a shoe with a sole thicker than
that of the other foot. Where the shortness arises from luxa-
tion upwards of the os femoris, a crutch is the best substitute
for sustaining that side of the pelvis.
In running, the position of the feet is somewhat different from
what it is in walking; they are extended so as to support the
trunk on the phalanges alone, instead of on their soles: whereby
a double advantage is obtained, that of keeping the lower extre-
mities at their greatest possible length, and also of enabling them
to detach themselves quickly from the ground. The velocity
here is the principal difference between it and walking, yet there
are some peculiarities.
The trunk of the body is kept continually and largely inclined
forwards, which enjoins the necessity of a quick successive ad-
vance of the lower extremities to prevent it from falling. This
248 SKELETON.
position, also, by advancing the bony points, from which arise
several of the muscles used in the extension of the thigh, removes
these muscles more from the line of their contraction, and there-
by enables them to act more advantageously and promptly. As
each pace on these occasions is taken to the fullest stretch, the
pelvis is rotated forwards from side to side, alternately upon the
head of the os femoris, which may be fixed at the time. The
face being directed forwards, whatever rotation in the vertebrae
can occur, is then performed. As the pelvis communicates its
motions to the trunk, so the latter carries its own to the upper
extremities; which are thereby slung, alternately, backwards
and forwards, and are brought, continually, to adjust the centre
of gravity, which is then more in danger of being lost than in
ordinary walking.
The ascent of an inclined plane, either by walking or running,
is attended with unusual fatigue and difficulty, for the following
reasons: In order to advance the thigh, it is necessary to give it
great flexion at the hip joint, the knee must also be bent in an
equal degree, and the foot be flexed, in order to adjust it to the
surface against which it reposes. To bring forward the other
extremity, it requires an equal flexion at the hip and knee; be-
sides which, its heel being below the phalanges, the foot must
perform a full rotation at the ankle joint. The difficulty is
somewhat diminished by stepping only on the phalanges. As, in
these cases, the trunk of the body, to preserve its equilibrium,
must be inclined forwards, there are certain acclivities, which,
though they furnish a base sufficiently large for the foot, are
yet impracticable from not allowing the trunk to be thrown for-
wards.
The descent of an inclined plane is more easy, because it re-
quires but little flexion, in the articulations mentioned, to bring
the extremity behind on a line with that in front; and its subse-
quent descent is produced by keeping it almost straight, and
shortening the extremity which is fixed. Running is then at-
tended with some inconveniences, for the impulsion, forwards,
which this motion communicates to the trunk, assisted by the in-
clination of the plane in that direction, determines a fall, inevita-
bly, without a successively accelerated advance of the hind leg.
We see frequently, in the descent of a very inclined hill, a step,
at first guarded and leisurely taken, converted, unavoidably,
MECHANISM OF THE INFERIOR EXTREMITIES. 249
into a full run, to prevent the body from being precipitated for-
wards to the ground.
In jumping, the whole body is projected abruptly from the
ground, either in a vertical or oblique direction.
In the first, the lower extremities are shortened by a general
flexure of their articulations, and, by a very sudden and simul-
taneous extension of them, the resistance of the ground causes
the whole frame to mount upwards, till its gravitation causes
the momentum to cease; it then descends on the same principle
with projectiles, generally. In the oblique leap, there is the
same flexion in all the articulations of the, lower extremities,
with the addition of an inclination, forwards, of the trunk. At
the moment when the limbs straighten themselves, the trunk is
projected, not only upwards, but forwards, owing to its inclina-
tion, and describes in its ascent and descent a parabola. In this
effort, the space traversed will be more considerable, if a pre-
vious horizontal momentum has been communicated to the trunk
by running several steps before the leap be made.
The more oblique the leap is, the greater will be its extent,
to effect which the trunk must be inclined proportionably for-
wards. But, to obtain this inclination without falling, it is ne-
cessary for one of the lower extremities to be very much ad-
vanced at the moment of springing with the other, so as to con-
vert the motion into a very long step. With this position of
the lower extremities, a much longer space can be cleared than
if they were kept together.*
* For a farther exposition of the principles of locomotion, see Joh. Alph. Bo-
relli de'Motu Animalium, 1710. Haller, Element Physiol. torn. iv. 1757. Bi-
chat, Anat. Descript. 1801. Barthez, Nouvelle Mechanique des Movemens de
1'Homme et des Animaux, 1798.
BOOK I.
PART III.
CHAPTER I.
ARTICULATIONS.
OF THE CARTILAGINOUS SYSTEM.
CARTILAGES (Cartilagines, Systkme Cartilagineux,) supply the
place of bone in many parts of the human skeleton, as in the
space between the ribs and sternum, in the larynx, in the ex-
ternal ear, in the nose, and elsewhere. They are also to be
found in all the moveable, and in several of the immoveable ar-
ticulations. Wherever placed they may be recognised by their
whiteness, by their flexibility, by their great elasticity, and by
a hardness only short of that of the bones. There are many ani-
mals whose skeletons are .entirely cartilaginous, as the chon-
dropterous or cartilaginous fishes, so excellent a substitute is
cartilage for bone.
Cartilages have neither canals nor cells in them. They appear
homogeneous; and, upon a superficial inspection, present neither
laminas nor fibres. The immersion of them in boiling water
dissolves into a jelly, such as are found upon the articular sur-
faces of the bones, and a few others ; but, such as supply the
place of bone, though softened by the process, are not rendered
by any means so gelatinous. Their chemical analysis, accord-
ing to Mr. I. Davy, is gelatine, 44.5; water, 55.; phosphate of
lime, 0.5. The testimony of different experimenters, upon the
latter point, does not coincide, and their results must vary ac-
cording to the kind of cartilage, and the period of life.
Cartilages are composed of a tissue exclusively their own,
252 SKELETON.
and of parts which they have in common with other organs.
The first has some very distinguishing properties. It resists
putrefaction, either with or without maceration, longer than any
other tissue, except the bones. In the midst of gangrene it pre-
serves its appearance almost unchanged. Boiling gives it a yel-
low colour, causes it to swell, and, if protracted, the gelatinous
portion is dissolved. When dried, it becomes of a semi-trans-
parent yellow, diminishes Fn bulk, and loses its elasticity ; in
these respects resembling ligaments and tendons.
Cellular substance exists, in very small quantities, in carti-
lage, and is therefore, not readily demonstrated; it is, however,
made manifest by maceration, and by the action of boiling wa-
ter: the latter, by dissolving the gelatinous portion, leaves a
membranous and cellular structure. It is also stated, that in
certain diseases, the gelatinous portion being less abundantly
secreted, the cellular is left in a soft spongy condition.
In a healthy state, no blood vessels can be seen in cartilages;
yet there are the strongest proofs of a species of circulation go-
ing on in them, either by very fine capillary vessels, or an in-
terstitial absorption. All experienced anatomists have seen, in
subjects affected with jaundice, the entire cartilaginous system
losing its brilliant whiteness, and becoming of a light yellow:
also, the conversion into bone, in extreme old age, to which all
cartilages, with but few, perhaps no exceptions, are subject ; and
this ossification sometimes beginning in the centre of the carti-
lage, prove that the calcareous matter has been conveyed there
by some kind of channel.
Neither absorbents nor nerves have been traced into them,
and it is not possible to prove conclusively, their existence by
the circumstances of disease. We only know, that in inflam-
mations of the joints, terminating by anchylosis, the cartilages
are absorbed ; and that in some cases, even without evident in-
flammation, the cartilage is removed from a joint as if it had
been worn away. Ulcerations of the arytenoid cartilages are
spoken of as common, by the French anatomists;* but it has
not occurred to me to see either them or any others in this
state : the late Dr. Physick's experience is also the same with
* I have, since the first edition of this work, seen several instances in _chronic
Laryngitis.
DEVELOPMENT OF CARTILAGES. 253
my own. Possessed of no animal sensibility in the natural
state, it is doubtful whether they ever have it, or can inflame,
as the pains in inflammations of the joints may arise from the
synovial membranes.
In the embryo, the osseous and cartilaginous systems are
confounded, so as to present a homogeneous, mucous or pulpy
appearance; they only become distinct by the deposite of cal-
careous matter in the bones: when the latter. are somewhat ad-
vanced, the cartilages, which are to remain such, have also
additional consistence, and more of a proper cartilaginous look;
but the appearance is generally unsatisfactory, by which one
can learn to distinguish the cartilages that are to remain such,
from the cartilaginous rudiments of the bones. The following
circumstance, however, is pointed out by Bichat: in the carti-
lages of ossification, there is a vascular net-work between the
cartilage and the ossification which has occurred, and owing
to the interposition of it, the two may be easily separated.
But, in the permanent cartilage, this net-work does not exist
between the proximate surfaces, consequently they adhere
with a tenacity not admitting of a rigid separation from one
another.
As the individual reaches adult age, the cartilages acquire
the strength, whiteness, and great elasticity which distinguish
them. In old age they become yellowish, more brittle, and
are, as said, generally disposed to ossify. Those of the ribs
and larynx are frequently ossified at forty years of age. The
ossification of those of the moveable joints is rare, and begins
at a more advanced period. In the first two it begins com-
monly near their centre, and in the last on the surface.
ACCIDENTAL DEVELOPMENT OF CARTILAGES.
The unnatural development of cartilages, in the tissues and
organs of the body, to which they are very slightly allied in
their nature, is a circumstance by no means uncommon, and
is met with annually, in most of its varieties, in our dissecting-
rooms. As there is a great disposition in such cartilages to
ossify, they are presented in the several gradations from a soft
gelatinous body to that of perfect bone. They occur in the
VOL. L— 22
254 SKELETON.
articulations; in the lungs, and form there fistulous passages;
very frequently on the surface of the spleen; in the pleura; in
the fibrous coat of the large arteries, particularly the arch of
the aorta; and in the semi-lunar valves of the same; in the ova-
rium, when it becomes dropsical; and also in many other parts
of the body.
The cartilages which are found loose in the joints and float-
ing about there, begin, for the most part, in the fibrous struc-
ture* exterior to the synovial membrane; the latter is protruded
inwards by them, and gives them a covering resembling the
finger of a glove. As these bodies are small and rounded,
when they protrude into the joint the synovial membrane forms
a pedicle or base to them, which is finally ruptured, and then
the cartilage becomes loose. These bodies are generally ossi-
fied in their centre, of course they have gone through the usual
progress and phenomena of ossification. The other forms of
preternatural cartilage are much disposed to ossify in the arte-
ries, but not so much so in the other organs. In these cases
they are laminated and adhere by their surfaces, very closely,
to the contiguous structure, so as to be membranous. M.
Laennec has seen a cartilaginous transformation of the mucous
membrane of the urethra; M. Beclard of the mucous membrane
in the vagina, attended with prolapsus uteri, and also of the
prepuce of an old man who had a phyrnosis from birth.
OF THE PERICHONDRIUM.
All the cartilages, except the articular ones, are invested by
a membrane called perichondrium, (perichondre.) It is best
seen on the larynx, and on the cartilages of the ribs. Its struc-
ture is fibrous, and corresponds so fully with that of the peri-
osteum that it may be considered the same sort of membrane.
It is, however, less vascular than the periosteum, and adheres
to the cartilages with less force, owing to the fibrous connexion
between them being not so abundant. Bichat's experiments
prove that the cartilage is much less affected by the loss of this
membrane, than the bone is by that of the periosteum: its uses
are no doubt the same.
* Beclard, Anat. Gen.
ARTICULAR CARTILAGES. 255
OF THE ARTICULAR CARTILAGES.
To this class we refer, exclusively, such as adhere by one
surface to the articular facings of the bones, and present the
other surface to the cavity of the joint. Every moveable, and
some of the immoveable articulations, have their surface uni-
formly thus incrusted, to a thickness varying from the fraction
of a line in the smallest joints, to one line in the largest. The
cartilage itself is rather thinner near the margin of the articular
surface, when the latter is convex, than it is near the centre;
on the contrary, when the surface is concave, the cartilage is
thickest near its periphery.
These cartilages, when subjected to a maceration of six
months, are stripped of the reflection of synovial membrane,
which covers their articular surfaces, and are resolved into
fibres, one end of which adheres to the bone and the other end
points to the joint. If the preparation be then dried, the dis-
tinction of fibres becomes more manifest.
The most successful injections, closely examined with a mi-
croscope, demonstrate the defect of blood vessels in them. The
vessels are uniformly seen to terminate at the circumference of
the cartilage and at the face which adheres to the bone, but
never to penetrate it. Their organization is, therefore, ex-
tremely simple, and such as subjects them to but few morbid
alterations. When partially removed from the bone the latter
occasionally reproduces them, but the edges of the new and of
the old production do not unite. I have, in cases of inflamma-
tion of the joints, seen the fibres of these cartilages much longer
than usual and detached from each other. When a joint is
laid open by a wound, and suppurates, the cartilage softens
and disappears from the circumference to the centre.*
* Bichat, Anat. Gen. The same author speaks of the idiopathic ulceration of
the cartilage, as a result of its inflammation. The late Dr. Physick, whose ex-
perience is equal, denies both.
256 SKELETON.
CHAPTER II.
OF THE FIBRO OR LIGAMENTO-CART1LAGINOUS SYSTEM.
THIS set of organs (Systeme fibro-cartilagineux) has been
placed -by anatomists, indiscriminately in the cartilaginous or
in the ligamentous system, in consequence of its participating
in the characters of both; it, however, from its importance,
should have a distinct position. There are three varieties of
this system. The first presents itself in a membranous state,
and is represented by the external ear, by the alas of the nose,
by the cartilage of the eye-lids, and by the trachea. The se-
cond is represented by the inter-articular cartilages of the move-
able articulations, as of the knee, the wrist, lower jaw, and also
by the inter-vertebral matter which holds the bodies of the ver-
tebrse together. And the third is represented by the trochleas
and sheaths, formed on the surface of bones for the gliding of
tendons.
The principal constituent of this system is a strong fibrous
matter, which is intermixed with the cartilage, and has in some
places its surface covered by the latter. The fibres even by
superficial observation may be traced in various directions: in
some places they are parallel; in others intermixed and crossed
very much ; in others concentric. Their strength is of the first
degree. The cartilaginous part fills up the intervals between
the fibres, and gives to the whole structure its whiteness and
elasticity.
The Fibro-cartilages may be converted by the action of hot
water into gelatine, but the process is slower than in the sim-
ple cartilage. The membranous, or first variety, differs how-
ever from the other two in this respect; for if it can be reduced
at all into gelatine, the quantity it yields is not perceptible.
This system is destitute of perichondrium, with the excep-
tion of the first variety, in which it is distinguishable; but the
others either adhere to the bone, or are covered by a synovial
LIGAlVfENTOUS TISSUE. 257
reflection; their margins adhering in such cases to the conti-
guous ligamentous structure.
There is a very small quantity of cellular tissue in this sys-
tem. Artificial injection manifests but few blood vessels in it;
if the animal, however, be strangled for the purpose, the blood
by accumulating in the capillaries becomes sufficiently appa-
rent.
CHAPTER III.
OF THE LIGAMENTOUS OR DESMOID TISSUE.
SECT. I.
THE Desmoid Tissue, (Textus Desmosus, Sys&me Fibretix,)
is very generally diffused in the human body, has a very close
connexion with the cellular texture, and is continuous with it
in divers places. It may be known by its whiteness, the firm-
ness and unyielding nature of its materials, and its fibrous ar-
rangement. It is most commonly employed in fastening the
bones to each other at their articulations, and in enveloping
the muscles, but it is also applied in many other ways. Its ap-
plication in the former is our present object, but before that is
particularly noted, it will be useful to enter into some general
considerations in regard to its intimate structure, and the ob-
servations now made can be applied on all other occasions
when this tissue is in question.
A desire to generalize, and consequently to simplify, has in-
duced anatomists to seek for some fountain or source from
which all the reflections and applications of the desmoid tissue
might be traced. The Arabians thought that the dura mater
was this source; and the error was sanctioned for a long time
by the authority of Sylvius. The celebrated Bichat, in ob.
serving the connexions of this tissue, finding that all its points
of application might be traced either mediately or directly to
the periosteum, considered the latter as its centre, as the heart
22*
258 SKELETON.
is the. centre of the circulation, and the brain of nervous ener-
gy.; not that he thought the periosteum radiated its influence
on all its dependent organs, but because anatomical inspection
demonstrated all the fibrous organs to be connected with it, and
communicating through it with each other. The late Profes-
sor Bonn, of Amsterdam, reversed the idea of Bichat, and con-
sidered the aponeuroses of the extremities, and of the trunk,
which send their partitions between the muscles, and down to
the periosteum and joints, as the much desired centre of the
desmoid system. The latter idea has been reiterated by
others, and the supposed emanations from the superficial apo-
neurcses diligently traced. As means of studying the position
and connexions of parts, notwithstanding the construction is a
very forced one, which makes desrnoid tissue cellular mem-
brane, and cellular membrane desmoid tissue, alternately, so
as to suit the arrangement of the anatomists, instead of that of
nature; yet, any or all of these plans have their use, and may
be followed advantageously, after the study at large of the hu-
man fabric.
The desmoid tissue is essentially fibrous, but without a uni-
form arrangement, as its fibres are either parallel, crossed, or
mixed. In some places the fibres are very compact, and sepa-
rate with difficulty, but generally prolonged maceration will
cause them to part into filaments as fine as the thread of the
silk-worm. Anatomists differ in regard to the ultimate struc-
ture of these fibres. By M. Chaussier they are thought to be
primitive and peculiar; Mascagni* supposed that they were
lymphatics enclosed in a vascular web ; Isenfiam, that they were
cellular substance imbued with gluten and albumen. And M.
Beclard, observing that maceration resolves them into a spe-
cies of mucous or cellular substance, teaches that they are the
latter in a condensed state. Bichat's opinion is probably correct
that the tissue is peculiar, and tha-t maceration only brings into
view the cellular substance which unites its fibres. Though
maceration and chemical management evolve some striking
coincidences with cellular membrane, yet in the natural and
ordinary state there are some very strong points of difference
from it. Among these may be remarked its great want of elas-
* Prodrome della Grande Anatomia.
LIGAMENTOUS TISSUE. 259
ticity, which causes it to tear sooner than to stretch ; and in
general anasarca, its being only very partially affected, merely
rendered a little more moist and tumid, which even then may
arise from the small quantity of cellular substance in it. Many
parts of it, however, are unaffected in the latter way, as the
tendons and their sheaths. This tissue naturally contains a
considerable quantity of water, which it loses by exposure to
the air; it then is much reduced, and becomes hard and yellow-
ish, and is made semi-transparent by being put into spirits of
turpentine.
The desmoid tissue, by being subjected to the heat of boiling
water, contracts, becomes more solid, and is elastic; but if it be
continued there, it gradually softens, becomes semi-transparent,
and gelatinous. The mineral acids reduce it to a pulpy state,
and if concentrated, will dissolve it entirely. The alkalies loosen
its texture, cause the fibres to separate easily, and to assume a
diversity of colours. It putrefies but slowly, in this respect be-
ing next to the cartilages.
The strength of this texture is remarkable, and adapts it to
the sustaining of enormous weights; a faculty which is conti-
nually in requisition, both to retain the articular surfaces of
bones in contact, and the muscles and tendons in their places.
It is well known that the patella, the olecranon, and the os cal-
cis, break frequently before their tendinous attachments will
give way. In the history of punishments, where criminals
have been fastened to four horses, it is said that it has been found
necessary to use a knife to assist in their disarticulation. All
these phenomena occur when abrupt violence is resorted to, so
little are the ligaments disposed to yield; but when the causes
of distention act slowly and gradually, as in dropsies of the
joints, the fibres separate, and are sometimes completely disu-
nited. When ihe distending cause ceases to operate in the lat-
ter case, the ligaments have the power of contracting in the
same gradual way, and of restoring themselves.
Some of the desmoid tissues, besides having their fibres sur-
rounded and their interstices occupied by cellular substance,
contain a very small quantity of oily or fatty matter. This
is not very obvious in their recent state; but, by drying them,
it will be seen in small quantities on their surface, like a greasy
exudation: this probably comes from the cellular substance in
260 SKELETON.
them. They are furnished but sparingly with blood vessels,
which for the most part, are capillary. The periosteum and
the dura mater are, however, exceptions to this rule. Lym-
phatic vessels have been observed in some of them, but it is
doubtful whether they generally have nerves.*
The sensibility of this system is extremely obscure, and is not
manifested under the usual mechanical and chemical irritants;
it may, however, be elicited by communicating to the joints a
twisting motion, as the experiments of Bichat prove. Inflam-
mation augments their sensibility, in which case it becomes ex-
tremely acute, as in gout and rheumatism, or any other cause
productive of it.
SECT. II. OF THE LIGAMENTS OF THE JOINTS.
The ligaments, (ligamenta,) properly speaking, are those or-
gans which tie the bones together, and in the moveable joints
are either capsular (capsules jibreux) or funicular, (ligamens
jibreux fasciculaires.) The first are like a bag open at the
ends, at either of which the articular extremity of a bone is in-
cluded. These are much more complete in some joints than in
others; the shoulder and the hip joints afford the most perfect
examples; in other joints they are divided into irregular fasci-
culi of fibres, permitting the synovial membrane to appear in
their interstices, and sometimes they are still more widely se-
parated.
The funicular ligaments are mere cords, extending from one
bone to another; some of them are flattened, some rounded, and
others oval or cylindroid. They are variously placed ; in some
instances they are within the capsular ligament, and in others,
on its outer surface, and sometimes so blended with it as not to
be separated without an artificial dissection. Their names are
derived either from their position or shape, and are generally
sufficiently appropriate.
* Beclard, Anat. Gen.
SYNOVIAL ARTICULAR CAPSULES. 261
SECT. III. OF THE SYNOVIAL ARTICULAR CAPSULES.
Each moveable articulation is lined by a membrane, (Mem-
brane Synoviale,} reflected over the internal face of the capsu-
lar ligament and the articular cartilages. This membrane is
a perfect sac; and unlike the capsular ligament, has no opening
in it. It is remarkably distinct where it is not attached to the
articular cartilages; and, by being inflated, is caused to protrude
in small vesicles, or pouches, between the fasciculi of the liga-
mentous structure. Its connexion with the cartilage, and its
continuation over it, are not quite so obvious, and require more
management to demonstrate: it is, indeed, so thin and transpa-
rent at this part, and adheres so-closely, that its existence there
has been questioned, but may be proved in a variety of ways.
By maceration it becomes so loose, that, with a pair of forceps,
shreds of it may be raised along the whole extent of the carti-
lage. If a flap of cartilage be raised up by a knife, its base
being left attached, in attempting to tear away the base it will
be found that the synovial membrane is continued from this
base to the contiguous cartilage. Saw a bone through to its
articular cartilage, then tear through the cartilage gently, in
which case the continuity of the synovial membrane will also
be manifested.
From these several proofs the fact is established, that the sy-
novial membranes are bags, closed at both extremities, and dif-
fer thereby from the capsular ligaments.
The synovial capsules are liable to a fungous degeneration
which occurs equally upon the cartilaginous and capsular por-
tions of them. Factitious bridles sometimes form in the joints,
attached indiscriminately to either portion of the synovial mem-
brane. M. Beclard says, that protracted inflammation will,
finally, redden the cartilaginous portion, and that it extends from
the circumference to the centre, the hues being lighter the
nearer it is to the latter. It has not occurred to me to meet
with this proof; though I have made frequent dissections in
subjects, of inflamed joints, the redness has always ceased at
the margin of the articular cartilage. Dr. Physick's experience,
262 SKELETON.
most valuable on all occasions, affords support to my own. —
Some years ago I had an opportunity of investigating, some-
what fully, this point, in a subject, all of whose large joints were
in a state of inflammation.
These synovial capsules, or membranes, are white, thin, se-
mi-transparent, and soft. Wherever there is a deficiency of
capsular ligament, they adhere to the contiguous cellular sub-
stance, and are so blended with it as to appear absolutely con-
tinuous. Dissection, inflation, and maceration, prove them to be
laminated, and develop their structure in such a way that it re-
solves itself into a cellular tissue, the more interior layers of
which had been in a very compacted state. In all this they re-
semble the serous membranes, generally, and are ranked among
them; Bichat, therefore, considers them only as an interlace-
ment of absorbents, and of exhalents. But, for the farther ex-
position of this point, see the article on the Serous Membranes.
The synovial sacs have, on their outer surface, but projecting
into the cavity of the joint, adipose cushions of different sizes,
called the Synovial Glands of Havers, from which, till lately, it
was supposed that the lubricating liquor of the joints is exclu-
sively secreted. These cushions have their projecting margins
fringed and unusually vascular, and occupy the small spaces
left between the articular faces of the bones. As they are co-
vered by the synovial membrane, they no doubt assist in the
secretion of the synovia.
The moveable articulations are all furnished with the fluid
called Synovia; this name was given to it by Paracelsus, from
its resemblance to the albuminous part of an egg, to the con-
sistence and colour of which it has a close affinity, and, like it,
is thick, ropy, and somewhat yellowish. The chemical analysis
of it indicates the presence of water, albumen, and a kind of in-
coagulable mucus. It was once supposed to be a mixture of
serum, with the adipose matter of the bones, which found its
way into the joints by transudation; but as it contains upon ex-
periment no oil, the opinion is evidently erroneous. It is se-
creted from the whole internal surface of the synovial mem-
brane, and, perhaps, in greater quantities from the fringed fatty
ARTICULATION OF THE LOWER JAW. 263
cushions in the joints in consequence of their increased vascu-
larity. M. Beclard teaches, that it is neither a follicular nor a
glandular secretion, nor a transudation, but a perspiration, in
which a perfect equilibrium is kept up between its exhalation
and its absorption. Its use is to diminish friction, and, conse-
quently, to facilitate the sliding of the bones upon each other.
CHAPTER IV.
ARTICULATION OF THE LOWER JAW.
THE articular connexion, here, is formed by that portion of the
glenoid cavity anterior to the fissure, and by the condyle of the
lower jaw. Each surface is covered by thin cartilage; and a
thin, loose, irregular, fibrous, capsular ligament, arises from the
articular margin of one bone, to be inserted into that of the other.
Besides this, there are four other ligaments for strengthening
the joint, an inter-articular cartilage, and two synovial mem-
branes.
The External Ligament (Membrana Articularis Ligamen-
tosa) arises from the inferior margin of the root of the jugal or
zygomatic process of the temporal bone, and from the anterior
side of the meatus externus, and is inserted into the neck of the
condyloid process. It is somewhat triangular, having the base
upwards. Just in advance of this, and separated from it by a
small fissure, is another triangular ligament, the discovery of
which is claimed by Caldani.* It arises from the anterior part
of the inferior margin of the zygomatic process of the tempo-
ral bone, and is inserted into the neck of the bone in advance
of the other.
The Internal Ligament (Lig. Maxillce Laterals) arises from
the extremity of the spinous process of the sphenoid bone, and
from the posterior margin of the glenoid cavity, that is the pro-
cessus vaginalis,and going downwards and outwards, is inserted
* Tabul. Anat. Venetiis, 1802.
264 SKELETON.
into the spine bordering the posterior mental foramen, and for
some distance lower down on the ramus of the jaw. It is placed
between the two pterygoid muscles, and is in contact with
the maxillary vessels and nerves, as they run between it and
the condyle to the posterior mental foramen. It is thought by
Caldani to be not so useful in restricting the motion of the jaw
forwards, as in holding the vessels and nerves, and regulating
their position, lest in the various motions of the lower jaw
they should be displaced and injured.
The Stylo-maxillary Ligament is thinner than the above. It
arises from the external side of the styloid process, and is in-
serted into the posterior margin of the jaw, near its angle, be-
tween the masseter and internal pterygoid muscles. The sty-
lo-glossus muscle is much connected with it, and is thereby as-
sisted in elevating the base of the tongue, the fascia profunda
of the neck is in continuation with it.
There are two synovial membranes, the one reflected be-
tween the glenoid cavity and the upper surface of the inter-
articular cartilage, and the other between this latter substance
and the condyle of the lower jaw. They may be seen at differ-
ent points protruding between the fibres of the capsular liga-
ment.
The Inter-articular cartilage, by being placed between the
two synovial membranes, separates completely the two bones.
Above, its surface corresponds to the convexity of the tubercle
of the temporal bone, and to the glenoid cavity; below, it is
simply concave for receiving the condyle. It is thicker at the
circumference than in its middle, and at the posterior than the
anterior margin. Sometimes it is open in the centre, in which
case the two synovia! membranes run into one another. Its
structure is fibro-cartilaginous. It moves very readily back-
wards and forwards.
On the posterior face of the capsular ligament, I have found,
in several cases, indeed, on all occasions of special examination
for it, since the first observation, an erectile tissue or structure
resembling the corpus cavernosum penis. It has not been
LIGAMENTS OF THE SPINE. 265
filled with blood like the latter, but is, probably, an arrange-
ment for giving great mobility forwards to the lower jaw.
The movements of this bone may be simply hinge-like, by
its depression, in which the mouth is regularly opened ; or, by
the action of the pterygoid muscles, it may be slid forwards.
When the muscles of but one side act, a species of rotation is
communicated ; in which one condyle advances on the tubercle
of the temporal bone, while the other reaches to the back part
of the glenoid cavity. The looseness and length of the capsu-
lar ligament of the articulation, along with the extreme facility
of motion from the interposition of a moveable cartilage, con-
tribute very materially to this movement. The sliding back-
wards and forwards of the intermediate cartilage of this arti-
culation, during mastication, sometimes produces a cracking;
audible to the by-standers, and extremely annoying to the in-
dividual who is the subject of it, from the noise being so near
his ear.
Some persons are liable to a spontaneous dislocation of this
bone, from yawning too widely. I am disposed to believe, that,
in such cases, the accident arises from the posterior boundary
of the glenoid cavity, (as established by that margin of the
temporal bone which is continuous with the vaginal process,
and forms a part of the meatus externus,) being more advanced
and higher than usual; in consequence of which, whenever the
bone is depressed to a certain point, its neck strikes against
this ridge, and not being able to go farther back, the ridge acts
as a fulcrum, and starts the condyle over the tubercle of the
temporal bone into the zygomatic fossa. The fact is certain,
that very strongly marked differences of the glenoid cavity, in
this particular, occur in different individuals.
VOL. I.— 23
266 SKELETON.
CHAPTER V.
OF THE LIGAMENTS OF THE SPINE.
Ligaments of the Bodies of the Vertebrce.
1. Inter -vertebral Substance, (Ligamenta Interverlebralia,
Ligamens Jntervertebraux.) — The bodies of the true vertebrae
are united by a substance blending the nature of ligament and
that of cartilage, and, therefore, called fibro or ligamento-carti-
laginous matter. It occupies all the space between the conti-
guous bodies of the vertebra, and adheres most closely to their
substance. This inter-vertebral matter increases successively
in thickness, as it is placed lower down on the spine, whereby
the lumbar vertebrae are mutually at a much greater distance
than any others. The curvatures of the spine, as formerly
stated, depend considerably upon the arrangement of this sub-
stance: between the vertebras of the neck it is thicker at its
.anterior margin than at the posterior; on the contrary, between
the dorsal vertebree it is thinner in front. In the loins, it is
again much thicker in front than behind, and this feature is un-
usually marked between the last lumbar vertebra and the sa-
crum.
This inter-vertebral matter is formed of concentric lamellae,
the texture of which is ligamentous. These lamellae are more
abundant anteriorly and laterally than behind. Their fibres
cross in every direction, leaving between them interstices or
cells, filled with a soft, pulpy substance: this substance is not
very obvious near the circumference, but in approaching the
centre, it becomes more and more abundant, as the interstices
are larger, until the centre seems to be constituted almost -en-
tirely by it. The pulpy mass in the centre is in a state of con-
siderable compression, which may be proved by separating the
bodies of adjoining vertebrae, or by making a vertical section
through them; in which case the pulpy mass will be freed from
compression, and will rise up into the form of a cone. This
LIGAMENTS OF THE SPINE. 267
experiment will succeed remarkably well in the loins; from
which it is evident, that this mass is a soft and elastic ball, on
which the bodies of the vertebrae play.
The pulpy matter is proportionately much more abundant in
infancy than in the subsequent periods of life; it is also much
softer, whiter, and more transparent. In advanced life there is
great diminution of its volume, as well as of its elasticity,
which accounts, in some measure, for the comparative stiffness
of the spine in old people. The fibrous part in them is always
more abundant, and is much disposed to ossify. When the
trunk is kept erect for several hours in succession, it becomes
shorter, from its weight bearing upon the inter-vertebral mass;
but a short period of rest in the horizontal position, restores if,
to its original length.
2. Anterior Vertebral Ligament, (Fascia Longitudinalis An-
terior, Ligament Vertebral Anterior.) — This ligament is placed
on the front part of the spine, and extends from the second
vertebra of the neck to the first bone of the sacrum, inclusively.
It increases gradually in breadth, from its commencement to
its termination, but is not every where of the same thickness;
for it is thin on the neck, thicker in the thorax, and again be-
comes thin in the loins: in the latter, however, it is strengthened
by an accession of fibres from the tendinous crura of the dia-
phragm.
This ligament adheres very closely to the inter-vertebral
substance, and to the projecting margins of the bodies of the
vertebra, but less closely to the middle or concave parts of the
latter. Its fibres do not run out its whole length, for the more
superficial extend from one vertebra or inter- vertebral substance,
to the fourth or fifth below: the middle ones extend to the se-
cond or third below ; and the deepest seated are applied be-
tween the proximat'e vertebra? only. In general, more of the
fibres are inserted into, and arise from the fibro-cartilaginous
matter than the bones. In several parts, but particularly in the
neck, small slips are sent off obliquely to the vertebra below.
The laminae of this ligament leave intervals between them for
the passage of blood vessels.
Beneath the anterior vertebral ligament are found a great
many short and insulated ligamentous fibres, extended oblique-
268 SKELETON.
Iy from one vertebra, to another which is contiguous. These
fibres have different directions, and cross each other at acute
angles; they adhere very closely to the fibro-cartilaginous mat-
ter, and leave interstices between themselves, through which
the anterior vertebral ligament adheres to the same substance.
Moreover, there are at the sides of the bodies of the vertebrae,
a number of short straight fibres, passing from the edge of the
bone above to the edge of the bone below.
3. Posterior Vertebral Ligament, (Ligamentum Commune
Posterius, Ligament Vertebral Posterieur.) — This is placed on
the hind part of the bodies of the vertebra, within the spinal
canal, and extends from the cuneiform process of the occiput
just beyond the foramen magnum, to the os coccygis. It is
more narrow and thick in the thoracic vertebrae than else-
where. At each inter-vertebral substance it increases in
breadth and adheres more closely, whereas, opposite the body
of a vertebra it is narrower and more loose, by which arrange-
ment a kind of serrated or unequal edge is formed on each
side.
This ligament is more dense and compact than the anterior,
and presents a smooth, shining surface, resembling a tendinous
expansion. Its fibres, also, do not run individually the whole
length of the spine, but are in laminae; the more superficial of
which have their fibres inserted into the fourth or fifth inter-
vertebral substance or vertebra, below their origin. The mid-
dle laminae are inserted into the second or third below, and the
deeply seated into the first below. The blood vessels do not
penetrate the ligament, but pass by its sides into the vertebrae.
The superior extremity of this ligament going from the second
vertebra to the margin of the foramen magnum, is sometimes
considered as distinct.
Ligaments of the Processes of the Vertebrce.
1. Articulation of the Oblique Processes. — These processes
are faced with cartilage, and a synovial capsule is displayed
upon them so as to shut up completely the cavity of the articu-
lation. The capsular ligament is not uniform and fully deve-
LIGAMENTS OF THE SPINE. 269
loped, but is represented by a few irregular fibres, passing from
one bone to the other.
2. Articulation of the Spinous Processes. — With the exception
of the neck, ligamentous fibres are found to occupy the spaces
between all the spinous processes, by passing from the spinous
process above, to the spinous process below. Muscles supply
their places in the neck, and in the upper part of the thorax.
These ligaments have much of a cellular structure above, but
in their descent they become more ligamentous and large, till,
in the loins, they assume a very decided character, and have a
quadrilateral shape.
At the extremities of the spinous processes there is, also, a
ligamentous band, belonging to the dorsal and lumbar verte-
brae; commencing at the seventh cervical, it terminates on the
spinous processes of the sacrum. It is thin in the back, but on
the loins it is very thick, and so blended with the tendinous
origins of the muscles, that it is not very distinguishable from
them. The fibres of which it consists are of unequal lengths,
being extended between two, three, four, or five vertebrae, ac-
cordingly as the fibres are superficial or deep-seated.
3. Owing to the shortness of the spinous processes of the
neck, an arrangement exists there called Ligamentum Nuchas,
(Ligament Cervical,) or the Descending Ligament of Diemer-
broeck. This ligament, though continuous with the one last
described, may be considered, for the sake of perspicuity, as
distinct. It begins, therefore, at the seventh cervical spine, as-
cends between the muscles of the opposite sides of the neck, and
is inserted into the posterior occipital protuberance. It is blend-
ed very much with the tendons of muscles, and is distinguished
from them with some difficulty, occasionally.. Its posterior mar-
gin is thick, but the anterior is a thin membranous expansion,
which runs to the ends of the spinous processes of the cervical
vertebra3, and to the vertical ridge of the occipital bone, lead-
ing from the occipital protuberance to the foramen magnum.
The ligamentum nuchre, therefore, forms a complete septum be-
t. veen the muscles of the opposite sides of the neck, and is con-
tinuous with the sheaths in which they play. In quadrupeds it
is remarkably strong ; but in man, who, from the proportions
23*
270 SKELETON.
of his head and his erect position, keeps the head nearly in
equilibrium, it is comparatively feeble.
4. Articulation of the Bony Bridges of the Vertebra. — The in-
tervals between the vertebrae, at the posterior part of the spinal
canal, are filled up by the Yellow Ligaments, (Ligamenta Flavce,)
so called from their peculiar colour. These intervals exist be-
tween all the true vertebras, being bounded laterally by their
oblique processes,, and are very considerable in the loins, par-
ticularly that below the last vertebra; they are not so large in
the neck, and are still smaller in the back ; and their shape va-
ries considerably in the several portions of the spine.
The yellow ligaments are two in number, forming a pair in
each of these intervals : the two approach, behind, at an angle,
in a line with the spinous processes, but are kept separated by
a small vertical fissure filled up with cellular substance. They
extend to the oblique processes laterally; are connected to the
anterior face of the bony bridge of the vertebra above; where-
as, they are inserted into the superior margin of that of the ver-
tebra below. From this arrangement, the yellow ligaments
may be best seen on the side of the spinal canal. The angle
which they form, behind, is continuous with the ligaments be-
tween the spinous processes.
These yellow ligaments are smooth and shining on their an-
terior surfaces, but behind they are rough and unequal. Their
fibres are numerous and extremely compact, their strength is,
therefore, very great. Their elasticity is well marked and pe-
culiar to them, and assists greatly in erecting the spine when it
has been curved forwards. Bichat says that there is but little
cellular tissue between their fibres: that they are dissolved with
extreme difficulty in boiling water, and resist its action to such
a degree, that it is manifest they contain much less gelatine than
the greater number of analogous organs.
The first pair of yellow ligaments is between the second and
third cervical vertebras, and the last between the last lumbar
and the sacrum ; there are, consequently, only twenty-three pairs
in all.
Particular Articulations of the Spine.
1. Articulation of Occiput with Atlas. — The Anterior Ligament
s placed at the anterior part of the occipital foramen, and ex-
LIGAMENTS OF THE SPINE. 271
tends from it to the corresponding edge of the atlas. On its
centre in front is a fasciculus, which being narrow and some-
what rounded, descends from the middle of the cuneiform pro-
cess to terminate in the tubercle on the front of the atlas ; and
consists in parallel fibres. The remainder is called by Caldani,
Membrana annuli anterioris atlantis, (Ligament occiptto-atloidien
anterieur.) It occupies and shuts up the whole space between
the basilar process of the os occipitis, from which it takes its
origin near the occipital foramen ; and the anterior arch of the
atlas, in the superior margin of which it is lost: in it are many
oblique fibres, which run from within outwards.
The posterior Ligament is placed at the back part of the oc-
cipital foramen, and extends from it to the corresponding edge
of the atlas. It is called by Caldani, Membrana annuli poste-
rioris atlantis, (Ligament occipito-atloidien posterieur;) and arising
from the whole posterior margin of the occipital foramen be-
tween the condyles, it is extended to the upper contiguous mar-
gin of the atlas, so as to fill up completely this space. Bichat
says that it also consists in two laminae, the anterior of which
is fibrous, and runs into the dura mater of the spine instead of
into the bone: the posterior is of a much looser texture, and re-
sembles common cellular substance. A part of this membrane
runs obliquely from the transverse process of the atlas to the
part of the occiput just beneath the insertion of the rectus pos-
ticus minor.
The articulating surfaces of the condyles, and the superior
oblique processes of the first vertebra, are covered with carti-
lage, and furnished with a synovial membrane arising from
their margins. On the exterior of the synovial membrane there
are irregular ligamentous fibres going between the bones, and
forming a capsule.
2. Articulation of the second Vertebra with the Occiput, and
with the first. — The second vertebra has no articular surface
joining the occiput, but some strong ligaments are passed be-
tween them. When the posterior vertebral ligament is removed
at its commencement from the occipital bone, we see on each
side of it, and beneath it, ligamentous bands (Lacerti Liga-
mentosi,) coming from the internal face of the os occipitis, to
272 SKELETON.
be affixed to the body of the second vertebra behind. Some
of these fibres arise from the margin of the occipital foramen,
and others from the internal face of the condyloid processes.*
They are joined at their external margins by a few fibres from
the first vertebra, near its upper oblique process.
The Transverse Ligament (Ligamentum Transversale At-
lantis, Ligament Transverse,) is placed immediately behind the
processus dentatus, and divides the atlas into two unequal rings
by being stretched from one side to the other. It is larger in
the middle than at the extremities, and has the latter inserted
into the little tubercle at the internal side of the atlas, between
the upper and the lower articular surfaces. It is^a thick, strong
fasciculus of fibres, and binds the processus dentatus so as to form
for it a sprt of collar, amounting to about one-fourth of a circle.
The superior appendix of this ligament arises by a broad base
from the anterior margin of the foramen magnum, and termi-
nates below by a narrow .end in the upper margin of the trans-
verse ligament. The inferior appendix arises from the lower
edge of the transverse ligament, and is attached, by a some-
what converging end, into the posterior face of the body of the
vertebra dentata.
The surfaces of contact belonging to the processus dentatus,
and to the anterior ring of the atlas, are covered with cartilage,
and have a synovial membrane, so as to form a perfect joint
called the vaginal ligament. A joint with a distinct synovial
membrane is, in like manner, formed between the posterior face
of the processus dentatus and the anterior of the transverse li-
gament, where they come into contact.
The Oblique or Moderator Ligaments (Lig. Later alia, Liga-
mens Odontoidiens) are two, one on either side of the tooth-like
process. They may be seen most advantageously by cutting
through the transverse ligament, and arise from the side and
summit of the processus dentatus, to be inserted into the inter-
nal margin of the occipital condyle. They are thick, short, and
strong, and consist in parallel fibres ; their lower margin has been
considered as a distinct ligament by Weitbrecht, and described
* Caldani, Icon. Anat. Explicatio, vol. i. p. 255.
LIGAMENTS OF THE SPINE. 273
by him as coming from the neck of the process. There is some
cellular tissue at the front, in which the process revolves.
The Middle Straight Ligament, (Lig. Medium Rectum, Liga-
ment droit Moyen,) or Occipito-Dentate, arises from all that
part of the summit of the processus dentatus anteriorly which
is between the moderator ligaments, and is inserted into all that
part of the interior circumference of the foramen magnum be-
tween the insertion of the moderator ligaments. It is a thin
ligamentous membrane, disposed to form in its middle a verti-
cal fissure, separating its two halves. It cannot be seen well,
unless the whole membrana annuli anterioris be dissected away,
and the anterior bridge of the first vertebra sawed off; it will
then be found immediately behind the bursa of the processus
dentatus. It is separated from the superior appendix of the
transverse ligament by a layer of condensed fatty substance.
This ligament should not be confounded with the superior ap-
pendix of the transverse ligament, nor with the beginning of the
posterior vertebral ligament, as has been done by Bichat and
others. The difference is well established by Caldani, as it lies
deeper than either of them when viewed from the vertebral
cavity; though, from the close connexion of the fibres of the
ligaments among themselves, as well as with others, the mistake
may readily occur.*
The Articulation between the oblique process of the first and
of the second cervical vertebra is very moveable, as the atlas
is permitted to revolve around the processus dentatus to the
amount of one-fourth of a circle at least. This articulation has
a synovial capsule which is strengthened by an anterior and by
a posterior ligament.
The anterior ligament of the articulation between the oblique
processes arises from the inferior margin of the atlas and from
its anterior tubercle, and is inserted into the base of the pro-
cessus dentatus, and into the front of the body of the second
vertebra. The fibres of the latter insertion are long and fre-
quently distinct from the first.
* Its existence is, however, scarcely to be considered uniform, as it is often
wanting where the processus dentatus is very long, for example when it reaches
the anterior part of the foramen magnum and forms a joint there, as it sometimes
does.
274 SKELETON.
The posterior ligament is placed between the first and second
vertebrae behind, and is connected to their contiguous margins
so as to fill up the interval between them, and to supply the
place of the yellow ligaments. It is extremely loose and thin,
so as not to interfere in the movements of the vertebrae, and is
almost of a cellular structure.
The syuovial membrane of these oblique processes is unu-
sually lax, and is reflected from the margin of the one articular
surface to the other. It is in contact in front with the anterior
ligament; behind with the posterior and with much cellular
substance; internally with the ligaments within the spinal canal,
and externally with the carotid artery. The latter obtains from
it a serous covering, without which, according to Bichat, it
would be bathed in the synovial fluid.
CHAPTER VI.
OF THE LIGAMENTS OF THE PELVIS.
THE mode of junction between the sacrum and the last lum-
bar vertebra, is, in every respect, the same as that described
for the bones of the spine generally, with the addition of a liga-
ment on each side, sometimes met with, called Sacro-vertebral,
which arises from the transverse process of the last lumbar
vertebra, and going obliquely downwards, is inserted into the
superior part of the sacrum by blending itself with the anterior
fibres of the sacro-iliac junction.
The Sacrum is united to the coccyx by a fibro-cartilaginous
substance, resembling that between the bodies of the true ver-
tebrae, with the exception of there being less pulpy matter in
its centre, and of its fibrous lamellae being more uniform. The
bones of the coccyx are also united with one another in the
same way ; in consequence of which they are very flexible till
the approach of old age.
The Anterior Coccygeal Ligament, (Lig. Sacro-coccygeum
LIGAMENTS OF THE PELVIS. 275
dnterius) is placed on the forepart of the latter bone ; runs its
whole length, and arises from the inferior extremity of the sa-
crum. Its fibres are rather indistinct, from their being blended
with fat : on the lateral margins of the coccyx they are rather
better marked.
The Posterior Coceygeal Ligament, (Lig. Sacro-coccygeum
Posterius,) as its name implies, is placed on the back part of the
coccyx. It arises from the inferior margin of the spinal canal
of the sacrum, arid forms a sort of membranous expansion,
which passes the first bone of the coccyx, and is inserted into
the second. There are also a few other ligamentous fibres con-
necting the bones of the coccyx.
The Ilio Lumbar ligament (Lig. llio Lumbare) arises from
the transverse process of the last lumbar vertebra, and from its
inferior oblique process, and going outwards is inserted for two
inches into the crista of the ilium. It is often blended with
adipose matter, which separates it into several fasciculi. Cal-
dani describes it as two ligaments, making a distinction between
the one part from the transverse, and the other from the ob-
lique process.
The Sacro-Iliac Articulation is formed by the corresponding
surfaces of the sacrum and ilium. Each bone is incrusted with
its own cartilage, the one on the sacrum being somewhat more
thick. Their surfaces are slightly rough, and between them
exists a thick yellow fluid in a very small quantity, which lu-
bricates them, and is more abundant in early life.
The Sacro- Spinous Ligament (Lig. Sacro Spinosum) is
placed superficially on this articulation behind. It is very
strong, flat, long, and perpendicular. It consists of two lamince,
of which the more superficial arises from the posterior supe-
rior spinous process of the ilium, and is inserted into the fourth
transverse process of the sacrum. The deep-seated lamina
arises from the same point, and is inserted into the third trans-
verse process of the sacrum. Bichat describes, connected with
the inferior margin of this ligament, a fasciculus, which comes
from the posterior inferior spinous process of the ilium.
276 SKELETON.
The Sacro-Iliac Ligament (Lig. Sacro-lliacum) is next to the
articular faces of the bones. It surrounds the joint, but is much
stronger on its posterior face. It consists in an assemblage of
ligamentous fasciculi, some of which have obtained, by the
writers on Syndesmology, particular names, but which it would
scarcely add to the student's information to designate. On the
front of the joint this ligament is uniform, and consists of a
plane of short, strong fibres, passing from the margin of one
bone to that of the other. But, on the posterior surface, it is
much more irregular, and arises from the first two eminences
near the lateral margin of the sacrum, and from that surface of
the sacrum between these eminences and its articular face.
From thence the sacro-iliac ligament goes to be inserted into
the rough surface of the ilium, immediately behind its articular
face; it fills up there a considerable space, and, from its posi-
tion, must be extremely irregular. Its strength is so great,
that in forcing the joint the ligament does not rupture, but parts
preferably from the surface of the ilium, and sometimes brings
with it a lamella of bone.
The bones of the pelvis are also fastened by two other very
strong ligaments, the sacro-sciatic.
The Posterior Sacro-Sciatic (Lig. Sacro-lschiadicum majus)
is the most considerable of the two. It arises from the poste-
rior inferior spinous process of the ilium, from the margin of
the sacrum below this bone, and somewhat from its posterior
surface, and from the first bone of the coccyx. It goes down-
wards and outwards, becomes thicker in its middle, but nar-
row; it then spreads out, and is inserted along the internal mar-
gin of the tuberosity of the ischium. Its anterior extremity is
extended along the internal face of the crus of the ischium for
some distance, and has the obturator internus muscle adhering
to it. Its fibres, where they converge from their origin, are
separated into planes by masses of fat and by blood vessels.
The Anterior Sacro-Sciatic Ligament (Lig. Sacro-lschiadi-
cum minus] is much smaller than the other, and is placed in
front of it. It arises from the margin, and somewhat from the
posterior surface of the sacrum, below the ilium ; and from the
lateral margin of all the bones of the coccyx. The fibres con-
LIGAMENTS OF THE PELVIS. 277
verge, and are inserted into the spinous process of the ischium,
by embracing it. The fibres constituting its base-, have their
fasciculi separated by cellular adipose matter and by vessels,
and are also intermingled with the fibres of the coccygeus mus-
cle, and of the posterior sacro-sciatic ligament.
The two sacro-sciatic ligaments supply, in some degree, the
place of bone, and form a part of the inferior lateral parietes of
the pelvis. They convert the sciatic notch into a foramen, or,
rather, form with it two foramina; the upper and larger of
which transmits the pyriformis muscle, the sciatic nerve, and
the gluteal blood vessels; while the lower, placed between
the insertion of the two ligaments, transmits the obturator in-
ternus muscle, and brings the internal pudic artery into the
pelvis.
The Obturator Ligament (Membrana Obturatoria) is extend-
ed across the foramen thyroideum, so as to close it up, with
the exception of a foramen at its upper part, for transmitting
the obturator vessels and nerves. It is a thin, but strong mem-
brane, having its fasciculi of fibres passing in various -directions,
and arising from the margin of the foramen. It affords origin
to many of the fibres of the obturator muscles. Sometimes
portions of it are defective.
The Articulation of the Pubes is formed between the bodies
of the two ossa pubis. It consists principally in a fibro-carti-
laginous matter, which has a strong resemblance to that of the
vertebras. When the bones are torn apart by bending them
forwards, the fibrous arrangement becomes very apparent, and
is seen to consist in concentric lamella?, the fibres of which cross
one another. Sometimes in the male, but most frequently in
the female, the posterior third of the articulation is deprived of
these fibres, in place of which we find, in the middle of the
cartilage, a small longitudinal cavity, the surface of which is
smeared with a kind of mucosity. There is no central pulpy
matter in this articulation, as there is between the vertebras. On
its posterior surface it often makes a ridge projecting into the
cavity of the pelvis. From frequent observations made in our
dissecting-rooms, I have no doubt that this articulation is al-
ways very much relaxed in the parturient and pregnant female,
VOL. I.— 24
278 SKELETON.
which is manifested not by the bones separating, but by their
sliding upwards and downwards with great readiness. The sa-
cro-iliac junction also becomes relaxed. It was upon the ob-
servation of these facts, that the clebrated, but now exploded,
Sigaultian operation was founded.
The Anterior Pubic ligament is not very distinct. It lies in
front of the last articulation, and consists in a few oblique and
transverse fibres gomg from the one bone to the other.
The Sub or Inter-Pubic Ligament (Lig. Pubis Inferius) oc-
cupies the summit of the arch of the pelvis. It is of a trian-
gular form, about half an inch in breadth, and passes from the
margin of the crus of the pubes of the one side, to a corre-
sponding line on the other. It is remarkably strong, and is ra-
ther more so below than above. It seems rather an extension
of the ligament of the symphysis pubis, than a distinct struc-
ture.
CHAPTER VII.
ARTICULATIONS OF THE THORAX.
Posterior Articulations of the Ribs.
As mentioned, in the account of the bones, the articulations
here are double; being formed at one point between the heads
of the ribs and the bodies of the vertebrae with the inter-verte-
bral matter; and at the other, between the tubercles of the ribs
and the transverse processes. In either case the respective
surfaces are covered by articular cartilage, and have a syrio-
vial membrane. The first joint is the Costo- vertebral, and the
second the Costo-transverse.
1. The Costo- vertebral articulation presents an anterior liga-
ment, an inter-articular ligament, and two synovial membranes.
The Anterior or Radiating Ligament, (Lig. Capituli Costa-
ARTICULATIONS OF THE THORAX. 279
rum,) is fixed, as its name expresses, in front of the joint. It
arises from the margin of the head of the rib by the whole
breadth of the latter, and diverging towards the spine, is fixed,
by its superior fibres, into the vertebra above; by its inferior
fibres, into the vertebra below; and, by its middle fibres, into
the inter-vertebral substance. It is a thin, flat, fibrous mem-
brane, leaving intervals in it for the passage of blood vessels,
and may, indeed, be considered as a capsule to the articula-
tion, and is frequently described as such. The inter-articular
ligament passes from the ridge on the head of the rib, to a cor-
responding line of the inter-vertebral substance. It is short
and strong, and divides the articulation of the head of the rib
into two cavities, which have no communication. It is in
consequence of the latter, that there are two synovial mem-
branes to the head of every rib which has a double articular
face; but the ribs which are articulated with a single vertebra,
as the first, the eleventh, and the twelfth, have not the inter-
articular ligament, and, therefore, only one synovial mem-
brane.
The synovial membranes are not very apparent, neither is
the fluid abundant; the cavity is occasionally very small from
the encroachment of the inter-articular ligament. Anchylosis
occasionally takes place here, but it is much less frequent than
in the anterior articulations of the thorax.
2. The Costo-transverse articulation has, in addition to the
joint formed between the tubercle of the rib and the end of the
transverse process, several ligamentous fasciculi which pass in
varied directions.
Its synovial membrane is much more distinct than in the pre-
ceding articulation, and contains more synovia. The joint is
more loose, and is never anchylosed, except by disease. There
are a few fibres around it having the semblance of a capsule.
The Internal Transverse Ligament (Ligamentum Transver-
sarium Internum, or Costo-Transversarium Inferius,) arises from
the inferior margin of the transverse process, between its root
and external extremity, and proceeding downwards and in-
wards, is inserted into the upper margin of the neck of the rib
below. In many of the ribs there is a plane of ligamentous
fibres parallel with this ligament, but just behind, and arising
280 SKELETON.
from a more posterior situation of the transverse process to go
to the neck of the rib, somewhat more towards the tubercle of
the latter. It is designated by some writers as the posterior
transverse ligament, but the distinction between it and the lig.
trans, internum is so slight that it scarcely seems necessary to
consider them apart. The Internal Transverse Ligament is
much more conspicuous in the middle eight ribs, and in ex-
tremely emaciated subjects; in others, it is obscured by cellu-
lar adipose matter around the heads of the ribs.
The External Transverse Ligament (Ligamentum Transver-
sarium Externum, or Costo-Tmnsversarium Posterius) is a well-
marked quadrangular plane of ligamentous fibres, placed on the
posterior surface of the costo-transverse articulation. It arises
from the extremity of the transverse process, and going out-
wardly, is inserted into the proximate rib, just beyond its arti-
cular tubercle.
The Middle Costo-Transverse Ligament (Ligamentum Cer-
vicum Costarum, or Costo-Transversarium Medium) is extended
between and concealed by the neck of the rib and the contigu-
ous transverse process, and cannot be seen well without sepa-
rating them, or by sawing through their length. It is a collec-
tion of fibres, somewhat irregular, resembling condensed cellu-
lar substance, and slightly red.
These posterior articulations all require a patient dissection,
as they are surrounded by small masses of adipose matter,
have the intercostal nerves and blood vessels in contact with
them before, and the muscles of the spine behind. The liga-
ments between the transverse processes and the ribs are, of
course, not found in the eleventh and twelfth, from the bones
not touching there.
Besides what has been described, an aponeurosis or liga-
mentous membrane is extended from the transverse process of
the first and second lumbar vertebrae, to the inferior margin of
the last rib. A ligamentous membrane is also found near the
spine, extended between the contiguous margins of the last
two ribs.
ARTICULATIONS OF THE THORAX. 281
Anterior Articulations of the Ribs.
The surface of each pit in the side of the sternum is covered
by a thin cartilaginous plate, to receive the corresponding car-
tilage of the rib, and the articulation presents an anterior and
a posterior ligament, also a synovial capsule.
The anterior ligament arises from the extremity of the car-
tilage, and, going over the front of the sternum, radiates very
considerably in every direction. Some of its fibres are con-
tinuous with the corresponding fibres of the opposite side;
others are lost in the periosteum and in the tendinous origin of
the great pectoral muscle; others join the fibres of the ligament
above, and of that below. The more superficial the fibres are,
the longer they become; but the more deeply seated pass only
from the margin of the cartilage to the margin of the cavity in
the sternum. The thick ligamentous covering found on the
front of the sternum, may be considered as only the continua-
tion of these anterior ligaments. The fibres from the two lower
articulations on the opposite side, form, by their junction, a
striking triangular ligamentous plane, just on the lower end of
the second bone of the sternum. Besides which, there are se-
veral strong ligamentous fasciculi running in a great variety of
directions.
The posterior ligament has a similar arrangement with the
anterior, in the radiation of its fibres into the contiguous, liga-
ments, and in their origin from the costal cartilage. Altogether
they form, on the posterior face of the sternum, a strong, smooth
covering, the fibres of which do not run in fasciculi, but present
a uniform polished membrane, and are closely interwoven with
each other. Some of these fibres are longitudinal, and, of
course, cannot be referred to the posterior ligaments, but are
independent of them.
The synovial membrane, though its existence is admitted, is
not in a very distinct state. It scarcely gives a polish to the
articular surfaces, and has so little looseness in its reflection
from the one to the other, as to indicate clearly that but an in-
24*
282 SKELETON.
considerable motion is admitted in these joints. The synovia
is in very small quantity, not abundant enough for satisfactory
examination, and its character is rather inferred than proved.
The first cartilage is continuous with the sternum, and not se-
parated from it by any joint, except in rare instances. The
second cartilage has its joint with the sternum, separated into
two, one above and the other below, by a ligamentous parti-
tion resembling that at the heads of the ribs. The lower arti-
culations become, successively, more moveable than the upper.
Besides the attachments mentioned as connecting the carti-
lages of the true ribs to the sternum, there is one superadded
to the seventh cartilage, called the Costo-Xiphoid Ligament.
It arises from the inferior margin of the seventh cartilage, near
the sternum, and going obliquely downwards and inwards, is
inserted into the anterior face of the xiphoid cartilage, and has
its upper fibres running into the corresponding fibres of its fel-
low. It is, of course, placed behind the rectus abdominis mus-
cle, and fills up, in some measure, the angle between the se-
venth cartilage and the third bone of the sternum.
At the surfaces where the sixth and seventh cartilages come
into contact by their edges, also the seventh and eighth, a sy-
novial membrane exists. A similar articulation is sometimes
found between the fifth and sixth, and the eighth and ninth car-
tilages, but not uniformly. These synovial membranes are co-
vered by strong fibres.
It has been already stated that the anterior extremity of each
of the first three cartHages of the false ribs, is united by liga-
mentous fibres to the cartilage above. These ligaments are
strong and extensive, and give great solidity to the common
margin of the cartilages. The last two cartilages being much
smaller than the others, no ligaments pass from them; but they,
with their ribs, are held in their position by the intercostal and
abdominal muscles.
The cartilages adhere very closely to their respective ribs,
which receive them into the oblong fossa?, at their anterior ex-
tremities. The periosteum of the rib is continuous with the
perichondrium of the cartilage, and the membrane, which is,
in fact, one and the same, adheres very closely to the margins
of the articulation; it is also re-enforced by some ligamentous
fibres beneath it. No motion whatever is admitted at this ar-
ticulation.
ARTICULATIONS OF THE UPPER EXTREMITIES. 283
CHAPTER VIII.
OF THE ARTICULATIONS OF THE UPPER EXTREMITIES.
' i
Of the Articulations of the Shoulder.
THESE articulations consist in the junction of the clavicle to
the upper part of the sternum, and to the first rib; of the scapula
to the clavicle, and of the os humeri to the scapula. .
1. Of the Sterno-Clamcular Articulation.
The uneven triangular face of the internal end of the clavicle,
and the concavity of the sternum, at its upper corner, form the
surfaces which enter into this articulation. The first is much
more extensive than the articular surface of the sternum, pro-
jects on every side beyond its margins, and is very prominent
in case of extreme emaciation. The two surfaces are covered
by cartilage, of which that on the clavicle is the thickest, and
serves to fill up its inequalities; while the one on the sternum is
thin and smooth.
The joint is invested by a thick fibrous capsule, the anterior
portion of which presents a strong fasciculus of fibres, somewhat
separated by small interstices. This portion, called by some
the radiated ligament, arises from the anterior extremity of the
clavicle, and, going downwards and inwards, is inserted into
the margin of the articular cavity of the sternum. It is placed
just behind the origin of the sterno-cleido mastoid muscle. The
capsular ligament is also strengthened on its posterior surface
by additional fibres, not so distinct as the preceding, but ob-
taining the name of the posterior ligament.
Of the Inter-Clavicular Ligament, (Lig. Inter-Claviculare.) —
Closely connected with the capsule of the preceding joint, this
284 SKELETON.
ligament is placed on the superior end of the sternum, and ex-
tends from the internal end of one clavicle to that of the other.
It is flat before and behind, thin and narrow, is blended with
the contiguous ligamentous structure of the sternum, and might,
with propriety, be considered only an appendage to the capsu-
lar ligaments, or a process sent between them. In front it
corresponds with the integuments, and behind with the sterno-
hyoid muscles.
Of the Inter-Articular Cartilage. -~- When the capsule of the
joint is cut open, this is brought into view. It separates the
bones completely from each other by its extent, and supplies by
its shape the want of correspondence in their articular faces.
It is thicker above than below; its centre is thin, and sometimes
perforated. Its margins adhere closely to the capsular ligament;
it is also fixed by adhesion to the upper posterior margin of the
surface of the clavicle, and below to the union of the sternum
with the first rib; in consequence of which it has but little mo-
tion, and in luxations must be lacerated. Its structure is fibro-
cartilaginous.
Of the Synovia! Membranes. — There are two of these, one on
each side of the inter-articular cartilage; in consequence of
which, a double cavity exists in this articulation, excepting the
cases where the cartilage is perforated. These membranes^
contain but little synovia: they adhere closely to the adjoining
surfaces, and cannot be made very distinct, except in points
where there are small interstices in the' capsule, when, by press-
ing the bones strongly together, they protrude in little vesicles.
Of the Costo-Clavicular Articulation. — It consists in a short
fasciculus of ligamentous fibres, frequently called the Rhomboid
Ligament, which, arising from the upper surface of the cartilage
of the first rib, ascends obliquely outwards, and is implanted into
the roughness on the inferior face of the clavicle, near its sternal
end. Its fibres are parallel, all oblique, and longer at its external
than at its internal margin. It corresponds in front with the
origin of the subclavius muscle, and behind with the subclavian
vein. It has for its object the strengthening of the junction of
the clavicle with the sternum.
ARTICULATIONS OF THE UPPER EXTREMITIES. 285
2. Of the Scapulo-Clavicular Articulations.
These exist at three places; the first by a junction between
the acromion scapulae and the external end of the clavicle; and
the last two by ligaments sent from the coracoid process to the
under surface of the clavicle.
The Acromio-Clavicular Articulation presents, on each bone,
a small oblong face, covered with cartilage. The fibrous cap-
sule which invests it is very strong and thick, so as to give the
appearance of a much greater extent to the articular faces of
the bones than really exists. This capsule is strengthened by
additional fibres on its upper surface, passing from one bone to
the other, and sometimes called the superior ligament: they are
parallel to each other, and somewhat blended with the tendi-
nous fibres of the deltoid and trapezius muscles. The capsule
is also strengthened on its lower face, by additional fibres, con-
stituting the inferior ligament; they are not so abundant as the
superior, and pass from the margin of one bone to that of the
other, after the same manner. A synovial membrane is reflect-
ed over these articular surfaces, and contains but a very small
quantity of fluid. In some instances, an inter-articular fibro-
cartilage is found in this joint; as in the sterno-clavicular; in
such case there is a double synovial membrane.
Of the Coraco-Clavicular Ligament.— -This ligament is double,
one part being called the Conoid (Lig. Conoides,) and the other,
the Trapezoid (Lig. Trapezoides.) It arises from the roughness
at the root of the coracoid process, and is attached to the under
surface of the clavicle. The conoidal portion, having its base
upwards, is inserted into the tubercle, near the external end of
the clavicle. Its fibres are compact, strong, and diverging. The
trapezoid is placed at the acromial side of the other. It is qua-
drilateral, longer, broader and thinner than the other, having its
fibres separated by small interstices; and arising also from the
root of the coracoid process, it is inserted into an oblique line
leading from the tubercle of the clavicle to its acromial end.
The union of these two portions behind forms a projecting angle;
in front there is a depression between them filled with fat and
286 SKELETON.
cellular substance, also a bursa mucosa. These ligaments are
bounded in front by the subclavius, and behind by the trapezius
muscle.
The Bifid Ligament (Lig amentum Bicorne) is placed in front
of the subclavius muscle. It arises from the root of the cora-
coid process, at the sternal side of the conoid ligament; and
proceeding with but little elevation, inwards and upwards, in-
creases in breadth and bifurcates. The superior horn is in-
serted along the under margin of the clavicle, to near the rhom-
boid or costo-clavicular ligament; but the lower one goes to
the end of the first rib, under the tendon of the subclavius mus-
cle. This ligament is a sort of fascia placed over the subclavius
muscle, to bind and strengthen it.* Some of the fibres of the su-
perior horn sometimes proceed farther, and leaving the clavicle,
go with the rhomboid ligament into the cartilage of the first
rib.t
The Coracoid Ligament (Lig. Coracoideum) stretches across
the notch on the superior costa of the scapula, and converts it
into a foramen. It runs from the posterior margin of the notch
to the base of the coracoid process, and has some of its fibres
blending with the conoid ligament. It consists of a small fasci-
culus of fibres, and is of very little consequence, excepting in its
relation to the superior scapular vessels and nerves.
The Triangular Ligament (Coraco-Acromialis) of the Scapula,
as its name implies, extends from the coracoid to the acromion
process above the shoulder joint. It arises from nearly the
whole superior margin of the coracoid process, in two divisions,
separated partially by cellular tissue. Its fibres converge in
their progress, by which it becomes thicker, and is inserted into
the point of the acromion process, just beneath its junction
with the clavicle. This ligament is covered by the deltoid mus-
cle and the clavicle, and has the supra-spinatus beneath it. Its
anterior margin is continuous with a condensed cellular mem-
brane beneath the deltoid.
* This ligament is called the clavicular fascia by M. M. Velpeau and Blandin,
in their treatises on surgical anatomy,
f Caldani, Plate XLI.
ARTICULATIONS OF THE UPPER EXTREMITIES. 287
Of the Scapula-Humeral Articulation.
The glenoid cavity of the scapula, and the head of the os
humeri form this joint. As usual, each articular surface is
covered with cartilage, of which that on the os humeri is thick-
er in the middle than near its circumference, while the reverse
occurs on the scapula. From the shallowness of the glenoid
cavity and the much greater size of the head of 'the os humeri,
but very few points of their opposed surfaces can come into
contact at the same moment, though they may all do so in suc-
cession: hence, a considerable portion of the head of the os hu-
meri is always against the capsule of the joint. The remaining
parts of this articulation are the capsular ligament, the synovia!
membrane, and the glenoid ligament.
The capsular ligament invests completely this joint, though it
is thinner in some places than at others. It arises from the mar-
gin of the glenoid cavity, and is inserted into the neck of the os
humeri, including a larger space of the neck below, than it does
above. The tendons of the muscles whrich arise from the ex-
ternal and internal surface of the scapula, to be inserted into
the tuberosities of the os humeri, as they approach their points
of insertion adhere very closely to the capsular ligament, and
are, indeed, more or less blended with it. Bichat' considers,
that the tendon of the sub-scapularis muscle supplies the place
of the capsular ligament entirely at its lower part. This liga-
ment is formed by fibres, which are very much intermixed with
one another, arid have a greater degree of thickness above than
below, or, indeed, at any other point. The former is due to a
thick fasciculus, the Coraco-Humeral Ligament, also called by
some Ligamentum Adscititium, which takes its origin from the
posterior and external margin of the coracoid process, and pro-
ceeding beneath the triangular ligament to the upper part of the
os humeri, joins the capsular ligament, and adheres very firmly
to it. This ligament keeps the head of the os humeri on its
proper level in regard to the glenoid cavity; but the moment it
is cut, the length of the capsular ligament permits the head of
the os humeri to fall about an inch, and, indeed, to suffer a par-
tial dislocation. The strength of the joint however depends
288 SKELETON.
essentially upon the muscles which surround it, as the deltoid,
supra-spinatus, infra-spinatus, teres minor, sub-scapularis, long
head of triceps, and some others, which are farther removed
from it.
The synovial membrane is a perfect sac, which covers the
glenoid cavity, the internal face of the capsular ligament, and
the neck and head of the os humeri. On the lower part of the
neck it is reflected over some small fatty masses, commonly called
glands. Just beneath the root of the coracoid process, from there
being a deficiency of the capsular ligament, the synovial mem-
brane covers the articular side of the tendon of the sub-scapu-
laris, and is reflected for ten or twelve lines, between it and the
scapula, forming a sort of pouch, resembling a bursa mucosa.
The tendon of the biceps muscle runs through this articulation
from the superior end of the glenoid cavity. The cavity itself is
deepened by a fibrous margin all around, called the glenoid liga-
ment; a considerable part of whose fibres may be traced from
the tendon of the biceps by its bifurcating. The tendon is bound
down in the bicipital -groove by fibres passing from one to the
other of the bony margins, and which may be considered a
continuation of the capsular ligament. As the tendon is about
emerging from the groove at the lower margin of the tuberosi-
ties, the synovial membrane which lines the groove thus far, is
reflected from it, to the surface of the tendon, and continues to
cover and enclose it up to the origin at the glenoid cavity. It is
thus evident that though the tendon passes through the joint,
the cavity of the synovial membrane is kept entire.
Of the Elbow Joint.
This articulation is formed by the lower end of the os hu-
meri and the upper end of the ulna and of the radius. The ar-
ticular faces which were described in the account of these
bones are covered, as usual, with cartilage, the particular ar-
rangement of which will be presently pointed out. A strong
capsular ligament, an annular or coronary ligament, and a syno-
vial membrane, hold these several bones together.
The Capsular Ligament invests completely the articular ex-
ARTICULATIONS OF THE UPPER EXTREMITIES. 289
tremities of these bones, and conceals them from view. It is
attached to the sides of the os humeri at the lower part of its
condyles near the articular surface ; but in front it arises some
distance from the articular face at the upper margins of the lit-
tle cavities, for the head of the radius and for the coronoid pro-
cess of the ulna: behind, it arises in like manner from the upper
margin of the cavity for receiving the olecranon process ; so
that the depressions, both before and behind, are included with-
in the circumference of the articulation. The lower part of
the capsular ligament is inserted into the margin of the articu-
lar surface of the ulna, all around*, including, also, the whole of
the head of the radius, and the upper part of its neck.
This capsule is strengthened very much at particular points,
and as the joint is hinge-like, the strengthening is more abun-
dant at its sides, constituting lateral ligarnexits.
The external Lateral, or the Brachio Radial Ligament, (Lig.
Cubiti Externum,) is connected above to the lower part of the
external condyle, and is fixed below into the annular ligament
which surrounds the neck of the radius. It is very much con-
founded with the tendinous mass common to the muscles at this
part of the arm, more particularly that of the supinator radii
brevis. It is a round fasciculus of parallel and condensed fibres,
spreading somewhat below into the annular or orbicular liga-
ment. The Internal Lateral or the Brachio Ulnar Ligament,
(Lig. Cubiti Iriternum) arises from the lower part of the inter-
nal condyle, and spreading out so as to assume a triangular
shape, divides into two portions, one of which is inserted into
the internal margin of the coronoid pfocess of the ulna, and the
other into the internal margin of the olecranon process. It also
is much blended with the tendons of the muscles which lie over
it. Intermediately to the lateral ligaments, both before and be-
hind, the fibrous structure of the capsular ligament is very dis-
tinct, but thin, in order to accommodate the motions of the
joint; some of the fibres are insulafed, and have interstices be-
tween them filled with fat. Some of these fibres are oblique,
and others straight: they are called, generally, accessory liga-
ments.
The Coronary Ligament of the Radius (Lig. Radii Orbiculare)
VOL. I.— 25
290 SKELETON.
is brought more distinctly into view by cutting open the joint. It
is then seen to arise from the anterior margin of the lesser sig-
moid cavity of the ulna, and surrounding two-thirds of the neck
of the radius, to be inserted into the posterior margin of the same
cavity. Jtis a strong, flat, narrow fasciculus, the fibres of which
go in a circular direction. Its superior margin is blended with the
external lateral ligament; its inferior margin fs loose, being con-
nected with the lower part of the neck of the radius only by a
reflection of the synovial membrane, with the exception that a
few fibres pass from it behind, to the contiguous part of the ulna.
Its density is very considerable, sometimes almost cartilaginous.
The Synovial Membrane lines the whole internal face of the
capsular ligament, from which it is separated behind by a large
mass of fat in the olecranon depression of the os humeri, and in
front by another mass in the coronoid depression. A small
circular ridge of fat also projects into the joint around the head
of the radius, and there is another at the internal margin of the
olecranon. The object of these masses seems to be to fill up
the partial vacancies which exist between the articular faces
of the bones, and they are all so directed by their attachment
to the capsular ligament, as to be preserved from being pinched.
The synovial membrane is also reflected from the capsular li-
gament to the articular faces of the bones, so as to line the se-
veral depressions on the os humeri, and to include the neck of
the radius.
The head of the radius is completely invested with cartilage.
The greater sigmoid cavity of the ulna has the cartilage sepa-
rated transversely into two portions, by a small mass of fat
traversing its bottom. The cartilage elsewhere is uniformly
spread over the articular surfaces of the bones.
Of the Literosseal Ligament, (Membrana Interossea.} — It fills
up the space between the two bones of the fore arm almost en-
tirely, by commencing just below the tubercle of the radius
and ending near the wrist. It consists in oblique and parallel
fibres, which pass from the ulnar edge of the radius downwards
to the radial edge of the ulna. It is thin, but extremely strong,
bein^ covered in front by the flexor muscles; and behind by the
ARTICULATIONS OF THE UPPER EXTREMITIES. 291
extensors, and, as Mr. Boyer observes, seems to be intended
rather to afford origin to muscles than to unite the bones. Its
superior part is thinner above, and a large opening exists there
for the passing of the interosseal vessels to the back of the fore
arm. Its inferior part, is thicker, where openings also exist,
but small, for the passing of vessels. There are some other
smaller perforations in this ligament, but of less note than the
preceding, also for vessels. On its posterior face there are one
or two bands, the fibres of which decussate the other fibres.
Beside the interosseal ligament, there is one called round
(Teres,) situated obliquely between the two bones at the upper
part of the interval which separates them. It arises from the
base of the coronoid process, just below the insertion of the
brachialis internus; and descending obliquely outwards, is in-
serted into the radius below its tubercle. Its object is to bind
the bones together, at a point which is weakened by the defi-
ciency of the interosseal ligament. This deficiency is, in fact,
much larger than the simple passing of the vessels requires;
for it is also large enough to allow the tubercle of the radius to
rotate freely, a motion which would have been checked by the
presence of the ligament.
Of the Articulations of the Wrist.
Several articular cavities present themselves at this point.
One is between the lower part of the ulna and the radius, ano-
ther between the carpal bones and those of the fore arm, and
a third between the two rows of carpal bones. One general
capsule invests these parts.
1. The Lower Radio-Ulnar Articulation — is surrounded by a
section of the fibres belonging to the general capsular ligament
of the wrist: their attachment, however, is so loose, that they
allow the bones to rotate freely upon each other, besides which
they are not so abundant as in other places. When this joint
is cut open, it will be seen that the head of the ulna is covered
with cartilage, and that the cartilage which covers the carpal
articular face of the radius, projects between the ulna and the
os cuneiforme; and covers also the sigmoid cavity of the radius;
so that a cavity for receiving the convex head of the ulna is
292 SKELETON.
formed by the cartilage of the radius. The margins of this
projecting point of the radial cartilage are fibrous, which has
induced the French anatomists to speak of it under the name
of triangular ligament. It is, in fact, an inter-articular fibro-
cartilage, and is said to be occasionally .detached from the ra-
dius, but I have not seen it in that state: ite centre not unfre-
quently is perforated, so that a communication exists between
this joint and the next of the wrist. Its margins adhere very
closely to the capsular ligament, and its point is fixed into the
depression which separates the styloid process of the ulna from
its head. The synovial membrane which lines this cavity is
unusually loose, both before and behind, in consequence of the
great motion of the bones: it is also very loose above. This
joint is sometimes called the Sacciform, from its looseness.
2. Of the Radio-Carpal Articulation. — The radius above, and
the scaphoides, lunare, and cuneiforme below,, form the basis of
this articulation. An oblong, elliptical cavity, the ulnar extre-
mity of which is made by the projection of the cartilage of the
radius, receives the convexity of the bones of the wrist. The
scaphoides and the lunare come in contact with the radius,
while the cuneiforme rests against the projecting cartilage.
There is a slight elevation of the radial cartilage opposite to
the interstice between the first two bones. The oblong ellipti-
cal cavity is filled by a corresponding head, on the part of the
bones of the carpus just enumerated. Each of the latter bones,
in a fresh state, is covered by its appropriate cartilage. The
cartilages are connected, or rather continued into one another,
by a narrow fibro-cartilaginous substance placed at the margin
of the interstice between these bones. This substance sepa-
rates the cavity of the radio-carpal articulation from that of the
proper carpal articulation.
The Capsular Ligament arises, before and behind, around
the margin of the articular face of the bones of the fore arm,
from the styloid process of the radius to that of the ulna, ad-
hering very closely to the margins of the fibro-cartilage insi-
nuated between the ulna and the cuneiforme. It is inserted
below7, into the circumference of the head formed by the sca-
phoides, lunare, and cuneiforme, though many of its fibres may
ARTICULATIONS OF THE UPPER EXTREMITIES. 293
be traced to the bones of the second row. It is a loose and
thin membrane, the fibrous fasciculi of which leave interstices
at several points between them, through which the synovial
membrane may be seen. The capsular ligament is strengthened
at particular places, by additional fasciculi of fibres having ap-
propriate names. For example, the internal lateral ligament
arises from the styloid process of the ulna, and is inserted into
the cuneiforme, some of its fibres being extended to the ante-
rior annular ligament, and to the pisiforme. The external la-
teral ligament arises from the styloid process of the radius, and
is inserted into the radial end of the scaphoides; some of its
fibre? being continued on to the trapezium, and to the anterior
annular ligament. The anterior ligament arises from the vici-
nity of the styloid process of the radius, and passing obliquely
downwards and inwards, is inserted into the anterior face of
the scaphoides, lunare, and cuneiforme. Its fibres are not very
evident or well marked. The posterior ligament is not so
broad as the last, and is more distinct. It also arises from the
radius, by and near its styloid process, and descending oblique-
ly inwards, is inserted into the lunare and cuneiforme. The
last two ligaments have no connexion with the ulna, the rota-
tion of the fore arm is, therefore, unimpeded by them.
The synovial membrane of the radio-carpal articulation is
displayed on the articular faces af the bones and their interme-
diate fibre-cartilage, and lines the internal face of the capsular
ligament. When the joint is pressed upon, this membrane is
protruded, in the form of little vesicles, in the interstices be-
tween the fasciculi of the capsular ligament. A fold of it con-
taining a small quantity of adipose matter is observed on the
back of the cavity of the joint, passing from the junction of the
scaphoides and lunare to the corresponding point of the radius;
it is the ligamentum mucosum of some writers.
3. Of the Articulation between the two rows oftfie Carpal Bones.
—The scaphoides, lunare, and cuneiforme of the first row, and
all the bones of the second row, are the foundation of this joint,
the surfaces of which have been described already. These
surfaces are covered with cartilage, each bone having its ap-
propriate cartilage, which is continued on its side where the
25*
294 SKELETON.
bone touches the adjacent one. The joint is furnished with a
capsular ligament and a synovial membrane.
The Capsular Ligament surrounds the articulation, passing
on every side from the upper lo the lower row, and adhering
strongly to the bones. It is in a great degree a continuation
of the capsule of the radio-carpal joint, and has, at the same
points, an increase of thickness, called after the same names.
The internal lateral ligament is attached by one end to the cu-
neiforme, and by the other to the side of the unciforme. The
external lateral ligament arises from the extremity of the sca-
phoides, and is inserted into the side of the 'trapezium. The
posterior and anterior ligaments have the course of their fibres
more distinctly seen on the side of the synovial membrane.
The first consists in many fibres arising from the bones of the
first row and going to the second row; its fibres are shorter
and more compact. The anterior arises and is inserted after
the same way, some of them terminating in the anterior liga-
ments of the hand.
The Synovial Membrane is not only displayed on the oppo-
site surfaces of the two carpal rows, but also is reflected upoft
the lateral faces of the bones belonging to each row. It, there-
fore, sends processes, two of which are found, above; one be-
ivveen the scaphoides and the lunare, and the other between
the lunare and cuneiforme. These processes are arrested at
their upper extremities by the fibro-cartilaginous matter be-
tween the bones, which was spoken of in the radio-carpal ar-
ticulation. It also sends three processes downwards, one be-
tween the trapezium and the trapezoides. another between the
latter and the magnum, and the third between the magnum and
the unciforme. Those latter processes communicate with or
are continuous with the synovial membrane, between the car-
pal and the metacarpal bones of the fingers.* The connexions
and reflections of this membrane are of the greatest impor-
tance, as they form a commonieation from the top of the wrist
to the base of the metacarpal bones; not only covering the ar-
ticular surfaces, but being prolonged in some instances beyond
* Eicliat, Anat. Dcscr
ARTICULATIONS OF THE UPPER EXTREMITIES. 295
them, as on the back of the os magnum, where it answers as
a periosteum.
In addition to the articulation just described, between the
two rows of carpal bones, the individual bones of each row have
particular fastenings of ligarnentous fibres, which run trans-
versely from the margin of one bone to the margin of the next.
These fibres, from their position, are called dorsal and palmar
ligaments. The upper row has one dorsal ligament between
the scaphoid and lunar, and another between the latter and the
cuneiform — it has in the same way two palmar ligaments on
its front surface. The lower row has, after the same plan,
three dorsal and three palmar ligaments between its bones.
These several ligaments are best seen on the side of the syno-
vial membrane, as externally their fibres are very much mixed
with those of the capsular ligament. It is obvious that they
are highly useful in preventing the bones from sliding laterally
on each otherj, except to a small extent.
The Pisiform Bone has an articulation with the cuneiform
completely distinct from any other. The articular faces of
this joint are covered with cartilage and invested by a synovial
membrane and a capsular ligament, which allow, from their
looseness, considerable motion. The capsule, though general-
ly thin, is strengthened by accessory fibres, which are well
marked below. These fibres arising from the inferior extremi-
ty of the pisiform, some of them are attached to the extremity
of the unciform process of the os unciforme, and others to the
base of the fifth metacarpal bone. The insertion of the tendon
of the flexor carpi ulnaris answers as a ligament to this bone
above, and there is a very strong fasciculus of ligament, passing
from the pisiforme to the end of the unciform process, and by
that means conveying the action of the flexor ulnaris to it. It
has but little motion from above downwards, and a good deal
laterally.
Of the Carpo-Metacarpal Articulations.
The. bony articular surfaces, here, as well as all the others,
of the hand, have been sufficiently described and are in the recent
state covered with cartilage. It will therefore be unnecessary
to renew the observations on these subjects.,
296 SKELETON.
The first of these articulations, or that of the metacarpal
bone of the thumb, with the trapezium, is much more movea-
ble than any of the others, and presents some peculiarities. It
is entirely distinct, slightly removed from the next, and is sur-
rounded by a capsule which is attached by its ends to the ar-
ticular margins of the bones. This capsule is strengthened by
additional fibres, which are particularly distinct and abundant,
posteriorly and externally. The synovial membrane is dis-
played, as usual, on the internal face of the capsule, and over
the articular faces.
The other four metacarpal bones are articulated as follows:
The second one is joined to the trapezoides, trapezium, and mag-
num— the third unites to the magnum alone — the fourth to the
unciform, with a small portion of the magnum — and the fifth
to the nnciform. The ligaments are placed before and behind,
and may also be termed dorsal and palmar.
The dorsal ligaments descend from the carpal to the metacar-
pal bonjes. The second metacarpal bone receives two ligaments,
one from the trapezium, and another from the trapezoides —
the third receives one from the rnagnum — the fourth receives
two, one from the magnum, and the other from the unciform —
the fifth receives one from the unciform. Transverse fibres
pass between these dorsal ligaments to connect the bases of the
metacarpal bones.
The palmar ligaments are arranged on a plan corresponding
with that of the dorsal ; but, from the length of their superficial
fibres, are not so distinct from each other. Transverse fibres
pass also between the metacarpal bones of the fingers at their
base, and form interosseous ligaments which keep them to-
gether.
The articulations thus formed and held together, are covered
by two synovial membranes, being processes from that between
the two rows of carpal bones. One of these processes, sent down
between the trapezoides and the magnum, displays itself over
the inferior surface of these bones and the head of the metacar-
pal bone of the fore and of the middle finger. The second pro-
cess which is sent down between the magnum and the unciforme,
is reflected over the two last carpo-metacarpal articulations.
These processes have a septum between them, at the ulnar side
ARTICULATIONS OF THE UPPER EXTREMITIES. 297
of the base of the third metacarpal bone, and do not communi-
cate with each other, except through the proper carpal articu-
lation. The specification of this arrangement is overlooked by
anatomists generally.
The Inferior Palmar Ligaments are three in number, and are
between the lower ends of the metacarpal bones of the fingers,
each one consists in a transverse fasciculus, placed between the
flexor tendons and the interosseous muscles, and on a level
with the anterior part of the first joint of the fingers. Their
more superficial fibres may be traced across the bones, and are
somewhat blended with the capsular ligaments; the more deep-
seated are short, and pass from one bone to the other.
Of the Metacarpo-Phalangial Articulations.
These are formed by the lower ends of the metacar.pal bones,
and the upper ends of the first phalanges. Each one presents
an anterior ligament, two lateral ones, and a synovial mem-
brane.
The anterior Ligament* is a flat fibrous semicircle, on the
front of the articulation, of considerable thickness. It goes trans-
versely, and has its two extremities attached to the ridge on
either side of the articular margin of the metacarpal bone. Its
inferior margin descends a little, and comes in contact with the
synovial membrane. In front, many of its fibres are obtained
from the ligamento-cartilaginous sheath of the flexor tendons,
so that it may be considered as made by two planes — the pal-
mar one facing towards the tendons, and forming the trochlea,
in which they play, and the other being next to the joint, and
continued to- the lateral ligaments. The thickness of the ante-
rior ligament, besides communicating great strength to the joint
is useful in removing the tendons from the line of motion of the
phalanges, and thereby giving increased power and delicacy of
motion to the muscles. Bichat considers himself to have first
indicated particularly this structure, which he thought was in-
tended to protect the articulation from the impression of the ten-
don: he ought to have added, in the firm grasping of bodies, and
to make the movements of the joint more delicate. On the sides
* Bichat, loc. cit.
298 SKELETON.-
of this ligament belonging to the thumb, and in its thickness,
are developed the sesamoid bones.
The Lateral Ligaments are situated one on each side. They
arise from the sides of the metacarpal bone behind the former,
and in connexion with it, and, descending obliquely forwards, are
fixed into the sides of the upper end of the first phalanx. They
are round, distinct, and strong, and are formed from numerous
parallel fibres.
The Synovial Membrane lines this articulation,being displayed
over its lateral and anterior ligaments, and on the articular faces
of the bones. It is reflected on the metacarpal bone, some little
distance from the margin of its cartilage in front, whereby the
cavity is enlarged, arid the flexion of the fingers is favoured. It
is in contact, behind, with the tendon of the extensor muscle,
which there supplies the place of ligament.
Of the Phalangial Articulations.
There are two of these to each finger, and one only to the
thumb. They are provided with an anterior ligament, a lateral
ligament on each side, and a synovial membrane.
The anterior Ligament corresponds so exactly with what has
been said in the preceding article on the same structure, that,
with the exception of its being smaller, the description already
given, will suffice. It seems to answer, in every respect, the
same objects.
The Lateral Ligaments, also, arising from the sides of the pha-
lanx above, run downwards and somewhat forwards to be insert-
ed into the upper part of the sides of the phalanx below.
The Synovial Membrane has reflections corresponding with
those of the preceding articulations, with the addition that it co-
vers more of the anterior inferior face of the first and second
phalanges. Thus, by cutting through the anterior ligament,
longitudinally, and turning it aside, it will be seen that the cavity
ARTICULATIONS OF THE LOWER EXTREMITIES. 299
of the second and third joints of the finger is, by this reflection
of the synovial membrane, extended upwards between the pha-
lanx and the flexor tendons nearly one-third of the whole length
of the phalanx,* a circumstance worth attending to in the ac-
cidents of the part.
CHAPTER IX.
OF THE ARTICULATIONS OF THE LOWER EXTREMITIES.
Of the llio-Femoral, or Hip Articulation.
THE basis of this articulation is laid by the head of the os fe-
moris being received into the acetabulum. Both surfaces are
covered by thick cartilage: in the former it is interrupted, how-
ever, by the depression near the centre, and becomes very thin
near the margin; and, in the latter, the cartilage is deficient in
the whole extent of the rough surface at its lower part. A
cotyloid ligament, a fibrous capsule, the round or inter-articu-
lar ligament, and a synovial membrane, are moreover, con-
cerned in this joint.
The Cotyloid Ligament (Lig. Cotyloideum) is a fibrous pris-
matic ring which tips the margin of the acetabulum, and there-
by increases its depth; it can only be seen by cutting open the
capsule. Its thickness is unequal, being considerable on the
anterior third of the circumference of the acetabulum, where
it assists in converting the notch into a foramen, but not so
much so elsewhere. Just below the anterior inferior spinous
process, the acetabular head of the rectus femoris sends some
tendinous fibres to it. Its base is broader than its margin, and
is marked off from the articular cartilage by a line, or narrow
groove, between them. Its acetabular side is covered by the
synovial membrane;- the other side has the capsular ligament
* Bichat, loc. cit.
300 SKELETON.
adhering to it; and the third side adheres to the bone. Where
it subtends the notch of the acetabulum, the cotyloid ligament
is re-enforced by additional ligamentous fibres, placed beneath
it, and going from the upper to the lower end of the notch.
These fibres consist of two planes, one internal and the other
external, partly crossing each other, and adhering closely to
the cotyloid ligament.
The Inter-Articular, or Round Ligament, (Lig. Teres,) is a
true ligamentous band, which is attached at the one end to the
pit on the head of the os femoris, and aftevwards by a slight
dissection, is easily separated into two fasciculi. Of these, the
lower one may be traced to the inferior end of the cotyloid
notch, where, winding around the prominence of bone, it begins
to adhere to the ischium, and continues to do so from that
point along the anterior face of the ischium, just below the
acetabulum, to a point between the latter and the upper ante-
rior part of the tuber. The other portion is directed towards
the superior end of the notch, and is attached there by two ex-
tremities, one near the margin of the acetabulum, and the other
three or four lines from it within.* The fibres of the round
ligament are somewhat intermixed also with those of the coty-
loid ligament subtending the notch.
The Capsular Ligament (Capsula Fibrosa) is the strongest in
the body, and represents a conoidal sac, open at both extremi-
ties, by which it adheres to the bones. It is fixed by its base
to the circumference of the acetabulum, beyond the cotyloid
ligament, and to this ligament itself, where the latter subtends
the notch. It embraces that part of the head of the os femoris
which projects above the margin of the acelabulum, and de-
scends along the neck to its root. It is longer in front; is fixed
there to the oblique line which runs between the two trochan-
ters, and, behind, into the root of the neck, a little in advance
of the posterior oblique ridge, and in such a manner as to leave
a small part of the neck of the os femoris bare below it. Above,
it is fixed to the neck, just below the rough fossa in the tro-
chanter major; and on the under surface of the neck it adheres,
* Antonius et Caldani, Tabula II.
ARTICULATIONS OF THE LOWER EXTREMITIES. 301
just above the trochanter minor. It is strengthened in several
places by processes from the fascia lata femoris, which descend
to it between the muscles surrounding the hip joint.* Its thick-
ness is considerable, but variable. In front, and above, it is
remarkably strong, is two or three lines thick, where it is re-
enforced by a large fasciculus of fibres coming from the ante-
rior inferior spinous process of the ilium, and descending, lon-
gitudinally, to the anterior oblique ridge of the os femoris.
The internal and posterior portions of the orbicular or capsular
ligament are not so thick; it is, indeed, very thin near the pos-
terior ridge of the os femoris, not more than half a line, and
has a number of holes in it for the passage of vessels. It is
strengthened, internally, by some fibres coming from the supe-
rior margin of the thyroid foramen.
This capsular ligament keeps the bones closely applied (o
each other, and is by no means so loose as the corresponding
one of the shoulder joint. Its fibres are very irregular, gene-
rally, in their course, and difficult to follow.
The strength of this articulation depends principally on the
muscles which surround it, of which the rectus femoris, and
the iliacus internus and psoas magnus united, are in front; be-
tween the latter two and the capsule, is a bursa mucosa.
Within, are the pectineus and the obturator externus; behind,
are the quad rat us, the gemini, the obturator internus, and the
pyramidalis; above and behind, are the glutei.
The Synovial Membrane is a complete sac, displayed over
the articular surfaces of the bones, and the internal face of the
* Scemmerinor, De Corp. Hum. Fabrica, vol. ii. p. 61, 1794. Andrew Fyfe,
Compendium of Anat. Philad. 1807, vol. i. p. 179.
For an interesting account of the connexion of this capsule witli the fascia fe-
moris, sec Anatomical Investigations, by J. D. Godman, M. D., Philad. 1824.
The author, in following the sheaths of the muscles, or, in other words, the pro-
cesses of the fascia lata, between the muscles, to the capsule, with great attention,
has been brought to the conclusion that tiro capsule is formed entirely from them,
He has presented the same views in regard to the shoulder joint, and others
Though not disposed to concur in so general an inference on the source of cap-
sular ligaments, inasmuch as their peculiar texture is opposed to it, and many
other circumstances in their anatomical arrangement, I have yet to express
great satisfaction in the fidelity with which these connexions of the larger joints
have been traced.
VOL. I.— 26
302 SKELETON.
capsule. It is separated from the roughness at the bottom of
the acetabulum, by the existence there of a pad of very vascu-
lar, fine, fatty matter, from which, according to Bichat, it may
be raised by blowing beneath the ligament of the notch, at the
point where the blood vessels enter. Coming from the aceta-
bulum, it covers the articular face of the cotyloid ligament, and
is then reflected to the capsule, to which it gives a polished in-
ternal face, and from which it may be dissected. On reaching
the root of the neck of the os femoris, it forms small duplica-
tures, and is reflected upwards along the neck to the head,
being separated from the neck by periosteum, or by a fibrous
tissue, which M. Boyer considers a continuation of the capsule.
It covers all the head, except the point of attachment for the
round ligament, and to the latter it gives a sheath, which, at
the other. end, is continuous with the part of the synovial mem-
brane covering the fatty matter. From the latter circumstance,
arises a deceptive appearance of the round ligament being in-
serted into the roughness in the bottom of the acetabulum.*
Of the Knee Joint.
It is formed by the os femoris, the tibia, and the patella, the
particular modelling of whose surfaces, for the purpose, has
been described. These surfaces are all covered by a uniform
lamina of cartilage, and are held together by an apparatus
which for the number of its parts and their arrangement, makes
this the most composite joint in the skeleton.
The most superficial layer of the knee joint is the fascia lata
of the lower extremity, which, in passing down from the thigh
to the leg, is so near the cavity of the articulation on each side
of the tendon of the patella, that it is by Weilbrecht spoken of
under the term of Common Investment (Involucrum Generate.)
It is here not only a continuation of the fascia femorig, but this
* I have found, in one instance, Dec. 10, 1838, the capsular ligament of this
joint with a large opening, nine by eighteen lines, in front, and the synovial
membrane communicating through it with the bursa between the trcchlea of the
ilium and the iliacus internus muscle. A similar arrangement existed on both
sides of the body, every thing else being normal. Such a condition must, of
course, favour, under suitable circumsiarsces, the internal dislocation of the oa
emoris. It was repeated in another subject, Jan. 2, 1830.
ARTICULATIONS OF THE LOWER EXTREMITIES. 303
fascia is increased and thickened by an aponeurosis, which
springs from the inferior extremity of the extensor muscles on
the thigh. The membrane thus formed covers both the patella
and its ligament, and extends on each side to the lateral liga-
ments of the joint, to which it adheres; it may be traced even
behind them, but there it becomes indistinct, loose, and blended
with common cellular and adipose membrane. The involu-
crum adheres strongly to the internal and external condyle?,
and to the head of the tibia; it has oblique fibres on the patella,
transverse ones on the ligament of the latter, and longitudinal
ones on each side. It is in contact with ihe synovial mem-
brane of the joint, except in the middle portion, where it is se-
parated from it by the patella, and its tendon, and some adi-
pose matter. It may be dissected without difficulty from the
subjacent parts, by which the ligament of the patella, and the
synovial membrane are brought into view.
The Ligament of the Patella being situated at the fore part
of the articulation, though separated from the extensor muscles
by the intervention of the patella, is, neverthless, their tendinous
insertion into the leg. It arises from the whole inferior margin
of the patella, and is inserted into the tubercle of the tibia. It
consists in longitudinal, closely compacted fibres, of a character
entirely tendinous; the more superficial of them give a layer to
the front of the patella, and in the fracture of the latter some-
times prevent a separation of its fragments. In front, as just
mentioned, it is in contact with the involucrum generale; behind,
is a large mass of fat placed between it and the synovial mem-
brane of the joint; and on the same surface, but lower down, it
is in contact with a bursa mucosa fixed between it and the tri-
angular flatness of the tibia above the tubercle'.
A posterior ligament, an internal and an external lateral liga-
ment, two crucial ligaments, two semi-lunar cartilages, and a
synovial membrane, compose the remaining apparatus of the
joint.
The Posterior Ligament (Lig. Posticum,} is a fibrous expan-
sion on the back of the knee joint, which may be considered as
the proper capsular ligament at this point, and has its fibres ex-
304 SKELETON.
tending obliquely from the external condyle of the os femoris
to the posterior part of the head of the tibia. It is frequently
called the ligament of Winslo-w, and by the French anatomists
is considered as one of the divisions of the tendinous insertion of
the scmUmernbranosus muscle, in consequence of its close con-
nexion with it. There are several foramina or interstices in it,
which permit a passage of blood vessels to the fatty matter
placed between it and the crucial ligaments; and beneath it
there are some transverse fibres.
The Inlernal Lateral Ligament (Lig. Laterals Internum) is a
flattened fasciculus of fibres placed at the internal side of the
joint. It arises from the tuberosity on the inner side of the in-
ternal condyle, and descending vertically is slightly attached to
the inner semi-lunar cartilage, and is then inserted into the su-
perior margin and the internal face of the head of the tibia for
two inches or more, increasing in breadth as it descends. On
the one side it is in contact with the synovial membrane, and on
the other, with the invohicrum and the tendon of the sartorius,
the scmi-lendinosus, and the gracilis,
The External Lateral Ligament (Lig. Laterale Extemum
Longum,) placed on the external side of the joint, is nearer its
posterior face than the internal ligament. It arises from the
tuberosity on the outer face of the external condyle, above and
behind the tendinous origin of the popliteus muscle, and is in-
serted into the external part of the superior extremity of the
fibula, being covered in almost its whole extent by the tendon
of the biceps. Its inner face is in contact with the synovial
membrane, and ihc articular vessels. Its rounded form and
shining appearance make it look very much like a tendon. Be-
hind it, occasionally, is a small fasciculus, called by some the
short external lateral ligament, which passes from the external
condyle to the head of the tibia.
The Crucial Ligaments (Lig. Cructata,) two in number, are
named from their crossing one another laterally, and thereby
forming a figure, resembling the letter X, or a Malta cross.
They arc situated at the posterior part of the articulation be-
tween the posterior ligament and the synovial membrane. One
ARTICULATIONS OF THE LOWER EXTREMITIES. 305
of them is called anterior, and the other posterior, from their re-
lative situations to each othcc. The first arises from the inter-
nal face of the external eondyle, by a depression near the bot-
tom of the notch and just at the margin of the articular surface ;
it descends forwards, and is inserted immediately in front of
the little ridge between the articular fac.es of the tibia-. The
second arises from the bottom of the notch between the condyles,
just behind the trochlea for the patella, upon a surface that may
be considered as belonging to the internal eondyle; it descends
backward-s :md is inserted into the rough surface behind the
aforesaid spine or ridge of the Libia. The crucial ligaments arc-
large, round, and composed of parallel fibres very closely com-
pacted; their strength is very considerable, and they servo not
only to limit the extension of the leg, but also to cheek any
^ like rotation inwards.
The Semilunar Cartilages (Cartllagines Scmilunares, fal-
are two in number; one placed on either side of the su-
perior face of the tibia, hoi ween it and the condyles of the os
femoris. Their .shape is su.Ticiently indicated by their names,
and as they are placed on the circumference of each articular
surface of the tibia, leaving the middle uncovered, they increase
considerably the depth of the concavities for receiving the con-
dyles. Their external circumference is thick, whereas, the in-
ternal is reduced by a gradual diminution of their thickness, to
a very thin edge. The internal cartilage is but little more than
a semicircle, and is longer in its antero-posterior diameter than
in its transverse: on the other hand, the external is almost cir-
cular; an arrangement by which each is suited to its rcspectirc
surface. They adhere by their greater circumferences to the
fibrous matter surrounding the joint, particularly the lateral li-
gaments, but not so closely as to prevent their sliding back-
wards and forwards in the flexions of the leg. The tendon of
the popliteus adheres to the external, either directly or by the
intervention of a small synovial sac.
The internal semiluriar cartilage is attached by its fore ex-
tremity to the anterior internal side o"!" the roughne ;s in front of
the ridge, called spinous process, on the top of the tibia, and by
the hind extremity to the posterior face of the base of the ridge,
just in advance of the posterior crucial ligament. The external
cartilage is attache 1 by its anterior end, also, to the roughru
20*
306 SKELETON.
in front of the ridge; but this attachment is considerably behind
the corresponding one of the internal cartilage, and is somewhat
blended with the anterior crucial ligament: the posterior end is
fixed into the depression on the summit of the ridge or spinous
process, and is there between the two crucial ligaments. The
anterior extremities of the two cartilages are united by a trans-
verse ligamentous fasciculus a line in thickness, which is rather
inconstant; but when found, is in front of the anterior crucial
ligament. These bodies, though presenting an appearance cor-
responding with cartilages, on their surface, are, nevertheless,
formed principally from concentric ligamentous fibres; the cha-
racter of vyhich is very evident at their extremities, and when,
they are lacerated.
The Synovial Membrane is thin, loose, and delicate, and, as
in other joints, is a perfect bag, covering the articular faces of
the bones, and reflected from the one to the other. As there is
>io regular capsular ligament to the knee joint, the synovia!
membrane is very distinct on each side of the tendon of the pa-
tella; and comes in contact there with the fascia lata, or involu-
crum, as it passes from the thigh to the leg. The synovia!' mem-
brane, after covering the articular faces of the tibia, is reflected
from their margin upon the semilunar cartilages so as to invest
their inferior and superior surfaces; it then ascends to the con-
dyles of the os femoris. It covers the condyles, laterally, as
well as on their articular faces, and leaves thereby half an inch
or more of their circumference on each side of the tro-chlea of
the patella, included in the periphery of the joint. The syno-
vial membrane, anteriorly, being separated from the tendon of
the patella, by the large mass of fat, then covers the posterior
face o-f the patella, and, rising up still farther, lines the posterior
face of the tendons of the extensor muscles for the distance of
three inches or thereabouts. The superior end of this reflection
is formed into a small pouch, communicating freely with the
general cavity, but marked off from it by a partial and variable
septum on each side. Some anatomists consider the pouch as
a bursa,but it is so seldom seen entirely distinct from the joint,
that it answers better to describe it as a part only of the gene-
ral reflection. The synovial membrane, at the sides of the joint-,.
i? in contact wiih the lateral ligaments. Behind, it is reflected
ARTICULATIONS OF THE LOWER EXTREMITIES. 307
on the anterior surface of the tendinous origins of the gastroc-
nemius, and envelops the tendon of the popliteus; it also invests
the crucial ligaments, but in such a way as to leave them out
of its cavity.
The mass of fat behind the tendon of the patella forms, just
below the latter, a ridge on each side, protruding into the arti-
culation, and having a fringed summit formed by a doubling of
the synovial membrane. The external ridge is the Ligamentum
Alare Minus Externum, and the other the Ligamentum Alare
Majus Internum. These ridges converge at their lower extre-
mities, and from their point of union proceeds a duplicature of
the synovial membrane, in front of the anterior crucial ligament;
the other end of the duplicature is attached to the posterier ex-
tremity of the groove, in the middle of the trochlea, for the pa-
tella. This duplicature is the Mucous Ligament, (Ligamentum
Mucosum.)
Of the Peroneo-Tibial Articulation.
The tibia and fibula are held together by three places of
union, one above, another below; and, thirdly, the ligament
which fills up the space between the bodies of the bones.
1. The Superior Articulation, formed by the upper extremity
of the fibula and the outer side of the head of the tibia, is entire-
ly disconnected with the cavity of the knee joint, and has no-
thing in common with its apparatus, except the external lateral
ligament, which has been described. The articular faces are
small, and covered with cartilage; an anterior and a posterior
ligament, and a synovial membrane, hold the bones together at
this point.
The anterior ligament is attached by one end to the front of
the head of the fibula, and proceeding upwards and inwards, is
inserted by the other into the contiguous part of the head of
the tibia, before the articular facet. The fibres are separated
into fasciculi, leaving interstices between them for cellular sub-
stance.
The posterior ligament is narrower than the anterior, but its
fibres are more compact; and, like the anterior, they observe a
transverse course, being attached by the one end to the head of
the fibula, and, by the other, to the head of the tibia. The pop-
308 SKELETON.
liteus muscle covers them. This joint is also strengthened by
other ligamentous fibres, and by the insertion of the tendon of
the biceps.
The synovial membrane is reflected over the articular faces
and the ligaments described, and has nothing of particular inte-
rest in it. Occasionally, the synovial membrane of the knee
joint runs into it.
2. The Inferior Articulation, which is formed between the
lower extremities of the bones, is not incrusted by cartilage, ex-
cept to the breadth of a line at its lower part, bordering on the
ankle joint.
Its anterior ligament is broad, and covers the face of the
bones which are in apposition. Attached by the one side to
the front of the lower extremity of the fibula, its fibres pass ob-
liquely upwards and inwards, to be inserted into the correspond-
ing part of the tibia. Several interstices exist in it for the pas-
sage of vessels, and it is covered by the peroneus tertius. Its
lower margin is in contact with the astragalus, and forms a por-
tion of the ankle joint.
The posterior ligament, in the arrangement and course of its
fibres, corresponds with the anterior; being attached by one side
to the posterior face of the fibula, and by the other to the cor-
responding part of the tibia. Like the other, its fibres are longer
near the ankle joint than above. Its lower margin is in contact
with the astragalus, and is connected with other ligaments
coming from the fibula.
In the space between the anterior and the posterior ligament,
where the bones touch, they are agglutinated by a short, strong,
fibrous tissue, leaving intervals occupied by adipose matter. It
contributes much to the solidity and immobility of this articula-
tion.
3. The Interosseous Ligament (Membrana Inlerossea,) is ana-
logous to that in the fore arm, by being a membrnne stretched
between the two bones. It arises from the ridge on the outer
face of the tibia, and is attached to the corresponding ridge on
the inner face of the fibula. It is broader above than below,
being at the latter point continuous with the fibrous structure
\yhich agglutinates the bones. Just below the head of the fibula
ARTICULATIONS OF THE LOWER EXTREMITIES. 309
is a large hole for transmitting the anterior tibial vessels, and
the origin of the tibialis posticus muscle. It also presents, in its
descent, several smaller foramina for the passage of vessels. Its
fibres are strong and unyielding, and run obliquely downwards
from the tibia to the fibula. It is covered in its whole length,
both before and behind, by muscles, and serves as an origin to
them and as a means of attachment between the hones*
Of the Ankle Joint.
The articular surfaces, here, being covered by cartilage as
in other moveable joints, are formed by the astragalus being
received into a deep cavity made by the tibia and the fibula.
The capsular ligament, properly speaking, does not exist ei-
ther on the front or the back of the joint, and is represented,
there, by a few scattered, loose fibres, on the periphery of the
synovial membrane. An internal and an external lateral liga-
ment, with the synovial membrane, constitute the whole appa-
ratus.
The Internal Lateral Ligament, also called the Deltoid, (Lig.
Deltoideum) arises from the whole inferior margin of the mal-
leolus internus, and with particular strength from the depress-
ion which exists in it: it then descends and is inserted into the
internal face of the astragalus, and into the lesser apophysis of
the os calcis, which lies just below it. This ligament is broad,
thick, quadrilateral, and composed of fibres which descend
obliquely backwards. The tendon of the tibialis posticus runs
in a trochlea which is formed on the internal face of this liga-
ment.
The External Lateral Ligament (Lig. Triquelrum) consists in
three distinct fasciculi, of which one is anterior, another pos-
terior, and the third in the middle. The anterior arises from
the lower extremity of the malleolus externus, and, running in-
wards and forwards, is inserted into the outer face of the as-
tragalus in front of the surface for the fibula. The posterior
arises from the depression in the extremity of the malleolus
externus, and, running inwards and backwards, is attached to
the point of the astragalus, at the outside of the groove, for
310 SKELETON.
the tendon of the flexor pollicis. The middle arises from the*
pointed termination of the malleolus externus, and, descending
beneath the tendons of the peronei muscles, is attached to the
external face of the os calcis, below the surface for the astra-
galus. These fasciculi arc composed of strong longitudinal
and parallel fibres. The posterior is lander than either of the
others, and occasionally detaches a part which is inserted into
the posterior margin of the articular face of the tibia.
The Synovial Membrane is reflected, as usual, over the arti-
cular surfaces, and from one bone to the other. It sends up a,
short process of a line in length between the tibia and the fibula,
it is remarkably loose in front and behind, and has on its super-
ficial face a considerable quantity of adipose matter, which can-
not be easily detached from it. It commonly contains an un-
usual quantity of synovia.
Of the Articulations of the Foot.
Of the Tarsal Articulations.— }. The Os Astragalus is
united to the Os Calcis by a double articular surface, which has
been described. The ligaments which hold them together are
as follow: —
The Interosseous Ligament is pla-ced between the two bones,
so as te occupy the large oblique fossa between the double ar-
ticular surface in each. It is a collection of very strong, short
fibres, with interstices for fatty matter, which, arising from the
whole length of the groove in the astragalus, descends to be in-
serted into corresponding points in the groove of the os calcis.
Where the fossa is narrow, as it is behind, the ligament is thin
and flat, but it augments considerably in front, where there is
more room for it.
•
• The posterior Ligament arises from the posterior margin of
the astragalus, and, descending obliquely inwards, is inserted
into the adjacent portion.of the os calcis. Its fibres, are blend-
ed with those of the Deltoid Ligament, and on their posterior
face they form a ligamentous trochlea for the tendon of the
flexor pollicis.
ARTICULATIONS OF THE LOWER EXTREMITIES. 311
This articulation is also strengthened by the insertion of the
lateral ligaments of the ankle joint into the os calcis.
The Synovial Membrane forms a distinct cavity on the pos-
terior and larger articular face of the two bones, and is in con-
tact with the fatty matter in advance of the tendo-achillis.
2. The Articulation of the Astragalus with the scaphoides is
formed by the convex head on the part of the former, and by
the concavity on the part of the latter. It is covered, above, by
a thin, broad ligament, with parallel and oblique fibres, which,
arising from the superior and internal face of the astragalus, are
implanted into the upper face of the scaphoides, some of its
fibres extending over to the cuneiform bones. It is covered,
above, by the tendons of the extensor muscles of the toes and
of the tibialis anticus.
On the under surface of the foot, this articulation is support-
ed by two ligaments, called the Calcaneo Scaphoid, (Lig. Pla-
num,) from their origin and insertion. The interior one arises
from the internal margin of the lesser apophysis of the os cal-
cis, and, running obliquely forwards and inwards, is inserted
into the under and internal surface of the os scaphoides. It is
a very thick, flattened fasciculus, on the under surface of which
is formed the ligamentous trochleee, in which run the tendons
of the flexor pollicis and flexor longus digitorum, and which
surface is also in contact with the tendon of the tibialis posti-
cus. By subtending the head of the astragalus, it contributes
largely to the keeping of it in its place in the erect position.
The External Calcaneo Scaphoid Ligament, placed at the outer
margin of the last, arises from the under surface of the greater
apophysis of the os calcis, and running obliquely inwards arid
forwards, is implanted into the under external surface of the
scaphoides. It consists in two or more short, strong fasciculi.
The Synovial Membrane of the articulation between the as-
tragalus and the scaphoides covers the articular faces of these
bones, and lines the ligaments above and below. A reflection
of it, also, lines the articulation between the os calcis and the
312 SKELETON.
astragalus, in front of the rough fossa which is occupied by their
interosseous ligament.
S. The Calcaneo Cuboid articulation, formed by the two
bones indicated in the name, is maintained by two ligaments,
one above, the other below, and by a synovial membrane.
The Superior Calcaneo Cuboid Ligament arises from the up-
per anterior surface of the os calcis, and is inserted into the
adjoining upper surface of the cuboides. It is broad, thin, and
quadrilateral, with short parallel fibres, and is in contact, above,
with the peroneus tertius tendon.
The Inferior Calcaneo Cuboid Ligament, (Lig. Plantare,)
placed on the plantar surface of the foot, is remarkable for its
size and extent. It consists of two horizontal planes of fibres,
of which the superficial is the longest. The latter arises from
the back under surface of the os calcis, and, advancing for-
wards, its fibres are inserted into the summit of the ridge which
traverses the cuboides obliquely; the greater part of them, how-
ever, go beyond this point, and, dividing into fasciculi, are in-
serted into the base of the fourth and fifth metatarsal bones.
The tendon of the peroneus longus is confined between these
fasciculi and the under surface of the cuboides. The other
plane of this ligament being more deeply seated, is also shorter.
It arises from the front under surface of the os calcis, where
the tuberosity exists at this point, and, by advancing, is inserted
entirely into the oblique ridge of the euboides.
The Synovial Membrane being reflected over the articular
surfaces of the bones, and lining the ligaments, is uncovered at
several places above, where interstices exist between the fibres
of the superior ligament, and externally it is contiguous to the
tendon of the peroneus longus.
4. The Scaphoid and the Cuboid bones touch at the external
posterior angle of the cuneiforme externum, and form, there,
occasionally, a distinct articular surface, with a synovial mem-
brane. Besides this mode of union, an interosseous ligament
ARTICULATIONS OF THE LOWER EXTREMITIES. 313
is introduced between them. On the dorsum of the foot there
is a transverse ligament running from one bone to the other be-
neath the extensor tendons ; and on the sole of the foot there
is an oblique ligament, which, arising from the under surface of
the scaphoides, is inserted into the anterior internal margin of
the cuboides.
The articular surfaces of the Cuboides and Cuneiforme Ex-
ternum, which are in contact, besides a distinct synovial mem-
brane, are secured by transverse and oblique ligamentous fibres
going from the one bone to the other.
5. The Articulation between the scaphoides and the three
cuneiform bones is secured by a dorsal and a plantar ligament.
The dorsal, arising from the back of the scaphoides, is divided
into three fasciculi, that go, respectively, to the back of each
cuneiform bone; of these, the internal is the strongest, and is
particularly well marked on the internal face of the cuneiforme
internum. The plantar ligaments are, also, three in number,
and, having a sort of common base from the under surface of
the scaphoides, by being divided into three fasciculi, as the
above, are inserted into each cuneiform bone. They are not
so well marked as the upper ones.
The cuneiform bones are also connected together above and
below, by short transverse ligaments going from one bone to
the other, and holding their lateral surfaces in contact. Those
below are not so distinct as the upper ones, arid are blended
with the insertions of the tibialis posticus.
One synovial membrane covers the articular surfaces of the
scaphoides and of the cuneiform bones which are in contact;
and it extends itself by digital processes between the first and
second, and the second and third cuneiforms, so as to line also
the articulations there. The process between the two latter is
much shorter than the process between the other two, which
extends itself into the tarso-metatarsal articulations, after the
same principle which is observable in the hand.
VOL. I.— 27
314 SKELETON.
Of the Tarso-Metatarsal Articulations.
The articular faces of the bones, here, having been sufficient-
ly described, it is to be noted in addition, that besides being
covered with cartilage, they have the apparatus of the movea-
ble articulations generally, in ligaments which hold them toge-
ther, and in synovial membranes. The ligaments are above
and below.
1. The articulation of the first metatarsal bone with the cu-
neiforme internum is one-third of an inch in advance of the
next, and completely insulated by its synovial membrane: it is
strongly secured by ligamentous fibres above, internally and
below, which give it almost a complete capsule.
2. The dorsal or upper ligaments of the remaining metatar-
sal bones are arranged as follow. There are three for the se-
cond metatarsal; one comes from the second cuneiform, one
from the first, and another from the third: the two latter are
oblique; and they all converge to be inserted into the base of
the bone to which they belong. One dorsal ligament passes
from the third cuneiform to the base of the third metatarsal;
it is sometimes assisted by a fasciculus from the cuboides.
From the superior face of the cuboid bone a fasciculus is sent
to the base of the third and fourth metatarsals.
The plantar or under ligaments are arranged on the same
plan with the dorsal. Not being quite so strong, they are re-
enforced by the fibrous sheaths of the flexor tendons which lie
upon them.
The synovial membrane, which is reflected over the articu-
lar surfaces between the second and third metatarsals and their
corresponding cuneiforms, is the elongation of the digital pro-
cess sent from the scaphoid articulation between the first and
second cuneiforms. This process, besides extending to the
aforesaid tarso-metatarsal articulations, insinuates itself to the
articular surfaces on the sides of the second metatarsal bone;
ARTICULATIONS OF THE LOWER EXTREMITIES. 315
but a distinct synovial capsule is sometimes formed between
the base of the third and fourth metatarsals.
One synovial membrane is reflected over the surfaces, be-
tween the cuboides and the last two metatarsals, and sends in
a process between the latter. In all these cases the synovial
membranes line the dorsal and plantar ligaments of their re-
spective articulations.
Of the Metatarsal Articulations.
The metatarsal bones, with the exception of the first, articu-
late with each other by the contiguous faces of their roots;
which has just been stated, along with the manner of their get-
ting at these points, a lining of synovial membrane. They are
farther fastened to each other by short transverse ligamentous
fasciculi, which pass from the base of one to the base of the
adjoining. These fasciculi exist both on the upper and under
surface of the bones, and are, therefore, denominated dorsal
and plantar metatarsal ligaments. There is also a description
of interosseous ligament between the bases of these bones, oc-
cupying the space intermediate to the dorsal and plantar liga-
ments of each.
The anterior extremities of the metatarsal bones are not in
contact; they are, however, fastened to each other by a trans-
verse or Anterior Plantar ligament on their under surface, the
fibres of which are somewhat blended with the capsular liga-
ments of the first joints of the toes.
Of the First Joint of the Toes.
The surfaces of the bones here being covered with cartilage,
are formed into an arthrodial articulation. There is a fibrous
capsule surrounding the articular faces, and enclosing the sy-
novial membrane. This capsule is considerably thickened be-
low, where the flexor tendons pass over it ; above, it does not
exist, as the extensor tendon is there lined by the synovial
membrane: on each side it is also thickened, so as to form a
lateral ligament. In the under part of the capsule of the great
toe, we find on each side the sesamoid bone. These joints re-
316 SKELETON.
semble so strongly the corresponding joints of the fingers, that
a farther description is unnecessary.
Of the Second and Third Joints of the Toes.
From the shape of the surfaces of the bones composing them,
these are simply ginglymous articulations. They have their
cartilaginous incrustations, synovial membrane, and capsular
ligament. The under part of the latter is much thickened, and
forms a trochlea for the flexor tendons; on each side it is ar-
ranged into a lateral ligament, and above it is defective, as the
synovial membrane is in contact with the extensor tendon.
These joints also resemble so strongly the corresponding ones
of the fingers, that farther description is unnecessary.
BOOK II.
Of the Integuments of the Body.
THE integuments of the body consist in the Cellular and
Adipose Substance, and in the Dermoid Covering.
PART I.
Cellular and Adipose Substance.
CHAPTER I.
OF THE CELLULAR SUBSTANCE.
THE Cellular Substance (Textus Cellulosus, Mucosus) is an
elementary tissue, and is more generally diffused than any other
of the body, for it seems to be quite as indispensable to the lat-
ter as the corpus mucosum is to vegetables. It is found abun-
dantly beneath the skin; between muscles; in the interstices of
muscles and of other parts ; connecting membranes to one ano-
ther; surrounding organs; entering into their composition;
gluing them together; in fine, under every variety of circum-
stance and locality of which the human organization admits.
Indispensable as it is to the texture of all other parts, we find
it, as may be expected, preceding them in the development of
the foetus; at which period it is in the condition of a fluid slight-
ly coagulated.
When examined with a microscope, as it winds around a
muscle and introduces itself between the fasciculi of its fibres,
it will be seen that, however fine the latter may be, yet this body
27*
318 INTEGUMENTS.
is interposed between them in thin laminse. On separating
these fibres, the intervening laminae are resolved or drawn out
into fine filaments, which, finally, break after being stretched to
a certain extent. The lamina which surrounds the whole body
of the muscle, and constitutes its sheath, on being put upon the
stretch, also tears after having been attenuated into still thinner
laminae and into fibres.
If air be blown into the sheath of a muscle, this sheath is
distended into a multitude of cells of various forms and sizes,
which have no determined shape, and do not upon expulsion
of the air return to the same shape upon a repetition of the in-
flation. These cells communicate very freely; all limpid fluids
pass with the greatest ease from one to the other, so that from
any single point they may, by the force of injection, be distri-
buted throughout the body; this is manifested in emphysema,
where from a small wound in the thorax, air becomes univer-
sally diffused. Fluids of any kind, except they be inspissated,
when deposited in these cells, are subject to the common laws
of gravity, and continue to descend successively from the high-
er to the lower cells, as in anasarca. Blood traverses them
very readily in ecchymosis.
Cellular tissue enjoys a good deal of elasticity, for when
stretched it readily returns upon itself. When .very thin, as
between the fibrillse of muscles, it is colourless or nearly so, and
of a gelatinous or glue-like consistence ; but when its lamina?
are thicker, it is of an opaque white, and has a strength
amounting almost, to that of ligamentous matter. When dried
it becomes crisp and of a dark brown ; but may be restored to
its colour and condition by soaking in water. It is only
very slightly affected by the usual heat of the culinary pro-
cesses of roasting or boiling, as our dishes of meat daily prove;
but may be resolved into gelatine after a protracted ebullition.
Its putrefaction is slow, and cannot be accomplished, by mace-
ration, under several months.
The cellular substance is pervaded by a large number of
blood vessels, the majority of which do not, in a natural state,
convey obviously red blood; but if any portion of it be ex-
posed for a short time to the air, or to any other unusual sti-
mulus, it quickly becomes suffused with red blood, circulating
through an infinitude of channels. It cannot, however, be con-
CELLULAR SUBSTANCE. 319
ceded, as Ruysch supposes, that it is formed exclusively of
blood vessels. Some anatomists, indeed, as Haller and Pro-
chaska, allow that though blood vessels ramify through it, yet
they are not spent upon it, or do not form a part of its organi-
zation. The distinction is rather to subtle, to be readily ad-
mitted, and seems, moreover, to be refuted by the continued
exhalation and absorption which is going on within. It does
not appear that nerves are spent upon the cellular substance,
though they pass abundantly through it to their respective
organs.
It is probable that the granulations on which injured parts of
the body depend for their restoration, arise from this cellular
substance. The late Professor Wistar attended a patient for
compound fracture of the leg, with a large wound, which was
subsequently covered with luxuriant granulations. The limb
was suddenly attacked with an oedematous swelling, which ex-
tended itself to the sore, and caused its granulations to tumefy,
so that they pitted upon pressure precisely like other parts.*
The most generally received opinion of anatomists,! in re-
gard to the arrangement of cellular tissue is, that it results from
the assemblage of a multitude of lamella, and of fine soft fila-
ments, which, being variously interwoven, produce a series of
cells all communicating one with another, but varying in their
shape and size; so that the whole cellular substance may be
considered to represent a single cavity subdivided into an infini-
tude of smaller ones. To this it is objected, f that when this
tissue is accurately examined, it appears rather as a homoge-
neous, viscid, and only partially solidified substance; particular-
ly in the inferior orders of animals, and in the embryo state of
the more exalted, where it has still to admit the deposite or for-
mation of the several organs. That the same is manifested at
any period of life; for neither with the naked or assisted eye
does it assume any other appearance. That its laminated and
fibrous condition, when such does appear, is owing to its gluti-
nous or glue-like consistence, which causes it to assume a fac-
* System of Anat. vol. i. p. 388, 2d edition.
t Haller, Beclard, JBichat, Wm. Hunter, &c.
t Bordeu, Recherches sur le Tissu Muqueux et Celluleux. Paris, 1790. J.
F, Meckel, Manuel D'Anat. vol. i. p. 105.
320 INTEGUMENTS.
titious arrangement upon being drawn or inflated. For ex-
ample, if one separates two muscles for a short distance, the
cellular substance between them becomes unequal and furrowed
without losing its cohesion; but if they be farther separated,
filaments and cylindrical columns are produced. If the trac-
tion be then suspended, and the muscles replaced, the filaments
shorten, and are finally united into a consistent mass whose
parts all adhere together.*
While such tractions are going on, it most frequently hap-
pens that air is insinuated into the cellular substance, from which
corrres the appearance of small cells and vesicles : upon the es-
cape of this air, the primitive state of cohesion is restored, and
upon a renewal of the traction, cells of a different shape, size,
and appearance arise. Again, if air be so introduced, one may
push it in any direction, separate its globules, collect them again,
and into larger masses; vary their shape, and, in fine, by such
means mould the supposed cells into an infinity of forms. From
these considerations, the inference is plain, that when cellular
substance is drawn it must yield itself into filaments; when in-
flated, as the air acts in every direction, its supposed lamellae
must be separated and assume a cellular shape; and, by the ap-
plication of both forces at once, it may be caused to assume
both a cellular and a filamentous appearance. Upon the whole,
Meckel conceives that the term Mucous Tissue, adopted by
Bordeu, is much more exact than the one of Cellular Tissue,
now most generally used.
Notwithstanding the perfect continuity of the mucous or cel-
lular substance throughout the body, anatomists for the ease of
description have divided it into External and Internal.
The External Cellular Substance (Textus Cellulosus Inter-
mediuSj sen laxus) has the general extent and shape of the body
and of its organs, so that if it were possible to extricate the lat-
ter from their envelope, it would present a chamber for the
lodgement of each part. But the walls of these chambers
would not all be of the same thickness, as the quantity of cel-
lular substance varies. In the cranium and spinal cavity there
is very little of it: on the surface of the head and in the orbits
more: about the trunk, both internally and externally, it is abun-
dant; in the extremities still more so, where it penetrates between
* J. F. Meckel, loc. cit.
CELLULAR SUBSTANCE. 321
the muscles. In the arm pit, in the groin, and in the neck, all
parts where much motion is enjoyed, it is unusually abundant.
The foramina of the cranium and of the spine, establish the
points of connexion of the cellular substance of these parts with
others adjacent. The cellular substance of the face is conti-
nued into that of the neck; that of the latter is continued through
the upper opening of the thorax upon the viscera of this cavity;
and thence through the openings of the diaphragm, along the
great vessels and oesophagus upon the viscera of the abdomen
and pelvis. The cellular substance of these cavities is again
continuous with the deep-seated cellular substance of the limbs
at the arm pit and at the groin. The trunk of the body being
enveloped by one broad sheet of cellular substance, it is con-
tinued superficially to the limbs.*
With this general sketch of the distribution and extent of
cellular substance, it is not surprising that in certain bad cases
of emphysema, the air shows itself every where, even at points
the most remote from the lungs, and apparently the least ex-
posed to the accident, as the interstices of muscles, of glandular
organs, and so on. It will also now be understood how this
varied distribution of cellular substance and its proteiform
shape, have been the inexhaustible but delusive source of ana-
tomical discoveries and supposed novelties, under the name of
fascise, sheaths of vessels, and so on; and will continue to be
so, to such as do not recollect that all these things are included
under the general character of this tissue; and that each mus-
cle, each viscus, each nerve, and each blood vessel, has its own
particular chamber under this multiform arrangement, which
chamber may be traced to or from any other point, according
to fancy. At the same time it should be noted that many of
the laminae have a condensed form, which renders a special
knowledge of them of the greatest use to the surgeon, and
which is elsewhere succinctly pointed out, with the description
of their respective organs.
* For a detailed account of the inflections of the cellular substance, the stu-
dent may consult with advantage, Bordeu, loc. cit. These inflections are the fas-
ciae of modern Surgical Anatomy.
Bichat, Anatomic Generate; Systdme Cellulare. Paris, 1818.
Andreas Bonn, de Conlinuationibus Membranarum, in Sandifort's Thesaurus
Dissertationum, Rotterdam, 1769.
Haller, Element. Physiol. vol. i. 1757.
322 INTEGUMENTS.
Anatomists who lived at a period much less illuminated than
the present on the subject of the elementary tissues of the body,
seem to have seized upon the idea of the universal inflection of
cellular substance over the surfaces, and through the texture
of the several organs. Mangetus,* without pretending to ori-
ginality, but in alluding freely to the observations of others,
says, " Membrana adiposa, est expansio cellulosa, quae totum
corporis habitum, paucissimis, iisque minimis partibus exceptis,
circumambit; etin qua materia albicans unctuosa, sensu expers,
ad partes fovendas ac lubricandas colligitur. — Hsec membrana
cellulosa seu pinguedinosa, non tantum in exterioribus corporis
reperitur; sed interius in intestinis, mesenterio, aliisque prope
omnibus partibus, non exceptis etiam vasis sanguiferis, ut suo
loco videbirnus, observatur." And in describing the aponeuro-
tic covering of the body and of the limbs, which in his day
was called Membrana Musculosa, from some false notions of
its nature, he adds, " Dicitur oriri a dorsi vertebris, quia scili-
cet earum spinis firmiter adhaeret, inibique multo quam alibi
usquam robustior conspicilur. Usus est, musculos universim
in sua sede firmare, iisque quasi thecam praestare, in qua ut
supra innuimus laxius sibi cohaerente, lubrice moveri queant."
The cellular investments of the muscles the same author calls
Membrana Musculi Propria, and he speaks of their penetrating
between the fasciculi of muscles, and most evidently those of
the glutaeus maximus and deltoides.
The Internal Cellular Membrane (Textus Cellularis Stipatus)
presents itself under different arrangements according to the
organ or part whose interstices it penetrates. As it forms in
the muscles an envelope for each fasciculus and fibre, if the
latter by any art could be withdrawn, it would represent a
congeries of fine parallel tubes. In the case of glandular bo-
dies the internal cellular membrane imitates the shape of their
lobe-s, lobules, and acini or small graniform masses, and may,
therefore, be compared to a sponge. In the hollow viscera, as
the stomach and bladder, it unites their successive laminae to
one another. In the .ligaments, even where the fibrous struc-
ture is perfectly evolved, the fibres are united by cellular tissue
* Theatrum Anatomicum, Geneva, 1716, vol. i. Ch. Hi.
CELLULAR SUBSTANCE. 323
in their interstices. This tissue is not sufficiently abundant in
the bones, tendons, or cartilages, to be very distinct; but from
what is seen of it in the forming stage of the embryo, it is ne-
vertheless ascertained to be the base of every part. In glan-
dular textures it is frequently spoken of under the name of pa-
renchyma,
Most of the membranous textures of the body may by ma-
ceration be resolved into this mucous or cellular tissue, so that
we hear anatomists, without hesitation, asserting, that under
various degrees of consistence, it forms the skin, the serous
membranes, the vessels, the ligaments, in short, almost every
thing excepting the bones, the muscles, the nervous system,
and the glands, and they only depart from it in having their
globules deposited in its interstices.* Meckel even adds to the
list the epidermis.
The term mucous tissue was substituted for that of cellular,
by Bordeu,t owing to its glue-like consistence, and to its re-
semblance to the corpus mucosum of vegetables. Notwith-
standing its propriety on these grounds, yet as the lining mem-
brane of all the hollow viscera has the same name, some con-
fusion may be produced unless one bears in mind the distinc-
tion. Bordeu has expressed the character of the internal
cellular membrane very forcibly in saying, that in embryos all
their organs are species of buds, which vegetate in the cellular
tissue, like plants do in the open air, or their roots in the ground,
and that each one having an apartment of its own, this apart-
ment is to it a cellular atmosphere, which keeps in a perfect
relation with the action of the organ.J
In tracing many of the laminae of the cellular substance, we
find, that as life advances, they assume a more fibrous charac-
ter than what they possessed in infancy; this also occurs when
* Beclard, Anat. Gen. p. 141. Haller, loc. cit. p. 19; vol. i. p. 113.
t Loc. cit.
t Loc. cit. p. 65. Rechcrches Anatomiques sur les Glands, Paris, 1752. Also-,
An Exposition of the Physiol. and Pathol. Doctrines of Theoph. Bordeu, under-,
stood to be from the pen of a learned friend, R. La Roche, M. D., in the North
American Med. and Surg. Journal. Philad. April, 1826.
324 INTEGUMENTS.
they are pressed upon by tumours, or irritated from many other
causes. This disposition of the cellular substance to assume a
ligamentous character, in many of the attachments which are
formed between the two tissues, frequently leaves it doubtful
with which the membrane under examination should be classed;
in some individuals the fibrous substance is predominant, and
in others the cellular. This deposite of fibrous matter into cel-
lular substance, or rather the change of the latter into it, may
be compared to the partial or even perfect conversion of the
cartilages of the thorax into bone by an increased deposite of
the phosphate of lime. It perhaps will be better understood by
repeating that this cellular tissue is an elementary one, where-
as the ligamentous is composed of it and ligament.
In addition to the uses of the cellular substance in forming a
nidus for the deposite of all the molecules of the body, and in
circumscribing each organ, so as to keep it distinct from the
contiguous ones of a different character, its elasticity and yield-
ing nature permit it, in the movements of the several parts upon
each other, to change its position, and upon the cessation of
the active cause, to re-establish itself. Its extreme flexibility is
kept up by a continued exhalation of moisture from the arte-
ries that ramify through its texture. This cellular serosity,
when an animal is recently killed, and its internal parts ex-
posed to a cold atmosphere, rises in the form of vapour, and
has a particular smell. It is more abundant in certain parts
than in others; and, as a general rule, where there is the least
adipose matter. Indeed, these two substances seem to exist in
an inverse ratio: in a person, for example, who has died very
fat, the parts are comparatively dry; whereas, in such as have
all the adipose matter wasted by a lingering disease, there is a
humidity which quickly disposes to putrefaction; a fact fre-
quently exemplified in our dissecting-rooms. The cellular se-
rosity is, consequently, more abundant in the scrotum, in the
eyelids, and in the penis. Bichat informs us, that he has satis-
fied himself by experiments, of its augmentation during diges-
tion, during heavy perspirations, and after sleep; which will
account for the swelling of the eyelids, so commonly observed
in the morning, upon rising.
This serosity is albuminous, as proved by its being coagu-
ADEPS. 325
lated by alcohol, and by the mineral acids. It is removed by
the absorbents; assisted by the tonic contraction of the cellular
membrane, according to M. Beclard.* The latter author, in-
deed, goes on to say, that the cellular membrane is the essential
organ of absorption, by which the skin and the villosities of the
internal membrane of the hollow viscera perform this function.
That the substances introduced through it into the blood-ves-
sels, no doubt, in doing so, undergo some kind of elaboration,
in the same way that those do which are deposited in its inter-
stices for the growth, repair, and changes of the body.
CHAPTER II.
OF THE FAT, (ADEPS.)
THE Adeps, in subjects not much emaciated, is found be-
neath the skin; between it and the fasciae; and in the layers of
common cellular substance which are next to the muscles; as
on the face, the neck, the trunk of the body, the buttocks, the
limbs, the palms of the hands, and the soles of the feet. In the
adult, it is also found between the serous membranes and the
cavities which they line, as in the thorax and abdomen; it is
also found between the lamina? of these membranes, as in the
omenta, mesentery, and so on. It, likewise, exists between the
interstices of muscles; in the hones, and elsewhere; so that its
whole amount is estimated at about one-twentieth of the entire
weight of the body. There are, however, certain portions of
the body, where its presence would have been very inconve-
nient: they, accordingly, are destitute of it; to wit, the interior
of the cranium, of the ball of the eye, the nose, the ear, the in-
testinal canal, the eyelids, the scrotum, the penis, the labia in-
terna, and the substance of the glands.
The adops is of a yellowish colour, and of a semifluid state
in the living body: when after death it has got a few degrees
below the standard of animal heat, it becomes somewhat solidi-
* Anat, Gen. p, 149.
VOL. I.— 28
326" INTEGUMENTS.
fied, and then appears in small aggregated masses of cfiffererrf
shapes and sizes.
In chemical composition it differs from all other parts of the
body by the absence of nitrogen, and is formed of oxygen, hy-
drogen, and carbon, which render it, in animals, a very suita-
ble- article for candles and lamps. According to the analysis
of Chevreuil,* it consists of two kinds of matter, elain and stea-
rin; the former of which remains fluid at the freezing point,
while, as mentioned, the other becomes solid by a very small
abatement of its living temperature. The application of porous
paper enables one to separate them in a small way.
The adeps, though lodged in the cellular substance, is accom-
modated there under different circumstances from the cellular
serosity, and is supposed to be in different cells. This doctrine
was promulgated by Dr. Wm. Hunter,^ and upon the following
grounds: That certain parts of the cellular membrane are des-
titute of it; that in persons who have died from dropsy, the
portions of the cellular membrane which originally contained
fat, have a more ligamentous condition than others ; to wit, those
on the loins next to the skin, more than the stratum next to the
lumbar fascia; that water or flui'ds pass readily from a higher
to a lower part of the cellular membrane, either when extrava-
sated naturally or injected; that oil, when injected artificially,.
subsides*in the same way, and has a doughy or oedematous feel,
yielding readily to pressure and pitting, whereas, fat never
shifts its position simply from gravitation.
From these several causes, Dr. Hunter adopted the opinion
that the fat of the cellular membrane is lodged in peculiar ve-
sicles, and not as the water of anasarca, in the reticular inter-
stices of parts. This idea has been adopted by Beclard, who
says that the lobules of fat, when examined with a microscope,
are seen to be composed of small grains or vesicles, from the
six hundredth to the eighth huridreth part of an inch in diame-
ter, each one having a pedicle furnished from the adjacent
blood vessel. That the parietes of the vesicles are so fine as to
escape observation, but that he considers them as arranged in
the same way with the pulp of oranges, lemons, and such kind
of fruit. These several reasons a?e so plausible that I cannot
* Annalcs de Cliimie, vol. xciv.
t Medical Observations and Inquiries. London, 1762,
ADEPS. 327
but subscribe to their force and accuracy, notwithstanding the
objection raised from quarters of :high authority.
It is more abundant in the female than in the male, and in
both sexes it is removed as life declines. In the infant the fat
is found at the surface of the body chiefly, little or none exist-
ing in the interstices of muscles, and in the cavities.
Its uses are not fully understood. At some points it serves
to diminish pressure, as on the hands and feet; at others it fills
up interstices; it is also a bad conductor of caloric, and may,
therefore, serve in retaining animal heat. But its most general
application is to the purposes of nutrition, it being one of those
forms which nutritive matter assumes previously to being per-
fectly assimilated. This is very fully manifested in hibernating
animals, which being fat in the beginning of their torpid state,
return from it quite lean; and in insects which during their re-
pose in the chrysalis state, live upon their own fat while under-
going the metamorphosis into the perfect animal.*
* Beclard, Anat Gen. p. 170.
PART If.
Of the Dermoid Covering.
THE Dermoid Covering, or tissue of the body, consists in. the
Skin; — its Sebaceous organs; — the Nails; — and the Hair.
CHAPTER I.
OF THE SKIN.
THE Skin (Pellis, Cutis, hp/**) is extended over the whole
surface of the body, and thereby constitutes a complete invest-
ment of it. At the orifices of the several canals which lead
into the interior of the body, as the mouth, nose, vagina, anus,
and urethra, it does not cease abruptly, but is gradually con-
verted into the mucous membrane of the part, so that it is
plainly continuous with it. At certain places, on the middle
line of the body, the junction of the skin of the two sides is in-
dicated by a change in its appearance, called Raphe; as on the
upper lip; from the navel to the pubes; on the scrotum, and in
the perineum; in all of which places, in the development of the
fo3tus> the two sides of the body are later in uniting than else-
where.
The colour of the skin varies in different nations: it is black
in the negro; of a copper colour in the American savage;
bronzed, or tawny, in the Arabian; and white in the Europeans
and their descendants. It is also subject to various shades,
from the mixture of these races, and from the influence of cli-
THE SKIN. 329
mate; its general tendency being to turn dark on parts exposed
to the influence of tropical heat and light.
The external surface of the skin, or that which is free, has
on it a great multitude of wrinkles; some of them depend upon
the subjacent muscles, as on the forehead and face; some are
caused by the flexions of the articulations, and are to be seen
at all of these places on the limbs; in addition to which, where
there is much emaciation of the parts beneath, the skin not
having sufficient elasticity to accommodate itself to their state,
is thrown into other wrinkles, and sometimes into loose folds.
Finer wrinkles of another description are also found on the
skin, arranged in various angular and spiral directions: they
depend on an entirely different cause, which will be treated of
elsewhere.
The skin abounds in hairs, which vary in fineness and in
length according to the region over which they are distributed :
it, likewise, presents many small pits, or follicles, which are
the orifices of sebaceous glands. A finer description of pores,
which are visible only to the assisted eye, are supposed to be
the orifices of exhalents and of absorbents, but this is not quite
certain.
The internal surface of the skin is connected to the subja-
cent parts by the cellular tissue, which permits a considerable
sliding of it backwards and forwards on most parts of the
body; on others, however, this is restrained, as on the cranium,
the palms of the hands, and the soles of the feet, by ligamen-
tous fibres passing to it from the fascia3 and bones below. A
very interesting attachment of this kind exists on the fingers,
where a plane of ligamentous fibres is seen passing from each
side of the lower end of the first phalanx, downwards, to be
inserted into the skin, half an inch or an inch off.
Since the first observation of Malpighi, on the tongue of a
bullock, whereby he ascertained that its integuments consisted
in three layers, and the discovery of a similar arrangement on
other portions of the integuments by Ruysch,* anatomists have,
for tho most part, admitted the skin to consist of three lamince,
the Cuiis Vera, the Rete Mucosum, and the Cuticula.
* Thesaurus, Anat. IX.
28*
330 INTEGtJMENtS.
SECT. I. OF THE CUTIS VERA.
The True Skin (cutis vera, derma, corion,) is the deepest, of
the layer next to the cellular substance. Its thickness varies
according to age, sex, and the region of the body over which it
is stretched; on the trunk it is thicker behind than it is in front;
on the limbs, thicker on their external than on their internal
faces or semi-circumferences. On the mammae, the penis, scro-
tum, and external ear, its tenuity is remarkable. When unin-
jected, it is perfectly white in people of all complexions, and in
the living state has a semi-transparency that permits the blood
of the veins to be seen beneath it.
The internal surface of the true skin is so blended with the
cellular substance, that in the recent subject there is a difficul-
ty in distinguishing where one terminates and the other begins,
yet they may be separated by maceration so as to determine
this line ; mortification of the cellular substance sometimes does
the same thing; and in the ham, cured by salting and smoking,
the true skin, after boiling, may be stripped off with but little
difficulty. In either of these cases the internal surface of the
latter is seen to be studded with small areolar depressions,
caused by the projection of granulated masses of adeps; the
margins of those alveoli are the principal points of adhesion
to the subcutaneous cellular tissue, while their bottoms are
pierced with small openings that lead through the skin.
The external surface of the true skin is covered with very
fine papillae, or villi, (Papillce Tactus,) that are readily brought
within the observation of the naked eye, by maceration, when
protracted long enough to permit the separation of the cuticle.
The projections on the tongue are very similar to them, and
the whole are designated as the papillary body. These cuta-
neous papillae are particularly distinct at the bulbous ends of
the fingers and toe?, upon the palms and soles, on the lips, on
the glans penis, and the nipple; in other parts they are not so
evident, but still there can be no doubt of their existence, from
analogy. On the hands and feet they are arranged in double
rows or files, which occasion the semicircular and spiral turns
CUTIS VERA. 331
of small wrinkles or ridges at the ends of the fingers and toes ;
and the transverse oblique, and curved ones, on other parts of
the soles and palms. The small, triangular, lozenge-shape, and
multangular elevations of the cutis vera, seen elsewhere on it*
external surface, are caused rather by its contraction than by
the papillae.
These papillary projections resemble very much small conoi-
dal, cotton-like filaments, standing up the twelfth of a line, or
thereabouts, from the surface of the skin: they are by no means
so long as the villi generally of the intestines, and, like them,
consist in very delicate ramifications of nerves and blood ves-
sels, united by cellular tissue. In places where these papillae
are less abundant, the cutis vera is not so vascular or sensitive.
They readily receive a fine injection, and, if the cuticle be
afterwards separated by maceration, their vascularity is very
distinct. Their nerves are destitute of neurileme.*
The texture of the true skin is fibrous; the fibres which com-
pose it, by their irregular intermixture, resolve it into a mass
of net-work or areolae, the meshes of which are sufficiently
large in some parts to permit the introduction of the he-ad of a
small pin. The meshes, though they are larger and more dis-
tinct on the internal fhan on the external surface of the true
skin, open, however, upon the latter surface; having passed
through the skin obliquely, after the manner of the ureters
through the coats of the bladder. Those intervals between
the fibres of the skin are rendered very obvious after mace-
ration of a month or two, or after skin has been tanned.
They serve to transmit hairs, bloodvessels, nerves, absorbents,
and exhalent vessels also if such exist. These interstices com-
municate freely with the cellular substance, for in many cases
of anasarca, blisters, when made upon a depending part,
empty the cellular membrane of water almost as quickly as
scarifications;! but if the blisters inflame, they discharge incon-
siderably, owing to the porosities being shut up by the tume-
faction and fulness of the parts. The same is observable in
scarifications.
A fine injection, when forcibly driven into the extremities of
* Beclard, Anat. Gen. t \V. Hunter, loc. cit.
332 INTEGUMENTS.
a foetus, will become extravasated between the cutis vera and
cuticle, and raise up the latter in small blisters, as I have fre-
quently experienced, though it cannot be caused to pass through
the cuticle.
The precise nature of the tissue which composes the true skin
is not yet fully ascertained; it seems, however, to be a mixture
of cellular substance and ligamentous matter; with a striking
predominance of the latter in most parts of the body, though
its proportion varies considerably, being very abundant on the
thickest parts of the skin, while it is scarcely discernible on
the thinnest. The following analogies of dermoid with liga-
mentous or desmoid tissue are observable. It becomes yellow
and transparent on being boiled, and a continuation of the
process dissolves it into gelatine. It resists putrefaction for a
long time; is remarkably tenacious. Contrary, however, to li-
gamentous matter, it is extensible and elastic, though this pro-
perty may arise from the oblique intertexture of its fibres ; as a
bandage from a piece of muslin, when torn longitudinally or
transversely, is inelastic, but if it be cut bias, it is then very
elastic. The application of tannin increases its resistance, and
makes it one of the strongest animal substances known in hu-
man arts.
The skin has a very strong power of contraction, which is
manifested in an amputation, in a long incised wound, or when
a sensation of chillness exists, as in an ague or from the appli-
cation of cold. Owing to the diminution in size of its areolae,
its external surface then becomes wrinkled, rough, and studded
with projecting points, constituting the Cutis Anserina.
The cutis vera is very vascular, and abounds also in nerves
and absorbents.
SECT. II. OF THE RETE MUCOSUM.
The Mucous Net (Rete Mucosum*) of Malpighi, is the second
layer of the skin, and is that in which resides the colour of the
several races of men. It covers every part of the surface of
the cutis vera; its existence, however, is not so obvious beneath
the nails and about the junction of the skin with mucous mem-
* Caldani, Icon. Anat. PI. xci. Albinus, Annot. Acad. Ley den, 1756.
Ruysch, Thes. Anat. ix.
RETE MUCOSUM. 333
branes, as it is elsewhere ; though taking all things into consi-
deration, it is probable that it exists also at these several places*
but much finer. It is so extremely thin, and of such a soft muci-
laginous consistence, that it is difficult to separate it as a distinct
lamina, either by maceration or by any other means ; for it most
commonly peels off by adhering to the cuticle, after the man-
ner of a pigment. It, however, by good management, may be
fairly raised as a membrane, and separated for a certain dis-
tance from the other two coats of the skin.
Fine as this membrane is, it would seem, from the observations
of Mr. Cruikshank* upon a negro dead from small-pox, and upon
an injection executed in London, by the late Dr. Baynham, of
Virginia,! and from more recent experiments in Paris, by M.
Gaultier,J that it consists in several layers. 1. Upon the in-
equalities or papilla? of the cutis vera, there is a layer called, by
M. Gaultier, bloody pimples, (Bourgeons Sanguins,) but which,
in the opinion of some other anatomists, are only the papillae
themselves of the cutis vera. 2. Then there is a very thin and
transparent coat, called, from its colour, Tunica Albida Pro-
funda: it is especially visible in the negro; under the coloured
horns and scales of animals, and beneath the nails of white per-
sons. 3. Over this layer is spread another, (the Gemmula,)
which contains the colouring matter of the several complexions
of the human family, and consists in a multitude of dark brown
points in the negro ; it is visible also in those forms of disease
called ephelides (freckles,) by the French, where the skin be-
comes spotted; it is not so distinct in the healthy state of the
white individual. 4. The last lamina of rete mucosum, is called,
by M. Gaultier, Tunica Albida Superficialis, from its whiteness
and superficial situation : in many animals it is very distinct,
in the negro somewhat so, but in the white it is not to be seen
except under the nails, about the hair, and under accidental
horny excrescences.
These observations of M. Gaultier have been verified by M.
Dutrochet,§ in experiments upon the texture of the skin of ver-
* Expts. on Perspiration. London, 1795.
t Wistar's Anat. vol. i. p. 394.
t Recherches sur la peau, Paris, 1809; in Anat. De L'Homme,par J. Cloquet.
PI. cxvu.
§ Journal de Physique, May, 1819. Journal Complementaire, vol. v.
334 INTEGUMENTS.
tebrated animals; and are now generally acknowledged by the
French anatomists. In negroes, in cutting through the skin of
the sole of the foot, from heel to toe perpendicularly to the fur-
rows, this arrangement is readily recognised;* and when it has
become indistinct, it may be improved by immersing the skin
for three or four days in lime-water, or a solution of potash or
barytes, and afterwards keeping it the same length of time in a
solution of corrosive sublimate. Blisters also elucidate this
point on other parts of the body: the fluids being locally at-
tracted there, infiltrate the rete mucosum, and separate in part
its 'layers, so as to form a vesicle frequently very thick, parti-
cularly in fat persons.
The scrotum of the negro is also well suited to the exhibition
of the rete mucosum, as it is there very distinct, and is univer-
sally much thicker and better marked in the negro than in any
other race. From its extreme tenuity in the whites its existence
in them has by some persons been doubted, but erroneously, as
in them also its change of colour, from the influence of the sun,
is readily demonstrated. There are in fact few persons, perhaps
none, so white, but what a slight tinge of yellow exists in their
skins; which may be proved by contrasting them with any per-
fectly white surface, as snow, bleached paper, or linen. This
slight tinge of yellow is increased to an olive colour by the sun's
rays, and, in some instances by a spontaneous deposite; in other
cases, it is in certain spots removed, so as to leave a colour al-
most perfectly white, or that only of the cutis vera.t When the
latter change occurs in the African, it occasions a hideous pie-
bald complexion, and the cuticle is readily elevated into blisters,
by the irritation of the solar rays. Some persons have an entire
deficiency of this pigment on the skin, from birth; the same de-
ficiency occurs in the eyes, and hair; they are designated as al-
binos. The deficiency of the pigmentum nigrum in the eye,
causes it to look red, like that of the white rabbit; and also
makes it intolerant of a strong light, as that of noon-day.
" In some very remarkable instances the skin becomes entire-
ly black. We have read to the Society of Medicine of the Fa-
* J. Cloquet, Anat. De L'Homme. PI. cxvi. Fig. 6.
f A case of this kind is now in the Philadelphia Alms House, where the ab-
sorption of colour has occurred in spots on the hands of a dark-complexioned Eu-
ropean. June 15,
RETE MUCOSUM. 335
culty, the history of a woman whose skin became black in the
period of a night, in consequence of a strong moral impression.
This woman had seen her daughter throw herself out of the win-
dow with her two little children; and we have since had occa-
sion to see, also, a woman, who having escaped capital punish-
ment, in the revolution, had experienced the same accident. The
latter was at the period of menstruation when she learned this
news. The menses were immediately suppressed, and from
white, which she was, she became black as a negress, which
colour continued even to her death. We dissected with care
the skin of these two women, and found the coloured portion to
be the rete mucosum. We found it sufficiently easy to isolate
the epidermis and the dermis, which presented no abnormal co-
loration. This black colour must be the result of a sanguineous
exhalation which operates upon the rete mucosum.
" The violet tinge of the skin is, ordinarily, the result of em-
barrassed circulation. The skin becomes blue in many very ad-
vanced diseases of the heart. The name of Cyanosis, or blue
disease, has been given to this colour of the skin, which is falsely
attributed to an immediate communication of the auricles by
means of the unobliterated foramen ovale. This cause of the
cyanosis is much more rare than is commonly supposed."*
The pigment of the rete mucosum would seem, for the fore-
going reasons, to be continually undergoing a deposition and ab-
sorption. When it has been lost by a blister in an African, it
is generally restored in a short time afterwards: the same oc-
curs in their cicatrices, but requires a longer period. The ob-
servations of chemists tend to prove that it is formed principal-
ly by carbon. Its apparent use is to defend the skin from the
rays of the sun, in illustration of which several ingenious ex-
periments have been executed by Sir Everard Home.f
The influence of the continued use of nitrate of silver, in
giving a lead colour to the skin is well known. Anatomists
generally have rejected the idea of the vascularily of the rete
mucosum, yet it would seem to have been injected, on one oc-
casion at least by the late Dr. Baynham, in a leg which was
* Cours de Medecine Clinique, par Leon Rostan. Paris, 1830.
f Philos. Transact. London, 1821.
336 INTEGUMENTS.
diseased from exostosis;* and there are now in the anatomical
cabinet of the University, three preparations by myself of the
fingers of an African, where the colouring matter of the injec-
tion has been passed from the papillae of the cutis vera into the
rete mucosum ; and there deposited in dots, indicating the for-
mer position of the papilla?.
SECT. III. — OF THE CUTICLE (CUTICULA.)
The Cuticle or Epidermis, is the most superficial layer of the
skin, and takes its wrinkles from the closeness of its applica-
tion to the true skin. It is a thin, dry pellicle, which cannot
be separated from the cutis by dissection; in consequence of
which we have to resort to the alternate application of hot and
cold water; to partial putrefaction ; or in the living body to
vesicatories. The mode of adhesion between the cuticle and
the true skin is not precisely understood: the surfaces unques-
tionably adhere, through the intervention of the rete mucosum,
with equal tenacity where there are neither hairs nor sebaceous
follicles to pin them together, as on the palms of the hands and
soles of the feet; and when by previous management this union
is somewhat softened, they part very much after the manner
of two sheets of paper, which had been recently glued and
were almost dry. From this it would appear that the adhe-
sion is universal, and not defective at any points.
In most parts of the body the cuticle presents itself MS a sin-
gle homogeneal layer, of a thickness uniformly about that of
the thinnest Chinese blotting paper. Upon the palms and soles
of persons generally, but especially of such as are addicted to
heavy labour, and exposed to a continued mechanical irrita-
tion of these parts, the cuticle becomes much thickened and
laminated, apparently from a successive deposite of it on the
skin, there. It is transparent, by which the colour of the parts
beneath is readily discernible; in the African, however, it is
extremely difficult, nay, impossible to clean it wholly of the
colouring matter of the rete mucosum; it seems indeed as if it
were, according to the opinion of some, impregnated by it.
* Mec&el speaks familiarly of its being furnished with an innumerable quanti-
ty of capillary vessels. Vol. i. p. 470.
CUTICLE. 337
The structure of this body is entirely peculiar; there is no
evidence whatever of the existence of vessels in it: on the con-
trary, in inflammations, when the skin becomes of the deepest
tinge of red, the epidermis never has its colour changed in the
smallest degree; the impression made on it is only manifested
by its dropping off, while another layer is preparing to take its
place.
Dr. W. Hunter, though he disbelieved in the possibility of
injecting the cuticle, and did not admit the evidence of the
preparations of his time having that reputation ; yet thought the
communicating or perspiratory vessels might be exhibited in a
different manner, that is, by macerating for a short time a piece
of the sole of the foot : afterwards, in separating the cuticle
from the cutis vera, as the two membranes parted, these vessels
would be found in the angle of separation passing from one to
the other like cob-web filaments.*
There can be no doubt of the accuracy of this statement,
for it is easily verified by any one who will take the trouble
to perform the experiment; yet it is more than probable that
Dr. Hunter was deceived in the nature of these filaments, and
that as M. Beclard has suggested, they were merely the threads
formed out of the rete mucosum, which was rendered a viscous
fluid by the commencement of putrefaction; and, therefore,
when parted, would put on the same filamentous appearance,
that half dissolved glue does in a similar situation. Some of
the aforesaid filaments also are supposed by Bichat and Chaus-
sier to be absorbents; but this opinion of course sinks with the
objections brought against Dr. Hunter.
Neither is there any evidence of the existence of nerves or
of the cellular membrane in this tissue; for it is in all states
entirely devoid of sensibility, and never puts forth granulations.
The excrescences which belong to it, as corns and indurations,
are, like it, laminated, owing to their thickness, and have no
interior circulation; and though sometimes painful, are so only
by their pressing upon the subjacent nerves of the skin. It is
also destitute of filaments.
•The cuticle is penetrated by hairs, and by the orifices of the
sebaceous follicles and glands; and according to Bichat, also,
* Mcd. Obs. and Inquiries, vol. ii. p. 53, London, 1762.
VOL. I.— 29
338 INTEGUMENTS.
by the exhalents and absorbents, the several orifices of which'
he says become distinct by holding it between the eye and a
strong light. As it, when raised by a blister, does not allow
the effused fluid to pass through any of these pores, it is very
reasonably supposed that they are all oblique, and therefore
exercise a valvular office on such an occasion. Or if, accord-
ing to the supposition of Mr. Cruikshank, the finest pores of the
cutis vera are lined by processes from the cuticle, the collapse
of these processes on the separation of the cuticle will also ac-
count for the fact. It seems to be well ascertained at the pre-
sent time, that as the epidermis is more transparent at certain
points than elsewhere, the appearance has been mistaken for
porosities of exhalents and sbsorbents. The cuticle, when de-
tached, will not allow a column of mercury to pass through ity
except its weight be so great as to lacerate it : this fact is ra-
ther against the doctrine of the pores being visible when exa-
mined by permitting the light to shine through, and shows that
even those for the hairs and the sebaceous follicles are stopped
by some arrangement or other. Upon the whole, the opinion
of organized pores in the cuticle for exhalation or absorption,
is not sustained by unobjectionable testimony, and is scarcely
admissible upon any principle. At the same time it maybe re-
marked, that the interstices which exist in it would seem to be
sufficient to account for many of the phenomena of exhalation
and of absorption.
The cuticle has but little power of extension, and, conse-
quently of contraction, and tears with the application of a very
slight force. It naturally contains so little moisture, that its
bulk is only inconsiderably altered by drying. Ir, like the hair
or nails, resists putrefaction so much, that it has been found in
burial places after a lapse of fifty years. When held in water,
it swells, becomes white, wrinkles more, loses its transparen-
cy, and dulls the sensibility of the cutaneous papilla?. It can-
not, like the true skin, be readily reduced by boiling water into
gelatine, and consequently, is not affected by tanning: it, in-
deed, retards that process, when left on the proximate surface
of the cutis vera. When applied to a fire, it burns, like the
hair and nails, wilh extreme facility, owing to the presence of
a similar oil in it, and it gives out a very disagreeable odour.
The little extensibility of the cuticle causes it to be ruptured
aao
whenever tumours, as warts, &c., rise from the surface of the
cutis vera: it is supposed, however, not to be entirely deprived
of this quality, as it seems to stretch when raised into a blister,
though this may arise, in some measure, from the small wrinkles,
naturally existing in it, being drawn out. It has not the slightest
sensibility, neither is this quality evolved by any condition
whatever, as it is in tendons, ligaments, and bones, when
they become inflamed.
There is, in all probability, a slow loss and reproduction of
the cuticle constantly going on, The former is manifested by
the large quantity of branny scales that are detached from its
surface, when one has abstained from bathing for a long time.
This is more remarkable on the palms and soles than elsewhere.,
and the loss must, of course, be continually supplied. It, as is
well known, is rapidly regenerated when it has been lost sim-
ply by an abrasion or blistering, which has not interfered with
the organization of the rete mucosum. In some cases there is
an unusual development of it : Bichat retained the skin of a
patient, dead at the Hotel Dieu, in whom the cuticle, at the pe-
riod of birth and in subsequent life, was three times the natural
thickness; and had always, with the exception of that of the
face, been subject to a continual desquamation.
As the epidermis has in itself no power of regeneration, ow-
ing to its deficient organization, the most plausible opinion in
regard to its source is, that it is produced by the inspissation
and drying either of the external layer of the rete mucosum or
of a secretion from it, which renders it a sort of varnish, well
qualified to resist the agency of exterior objects, and to protect
the delicate organization of the proximate surface of the cutis
vera. This opinion of its origin seems to be proved by its par-
ticipating in the colour of the rete mucosum, more or less, so
as to give it a sensible tinge, which cannot be washed from it.
One of the most striking properties of the cuticle is its re-
sistance to evaporation from the surface of the body : in a sub-
ject, any part of the derm, when deprived of it and exposed to
the air, dries up in the course of a day or two, while the other
portions remain soft and flexible for weeks, and, if it were not
for putrefaction causing- the cuticle to peel off, would some-
times remain so for months. Though it suppresses evapora-
340 INTEGUMENTS.
tion, in a great measure, it does not do so entirely ; for, after
a subject has been kept some time, its fingers, toes, nose, and
ears get very dry and hard.
During life the process of perspiration is continually going
on, either in a sensible or insensible manner; and according to
the experiments of Sanctorius, more than one-half of the
weight of our food is lost in that way through the skin and
lungs. MM. Lavoisier and Seguin ascertained that the propor-
tionate exhalation from these organs was eleven of the former
to two of the latter. When the perspiration is rapid, it assem-
bles on the surface of the body in the form of small drops,
having an acid, saltish taste, and a peculiar odour. In this
state, according to the analysis of Berzelius, it consists princi-
pally in water, holding in solution a hydrochlorate of soda and
of potash, some lactic acid, lactate of soda, and a little animal
matter. The perspiration, besides its use as an excretion, is
a powerful means, by it«s evaporation, of enabling the body
to resist a high temperature. It varies, both in quality and
quantity, according to age, sex, state of health, food, and habits
offife.
The power of the cuticle to absorb or to transmit inwardly
articles through it, is not by any means so obvious as its exha-
lation: the facts, however, upon the whole, seem to prove that
though this power is much curtailed when compared with that
possessed by mucous surfaces, yet it does exist to a certain ex-
tent.*
CHAPTER II.
OF THE SEBACEOUS ORGANS OF THE SKIN.
THE Sebaceous Organs consist in Follicles (Cryptce, Mucosa)
and Glands, (Glandules Sebacece.) They furnish the oily exha-
lation, which lubricates the surface of the skin, gives linen,
when worn a long time, a greasy appearance, and causes the
A
* Wistar's Anat. Vol. ii. p. 396, 3d edit.
THE SEBACEOUS ORGANS. 341
water in which we bathe to assemble in drops, on the surface
of the body, rather than to wet it uniformly. This humour
produces a rancid disagreeable smell in negroes, and such per-
sons as do not resort to ablutions of the whole skin, from time
to time. It is particularly abundant about the places provided
with hairs, as the scalp, the genital organs, the axillce, and
seems to be intended to maintain the flexibility and smoothness
of the skin and hair, and to prevent the former from chapping.
These qualities of it are possessed, in a considerable degree,
by the oily articles of the toilet, which are used for the same
purpose. There can be no doubt of the unctuous quality of
this secretion, as, when collected on a piece of clothing or on
blotting-paper, it burns with a white .flame. Its quantity is
readily augmented by certain kinds of clothing, which most
persons must have observed shortly after putting on a flannel
shirt next to the skin.
It is sufficiently certain that the apparatus producing this oil
is not visible to the naked eye in most parts of the skin, so that
there would seem to be a necessity of accounting for its ap-
pearance there, in some other way besides a distinct glandular
apparatus. Bichat considered it to arise from a set of exha-
lents differing from those which secrete the matter of perspira-
tion, a theory far more rational than that which attributes it to
the percolation of the subcutaneous fatty matter. M. Beclard,
however, admits that sebaceous follicles exist over the whole
surface of the skin, with the exception of the palms and
soles; because the skin is universally rendered unctuous by this
discharge: many follicles exist, which are only visible to the
microscope; and because morbid changes frequently render
them evident, where their existence was not suspected before-
In many places these follicles are sufficiently obvious and very
numerous, as on the nose, about the corners of the mouth, on
the ear and behind it, and on the face, generally, of some indi-
viduals. When the skin has been injected, they are found to
consist of small pouches placed in its thickness and having
their parietes abundantly furnished with blood vessels.
The discharge from them sometimes becomes inspissated, and
does not readily pass through their orifices; in which case, con-
tinuing to accumulate, it will, finally, form a sensible tumour.
Most frequently it does not collect to such an exten% but is
342 INTEGUMENTS.
indicated simply by a small black point, owing to the adhesion
of dirt to it: in this condition, when squeezed out, it assumes a
small vermicular shape.
The Sebaceous Glands, properly speaking, are about the
size of a millet seed, of a light yellow colour, and are placed,
wherever they exist, immediately under the cutis vera. They
are particularly numerous under the skin of the mons veneris.
1 have not observed them so distinctly elsewhere.
CHAPTER III.
OF THE NAILS.
THE nails (Ungues) supply the place of cuticle on the ex-
tremities of the fingers and toes, and may be considered as a
continuation of this membrane, because in maceration they
come off along with it. They correspond with the talons and
hoofs of the lower orders of animals.
Each nail consists of a root, of a body, and of a free ex-
tremity, or that which projects and requires paring. The
root is about one-fifth of the length of the nail; is thin, soft, and
white, and is received into a fold or fossa of the true skin,
which is very distinct when the cuticle and nail are removed
together by maceration. The concave surface of the nail
adheres closely to the skin below, precisely as the cuticle does
in any other part of the body, and therefore may be loosened
by the same processes, as hot water and maceration. The
white part of the nail, at its root, is called the crescent, (lunula,)
and is said, by Mosely,* never to exist in the fingers of Africans
or of persons who have even a slight mixture of negro blood:
the latter opinion I am disposed to consider incorrect. This
appearance, however, does not depend upon any peculiar or-
ganization of the nai! itself at that part, but upon the cutis venv
belpw it, which being more vascular elsewhere, causes tLat
spot to Ipok white, the nail being semi-diaphanous and permit*
* Diseases of 'Warm Climates.
THE NAILS. 343
ting a view of the circulation beneath. This is also sufficiently
proved by the fact, that when a nail is torn off, its lunula disap-
pears. The nail increases gradually in thickness from its root
to its free extremity.
The nail is covered on the posterior face of its root by the
epidermis, which terminates there in a thin, adherent, diapha-
nous band: behind this band the root of the nail projects, and
is received into the groove of the cutis vera. The epidermis
also adheres to the lateral margin of the nail, and in a curved
line to the concave side of its anterior end. The under sur-
face of the nail is soft, pulpy, and has an arrangement of
superficial longitudinal grooves, receiving the papilla of the
corresponding surface of the cutis vera. As the black co-
lour of the negroes is sometimes seen beneath their nails, it is
probable, as stated, that the rete mucosum exists there also;
but it is not so clearly ascertained, though the observations of
M. Gaultier, on the rete mucosum of animals, tend to prove
it.*
As the nails are entirely destitute of organization, having
neither vessels nor nerves, they have no power of growth nor
of disease in themselves, these qualities being derived exclu-
sively from the cutis vera. The materials of their formation
are, accordingly, secreted from the cutis vera, in the bottom of
the groove, formed by the latter for the reception of their root.
As these materials adhere to the preceding formation, and
become concrete, by adding continually to its length, they
shove it forward, and thereby elongate it. While this is going
on in the groove, the thickness of the nail is also somewhat in-
creased by an excretion from the skin contiguous to its con-
cave surface. This accounts for the nail being thicker at its
free extremity than at its root.
Owing to a peculiarly morbid state of this proximate surface
of the true skin, it sometimes happens, that the contribution to
the nail from it exceeds that from the groove; the consequence
of which is, that the whole nail grows upwards like a horn, in-
stead of forwards. An example of this kind was lately exhi-
bited to me by a scientific friend, Dr. Charles D. Meigs, of
tliis city,, in a female aged about ninety. In this case one of
* See Rete Mucosum..
344 INTEGUMENTS.
the big toe nails had grown upwards, in a semi-spiral manner,
to the length of four and a quarter inches, when measured
along the outer edge of the spiral. The corresponding nail
of the other side would have been of nearly the same length,
but it had been broken. The nails of all the other toes
had assumed a similar manner of growth, and measured
from one and a half to two inches. In the case of each
nail its anterior extremity presented the primitive nail as
it had been before this extraordinary hypertrophy.
The statement of the patient was, that the growth had com-
menced about fifteen years previously. A tendency to this
horny growth from the skin, was also manifested in a tubercle,
three or four lines long, and with an ulcerated base, from the
back of her nose; and also by scaly excrescences on the legs.
The patient having died shortly afterwards, the collection of
nails was politely presented to the Anatomical Museum, by Dr.
Meigs.
In cases where the nail has been lost by violence or disease,
the cutis vera secretes another; but it differs from the first, un-
less the cutis vera has been restored to a perfectly healthy ac-
tion: from this cause, we see in individuals thick black nails,
sometimes cleft longitudinally.
The nails begin to appear about the fifth month of fetal life,
and are still imperfect at birth. When analyzed, they seem to
consist in coagulated albumen, with a small quantity of the
phosphate of lime.
CHAPTER IV.
OF THE HAIRS.
THE Hairs (Pili, Crines) are cylindrical filaments, which
are found on most parts of the skin, excepting the palms and
the soles. The finest of them are microscopical, and have not
a diameter exceeding the one-sixth hundredth of an inch.
THE HAIRS. 345
The hairs differ much in their size and appearance in the se-
veral parts of the body. Those on the head (capilli, caesaries,)
grow to the greatest length of any, and are most numerous in
proportion to the space they occupy. Those which surround
the month, and are on the cheeks, (julus, mystax, barba,) ex-
ceed the others in size, and when allowed to grow, are next in
length, and more disposed to curl. Those around the eyes
(cilia and the supercilia,) are not disposed to exceed an inch in
length, and have a long slender spindle shape. Those at the
orifices of the nostrils and ears are of the same habits as the
latter. Those of the arm pit, (glandebalae,) and about the or-
gans of generation, (pubes,) are limited to the growth of a few
inches.
In the male subject there are hairs of considerable length,
also, on the sternum, and about the nipples, an arrangement
which seldom occurs in females. In most individuals, hairs
are found over the whole remaining surface of the body; but
in females, and in many males, they are too fine to be readily
visible. In some subjects, brought into our dissecting-rooms,
the pilous system has been so developed as to form a shaggy
coat over the whole body, and almost to conceal the skin.
We are informed, on the authority of Jameson's Tour, of
a man, at Ava, covered from head to foot with hair. That
on the face and ears is shaggy, and about eight inches long;
on the breast and shoulders it is from four to five. He is a
native of the Shan country, and married a Burmese woman,
by whom he has two daughters: the youngest is covered
with hair like her father, but the eldest resembles her mo-
ther.*
In the female the hairs of the head are more abundant, and
reach a greater length than they do in the male. As a general
rule, the colour of the hairs corresponds with that of the eyes
and of the skin, and the darker they are, the coarser. Accord-
ing to WithofF, a quarter of an inch square of skin has upon it
147 black hairs, while the same extent has 162 hazel, or 182
white ones, in other individuals.
Each hair consists in a bulb and in a stalk. The bulb is the
adherent extremity, and is whiter, softer, and generally larger
* Littell's Museum, No. 69; p. 412.
34G INTEGUMENTS.
than any other part; it is received into a follicle, compared ap-
propriately by Malpighi to the vase containing a flower or plant,
and which is deposited most commonly in the subcutaneous cel-
lular substance, but sometimes in the skin itself. This follicle
is of an oblong ovoidal shape; its open orifice is continuous
with the surface of the body, while its internal end is closed,
and has some filaments passing from it to the adjacent cellular
substance. It is formed of two membranes; the external is
white, strong, and continuous with the derm or cutis vera; the
second being within the last, is more soft, delicate, and vascu-
lar, and seems to be a continuation of the rete mucosum. From
the bottom of the cavity of the follicle, a small conoidal papilla
erects itself towards the orifice. This papilla is vascular, and
from the dissections of M, Beclard, on the human subject, and
of M. Rudolphi, on the mustachios of seals, is furnished with
nerves. The mode of approach of its vessels is not yet settled.
M. Gaultier says that the arteries pass from the surface of the
skin into the orifice of the follicle, and then descend, in a ser-
pentine manner, between its two membranes to the bottom.*
M. Bdclard, on the contrary, considers them to pass through
the bottom of the follicle. Each piliferous follicle is, moreover,
furnished, within its orifice, with many small sebaceous follicles
arranged round it.
The bulb of the hair has in it a conoidal cavity, open at its
base, and receiving the conoidal papilla of the follicle.f The
hair receives its nourishment from the papilla. The hair is
moreover attached to the skin by the cuticle ; for the latter
having reached the orifice of the follicle is then reflected for
some distance along the hair: this increases the strength of the
attachment of the hair to the skin.
The stalk of a hair has generally the loose extremity smaller
than any other part, and frequently split. When examined with
a microscope the stalk appears to consist of two substances, one
within the other. The exterior is a diaphanous sheath almost
colourless, and, from having the properties of the epidermis,
may be a continuation of it. The interior consists of from five
• J. Cloquet, Anat. de 1'Homme, Pi, CXVIH. fig. II,
t Gaultier, see Cloquet, loc, cit,
THE HAIRS. 347
to ten filaments, parallel with one another, and forming a tube
in the centre of the fasciculus. The tube, as well as the inter-
stices between the filaments, is filled with a fluid called the
marrow of the hair. This substance corresponds with one of
the layers of the rete mucosum of the skin, and contains the co-
louring matter. The probability is, that the whole hair is a
continuation of the rete mucosum, to which is joined the enve-
lope of the epidermis. The canal in the centre of the hair is
said to be unusually distinct in the hog's bristle ; it is also well
seen in the supercilia : the follicle and bulb are best studied in
the mustachios of the larger animals. According to Mr. Heu-
singer,* the substance of the hair, when examined with a mi-
croscope of strong power, exhibits an areolar appearance.
Though the stalk of the hair is destitute of blood vessels and
of nerves, yet it is probable, from the sudden changes of colour
that sometimes occur in it from black to white, owing to terror
and grief, that there is a species of interstitial circulation going
on. The emaciated and peculiar appearance which sickness
gives to it, would also tend to support this opinion. Strictly-
speaking, the hairs are devoid of sensibility, yet, as the bulb is
planted over a sensitive papilla, they communicate certain sen-
sations by being removed or touched. Animals apply their
mustachios particularly to this use in groping through dark
places, or when they are deprived of sight. The hairs are emi-
nently hygroscopic, moisture lengthens, and dryness shortens
them ; this property has caused them to be applied to the con-
struction of hygrometers.
In certain animals the hairs are erected by the contraction
of the subcutaneous muscle; the movement in the human sub-
ject corresponding with that, is the effect of great fright, and is
produced by the contraction of the occipito fronta-lis muscle.
In the development of hair, the part which first forms is the
follicle, the young hair then pierces it at its summit, in the same
way that the tooth pierces its capsule. The death of the cap-
sule, or the drying up of its fluids, occasions the fall of the hair
and prevents its regeneration. In old men who are bald there
is no appearance of capsules; while in persons from whom the
hair has fallen, owing to sickness, as the capsules still remain,
* J. Cloquet, loc. cit.
348 INTEGUMENTS.
they soon put forth another crop of hair. The rudiments of the
hair are seen about the fifth month of foetal life. The first crop
is deciduous, and after covering the body of the foetus like a fine
down, till the eighth month of utero-gestation, it then falls off:
sometimes, however, it is retained either in whole or in part
till after birth ; this is particularly the case in regard to the hair
of the head. In this deciduous character we see another analo-
gy between the hair and the teeth.
When the hair becomes white from age, the conversion
of colour begins at the loose extremity, another proof of the
interstitial circulation, or change of particles in it. The same
fact is observable in animals who change colour only for the
winter. But the restoration of colour begins at the root.
It is probable, in those cases of plica polonica attended with
bleeding from the root of the hair when it is cut, that the vas-
cular papilla has been so much augmented as to elevate itself
above the level of the cuticle, and of course interferes with the
sweep of the razor employed in shaving the head. Ignorance
in regard to the organization of the hair, and a slight inclination
to the marvellous, would magnify this into every hair, in such
a disease, being a sort of branch-pipe from the general circu-
lating system, and therefore bleeding upon being wounded.
Many of the victims to this disease accordingly prefer the loath-
some matting of the hair with which it is accompanied, to the
supposed risk of dying by hemorrhage.
BOOK III.
PART I.
CHAPTER I.
ON THE GENERAL ANATOMY OF THE MUSCLES.*
THE muscles (musculi) by their contraction produce the va-
rious flexions of the body, and are, therefore, the organs of mo-
tion. They may be known by their redness, softness, irrita-
bility, contractility, and by their being formed of long parallel
fibres. The redness, however, does not always attend them ;
as this colour is very faint in the foetus, and does not exist at
all in animals that have not red blood. They form a very con-
siderable share of the whole bulk of the body.
Though the most perfect organs of motion, and producing it
more efficiently and rapidly than any other apparatus, they are
not indispensable to it; for they are not observable in animals of
a very low grade, which apparently consist of a sort of cellular
or mucous substance. In the next grade of animals, as the
worms, where there is a deficiency both of bony and of carti-
laginous skeleton, the muscles are perceptible, and produce lo-
comotion by their attachment to the skin or integuments; and,
finally, in animals which have a skeleton, the muscles are al-
most exclusively attached to its different points, and by alter-
nately approximating them, effect locomotion.
The muscles of the human body are referrible to two classes,
in consequence of their position and functions, though they pre-
* These organs were very imperfectly known to the ar dents, excepting Ga-
lon, and had not generally received names till the time of Sylvius, A. D. 1587.
The paramount authority of Albinus, in this department of anatomy, in his work
Historia Musculorum Hominis, Leydcn, 1734, has induced me to adopt it as the
standard of correct description and nomenclature, with but few exceptions.
VOL. I.— 30
350 MUSCLE?.
sent a perfect similitude of structure every where. The most
numerous class, as well as that in which they are of the greatest
magnitude, are the muscles of voluntary motion : they are placed
between the skeleton and the integuments, and constitute the
principal bulk of the extremities, and also afford a thick fleshy
covering to the trunk. The second class is contained within
the large cavities of the skeleton, and forms a portion of the
structure of the circulatory, of the digestive, and of the urinary
organs ; and produces the principal internal motions of the ani-
mal economy.
Every muscle is surrounded by an envelope of cellular sub-
stance, called its sheath, (Membrana Musculorum Communis*)
which at different points of the body exhibits various degrees of
condensation. In the muscles of voluntary motion these sheaths
are formed by partitions, going from the aponeurotic expansions
just beneath the skin, to the periosteum, and are the prolonga-
tions which induced Bichat to consider the periosteum, as the
centre of the desmoid system. These sheaths in some cases pre-
serve to a considerable extent the ligamentous appearance, but
generally cellular substance predominates in them. Upon their
existence is founded the great variety of views and descriptions
which the later anatomists have taken of the fascia? of the hu-
man body, some choosing to describe them in one way and some
in another. The sheaths of the second class of muscles are com-
posed of a much finer and looser coat of cellular substance than
those of the first, and are commonly described as lamina? or tu-
nics to the organs to which they respectively belong. In every
ease, however, from the internal face of these sheaths a great
many partitions pass off, which penetrate the body or thickness
of the muscle, and divide and subdivide it into fasciculi, and into
fibres, even to their most minute condition. These partitions be-
come thinner the more they are multiplied.
Many of the muscles are subdivided by fissures, into several
large portions called Fasciculi, or Lacerti. These vary very
much in size, and in their distinctness from each other. Some
are so large and so widely separated as to appear like distinct
muscles; such, for example, are the biceps of the arm and of the
thigh, the deltoid, the columnar carneas of the heart, and several
others. But the greater part of the fasciculi are strictly parallel
* Haller, Element. Physiol. torn. i.
GENERAL ANATOMY OF THE MUSCLES. 351
with each other, and merely separated by a thin lamina of eel*
lular substance. The fasciculi are again subdivisible into fibres,
which from their smallness are not appreciable to the naked
eye, and even when examined with powerful microscopes seem
to admit of an endless division. On this account some anato-
mists have undertaken to classify the fasciculi under the terms
of first, second, and third orders. It is evident, however, thai
this arrangement is too arbitrary to be needful, and that the
circumstance is sufficiently expressed by considering the fasci-
culi as indefinitely divisable. The fibrous arrangement of
muscles is rendered still more distinct by boiling them, or by
immersing them in alcohol.
The structure of the muscular fibre has been studied with
great attention by microscopical observers. From such ob-
servations, it appears that their ultimate shape is prismatic,
pentagonal, or hexagonal. According to Prochaska, every
fibre extends the whole length of the muscle, considering this
length as represented by the tendinous beginning on the one
hand, and the tendinous termination on the other. This ar-
rangement holds even in regard to the longest muscles, as the
sartorius^
The most approved accounts, of modern times, of the ulti-
mate structure of muscular fibre, are those of Mr. Bauer; with
Sir Everard Home, and of MM. Prevost and Dumas. These
gentlemen concur in stating that the results have been uniform
in all animals to which their observations have been extended.
That the muscular fibre is a series of globules, resembling the
globules of the blood deprived of colouring matter and adhering
in a line to each other. That the medium of adhesion is invi-
sible from its transparency and want of colour; but if the mus-
cle be macerated in water frequently changed, that this medium,
from its greater solubility and more ready putrefaction, may be
removed so as to leave the globules detached from each other,
and still resembling the globules of the blood. The fact of the
globular condition of the muscular fibre was first pointed out
by Leuwenhoek and Hook ; it is also confirmed by the testi-
mony of Mr. Milne Edwards and M. Dutrochet. The evidence
of their size is very unsettled ; it is stated at from one diameter
to one-seventh of the diameter of a globule of blood, the latter
352 MUSCLES*
being estimated at the two-thousanth part, or less, of an inch*
Such minute observations are necessarily very uncertain.
In meat which is prepared for the table by roasting or boil-
ing, or in a muscle which is contracted, one frequently sees
the fibres undulated or crooked. By Prochaska it is attributed
to the bridling of the fibre, by the contraction of its cellular
substance, nerves, and blood vessels. The cause, however, i»
not well ascertained : the condition seems to be one of the pe-
culiarities of muscular fibre, which it manifests when in a state
of contraction only; for it disappears whenever the fibre is re-
laxed, either by spontaneous movement, or by stretching it in
the dead body. This undulation has probably contributed to
the many inexact observations on the structure of muscles.
Thus, Haller thought they consisted in a series of ovoid vesi-
cles, which lengthened in a state of relaxation, and became
more globular in a state of contraction. It is unnecessary to
dwell on mere errors of the eyes or of the imagination, for the
fact seems to be now well established, that, though the muscu-
lar fibre, by contracting, loses its straightness and becomes
crooked, yet this is effected without change in the form of the
ultimate globules of which it consists.
By some it has been asserted that muscles are only the con-
tinuation of blood vessels. To this it is replied,* that though
insects have muscles, yet they have not blood vessels, so that
the former cannot be a continuation of the latter. Moreover,
a successful injection, though it may penetrate very finely be-
tween the fibres, so as to cause the muscle to swell considera-
bly, yet none of these vessels can be traced into the ultimate
fibre. The vital phenomena and the organization of muscular
fibre, are so very different from cellular substance, from nerves,
and from vessels, that it cannot be less than a distinct struc-
ture.
Notwithstanding this limitation, which is put upon the dis-
tribution of the blood vessels, every muscle is abundantly sup-
plied by them. The arteries come from the adjacent large
trunks, and penetrate at different points of the periphery of the
muscle. They first of all pass between the larger fasciculi and
* Beclard, Anat. Gen.
GENERAL ANATOMY OF THE MUSCLES. 353
parallel with them; they then divide and follow the course of
the smaller fasciculi; they divide and subdivide again after the
same rule, till they become mere capillary tubes, from which
the nutritive matter is exhaled. The veins accompany the
arteries, and receive their blood; some of them creep along the
surface of the muscle without having corresponding arteries.
Bichat says that they are injected with great facility from their
trunks, from which he supposes that their valves are less nu-
merous than in other parts of the system.
The colour of the muscular fibre seems to be, in a measure,
independent of the blood which circulates in it. Some animals
with red blood have white fibres, as frogs. The colour of the
muscular fibre is not altered in animals that have been suffo-
cated. The muscular fibres of the intestines and of the bladder,
though abounding in blood vessels, are whiter than the muscles
of voluntary motion.
Lymphatics have been injected in the intervals between mus-
cles and between their fasciculi.
The Nerves of the muscles are large and abundant, as the
nerves of the brain and spinal marrow are chiefly spent upon
them. They are generally proportioned to the size of the mus-
cle which they have to supply, but there is some variety in this
respect. They accompany the arteries, and are united to them
by cellular substance. Their ultimate terminations are traced
with great difficulty, and there is consequently an uncertainty
in this respect. Before they disappear they become soft by
divesting themselves of their cellular envel >pe, and are supposed
to bring thus their medullary substance in immediate contact
with the muscular fibre. The recent observations of MM. Pre-
vost and Dumas, are thought to throw some light on this sub-
ject, and have been received with a very respectful attention.
They say, that by macerating in clean water, and in a dark
place, the muscle of a bullock, and then throwing a strong con-
centrated light upon it, the distinction of colour between the
nerves and the muscular fibres becomes very apparent. With
the aid of a microscope and a fine knife, the nervous ramifica-
tions may be thus traced. The trunk of the nerve enters the
muscle parallel with its fibres, and soon begins to give off, at
30*
354 MUSCLES.
right angles, lateral filaments, which penetrate between the fas-
ciculi and fibres of the muscles, and may be traced to the top
of the undulations formed in the muscular fibres. These lateral
filaments at some places are two in number, which pass at some
distance from each other, but parallel, and terminate by an
interchange of fikments; at other places the terminating
branches are spread out transversely to the muscular fibre,
and end by forming loops with themselves. According to this
view, the nervous filaments, strictly speaking, have no termi-
nation, but run again into the source from which they are de-
rived.
The chemical analysis of muscles shows them to be com-
posed of fibrine, albumen, gelatine, extractive matter, the phos-
phate of sodst, ammonia, and of lime, and of the carbonate of
lime. The extractive matter of the muscle may be removed
by maceration in clean water, often changed. If it be allowed
to remain long, it assumes certain appearances in its putre-
faction peculiar to itself, but occasionally it is converted into a
substance resembling spermaceti. When* a muscle is exposed
to boiling water, the albumen is raised to the surface, like
foam; the gelatine coagulates when the muscle is cold; and the
fibrine appears as a fibrous grayish substance, insoluble in hot
water, closely resembling the irbrine of the blood, and evolv-
ing large quantities of nitrogen by the action of nitric acid.
When a muscle is exposed to the fire alone, as in roasting,
the albumen is hardened; the gelatine is melted, and runs oflf,
in part, with the juices of the meat: the extractive matter is
that which gives a dark colour to the outside; the fibrine is
cooked in the juices of the meat, and is then rendered very
tender. The muscular parts of animals are amongst the easiest
of digestion.
The muscular system of the embryo is first of all in a
gelatinous state, and confounded with cellular substance^
but at two months from conception, the fibres are distinct,
and at four they begin to contract and to execute different mo-
tions.
The muscular system is subject to varieties of conformation.
Hobust, muscular individuals frequently have supernumerary
. muscles and supernumerary heads to their muscles, particularly
MUSCULAR MOTION. 355
in the extremities. In monstrous foetuses it sometimes hap-
pens that the muscular system is either wholly or partially
supplanted by adipose matter and by infiltrated cellular sub-
stance.
CHAPTER II.
ON MUSCULAR MOTION.
THE muscles, after death, are soft, easy to tear, and have
but little elasticity; it is only during life that they manifest such
extraordinary strength, and retain their powers of motion.
The general phenomena of the latter have been happily ex-
pressed by the word myotility, suggested by M. Chaussier.
These phenomena are, contraction, elongation, and, according
to Barthez, a power of remaining motionless or fixed.
In contracting, the muscle shortens, swells and becomes
hard; presents wrinkles on its surface; and its fibres are some-
times thrown into a state of oscillation or vibration, from their
alternate relaxation and contraction. It is owing to the vibra-
tory motion in the fibres of a muscle, during their contraction,
that a rustling is heard on the application of the stethoscope to
them. The hollow, distant rumbling, when the meatus exter-
nus is closed by the finger, is owing to the same vibration in
the muscles of the finger employed. This is readily proved by
the following experiment: close the meatus with the end of the
handle of an awl or a fork, pressed against it by the finger, and
it will be found that the muscular vibrations are continued
along the instrument: plant, afterwards, the point of the instru-
ment upon a soft, inelastic substance, so as to make, in that
way, the closure of the meatus, and the rumbling will instantly
cease. The roaring noise of sea-shells may be explained In
the same way. The colour remains the same, which proves
that there is not an appreciable addition to the quantity of its
circulating fluids. The rapidity with which this contraction
may take place, is manifested in speaking, in running, and in
playing upon a stringed instrument; and its strength, by the
immense burdens that some individuals can raise and bear,
356 MUSCLES.
The power of elongation or relaxation seems to be an active
state of the muscle, as well as its contraction. This power of
relaxation or of elongation is much inferior to that of contrac-
tion; it seems to be only what is sufficient to restore the mus-
cle to its proper length, so as to put it in a condition for the
renewal of its contractions. The fixedness of muscles, which
are contracted spasmodically, and their retaining this position
even after death, until putrefaction begins to assail them, show
that the power of elongation does not depend simply upon
elasticity; for the latter quality being as much the attribute of
dead as of living matter, would be brought into play on death.
The fixation of muscles is not a distinct power, but merely
a qualification of contraction, by which the latter may be ar-
rested at any given point, and retained there.
As every muscle augments in thickness during its contrac-
tion, it has been a subject of inquiry to physiologists whether
the whole mass of muscle was increased or diminished by its
contraction. Swammerdam, in order to ascertain it, put an
insulated solid muscle, not yet dead, into a tube filled with wa-
ter; by irritating the muscle, and causing it to contract, the
water descended; but this result was not uniform. When an
arm is plunged into a tube properly formed and filled with wa-
ter, if the muscles be caused to contract, the fluid descends;
but the objection to the inference from this experiment is, that
when all the muscles of the arm are caused to contract vio-
lently, the introduction of arterial blood is much arrested, if
not fully stopped; and the venous blood is at the same time ex-
pelled : so that the change in the size of the member may be
accounted for in that way. The experiments of Erman on eels,
fully immersed in a fluid, and submitted to Galvanic influence,
are said to substantiate the theory cf the muscles diminishing
in bulk by contracting.*
The activity of a muscle, though closely depending upon the
•afflux of blood to it, is not entirely so; for it is ascertained that
Galvanism will cause the muscles of frogs to contract, when
the circulation is arrested by death, or when the blood is co-
agulated, or even when it has been drawn off.t This pheno-
* Beclard; loe. cit.
t Prochasku dc Carne Muscular!. Vienne, 1778.
MUSCULAR MOTION. 357
menon, however, can only last a comparatively short time;
for a muscle soon dies, and runs into a state of mortification,
after its vascular and nervous communications have been cut
off. Physiologists have entertained very different opinions on
the causes of the muscles contracting, or on muscular irritabi-
lity, as it is called. Some have supposed it to be an attribute
of the muscle itself;* others, that it depended on the blood ves-
sels, which, by bringing a greater afflux of fluids into its inte-
rior, between its fasciculi and fibres, obliged the two latter to
take a more flexuous course; and others, on the nerves.f Any
decision on this point is inconclusive, because it is well known
that perfect muscular action requires a healthy state of the
muscle, and an uninterrupted nervous and sanguineous influence;
so that it seems to be a result from the combination of three
systems, more than an attribute of one alone.f
MM. Dumas and Prevost say, that in consequence of the final
nervous ramifications crossing the muscular fibres at right an-
gles to them, and parallel with one another, the Galvanic current
which passes through these ramifications, causes the latter to
approach each other reciprocally; whereby the muscular fibres
to which the ramifications are fixed, are thrown into wrinkles.
It is clear, from this theory, that the muscular fibres themselves
are destitute of the power of contraction, and that they are only
the frame-work upon which the Galvanic batteries of the ner-
vous system are displayed.
There are no muscles which have not the power of contract-
ing some time after apparent death, and this phenomenon fre-
quently continues for an hour;§ it is uncommon for it to cease
with the apparent extinction of life. This irritability is of dif-
ferent durations in the different muscles; it is first lost in the
left ventricle of the heart; then in the large intestines; after-
wards in the small, and in the stomach; and then in the blad-
der; then in the right ventricle, the iris, and in the voluntary
muscles, of which those of the trunk die first; those of the in-
* Haller, Physio!.
t Legallois sur le principe de la vie.
t Meckcl, Anat. Gen.; from Barzellotti, Esame di alcuni moderne teorie inter-
no alia causa prossima della contrazione moscolare, 1796.
§ The recent visitation of cholera in Europe and in this country has given many
persons an opportunity of examining this singular fact.
358 MUSCLES.
ferior extremities next, and those of the superior last. The last
act of life is in the auricles, of which the right pulsates longest.
Different circumstances may produce some variety of this pro-
gress, in the loss of muscular irritability, but it will be found ge-
nerally correct.* The experiments of Himlyf demonstrate,
that laurel water, or that of bitter almonds, applied to the sto-
mach or brain, renders the heart insensible to the strongest sti-
mulants, while the muscles of volition continue to move for
some hours afterwards. The duration of irritability is, however,
much varied, according to the nature of the death, and the state
of health preceding. Nysten asserts, that he has seen the right
auricle of a robust man pulsate nine hours after death. In death
from chronic diseases, with much emaciation, the heart ceases
to beat shortly after intellectual phenomena cease. And in
death from electricity; from a blow upon the stomach; from the
inhalation of carburetted hydrogen gas, and some other poison-
ous ones, muscular contraction ceases universally in a few mo-
ments, and cannot be excited by any artificial means.
The irritability of the muscles is so modified that certain sti-
mulants are peculiarly appropriate to one and not to another.
For example, light is the specific stimulant to the iris; a me-
chanical application, to it as in making artificial pupil, is borne
frequently without its contracting. The heart is very sensible
to mechanical stimulants, and additionally so when they are
applied to its internal surface.
Some of the muscles are regularly under the influence of the
will, others not at all so, which has given rise to their division
into voluntary and involuntary. These states, though kept per-
fectly distinct from each other in health, are sometimes blend-
ed in disease, the voluntary muscles becoming involuntary in
their actions, and the involuntary voluntary; which, however,
is much more uncommon than the other.
The voluntary muscles are generally such as serve for loco-
motion and speech, and receive their nerves directly from the
spinal marrow. The involuntary muscles are such as are con-
cerned in the functions of digestion, respiration, and circulation,
and which, in order to continue the life of the animal, must
* Meckel, Anat. Gen.
| Commentatio <Je Morte, Goettingue, 1794.
MUSCULAR MOTION. 359
never cease their actions for any long interval. It is worthy of
remark, that apoplexy and other cerebral affections, paralyze,
most commonly, the voluntary muscles alone, while the others
retain their usual state and sensibilities.
When irritability is entirely gone from a muscle, and it is
actually dead, the whole muscular system becomes stiff, begin-
ning with the trunk, then the inferior, and, lastly, the superior
extremities. This stiffness seems to be independent of the ner-
vous system, as the destruction of the spinal marrow, the cut-
ting of nerves, and hemiplegia do not arrest it. It is thought,
by M. Beclard, to be analogous to the contraction of the fibrine
of the blood; and, like the latter, does not cease till putrefac-
tion begins. The degree, as well as the time, of its access is
variable under different circumstances. In very aged persons;
in such as have died from protracted disease attended with
great emaciation ; in scorbutic and gangrenous diseases, the
stiffness comes on quickly, is very slight, and disappears in a
couple of hours. But in muscular subjects who have died from
sudden violence or from acute diseases, the stiffness is some-
times postponed for twelve hours or more, and may continue,
in the winter, from three or four days to a week, or even
longer, depending upon the access of putrefaction.
The sensibility of the muscles is moderate. When they have
been much exercised, they only give out the sensation of fa-
tigue. In amputations, the pain of cutting through them is not
equal to that of the skin. In inflammations they, as most other
parts, have their sensibility exalted to an exquisite degree.
CHAPTER III.
OF THE MECHANICAL SHAPE AND ARRANGEMENT OF THE
VOLUNTARY MUSCLES.
EVERY muscle consists in a belly and in two extremities, of
which the one that is the fixed point is the head or origin, and
the other is the tail or insertion. The belly or body is the
fleshy part, the extremities are generally tendinous, either com-
pletely or partially.
860 MUSCLES.
Some of the muscles arise by a single head, and are inserted
into one point. Some few arise by a plurality of heads, but
have a single insertion, as the biceps flexor of the arm, and of
the thigh; others, again, have a single head, but a plural inser*
tion, as the flexors of the fingers and of the toes; others, again,
have multiplicate heads and multiplicate insertions, as the mus-
cles of the back.
The most simple muscles are such as have their fibres run-
ning in the direction of the length of the muscles, of which
there are many examples, as the sartorius, the biceps flexor
cubiti, the semi-tendinosus, and others. Others, again, have
their fibres running obliquely from a tendon or a bony origin
on one side of the muscle, to a tendon on the other, as the se-
mi-membranosus, the peronei, &c.; these are called musculi
semi-pennati. Others have a long tendon in the centre, to
which the fibres converge obliquely, forming an angle with
each other; they are the penniform, (musculi pennati.) Others,
again, are formed of a congeries of smaller muscles, the fibras
of which run in different directions and are intermixed with
tendinous matter, as the deltoid and the subscapular. As the
strength of a muscle depends upon the number of its fibres,
those whose fibres go obliquely are stronger than if their fibres
had run longitudinally.
CHAPTER IV.
OF THE TENDONS, (TENDINES.)
THE tendinous extremities of muscles, present themselves
under two general shapes: one is funicular, or like cords, va-
rying in shape from cylindrical to paraboloid; the other is
spread out into a membrane, and resembles an aponeurosis.
They both adhere with great tenacity to the muscular fibres,
so as to have induced, erroneously, the opinion of absolute con-
tinuity: but maceration and boiling will separate them, and the
course of the fibres is different even to the naked eye; besides
the very obvious difference in colour, in consistence, and in
vital properties.
THE TENDONS. 361
The tendons are surrounded by a loose cellular membrane or
capsule, which permits them to glide freely upon each other :
in some places this membrane is wanting, and is supplied by a
synovial membrane answering the same purposes.
The tendons are readily recognised by their white and shining
appearance; they have no elasticity or power of elongation
and contraction, and, therefore, like other ligamentous matter,
they are lacerated sooner than they can be stretched. They
are composed of desmoid tissue, the fibres of which are united
by a compact cellular substance in small quantities. The
fibres are longitudinal, and may be readily separated either by
maceration or by a slight boiling. When a round tendon is
prepared in this way, it is easy to flatten it out into an aponeu-
rotic membrane : the fibres are then made very distinct, and
seem to adhere to each other by lateral fibrillae. In ordinary
health no red blood penetrates into the tendons, but if they be-
come inflamed, as their capillaries then enlarge, they admit the
red globules; at the same time their sensibility, from being en-
tirely organic, or what is only sufficient for the internal actions
of the organ, is so much augmented as to be very manifest.*
No nerves have been traced into them. The tendons have the
character, at large, of the desmoid tissue, but are more gela-
tinous, or completely soluble in boiling water, than the liga-
ments. They have a great affinity for the phosphate of lime ;
and, hence, we frequently find them hardened and having small
pieces of bone in them, where they run over bony trochleae.
* A knowledge of the disposition in tendons to augment their powers of circu-
lation on being inflamed, together with the late Dr. Physick's great success in
the treatment of unnatural joints by a seton passed through the cavity of the
fracture, induced me in a late tour of service at the alms-house to try the effect
of a similar plan upon a ruptured tendo-achillis; which, from the long period
since the accident happened, did not promise a cure on the ordinary principles
of treatment. A seton of silk riband was accordingly introduced, and kept in
its place for six weeks and a half. It produced considerable pain, tumefaction,
and inflammation, but was followed by a perfect reunion of the ruptured ends of
the tendon. — Chapman's Mod. and Phys. Journal, for July, 1826. For a highly
interesting series of experiments on animals, undertaken at my suggestion, to
illustrate the same thing, see An Essay for the Degree of Doctor of Medicine,
by R. L. Fearn, Id. April 9, 1827.
VOL. L— 31
BOOK III.
PART II.
Special Anatomy of Muscles*
CHAPTER I.
MUSCLES OF THE HEAD AND NECK.
SECT. I.— MUSCLES OF THE FACE.
Occipito-Frontatis.
THE occipito-frontalis, a single muscle, consists of two symme-
trical parts, coming from the back of the head, and inserted into
* I may here mention, once for all, in regard to the muscular system, that
though the very rigid mode of description adopted by anatomists may lead the
inexperienced student to infer that there are no departures from a common
standard, and that one invariable type for the muscles prevails in all human be-
ings; yet there will be found upon actual dissection occasional disagreements
with the best established descriptions, and which it is of some use to know.
Some of these departures are common enough, others very rare; and they con-
sist either in a deficiency or a redundancy of muscles. Wishing not to give false
ideas of their importance and frequency, and, indeed, fearful of doing so, they
are purposely introduced subordinately in notes: many of them have been ob-
served by me personally, others are recorded in different medical writings, and
for the remainder I am indebted to the learned treatises on anatomy of T. Soem-
mering and J. F. Meckel.
No part of the muscular system varies more in different subjects than the mus-
cles of the back; but, as it would be useless to enter fully on such trivial details,
they have been passed by, except in a few instances.
364 MUSCLES.
the front of it. It is superficial, being placed immediately below
the skin of the scalp, and has four bellies of muscular fibres, two
behind and two before, connected by a thin tendon, which covers
all the top of the head. The tendon adheres by a short cellular
tissue, having no adeps, to the pericranium below, and is at-
tached to the common integuments above. The common in-
teguments on the hairy scalp are formed by skin and by a
closely adhering, and, indeed, almost inseparable layer of
granulated adeps, 'intermixed with the capsules of the hairs.
This muscle arises from the superior semicircular ridges of
the os occipitis by tendinous and fleshy fibres, which form two
distinct bellies (musculus occipitalis) about an inch and a half
long, one on each side of the bone. Its tendon, when carefully
traced, will be found terminating a little in front of the coronal
suture, in the two anterior fleshy bellies (musculus frontalis)
which cover the whole front part of the os frontis. The internal
edges of these latter are in conjunction below.
It is inserted, on each side, fleshy, into the superior margin
of the orbicularis oculi and of the corrugator supercilii; and,. by
its nasal slip, into each internal angular process of the os frontis,
and into the root of the os nasi.
It pulls the skin of the head backwards and forwards, and
throws that of the forehead into horizontal wrinkles. It also
elevates the supercilia.*
Compressor JVaris.
The compressor naris arises by a pointed beginning from the
root of the ala nasi, and spreads like a fan over the lateral parts
of the nose below; it is inserted into its fellow of the opposite
side on the dorsum of. the nose, and into the lower part of the
os nasi, where it is connected with the nasal slip of the occipito-
frontalis.
This muscle consists of thin and pale fibres placed immediate-
ly under the skin. If it act from'both extremities, by its curved
fibres being made straight, it will compress the nostril; but if it
* Varieties. Its fleshy portion is said to have covered, in some instances, the
whole skull-cap.
MUSCLES OF THE NECK.
act from its dorsal margin, assisted by the nasal slip of the occi-
pito-frontalis, it will dilate the ala nasi, and has, therefore, been
called dilatans nasum by Columbus.
Orbicularis, or Sphincter Palpebrarum.
The orbicularis oculi or palpebrarum is a broad circular
muscle, lying immediately under the skin of the eyelids, and
over the tarsi cartilages. It is much connected with essential
points in the anatomy of the eyelid.
Its diameter exceeds that of the orbit, by from four to eight
lines all around. The fixed point of this muscle is principally
the ligamentum palpebrale internutn and the internal canthus
of the orbit ; for, in the greater part of its extent, besides, it is
only loosely attached to the parts below.
The orbicularis arises, by short tendinous fibres, from the up-
per end of the nasal process of the os maxillare superius, from
the internal angular process of the os frontis, and from the con-
tiguous part of the os unguis. It also arises along the whole
superior margin of the internal palpebral ligament.
The fibres from this origin compose the lamina of the upper
eyelid. They may be traced, thence, around to the lower eye-
lid, and are found again terminating at the internal canthus of
the orbit, where they are fixed into the anterior margin of the
orbitar process of the upper maxillary bone, into the corre-
sponding ridge of its nasal process, and into the inferior margin
of the palpebral ligament.
The temporal portion of this muscle is attached to the tem-
poral fascia, so as to prevent it from being much displaced. It
is, therefore, obvious that the effect of the contraction of the
upper and of the lower half of the muscle will be to bring the
eyelids together. The fulcrum of motion is the internal or na-
sal side, as manifested by the radiated wrinkling of the skin at
that point.
The interior portion of this muscle, which is laid upon the
tarsi cartilages, is called Ciliaris by Albinus: this distinction,
which is too arbitrary, is now abandoned.
31*
36(> MUSCLES.
The Corrugator Super citti.
This muscle is placed beneath the upper margin of the or-
bicularis, at its internal extremity; by which, and by the adja-
cent portion of the occipito-frontalis, it is concealed.
It arises from the internal angular process of the os frontis,
and going outwards and a little upwards, its fibres are lost in
the inferior margin of the occipito-frontalis and in the superior
of the orbicularis.
It draws the eyebrow and the skin of the forehead into ver-
tical wrinkles, and also draws them over the eye so as to over-
shadow it.
The Levator Labii Superioris et Alec Nasi,
Is fixed just at the side of the nose. It arises by a pointed
production from the nasal process of the superior maxillary
bone at the internal canthus of the eye, and by a broad origin
from the anterior margin of the orbitar process of the same
bone. Passing downwards, it is inserted into the side of the ala
nasi, and into the upper lip, being narrower below than above.
The part of this muscle which comes from the orbitar process
is so distinct, that Albinus and the continental anatomists give
it the exclusive name of Levator Labii Superioris.
It draws the upper lip and the ala nasi upwards.
Just beneath this muscle there is sometimes a fasciculus,
called the Anornalus Faciei of Albinus, which is attached by
one end to the upper jaw near the canine fossa, and by the
other to the upper lip.
The Levator JJnguli Ori&,
Is a small muscle, concealed very much by the last; it arises
from the anterior part of the superior maxillary bone, between
the foramen infra-oibitarium and the first small grinder, and is.
inserted into the corner of the mouth.
It raises the angle of the mouth.
MUSCLES OF THE FACE. 367
The Zygomaticus Minor,
Is a small muscle, arising from the fore part of the os make ;
it descends obliquely, and is inserted into the upper lip just
above the corner of the mouth.*
Zygomaticus Major,
Is just on the outside of the last, and is much larger. It
arises from the malar bone, externally, at its posterior inferior
part, just above the lower eqlge, where this bone contributes to
form the zygoma. It passes obliquely downwards to be in-
serted into the corner of the mouth, and runs into the depressor
anguli oris.
The last two muscles draw the corner of the mouth towards
the cheek bone, or obliquely upwards and outwards, as in
smiling.
The Depressor Labii Superioris et Alee JVasi,
Is concealed by the orbicularis oris, and the levator labii su-
perioris et alae nasi. To get a view of it, the upper lip must
be inverted, and the lining membrane of the mouth removed
on the side of the frsenurn of the lip. This muscle arises from
the inferior part of the upper maxilla in front of the alveolar
processes for the dens caninus and the incisores, and is inserted
into the side of the ala nasi, and into the contiguous part of the
upper lip.
It depresses the upper lip and the ala nasi..
The Depressor Anguli Oris,
Arises broad and fleshy from the base of the lower jaw or>
the side of the chin; being somewhat triangular, its apex is in-
serted into the corner of the mouth.
This muscle draws the corner of the mouth downwards. It
* Varieties. Frequently it is deficient; sometimes it is a fasciculus of the or-
bicularis oculi; sometimes it is double; sometimes it does not reach the corner
of the mouth..
368 MUSCLES.
lies immediately under the skin, and blends above with the zy-
gomaticus major and with the levator anguli oris.
The Depressor Labii Inferioris,
Is in part beneath the last muscle, and, like it, arises broad
and fleshy from the basis of the lower jaw on the side of the
chin; its fibres pass obliquely upwards and inwards, and are in-
serted into the whole side of the lower lip.
It draws the lip downwards.
These last two muscles are much obscured by being mixed
with a quantity of adipose matter ; the skin, also, is closely
blended with them, and the roots of the beard penetrate be-
tween the intervals of their fibres.*
The Levator Menti, or Labii Inferioris,
Being placed beneath the depressor labii inferioris, is demon-
strated by turning downwards the lower lip and dissecting away
its lining membrane on the side of the fraenum; it will then be
seen to arise in front of the alveolar processes of the external in-
cisor and the canine tooth, and, passing obliquely downwards,
to be inserted into the lower lip.
It elevates the lower lip.
The Buccinator,
Arises from the root of the coronoid process of the lower
maxilla ; from the back part of the upper maxilla near the pte-
rygoid process of the sphenoid bone, and from the roots of the
alveolar processes of both the upper and the lower maxillary
bone, as far forwards as the denies bicuspides. It is inserted
into the corner of the mouth, and into the contiguous parts of
the upper and lower lips.
It draws the corner of the mouth directly backwards.
* Varieties. Its exterior border is often formed by the Platysma Myodes.
MUSCLES OF THE FACE. 369
The Orbicular is 0m,
Is a circular musclejust beneath the skin, much blended with
adipose matter externally, but more plain on the surface conti-
guous to the lining membrane of the mouth. It constitutes a
considerable part of the thickness of the lips, and surrounds
the mouth entirely. It has no bony origin, but arises from the
fibres of the several muscles which join each other at the cor-
ner of the mouth, and therefore consists of two semicircular
planes, one for the upper and the other for the lower lip.
It is the antagonist to most of the other muscles of the mouth.
From its superior part a pyramidal slip goes to the tip of the
nose, being called, by Albinus, Nasalis Labii Superioris.
Masseter.
The masseter is placed between the skin and the ramus of
the lower jaw; it is of an oblong shape, and evidently consists
of two portions, an external and an internal, which may be
readily recognised by the course of their fibres as they decus-
sate.
As a whole, it arises, tendinous and fleshy, from the malar
process of the maxillare superius; from the inferior edge of the
malar bone, between the maxillary and the zygomatic sutures,
and from the zygomatic process of the temporal bone. Of its
two portions, the internal is the smaller, and is inserted tendi-
nous into the outer part of the root of the coronoid process of
the lower jaw; while the external extends from the malar bone
to the angle of the lower jaw, where it is inserted tendinous
and fleshy. A part of the internal portion may be seen at the
zygomatic suture, behind the external, without the latter being
raised up.
When both portions act together, they close the jaws: the
external, alone, also draw's the jaw forwards; and the internal,
alone, will also draw it backwards.
370 MUSCLES.
•> Temporally.
The temporal muscle is placed on the side of the head, and
occupies its middle inferior region. It is covered externally
by the Fascia Temporalis, a thick, dense, tendinous membrane;
which arises by the semicircular ridge on the side of the cra-
nium, and is inserted into the upper margin of the zygoma.
The temporal muscle arises from the inner face of this fas-
cia; from the whole length of the semicircular ridge on the
side of the os frontis and parietale; and from the surface of the
cranium between this ridge and the zygoma, including the part
contributed by the frontal bone, the parietal, the squamous por-
tion of the temporal, and the sphenoid. This muscle also re-
ceives an accession of fleshy fibres from the internal face of
the zygoma.
From this extensive origin the fibres converge towards the
zygoma, and passing beneath it, are inserted tendinous into the
coronoid process of the lower jaw, so as to surround it on eve-
ry side; some of these tendinous fibres go down in front almost
to the last dens molaris.
It pulls the lower jaw directly upwards*
Pterygoideus Externus*
The external pterygoid muscle, so called from its position,
arises fleshy from the outer side of the external pterygoid pro-
cess of the sphenoid bone, and from the adjoining surfaces of
the same bone by its spinous and temporal processes; also,
from the tuber of the upper maxillary.
It passes outwards and backwards horizontally, and is in-
serted into the inner side of the neck of the inferior maxilla,
and into the capsular ligament of the articulation.
When the muscles of the opposite sides act together, they
draw the lower jaw forwards, but if alternately, they give it a
grinding motion.*
* Varieties. I have seen, in one case, this muscle continued into the inferior
margin of the temporal.
MUSCLES OF THE NECK. 371
Pterygoideus Internus,.
The Internal Pterygoid muscle arises by tendinous and fleshy
fibres from the internal pterygoid process of the sphenoid bone,
along the outer margin of the Eustachian tube, and from the
greater part of the pterygoid fossa. Passing downwards and
backwards, it is inserted tendinous and fleshy into the internal
face of the angle of the lower jaw.
When the muscles of the opposite sides act, they close the
jaw.
SECT. H. MUSCLES OF THE NECK.
Of the Fascia Superficialis CoIlL
Between the skin of the neck and its superficial muscles,
may be observed a layer of compact cellular substance, the
consistence of which is more strongly marked in some subjects
than in others. It is the continuation of the same membrane
which is spread upon the external abdominal muscles, and is
called there the Fascia Superficialis Abdominis. Passing from
the abdomen over the thorax, it adheres to the clavicles and
sternum, but not very strongly; it then goes from them over the
neck to the face, being slightly fastened to the base of the lower
jaw in advance of the masseter muscle.
It is spread over the submaxillary and parotid glands, is in
many subjects strongly marked there by its fibrous character ;
and sends down partitions between their lobules, as well as be-
tween the muscles and their fasciculi; thereby forming sheaths
for the same. By these partitions it communicates with the
fascia profunda colli. Above, it is fixed to the mastoid process,
to the meatus auditorius externus, and to the zygoma. Just
above the latter it adheres to the fascia temporalis, and a thin
layer of fat intervenes between them. This fascia is more
strongly characterized about the parotid gland and lower jaw
than elsewhere. It is remarkably distinct in the fretus at full
time, the sheaths, which it forms for the muscles, being then
very clear of adipose matter, and semi-diaphanous.
372 MUSCLES.
The Platysma Myodes,
Or the Musculus Cutaneus, lies upon the fascia superficialis,
or rather is included between two laminae of it, one above and
the other below, forming its sheath, which is very thin, espe-
cially on the side next to the skin. This muscle covers, by its
breadth, a very considerable portion of the side of the neck;
and extends, obliquely, from the thorax to the face.
It arises from the condensed cellular membrane on the upper
part of the pectoralis major muscle, and of the deltoid, just be-
low the clavicle, nearly the whole length of this bone. Its
fibres are much more pale than those of other voluntary mus-
cles, are collected into longitudinal fasciculi, constituting a
plane of scarcely a line in thickness, and terminate in the inte-
guments of the lower jaw and cheek. It is slightly attached
to the lower jaw, and not unfrequently runs into the muscles of
the lower part of the face.
When the whole muscle is in action, it elevates the skin of
the neck. The external jugular vein is seen running nearly in
the centre of it, in the same direction with the fibres of this
muscle, and between it and the sterno-cleido mastoid.*
The Sterno-Cleido Mastoideus,
Is beneath, and decussates the last muscle. It forms always
a prominent feature in the outline of the neck, in passing
obliquely from the upper front part of the thorax to the base of
the cranium.
It arises tendinous and fleshy from the edge of the upper
part of the sternum, and fleshy from the sternal end of the cla-
vicle. These origins are separated by a considerable fissure;
but they soon unite. It is inserted tendinous into the mastoid
process, and into the part of the superior transverse ridge of
the cranium next to it.
It draws the chin towards the sternum. f
* Varieties. In some rare instances this muscle has been found thick and
round; and instead of going towards the face, inserted into the occiput.
t Varieties. Sometimes a fasciculus, at its posterior margin, is presented in
a state entirely insulated. Occasionally, its lower extremity has been observed
MUSCLES OF THE NECK. 373
Of the Fascia Profunda Cotti.
When the origin of the sterno-cleido mastoideus is turned to
one side, the Fascia Profunda of the neck is seen beneath the
fascia superficialis, and somewhat separated from it by a lami-
na of cellular adipose matter. This membrane arises from the
larynx, forms a thin capsule to the thyroid gland, and, being
closely attached to its inferior margin, descends by investing
the sterno-hyoid and thyroid muscles, being well seen on
their anterior surfaces. It is firmly fastened to the upper edge
of the sternum, to the sternal end of the clavicles, and to the
cartilages of the first ribs, forming an elastic and resisting
membrane from the larynx to the thorax. By turning off the
sterno-hyoid and thyroid muscles from their attachment to the
sternum, the fascia profunda will be seen still more distinctly,
passing behind them from the inferior margin of the thyroid
gland, to the upper bone of the sternum: this lamina of it is in-
serted into the sternum, twelve or fifteen lines below the upper
edge. It encloses or surrounds the transverse vein and the ar-
teria innominata. Beneath the fascia profunda, are the tra-
chea, the roots of the arteries of the head and upper extremi-
ties and the trunks of their veins. There is much loose
cellular and adipose matter placed at the lower part of the
neck, beneath this fascia ; and between it and the trachea;
through which the thyroid veins with their ramifications pass.
This last circumstance must always render suppurations and
operations in the part highly dangerous, as the pus will form
fistulas under the sternum; moreover, the continual motion of the
part in respiration, prevents adhesions from forming, and, there-
fore, disposes to ulceration. An ingenious idea on the uses of this
fascia and of the sterno-hyoid and thyroid muscles as connect-
ed with it, was suggested by the late Allen Burns: he con-
ceived that they were a defence to the upper part of the thorax,
and sustained, in inspiration, the atmospheric pressure, which,
without them, would fall upon the trachea and produce difficul-
to reach as far as the rcctus abcbminis muscle, and even to the point of the third
bone of the sternum. The fissure between the sternal and clavicular portions in
mammiferous animals, i.-?, naturally, so much extended, as to produce two dis-
tinct muscles.
VOL. I.— 32
374 MUSCLES.
ty of breathing, from the air not passing through the larynx
sufficiently rapidly to keep pace with the dilatation of the thorax.
He illustrates the opinion by a case very much in point, of a gen-
tleman who had lost this fascia and the muscles by suppuration,
and who was afterwards incommoded by atmospheric pressure
upon the trachea at this place.* Mr. Velpeau, on the contrary,
asserts that cutting through it in opening abscesses and in ope-
rations has no such consequence.t
The external borders of the fascia profunda are continued
into the sheaths of the great vessels of the neck. It and the
fascia superficialis are also continuous with one another along
the anterior edge of the sterno-cleido mastoideus.
Within the inferior maxilla, at its angle, a ligamentous ex-
pansion arises at the pterygoideus externus muscle, and is
spread out between the styloid process, and the ramus of the low-
er jaw. This membrane, described as the stylo-maxillary liga-
ment, is joined at its inferior edge by the fascia superficialis,
just before the upper part of the sterno-mastoideus, and which in-
creases its breadth downwards in the neck, giving it somewhat
the condition of a vertical septum of that region; at its lower edge
it runs into the theca of the great vessels of the neck. Through
its lower part penetrate the stylo-hyoideus and digastricus
muscles, and the upper part separates the parotid from the
sub-maxillary gland. It is felt like a cord extending downwards
and backwards below the angle of the maxillainferior. It
is connected at its internal edge with the compages of the
nerves and vessels of the part, in such a manner as to forbid
description, but the practical anatomist will find no difficulty
in discovering and understanding it.
Below this septum, the round ligament, like a nerve, passes
from the extremity of the styloid process to the appendix of
the os hvoides.
The fascia profunda colli is also well marked in the foetus,
and not much blended with adipose matter. It, like the fascia
superficialis, is only the sheath the for muscles which it sur-
* The late Dr. La\vrcnce informco! inc that the fascia profumla is well developed
in the neck of a cat, end that having occasion to remcvc it in an experiment, the
respiration of the animal w;;s conducted with great difficulty, amounting almost
tt suffocation. This is a jrood confirmation of Mr. Burns's hypothesis.
f Anat. Chir. Vol. i. p. 438, 2nd edit.
MUSCLES OF THE NECK. 375
rounds, and is called fascia from having some development of
fibrous matter in its substance.
The Sterno-Hyoideus,
Arises thin and fleshy on the interior of the thorax from the
approximated surfaces of the cartilage of the first rib, the cla-
vicle, and the first bone of the sternum; it passes upwards some-
what obliquely, and is inserted into the inferior edge of the base
of the os hyoides. Its lower end is covered by the sterno-mas-
toideus.
It draws the os hyoides towards the sternum.*
The Sterno- Thyroideus,
Is beneath the last, and concealed, in a considerable degree,
by it. It arises fleshy from the interior surface of the sternum,
about an inch below its upper margin, and from the cartilage of
the first rib; diminishing somewhat in breadth, as it ascends, it
Is inserted obliquely into the side of the thyroid cartilage.
It draws this cartilage towards the sternum.t
The Thyro-Hyoideus.
Arises obliquely from the side of the Thyroid Cartilage ex-
ternally, and is inserted into a part of the base, and into nearly
all the cornu of the os hyoides. It seems almost like a conti-
nuation of the Sterno-Thyroideus,
Its use is to approximate the os hyoides and the thyroid car-
tilage, in doing which it has the effect of planting the epiglottis
against the root of the tongue, and of drawing the cricoid and
* Varieties* Sometimes it arises frprn the middle of the clavicle; it is double,
or is confounded below with the next muscle.
t Varieties. Sometimes there are two of these muscles, one placed above the
other; sometimes it runs into the inferior constrictor of the pharynx; sometimes
it runs into the posterior margin of the thyro-hyoid muscle; sometimes the mus-
cle on one side is united to the other by transverse fibres. 1 have, in one in-
stance, Jan. 1, 1839, seen a slip at the external margin of this muscle which
arising from the cartilage of the first rib, ascended in front of "the great vessels'
and was inserted into their sheath on a level with the thyroid cartilage.
376 MUSCLES.
the arytenoid cartilages against it, so that the opening of the
glottis is protected.*
The Omo-Hyoideus,
Passes obliquely across the neck, from the superior edge of
the scapula to the os hyoides. It is a thin, narrow muscle, di-
vided into two bellies, one at each end, by an intermediate ten-
don; its inferior part is concealed by the trapezius muscle; its
middle, where the tendon exists, crosses the great vessels of the
neck, and is covered by the slerno-eleido-mastoid muscle; and
its upper extremity is overlapped by the platysma myodes.
It arises from the scapula just behind the notch in its supe-
rior costa, and curving somewhat downwards in its course, it is
inserted into the lower edge of the base of the os hyoides, next
to its cornu.
It draws the os hyoides downwards.f
The Digastricus,
Is placed at the upper side of the neck, and passes from the
back part of the base of the head to the chin.
It arises principally fleshy from the fossa of the temporal bone
at the base of the mastoid process; its middle is converted into
a round tendonj which passes through the stylo-hyoideus mus-
cle, and is fixed by a ligamentous loop to the cornu of the os
hyoides. After which another fleshy belly is formed, which is
inserted into the inside of the base of the maxilla inferior, at
the side of its symphysis. It receives an accession from the
base of the os hyoides.
Its use is to draw the os hyoides upwards when its extremi-
ties are fixed, and, as Mr. Hunter has pointed out, to throw the
head backwards, and thereby to open the mouth when the lower
jaw is fixed upon a body of the same height.J
* Varieties. Its fibres sometimes run into those of the middle constrictor of
the pharynx; sometimes they arise from the cricoid cartilage; sometimes it is
continuous with the sterno-thyroideus.
t Varieties. Sometimes it is double, so that besides the usual insertion, it has
one into the side of the tongue.
t A common variety in this muscle consists in the mutual adhesion of the
two anterior bellies belonging to the opposite sides, showing thereby a marked
tendency to the quadruped arrangement.
MUSCLES OF THE NECK. 377
The Stylo-Hyoideus,
Is the more superficial of the three styloid muscles. It arises
tendinous from the middle and inferior part of the styloid pro-
cess of the temporal bone; and being perforated, as mentioned,
by the tendon of the digastricus, is inserted tendinous into the
cartilaginous juncture of the base and cornu of the os hyoides.
It draws the os hyoides upwards and backwards.*
The Stylo- Glossus,
Is within and above the other; it arises from the upper in-
ternal part of the styloid process, tendinous and fleshy, and is
inserted into the side of the root of the tongue, forming a part
of its structure.!
It draws the tongue backwards.J
The Stylo- Pharyngeus,
Is more deeply situated than either of the other two muscles.
It arises from the inner side of the styloid process near its root,
and runs into the side of the pharynx between the middle and
upper constrictors, opposite the tonsil gland; it afterwards de-
scends between the lining membrane of the pharynx and the
middle and lower constrictors, and is inserted into the posterior
margin of the thyroid cartilage.
It draws the larynx and pharynx upwards.
The Mylo-Hyoideus,
Forms the floor of the mouth and suspends the tongue; it
arises at the root of the alveolar processes of the lower jaw,
from a ridge extending from the last dens molaris to the chin.
Its fibres converge towards a white tendinous line placed be-
.* Varieties. This muscle is frequently double.
t See Tongue.
t Varieties. J. F. Meckel says, that on one occasion he found it double on
both sides.
32*
378 MUSCLES.
tween it and its fellow, and reaching from the base of the os
hyoides to the chin. This muscle is concealed by the anterior
belly of the digastricus. When it contracts, it draws the os
hyoides upwards and projects the tongue.*
The Genio-Hyoideus,
Is concealed by the last; by turning over the anterior edge of
which, it is seen. It arises tendinous from the tubercle on the
posterior side of the symphysis of the lower jaw; and, in-
creasing somewhat in breadth, is inserted into the anterior part
of the base of the os hyoides.
It draws the os hyoides upwards and forwards.!
(For the muscles of the tongue, see Mouth.)
There are seven pairs of muscles, on the front and sides of
the cervical vertebrae, which lie closely upon them. They are
named from their situations and shapes.
1. Longus Colli.
The Longus Colli is next to the middle line of the vertebrae.
It arises from the sides of the bodies of the three superior ver-
tebrae of the back, and from the anterior edges of the trans-
verse processes of the five lower cervical vertebrae. Its fibres
pass somewhat obliquely upwards and inwards, to be inserted
into the front of the bodies of all the cervical vertebras.
It bends the neck forwards, and to one side.J
* Varieties. Sometimes a part of it is inserted into the middle tendon of the
digastricus, or is joined with the sterno-hyoidcus.
t Varieties. Sometimes a distinct fasciculus of this muscle is inserted into
the greater part of the cornu of the os hyoides. Sometimes the-re is but one
muscle. Rarely it is double on both sides.
t Varieties. Sometimes a fasciculus from the first or second rib, or from the
body of the sixth or seventh vertebra of the neck, joins it.
MUSCLES OF THE NECK. 379
2. Rectus Capitis Anticus Major,
Is placed on the outside of the last. It arises tendinous and
fleshy from the fronts of the transverse processes of the third,
fourth, fifth, and sixth cervical vertebrae; forms a considerable
fleshy belly, and is inserted into the cuneiform process of the
os occipitis, just before the condyle. It bends the head for-
wards.*
3. Rectus Capitis Anticus Minor.
This is a very small muscle. It arises fleshy from the front
of the first cervical vertebra near its transverse process, and is
inserted under the rectus major before the root of the condy-
loid process of the occipital bone.
It bends the head forwards.
4. Rectus Capitis Lateralis.
This is also small, and arises fleshy from the front of the
transverse process of the atlas. It is inserted, tendinous and
fleshy, at the outside of the condyle of the occiput, into the
ridge leading from it to the mastoid process.
It pulls the head a little to one side.t
5. Scalenus Prior, or Jlnticus.
•
The scalenus anticus arises by three distinct tendinous heads
from the transverse processes of the fourth, fifth, and sixth cer-
vical vertebras, and is inserted tendinous and fleshy into the
upper surface of the first rib, just anteriorly to its middle.
6. Scalenus Medius.
The scalenus medius arises by distinct tendons from the trans-
verse processes of all the cervical vertebra, and is inserted ten-
* Sometimes it also arises from the first and second vertebrae.
t Varieties. Sometimes another muscle arises from the body of the first ver-
tebra of the neck.
380 MUSCLES.
dinous and fleshy into the upper face of the first rib, in all the
space from its middle to its tubercle.
7. Scalenus Posticus.
The scalenus posticus arises from the transverse process
of the fifth and sixth cervical vertebrae, and is inserted into the
upper face of the second rib, just beyond its tubercle.
The last three muscles are concealed by the sterno-cleido
mastoideus and the anterior edge of the trapezius. The scale-
nus posticus is best seen in dissecting the muscles of the spine,
and resembles very much one of the class to which Albinus
gives the name of Levatores Costarum.
All the Scaleni elevate the ribs and bend the neck to one
side. They are particularly interesting as connected with the
course of the large blood vessels and nerves of the upper ex-
tremity.*
CHAPTER H.
MUSCLES OF THE TRUNK.
SECT. I. MUSCLES ON THE FRONT OF THE THORAX.
The PectoraHs Major,
Is superficial, and forms the large swelling cushion of flesh
under the skin of the breast. It arises tendinous from the ante-
rior face of the first two bones of the sternum, their whole length,
fleshy from the cartilages of the fifth and sixth ribs, and by a
fleshy slip from the upper part of the tendon of the external ob-
* Varieties. Besides the three scaleni which are described, there are frequent-
ly supernumerary muscles or fasciculi. One of these, called the Scalenus Mini-
mus Albini, is between the first two, and occasionally appears as a fasciculus of
the scalenus anticus, separated from it by one or more of the brachial nerves; it
is sometimes double. Another fasciculus, called the Scalenus Lateralis, is be-
twecn the scalenus medius and posticus; it comes from the posterior part of the
rirst rib, and is inserted into the transverse process of the fourth, fifth, and sixth
vertebrae.
MUSCLES OF THE THORAX. 381
lique muscle. It arises, also, fleshy from the anterior two-
thirds of the clavicle. The clavicular and sternal portions of
the origin are separated by an interval, giving the appearance
of two muscles.
The fibres converge, and terminate by a broad, thin tendon,
which is inserted into a roughness on the exterior edge of the
bicipital fossa of the os humeri, and into the fascia brachialis,
just at the internal edge of the deltoid muscle. At this inser-
tion it adheres to the tendon of the latissimus dorsi. The un-
der edge of the muscle, near its insertion, is folded inwards and
upwards, which gives the rounded thick margin to the fore
part of the axilla. That part of the broad tendon belonging to
the clavicular portion is inserted lower down than the sternal,
which produces a decussation of the fibres of the tendon.
The pectoralis major draws the arm inwards and forwards;
and also depresses it when it is raised.*
The Pectoralis Minor,
Is brought into view by raising the last muscle. It is com-
paratively small, and somewhat triangular. Arising by thin
tendinous digitations from the upper edges of the third, fourth,
and fifth ribs, it soon becomes fleshy, and is inserted, by a short
flat tendon, into the inner facet of the coracoid process of the
scapula. Its use is to draw the scapula inwards and down-
wards.f
* Varieties. Sometimes a single fasciculus arises from the eighth rib, which
ascends towards the os humeri, has a tendon in its centre, and finally joins with
the tendon of the pectoralis minor; — sometimes this muscle attaches a small fas-
ciculus to the brachialis internus; — sometimes there is a small square plane of
muscular fibres on its front surface, decussating the fibres at right angles ; —
sometimes a fasciculus almost cylindrical proceeds from it towards the axilla,
and, being changed into a long tendon, is inserted into the internal tuberosity of
the os humeri. Supernumerary fasciculi are also found going from one rib to
another, or towards the sternum; sometimes its tendon detaches a fasciculus,
which, crossing the insertion of the muscle, covers the bicipital groove of the oa
humeri like a bridge, is blended with the tendon of the supra-spinatus, and in-
creases the thickness of the capsular ligament of the shoulder joint. In a mus-
cular male subject, black, it was entirely deficient, except the external clavicular
half. The pectoralis minor was wholly wanting in the same. Deer. 1837.
t Varieties. Sometimes it sends a fleshy fasciculus to the tendinous origin
of the coraco-brachialis. Sometimes, below it, there is a third pectoral muscle,
382 MUSCLES.
The Subclavius,
Is a small muscle, placed immediately under the clavicle. It
arises from the cartilage of the first rib, and is inserted into the
inferior face of the clavicle, from near the sternum, to the co-
noid ligament, which connects the coracoid process and the
clavicle together. It draws the clavicle downwards.*
The Serratus Magnus, or Serratus Major Anticus,
Is a broad muscle, lying on the sides of the ribs, between them
and the scapula, and beginning at a line anterior to their middle.
It arises from the nine upper ribs by fleshy digitations, the su-
perior one of which seems almost like a distinct muscle: the
five lower are connected to the obliquus externus abdominis,
the digitations of the two muscles inter-locking with each other.
The fibres converge, and are inserted into the base of trie scapula
its whole length. Its action is to draw the scapula forwards. t
The Inter costales,
Fill up the spaces between the ribs. There are two in each
space, of which the external arises from the transverse process
of the vertebra, and from the inferior acute edge of the rib,
from its head almost to its cartilage, and is inserted into the su-
perior rounded edge of the rib below for the same distance, its
fibres passing obliquely forwards and downwards. The inter-
nal intercostal arises from the inferior edge of the rib, beginning
at the sternum, and extends backwards to the angle of the rib;
it is inserted into the superior rounded edge of the rib, below,
which arises from the first and second ribs, and is inserted into the coracoid pro-
cess; whereby a striding analogy with birds is established. Another variety has
also been observed in the existence of a fasciculus, which comes from the upper
rib, and which, covered by the little pectoral muscle, is inserted into the capsular
ligament of the scapulo-humeral articulation.
* Varieties. Sometimes two muscles exist; a bursa mucosa is formed between
its tendon and the cartilage of the first rib.
t Varieties. Sometimes, it has ten or eleven origins ; the upper origin is defi-
cient; the latter is so distinct that it may pass for a particular muscle; a wide
gap exists in the middle of the muscle, dividing it into two distinct parts.
MUSCLES OF THE THORAX. 383
on its inner side, its fibres passing obliquely backwards and
downwards. They draw the ribs together.
The Triangular is Sterni.
Is on the posterior or cardiac face of the cartilages of the ribs,
and arises from the whole length of the cartilago ensiformis at
its edge, and from the inferior half of the edge of the second
bone of the sternum. The fibres go obliquely upwards and
outwards, to be inserted into the cartilages of the third, fourth,
fifth, and sixth ribs by fleshy and tendmous digitations. Its
use is to depress the ribs, and, consequently, to diminish the
cavity of the thorax.
This muscle is frequently defective or redundant in the num-
ber of its heads, and is commonly more or less continuous with
the transversalis abdominis; but occasionally it is so much so,
that the two seem to make but one muscle, and have, therefore,
been called Sterno-abdominalis, by Rosenmuller.
SECT. II. MUSCLES AND FASCIJE OF THE ABDOMEN.
Between the most superficial of the abdominal muscles, which
is the external oblique, and the skin, is found the Fascia Super-
ficialis Abdominis. In lean subjects it is very distinct, but in
fat ones not so much so, from being blended with adipose mat-
ter. The laminae of it which are next to the muscles, are kept,
in the latter case, rather more free from fat than the more su-
perficial. It consists of condensed cellular substance, with very
little fibrous matter in it, and may be considered as taking its
origin on the front of the thigh,* and extending in front of the
abdominal muscles, as high up as the thorax: indeed, if we are
disposed to trace it to its whole extent, there is no difficulty in
following it over the front of the thorax; thence to the neck, as
* This statement of origin is to be viewed merely as an anatomical license for
descriptive purposes; the most natural line of origin is the whole length of the
linea alba, and this same line might be considered as going along the front of
the sternum for the pectoral fascia, and along the middle of the neck for its fascia
iiiperficialis and profunda.
384 MUSCLES.
the fascia superficial colli; and even to the face. In ordinary
cases its desmoid or aponeurotic character is very equivocal, but
where the parts about the groin have been pressed upon and
thickened by the irritation of hernial protrusion, it is better
marked. On the thigh it is blended with fat; and encloses be-
tween its laminae the lymphatic glands of the groin, and the ex-
ternal pudic vessels given off from the femoral artery, immedi-
ately below Poupart's ligament. On the tendon of the external
oblique it is more condensed; branches of the femoral artery
are also seen in it there. One longer and larger than the others,
the arteria ad cutem abdominis of Haller, winds over Poupart's
ligament, and runs upwards somewhat in the line of the epigas-
tric artery, to be distributed to the skin of the abdomen : the di-
vision of it will produce sufficient hemorrhage to require atten-
tion. On the symphysis pubis and about the external ring the
laminae of the fascia superficialis are multiplied, and it has
more of the character of common adipose matter, as in most
cases the adeps there is abundant. From the pubes it may be
traced as a condensed cellular membrane blended with the
ligamentum suspensorium along the penis to its extremity; and,
according to Mr. Colles, of Dublin, when matter is formed be-
neath it, it is apt to create fistulous sores on this organ. A
thin process of this membrane may be traced along the sper-
matic chord, and identified with the tunica vaginalis communis.
This fascia is more loosely connected to the parts beneath it,
along the anterior margin of Poupart's ligament, than elsewhere,
which disposes femoral hernia to observe that course in its in-
crease.
The fascia Superficialis, under the name of Tunica Abdo-
minalis, is well developed in animals with a large and project-
ing belly, particularly in the large rumiriantia and the solipedia.
It has a yellowish tinge in them, is very elastic and strong, and
well calculated to support their viscera.*
There are five pairs of muscles called abdominal; to wit, the
External Oblique; the Internal Oblique; the Transverse; the
Straight; and the Pyramidal. The first three are flat and
broad, and lie in layers one upon the other; the other two are
long.
* Breschet, Thesis sur L'Hcrnie. Paris, 1819.
MUSCLES OF THE ABDOMEN. 385
1. The Obliquus Externus,
Arises from the eight inferior ribs by muscular and tendinous
digitations attached near their anterior extremities. The first
head is covered by a slip from the pectoralis major, the five
upper heads are interlocked with the origins of the serratus
major anticus, and the three inferior with those of the latissi-
mus dorsi. The fibres pass obliquely downwards, and termi-
nate in a broad thin tendon. This tendon extends over the
whole front of the abdomen, from the lower end of the second
bone of the sternum to the symphysis of the pubes.
This muscle is inserted into the whole length- of the linea
jilba; into the anterior half or two-thirds of the crista of the ilium,
by muscular fibres posteriorly, and tendinous anteriorly; and,
from the anterior superior spinous process, the tendon extends
to the body and to the symphysis of the pubes, forming thereby
the ligament of Poupart, or the Crural Arch.
In the middle line of the body, the tendons of the three broad
muscles, on both sides of the abdomen, unite to form the Linea
Alba, which extends from the sternum to the pubes. From
two to three inches in the adult, on either side of the linea alba,
but more distant from it above than below, is another line, formed
by the same tendons, which is the Linea Semilunaris. The
navel, which originally was a hole for the passage of the
umbilical vessels, and, in the adult, is commonly depressed into
a pit, appears in the linea alba as a protuberance composed of
a condensed cellular membrane. Just at the navel there is a
line crossing the linea alba, and extending from one linea se-
milunaris to the other; at the lower end of the Cartilago-Ensi-
formis, there is another; and half-way between this and the
navel, a third : about half-way between the navel and the pubes
is a fourth, but it is generally imperfect. These are the Linear
Transversoe, and they are formed foy tendinous matter in the
substance of the recti muscles, connecting them to their tendi-
nous sheath in front.
The most interesting insertion of the tendon of the external
oblique, is the portion constituting Poupart's ligament, or the
Crural Arch. The latter as it gets to the pubes from the ilium,
splits so as to leave a hole for the passage of the Spermatic
VOL. I.— 33
386 MUSCLES.
Chord in the male, and of the Round Ligament of the Uterus in
the female. This opening is named the External Abdominal
Ring. The tendon forming its upper boundary is inserted into
the symphysis pubis, and into the pubes of the opposite side, by
fibres which are interwoven with and decussate those of its fel-
low. The tendon forming the lower margin of the ring is in-
serted into the spine of the pubes, and into its crislafor an inch.
The portion inserted into the crista of the pubes is Gimbernat' s
ligament, which it will be readily understood, means only a
part of the Crural Arch.
The Ring in the External Oblique is rather triangular than
round; its base is formed by the body of the pubes, and its point
is at the place where the tendon splits. The latter is kept from
parting still farther by a fasciculus of tendinous fibres, which
runs across it The sides of this opening are called its Columns,
and from their situation, internal and external, or upper and
lower Columns. In the female it is oval and scarcely half an
inch long.
There are several small round holes in the tendon of this
muscle, which afford passage to nerves and to veins. When,
by the clearness of the dissection, the tendon has its characte-
ristic gloss and polish, they are very distinct.
Use. This muscle compresses the viscera of the abdomen
and brings the pelvis and thorax towards each other.*
The Obliquus Interims,
Lies beneath the last, and its fibres pass in a contrary direc-
tion to the fibres of the other. It arises tendinous, by the fascia
lumborum, from the three inferior spinous processes of the loins
and from all those of the sacrum; tendinous and fleshy, from the
whole length of the crista of the ilium ; and fleshy, from the
upper half of Poupart's ligament. Though the fibres of this
* Varieties. Sometimes a considerable part of its middle and anterior portion
is deficient, a vitiated conformation, to which it is subjected along with the other
abdominal muscles. The inferior part of its tendon is incompletely developed
by the absence of, tbe superficial fibres which retain together the more deeply
seated, by which it is weakened and caused to gape by one or more large oblong
fissures: this variety gives occasion to a form of inguinal hernia, differing mate-
rially from what is common.
MUSCLES OF THE ABDOMEN. 387
muscle, in general, decussate the fibres of the external oblique,
all of them do not; for the lower are brought gradually to pur-
sue the same direction towards the symphysis of the pubes.
Near the Linea Semilunaris, the muscular fibres cease, and
the tendon begins.
It is inserted, by condensed fibrous cellular membrane, into
the cartilages of the seventh, eighth, and ninth ribs; and by
flesh into the tenth, eleventh, and twelfth. It is inserted also,
membranous, into the side of the ensiform cartilage, its whole
length; and into the linea alba, from the sternum to the pubes.
The tendon of this muscle divides into two laminae, which
enclose the rectus muscle, and thereby form a sheath for it,
imperfect, however, at the lower posterior part near the pubes.
Its use is the same as that of the External Oblique.*
3. The Transversalis Abdominis,
Arises from the transverse processes of the last dorsal, of the
four upper lumbar vertebra, and from the back part of the
crista of the ilium by the Fascia Lumborum. It also arises,
fleshy, from the anterior two-thirds of the spine of the ilium,
and from the exterior half of Poupart's ligament; and tendinous
and fleshy alternately, from the inferior margin of the thorax,
formed by the cartilages of the six or seven inferior ribs, at
their inner surfaces, where they are concerned in the origin of
the diaphragm.
The fleshy part of this muscle occupies about one-third of
its extent. It is inserted into the side of the ensiform cartilage;
filling up the vacancy between it and the cartilages of the sixth
and seventh ribs; and into the linea alba, from the extremity of
the sternum to the pubes. The Transversalis and the Internal
Oblique also form below a common tendon, which is inserted
for an inch into the crista of the pubes, behind the insertion of
Gimbernat's Ligament; — into the spine of the pubes; — and into
that part of the body of the pubes which forms the lower pos-
terior boundary of the external abdominal ring. Just above
this insertion the common tendon alluded to splits into two la-
* Varieties. It is sometimes defective at its lower part, and on other occa-
sions redundant.
388 MUSCLES.
minae, terminating in the linea alba; one of which goes before
and the other behind the pyramidalis muscle, so that a sheath
is thus formed for it.
Use; to compress the contents of the abdomen.*
4. The Rectus Mdominis,
Is seen beneath the tendons of the other muscles on either
side of the linea alba. Its origin is by a flat tendon of an inch
or more in breadth from the symphysis pubis and the upper
posterior part of the body of the pubes. The muscle increases
gradually in its ascent to the breadth of three or four inches.
The tendinous intersections, confining it to the tendinous sheath
in front, are fixed at the places mentioned as linese trans versa?;
hut, for the most part, they do not extend through the muscle.
When the origins of the Recti are examined from behind, it
will be seen that the internal edge of one tendon, just above the
symphysis pubis, overlaps the corresponding part of the other;
also, that a small pyramidal ligament finishes more completely
the structure just above the symphysis pubis; this ligament is
called by M. G. Breschet, the Superior Pubic.
The Rectus is inserted fleshy into the base of the cartilago-
ensiformis, and into the cartilages of the fifth, sixth, and se-
venth ribs.
It draws the thorax towards the abdomen.t
5. The Pyramidalis,
Is at the lower front part of the rectus, and is about three
inches long. It arises somewhat thick, tendinous, and fleshy,
from the upper part of the pubes, from near its spine to the sym-
physis, between the rectus behind and the insertion of the ex-
* Varieties. Sometimes transverse tendinous fibres creep across its belly, and
on other occasions a small transverse muscle is present, which decussates the
larger, and is inserted into the twelfth rib.
f Varieties. If there are eight sternal ribs, then this muscle has an additional
costal insertion. It sometimes sends a fasciculus to the fourth rib; and I have
seen it ascending over the pectoralis major, to the root of the neck, as occurs in
mamraiferous animals.
MUSCLES OF THE ABDOMEN. 389
ternal oblique before. Being fixed in the sheath formed by the
separation of the tendon of the transversalis muscle it tapers to
a point above, and is inserted into the linea alba and internal
edge of the rectus, for about the upper two-thirds of its own
length.
It strengthens the lower part of the abdomen.*
At the linea semilunaris the tendon of the internal oblique
and of the transversalis unite intimately; and just beyond this
junction the two laminae are formed, which enclose the rectus
muscle. The anterior lamina is one half of the tendon of the
internal oblique, which, after passing half an inch or an inch, is
joined to the tendon of the external oblique, goes in front of the
rectus muscle, and covers it from origin to insertion. The
posterior lamina, made by the posterior half of the tendon of
the internal oblique, is united already at the linea semilunaris to
the tendon of the transversalis: in this manner they pass behind
the rectus muscle from the cartilago-ensiformis to a line half-
way between the umbilicus and the pubes. From this line,
downwards, all the tendons go in front of the rectus muscle.
The obliquus externus tendon may be dissected from the
common tendon of the others, without much difficulty, almost
to the linea alba. The term insertion, expresses, very imper-
fectly, the manner in which the tendons of these broad muscles
all terminate in the linea alba from the thorax to the pelvis.
It should rather be said, that they coalesce there by a general
intertexture of their fibres.
The Cremasler,
Is commonly attributed exclusively to the internal oblique,
as it is said to be a detachment of fibres from it; but it is also
formed by fibres from the lower edge of the transversalis mus-
cle. The history of its formation is as follows: in the descent
of the testicle, the latter has to pass beneath that edge of the
transversalis and of the internal oblique which is extended from
the outer portion of Poupart's ligament, to the spine and crista
* Varieties. It is frequently defective, but sometimes two, three, or even four,
are seen on a side. When defective, the rectus or obliquus internus is better
developed than usual.
33*
390 MUSCLES.
of the pubes. As the testicle descends, it comes in contact
with a fasciculus of these fibres, and takes it along. This con-
stitutes the Cremaster muscle, which, in adult life, and in a
strong muscular subject, is seen descending on the outside of
the spermatic chord, and spreading over the anterior part of
the tunica vaginalis in arches with their convexities down-
wards, then rising on the inner side of the chord, to be inserted
into the spine of the pubes.*
It draws up the testicle.
Fascia Transversalis Abdominis.
The Fascia Transversalis is placed immediately behind the
transversus muscle, between it and the peritoneum. An open-
ing in it, which permits the spermatic chord to pass, is called
the Internal Abdominal Ring, in order to distinguish it from the
opening in the tendon of the external oblique, called the Exter-
nal Ring. The internal ring is rather nearer to the symphysis
pubis than to the spine of the ilium. The space between the
internal ring and the external ring, is about eighteen lines in
the adult, and is very properly called the Abdominal Canal,
from giving passage to the spermatic chord. The anterior side
of the canal is formed by the tendon of the external oblique;-
the inferior part, in the erect posture, is formed by Gimbernat's
ligament; the posterior side is formed by the fascia trans versa-
lis; and above, this canal is overhung by the internal oblique
and the transversalis muscles. The spermatic chord, after pe-
* Anat. De L'Homme, par Jul. Cloquet. This account, though easily verified
in some subjects, and especially in such as are muscular, does not appear to be
applicable to all, or, in other words, the arrangement in them is not quite so ob-
vious. It does not agree with Mr. John Hunter's observations on the descent of
the testicle; for he always found, while the latter was still in the loins, the cre-
master running towards it. Moreover, in the buffalo of America, a testicle of
which Dr. R. Harlan, of this city, was obliging enough to furnish me with for
dissection, I found that the cremaster, though remarkably robust and strong,
forms none of those nooses or arches with their convexities downwards, but ter-
minates at the testicle in a tendinous and somewhat abrupt manner. Taking all
these points into consideration, it may be, that a part of the cremaster is formed
after the manner indicated by Mr. Hunter, and another part after that mentioned
by M.. Cloquet; or, indeed, cases may occur, presenting exclusively one or the
other.
MUSCLES OF THE ABDOMEN. 39 1
netrating the fascia transversalis, does not cross, directly at
right angles, the inferior edge of the internal oblique and trans-
versalis, but it slips under them very obliquely ; its inclination
being towards the pubes, so that it can be considered as disen-
gaged from the inferior edge of these muscles, only about the
middle of the abdominal canal.
The opening in the Fascia Transversalis, or the Internal
Ring, is not abrupt and well defined; but the fascia, where it
transmits the spermatic chord,, is reflected by a thin process,
and terminates insensibly in its cellular substance. At the pos-
terior or ventral face of the External Ring, the fascia transver-
salis is not in contact with the cord; but that part of the ten-
don of the internal oblique and transversalis^which is inserted
into the crista of the pubes, and forms a sheath for the pyrami-
dalis muscle, is placed between them, and secures this opening.
The peritoneum covers the posterior face of the fascia trans-
versalis, and is thrown into a duplicature or falciform process,
passing from near the middle of the crural arch towards the
umbilicus. This duplicature depends upon the round ligament
of the bladder, which was once the umbilical artery of the foe-
tus. It is broader near the pelvis than it is above, has its loose
edge turned towards the cavity of the abdomen, and ascends
near the pubic margin of the Internal Ring. The effect of its
existence is to divide the posterior face of the inguinal region
into two shallow fossae; one next to the ilium, and the other
next to the pubes. The one next to the ilium contains the be-
ginning of the internal abdominal ring, which is frequently
marked by a little pouch of peritoneum, going along the sper-
matic chord for a few lines. The fossa on the inner or pubic
side of the falciform process is just behind the external ring,
but separated from it by the fascia transversalis, along with the
tendon of the lower part of the internal oblique and of the
transversalis muscle, where it is inserted into the pubes, and
forms the sheath of the pyramidalis. The two fossae indicate
the points where inguinal hernias commence ; the proper ingui-
nal protrusion begins in the external fossa, and the ventro-in-
guinal sometimes in the internal fossa.
The view of the fascia transversalis from behind is extremely
satisfactory. For a proper knowledge of this membrane, the
profession is indebted to the labours of Sir Astley Cooper ; and
392 MUSCLES.
much of the zeal with which the anatomy of hernia has been
investigated, in latter years, is attributable to him. The fascia
transversalis is a thin tendinous membrane, most generally; oc-
casionally it is merely condensed cellular membrane. It arises
from the internal or abdominal edge of Pouparfs ligament, and
from the crista of the pubes just behind the insertion of the
common tendon of the internal oblique and transversalis mus-
cles, and is extended upwards on the posterior face of the trans-
versalis muscle to the thorax. At its origin it is attached to the
inferior edge of the transversalis and internal oblique, particu-
larly the part between the internal ring and the symphysis
pubis. It is also attached to the exterior margin of the rectus
abdominis where it is deprived behind of its sheath. The in-
ternal abdominal ring, or opening in this fascia, marks it out
in some measure into two portions, of which that on the iliac
side of the ring is not so thick as the other, or the one on the
pubic side; and both portions are much more tendinous near
the crural arch than they are higher up.
Were it not for the important influence of the fascia superfi-
cialis abdominis and the fascia transversalis upon hernia, and
the consequent necessity of a minute knowledge of them, their
description might be much curtailed in considering them in their
proper light, to wit; as sheaths of the abdominal muscles; for
it is now sufficiently apparent that the first is contiguous to the
external oblique, and the second to the transverse muscle.
Upon the same principle, fasciae might be made of all the la-
minae of cellular substance intermediate to the abdominal mus-
cles, but it would be useless,*
* A very elaborate and exact account of the construction of the parts concerned
in hernia has lately been presented by Alexander Thomson, M. D., under the
title of Oiivrage complet sur L'Anatomie du Bas Ventre. Paris, 1838. The cha-
racter of this work is not so much inventive as distinguished by great minute-
ness of research, and a different distribution of the matter from what is common*
together with a most copious supply of new terms in place of old ones. Highly
creditable as it is to his industry, we can scarcely do less than protest against
the latter irregularity, and express our apprehensions that this objection, together
with the unusual approaches which he has opened to the structure as a substi-
tute for the settled ones, will restrict very much the reception of his work, and
render it less acceptable to both teacher and student. The splitting and inven-
tion of fasciae was considered for some time as almost exclusively an Anglican
malady; it appears, also, to have propagated itself to Paris in an exasperated
form in this production of Mr. Thomson and in that of Mr. Velpeau, (Anatomie
MUSCLES OF THE PARIETES OF THE ABDOMEN. "393
i
On removing the peritoneum from the iliacus internus mus-
cle, the spermatic vessels are seen to descend from the loins
to the internal ring, where they are joined by the vas deferens
coming from the pelvis. As they engage under the edge of
the internal oblique muscle, after penetrating the ring, the cre-
master muscle is detached to spread itself over them. The
spermatic chord, thus constructed, passes through the abdominal
canal in the manner mentioned, obliquely downwards and in-
wards; and, emerging from the external ring, it descends ver-
tically, lying rather upon the outer column of the ring than
upon its base.
On the posterior face of the fascia transversalis, between it
and the peritoneum, is the Epigastric Artery. The epigastric
arises from the external iliac as the latter is about to go under
the crural arch; it ascends inwardly along the internal margin
of the internal abdominal ring to the exterior margin of the
rectus abdominis muscle, which it reaches after a course of
two and a half or three inches. The spermatic chord, in get-
ting from the abdomen to the abdominal canal, therefore,
winds, in part, around the epigastric artery; in the first of its
course being at the iliac edge of the artery, and then in front
of it. Two epigastric veins attend the artery, one on each
of its sides, and end by a common trunk in the external iliac
vein.
The anatomical arrangement of the parts concerned in in-
guinal hernia in the female is the same as in the male, except
Chirurgicale, 3d Edition, 1838,) both, unquestionably, works of much merit.
The practical anatomist may, however, ask, if all of the laminae described as such
be fasciee, what has become of the cellular substance which formerly entered so
largely into the composition of the human body ? Will he not rather find verbal
novelties than new existences? A sound anatomical verdict is yet to be given on
these points: our own opinion is, that anatomy is too staid a science for mere
caprices in description and names, and that such innovations cannot possibly be-
come oecumenical. The introduction of a new name in the place of an old one
is the highest act of medical authority, and is so seldom sanctioned by general
suffrage, that an individual inclining to it may well pause, lest, in so doing, he
may seal up his own publications, by the use of terms too little known to be con-
venient or desirable.
394 MUSCLES.
that the round ligament of the uterus supplies the place of the
spermatic chord, and there is no cremaster muscle.*
SECT. III. — MUSCLES OF THE UPPER AND POSTERIOR PARIETES OF THE
ABDOMEN.
These muscles are constituted by a single symmetrical one,
and by four pairs : they can only be seen advantageously by
removing the abdominal viscera.
1. The Diaphragm, (Diaphragma,)
Is a complete, though moveable septum, placed between the
thoracic and abdominal cavities; it is extremely concave be-
low and convex above, the concavity being occupied by seve-
ral of the abdominal viscera. It is in contact above with the
pericardium and lungs, and below with the liver, spleen, and
stomach.
It is connected with the inferior margin of the thorax on all
sides, and has for its centre a silvery tendon, resembling in its
outline the heart of a playing card. This cordiform tendon
occupies a considerable part of the extent of the diaphragm,
has its apex next to the sternum, and its notch towards the
spine ; and the muscular part of the diaphragm is inserted all
around into its circumference. The cordiform tendon is nearly
horizontal in the erect posture, its elevation being on a line
with the lowest end of the second bone of the sternum. On
each side of this tendon some of the muscular fibres rise so high
upwards before they join it, that they are on a horizontal level
with the anterior end of the fourth rib. The fasciculi of mus-
cular fibres are, for the most part, convergent from the cir-
cumference of the thorax, and are easily separated from one
another.
In the diaphragm are three remarkable foramina. The first
(the Foramen CEsophageum) is in the back of the muscle, be-
* For an account of both Inguinal and Femoral Hernia, the reader is referred
to Lessons in Practical Anatomy, 2d Edition. Philadelphia, 1836.
MUSCLES OF THE PARIETES OF THE ABDOMEN. 395
tvveen the spine and the notch of the cordiform tendon, a little
to the left of the middle line. It gives passage to the oesophagus
and the par vagum nerves along with it, and is rather a fissure
or a long elliptical foramen made by the separation and reunion
of the muscular fibres; for, above and below, at each end of the
ellipsis, these fibres decussate- one another in columns. To the
right of this foramen, and a little above its horizontal level, in
the back part of the cordiform tendon, is a very large and pa-
tulous foramen for the ascending vena cava, (Foramen Quad-
ratum.) Its form is between an irregular quadrilateral figure
and a circle ; its edges are composed of fasciculi of tendon
rounded off, and are not susceptible of displacement, or of al-
teration in their relative position to each other; by which means
is obviated any impediment which might arise from a different
arrangement, to the course of the blood in the ascending cava.
Almost in a vertical line below, and about three inches from
the foramen for the oesophagus, is the third hole, in the dia-
phragm, which affords passage to the aorta, (Hiatus Aorticus.)
It is just in front of the bodies of the three upper lumbar verte-
brae, and is a much longer elliptical hole than the ossophageal;
its lowest extremity or pole is constituted by the tendinous
crura of the diaphragm, and its upper by a decussation of mus-
cular fasciculi arising from them. Through it,besides the aorta,
pass the Thoracic Duct, and the Great Splanchnic Nerve of
both sides.
In the horizontal position of either the dead or the living
body, the right side of the diaphragm ascends higher in the
thorax than the left ; but the weight of the liver makes it, in
the vertical posture, descend lower than the other.
Thus circumstanced, the detailed origin of the Diaphragm is
as follows : It arises fleshy from the internal face of the upper
edge of the Xiphoid Cartilage, from the internal face of the car-
tilages of the seventh true, and of the succeeding false ribs,
on each side; that is, from the cartilages of the eighth and ninth,
from the osseous extremities of the tenth and eleventh, and from
both the osseous and cartilaginous termination of the twelfth
rib. As the line described includes almost the whole of a
circle, and the fibres all converge to the cordiform tendon,
they, of course, will pass in different radiated directions, and
be of different lengths, which it is unnecessary to specify. Be-
396 MUSCLES.
tween the sternal and costal portion on each side, there is a
triangular fissure filled with fatty cellular tissue, which some-
times leaves an opening for hernia. I have seen a case of the
kind, in which the transverse part of the colon was the subject
of protrusion into the thorax. It is probable that the great dis-
placement of the abdominal viscera into the thorax, which some-
times occurs, may have a congenital origin in this very fissure,
and is subsequently, when the parts are accommodated to their
unnatural situation, thought to be a lusus naturae. The portion
described is called the Greater Muscle of the Diaphragm.
Besides these origins, the diaphragm has several from the
vertebrae of the loins, constituting its crura; there being four
on each side of the foramen for the aorta. The first pair, en-
tirely tendinous, comes from the front of the body of the third
vertebra of the loins, and is prevented from being very distinct
in its origin, in consequence of running into the ligament in front
of the bodies of all the vertebrae or the Anterior Vertebral Li-
gament as it is called. The second pair of heads is on the out-
side of the first, and arises, tendinous, from the intervertebral li-
gament, between the second and third vertebrae. The third pair
of heads arises tendinous from the upper part of the lateral face
of the second lumbar vertebra. And the fourth pair of heads
comes also tendinous, from the fore part of the root of the
transverse process of the second lumbar vertebra. These ten-
dinous heads terminate in what is called the Lesser Muscle of
the Diaphragm, which is inserted into the notch of the cordi-
form tendon. It will now be understood that the aorta passes
between the two sides of the lesser muscle, and that the oeso-
phagus has a hole in the upper part of its belly.*
The origin of the diaphragm is completed between its great-
er and lesser muscle, by a tense ligament, the Ligamentum Ar-
cuatum, which passes from the root of the transverse process
of the first lumbar vertebra to the inferior part of the middle
* This origin of the lesser muscle of the diaphragm is given by Albinus, but
it is difficult to make out fairly; for the most part it would be much more correct
to say that it arises tendinous, from the first, second, and third vertebrae in front,
and the corresponding intervertebral matter. The heads are generally much
smaller on one side, the left, than the other. From which cause a large fascicu-
lus of muscle passes from the right to the left side in ascending, and separates
the hole for the aorta, from that for the oesophagus.
MUSCLES OF THE PARIETES OF THE ABDOMEN. 397
of the twelfth rib ; with the upper edge of this ligament the
diaphragm is connected; and with the lower, the psoas mag-
nus muscle, and the quadratus lumborum. At the margin of
the other ribs, the diaphragm is connected with the transver-
salis abdominis.
Use. In consequence of the muscular fibres of the diaphragm
passing in a curved direction from the circumference of the
thorax to the cordiform tendon; and of those fibres forming a
body concave below and convex above, their contraction at
the same moment enlarges the cavity of the thorax, and has a
tendency to diminish that of the abdomen, which latter is pre-
vented by the yielding of the abdominal muscles. In easy res-
piration, its contractions and relaxations produce alternately
the actions of inspiration and of expiration. Its descent, also,
assists in the expulsion of faecal and other matters from the
abdomen. By the experiments of Bourdon,* it appears that it
only acts a secondary part in the latter, — that its functions are
limited to inspiration and the associated actions; but that in
regard to its power of assisting in the expulsion of the contents
of the abdomen, all that it does is first of all to fill the lungs
with air, and then the closure of the glottis prevents the air from
being expelled from the lungs. Common observation in partu-
rition shows us, that the expulsive effort of the abdominal mus-
cles does not take place when inspiration is going on, for the
former would prevent the latter; but the moment that expira-
tion begins, it is arrested by the firm closure of the glottis, and
then the abdominal muscles contract advantageously.
The Quadratus Lumborum,
Is an oblong muscle, arising from the crista of the ilium, at
the side of the lumbar vertebras, by a tendinous and fleshy ori-
gin of three inches in length. It is inserted into the transverse
process of each of the lumbar vertebrae and of the last of the
back by a short tendinous slip: it is also inserted into the low-
er edge of the last rib near its head, beneath the ligamentum
arcuatum.
It bends the loins to one side, and draws down the last rib.
* Recherches sur la Respiration et la Circulation. Paris, 1820.
VOL. I.— 34
398 MUSCLES.
It is? covered behind by the tendinous origin of the transver-
salis abdominis, which separates it from the sacro-Iumbalis and
from the longissimus dorsi. It may also be seen very well
from behind, in the dissection of the back.*
The Psoas Parvus,
Arises, fleshy, from the contiguous edge of the body of the
Jast dorsal and of the first lumbar vertebra at their sides, and
from the intervertebral ligament. It is at the anterior and in-
ternal edge of the psoas magnus; has a short belly, and a long
tendon by which it is inserted into the linea innominata, about
half-way between the spine of the pubes and the junction of
this bone with the ilium. The tendon, besides, is expanded into
the fascia iliaca.
Its use seems to be, to draw upwards the sheath of the fe-
moral vessels, which is derived from the fascia iliaca, and, con-
sequently, to draw upwards the vessels themselves; which pro-
bably diminishes the liability to injury from their too great or
sudden flexion. This muscle is sometimes wanting.
The Psoas Magnus.
Arises, fleshy, from the side of the body of the last dorsal
and of the four upper lumbar vertebrae, and from the transverse
processes of all the lumbar vertebrae. It forms an oblong fleshy
cushion on the side of the lumbar vertebrae, and constituting the
lateral boundary of the inlet to the pelvis, it passes out of the
pelvis, under Poupart's ligament, about its middle.
It is inserted tendinous, into the trochanter minor of the os
femoris, and fleshy for an inch below it.
It bends the body forwards, or draws the thigh upwards.f
* Varieties. Sometimes a broad tendon from it is inserted into the inferior
margin of the body of the eleventh vertebra of the back. Sometimes a fascicu-
lus of it touches the margin of the eleventh rib, near its head, and above the in-
tercostal vessels.
•j- Varieties. Sometimes it is joined by muscular fasciculi from the first, se-
cond, and even the third bone of the sacrum. Sometimes, where it borders on
the pelvis, there is a small fasciculus, which continues distinct almost to the tro-
chanter minor, and then sends its own tendon into the common tendon of the
iliacus interims and psoas magnus.
MUSCLES OF THE PARIETES OF THE ABDOMEN. 399
The Iliacus Intern us,
Occupies the concavity of the ilium, being on the outside of
the psoas magnus. It arises, fleshy, from the transverse pro-
cess of the last lumbar vertebra; from the internal margin of the
crista of the ilium; from the whole concavity of the latter; from
its anterior edge at and above the anterior inferior spinous pro-
cess; and from that part of the capsule of the hip joint near the
latter process.
This muscle terminates in the tendon of the psoas magnus,
just above its insertion into the trochanter minor.
This and the psoas magnus, from having a common tendon,
might with propriety be considered as only one muscle. Their
action is the same,*
Of the Fascia Iliaca.
The Fascia Iliaca is a tendinous membrane, which lies on the
iliacus internus and psoas magnus muscles, and' is continued
into the tendon of the Psoas Parvus. Externally, it is connect-
ed to the margin of the crista of the ilium; at the internal edge
of the psoas magnus, it is connected with the brim of the pel-
vis, and sinks into the cavity of the pelvis, being continuous
with the Aponeurosis Pelvica; and below, it is inserted into the
edge of the crural arch, from the anterior superior spinous pro-
cess of the ilium almost to the pubes, and is there continuous
with the fascia transversalis abdorninis. The external iliac ves-
sels are upon this fascia, between it and tho peritoneum; and
below them the fascia iliaca goes over that part of the pubes
which gives origin to the pectineus muscle, and is continuous
with the pectineal fascia, or that which covers the pectinqus
muscle. By introducing the finger or a knife handle into a
cut through the fascia iliaca, its attachment to the crural arch,
and its continuity with the fascia pectinea will be rendered very
obvious.
* Varieties. Sometimes an additional fasciculus arises below the inferior an-
terior spinous process, and descends along the external margin of this muscle.
This fasciculus varies somewhat in its size at different points, and is inserted into
the linea aspera below the trochanter minor. In very rare cases, the iliacus in-
ternus is kept totally distinct from the psoas magnus, from origin to insertion.
400 MUSCLES.
The iliac vessels pass beneath the crural arch on the inner
margin of the psoas magnus muscle, the vein being nearest the
pubes and the artery at the outer side of the vein. The fascia
iliaca being inserted into the crural arch as far as the vein, may
indeed be traced to. the crista of the pubes; it is so connected
with the vessels that no opening for hernia exists between them,
or indeed in all the space from the internal margin of the" vein
to the spine of the ilium. But at the inner side of the vein,
between it and Gimbernat's ligament, an opening appears,
called the Crural or Femoral Ring, and is the place where fe-
moral hernia commences, This opening is generally occupied
by a lymphatic gland, and a lamina of condensed but loosely
attached cellular substance, continuous with the Aponeurosis
Pelvica.
SECT. IV. MUSCLES ON THE POSTERIOR FACE OF THE TRUNK.
The Trapezius or Cucullaris,
Is a beautiful broad muscle, immediately under the skin, co-
vering the back parts of the neck and thorax, and extending
from the bottom of the latter to the top of the former. Its an-
terior edge, above, is parallel with the posterior edge of the
sterno-cleido-mastoideus. Its posterior edge is joined with
that of its fellow, and below, it overlaps in part the latissimus
dorsi.
It arises from the occipital protuberance, and from eight or
ten lines, sometimes more of the superior semicircular ridge of
the occiput, by a tendinous membrane. It arises also from the
five superior spinous processes of the neck through the inter-
vention of the ligamentum nucha?, and tendinous directly from
the two lower spinous processes of the neck, and from all of
the back.
It is inserted fleshy into the external third of the clavicle,
tendinous and fleshy into the inner edge of the acromion pro-
cess, and into all the spine of the scapula. Its fibres having a
very extended origin, must of course converge in getting to.
MUSCLES OF THE BACK. 401
these insertions; the upper fibres descend, the lower ascend,
and the middle are horizontal.*
It draws the scapula towards the spine.
In the cervical portion of these muscles, formed by the ori-
gins of both united, is an elliptical expanse of tendon, lying over
the ligamentum nuchse, and extended on each side. The liga-
mentum nuchse itself, as mentioned elsewhere, is a vertical
septum of ligamentous matter, extending from the central line.
of the occipital bone, to the spinous processes of all the verte-
bras of the neck. At its upper part, where the spinous pro-
cesses of the neck are short, this septum is very broad, and di-
vides completely the muscles of the two sides of the neck.
The Latissimus Dorsi,
Is situated under the skin at the lower part of the back, so
as to cover the whole posterior portion of the latter. It arises
by a thin tendinous membrane, from the seven inferior spinous
processes of the back ; and by a thick tendinous membrane from
all those of the loins and sacrum. Its origin also extends along
the outer inferior margin of the sacrum, and from the posterior
third of the spine of the ilium.t Besides which, the latissimus
dorsi has from the sides of the three or four inferior false ribs,
as many fleshy heads which are connected with the inferior
heads of the obliquus externus abdominis.
From this extended origin the fibres converge, so as to form
the posterior fold of the axilla; and to terminate in a flat, thick
tendon, of two inches in breadth, which is inserted into the
posterior ridge of the bicipital groove of the os humeri. The
upper part of tins muscle passes over the inferior angle of the
scapula, and derives a fasciculus of fibres from it. It is there
behind the teres major, but as it advances it winds around the
inferior edge of the latter so as to get before it. Afterwards
* Varieties. It is sometimes short of the origin described, by from one to
four, of the lower spinous processes of the back. Also the lower fasciculus is
sometimes disjoined from the rest of the muscle, by a large triangular space.
j- This origin frequently is tendinous at the back part of the ilium, and fleshy
in front.
34*
MUSCLES.
the tendons of the two adhere closely, but have a bursa between*
them at their termination. That portion of the tendon of the
latissimus which is continuous with the lower edge of its fleshy
belly, by a half spiral turn in the latter, becomes uppermost ;
while the upper portion is by the same arrangement made
lowest. At the place of its insertion, it is commonly connected
to the pectoralis* major. The inferior margin of its tendon de-
taches a slip to the brachial fas<?ia, and the superior margin
another to the smaller tuberosity of the os humeri.
It draws the os humeri downwards and backwards.*
The thick tendinous membrane coming from the spinous pro-
cesses of the loins and back is the fascia lumborum, and is com-
mon to the latissimus the internal and external oblique muscles
of the abdomen, and several other muscles to be mentioned.
The Serratus Inferior Posticus.
The origin of this muscle is inseparably united to that of the
latissimus dorsi by the fascia lumborum, and comes from the
two inferior spinous processes of the back., and.the three superior
of the loins.
It is inserted by fleshy digitalions into the under edge of the
four inferior ribs.
It draws the ribs downwards, and is an antagonist to the dia-
phragm in some respects, but more particularly to the serralus
superior posticus.
The removal of the trapezius brings into view several mus-
• :les; the most superficial of which are the rhomboid, which,
being two together, look very much like one.
* Varieties. Sometimes. from its anterior extremity a fleshy or tendinous slip
is detached in front of the coraco-brachialis, and is inserted into the posterior
face of the tendon of the pectoralis major. The brachial vessels and nerves are
liable to compression from this arrangement, which is said to be natural to'birds
and moles. Another variety is where a slip runs from this muscle, adheres to
the coraco-brachialis, and is inserted tendinous into the coracoid process .of the,
scapula.
MUSCLES OF THE BACK. 403
v
The Rhomboideus Minor,
Is above the other. It is a narrow muscle which arises by
a thin tendon from the three inferior spinous processes of the
neck, and, passing obliquely downwards, is inserted into the
base of the scapula opposite the beginning of its spine.
The Rhomboideus Major,
Arises, also, by a thin tendon from the last spinous process of
the neck, and from the four superior of the back, and is insert-
ed into all the base of the scapula below its spine.
These muscles draw the scapula upwards and backwards.
The Serratus Superior Posticus,
Arises by a thin tendon from the three inferior spinous pro-
cesses of the neck, and the two superior of the back, and is in-
serted into the second, third, fourth, and fifth ribs, by tendi-
nous and fleshy slips, a little beyond their angles.
This muscle draws the ribs upwards.
Between the two serrati is an aponeurotic expansion de-
scribed by Rosenmuller,. which connects thenl with each other,
and has induced some anatomists to consider them as but one
muscle. It is thin and diaphanous, but has the fibrous structure
very apparent, and running in a transverse direction from the
spinous processes to the angles of the ribs. The superior mar-
gin of the latissimus dorsi also runs into this fascia, so as to
render its own bounds somewhat undefined. This fascia, along
with the ribs and vertebrae, forms that canal in which are con-
tained the deep-seated muscles of the back.
The Levator Scapulce,
Is placed between the posterior edge of the sterno-cleido-
mastoideus and the anterior of the trapezius ; its lower end is
just above the rhomboideus minor. It arises by rounded tea-
404 MUSCLES.
dons from the three, four, or five, superior transverse processes
of the neck, between the scaleni muscles and the splenius colli.
It is inserted, fleshy, into that part of the base of the scapula
above the origin of its spine. As its name expresses, it draws
the scapula upwards. A good view of this muscle may be ob-
tained in the front dissection of the neck.*
The Splenius,
Has its inferior extremity beneath the serratus superior pos-
ticus, but the principal part of it is covered by the trapezius.
It arises from the spinous processes of the five inferior cervical,
and of the four superior dorsal vertebrae.
It is inserted into the back of the mastoid process and into a
small part of the adjacent portion of the os occipitis, also into
the transverse processes of the two superior cervical vertebras.
It is customary to consider)- the part which goes to the head as
Splenius Capitis, and the part below as Splenius Colli: the lat-
ter, in that case, is said to arise from the third and fourth dor-
sal vertebrae. It draws the head and neck backwards.
Between the spinous processes of the vertebras and the angles
of the ribs, on either side, the deep fossa is filled up entirely by
muscles. Some of them are large and powerful, and the most
striking are the Sacro-Lumbalis and the Longissimus Dorsi.
The Sacro-Lumbalis and Longisnimus Dorsi,
Have a common origin from the back of the pelvis and of the
lumbar vertebrae, and extend to the top of the thorax. They
arise, tendinous posteriorly, and fleshy, anteriorly, from the pos-
terior surface of the sacrum by its external margin and spinous
processes: they arise, also, tendinous, from the spinous processes,
and fleshy, from the ends of the transverse processes of all the
* Varieties. Sometimes it arises from only two superior transverse processes;
occasionally its fasciculi are separated from the neck to the scapula; or, a long one
is detached towards the spine, thereby presenting a disposition similar to what
is met with in the dolphin.
f Albinus, loc. cit.
MUSCLES OF THE BACK. 405
vertebrae of the loins; and principally tendinous from the pos-
terior part of the spine of the ilium. The external margin of the
belly is fleshy, and all the part nearest to the spine is wholly
tendinous below; but, higher up in the loins, it is so only on the
surface. The tendon is very strong, and divided into fasciculi,
chiefly near the spinous processes of the lumbar vertebrae.
From the under surface of this common belly, two heads, ten-
dinous and fleshy, are inserted into the inferior edge of the
transverse process of each lumbar vertebra, the smaller near its
root, and the larger near its extremity. On a level with the
lower rib, and, indeed, somewhat below it, a fissure occurs in
the muscle which divides it into two parts.
The Longissirnus Dorsi is nearest the spine; it is inserted, by
small double tendons, proceeding from its internal surface, into
the ends of the transverse processes of all the vertebrae of the
back, except the first. It also, from its outer edge, sends long
slender tendons, by which it is inserted into the under edges of
all the ribs beyond their tubercles, except the two inferior.
The Sacro-Lumbalis is inserted from its outer edge into all
the ribs at their angles, by long and thin tendons, which are
successively longer, the higher they are inserted.
By turning over this muscle towards the ribs, from the other,
one may see coming from the eight lower ribs, as many slips,
which run into the under surface of the sacro-lumbalis ; they
are the Musculi Accessorii ad Sacro-Lumbalem.
These two muscles keep the spine erect, and draw down the
ribs.*
Tile Spinalis Dorsi>
Between the ends of the spinous processes and the edge of
the longissimus dorsi, is a muscle almost entirely tendinous, and
scarcely to be distinguished from the latter, both in consequence
* Varieties. The origin is uniform, but the insertions vary in their number.
Sometimes, a fasciculus commences by a tendinous beginning from the fourth
rib, and is inserted into the transverse process of the sixth vertebra of the neck;
a fasciculus from the sacro-lumbalis joins the fascia extended between the two
serrati, or reaches to the spleniuscolli: the two muscles are sometimes joined
closely by an intermediate fasciculus.
406 MUSCLES.
of its close connexion with it, and of its insignificant size. At
its lower part, it is absolutely a portion of the longissimus, and
can be separated from it only by a forced division. It is a mere
string lying along the sides of the spinous processes, and is called,
from its origin and insertion, the Spinalis Dorsi.
It arises tendinous from the spinous processes of the two supe-
rior lumbar, and of the three inferior dorsal vertebrae, and is in-
serted, tendinous, into tho spinous processes of the nine superior
dorsal vertebrae, except the first.
It tends to keep the spine erect.
The Cervicalis Descendens,
Is a small muscle placed at the upper portion of the thorax,
between the insertions of the sacro-lumbalis, and of the longis-
simus dorsi into the upper ribs; it looks, at first, very much
like a continuation or appendix of the first, running to the cer-
vical vertebra?.
This muscle arises from the upper edges of the four superior
ribs by long tendons: it forms a small belly, which is inserted
by three distinct tendons into the transverse processes of the
fourth, fifth, and sixth vertebrae of the neck, between the leva-
tor scapulae and splenius colli.
It draws the neck backwards.
The Transversalis Cervicis,
Is on the inner side of the last, and in contact with it, being
about the same size, and having very much the same course
and appearance. It is considered as an appendage to the lon-
gissimus dorsi.
It arises from the transverse processes of the five superior
dorsal vertebrae by distinct tendons, and forms a narrow fleshy
belly, which is inserted by distinct tendons, also, in the trans-
verse processes of the five middle cervical vertebrae.
It draws the head backwards.
MUSCLES OF THE BACK. 407
The Trachelo-Mastoideus,
Is at the inner side of the last muscle, in contact with it.
It arises by distinct tendinous heads, from the transverse
processes of the three superior vertebrae of the back, and of the
five inferior of the neck ; and is inserted, by a thin tendon, into
the posterior edge of the mastoid process.
The dorsal origins are frequently deficient or irregular.
It draws the head backwards.
The Complexus,
A fine large muscle, is situated at the inner face of the tra-
chelo-mastoideus, and is readily recognised by showing itself
between the bellies of the two splenii capitis, just below the
occiput. A quantity of tendinous matter exists in its middle,
which gives it the complicated appearance from whence its
name is derived.
It arises, by tendinous heads, from the seven superior dorsal,
and the four inferior cervical vertebrae, by their transverse pro-
cesses; also, by a fleshy slip from the spinous process of the
first dorsal. It is inserted into the inferior part of the os occi-
pitis, by the surface between the upper and lower semicircular
ridges, on the outside of the vertical ridge which exists in the
middle of the bone.
It draws the head backwards.
The Semi- spinatis Cervicis,
Is a muscle which passes obliquely from transverse to spi-
nous processes, and is situated between the complexus and the
multifidus spinae; the course of its fibres renders it difficult to
be distinguished from the latter.
It arises from the transverse processes of the six upper ver-
tebrae of the back, by tendons which adhere to those of the ad-
jacent muscles; and passes up to the neck, to be inserted into
the sides of the spinous processes of the five middle cervical
vertebrae.
It extends the neck obliquely backwards.
408 MUSCLES.
The Semi-spinalis Dorsi,
Is lower down on the spine, and with difficulty distinguished
from the multifidus: like the last, it passes from transverse to
spinous processes. It lies under the longissimus dorsi, between
it and the multifidus.
This muscle arises by tendons connected with those of the
other muscles, from the transverse processes of the seventh,
eighth, ninth, and tenth dorsal vertebra?; and passes upwards
obliquely, to be inserted, tendinous, into the sides of the spinous
processes of the two lower cervical, and of the five upper dor-
sal vertebras.
It draws the spine obliquely backwards.
The Multifidus Spines,
Lies under the muscles as yet mentioned, close to the bones
of the spine; in order to see it well, they, therefore, should all
be cut away.
It has its commencement, tendinous and fleshy, on the back
of the sacrum, being connected to its spinous processes and
posterior surface, also to the back part of the spine of the ilium.
It there forms a belly, of sufficient magnitude to fill up much
of the cavity between the spinous processes of the sacrum and
the posterior part of the ilium. It arises also from the roots of
the oblique and transverse processes of all the vertebra? of the
loins, of the back, and of the four inferior of the neck.
The multifidus is inserted, tendinous and fleshy, into the roots
and sides of the spinous processes of all the vertebrcc of the
loins, of the back, and of the five inferior of the neck.
This muscle consists of a great number of small bellies,
which are parallel to each other, and each of which arises
from a transverse or oblique process, and goes to the spinous
process either of the first or second vertebra above it.
It twists the spine backwards, and keeps it erect.
Between the head and the first and second vertebra), and be-
tween the two latter, there are on either side four small mus-
MUSCLES OF THE BACK. 409
cles, intended for the motion of these parts upon each other.
They are brought into view by the removal of the complexus.
The Rectus Capitis Posticus Major,
Arises, tendinous and fleshy, from the extremity of the spi-
nous process of the dentata, and is inserted into the inferior
transverse or semicircular ridge of the os occipitis, and into a
part of the continuous surface of bone below it.
Its shape is pyramidal, the apex being below. It turns the
head, and also draws it backwards.
The Rectus Capitis Posticus Minor,
Is at the internal edge of the first. It arises, tendinous, from
the tubercle on the back part of the first vertebra, and is in-
serted into the internal end of the inferior transverse or semi-
circular ridge of the os occipitis, and into a part of the surface
between it and the foramen magnum.
It is also pyramidal, with the apex downwards. It draws
the head backwards.
The Obliquus Capitis Superior,
Arises from the transverse process of the first cervical ver-
tebra, and is inserted into the outer end of the inferior semicir-
cular ridge of the os occipitis, behind the posterior part of the
mastoid process, and beneath the splenius muscle.
It draws the head backwards.
The Obliquus Capitis Inferior,
Arises from the side of the spinous process of the dentata,
and is inserted into the back part of the transverse process of
the first vertebra of the neck.
It rotates the first vertebra on the second.
VOL. L— 35
410 MUSCLES.
The Inter-spinales,
Are small short muscles, placed between the spinous pro-
cesses of contiguous vertebrae. In the neck they are double,
in consequence of its spinous processes being bifurcated; in the
back they are almost entirely tendinous ; in the loins they are
single and well marked.
They draw the spinous processes together, and keep the
spine erect.
The Inler-transversarii,
Are also short muscles, placed in a similar manner, between
the transverse processes of the vertebra?. In the neck they
are double, in the back they are small, tendinous, and not well
marked ; and in the loins they are single and well seen.
They draw the transverse processes together, and will, of
course, bend the spine to one side.
The Levatores Costarum,
Are small muscles concealed by the sacro-lumbalis and lon-
gissimus dorsi, and pass from the transverse process of the last
cervical and of the eleven superior dorsal vertebrae, to the up-
per edges of the next ribs. They are twelve on either side of
the spine, are tendinous in their origins and insertions, with in-
termediate muscular bellies.
The upper ones are small and thin. They increase in mag-
nitude as they descend. From the inferior edge of nearly all
these muscles a fleshy slip is detached, which passes over the
rib next below its origin, to the second rib below, and occa-
sionally to the third. These slips are called Levatores Costa-
rum Longiores. The others, which descend from the trans-
verse process to the rib next below, are called Levatores Cos-
tarum Breviores.
These muscles are parallel in their obliquity, with the ex-
ternal intercostals, and are not very obviously separated from
them. They perform the same service, that of elevating the
ribs.
FASCIA. 411
CHAPTER III.
OF THE FASCIA AND MUSCLES OF THE UPPER EXTREMITIES.
SECT. I. FASCIA.
THE muscles of each upper extremity are invested by an apo
neurotic membrane called the Fascia Brachialis, which extends
from the shoulder to the hand. It begins at the base and spine
of the scapula, the margin of the acromion process, the acromial
extremity of the clavicle, and from the cellular membrane in
the arm-pit, and extends itself over all the muscles of the dor-
sum of the scapula, and over the deltoid muscle. The tendons
of the latissimus dorsi and pectoralis major, each send off from
their margins an expansion which is lost in it. Below the spine
of the scapula it is strong and well marked, but on the deltoid
muscle, as well as on the muscles of the arm, its desmoid cha-
racter is by no means so well developed, though it still retains the
appearance of a distinct membrane, and can be raised up as such
from the muscles. On the fore arm its ligamentous appearance
is well preserved, and extends from the elbow to the wrist in-
clusively. Its longitudinal fibres there are well secured by
transverse ones.
Above the condyles of the os humeri, the Fascia Brachialis
sends down to the bone a strong tendinous partition to each
ridge, and which runs the length of the latter from its upper
end to the condyle. These processes separate the muscles on
the back of the arm from such as are on the front of it, and are
sometimes called the Ligamentum inter-musculare internum and
externum. They afford origin to many muscular fibres. At the
bend of the elbow, the fascia brachialis is joined by a fasciculus
of tendinous matter from the ulriar margin of the tendon of the
biceps flexor cubiti, and which, in the contraction of the mus-
cle, will keep the fascia tense.
At the lower extremity of the fore arm, the transverse fibres,
after diminishing sensibly, become more numerous, and by their
412 FASCIA.
attachments to the several ridges on- the back of the radius and
of the ulna, form the Ligamentum Carpi Dorsale. This liga-
ment is extended from the styloid or outer margin of the radius,
transversely to the styloid or inner margin of the ulna, to the
pisiform bone, and to the fifth metacarpal. It consists, in some
measure, of two portions: of which the superior is the smaller
and thinner, has its fibres descending from the radius to the ulna,
and is crossed, in part, by the fibres of the inferior or greater
portion. As this ligament adheres, with great strength, to the
ridges on the back of the bones of the fore arm, six trochleae for
the tendons of the extensor muscles are thus formed. The first,
or that next to the styloid process of the radius, contains the
tendons of the first two extensors of the thumb. The second is
'larger, and transmits the tendons of the two radial extensors of
the carpus. The third is small and oblique, for the tendon of
the third extensor of the thumb. The fourth is the largest, and
is for the tendons of the extensor communis of the fingers. The
fifth is between the radius and the head of the ulna, and is for
that tendon of the extensor communis which goes to the little
finger. The sixth is on the back of the ulna, and is for the ten-
don of the extensor carpi ulnaris.
The inferior margin of this dorsal ligament of the wrist does
not terminate abruptly, but resuming its fascia-like character,
is continued over the back of the wrist, and over that of the
hand to the fingers. In this progress it furnishes an envelope
to the extensor tendons, and is very much blended with the ob-
lique fasciculi, by which they communicate with each other.
The Fascia Brachialis affords origin, in part, to the muscles
on the dorsum of the scapula below its spine; on the arm it is
not so intimately connected with the muscles, but on the fore
arm they again begin to arise, in part, from it. In its whole
course partitions, constituting the sheaths of the rriuscles, and
which consist, for the most part, of common cellular and adipose
membrane, go from it down to the periosteum and interosseous
ligament. It adheres very tightly to the ulna, from the ole-
cranon to the styloid process. On its cutaneous surface are
found all the superficial veins, nerves, and lymphatics of the
arm. Bichat considers this membrane as the best example of
UPPER EXTREMITIES. 413
the continuity of ligamentous with cellular tissue, and conse-
quently of the affinity of the two.
The flexor tendons of the hand and fingers are held down,
by the Ligamentum Carpi Volare or the Anterior Annular Li-
gament of the Wrist. It is a very strong fasciculus of liga-
mentous fibres, which subtends the concavity of the carpal bones
in front, and converts it into the large oval foramen which con-
tains the tendons. It is attached by one end at the ulnar side
of the wrist, to the hook-like process of the unciforme, to the
cuneiforme, and to the pisiforme. Its fibres go straightly across
the wrist to be attached by their other extremities to the radial
end of the trapezium, and of the scaphoides ; and may be readi-
ly distinguished from the fascia brachialis by their uniformly
transverse course; by their superior whiteness; by their in-
creased thickness ; and by their great strength and unyielding
nature. Yet the superior margin of this ligament is partially
continuous with the fascia brachialis, and the inferior margin
with the aponeurosis palmaris. Several of the little muscles of
the hand arise from its front surface, while the posterior is in
contact with the flexor tendons.
The Aponeurosis Palmaris is placed just below the skin, and
covers the middle of the palm of the hand. It is triangular,
and has its apex above, where it arises from the inferior margin
of the volar or anterior annular ligament of the wrist, and from
the tendon of the palmaris longus; it spreads out in its descent,
and reaches the lower ends of the metacarpal bones, where it
is divided into four portions. Each of these portions bifurcates
and passes to the head of its appropriate metacarpal bone, to
be fixed to it just in advance of the inferior palmar ligaments.
The vacuity of the bifurcation permits the flexor tendons to pass
on to the finger, and its branches are held together by transverse
arid reticulated fibres, the interstices of which are filled with
fat. The lateral margins of this aponeurosis send off a thin
membrane, for the purpose of covering the muscles of the thumb
and of the little finger; or, in other words, the thenar and the
hypothenar eminences in the palm of the hand.
35*
414 • MUSCLES.
SECT. II. — OF THE MUSCLES OF THE SHOULDER.
The Ddtoides,
Is a muscle which is extended over the top of the shoulder
joint, and forms there the subcutaneous cushion of flesh which
protects and gives rotundity to the articulation. It arises from
the inferior edge of the whole spine of the scapula, from the
circumference of the acromion process, and from the exterior
third of the clavicle. Its origin, for the most part, is tendinous
and fleshy mixed; but at its posterior part it is entirely tendi-
nous.
It is inserted, by a tendinous point, into the triangular rough
surface on the outer side of the os humeri near its middle. Its
general configuration is triangular, and when spread out, its
upper margin is much more extensive than one would suppose,
as it is opposed to the entire insertion, of the trapezius. Its
fibres do not converge regularly to its insertion like the radii
of a circle, but the whole muscle is divided into several parts;
the interposition of inter-muscular tendons into which, affecting
the course of the fibres, makes several portions of the deltoid
look penniform, and others like smaller deltoids introduced into
the larger.
The deltoid covers the insertion of the pectoralis major, latis-
simus dorsi, and teres major, besides that of the other muscles
of the shoulder. It also conceals the origin of the biceps flexor
cubiti and of the coraco-brachialis. Its insertion is between the
triceps extensor and the biceps flexor, and above the origin of
the brachialis interims.*
It raises the os humeri.
Between the superior edge of the deltoid, the acromion pro-
cess, and the subjacent tendons on the top of the articulation,
there is a large Bursa Mucosa, which is sometimes partitioned
off into two.
* Varieties. Sometimes a fasciculus arises, between the infra-spinatus, find
the teres major, or from the inferior costa of the scapula, and joins itself to the
deltoids.
MUSCLES OF THE SHOULDER. 415
The Supra-Spinatus Scapulce,
Arises, fleshy, from the whole fossa supra-spinata, which it
fills up, and from its margins. Forwards it terminates in a
thick robust tendon closely connected with the capsular liga-
ment of the joint, and which passes under the jugum formed by
the articulation of the acromion with the clavicle.
It is inserted, tendinous, into the inner face of the great tu-
berosity of the os humeri.
It raises the arm, and turns it outwards.
The Infra-Spinal us Scapulce,
Arises, fleshy, from all that portion of the dorsum scapulae
below its spine, from the spine as far as the cervix, and from
the several margins of the fossa infra-spinata. Its fibres pass
obliquely to a middle tendon, which adheres closely to the
capsular ligament, and goes under the projection of the acro-
mion.
This tendon is inserted into the middle facet of the greater
tuberosity of the os humeri.
The infra-spinatus rolls the os humeri outwards and back-
wards. There is a bursa between its tendon and the scapula. •
The Tares Minor,
Is situated at the inferior margin of the infra-spinatus, in the
fossa of the inferior costa scapulae, and looks very much like a
part of the infra-spinatus, to which it occasionally adheres so
closely as to be separated with difficulty. It arises, fleshy, from
the whole of the fossa, and the margins of the inferior costa, in
the space from the cervix of the bone to within an inch or so
of its angle.
It is inserted, tendinous and fleshy, into the outer facet of
the great tuberosity of the os humeri, just below the infra-spi-
natus.
It draws the os humeri downwards and backwards, and ro-
tates it outwards.
416 MUSCLES.
The Teres Major,
Is situated at the inferior edge of the teres minor. It arises,
fleshy, from the posterior surface of the angle of the scapula,
and from a small part of its inferior costa ; the interstice be-
tween it and the teres minor is considerable.
It is inserted, by a broad tendon, into the internal ridge of
the groove of the os humeri, along with the tendon of the la-
tissimus dorsi. Their tendons, at first, are closely united, but
afterwards there is an intermediate cavity lubricated with sy-
novia. The tendon of the latissimus dorsi is anterior, and the
lower edge of the teres extends farther down the arm than it.
It rolls the humerus inwards, and draws it downwards and
backwards.
The Subscapularis,
Occupies all the thoracic surface of the scapula, being be-
tween it and the serratus major. It arises, fleshy, from the
whole base, superior and inferior costa, and costal surface of
the scapula; it is divided into several columns, which look some-
what like distinct muscles, but they all terminate in a thick ro-
bust tendon that adheres to the inferior surface of the capsular
ligament.
This tendon is inserted into the lesser tuberosity of the os hu-
meri.
The subscapularis rolls the bone inwards and draws it down-
wards. Between it and the neck of the scapula, there is a
bursa, which, as mentioned, communicates with the articula-
tion.
SECT. III. OF THE MUSCLES OF THE ARM.
Tfie Biceps Flexor Cubiti.
This muscle is just beneath the fascia and integuments,
and forms the swell so obvious in the middle front part of the
MUSCLES OF THE ARM. 417
arm. It arises by two heads. The first, called the long, is a
round tendon which comes from the superior extremity of the
glenoid cavity of the scapula, passes through the shoulder joint
and through the groove of the os humeri ; the second head arises
tendinous from the extremity of the coracoid process of the sca-
pula, in company with the coraco-brachialis muscle. The fleshy
bellies in which these tendons terminate, unite with each other,
several inches below the shoulder joint, to form a common mus-
cle. At first they are only connected by loose cellular sub-
stance ; but, about half-way down the arm, they are insepara-
bly united.
The biceps terminates below in a flattened oval tendon, which
passes in front of the elbow joint, to be inserted into the poste-
rior rough part of the tubercle of the radius. A bursa mucosa
is placed between the tendon and the front of the tubercle, the
surface of the latter being covered with cartilage. From the
ulnar side of this tendon proceeds the aponeurosis running into
that of the fore arm.
The relative position of the biceps is as follows: Its long
head is first within the cavity of the capsular ligament, and then
between the tendons of the latissimus dorsi and pectoralis ma-
jor, where it is bound down by strong ligamentous fibres. The
tendon below is superficial, and may be easily felt by flexing
the fore-arm, but its insertion dips down between the pronator
teres and supinator radii longus.
This muscle flexes the fore-arm.*
The Coraco-Brachialis,
Is situated on the upper internal side of the arm, at the inner
edge of the short head of the biceps muscle, with which it is
connected for three or four inches. It arises tendinous and
fleshy from the middle facet of the point of the coracoid pro-
* Varieties. Sometimes the division of the muscle is continued to the elbow;
sometimes there is a third head, coming either from the internal face of the os
humeri, or from the brachialis internus; very rarely, the number of heads^has
been multiplied to five, thereby making a close approximation to the arrangement
in birds. This muscle is very liable to anomalies.
418 MUSCLES.
cess of the scapula, in common with the short head of the bi.
ceps muscle.
It is inserted, tendinous and fleshy, into the internal side of
the middle of the os humeri, by a rough ridge, just below the
tendons of the latissimus dorsi and teres major, and in front of
the brachialis externus or third head of the triceps. The lower
end of this muscle is attached to the inter-muscular ligament of
the internal side of the os humeri, which separates the brachi-
alis interims from the third head of the triceps.
This muscle draws the arm upwards and forwards.*
The Brachialis Interims,
Is situated immediately beneath the biceps, and is concealed
by it, excepting its outer edge. It has a bifurcated fleshy ori-
gin from the middle front face of the os humeri on each side
of the insertion of the deltoid, and its origin is continued fleshy
from this point downwards, from the whole front of the bone
to within a very small distance of its articular surface.
It is inserted, by a strong short tendon, into the rough surface
at the root of the coronoid process of the ulna. A bursa some-
times exists between the tendon of the brachialis internus, that
of the biceps, the supinator brevis, and the elbow joint.
The brachialis flexes the fore arm, and, by passing in front of
the elbow joint, strengthens the latter very much. Its lower
part lies under the tendon of the biceps, and between the pro-
nator teres and the supinator longus.f
* Varieties. This muscle being generally penetrated by the musculo-cuta-
neous nerve, the perforation thus made sometimes exists as a fissure, extending
the length of the lower half of the muscle; on other occasions the fissure is so
long as to divide the muscle completely into two.
f Varieties. Sometimes, at its external margin, there exists a smaller brachia-
lis internus muscle, which arises from about the same point of the humerus, and
is inserted into the same part of the cubitus. Sometimes it detaches a fasciculus
which joins the biceps muscle. Sometimes its posterior part is distinct from the
anterior. Sometimes a fasciculus of it runs along the supinator longus of the fore
MUSCLES OF THE ARM. 419
The Triceps Extensor Cubiti, or Brachii,
Forms the whole of the fleshy mass on the back of the arm ;
it therefore occupies the space between the integuments and the
bone. It arises by three heads. The first, called Lorigus,
comes, by a flattened tendon, between the teres major and the
minor muscle, from a rough ridge on the inferior edge of the
cervix scapulas. The second, called the Brevis, arises by a sharp,
tendinous, and fleshy beginning, from a slight ridge on the outer
back part of the os humeri, just below its head. The third head,
called Brachialis Externus, arises, by an acute fleshy beginning,
from the inner side of the os humeri near the insertion of the
teres major. This muscle, both at its external and internal
edge, is separated from the muscles in front of the arm by the
external and internal inter-muscular ligaments, which arise near
the middle of the os humeri, and run to the condyles respec-
tively. The whole back of the os humeri, as well as the pos-
terior surface of these inter-muscular septa, is occupied by the
origin of the triceps. The muscular fibres run in various direc-
tions, according to their respective heads and places of origin.
At the inferior end of the muscle is found a broad tendon,
which covers its posterior face. This tendon is inserted into
the base or back part of the olecranon, and the ridge leading
down the ulna on its radial side. The bellies of the triceps
unite above the middle of the os humeri, but the interstices be-
tween them may be observed much lower down. There is a
bursa between the tendon and the olecranon process ; besides
which, there is sometimes another on each side of the first.
The triceps extends the fore arm.
The Jlnconeus,
Is a small triangular muscle, just beneath the skin, at the outer
posterior part of the elbow joint. It arises tendinous from the
posterior lower part of the external condyle of the os humeri,
adheres to the capsular ligament of the joint, and is partly co-
vered by the tendon of the triceps.
It is inserted, fleshy and thin, into the ridge leading from the
420 MUSCLES.
olecranon, on the outer part of the upper end of the ulna, and
into the triangular depression found there; so as to fill it up.
It extends the fore arm.
SECT. IV. OF THE MUSCLES OF THE FORE ARM.
There are eight muscles on the front of the fore arm, some
of which are superficial, and others deep-seated. They, for the
most part, are either directly or indirectly flexors of the fore
arm and hand, and in their origin adhere very much by the ten-
dinous partitions, called Inter-muscular Ligaments.
1. The Pronator Radii Teres,
Is just beneath the fascia of the fore arm, and forms the ra-
dial side of the muscles of the internal condyle. It arises,
fleshy, from the anterior face of the internal condyle of the os
humeri, and tendinous from the coronoid process of the ulna.
It passes very obliquely across the fore arm, at the internal edge
of the brachialis internus muscle, and is inserted, tendinous and
fleshy, into the external back part of the radius, just below the
insertion of the supinator radii brevis, occupying about two
inches of the middle of the bone.
It rolls the hand inwards.*
2. The Flexor Manus vel Carpi Radialis,
Is placed at the ulnar side of the last muscle, and is also su-
perficial. It arises, by a narrow tendon, from the lower front
part of the internal condyle of the humerus, fleshy from the in-
ter-muscular ligaments, fascia, and from the upper part of the
ulna. It forms a thick fleshy belly, terminating below in a ten-
don, which passes under the anterior annular ligament of the
wrist, and runs through a groove in the os trapezium.
It is inserted, tendinous, into the base of the metacarpal bone
of the fore finger, in front.
* Varieties. Sometimes it is double.
MUSCLES OF THE FORE ARM. 421
There is a bursa between the lower extremity of its tendon
and the trapezium ; the tendon is there held down by ligamen-
tous fibres.
It bends the hand, and draws it towards the radius.
3. The Palmaris Longus,
Is at the ulnar side of the flexor carpi radialis, and is super-
ficial. It is a small short muscle, terminating in a long slen-
der tendon, and arises by a small tendon from the internal con-
dyle, and fleshy from the inter-muscular ligament on each of its
sides.
It is inserted, tendinous, into the upper margin of the liga-
mentum carpi annulare anterius, near the root of the thumb;
and a division of its tendon passes on to the aponeurosis pal-
maris.
It bends the hand, and makes tense the palmar aponeurosis.*
4. The Flexor Manus vel Carpi Ulnar is,
Occupies, among the superficial muscles, the ulnar side of the
fore arm. It arises, tendinous, from the internal condyle of the
os humeri, fleshy from the upper internal side of the olecranon,
and by a tendinous expansion, being a part of the fascia of the
fore arm, from the ridge at the internal side of the ulna to with-
in three or four inches of the wrist.
It is inserted into the upper side of the os pisiforme by a
round tendon, which arises early at the radial margin of the
muscle, and receives the muscular fibres. Sometimes the ten-
don is continued over the os pisiforme, so as to be likewise in-
serted into the base of the metacarpal bone of the little finger.
There is a loose bursa at the junction of the tendon with the
pisiforme.
It bends the hand, and draws it towards the ulna.
* Varieties. Sometimes it is deficient in both arms; sometimes the middle part
only is fleshy; sometimes the belly goes almost to the wrist.
VOL. I.— 36
422 MUSCLES. f.- .
5. The Flexor Digitorum Sublimis Perforates,
Is concealed very much by the muscles just enumerated, in
consequence of being placed between them. To get a good
view of its origin, they all should be cut away from the os hu ••
meri. It arises, tendinous and fleshy, from the internal con-
dyle of the os humeri, tendinous from the coronoid process of
the ulna, and fleshy from the tubercle of the radius; the latter
part of its origin being extended, tendinous obliquely, for three
or four inches from that line of the radius which is at the upper
margin of the supinator radii brevis. With these origins the
muscle spreads over the front of the fore arm at its upper part,
from the radial to the ulnar margin.
Four distinct tendons pass from the lower end of the muscle?
which commence much above the wrist, pass beneath its ante-
rior ligament, and, having reached the palm of the hand, diverge
to the several fingers. A tendon is appropriated to each finger,
and passes in front of the metacarpal bone to the phalanges, be-
ing inserted, after having split into two, into the angles formed
by the junction of the cylindrical and flat surface of the second
phalanx near its middle.
It bends the second phalanges on the first; its action may also
be continued so as to clench the hand and to bend it on the fore
arm.*
6. The Flexor Digitorum Profttndus Perforates,
Is beneath the flexor sublimis and the flexor ulnaris. It arises,
fleshy, from the oblong concavity of the ulna, along the inner
side of the coronoid and the olecranon process, fleshy from
the lower margin of the base of the coronoid process, from the
ulnar portion of the interosseous ligament, and from the front of
the upper two-thirds of the ulna.
* Varieties. The tendon to the little finger is sometimes wanting, in which
case the deficiency is supplied by the tendon of the flexor profunchis. Some-
timjs the section of this muscle which belongs to the fore finger, is insulated
from the rest of it, by a long fissure, and, moreover, divided by a middle tendon,
into two fleshy portions.
MUSCLES OF THE FORE ARM. 423
The tendons of this muscle are different from those of the
other; they commence in front of it, like a tendinous membrane,
which is gradually divided into several fasciculi, adhering to
each other by cellular membrane. The fasciculated character
of the tendons is still preserved when they go under the ante-
rior carpal ligament, and until they begin to disperse as distinct
tendons to each of the fingers.
Each tendon, going in front of its metacarpal bone and of the
corresponding phalanges, gets through the slit in the flexor sub-
limis, and is inserted into the front part of the root of the third
phalanx of its respective finger.
It bends the last phalanges of the fingers, and may, by in-
creased action, flex the hand like the preceding muscle.*
7, The Flexor Longus Pollicls,
Lies in front of the radius, but beneath the flexor sublimis.
It arises by an acute fleshy beginning, from the radius just be-
low its tubercle; also fleshy from the middle two-thirds of the
front of this bone, and from the radial portion of the interosse-
ous ligament. The body of the muscle is joined by a small
fleshy slip having a tendinous origin from the internal condyle
of the os humeri.
A tendon is formed early on the ulnar margin of this mus-
cle, and to which the fibres pass obliquely. The tendon goes
under the annular ligament of the wrist, through the fossa formed
in the short flexor muscle of the thumb, and between the sesa-
moid bones, to be inserted into the base of the second phalanx
of the thumb.
From the inferior end of the fore arm to the middle of the
first phalanx, the tendon is invested by its appropriate bursa.
It bends the last joint of the thumb.
The several Flexor tendons, as they pass under the anterior
annular ligament of the wrist, are surrounded by the superior
Bursa Mucosa. It begins about an inch and a half above the
* Varieties. Sometimes a distinct fasciculus comes from the internal condyle
to join it; sometimes a fasciculus comes from the flexor longus pollicis, and ter-
minating in a tendinous expansion, is inserted into the tendon which the flexor
profundus sends to the fore finger.
424 MUSCLES.
radio-carpal articulation, and extends to the lower margin of the
annular ligament. It adheres by its circumference to this liga-
ment and to the capsule of the joint; internally, it sends in a
considerable number of processes, whereby each tendon is sur-
rounded, and connected to the adjoining tendons; while at the
same time no restraint is put upon the natural motions of the
part. In its texture this bursa resembles a dense and elastic
cellular membrane.
In addition to this, the flexor tendons, as they pass from the
root to the extremity of each finger, are surrounded by a syno-
vial bursa; which by its secretion continually lubricates them,
and permits them to play freely backwards and forwards, ac-
cording to the flexions and extensions of the fingers. These
mucous or synovial sheaths, begin a little distance above the
first joint of the finger, adhere there to both flexor tendons, and
extend to about the middle of the last phalanx. They give to
the tendons a very polished lubricated surface; are reflected
over the anterior flat faces of the phalanges, being separated
from them by a small quantity of adipose matter; they are also
reflected over the anterior faces of the capsular ligaments, and
line of the vaginal ligaments.
The Vaginal Ligaments of the fingers (Ligamenta Vaginalia)
bind down the flexor tendons and keep them applied to the
fronts of the phalanges. They are 'of the same extent from
above downwards, with the mucous sheaths just mentioned, and
are stretched between the ulnar and the radial margins of the
phalanges. The fibres of which they consist pass for the most
part transversely, and are of a fibre-cartilaginous character.
These fibres diminish in number towards the end of each finger,
and are stronger on the fore finger than on any of the others.
In front of the metacarpo-phalangial articulations, and the phu-
langial articulations, the vaginal ligaments are much thinner
than elsewhere, in order to permit the free flexions of the fingers.
The structure, indeed, at these points, is strongly marked off
by its diminished thickness ; and though the course of the fibres
is the same from side to side, yet some anatomists have thought
it worth while to designate it, particularly under the name of
Annuli Juncturarum Ligamentosi.
Within the vaginal ligaments small tendinous fraena arise
from the first and second phalanges; they vary in number in
MUSCLES OF THE FORE ARM. 425
different individuals, and run obliquely forwards, some to ter-
minate in the flexor profundus tendons, and others in those of
the flexor sublimis ; they are called Vincula Accessoria, and
are covered by a reflection of the'synovial sheath.
8. The Pronator Quadratics,
Is just above the carpal surfaces of the radius and ulna, and
between the other muscles and the bone. In the adult it is
about two inches wide, and its fibres run across the fore arm.
It arises, fleshy and tendinous, from the ridge at the inner sur-
face of the ulna, near its lower extremity, and from the front
of the bone.
It is inserted into the corresponding front surface of the ra-
dius.
It rotates the radius inwards.*
Of the Muscles on the back of the Fore Arm.
These muscles are ten in number. They arise, for the most
part, from the external condyle, and the ridge leading to it, and
are extensors either of the fore arm, or of the fingers and thumb.
Their origins are less blended with each other than those of the
flexor muscles; nevertheless, between several of them there are
inter-muscular ligaments which connect them. They are su-
perficial and deep-seated.
1. The Supinator Radii Longus,
Is situated along the radial edge of the fore arm, immediate-
ly beneath the integuments. It arises, fleshy and tendinous,
from the higher part of the ridge leading to the external can-
dyle; commencing just below the insertion of the deltoid mus-
cle, and being here placed between the brachialis internus and
the outer head of the triceps. It forms a thick fleshy belly,
constituting the external margin of the arm, about the elbow
* Varieties. This muscle in some very rare cases does not exist. Sometimes
it consists in two layers whose fibres cross each other. In a case noticed in the
Pennsylvania Hospital by Dr. J. R. Barton, it consisted in two triangular pieecs,
the bases of which were reversed.
36*
426 MUSCLES.
joint; and terminates about the middle of the radius in a flat
tendon.
Itjis inserted, by the tendon, into a small, rough ridge, on
the outer side of the radius just above its styloid process.
It rolls the radius outwards.
2. The Extensor Carpi Radialis Longior,
Is situated beneath the former muscle. It arises, tendinous
and fleshy, from the space of the external ridge of the os hu-
meri, between the supinator longus and the external condyle.
It forms a short, fleshy belly, which terminates in a flat tendon
above the middle of the radius.
It is inserted, by this tendon, into the posterior part of the
root of the metacarpal bone of the fore finger, near the thumb.
The tendon of this muscle is surrounded by a synovial sheath,
at the place where it passes the lower end of the radius, under
the posterior carpal ligament. Another bursa exists, also, at
its insertion; which, on one occasion, I found so much enlarged
in a young woman, as to require its extirpation: the operation
was fully successful.
It extends the hand.*
3. The Extensor Carpi Radialis Brevior,
Is beneath the last, but projects somewhat beyond it. It
arises, tendinous, from the posterior and lower part of the ex-
rernal condyle, and from the external lateral ligament of the
elbow joint. It forms a thick, fleshy belly, placed along the
radius, and terminates in a flat tendon about the middle of that
bone.
Its tendon, becoming rounded, is inserted into the posterior
part of the base of the metacarpal bone of the second finger,
and has a bursa beneath its insertion, and another at the. wrist.
It extends the hand.f
* Varieties. Sometimes a small fasciculus is detached from its posterior mar-
gin, and has a tendinous insertion into the third metacarpal bone.
t Varieties. Sometimes this muscle is so blended with the preceding, as to be
*n common with it.
MUSCLES OF THE FORE ARM. 427
4. The Extensor Carpi Ulnans,
Is superficial, and placed principally parallel with the ulna.
It arises, tendinous, from the external condyle, fleshy from the
inter-muscular ligament, and inside of the fascia. Crossing
very obliquely the upper part of the radius and the ulna, it also
arises fleshy from the back part of the latter bone. Its fibres
terminate obliquely in a tendon which goes through the groove
of the ulna, and is there furnished with a bursa.
It is inserted, by its tendon, into the ulnar side of the base of
the metacarpal bone of the little finger.
It extends the hand.*
5. The Extensor Digitorum Communis,
Is superficial, being placed between the extensor ulnaris and
the extensor radialis brevior. It arises, tendinous, from the ex-
ternal condyle, and fleshy from the inter-muscular ligament of
the contiguous muscles. As it approaches the wrist it sends off
four tendons, which pass together through a common groove on
the back of the radius. On the back of the hand these tendons
diverge, and near the roots of the fingers send cross slips to
each other.
Each tendon goes to its respective finger, and covers the
whole posterior part of it, being spread out into a membrane
which adheres to the phalanges from the root of the first to the
root of the last. The precise mode of the insertion of these
tendons is as follows : on the back of the first phalanx, the la-
teral margins of these tendons are joined by the tendons of the
lumbricales and interossei; and the tendinous membrane, thus
formed, simply adheres by condensed cellular membrane to the
whole back of the first phalanx ; the middle part of this tendon
then passes on to be inserted near the articular margin of the
base of the second phalanx; and the two lateral parts of the
tendinous membrane, after keeping separate for some distance,
* Varieties. Sometimes its tendon is joined, by a small fasciculus, to the ex-
tensor tendon of the little finger.
428 MUSCLES.
unite, and are jointly inserted into the back of the base of the
third phalanx.
The section of this muscle appropriated to the little finger
has a distinct appearance, and frequently its tendon goes through
a separate fossa in the radius, from which causes it has obtained
the name of Auricularis. A bursa invests these tendons at the
wrist as they pass through their groove, and is single above ;
but, in following the course of the tendons, like them it divides
and follows each tendon respectively to the base of the first
phalanx.
This muscle extends all the joints of the fingers, being the
antagonist of the flexors.*
6. TJte Supinalor Radii Brevis,
Can only be well seen by detaching the origin of the afore-
said muscles; it will then be found in contact with the radius,
making a close investment of its head and upper third. It arises,
tendinous, from the external condyle of the os humeri, tendi-
nous and fleshy from the ridge on the posterior radial edge of
the ulna which descends from its coronoid process.
Its fibres surround, obliquely, the upper external part of the
radius, and are inserted into its tubercle, and into its oblique
rough ridge, corresponding with the upper margin of the pro-
nator teres. At the interstice between the radius and ulna, near
the anterior edge of this muscle, a fleshy slip is occasionally
seen which passes from the radial side of the coronoid process
to the ulnar edge of the radius.
This muscle rotates the radius outwards.f
7. The Extensor Ossis Metacarpi Potticis Manns,
Arises, fleshy, from the posterior part of the ulna immedi-
ately below the anconeus, from the interosseous ligament, and
* Varieties. It sometimes sends a double tendon to the little finger, in which
case the auriculuris is more distinct than usual, and the tendon next to the ulna
runs through a distinct trochlea in the posterior carpal ligament.
t Varieties. Sometimes the superior part is separated from the inferior; some»
times the muscle is double..
MUSCLES OF THE FORE ARM. 429
from the back part of the radius just below the insertion of the
supinator brevis. It terminates in a rounded tendon which
passes over the tendons of the radial extensors, and through a
groove on the styloid side of the lower end of the radius. The
tendon is there invested by a bursa.
It is inserted, by its tendon, into the base of the metacarpal
bone of the thumb, and into the external side of the trapezium.
It extends the metacarpal bone of the thumb.*
8. The Extensor Minor Pollicis Mantis,
Is at the ulnar side of the last muscle. It arises, tendinous,
from the back of the ulna below its middle, and fleshy from the
interosseous ligament. It adheres to the radius, and terminates
in a tendon which passes through the groove in the styloid side
of the radius, along with the last named muscle.
It is inserted into the first phalanx of the thumb, by its ten-
don, which is extended to the root of the second phalanx.
It extends the first phalanx/f
9. The Extensor Major Pollicis Manus,
Arises, by a small tendinous, and an extensive fleshy origin,
from the back of the ulna above its middle, and from the inte-
rosseous ligament, also from the back of the radius; it terminates
near the wrist, in a tendon which passes through the groove on
the back of the radius near the ulna. The belly of this muscle
conceals, very much, the other extensors of the thumb.
It is inserted, by its tendon, into the oblong transverse tu-
bercle, on the back of the base of the second phalanx of the
thumb. Its tendon is furnished with one synovial sheath, at the
inferior extremity of the radius, which extends to the carpus, and
another which is smaller, and is placed upon the carpus and
upon the base of the first metacarpal bone.
It extends the second phalanx.J
* Varieties. This muscle is sometimes double, and has several other modifi-
cations which it is unnecessary to state.
f Varieties. This muscle is sometimes only an appendage of the preceding.
Occasionally, its tendon is confounded with that of the succeeding muscle.
t Varieties. Sometimes this muscle is completely double.
430 MUSCLES.
The tendons of the last two muscles are much connected with
each other, and are spread in the form of a membrane on the
back of the thumb, after the manner of the extensor tendons of
the fingers.
10. The Indicator,
Is a small muscle on the back of the ulna, concealed by the
extensor communis and extensor ulnaris. It arises, tendinous
and fleshy, from the back of the ulna, commencing near its mid-
dle, and from the contiguous part of the interosseous ligament.
It terminates in a tendon which goes through the same fossa
with the extensor communis; it afterwards is joined about the
head of the first phalanx to the tendon of the common extensor
belonging to the fore finger.
With the tendon of the extensor communis, it is inserted along
the back of the fore finger as far as the base of the third phalanx.
It extends the fore finger.*
SECT. V. — OF THE MUSCLES OF THE HAND.
The Palmaris Brevis,
Is just below the skin, at the inner side of the palm of the
hand. It consists of separate fasciculi unequally divided, and
arises from the anterior ligament of the wrist, and from the ul-
nar side of the palmar aponeurosis.
It is inserted into the skin and fat at the inner margin of the
hand, and covers the muscles of the little finger.
It contracts the skin of the hand.
* Varieties. This muscle is subject to many modifications? sometimes it is di-
gastric; sometimes it is double, and the second head goes to the middle finger. In
the latter case, anatomists have recognised a disposition similar to that of the short
extensors of the toes, and also an arrangement corresponding with what occurs in
some species of the ape. As a general rule, it is admitted that the most of those
varieties in the muscular system, commonly called anomalies, are only indications
on the part of nature of the alliance between the structure of man, and that of the
lower orders of animals. In this point of view, they are both instructive and
amusing, and are well deserving of attention.
MUSCLES OF THE HAND. 431
Beneath the Aponeurosis Palmaris are placed the long flexor
tendons, and many of the small muscles of the hand.
The Lumbricales,
Are conspicuous ; they are four in number, of the size and
shape of earth worms. They arise, tendinous and fleshy, from
the radial sides of the tendons of the flexor profundus, beneath
the ligamentum carpi annulare anterius, and a little beyond its
inferior edge.
They terminate in little flat tendons, which run along the outer
or radial edge of the fingers, and are inserted respectively into
the tendinous expansion of the extensor communis on the back
of the first phalanx of each finger, about its middle.
They bend the first phalanges.*
Four muscles constitute the ball of the thumb.
1. The Abductor Pollicis Manus,
Arises, tendinous and fleshy, from the anterior surface of the
ligamentum carpi annulare, and from the projecting ends of the
trapezium and scaphoides.
It is inserted, tendinous, into the outer side of the base of the
first phalanx of the thumb, and into the tendinous membrane
derived from the extensors on its back part.
It draws the thumb from the fore fingers. This muscle is
next to the skin.
2. The Opponens Pollicis ,
Is beneath the abductor, and without its removal can scarcely
be seen. It arises, tendinous and fleshy, from the projecting
point of the os trapezium, and from the adjacent part of the an-
nular ligament.
* Varieties. Sometimes one is deficient? sometimes one or more is double, in
which case the supernumerary goes to the ulnar edge of the adjoining finger.
432 MUSCLES.
It is inserted, tendinous and fleshy, into the radial edge of
the metacarpal bone of the thumb, from its base to its head.
It draws the metacarpal bone inwards.
3. The Flexor Brevis Pollicis Manus,
Is beneath the abductor pollicis, and at the side of the oppo-
nens pollicis. A groove is formed in it by the tendon of the
flexor iongus pollicis, which divides it into two heads.
The first head arises, fleshy, from the points of the trapezium,
trapezoides, and from the contiguous part of the internal sur-
face of the annular ligament, and is inserted into the outer sesa-
moid bone ; the sesamoid bone, like a patella, being connected
to the first phalanx of the thumb by a tendon.
The second or internal head arises, fleshy, from the magnum
and unciforme, near their metacarpal surfaces, and from the
base of the metacarpal bone of the middle finger. It is inserted
into the inner sesamoid bone, which, like the external, is con-
nected, by ligament, to the first phalanx.
The short flexor, as its name implies, bends the first phalanx
of the thumb.
4. The Adductor Pollicis Manus,
Lies in the palm of the hand, beneath the lumbricalcs and
the tendons of the flexor sublimis and profundus. It arises,
fleshy, from the ulnar edge of the metacarpal bone of the mid-
ble finger, between its base and head, and it is inserted, tendi-
nous, into the inner part of the base of the first phalanx of the
thumb, just above the sesamoid bone.
It pulls the thumb towards the fingers.
The Abductor Indicis Manus,
Is on the radial edge of the hand, between the metacarpal
bones of the fore finger and thumb, and is just beneath the skin.
It arises tendinous from the trapezium, and fleshy from the ul-
nar edge of the metacarpal bone of the thumb, between its base
and head.
MUSCLES OF TH& HAND. 433
Being placed along the side of the metacarpal bone of the
fore finger, it is inserted, by a short tendon, into the radial side
of the first phalanx.
It draws the fore finger from the others.
There are three muscles constituting the ball of the ulnar side
of the hand, or of the little finger.
1. The Abductor Minimi Digiti Manus,
Is the most superficial. It arises, fleshy, from the protube-
rance on the internal side of the os pisiforme, and from the con-
tiguous part of the annular ligament.
It is inserted, tendinous, into the ulnar side of the first pha-
lanx of the little finger, and into the tendinous membrane which
covers its back part.
It draws the little finger from the rest.
2. The Flexor Parvus Minimi Digiti Manus,
Is beneath the abductor. It arises, fleshy, from the unciform
process of the os unciforme, and from the contiguous part of
the annular ligament.
It is inserted, tendinous, into the ulnar side of the base of the
first phalanx of the little finger, being united with the tendon
of the abductor, and with the tendinous membrane expanded
over the back of the finger.
It bends the little finger.*
o
3. The Adductor Metacarpi Minimi Digili,
Is placed beneath the abductor and flexor, next to the meta-
carpal bone. It arises, fleshy, from the unciform process of the
os unciforme; and from the contiguous part of the annular liga-
ment of the wrist.
It is inserted, tendinous and fleshy, into the fore part of the
metacarpal bone of the little finger, from its base to its head.
* Varieties. Sometimes it is wanting-, in which case the preceding is more
developed than usual.
VOL, I.— 37
434 MUSCLES.
It brings the metacarpal bone of the little finger towards the
wrist, and thereby deepens the hollow of the hand.
The Interosseous Muscles till up the interstices of the meta-
carpal bones; they are seven in number, four on the palm, and
three on the back of the hand. The back ones arise by double
heads from the contiguous sides of two metacarpal bones; the
palmar ones have a single head, which comes only from the meta-
carpal bone of the finger which the interosseous muscle is in-
tended to serve. As a general description, they all may be said
to arise, fleshy and tendinous, from the base and sides of the me-
tacarpal bones, and to be inserted, tendinous, into the sides of
the first phalanges, and into the tendinous membrane on the back
of the fingers, derived from the tendons of the extensor commu-
nis. The first four must be looked for on the palm, the three
others on the back of the hand.
I. The Prior Indicts,
Is along the radial side of the first digital metacarpal bone,
and arises from the base and side of the same.
It is inserted, tendinous, into the radial side of the first pha-
lanx of the fore finger.
It draws the fore finger towards the thumb.
2. TTie Posterior Indicis,
Is at the ulnar side of the first digital metacarpal bone. It
arises from the base and ulnar side of the same bone, and is in-
serted, tendinous, into the ulnar side of the first phalanx of the
fore finger.
It draws the fore finger towards the others.
3. The Prior Annularis,
Is at the radial side of the metacarpal bone of the third or
ring finger. It arises from the base and radial side of the said
bone.
MUSCLES OF THE HAND. 435
It is inserted, tendinous, into the radial side of the first pha-
lanx of the ring finger.
It draws that finger towards the thumb.
4. The Interosseus Digiti Auricularis,
Is at the radial side of the metacarpal bone of the little fin-
ger, and arises from the radial side and base of said bone.
It is inserted, tendinous, into the radial side of the first pha-
lanx of the same finger*
It draws the little finger towards the other.
By removing the tendons of the extensor eommunis from-
the back of the hand, we see the three posterior or double-
beaded interosseous muscles*
5. The Prior Medii,
Is between the metacarpal bone of the fore and of the mid-
dle finger. It arises from the opposed roots and sides of these
bones.
It is inserted, tendinous, into the radial side of the first pha-
lanx of the middle finger.
It draws the middle finger towards the thumb,
6, The Posterior Medii,
Is between the metacarpal bone of the middle and of the
ring finger. It arises from the opposite sides and roots of these
bones.
It is inserted, tendinous, into the ulnar side of the first pha-
lanx of the middle finger.
It draws the middle finger towards the little.
7. The Posterior Annularis,
Is between the metacarpal bones of the ring and little finger.
It arises from the opposed sides and roots of these metiacarpal
bones.
436 FASCIA,
It is inserted, tendinous, into the ulnar side of the first pha-
lanx of the ring finger.
It draws the ring towards the little finger.
CHAPTER IV.
OP THE FASCIAE AND MUSCLES OF THE LOWER EXTREMITIES.
SECT. I. OF THE FASCIJE.
THE muscles of the lower extremity, from the pelvis to the
foot inclusively, are invested by a strong aponeurotic mem-
brane, placed immediately beneath the skin or common integu-
ments. Its external face is in contact with the superficial
nerves and blood vessels, and the internal face with the muscles.
Though it is absolutely continuous from one end to the other,
it will be useful, for study, to divide it into three parts; the one
covering the thigh, the second covering the leg, and the third
covering the foot; as each of them presents certain points of
arrangement, which could not be very conveniently introduced
into a general description.
1. The aponeurosis of the thigh (Fascia Lata Femoris) begins
posteriorly, from the upper part of the gluteus magnus mus-
cle, by a very gradual conversion of the cellular membrane of
the part into desmoid substance; it also begins in the way of
cellular substance from the margin of the sacrum and os coc-
cygis. The character here is seldom clearly aponeurotic till it
gets on a level with the tendon of the gluteus magnus, from
which emanate a great many of its fibres. Externally, it arises
from the whole length of the crista of the ilium, is there, striking-
ly aponeurotic, and is closely adherent to the gluteus medius
muscle, many of whose fibres arise from it. It also arises from
the body and rami of the pubes, and from the tuber and ramus
of the ischium. Its attachment at the latter is not very strong*
FASCIA OF THIGH. 437
neither is its character so well marked. It is there, in some
measure, continuous with the perineal fascia. In Front, it ad-
heres very closely to the inferior margin of the tendon of the
external oblique muscle, so as to be almost continuous with it,
from the anterior superior spinous process of the ilium to the
pubes.
From these several connexions at the pelvis, the fascia femo-
ris descends in enveloping the muscles of the thigh, and then
forms other strong attachments about the knee, to the condyles
of the os femoris and to the head of the tibia. In front, it ad-
heres very closely to, and is almost blended into the common
tendon of the extensor muscles; it adheres, also, to the inferior
margins of (he two vasti, and is one and the same with the
membranous expansion (Invohicrum) going from them to the
head of the tibia, and answering the purpose of capsular liga-
ment to the articulation of the knee, on each side of the patella,
as far back as the lateral ligaments. Behind, it covers up the
fat in the ham, and is continued into the fascia of the leg.
The fascia femoris, almost every where, consists in a fibrous
texture, which is sufficiently evident, but the fibres pass in very
various directions. At many places, particularly on the inter-
nal side of the thigh, there are oblique fibres spread upon a la-
mina which is not fibrous. On the outside of the thigh, the fas-
cia consists principally in longitudinal fibres, held together by
transverse ones; and when its interior surface is examined,
many oblique fibres are also found there. It is very thick and
strong externally, thinner behind ; and still weaker internally,
where cellular substance seems to predominate in its composi-
tion. It is pierced at several points with small round holes for
the passing of blood vessels and of the cutaneous nerves.
From the interior surface of the Fascia Femoris, partitions
pass off, which separate the muscles of the thigh from each
other, and form sheaths for them. Some of these processes are
merely cellular substance; others have a more distinct desmoid
character. Externally, as it passes from the gluteus medius to
the groin, it separates into two lamina?, which receive between
them the tensor vaginae femoris, and then reunite. The sarto-
rius muscle, in almost its whole length, is also enclosed between
two laminae. At the origin of this muscle, the posterior lami-
na passes on to the iiiacus internus, and psoas magnus muscles,
37*
438 FASCIA*
and then to the pectineus, to become the peotineal fascia, in alF
of which distance it is continuous with the iliac fascia of the
pelvis; but the anterior lamina of the fascia at this place has its
upper margin continuous with-Poupart's ligament; and this la-
mina terminates in a point or angle, which is turned inward to
the crista of the pubes, and ends by an insertion into it immedi-
ately exterior to Gimbernat's ligament, and in the same line
with it. This point, from the part which it acts in femoral her-
nia, has been studied with particular attention, and goes under
ihe name of Key's, or the Femoral Ligament.
The Pectineal fascia is placed behind the femoral vessels, but
the sartorial fascia is before them.* The latter terminates on
its pubic side, in a crescentic or lunated edge of one and a half
or two inches in length, the concavity of which is towards the
penis.f Hey's ligament is the superior extremity of the cres-
cent; the inferior end can scarcely be considered to have a de-
finite boundary, but is continuous with the adjacent part of the
pectineal fascia. The place of continuity is covered by the sa-
phena vein, which being between the skin and the fascia lata,
dips there into the femoral vein which is under the crescentic
edge. The femoral vessels reposing in their sheaths, are then
placed between these laminoe of the fascia femoris. The vein
is only partially covered by the lunated edge, while the artery,
which is on the iliac side of the vein, is completely concealed.
By keeping the leg extended, and turning the toes of the subject
inwards or outwards, it will be seen that the crescentic edge
and the tendon of the external oblique exercise a mutual ten-
sion. Beneath Poupart's ligament, at the inner margin of the
femoral vein, is the hole called the Femoral Ring, through which
the bowel escapes in femoral hernia. This hole is constricted
by turning the toes outwards, and relaxed by turning them in-
wards;, it becomes very much relaxed, if, at the same time, the
* By sartorial fascia is merely meant the portion of the fascia luta femoris con-
tiguous to the sartorius muscle; and, by pectineal fascia, the part covering- the
pectineus muscle.
f The crescentic edge is not always well defined, for in many cases it is blend-
ed insensibly with the sheath of the vessels, so that a defined exhibition of it is,
l&thev the. result of artificial separation or disseqtion. than a, natural condition,'.
FASCIA OF LEG. 439
thigh be drawn upwards. Valuable indications for the mode of
replacing a prolapsed bowel are thus obtained.
In addition to this arrangement, which is all-important in
hernia, the fascia femoris has the following. On the front of
the thigh it simply covers the extensor muscles, the partitions
between which are cellular substance. On the inner side it
dips down to the periosteum between the adductor muscles, but
is still cellular. Behind, it covers the ham-string muscles, and
sends down to the linea aspera a thick fibrous partition be-
tween the vastus externus and the biceps flexor.
The superior margin of the glutens magnus is inserted into
this fascia, which from its connexion with the gluteus medius
ahd tensor vaginae femoris, causes all these muscles to exercise
a mutual influence, as well as to keep tense the fascia itself.
On the internal semi-circumference of the thigh it adheres
somewhat closely to the muscles; but on the external, where
the fascia is opposed to the tendinous facing of the vastus ex-
ternus muscle, it is connected by a long, loose, and scattered
cellular substance, which scarcely presents an obstacle to the
introduction of the finger or any blunt instrument between the
two.
2. The Fascia Cruralis, or that of the Leg, though absolutely
continuous with that of the thigh, may be described as arising
externally, from the head of the fibula and from a prolongation
of the biceps flexor cruris; internally from prolongations of the
tendons of the sartorius, the gracilis, and the semi-tendinosus.
It, in descending, covers all the superficial muscles of the leg,
does not go over the tibia, but adheres to its spine and to its
internal angle. It unites below to the annular ligament of the
ankle, to the ligamentous sheath of the peroneal muscles, and
to that on the inner ankle. *
The fascia cruralis, in the superior half of the leg, assists in
giving origin to its muscles in front and externally, but is rather
loosely attached to them below. On the back of the leg it is
also rather loosely connected to the gastroenemii. It sends in
one aponeurotic partition between the common extensor of the
toes and the long peroneus, and another between the latter and
the soleus, both of which are inserted into the fibula. It also
is insinuated between the_ soleus and the flexor muscles next to
440 FASCIA.
the bones. This prolongation is strong and fibrous, penetrates
between these flexor muscles, dips down to the tibia and fibula,
and is lost insensibly just below the fascia of the popliteus mus-
cle. The popliteal fascia may also be considered one of the
emanations from the fascia cruralis.
The fascia cruralis is not so strong as the femoral, yet it has
the same compact desmoid texture, and is formed from fibres
crossing in various directions. It is thicker in front than be-
hind, and is made tense by its connexion with the internal and
external hamstring muscles.
Of the. Ligamentum Annulare of the Ankle Joint.
The muscles on the front of the leg have their tendons con-
fined at the ankle by this ligament, which may be very properly
associated with the description of the crural fascia, owing to
the closeness of their connexion. It consists in a fasciculus of
ligamentous fibres running across the front of the ankle joint.
It is attached by one extremity to the superior face of the
greater apophysis of the os calcis, just before the rnalleolus ex-
ternus; is there very strikingly fibrous or ligamentous, and has
its small fasciculi separated by fatty matter. It is then direct-
ed inwards, and divides into two Iamina3, one of which goes
above the tendons, and the other below them. These lamina,
by adhering to their respective sides of the tendons, form a
loose gutter for each of them to play in; the gutters, however,
for the tibialis anticus and extensor pollicis are not so perfect
behind as the others, and are also more loose. The ligament
is then fixed by one division to the anterior margin of the mal-
leolus internus, and by another, which is wrapped over the in-
ternal face of the foot, into the scaphoides and the internal
margin of the fascia plantans. As the upper margin of this lig-
ament is continuous with the fascia cruralis, so the inferior
runs into the fascia on the back of the foot, called aponeurosis
dorsalis pedis.
Of the FascicB of the Foot. — The fascia cruralis, being strongly
attached to the posterior and lower margins of the internal an-
kle, its fibres radiate thence to the lower part of the tendo-
achillis, to the inner side of the os calcis, and to the internal mar-
FASCIA OF FOOT. 441
gin of the fascia plantaris. This is the Ligamentum Laciniatum
(or plaited ligament) of writers, and conceals the tendons
which pass to the sole of the foot, along the sinuosity of the os
calcis.
The Aponeurosis Dorsalis is continued from the annular liga-
ment, over the upper surface of the foot, to the roots of the toes.
It is thin, but its fibrous texture is apparent. It is spread over
the extensor tendons of the toes and the extensor brevis muscle,
and is slightly attached along the internal and the external mar-
gin of the foot.
The Aponeurosis Plantaris is on the sole of the foot, between
its common integuments and the muscles. It is attached be-
hind to the tuberosities of the os calcis, and is quickly divided
into three portions, which are kept distinct by well marked de-
pressions between them. The internal portion lies upon the
muscles at the inner side of the foot, the external portion upon
the muscles at the outer side, and the middle covers longitudi-
nally the central parts of the sole. The first two portions are
thin, reticulated, and extended to the roots of the outer and in-
ner metatarsal bones, and along the margins of the foot, where
they join the fascia dorsalis. The middle portion increases in
breadth as it advances, and at the anterior extremity of the
metatarsus is divided into five slips, one for each metatarsal
bone. Each of these slips is subdivided into two, which pene-
trate upwards, and fix themselves to their respective side of
the head of the corresponding metatarsal bone. In the inter-
val left by this bifurcation, pass the flexor tendons, the lum-
bricales, the vessels and the nerves, to the toe.
The plantar aponeurosis, or fascia, affords behind, origin to
the superficial muscles of the sole of the foot. It also sends in
partitions between them. Its thickness is considerable behind,
but continually diminishes as it advances forwards. Its fibrous
texture is very well marked, and is much more compact near
the heel, where it looks like ligament; the fibres run principal-
ly longitudinally. From its inferior surface many strong fila-
ments pass to the skin on the sole of the foot, and contain with-
in their interstices a granulated adeps.
442 MUSCLES.
SECT. II. — MUSCLES OF THE THIGH.
The Tensor Fascia vel Vagince Femoris,
Is situated superficially on the anterior outer part of the hip.
It arises, tendinous, from the anterior superior spinous process
of the ilium; passes downwards and somewhat backwards be-
tween two lamina? of the fascia femoris, increasing in breadth
as it descends; and is inserted fleshy into the fascia femoris,
somewhat below the level of the trochanter major.
It rotates the foot inwards, and makes the fascia tense.
The Sartorius,
Is placed superficially on the internal side of the thigh. It
arises by a short tendon from the anterior superior spinous pro-
cess of the ilium, and passes in a spiral course to the inner side
of the thigh and to the back of the internal condyle. It then
winds behind the head of the tibia, and advances forwards so as
to be inserted into the internal side of the lower part of its tu-
bercle by a broad tendon. Its fibres run the whole length of
the muscle.
Its tendon is continued by a flat slip from its lower margin
into the fascia cruralis, by which attachment the muscle is held
in its spiral course. It crosses the rectus femoris and vastus in-
ternus above, the triceps adductor at the middle of the thigh,
and at the lower part of the latter, just above the knee, it is be-
tween the tendon of the adductor magnus and that of the gra-
cilis.
It bends the leg and draws it obliquely inwards.*
The Rectus Femoris,
Is in front of the thigh bone and just beneath the fascia femo-
ris, with the exception of its origin, which is covered by the
* Varieties. Sometimes a small fasciculus is detached from its inferior part;
sometimes its fibres are interrupted by a middle tendon which adheres closely to
the fascia femoris. Meckel reports it as deficient in one case that he met with.
In the African I have occasionally seen it unusually broad.
MUSCLES OF THE THIGH. 443
sartorius. It is a complete penniform muscle, fleshy in front,
for the most part, but faced behind with tendon. It arises from
the anterior inferior spinous process of the ilium by a round
tendon, which is joined by another tendon, coming from the
superior margin of the acetabulum.
It is inserted into the superior surface of the patella by a
strong tendon, and intermediately by the ligamentum patellae
into the tubercle of the tibia.
Its extends the leg.
The Vastus Exlernus,
Is a very large muscle on the outside of the thigh ; it arises,
tendinous and fleshy, from the upper part of the os fernoris, im-
mediately below the trochanter major. Its origin commences
in front, and passes obliquely around the bone to the linea as-
pera. It continues afterwards to arise from the whole length of
the linea aspera, and from the upper half of the line running
from it to the external condyle.
Its fibres pass inwards and downwards, and are inserted, by
a flat tendon, into the external edge of the tendon of the rectus,
and also into the external upper part of the patella. This mus-
cle has a broad tendinous surface exteriorly and above; at its
lower part it has a tendinous facing on the side next to the bone.
It also extends the leg.
The Vastus Internus,
Covers the whole inside of the os femoris. It arises, by a
pointed fleshy origin, in front of the os femoris, just on a level
with the trochanter minor, tendinous and fleshy from the whole
length of the internal edge of the linea aspera, and from the line
leading from it to the internal condyle.
Its fibres descend obliquely, and are inserted by a flat tendon
into the internal edge of the tendon of the rectus, and into the
upper internal edge of the patella.
It also extends the leg.
444 MUSCLES.
The CrurcBus,
Is almost completely overlapped and concealed by the two
vasti, and is immediately behind the rectus femoris. The edge
of the vastus externus, above, is very distinguishable from it, as
it overlaps it, and is rounded off, besides being somewhat sepa-
rated by vessels. But the origin of the vastus internus is not
so distinguishable, as the fibres of the two muscles run into each
other; it is, therefore, necessary, most frequently, to cut through
some of their fibres on the internal face of the os femoris, on a
level with the trochanter minor. The cruraeus will be seen to
arise, fleshy, from all the fore part of the bone, and from all its
outside as far as the linea aspera. Between the internal edge
of this muscle and the linea aspera, the interior face of the os
femoris is free or unoccupied, the breadth of an inch along the
whole shaft of the bone, which is very readily seen by turning
off the vastus internus.
The crurseus is inserted into the posterior face of the tendon
of the rectus below, and into the upper surface of the patella.
It also extends the leg.
The Ligamentum Patellae is the common chord by which the
action of the last four named muscles is communicated to the
tibia. It is a flattened thick tendon, an inch and a half wide,
arising from the inferior edge of the patella, and inserted into
the tubercle of the tibia. Between its insertion and the head
of the tibia, is a bursa. Besides this, a fascia or tendinous ex-
pansion, (Involucrum,) an appurtenance of the fascia femoris, as
mentioned before, comes from the inferior ends of these mus-
cles, extends itself over the whole of the anterior and lateral
parts of the knee joint, and is inserted into the head of the tibia
and of the fibula. Through this it happens that, even when
the patella or its tendon is fractured, some motion or extension
may be communicated to the leg from the thigh.
In consequence of the common insertion of these four mus-
cles, some anatomists describe them as but one, under the name
of Quadriceps Femoris.*
* Scemmering de Corp. Hum. Fab.
MUSCLES OF THE THIGH. 445
A bursa exists between the lower part of their tendon and
the fascia femoris, higher up than the patella; occasionally, one
is found still lower down, on the patella.*
The Gracilis,
Is a beautiful muscle at the inner margin of the thigh, and
lies immediately under the fascia; it extends from the pelvis to
the leg.
It arises, by a broad thin tendon, from the front of the os
pubis, just at the lower part of its symphysis, and from its de-
scending ramus; the muscle tapers to a point below, and, a lit-
tle above the knee, terminates in a round tendon, which passes
behind the internal condyle of the os femoris and the head of
the tibia. It then makes a 'curve forwards and downwards at
the internal side of the latter, and is inserted at the lateral and
inferior part of its tubercle.
The tendon at the knee is beneath the tendon of the sarto-
rius. This muscle is a flexor of the leg.
The Pectinalis. or Pecti?ieus,
Is a short, fleshy muscle, at the inner edge of the psoas mag-
nus. It arises, fleshy, from the concavity on the upper face of
the pubes, between the linea innominata, and the ridge above
the obturator foramen, and is inserted, tendinous, into the linea
aspera, immediately below the trochanter minor.
It draws the thigh inwards and forwards/]*
Adductors,
1. The Adductor Longus comes, by a rounded, short tendon,
from the upper front part of the pubes near its symphysis; it
forms a triangular belly which increases in breadth in its de-
* Some unimportant varieties have been observed in these extensor muscles.
Varieties. Sometimes this muscle is split into two by a fissure, in which
case the lower portion is the smaller, and has its tendon below connected or
joined to the tendon of the other, and its other extremity attached to the upper
internal margin of the thyroid foramen.
VOL. I.— 38
446 MUSCLES.
scent, and is mserted into the middle third of the linea aspera
at its inner edge.
As the subject lies on its back, this muscle is uppermost; its
origin is between that x>f the pectinalis, and of the gracilis; its
upper edge is in contact with the lower edge of the pectinalis.*
2. The Adductor Brevis is the smallest of the three ; it is situ-
ated beneath the adductor longus and pectinalis, and on the out-
side of the gracilis. It arises, by a rounded tendon, from the
middle front part of the pubes, between its symphysis and the
foramen thyroideum, just below the origin of the first adductor.
It is inserted into the upper third of the inner edge of the li-
nea aspera, between the trochanter minor and the upper edge
of the adductor longus, by a flat thin tendon.f
3. The Adductor Magnus is below the other two, and is by
far the largest. It arises, fleshy, from the lower part of the
body of the pubes and from its descending ramus, also from the
ascending ramus of the ischium as far as its tuberosity, occupy-
ing the whole bony surface between the foramen thyroideum
below, and the margin of the bone.
It is inserted, fleshy, into the whole length of the linea aspe-
ra, and on its internal margin a tendon is gradually generated
which passes downwards to be inserted into the upper part of
the internal condyle of the os femoris, and, by a thin edge or
expansion, into the line leading from the linea aspera to the in-
ternal condyle.
The adductor magnus separates the muscles on the anterior
from such as are on the posterior part of the thigh ; and its in-
sertion is closely connected with the origin of the vastus inter-
nus, the two surfaces adhering by a short and compact cellular
membrane. $
The three adductors contribute to the same end, that of draw-
* Varieties. Occasionally this muscle is divided into two by a fissure, which
is of various lengths. Sometimes it is continued much lower down than usual by
means of a small tendon united to that of the adductor magnus.
•f- Varieties. It is also occasionally split, more or less fully, into two muscles
by a fissure, which, according to Meckel, establishes a remarkable analogy with
apes.
$ Varieties. It also is occasionally divided into two portions, as in apes.
MUSCLES OF THE THIGH. 447
ing the thigh inwards. From their common action and very
close connexion at their insertions, they are sometimes described
as one, under the name of Triceps Adductor, and with great
propriety. The pectineus muscle is also associated with them
so closely in its course and character, that, as Meckel has sug-
gested, it ought to be considered as a fourth head to the triceps.
The Glutceus Magnus,
Arises, fleshy, from the posterior third of the crista of the
ilium, from the side of the sacrum below it, from the side of the
os coccygis, and from the posterior surface of the large sacro-
sciatic ligament. The fibres of this muscle are collected into
large fasciculi, with deep interstices between them ; and the
lower edge of it is folded over the sciatic ligament. .
Its fibres pass obliquely forwards and downwards, and ter-
minate in a thick, broad tendon, the upper part of which goes
on the outside of the trochanter major, and is very strongly
inserted into the fascia femoris; while the lower part is inserted
into the upper third of the linea aspera, going down as far as
the origin of the short head of the biceps flexor cruris.
This muscle is placed immediately under the skin, the fasci-
culi being separated to some depth by processes from the fascia
femoris. It covers nearly all the other muscles on the back part
of the pelvis, laps over its inferior margin laterally, and conceals
the origins of the ham-string muscles.
There is a very large bursa placed between the tendon of this
muscle and the external face of the trochanter major; another
of almost equal magnitude, between it, the superior extremity
of the vastus externus, and the inferior end of the tensor fasciae
femoris; and there are two smaller ones between the same ten-
don and the os femoris, which are placed lower and more pos-
teriorly.
The glutaeus magnus draws the thigh backwards, and assists
in keeping the trunk erect.
448 MUSCLES.
The Glutceus Medius,
Arises from the whole length of the crista of the ilium, ex-
cept its posterior third; from that part of the dorsum of the bone
which is between its crista and the semicircular ridge, extend-
ing from the anterior superior spinous process to the sciatic
notch; from the lunated edge of the os ilium, between the an-
terior superior and the anterior inferior spinous process ; and
from that part of the inner face of the fascia femoris which co-
vers it.
The anterior superior part of this muscle is not covered by
the glutaeus magnus, but lies before it. Its fibres converge, and
are inserted, by a broad tbick tendon, into the upper surface of
the trochanter major, and into the upper anterior part of the
shaft of the bone just in front of the trochanter.
It draws the thigh backwards and outwards.
A bursa is interposed between the extremity of its tendon and
the tendinous insertions of the small rotator muscles.
The GlutcBus Minimus,
Arises from that part of the dorsum of the ilium between the
semicircular ridge just spoken of, and the margin of the capsu-
lar ligament of the hip joint. It is entirely concealed by the
glutaeus medius.
Its fibres converge and terminate in a round tendon, which is
inserted into the anterior superior part of the trochanter major,
just within the anterior insertion of the glutaeus medius.
It abducts the thigh, and can also rotate the limb inwards.
A bursa of small size exists between its tendon and the tro-
chanter major.
There are several small muscles about the hip joint, the most
of which can be seen by the removal of the glutasus magnus.
The Pyriformis,
Arises, fleshy and tendinous, within the pelvis, from the an-
terior face of the second, third, and fourth bones of the sacrum.
MUSCLES OF THE THIGH. 449
It forms a conical belly, which passes out of the pelvis at the
upper part of the sacro-sciatic foramen, receiving a slip of fibres
from the posterior inferior spinous process of the ilium.
It is inserted, by a round tendon, into the upper middle part
of the trochnnter major within the insertion of the glutaeus me-
dius.
It rotates the limb outwards. Between its tendon and the su-
perior geminus a small bursa exists.*
The Gemini,
Are two small muscles, closely connected with each other,
which are situated lower down on the pelvis than the pyrifor-
mis. The upper one arises from the posterior part of the root ,
of the spinous process of the ischium ; the lower from the upper
back part of the tuberosity of the ischium.
Being parallel to each other, and connected by their conti-
guous edges, they are inserted together into the posterior part
of the thigh bone at the root of the trochanter major, where the
deep pit is.
They also rotate the limb outwards.f
The Obturator Inlernus,
Is principally situated within the cavity of the pelvis. It
arises, fleshy, from all the margin of the foramen thyroideum,
except where the obturator vessels go out; from the posterior
face of the ligamentous membrane stretched across it ; also from
the upper part of the plane of the ischium just below the linea
innominata; its fibres converge, and forming a tendon, pass out
of the pelvis over the trochlea of the ischium, between the sa-
cro-sciatic ligaments.
The tendon is placed between the gemini muscles, which
form a sheath for it; and it is inserted into the pit on the back
of the os femoris, at the root of the trochanter major.
* Varieties. It is sometimes split by the sciatic nerve, and when the latter di-
vides very high up, by one of its portions only.
•j- Varieties. The upper one, occasionally, does not exist, whereby a striking
resemblance with apes is established. Sometimes both are wanting.
38*
450 MUSCLES.
Between the tendon of this muscle and the gemini is a long
bursa; a second is found where the muscle plays over the is-
chium.
It rotates the limb outwards.
The Quadratus Femoris,
Is lower down than the other muscles. It arises, tendinous
and fleshy, on the outer side of the ischium, from the ridge
which constitutes the exterior boundary of the tuberosity. Its
fibres are transverse, and are inserted, fleshy, into the rough
ridge of the os femoris, on its back part, which goes from one
trochanter to the other.
It rotates the limb outwards. A bursa exists between it and
the trochanter minor.*
The Obturator Externus,
Is concealed, in front, by the pectineus and triceps adductor,
and, behind, by the quadratus femoris: to get a satisfactory
view of it, therefore, these muscles should be detached from the
bone. It arises from the whole anterior circumference of the
foramen thyroideum, excepting the place where the obturator
vessels come out, and from the anterior face of the ligamentous
membrane stretched across it.
The fibres of this muscle converge, pass beneath the capsu-
lar ligament of the hip joint adhering to it, and terminate suc-
cessively in a round tendon, which is inserted into the inferior
part of the cavity on the posterior surface of the os femoris, at
the root of the trochanter major. The course of the tendon of
this muscle is marked on the neck of the thigh bone by a su-
perficial fossa.
It rotates the thigh outwards.
* Varieties. Occasionally, this muscle is absent; more rarely it is divided into
a great number of fasciculi, amounting in one instance to thirty.
MUSCLES OF THE THIGH. 451
The Sleeps Flexor Cruris,
Constitutes the outer hamstring, and is situated on the pos-
terior outer part of the thigh; it arises by two heads. The
first, called the long head, has an origin, in common with the
semi-tendinosus, from the upper back part of the tuberosity of
the ischium, by a short tendon, which, in its descent, is changed
into a thick fleshy belly. The other, called the short head,
arises, by an acute fleshy beginning, from the linea aspera just
below the insertion of the glutaeus magnus, and this origin is
continued along the lower part of the linea aspera and from
the ridge leading to the external condyle.
A thick tendon is gradually formed on the outside of the
muscle, which, descending along the external face of the ex-
ternal condyle, is inserted into the superior face of the head of
the fibula at its point. A bursa is found between this tendon
and the external lateral ligament of the knee.
This muscle flexes the leg on the thigru*
, T/i e Se m iten dinosus,
Is on the inside of the thigh, between the biceps andgracilis;
it is superficial, being immediately under the fascia, and arises,
in common with the biceps, from the back part of the tuberosi-
ty of the ischium; it also adheres, for three or four inches, to
the inner edge of the tendon of this the long head of the
biceps.
About four inches above the knee it terminates in a long
round tendon, which passes behind the internal condyle and
the head of the tibia, and is reflected forwards to be inserted
into the side of the tibia, just below its tubercle and very near
it, being lower down than the insertion of the' tendon of the
gracilis. Its insertion is much connected with that of the gra-
* Varieties. Sometimes the short head does not exist, thereby affording an
analogy with animals. Sometimes there is a third head, but more delicate, which
comes either from the tuber of the ischium or from the long head, and descend-
ing along the back of the leg, runs into the tendo-aehillis, corresponding there-
by with the arrangement of mammiferous animals..
452 MUSCLES.
cilis, and is generally divided into two slips, one above the
other.
Between its origin, that of the long head of the biceps, and
the semimembranosus, there is a bursa : one or more are like-
wise found between its tendon below, that of the sartorius, of
the gracilis, and the internal lateral ligament of the knee.
It flexes the leg on the thigh.*
The Semimembranosus,
Is at the inner side of the thigh ; its upper part is concealed
by the semitendinosus and the origin of the long head of the
biceps, and below it projects between these two muscles. It is
in contact with the posterior surface of the adductor magnus.
It arises, by a thick round tendon, from the exterior upper
part of the tuberosity of the ischium, which tendon soon be-
comes flattened, and sends off the muscular fibres obliquely
from its exterior edge to a corresponding tendon below. The
latter passes behind the internal condyle and the head of the
tibia, and despatches a thin aponeurotic membrane under the
inner head of the gastrocnemius, to cover the posterior part of
the capsule of the knee joint, and to be fastened to the external
condyle.
It is inserted, by a round tendon, into the inner and back
part of the head of the tibia, just below the joint. The unfa-
vourable insertion of this muscle is compensated for by the
multitude of its fibres, which gives it a great increase of
strength.
A bursa exists between its tendon above and the quadratus;
another exists between its tendinous termination, the internal
head of the gastrocnemius, and the capsule of the knee.
It flexes the leg on the thigh.
SECT. III. MUSCLES OF THE LEG.
These muscles are situated anteriorly, posteriorly, and ex-
ternally.
* Varieties. Sometimes it is divided into three sections by two transverse
tendinous lines.
MUSCLES OF THE LEG. 453
The Tibialis Anticus,
Is situated superficially under the fascia of the leg, at the
outside of the spine of the tibia, and in front of the interosseous
ligament. It arises, fleshy, from the head of the tibia, from its
outer surface, spine, and from the interosseous ligament to
within three or four inches of the ankle. It also arises, by its
front surface, from the internal face of the fascia of the leg.
A rounded long tendon is formed in front below, into which
the fleshy fibres run obliquely, and which, passing through a
distinct noose of the annular ligament in front of the malleolus
internus, crosses the astragalus and os naviculare, and is in-
serted on the inner side of the sole of the foot into the anterior
part of the base of the cuneiforme internum, and into tha adja-
cent part of the metatarsal bone of the great toe.
A bursa surrounds the tendon where it passes beneath the
annular ligament; another also exists at its lower part.
This muscle corresponds with the radial extensors of the
arm.
It bends the foot, and presents the sole obliquely inwards.
The Extensor Longus Digitorum Pedis,
Is also superficially placed just under the fascia of the leg
and in front of the fibula, being in contact above with the tibi-
alis anticus, and 'below with the extensor proprius pollicis. It
arises, tendinous and fleshy, from the outer part of the head of
the tibia ; from the head of the fibula, and almost the whole
length of its anterior angle; also from the upper part of the
interosseous ligament and the internal face of the fascia of the
leg.
Its fibres go obliquely downwards and forwards to the ten-
don which begins not far from its upper end, and descends
along its anterior margin. About the middle of the leg the ten-
don splits into four, which are confined by the annular liga-
ment of the ankle, and then diverging, each is inserted into the
base of its respective toe, the big excepted, and expanded over
its back part as far as the last phalanx.
When these four tendons first reach the roots of the toes,
454 MUSCLES.
they expand over the back of the articulation there, and send
downwards triangular processes which are attached to the
base of the first phalanx, and to the tendinous terminations of
the interosseous muscles. On the back of the first joint the
tendon adheres closely to its synovial membrane, and is some-
what cartilaginous. At ,the second joint the tendon splits par-
tially into two, which pass somewhat laterally, and then re-
unite. The tendon then adheres again closely to the synovial
membrane of the third articulation, and finally terminates in
the base of the third phalanx.
This muscle extends the toes, but flexes the foot.
A long bursa is found enveloping the tendons where they
pass beneath the annular ligament of the ankle.
It extends all the joints of the small toes, anxl flexes the foot.
The Peroneus Tertius,
Is rather a portion of the extensor longus, is found at its
lower outer part, and cannot be naturally separated from it. It
arises from the anterior angle of the fibula, between its middle
and lower end.
It is inserted, by a flattened tendon, into the base of the me-
tatarsal bone of the little toe, and assists in bending the foot.
The Extensor Proprius Pollicis Pedis,
Is between the lower part of the tibialis anticus, and of the ex-
tensor longus. It arises from the fibula between its anterior
and internal angles, by a tendinous and fleshy origin, which
commences about four inches below the head of the fibula, and
continues almost to its inferior extremity. A few fibres also
come from the interosseous ligament, and from the lower part
of the tibia.. .
The muscle being half penniform, the fibres run obliquely to
a tendon at its fore part, which passes through a particular gut-
ter of the annular ligament, and over the astragalus and sca-
phoides and upper internal parts of the foot, to be inserted into
the base of the first and second phalanx of the great toe. A
MUSCLES OF THE LEG. 455
bursa invests this tendon where it passes beneath the annular
ligament.
It extends, as its name implies, the great toe.*
On the outside of the leg, between the fibula and fascia, are
the two Peronei muscles.
The Peroneous Longus, sen Primus,
Arises, tendinous and fleshy, from the fore and outside of
the head of the fibula, from the space on its outer side above,
between the external and anterior angles; also, from its external
angle to within a short distance of the ankle.
A flattened thick tendon, to which the fibres pass obliquely,
constitutes the outer face of the muscle. This tendon is lodged
in the groove at the posterior part of the malleolus externus,
being confined to it by a thick ligamentous noose, and furnished
there with a bursa; it then traverses the outer side of the os cal-
cis, where its passage is marked by a superficial sulcus; it then
runs through the groove of the os cuboides, where there is ano-
ther bursa. Lying deep in the sole of the foot, covered by the
calcaneo-cuboid ligament, and next to the tarsal bones, it is in-
serted into the base of the internal cuneiform bone, and into the
adjacent part of the metatarsal bone of the great toe.
It extends the foot and inclines the sole obliquely outwards.
It corresponds with the flexor carpi ulnaris of the fore arm.
As the tendon experiences much friction at the ankle, on the
os calcis, and where it winds around the os cuboides, it is not
unusual to find in it small sesamoid bones there, especially at
the latter place.
The Peroneus Brevis, sen Secundust
Is concealed in a great degree by the peroneus longus, being
situated between the latter and the extensor longus digilorum.
It arises, tendinous and fleshy, from the outer surface of the
fibula, commencing about one-third of the length of the bone
from its head, and continuing almost to the ankle.
Varieties. A partial effort is sometimes manifested to divide it into two mus-
cles.
456 MUSCLES.
A tendinous facing exists externally also in this muscle, to
which its fibres proceed obliquely. This tendon is continued
through the fossa at the back part of the malleolus externus, be-
ng covered by the tendon of the peroneus longus, and confined
by the same ligamentous noose; passing through the superficial
fossa at the outer side of the os calcis, it is inserted into the ex-
ternal part of the base of the metatarsal bone of the little toe.
Jt extends the foot, and presents the sole obliquely down-
wards. It corresponds with the flexor carpi ulnaris.*
Triceps Surce.
The muscular mass on the back of the leg, constituting its
calf, is formed by the two following muscles, which, with much
reason, may be considered as composing only one. Anatomists,
who view them in this latter light, describe them under the
name of Triceps Sura?, of which the Gastrocnemius portion has
two heads, and the Soleus, or Gastrocnemius internus, but one.
1. The Gastrocnemius is the most superficial muscle on the
back of the leg, and conceals the other, in consequence of its
breadth. It comes from the condyles of the os femoris by two
heads. One head arises, tendinous, from the up-per back part of
the internal condyle, and fleshy from the ridge leading to the
linea aspera: the other head arises, by a broad tendon in the
same way, from the external condyle and the ridge above it.
A triangular vacancy is left between the heads of the muscle
for the passage of the popliteal vessels; the heads then join to-
gether, but in such a way that the appearance of two bellies is
distinctly preserved, of which the internal is the largest. The
muscular fibres pass from a broad tendinous facing on the back
to a corresponding one on the front surface of the muscle, from
the latter of which comes the tendo-achillis.
2. The Soleus is beneath the Gastrocnemius, and arises, fleshy,
from the posterior part of the head of the fibula, and from the
external angle of that bone, for two-thirds of its length down,
behind the peroneus longus. It also arises, fleshy, from the ob-
* Varieties. It is sometimes double.
MUSCLES OF THE LEG. 457
lique ridge on the posterior surface of the tibia, just at the lower
edge of the popliteus muscle, and from the internal angle of the
tibia for four or five inches. The two origins are separated for
the passage of the posterior tibial vessels.
The body of this muscle has a great intermixture of tendinous
matter in it, and from its lower extremity proceeds another
origin of the tendo-achillis. About three or foftr inches above
the heel, this tendon joins the anterior face of the tendon of the
gastrocnemius, and by the union of the two the tendo-achillis
is completed, and then inserted into the posterior surface of the
os calcis near its tuberosities. The tendon becomes more round
as it descends.
These muscles extend the foot, and are all-important in walk-
ing. A bursa is between their tendon and the os calcis.
'The Plantaris,
is a singular little muscle, concealed by the gastrocnemius,
and has a short fleshy belly and a long tendon. It arises, fleshy,
from the ridge of the os femoris, just above the external eon-
dyle, passes across the capsular ligament of the joint, and ad-
heres to it in its course; the belly terminates somewhat below
the head of the tibia, in a long, delicate tendon, which descends
between the inner part of the soleus and the gastrocnemius.
At the place where the tendons of these unite, the tendon of
the plantaris emerges from between them, and, running at the
inner edge of the tendo-achillis, is inserted into the inside of the
os calcis, just before the insertion of the latter.
It extends the foot. This muscle is sometimes wanting. It
contributes so little to the motions of the foot, and, in other re-
spects, is of such doubtful use, that its proper destination is un-
certain. In some mammiferous animals it is large and impor-
tant; perhaps, therefore, in the human subject, it is one of the
links connecting us with animals, of which there are many evi-
dences in the muscular system.
The Popliteus,
Is a triangular muscle on the back of the knee joint. It arises,
by a thick round tendon, from a deep depression on the exte-
VOL. I.— 39
458 MUSCLES.
rior face of the external condyle, passes through the capsular
ligament, being connected with the external semi-lunar carti-
lage ; and then forms a fleshy belly which passes obliquely in-
wards and downwards.
It is inserted, fleshy, into the oblique ridge on the back of the
tibia, just below its head, and into the triangular depression
above it. A bursa exists between its origin and the capsular
ligament ; its tendon is in contact with the synovial membrane
of the joint.
It bends the leg, and rotates it inwards, when bent.
The Flexor Longus Digitorum Pedis Perforans,
Is behind the tibia, and at the inner edge of the tibialis pos-
ticus. It arises, by an acute, tendinous and fleshy beginning,
from the back of the tibia, a little below the popliteus muscle;
its origin being continued along the internal angle of the tibia
almost to the ankle joint. It arises, also, by tendinous and
fleshy fibres, from the outer edge of the tibia, just above its con-
nexion with the fibula at the ankle: the latter origin is, how-
ever, frequently deficient, and between this double order of
fibres the tibialis posticus passes.
The fibres go obliquely into a tendon at the posterior edge
of the muscle, which runs in the groove behind the internal
malleolus, and is confined there by a strong ligamentous sheath,
being placed behind, and within the tendon of the tibialis pos-
ticus. The tendon then gets to the sole of the foot along the
sinuosity of the os calcis, and being joined by a considerable
tendon, detached from the flexor longus pollicis, it divides into
four branches which are appropriated to the four smaller toes.
These tendons are inserted into the base of the last phalanges
of the lesser toes, are very near the tarsal bones, and, from per-
forating the tendons of the flexor brevis, correspond with the
flexor perforans of the hand. A bursa exists where the tendon
passes along the tibia and the os calcis; and another is found in
the sole of the foot, enveloping this tendon and that of the flexor
longus pollicis.
A fifth tendon is sometimes observed, which splks and goes
MUSCLES OF THE LEG. 459
to the second bone of the small toe: this occurs when the lat-
ter is not supplied from the flexor brevis.
This muscle flexes the small toes, and extends the foot.
The Flexor Longus Pollicis Pedis,
Is a stout muscle formed of oblique fibres, and situated on the
back part of the fibula, at the outer side of the tibialis posticus.
It arises, by an acute, tendinous and fleshy beginning, from the
posterior flat surface of the fibula, commencing about three
inches from its head, and continuing almost to the ankle,
The tendon of this muscle is large and round; it forms gra-
dually, and constitutes a facing to the posterior edge of the mus-
cle. It passes, through a superficial fossa of the tibia, at the
back of the ankle near its middle, and from thence through a
notch in the back edge of the astragalus, to the sole of the foot;
at the latter place it crosses the tendon of the flexor longus di-
gitorum, and gives off to it the branch just mentioned, which
goes, principally, to the second toe. This tendon is deeper
seated in the foot than the other.
The tendon of the flexor longus pollicis is inserted into the
last phalanx of the great toe.
It bends the great toe, and from its connexion with the others
will bend them also. A bursa invests its tendon in the canal
of the astragalus, and along the os calcis; another, as stated, is
common to it and the last muscle; and a third invests the ten-
don along the metatarsal bone, and the first phalanx of the great
toe.*
The Tibialis Posticus,
Is placed between, and concealed by the last two muscles. It
arises by a narrow fleshy beginning, from the front of the tibia,
at the under surface of the process which joins it to the fibula,
and then gets to the back of the leg through the hole in the up-
per part of the interosseous ligament. It continues its origin
from the whole of the interosseous ligament, and from the sur-
* The variations in this muscle consist, principally, in the manner of distri-
buting its tendon to that of the small toes, and frequently this connexion is defi-
cient.
460 MUSCLES.
laces of the tibia and fibula bordering on this ligament, except-
ing one-third of the lower part of the fibula, and rather more of
the lower part of the tibia.
The fleshy fibres run obliquely to a middle tendon which
passes in the groove at the back of the malleolus internus, and
is confined there by a fibro-cartilaginous noose, and invested by
a bursa. It is inserted into the posterior internal part of the os
naviculare or scaphoides, at its tuberosity; and also divides in
such a way as to be inserted into the internal and external cu-
neiform bones, into the os cuboides, and os calcis.
It extends the foot, and presents the sole obliquely inwards.
It corresponds with the flexor radialis of the hand*
SECT. IV. OF THE MUSCLES OF THE FOOT.
The. Extensor Brevis Digitorum Pedis,
Is a muscle situated on the superior surface of the foot. It is
placed beneath the tendons of the extensor longus, and arises,
tendinous and fleshy, from the fore upper part of the greater
apophysis of the os calcis, being intermixed with the origin of
the annular ligament of the ankle. It forms a short, fleshy bel-
ly, which is partially divided into four parts; from these parts
proceed as many tendons, which crossing very obliquely the
tendons of the extensor longus, are inserted into the great toe,,
and the three next toes, by joining with the tendons of the ex-
tensor longus, which are spread over their backs. The tendoa
going to the great toe has its principal insertion into the first
phalanx.
It extends the toes.*
When the Aponeurosis Plantaris is removed from the sole of
the foot, we see three muscles; the middle one having been co-
vered by the large central portion of the aponeurosis, is the
Flexor Brevis Digitorum Pedis; the outer, is the Abductor Mi-
nimi Digiti Pedis; and the inner, the Abductor Pollicis Pedis.
* Varieties. The internal part, or belly, is sometimes distinct from the adjoin-
ing. In some very rare cases all the bellies are insulated, as in birds. Sometimes
it sends a tendon to the little toe.
MUSCLES OF THE FOOT. 461
The, Flexor Brevis Digilorum Pedis,
Arises, fleshy, from the large tuberosity of the os calcis, by a
narrow beginning; also from the upper surface of the aponeu-
rosis plantaris, and the tendinous septa between it and the con-
tiguous muscles.
It forms a fleshy belly, going nearly as far forwards as the
middle of the metatarsal bones ; there it divides into four tendons,
which go to the four smaller toes.. These are perforated by the
tendons of the flexor longus, and are inserted into the sides of
the second phalanges. The tendon for the little toe is often de-
ficient.
It bends the second joint of the toes.
By detaching this muscle from its origin, and turning it down,
we bring into view the tendon of the Flexor Longus Digitorum
Pedis; and the attachment of the latter to the tendinous slip from
the Flexor Longus Pollicis, — to the Massa Carnea Jacobi Sylvii,
or Flexor Accessorius, — and to the Lumbricales Muscles.
The Flexor *flccessorius,
Is at the outside of the tendon of the flexor longus. It arises,
fleshy, from the inside of the sinuosity of the os ealcis, and, by
a thin tendon, from the outside of the same bone before its tu-
berosities.
It is inserted, fleshy, into the outside of the tendon of the flexor
longus, just at its division into four tendons. Like a second hand
to a rope, it assists in flexing the toes.
The Lumbricales Pedis,
Are four small tapering muscles, which arise from the tendon
of the flexor longus, just after its division, or while it is in the
act of dividing. One of them is appropriated to each lesser toe,
and is inserted into the inside of its first phalanx, and into the
tendinous expansion that is sent off from the extensor muscles to
cover its dorsum.
They increase the flexion of the toes, and draw them inwards.
39*
462 MUSCLES.
The Mduclor Polticis Pedis,
Arises, tendinous and fleshy, from the internal anterior part of
the large tuberosity of the os calcis; from a ligament being a
part of the aponeurosis of the sole of the foot extended from this
tuberosity to the sheath of the tendon of the tibialis posticus;
from the internal side of the naviculare, and from the cuneiforme
internum.
It forms the internal margin of the sole of the foot, and is in-
serted, tendinous, into the internal sesamoid bone, and into the
base of the first phalanx of the great toe.
It draws the great toe from the rest.
The Flexor Brevis Pollicis Pedis,
Is situated immediately at the exterior edge of the abductor
pollicis. It consists of two bellies, which are parallel with each
other, and separated by the tendon of. the flexor longus pollicis;
one is inseparably connected with the tendon of the abductor
pollicis, and the other with the adductor pollicis pedis.
It arises, in common with the calcaneo-cuboid ligament, ten-
dinous, from the under part of the os calcis, just behind, its con-
nexion with the os cuboides, and from the under part of the ex-
ternal cuneiform bone.
The internal belly is inserted, tendinous, into the internal se-
samoid bone, along with the tendon of the abductor pollicis, and
the external belly is inserted, tendinous, into the external sesa-
moid bone, along with the tendon of the adductor pollicis.
Each insertion is continued to the base of the first phalanx of
the great toe.
Jt flexes the great toe>
The Adductor Pollicis Pedis-,
Is situated at the outside of the flexor brevis, and is extended
obliquely across the metatarsal bones. It arises, tendinous, at
the external part of the foot, from the calcaneo-cuboid ligament,
and from the roots of the second, third, and fourth metalar.sa!
bones...
MUSCLES OF THE FOOT. 463
It is inserted, tendinous, into the external sesamoid bone,
which insertion is continued to the first phalanx of the great
toe, and is closely united to the tendon of the external head of
the flexor brevis pollicis,
It draws the great toe towards the others.
The Mductor Minimi Digiti Pedis,
Forms the external margin of the sole of the foot, and is im-
mediately beneath the aponeurosis plantaris. It arises, tendi-
nous and fleshy, from the outer tuberosity of the os calcis, and
also from the exterior part of the base of the metatarsal bone of
the little toe.
It is inserted, by a rounded tendon, into the exterior part of
the base of the first phalanx of the little toe.
It draws the little toe from the other toes.
The Flexor Brevis Minimi Digiti Pedis,
Is just within the tendon of the abductor minimi digiti. It
arises from the calcaneo-cuboid ligament as extended from
the tuberosity of the cuboid bone to the heads of the two outer
metatarsal bones; also from the root of the outer or fifth meta-
tarsal bone.
It is inserted, by a tendon, into the lower part of the first pha-
lanx of the little toe, at its base, and into the head of the meta--
tarsal bone of the same toe.
It bends the little toe.
The Transfer salis Pedis $
Is placed beneath the tendons of the flexor muscles.* It is
small, and lies across the anterior extremities of the metatarsal
bones. It arises, tendinous, from the capsular ligament of the
first joint of the little toe; it also arises from the capsular liga-
ment of the first joint of the next toe.
I.t is inserted into the exterior face of the common tendon oC
* The sole is presumed to be upwards.
i
464 MUSCLES.
the adductor and the flexor brevis pollicis, at the external sesa-
moid bone.
It approximates the heads of the metatarsal bones.
The Interosseous Muscles are seven in number, four of which
may be seen on the upper surface of the foot. There are two
to the first smaller toe, two to the second, two to the third, and
one to' the fourth, or little toe. The muscles seen on the upper
side of the foot are double-headed, that is, they arise from the
contiguous surfaces of the metatarsal bones.
The Interosseus Primus, Digiti Primi Pedis, or the Jlbductor
Indicts Pedis,
Is seen superiorly. It is placed between the metatarsal bone
of the great toe, and the first small toe, and arises, fleshy, by a
double head, from the opposed surfaces of their roots and bodies.
It is inserted, tendinous, into the inside of the root of the first
joint of the first small toe, and pulls it inwards.
The Interosseus Secundus, Digiti Primi, or the Adductor Indicis
Pedis,
Is also external or above. It is situated between the meta-
tarsal bones of the first and second small toes, arising from the
opposed surfaces of their roots and bodies by a double, fleshy,
and tendinous head.
It is inserted into the outside of the first phalanx of the same
toe, by a tendon.
It draws this toe outwards.
The Interosseus Secundus, Digiti Secundi, or the Adductor
Medii Digiti,
Is seen at the upper part of the foot, betvveen the second and
third metatarsal bones of the lesser toes, arising from the oppo-
site surfaces of their roots and bodies.
It is inserted, tendinous, into the outside of the base of the
first phalanx of the second small toe.
It draws this toe outwards.
MUSCLES OF THE FOOT. . 465
The Interosseus Secundus, Digiti Tertii, or the Adductor Tertii
Digiti,
Is seen on the upper surface of the foot, occupying the inter-
val of the metatarsal bones of the third and fourth small toes,
and arises, by a double head, from the opposite surfaces of their
roots and bodies.
It is inserted, tendinous, into 4he outside of the root of the
first phalanx of the third small toe.
It draws this toe outwards.
The Interosseus Primus, Digiti Secundi Pedis, or the Abductor
Medii Digiti,
Is at the bottom of the foot, and arises from the inside of the
metatarsal bone of the second smaller toe.
It is inserted into the inside of the first phalanx of the second
toe.
It draws this toe inwards.
The Interosseus Primus, Digiti Tertiit or the Abductor Tertii
Digiti,
Is in the sole of the foot. It arises from the inside of the me-
tatarsal bone of the third smaller toe, beginning near its root,
and is. inserted, tendinous, into the inside of the base of the first
phalanx of the same toe.
It draws this toe inwards.
The Interosseus seu Adductor, Digiti Minimi,
Is on the under surface of the foot. It arises from the inside
of the base and body of the metatarsal bone of the fourth small,
or the little toe, and is inserted, tendinous, into the inside of the
first phalanx of the little toe.
It draws this toe inwards.
BOOK IV.
OF THE ORGANS OF DIGESTION.
THE organs of digestion consist in an uninterrupted canal ex-
tending from the lips to the anus; and of numerous glandular
bodies placed all along its track, for pouring their secretions
into it.
This canal, called Alimentary, (Ductus Cibarius,) is in three
principal portions: the superior, the middle, and the inferior or
terminating. The superior portion is composed of the mouth,
the pharynx, and the oesophagus. The middle, of the stomach
and small intestine. And the inferior, of the large intestine.
The glandular organs are the salivary glands, the pancreas,
the liver, the spleen, and an extremely numerous set of mu-
ciparous glands, extending from one end to the other of the
canal.
The organs of digestion may be divided, according to their
physical functions, into those of mastication and deglutition, and
into those of assimilation.
BOOK IV.
PART I.
Organs of Mastication and Deglutition.
CHAPTER I.
OF THE MOUTH.
THE Mouth (Cavum Oris) occupies the space in the inferior
part of the face, between the upper and the lower jaw. It is
separated from the nose by the palatine processes of the supe-
rior maxillary and palate bones, and by the soft palate, which
is continued backwards from them. It extends from the lips,
in front, to the soft palate and pharynx behind, and its floor is
formed by the mylo-hyoid muscles.
The anterior and lateral periphery of the mouth is constituted
by the muscles of the lips and cheeks, covered externally by
common skin, and internally by the lining membrane of the
mouth. The cavity of the latter is divided into two portions,
by the projection of the teeth and of the alveolar processes of
the upper and under jaws; these two portions, when the teeth
are complete, are separated from each other while the mouth
is closed. The anterior portion, which is sometimes called the
vestibule of the mouth, varies its size very considerably in
mastication, and has its parietes extremely moveable. The ca-
paciousness of the posterior admits also of much change, by the
motions of the tongue and by. the depression of the lower jaw.
The whole cavity of the mouth is lined by a membrane, con-
tinued over the lips from the skin, and, in many respects, strong-
ly resembling the texture of the latter; it is, however, much
VOL. I.-— 40
470 ORGANS OF DIGESTION.
finer; is furnished every where with an epidermis; is very vas-
cular, and has beneath it a great number of muciparous glands.
Its texture undergoes some changes, according to its position,
upon the lips and cheeks, upon the gums and palate, and upon
the tongue ; all of which will be explained in due season.
This lining membrane of the mouth, for the most part thin
and very flexible, forms, at several points, folds or duplicatures.
Four of them are situated on the middle line of the body, and
are called frenula: one goes from the posterior face of the upper
lip to the middle palate suture in front of the central alveolar
processes of the upper jaw ; a second goes from the posterior
face of the lower lip to the front of the symphysis of the lower
jaw; a third goes from the under part of the tongue to the pos-
terior face of the symphysis of the lower jaw, (frcenulum lin~
guce ;) and the fourth goes from the front of the epiglottis carti-
lage to the middle of the root of the tongue. Besides these,
there are some other duplications, which wilt be mentioned in
their proper order.
The lips (Labia) are always somewhat thicker at their loose
margins than elsewhere; the skin which covers them there, is
remarkable for its vascularity, and changes its texture insensi-
bly, as it is continued from the face to the lining membrane of
the mouth.
The upper lip is longer and thicker than the lower, is some-
what pointed in the centre, and has on its front surface a ver-
tical depression, (philtrum,) beginning at the septum of the nose
and going downwards to the centre of the lip. This depression
is the remains of a fissure which always exists between the two
halves of the lip, in the early foetal or forming stage. The
junction of the extremities of the lips constitutes the corners of
the mouth (anguli oris.)
The lips are composed of muscular fibres, much blended with
adipose matter. The muscles which concur to form them are
the orbicularis oris and the buccinators ; besides which, the up-
per lip is furnished on each side with the two levators, with the
depressor, and the zygomatici ; while the lower lip has its two
depressors and a Jevator. See muscles of the face.
OF THE TEETH. 471
CHAPTER II.
OF THE TEETH.
THE Teeth (Denies) are by far the hardest portions of the
human fabric ; and though they bear in their composition and
appearance a strong analogy with bone, yet they diner from it
in their more limited duration, their mode of development,
their partial nudity, their nutrition, and in the manner by which
they are united to the body.
The greater part of the length of each tooth is implanted
into the alveolar process of the jaw, and the part so fixed is
technically called the root; immediately beyond this a small
portion of the tooth is embraced by the gum; this is the neck;
and the free, or projecting 'part of the tooth covered with a
shining porcelain like layer called the enamel, is its body.
SECTION I.
The whole number of teeth in the adult is thirty-two, sixteen
in each jaw, and, when healthy, they are all fixed with so much
firmness by the gomphosis articulation, that the very slight de-
gree of motion, which, by force, they may be caused to exe-
cute, is scarcely perceptible. The differences existing in their
shape, have caused anatomists to classify them accordingly;
on each side of the middle line of each jaw there are two Inci-
sors, one Cuspated, two Bicuspated, and three Molar teeth.
There are also some peculiarities, as they belong to the upper
or to the lower jaw; but they correspond exactly with their
fellows on the opposite side of the same jaw.
The Incisors (Denies Incisivi) are next to the middle line,
and are named from their being brought to a straight cutting
edge, like a chisel, by being bevelled from behind. They are
somewhat convex on their anterior faces, but behind they are
472 ORGANS OF DIGESTION.
very concave: owing to their thinness for some distance from
the cutting edge, they are apt to be broken. In early life, their
cutting edge is slightly serrated. They have each but one
root, which is conoidal, terminates by a sharp point, and is not
unfrequently impressed longitudinally on each side by a super-
ficial furrow.
The central incisors of the upper jaw are broader and longer
than the outer ones ; the anterior face of the latter is more con-
vex, and their cutting edge more rounded. The incisors of the
lower jaw are much narrower than those of the upper, and
have their roots flattened on the sides; they do not differ essen-
tially among themselves, except that the external ones are some-
what wider than the internal.
The enamel of the incisors is continued farther down, and is
thicker on their anterior and posterior surfaces than laterally;
it is also thicker on the front than on the back part.*
The Cuspated Teeth (Denies Cuspidati, Canini,) are next to
the incisors, one on each side. Their body is conoidal, and is
brought to a sharp point at its summit; the principal obliquity
in effecting the latter, being on the side of the interior of the
mouth. They are more convex externally, than the incisors,
but not so concave internally, they are also thicker and more
cylindroid. They have each but one root, which is conoidal,
and which, as also the body, is longer than the corresponding
portion of any of the other teeth. They stand nearly perpen-
dicularly, and are more covered on their sides with enamel
than the incisors.
The cuspated teeth of the upper jaw have longer roots than
those of the lower, and are called, in common language, eye-
teeth : those of the lower jaw sometimes are called stomach-
teeth.
The Bicuspated Teeth (Denies Bicuspidati,) two in number
on each side, are situated behind the cuspate; they are also
called small molar. They are almost precisely alike, with the
exception that the first is smaller than the other, and resembles
rather more the type of the cuspidatus than the second does.
* Natural History of the Human Teeth, by J. Hunter, London, 1778.
OF THE TEETH. . 473
Their body is very nearly cylindrical, being flattened, however,
on the faces next to adjoining teeth. The masticating surface
of the body is formed into two points, whence the name ; one
external, and the other internal: the former is the longest and
thickest, and, consequently, the most conspicuous. The ena-
mel forms an almost circular crown, covering the projecting
parts of these teeth. The root of each one is single, but has a
deep and well marked fossa on each side running its whole
length, and presenting the semblance of an effort at duplicity;
it is also conoidal, and sometimes in the upper jaw bifurcated
at its end.
The bicuspate teeth of the upper and of the lower jaw re-
semble each other so strongly that the difference between them
is not striking; it is, however, determined by those of the up-
per jaw being rather more voluminous and ovoidal in their bo-
dies, and having rather longer and larger roots.
The Molar Teeth, (Denies Molares,) three in number, on each
side, succeed the bicuspated. They are well characterized by
their greater size. Their bodies are almost cuboidal, with
rounded angles, and are protected with a circular crown of
enamel; their grinding surface has five points, three externally,
and two internally: the rule, however, is not uniform, as they
frequently have only four, and sometimes in the upper jaw only
three points.
The first molar is the largest of any, and very generally has
five points, in the upper jaw it has three roots, two of which
are outward, and the other inward; but in. the lower jaw it has
only two roots, one before the other.
The second molar of each jaw, with the exception of its being
smaller than the first, presents no essential difference from it,
either in regard to its body or roots. The fifth point is some-
times not so well developed.
The third molar resembles the other two in its body, but is
smaller than either of them. Most frequently its roots, instead
of diverging from each other and standing out distinctly, are
imperfectly developed, and fused together. Some slight sepa-
ration at their extremities, and the longitudinal depressions on
their sides, mark the effort to form three roots for the tooth of
the upper jaw, and two for the lower, according to the general
40*
474 ORGANS OF DIGESTION.
rule. Owing to this tooth growing at the posterior extremity
of the alveolar processes, in a place where, from the preceding
development of the other teeth, it is much cramped for room,
it is not only imperfectly evolved in most cases, but it often
takes a very irregular direction; its grinding surface sometimes
looking forwards and sometimes backwards.
The Alveolar Processes in each jaw form a semi-elliptical
row of sockets, for the insertion of the roots of the teeth into
them. These processes and the teeth, as Mr. Hunter has very
properly explained, have such a mutual dependence upon each
other, that the destruction of the one is inevitably followed by
that of the other: "If we had no teeth, it is likely we should
not only have no sockets, but not even these processes in which
the sockets are formed."* The semi-elliptical arrangement ob-
served by the teeth is such, that when the mouth is closed, the
exterior circumference of the row above projects beyond those
below; this is more obviously ihe case in front; but it also pre-
vails at the sides, and depends primarily upon the greater
breadth of the incisors of the upper jaw. The grinding sur-
face of the under row, as a whole, is slightly concave from be-
fore backwards, while the opposed surface of the upper row
has a corresponding convexity. Each row, viewed collective-
ly, forms a single edge, in front; but after having passed the
cuspidati, it becomes thicker, forms a double edge, and is con-
tinued backwards in that state.
SECT II. OF THE TEXTURE AND ORGANIZATION OF THE TEETH.
The teeth consist in two kinds of substance, one of which is
ivory or bone-like, and the other enamel.
. The Enamel forms the periphery of the body of a tooth, and
is distinguished by its whiteness, its brittleness, its semi-trans-
parency, and a hardness so considerable that it soon takes down
the edge of the best tempered saw or file, so that it is very dif-
* Loc. cit. p. 7.
TEXTURE AND ORGANIZATION OF THE TEETH. 475
ficult to penetrate it. It forms a crust upon the body scarcely
half a line in thickness, is more abundant upon the grinding
surface, and is reduced to a thin edge where it terminates at the
neck. When broken, it is seen to be fibrous, and the fibres are
so placed as to pass in a direction from the surface towards the
centre" of the tooth : by which all the friction to which the fibres
are exposed is applied against their extremities : an arrange-
ment on the principle of the articular cartilages, and, like them,
precisely suited to resist their being rubbed down in mastica-
tion, and also to prevent their splitting.
Enamel consists principally in a phosphate of lime, with a
very small proportion of gelatine. When immersed in a weak
acid, its form is retained, but the slightest disturbance afterwards
causes it to crumble down into a white pulp. When animals
are fed upon madder, the colour of the enamel is not affected;*
though it .may be changed by dyes applied externally, as ex-
hibited by the inhabitants of the Pebw Islands, who, by the
use of plants turn it black, and by persons who chew tobacco,
in whom it becomes yellow. It is entirely devoid of blood ves-
sels. When exposed to heat it becomes very brittle, cracks
off from the enclosed bony part of the body, and presents a
singed appearance, from the small quantity of gelatine in it.
The enamel is not so thick on the deciduous as on the per-
manent teeth; it is thicker on the cuspidati than on the incisors,
and on the first molar than on the second and third. It is very
readily dissolved in strong nitric or muriatic acid.
The Osseous portion of the tooth is by much the most abun-
dant, as it forms the root, the neck, and the body also, with the
exception of the crust of enamel upon it. In its texture it
strongly resembles the petrous bone, and is even harder than
it, but has no cellular arrangement within. It consists in a se-
ries of longitudinal laminae, one within the other, and when de-
composed presents about seventy parts of the phosphate of lime
and other calcareous combinations, with about twenty of gela-
tine and ten of water, f
* J. Hunter, loc. cit. I have also verified the same opinion by the same expe-
riment,
f Pepys.
476 ORGANS OF DIGESTION.
The bony part of a tooth has very nearly the same form with
the entire body; hence, upon the grinding surface, we have the
same modifications of shape as when the enamel is left on. The
application of a heated iron to it, turns it to a deep black from
the abundance of animal matter in it, which is one way to mark
out decidedly the distinction betwen it and enamel. The ani-
mal substance, when separated from the calcareous by muriatic
acid, is more compact than the corresponding substance of bone,
but, like it, is soft and flexible.
The bony part is not vascular; Mr. Hunter, after repeated
trials in old and young subjects upon this point, never succeed-
ed in making an injection of it; neither could he trace vessels
from the pulp to a growing tooth. In growing animals, fed
upon madder, he found that the portion which was formed pre-
viously to the commencement of this diet, retained its primitive
colour, while the part formed during the administration of the
diet was affected by it and turned red: again, if the animal were
permitted to live some weeks after the madder was suspended,
to the preceding condition was superadded a new layer of white.
In this experiment, a conclusive difference from common bone
is established; for besides, in all cases, the facility of injecting
the latter with size, it is susceptible of being dyed throughout
by the administration of madder; though the formed parts do
not take the latter so readily as the forming. These experi-
ments, which are confirmed by my own observations, prove sa-
tisfactory the total absence of blood vessels in the texture of
the teeth; and that the colouring matter, when fixed in them,
does not depend upon a circulation, but upon its being deposited
as the tooth grows, and left there permanently. The teeth are
consequently not subjected to a mutation of particles, and to
being continually remodelled as the bones are; but when once
formed, they remain in the same state, without change.
Every tooth has within its body a cavity, which varies in
form and size according to the class to which the tooth belongs:
this cavity is continued as a conoidal canal, through the whole
length of each root, and terminates, by a small opening, at its
point. The cavity is smooth on its internal surface, and is
filled with a soft pulpy matter which has no adhesion to the
TEXTURE AND ORGANIZATION OF THE TEETH. 477
sides of the tooth, but receives, through the opening in the root,
an artery, a vein, and a nerve. The surface of the pulp is
moistened by a slight exhalation, and its principal bulk seems
to be formed by the nerve, on which the vessels ramify; the
latter in youth are much more abundant than in old age.* The
base of each projection on the grinding surface of a tooth is hol-
lowed out for receiving a process from the pulp. The latter is
supposed, by M. Serres, to be a ganglion; it must, however,
be a point of much difficulty to fix this character upon it, as the
fine cellular substance which holds its constituents together may
be readily mistaken for soft nervous fibres.
The arteries of the teeth of the upper jaw are derived from
the alveolar and the infra-orbitar, and the nerves from the se-
cond branch of the fifth pair. The arteries of the teeth of the
tower jaw come from a single branch of the internal maxillary,
and the nerves from the third branch of the fifth pair. The in-
ferior maxillary, or dental artery, and nerve, go through the
canal in the centre of the spongy structure of the lower jaw,
and send off branches successively to the roots of the teeth.
The residue of the artery and nerve issues through the ante-
rior mental foramen.
The teeth have been, till lately, very generally ranged among
the bones belonging to the skeleton ; the continental anatomistsf
are, however, now more disposed to view them as the produc-
tion of the dermoid tissue, like the nails and the hair; and to
withdraw them from the class of bones for the following rea-
sons. The rudiments of the bones are always in a cartilagi-
nous state, and they are gradually changed from that condition
to^the perfect bone; the teeth are never so, for the secretion
which forms them is from the beginning deposited in the state
in which it ever afterwards remains. The bones are all fur-
nished with a periosteum; the teeth are not, but have the sur-
faces of their bodies exposed to the air. The general soften-
ing of the skeleton which occurs in some cases of rickets, never
is manifested in the teeth.J The texture of the bones is pene-
trated in every direction with blood vessels, but only the cen-
* Serres, Essai sur 1'Anat. et Physiol. des Dents, Paris, 1817.
t J. F. Meckel, Hipp. Cloquet, Breschet, Serres, &c.
t There is, however, a species of brittleness of the teeth, in which their strength
becomes about that of pipe clay.
478 ORGANS OF DIGESTION.
Iral pulp of the teeth is furnished with the latter. The teeth
are composed of two kinds of calcarious matter, one ivory-like,
the other enamel; the bones, on the contrary, have but one.*
To this we may add, that the teeth have no power of intersti-
tial growth like the bones. It is also said by naturalists, that
in mammiferous animals, the teeth present insensible transitions
from their most perfect state to a lamellated condition resem-
bling horns and nails.t Some animals, as the shark, have the
teeth only adhering to the gum and not fixed in sockets, others
have them in the stomach : both of which circumstances serve
to illustrate still farther the independence of the teeth upon the
osseous system; and that their being fixed in sockets belonging
to the latter, is merely a collateral and not an essential ar-
rangement.
SECTION III.
The Gums (Gingivce) are a continuation of the lining mem-
brane of the mouth over the alveolar processes, but its texture
there is much changed; as it becomes more fibrous and vascu-
lar, and loses much of its sensibility and capability of being ex-
tended. As the gums cover both the lingual and the buccal cir-
cumference of the alveolar processes, they adhere very closely
to the .periosteum, and send in partitions through the interstices
between the teeth. They also adhere tightly to the neck of
each tooth, so that when the latter is drawn, the gum, unless
previously detached, is apt to be lacerated; this adhesion is by
a sort of rounded or partially doubled edge, that admits of a
slight degree of motion, and which, from its thickness, if it be
removed by ulceration or by pressure, causes the tooth to ap-
pear to project unnaturally from its socket. The teeth, from
being united to the jaw by the gum, and by the periosteum
being continued over the cavity of the socket; have preserved
to them that degree of yielding motion which prevents them,
on their unexpected and forcible application to hard bodies,
from being fractured, and also saves their sockets.J
* Serres, loc. cit.
t Traducteurs de J. F. Meckel.
$ J. Hunter, loc. cit.
FORMATION OF THE TEETH. 479
SECT. IV. OF THE FORMATION OF THE TEETH.
The teeth, before they become visible, are formed in the in-
terior of the maxillary bones. Their rudiments consist in a
vascular pulpy substance, having somewhat the shape of the
future tooth, and surrounded by two membranes or sacs.
The external sac is soft, fibrous, and spongy, and, according
to Mr. Hunter, is destitute of vessels. It lines the interior of
the socket, thereby forming its periosteum;* adheres closely by
its deepest end to the dental nerves and blood vessels, and by
its superficial one to the cartilaginous thickening which exists
on the margins of the gums of infants. Fox, Blake, and Meckel,
consider this sac vascular, which I think more probable, from
its being a continuation of the periosteum, or acting as such.
Mr. Hunter might, therefore, mean that it was comparatively
destitute of vessels, and not totally. It is more spongy, loose,
and soft, than the internal sac, and owing to its adhesion to the
gum may, by pulling at the latter, be readily drawn out entire
with all its contents. The internal sac is extremely vascular,
and when successfully injected appears red all over; it is very
thin and transparent, and was considered by Bichat as a serous
membrane. It adheres to the external sac where the latter
corresponds with the gum; but is elsewhere detached from it
with the exception of its base, where it is united by the medium
of the vessels that penetrate to the pulp, and in doing so it ob-
tains its extreme vascularity from these vessels. Between it
and the pulp there is a mucilaginous fluid like the synovia of
the joints;! which causes the internal sac to protrude like a
hernia, if a small puncture be made through the parietes of the
external one. The internal sac forms an envelope to the ves-
sels and nerves of the pulp, and being reflected along them,
terminates by adhering to the base of the pulp. When the
tooth protrudes through the gum, the" capsule thus formed by
the two sacs is perforated at its apex; and wastes away, like
the gum, till the body of the tooth is sufficiently advanced.
The two capsules which are then to be considered as the peri-
osteum of the socket and of the root of the tooth, adhere close-
* Serres, loc. cit. t Hunter, loc. cit.
480 ORGANS OF DIGESTION.
ly to the neck of the latter and to its root. These sacs, or fol-
licles, as they are sometimes called, are visible in the tenth
week of uterine existence.
The Pulp, or germ of the tooth (Pulpas Dentis) is a very
vascular body, and adheres to the socket only at its bottom,
where the vessels enter; it becomes sufficiently distinct about
the fourth month of foetal existence, and rises up then from the
base of the internal membrane of the sac like a small simple
tubercle. In developing itself it acquires the precise form pe-
culiar to each tooth, and is actually the mould for it: it is sur-
rounded by a very fine vascular web, which is detached from
it with much difficulty.
The ossification of a tooth first commences on that surface
of the pulp next to the gum, by one or more points according
to the number of projections, which the future tooth is to have
on its grinding surface. The osseous deposite in its very early
stage is thin, soft, and elastic, but soon acquires a hard con-
sistence. The incisors begin to ossify by three points, the cus-
pidatus by one, the bicuspis by two, and the molaris by three,
four or five. The several points of ossification continue to in-
crease till their bases come into contact; they then coalesce,
and afterwards the tooth grows as an entire body. The tritu-
rating surface of the tooth being first formed after this manner,
a deposite of bone then takes place along its edges, till the
body of the tooth, with the cavity in the centre, is completely
built up. Jn this progress, it gradually surrounds the pulp, till
the whole of the latter, excepting its base, is covered with
bone.
The adhesion of the pulp to the new-formed bone is such as
to require some slight force to separate them; but this may be
done without rupturing either the one or the other; their sur-
faces which were in contact are perfectly smooth, neither is
there any evidence of a vascular communication between
them.* The line of the strongest adhesion is along the latest
* Hunter, Scrrcs, Mcckel, loc. cit.
FORMATION OF THE TEETH. 481
formed edge of the tooth, and that results from the exact appo-
sition of the pulp and it.
The crown or body of the tooth being finally finished, its
base is somewhat contracted, and thus forms the neck of the
tooth. In the subsequent process of the ossification of the roots,
the number of the latter is predetermined and always indicated
by the number of distinct vessels and nerves which go to the
pulp; there are, therefore, three roots to the upper molares, two
to the lower, one to the incisors, and so on. When the root is
fully formed, its extremity is tapered off to a conoidal point ;
and the canal or hollow in it containing the pulp is diminished
to a proportionate size, so that being also conoidal, its external
end appears as a very small opening not large enough to admit
a bristle.
From the preceding account, it is clear that the bony part of
the tooth is formed by an exudation from the external surface
of the pulp; consequently, that the external lamina of the crown
is the first one deposited, and is originally of the size which it
ever afterwards retains; and that the pulp continues this secre-
tion of bony matter, from the circumference to the centre; until
the tooth, (body, neck, and root,) is completely formed. The
pulp, during this process, diminishes continually in size, but
elongates itself at the same time towards the bottom of the sock-
et; or, in the words of Mr. Hunter, " is lengthened into a fang."
As the fang grows in length, the resistance being at its end,
causes the tooth to rise through the gum;. the socket, in the
mean time, has grasped the neck, or beginning fang, and, being
modelled upon the root, arises with it.* Mr. Hunter's experi-
ments on animals, interruptedly fed on madder, prove, conclu-
sively, that the bony part of a tooth is formed of lamellae, one
placed within another ; that the outer lamella being first formed,
is consequently, the shortest, and that the internal ones lengthen
successively.
* The present doctrine about the dermoid origin of tlie teeth, seems to have pre-
sented itself forcibly to the original and sagacious mind of Mr. Hunter ; for he
says, "JBoth in the body and in the fang of a growing tooth, the extreme edge of
the ossification is so thin, transparent, and flexible, that it would appear to be
horny rather than bony, very much like the mouth or edge of the shell of a snail
when it is growing: and, indeed, it would seem to grow mueh in the same man-
ner, and the ossified part of a tooth would seem to have much the same connexion
with the pulp as a snail has with its shell/'— Nat. Hist, of Human Teeth, p. 90,
VOL. I. -41
482 ORGANS OF DIGESTION.
In the formation of a molar tooth, when the body is finished,
ossifications shoot from its brim, and proceed to the centre,
where, by their union, they form the commencement of two,
three, or even more roots. Mr. Hunter says, that also a dis-
tinct ossification is frequently found upon the centre of the base
of the pulp; and two or more processes according to the num-
ber of roots to be formed, proceed to join it from the circum-
ference of the tooth ; and in this way the fangs of the multiform
teeth begin.
The secretion of enamel begins shortly after the external la-
minae of the bony matter commence being deposited. This
secretion, which has its mould always previously formed of the
bony part, comes from a pulpy substance adhering to the inter-
nal face of the internal capsule. The pulpy substance is placed
on the part of the capsule nearest to the gum, and faces the
pulp which secretes the bone; whatever eminences the one
pulp has, the other has the same, but reversed, so that they
exactly fit upon each other. This pulp is best seen in the foetus
of seven or eight months, and is not very vascular; it is much
thinner than the other, and decreases in size as the development
of the teeth advances. That which belongs to the incisor teeth
is in contact with their concave interior surface, but in the mo-
lar it is opposed to their biting surface.*
" In the graminivorous animals, such as the horse, cow, &c.,
whose teeth have the enamel intermixed with the bony part,
and whose teeth, when forming, have as many interstices as
there are continuations of the enamel, we find processes from
the pulp passing down into those interstices as far as the pulp
which the tooth is formed from, and there coming into contact
with it.
" The enamel appears to be secreted from the pulp above
described, and perhaps from the capsula which encloses the
body of the tooth. That it is from the pulp and capsula,,seems
evident in the horse, ass, ox, sheep, &c.; therefore we have
little reason to doubt of it in the human species. It is a cal-
careous earth, probably dissolved in the juices of our body, and
thrown out from these parts, which act here as a gland. After
it is secreted, the earth is attracted by the bony part of the tooth,
which is already formed ; and upon that surface it crystallizes,
* Hunter.
FORMATION OF THE TEETH. 483
" The operation is similar to the formation of the shell of the
egg, the stone in the kidneys and bladder, and the gall stone.
This accounts for the striated crystallized appearance which
the enamel has when broken, and also for the direction of these
strire.
" The enamel is thicker at the. points and bases than at the
neck of the teeth, which may be easily accounted for from its
manner of formation; for if we suppose it to be always secreting
and laid equally over the whole surface, as the tooth grows, the
first formed will be the thickest; and the neck of the tooth,
which is the last formed part enclosed in this capsula, must
have the thinnest coat; and the fang where the periosteum
adheres, and leaves no vacant space, will have none of the
enamel.
" At its first formation it is not very hard, for, by exposing
a very young tooth to the air, the enamel cracks and looks
rough; but 'by the time that the teeth cut the gum, the enamel
seems to be as hard as ever it is afterwards ; so that the air seems
to have no effect in hardening it."
The preceding passages have been extracted literally from
Mr. J. Hunter's Natural History of the Human Teeth, not only
on account of their graphical value, but to fix upon him the
merit of having first considered the human teeth as a secretion ;
an opinion the originality of which is falsely attributed to the
Baron Cuvier, by M. Serres.*
In infants, for several months after birth, the biting margins
of the gums upon each jaw are faced by a cartilaginous rising
of some lines in elevation,, and divided by slight fissures. Its
usual appellation is that of Dental Cartilage (Cartilago-Den-
talisi) it performs the function of teeth, in retaining the nipple,
and in mastication, and is analogous to the horny beak of birds,
and of some reptiles; it only disappears upon the protrusion of
the teeth. In the upper jaw it is about three lines wide, and
in the lower about two. If it be removed by thin slices, suc-
cessively made, till the margins of the alveoli appear, one
arrives by that means at the ends of the dental follicles or
sacs; from which it appears that there is no intermediate sub-
stance.
* Anat. et Phys. des Dents, p. 63,
484 ORGANS OF DIGESTION.
In the preceding cartilage are found many small glands,
grouped about in different parts of it. They were discovered
within a few years past by M. Serres,* of Paris; are about the
size of a millet seed, contain a whitish fluid, and when examined
by the aid of a microscope do not appear to have any distinct
opening or duct, in consequence of which they must be punctured
in order to expel their contents. The largest of them are on the
internal side of the gum near the molar teeth.
According to their discoverer, these glands serve to lubricate
the dental cartilages of the infant, but after the protrusion of the
teeth they secrete the substance commonly called Tartar, and
heretofore falsely attributed to the saliva. Their secretion being
of a fatty nature, keeps up the high and brilliant polish which the
teeth have till middle age; it being afterwards altered, the teeth
then become more dull and yellow. Salivation produces an ex-
cessive secretion and deposite of tartar from these glands. J. F.
Meckel states, that he has never been able to discover them till
towards the period of dentition, from which he is rather induced
to consider them as a morbid production depending upon irri-
tation, and probably not differing from little abscesses.
SECT. V. — DENTITION.
Infants have a set of teeth called Deciduous, from their being
lost after a certain period of time. Their whole number is twen-
ty, ten in each jaw, consisting on either side of two incisors; one
cuspidatus; and two molares, having a shape corresponding with
that of the large grinders in the adult. Several of these teeth
fall out about the seventh year, and all of them have disappeared
about the fourteenth. The time of their first protrusion through
the gums is variable, but may, as a general rule, be stated at
from the sixth to the eighth month after birth. They appear
commonly in pairs. The pairs of the lower jaw have prece-
dence in their protrusion; and are immediately followed, suc-
cessively, by their congeners in the upper. The order of pro-
trusion is as follows : —
The two central incisors, from the sixth to the eighth month ;
The two lateral incisors, from the seventh to the tenth month ;
* Loc. cit.
DENTITION. 485
The first molar tooth, on each side, from the twelfth to the
fourteenth month ;
The cuspated, from the fifteenth to the twentieth month;
The second molar, on each side, from the twentieth to the
thirtieth month.*
The Deciduous teeth, by a process which will be presently ex -
plained, drop from the gums and are succeeded by the perma-
nent teeth. The first permanent molar, about six or seven years
of age, by emerging behind the second infant molar, leads the
way to the second epoch of dentition which occurs in the fol-
lowing order: —
The central infant incisors fall out about the sixth or seventh
year, and are immediately followed by the central perma-
nent incisors ;
In a few months afterwards, sometimes at the same period,
the lateral infant incisors tumble out, and are succeeded by the
lateral permanent incisors;
About the ninth year the first molar teeth fall out, and are
succeeded by the first bicuspated ;
From the ninth to the eleventh year, the second molars fall
out, to be succeeded by the second bicuspated;
From the eleventh to the twelfth, the infant cuspated are fol-
lowed by the adult cuspated ;
About the end of the twelfth year, the second permanent
molars protrude behind the first permanent;
And, finally, from the sixteenth to the twenty-fifth year, the
third permanent molars or the Dentes Sapientias, make their
appearance. .
In the jaw of a fcetus of three or four months after conception,
the beginning of the alveolar processes may be observed, in the
condition of a longitudinal groove, deeper and more narrow in,
front, more shallow and wider behind; and in the bottom of the.
groove are small transverse ridges, dividing it into superficial
depressions. From this simple condition, ridges begin to shoot
out from the opposite sides of the canal near its brim ; and form,
by their junction, arches across it; more matter being added to
these arches, they make, in their progress, a sort of cell for each
* Serres, loc. cit.
41*
486 ORGANS OF DIGESTION.
tooth, open on its alveolar surface. This opening is nearer the
internal circumference of the alveolar processes, so that the teeth
are almost covered, and probably for the reason advanced by
Mr. Hunter, that the gums may be firmly supported before the
teeth come through.
The rudiments of the teeth which are earliest in their appear-
ance may be found in a fetus of two or two and a half months;
and at the expiration of three months, it is said that all the germs
of both sets of teeth exist in a manner to be distinguished.* The
germs of this period are lodged in. membranous folds belonging
to the gum, to which the germs of the first dentition are imme-
diately attached, while those of the second are suspended by
pedicles of a line or two in length, which circumstance alone
permits them to be distinguished. At four months all the germs
are contiguous to each other, with the exception of the incisors;
shortly afterwards they begin to be separated by the rudiments
of the alveolar processes ; and about the fifth month ossification
is perceptible in the infant incisors, and goes on in the other teeth
very much in the order of their appearance.
The germs of the deciduous teeth are placed in an arc of a
circle, the cuspidati being thrown forwards out of the line of the
others and somewhat lower; in consequence of which, the first
molar border closely upon the incisors The germs of the per-
manent teeth are brought into view by removing the internal
face of the jaw, and are at the posterior upper side of the first
germs ; being, therefore, nearer to the edges of the alveolar pro-
cesses.
At birth, ossification has taken place in all the infant teeth,
though their roots are not yet completed. The rudiments of the
permanent teeth, though seen at an early period of fcetal ex-
istence, do not be^in to ossify till after birth. Thus, the first
adult incisor and molar begin to ossify about the fifth or sixth
month of life, the second incisor and cuspidatus about the ninth
month, the first bicuspis about the fifth year, the second bicuspis
and second molar about the sixth or seventh, and the third mo-
lar about the twelfth year.t
The teeth which have no predecessors are in consequence
of their adhesion to the gum brought out in their regular places;
* Serres, p. 3. t Hunter.
DENTITION. 487
but, in the case of such permanent teeth as take the position oc-
cupied by the deciduous, there is, before the teeth protrude, a
pedicle, (Gubernaculum Dentis,) which passes from the alveolar
end of the sac of the permanent tooth to the sac of the decidu-
ous tooth; and even when the latter is fully formed and pro-
truded, the same pedicle may be traced to that part of the gum
•surrounding the neck of the deciduous tooth.* At birth, the
rudiments of fifty-two teeth may be found in the two jaws;
and, as a general rule at that period, the rudiments of the per-
manent are more superficial than those of the deciduous; but
their position is subsequently changed, so that the first descend
while the latter ascend. t
As the permanent teeth are preparing to protrude, the alveo-
lar cavities, in which they are contained, form orifices on the
internal surface of the jaw near the edges of the deciduous al-
veolar processes, and which are called the Alveolo-dental Ca-
nals, (Itinera Dentium.) Those for the incisor and canine teeth,
are just behind their corresponding deciduous teeth, and those for
the bicuspated near and somewhat behind the infant molares.
At this period, a bony septum separates almost completely the
two orders of alveolar cavities from each other, and there-
by prevents their mutual interference.
The permanent teeth being thus formed in new and distinct
sockets, and being kept off' from the deciduous, it is clear that
the latter cannot be pushed out of their alveoli, as is sometimes
supposed, by the growth of the former; and if it did take place,
it would produce the great inconvenience of causing them to rise
up into the mouth, beyond the level of the other teeth. On the
contrary, the deciduous teeth are made loose by the removal of
their roots, which progresses till nothing but the neck is left, and
then the slightest force applied dislodges them from their posi-
tion on the gum. This decay of the root is not even affected,
according to Mr. Hunter, by the pressure of the rising tooth, for
the new alveoli rise with the new teeth, and the old ones decay
along with their decaying fangs; and when the first set falls
out, the succeeding teeth are enclosed by a complete bony sock-
et; from which it is evident that the change is not produced by
* J. Cloquet, Anat. PI. XXII. fig. 16, 17. Serres, loc. cit. p. 109.
•f- Serres.
488 ORGANS OF DIGESTION,
mechanical pressure, but is a particular process in the animal
economy.* In farther proof, however, Mr. Hunter has seen two
or three jaws where the second deciduous grinders were shed-
ding by the decay of their roots, without there being under-
neath any tooth to press upon them ; and in another jaw he ob-
served the same circumstance in both grinders. In a female
patient, in whom the last temporary molar was loose, and was
pulled out in consequence, it was not succeeded by another
tooth. One of these patients at the time was aged twenty, and
the other thirty; from which it would appear, that though the
wasting of the fang of a deciduous tooth does not depend upon
the pressure of the permanent one, yet the latter determines,
in some measure, its expulsion, as, without some such influence,
the period of shedding would not have been so late.
From these observations of Mr. Hunter, it would appear,
that the pressure of the permanent tooth is not indispensable to
the removal of the deciduous one in all cases ; yet I think it
will be most frequently found that much of the decay of the
root of the deciduous tooth is owing to its being absorbed by
the pressure of the body of the permanent one. The alveoli
of the latter, judging from my own observations, are seldom
so perfect towards the period of their protrusion as to form a
complete separation of the two orders of teeth, and even when
the alveoli are perfect, they are made to press upon the root of
the deciduous tooth by the evolution of the body of the perma^
nent.
Besides the deciduous teeth being loosened, as stated by MrK
Hunter, by the absorption of their alveolar cavities while the
fangs are dissappearing, the following process occurs. The
permanent teeth protrude within the circle of the deciduous,
the arch of the latter is weakened, and its several pieces are in
that way detached by a force acting from within outwards;
this influence being much assisted by the obliteration of the al-
veolar cavities proceeding principally at their outer circumfe-
rence. The latter, however, is not so obviously the case with
the molar as with the incisive and canine teeth.
The deciduous teeth, even before they are loosened by the
absorption of their fangs and of their alveolar processes, are
much more easily extracted in proportion than the adult teeth,
• Hunter, loc.
ATTACHMENT OF TEETH. 489
from the texture of their periosteum being much softer and
more yielding.
A question of some interest has recently arisen in regard to
the precise apparatus of attachment of the fangs of both sets of
teeth to their alveolar cavities. The principal cause of attach-
ment is attributed to a distinct ligament or fasciculus for each
tooth, having for its position the side of the tooth the most dis-
tant from the front line of the symphysis of the jaws. The liga-
ment thus situated is said to arise from the edge of the alveo-
lus between the teeth, and proceeding forwards in the case of
the molars, and inwards in the case of the incisors: to be inserted
into the neck of the tooth not quite the sixteenth part of an inch
from the enamel. The ligamentous character is considered as
very distinct, the fibres being white and shining like tendon.
The exclusive cutting of it is also said to facilitate very much
the extraction of a tooth.*
My own observations, made upon the parts softened in mu-
riatic acid, and in the recent state, have not led me to see the
ligamentum dentis in so distinct a light or to witness the extreme
facility of extraction after it alone is cut. It is, however, pro-
bable that the insinuation of an instrument between the tooth
and alveolus will generally, to the extent of the incision, dimi-
nish the force of resistance in pulling the tooth out. The ac-
tual adhesion of the tooth to the alveolus appears to me to
arise from the original capsules of the teeth being converted
into a single layer of periosteum, one surface of which ad-
heres to the alveolus, and the other to the fang of the tooth.
The adhesion I have found particularly strong at the margin
of the alveolus, and converging circularly from it to the neck of
the tooth, somewhat in the manner of a coronary ligament.
Another subject of remark is, that the filaments of periosteum
are not laid down laterally to the teeth, but one end of the fila-
ment adheres to the alveolus, and the other to the tooth, like
the filaments of the interosseous ligament at the lower junction
of the tibia and tibula. In this way a cap of such fibres is found
over the whole fang of the tooth: one of the best means of de-
* See Description of the Ligamentum Dentis, by Paul B. Goddard, M. D. in
Am. Journ. of Med. Sciences, vol. xxiii. Phil. 1839.
490 ORGANS OF DIGESTION.
monstrating it, is, to chip off the alveolus in front of a cuspate
to@th of the lower jaw, then seize the body of the tooth with a
pair of strong pliers, and make it rotate on its axis, the fibres
will thus be seen to start up and to show the attachment of their
two ends, one to the alveolus and the other to the tooth. The
jaw of a strong muscular subject is especially recommended.
This arrangement of the course of the fibres is very well exhi-
bited in the cow and horse.
In the lower jaw of the adult, there is but one arterial trunk,
which supplies the teeth; but, in the fo6tus, and till the age of
six or seven years, there are two arteries,* and as many canals
for containing them. The lowest of these arteries belongs,
exclusively, to the deciduous teeth; it is distinctly visible in the
foetus, augments till the third or fourth year, afterwards it
shrinks, and is obliterated about the sixth or seventh year. In
some rare cases its canal remains open for a longer time, as
M. Serres has met with it in a woman of thirty. Being a branch
from the inferior maxillary, it enters the bone at a foramen
somewhat lower down than the posterior maxillary; and what
remains of it after the teeth are supplied comes out at another
aperture, a little below the anterior maxillary foramen, and
there anastomoses with the other dental artery.
M. Serres supposes that this artery, discovered by himself,
and obviously serving in the evolution of the deciduous teeth,
by being obliterated before they fall out, destroys their vitality,
and, therefore, they become absolutely foreign bodies, the ex-
pulsion of which is required by nature on common principles.
SECT. VI. OF IRREGULARITIES IN DENTITION.
^
The process in certain individuals is premature; Louis XIV
was born with two teeth; many instances of the same sort o
precosity are recorded by Haller, and other medical writers, in
some of which even ten teeth were found protruded at birth.
On other occasions, the process is retarded in a manner equal-
ly striking, and varying from the tenth month to the sixth or
seventh year. This unusual tardiness is sometimes manifested
in particular teeth; thus, I know a young gentleman in whom
* Serres, loc. cit. p. 17,
IRREGULARITIES IN DENTITION. 491
one of the permanent incisors of the upper jaw did not come
down before the fourteenth year. Borelli reports a woman in
her sixtieth year who never had teeth; a magistrate of Frede-
rickstadt lived to an advanced age, and never had either canine
or incisor teeth; he was however furnished with molares.
The teeth are sometimes supernumerary; it is not very un-
common to see this manifested by a single canine or incisor,
and more frequently in the upper jaw than in the lower. Occa-
sionally, there are several supernumerary teeth.
Cases are recorded in which several teeth have been fused or
joined together. Bernard Gengha reports, that in a pile of bones
belonging to the Hospital S. Esprit, at Rome, he found a cra-
nium in which there were only three teeth; in the two upper
maxillse one occupied the space of all the incisors and the two
cuspidati, and each of the others the space of all the molares of
its respective side.* According to the historians Plutarch and
Valerius Maximus; Pyrrhus, king of Epirus, and Prusias, king
of Bithynia, had a single dental piece in each jaw, which stood
in the place of the usual allowance of sixteen teeth. These,
cases are scarcely credible, for the reason, that for them to
have occurred, the middle palate suture, which is slow inform-
ing, and divides the germs of the two sides from each other,
could not have existed during the foetal state, at any time sub-
sequent to the third month; or what is more compatible with
this account, at, no time whatever. It is more probable, there-
fore, that notwithstanding the royal opportunities of cleanliness
possessed by these persons, their teeth were neglected, and per-
mitted to incrust themselves with a dense, thick coat of tartar,
which gave them the appearance of a single piece: a circum-
stance which occurred to Sabatier, in a girl of fifteen or six-
teen, and to Fournier in an individual of the same ageandsex.t
Another objection is, that as the common law of the germs is
to develop themselves, and to ossify at different epochs, in these
two cases they were all not only proceeding at the same rate, but
also joining one another so as to form but a common sac, con-
founding, thereby, all the known phenomena of dentition.
In most persons there are but two. sets of teeth; it .has hap-
pened, however, in several instances, for people about the age of
seventy to have one or more new teeth belonging to a third set:
* Sabatier, Anat. tome 1, p. 78. f Diet, des Sc. Med.
492 ORGANS OF DIGESTION.
they are commonly incisors. J. Hunter saw an example of the
kind.* The Countess of Desmond, who lived to her hundred
and fortieth year, had, at this period, according to Bacon, a
third set of teeth.t Mentzelius narrates a similar casej in the
following words: having accompanied the Elector of Branden-
burg on a visit to Cleves, in 1666, there arrived, at the same
time, a man aged one hundred and twenty, who exhibited him-
self for money, and whom I saw at the court of the Elector.
His strength of voice manifested that of his breast, and he having
run over the gamut, was heard at more than a hundred paces
off. Having then opened his mouth, he showed us two rows of
pearly teeth, and on the subject of their beauty related ' that be-
ing at the Hague two years before, on the same errand which
brought him to Cleves, there arrived an Englishman aged one
hundred and twenty; that he visited the latter, and addressed
him in the following terms: ' We are nearly of the same age,
for I am only two years younger than you, and I have had the
greatest desire to see one older than myself, for I have felt no
inconvenience till lately; but during the three days that I have
been here, I have had severe headach and dreadful pains in the
jaws, which convince me that I am about to die.' ' You are
mistaken, my dear friend,' said he to me: 'on the contrary,
you are becoming younger, for you are about to teethe again
like an infant.' « Oh !' answered I, 'I pray to God not to punish
me by prolonging my days.' « I left him then and went to bed,
and immediately after felt the most excruciating pains in the
jaws, which were followed by the protrusion of the teeth that
you now see."J
The circumstance of a third dentition, has given rise to a ques-
tion among physiologists, whether the germs are primarily super-
numerary ? or whether the gums have within themselves organs
capable of forming and of producing new teeth?
When such teeth come out in a straggling manner, they hurt
the opposite jaw, and require to be extracted.
In old persons who have lost all their teeth, there is a carti-
laginous hardening of the gum, as in infancy, whereby they still
retain some power of mastication.
When the body of the tooth has been worn away, nature pre-
vents the exposure of its cavity by the deposite of new matter,
* Loc. cit. p. 85. t Hist, vit et mort. Col. 536.
t Serres, loc. cit. p. 40.
MUSCLES OF THE TONGUE. 493
which may be known by its darker colour, and by its transpa-
rency.
The muscles of mastication being the Temporalis, the Mas-
seter, the Pterygoideus Intern us, and the Pterygoideus Exter-
nus, their description may be seen elsewhere.
CHAPTER III,
OF THE TONGUE.
THE Tongue (Lingua) is the principal organ of taste, and is
also concerned in mastication and in speech. It is an oblong,
flattened, symmetrical, muscular body, which extends from the
os hyoides posteriorly to the incisor teeth anteriorly, and, being
placed at the bottom of the mouth, fills up the space within the
two sides of the body of the lower jaw. The exact extent of room
which it occupies, varies according to its being in a state of re-
pose or. of activity.
The posterior extremity of the tongue is called its base or
root, and arises muscular from the body and the cornua of the
os hyoides; it is there considerably thinner than elsewhere, it also
has a fibro-muscular origin from the centre of the epiglottis car-
tilage: sometimes a cartilage is found in the middle of the base,
and which forms a sort of ball and socket joint with the os hy-
oides. Its anterior extremity is called the tip or point, is loose,
and has a rounded thin termination. Between the point and
the base is the body. The superior surface of the tongue is flat,
is divided by a middle longitudinal fissure of inconsiderable
depth into two equal parts, and is covered by the lining mem-
brane of the mouth, under a particular modification of structure.
The inferior surface of the tongue, with the exception of its
middle part, is also free, and covered by the common mucous
membrane of the mouth; but the latter is there very thin, and the
veins may be readily seen shining through it.
SECT. I. — MUSCLES OF THE TONGUE,
The muscles which compose the principal part of the bulk of
the tongue, are, the Stylo-glossus, the Hyo-glossus, the Genio-
VOL. I.— 42
494 ORGANS OF DIGESTION.
hyo-glossus, and the Lingualis. As these, besides belonging to
the general muscular system, also form so important a part of
this organ, with a view of collecting the account of its struc-
ture, their description will be repeated.
1. The Stylo-glossus arises from the styloid process of the
temporal bone, and soon reaches the side of the base of the
tongue. Some of its fibres extend to the tip and confound
themselves along with those of the superficial lingual muscle,
above and below the margin of the tongue: while others form a
broad transverse fasciculus, which is united to the correspond-
ing portion of the other side in the region of the greater pa-
pillae.*
2. The Hyo-glossus arises from the side of the base of the os
hyoides, from its cornu; and from its appendix, in a slight degree.
It is placed within the stylo-glossus, and extends forwards to
the tip of the tongue. Some of its fibres go as far as, the mid-
dle line of the tongue; others rise almost perpendicularly up-
wards to its base; while the remainder are confounded, along
the margin of the tongue, with the superficial lingual muscle.
3. The Genio-hyo-glossus arises from the tubercle on the
posterior face of the symphysis of the lower jaw, and imme-
diately after its origin spreads itself after the manner of a fan.
Its inferior fibres are inserted into the base of the os hyoides,
while the remainder, by their diverging, are inserted into the
whole length of the tongue from its base to its point. This
muscle is in contact, side by side, with its fellow, and there is
a sort of fissure with a small quantity of adipose matter be-
tween them.
As the fibres of this muscle go from below upwards, they pe-
netrate to the upper surface of the tongue; and, consequently,
traverse the transverse lingual muscles and the superficial lin-
gual.
4. The Lingualis is a small narrow fasciculus of fibres, which
arises indistinctly about the root of the tongue, in the yellow
* See Cloquet's Anat. pi. CXX.
MUCOUS COVERING OF THE TONGUE. 495
cellular tissue there, and advances to the tip between the liyo-
glossus and the genio-hyo-glossus.
5. The Superficial Lingual Muscle (Superficialis Linguce) is
a broad, thin layer, covering the upper surface of the tongue,
below the mucous membrane; it begins behind, on a line with
the greater papillas, and advances forwards to the tip. Its more
internal fibres converge and end at the middle line, but the ex-
ternal ones terminate above and below, near the margin of the
tongue.
6. The Transverse Lingual Muscles (Transver sales Lingua,}
consist in small scattered fasciculi, which are placed below the
last, and in the thickness of the tongue, which they traverse at
right angles. One end of them, on each side, ceases at the mid-
dle line of the tongue, where there is a small seam, and the
other end terminates in the covering membrane of the tongue,
at the lateral margin of this organ. These fibres are to be
found in the whole length of the tongue, and gradually become
more curved at its base.
7. The Vertical Lingual Muscles (Verticales Linguce) extend
from the upper to the under investing membrane of the tongue.
They consist in small scattered fasciculi, like the preceding,
and cross them at right angles in traversing the thickness of
the tongue.* Many of these fibres appear to me to proceed
from the genio-hyo-glossus.
SECT. II. MUCOUS COVERING OF THE TONGUE.
The mucous membrane of the mouth, where it forms the fra3-
num linguas, is over the anterior margin of genio-hyo-glossi
muscles; the same membrane, in going from the base of the
tongue to the epiglottis, and forming another frasnum, has, on
each side of it, a depression or pouch in which articles of food
sometimes lodge. Beneath the last fraenum is a ligamentous
tissue which runs to the base of the tongue from the front of
the epiglottis, and serves to keep the latter erect: some mus-
* The preceding views of the minute muscular structure of the tongue have
lately been advanced by M. Gerdy, of Paris. See J. Cloquet, Anat. de L'Homme,
pi. CXIX. CXX. J, F. Meckel, loc. cit. Note des Traducteurs, vol. iii. p. 313.
496 ORGANS OF DIGESTION.
cular fibres are occasionally seen in this tissue in the human
subject : in the black bear of North America, and in some
other animals, it consists in a pair of strong muscles. The
pouch, on each side, is bordered, externally, by a more super-
ficial doubling of the mucous membrane, which passes, from
the base of the tongue to the side of the epiglottis.*
The lingual portion of the lining membrane of the mouth, on
the upper surface of the tongue, is somewhat cartilaginous, and
into it is inserted many of the subjacent muscular fibres. At
the base of the tongue this cartilaginous condition is deficient,
and its place is supplied by a yellow cellular tissue which ad-
heres to the os hyoides, to the epiglottis, and to many muscular
fibres below, and has in it numerous mucous follicles.
As observed, the mucous membrane, on the under surface of
the tongue, offers no peculiarity of organization : but, on the up-
per surface, it is remarkable for the unusual size and develop-
ment of its papillae, for having its epidermis easily detached, and
also for having the muscular structure beneath fixed to it with
extreme closeness.
The anterior two-thirds of the upper surface of the tongue
are entirely covered by these papilla. They are so thickly
set as to touch one another ; and, as they present some pecu-
liarities of form, they are divided into Papillae Maximae or Ca-
pitata?, Media?, Villosae, and Filiformes.
The Papillae Maximae constitute the posterior border of the pa-
pillary surface of the tongue, and are about nine in number,
though they are frequently fewer, and sometimes more. They
are disposed in two oblique rows, which, by converging back-
wards, meet and generally form something like the letter V. ; the
fifth papilla being the angle of the figure. Each of these bodies
resembles a cone standing upon its summit, and is surrounded by
a circular fossa which permits it to project but inconsiderably
above the general level of the tongue. Sometimes two or more
are in the same fossa. The Papilla? Mediae, or Fungiformes, are
more numerous than the last, and next to them in size; they
are enlarged at their loose end into a sort of rounded head,
whence their name; they are irregularly scattered over the
* This doubling also exhibits, occasionally, a small muscle inserted into its base,
and arising from the upper constrictor of the pharynx, and which has the
effect of widening the pouch.
MUCOUS COVERING OF THE TONGUE. 497
tongue. Those which are next in size and still more abundant,
are the Papillae Villosse. The Papillae Filiformes fill up the in-
tervals of the others, are the smallest, and are found, principally,
near the middle of the tongue and at its front extremity.
Most commonly the central papilla maxima has the largest
fossa of any.of that class, and which is designated by the term
foramen ccecum. A little behind this foramen there is frequent-
ly another, called the same by some anatomists, but not fur-
nished with a papilla, into which some mucous follicles discharge
their contents: from time to time it has been fallaciously consi-
dered as receiving the excretory duct of the thyroid, or of some
of the salivary glands.
The papillae of the tongue, though they vary in their shape
and size, have very much the same structure in regard to the
abundance of blood vessels and nerves which enter into their
composition. When uninjected, and viewed with the naked eye,
their surface appears smooth, but when made turgid by injection,
they are covered with little asperities or filaments, which seem to
be formed principally of blood vessels, having a very tortuous and
superficial course; forming loops, or doublings, in projecting on
the surface of the papilla, and anastomosing freely with each
other.* Besides vessels, there is a soft whitish substance, sup-
posed to be nervous, entering into the composition of each fila-
ment. The larger papilla? on the back part of the tongue are
supplied by the glosso-pharyngeal nerve, and the papillae on its
front part by the trigeminus or fifth pair.
The surface of the tongue between the papilla? maximae and
the os hyoides is destitute of papillae, and is covered only by the
common mucous membrane of the mouth, having beneath it many
muciparous glands, which in different individuals produce promi-
nences more or less elevated, and are of a lenticular shape with
a diameter of a line or two. Their orifices are very visible, and
easily receive a large bristle.
The Epidermis, which is found upon all other parts of the lining
membrane of the mouth, is also continued over the whote upper
surface of the tongue, and consequently invests each papilla; it
is called there Peri-glottis. It is soft and humid, may be detached,
by maceration, and is frequently detached in fevers. On its up-
* Soemmering, Anat. J. Cloquet. pi. cxix.
42*
498 ORGANS OF DIGESTION.
per surface, it, when detached, will have many elevations; while
on the lower there will be corresponding excavations, which to
superficial observation give it the appearance of being cribri-
form.
The tongue is supplied with arteries, principally from the lin-
gual branch of the carotid, and with nerves from the hypo-glos-
sal, the fifth pair, and the glosso-pharyngeal. The former is
supposed to be exclusively appropriated to its muscular move-
ments, and the two latter to its sensations. Its faculty of taste
seems to be most active at the tip; on the sides, and near the
middle, behind, it is inconsiderable. The soft palate seems also
to participate in the function of taste.
CHAPTER IV.
OF THE PALATE.
THE Palate (Palatum) is composed at its anterior part of the
palatine processes of the superior maxillary and palatine bones,
covered above by the pituitary membrane, and below by the
lining membrane of the mouth. This portion of it is the hard
palate, and separates the mouth from the nose. Behind it is a
membranous portion called the soft palate, which separates par-
tially the mouth from the upper part of the pharynx.
That part of the lining membrane of the mouth which covers
the hard palate, has a hard cartilaginous feel, and is not so vas-
cular or sensible as other parts. It has a ridge in its centre just
beneath the middle palate suture, and from each side of it there
are transverse ridges extending to the alveolar processes. This
arrangement is more evident at its anterior part, and in middle-
aged persons; in the old it is faint, and frequently does not exist
when the alveoli are gone. Beneath this membrane, particular-
ly at its posterior part, the muciparous glands are very abundant
and closely set against each other, so as to form a perfect layer,
extending itself upon the front of the soft palate, and making one
half of its thickness.
The Soft Palate (Velum Pendulum Palati) has on oblong shape,
MUSCLES OF THE PALATE. 499
and being continued from the posterior margin of the hard pa-
late, it is stretched across the back of the mouth from one side to
the other, and obliquely downwards and backwards. Its inferior
margin, which is free, offers in its centre a projection of half an
inch or three quarters in length, which is the Uvula. From each
side of the latter there proceed two crescentic doublings of the
lining membrane of the- mouth, called the lateral half arches of
the palate.
The Anterior Half Arch is more distinct than the other, and
arising at the side of the uvula by one end, terminates by the
other in the side of the base of the tongue on a line with the
papillse maximse.
The Posterior Half Arch arises from the side of the uvula near
the last, and diverging from it backwards, and outwards, has the
other end lost gradually in the lining membrane of the pharynx
near its middle. In the depression between these duplications,
on either side, is the Tonsil Gland. The space bounded in front
and behind by these lateral half arches is the Fauces, and the
anterior opening into it, is the Isthmus of the Fauces.
When the mucous membrane of the soft palate is removed, its
muscles are exposed, and are as follow : —
1. The Constrictor Isthmi Faucium is a small fasciculus of
fibres, on each side, within the duplicature of the anterior lateral
half arch. It arises from the middle of the soft palate near the
base of the uvula, and is inserted into the side of the tongue near
its root in a line with the papillae maxima?.
It tends to close the opening between the mouth and the pha-
rynx.
2. The Palato-Pharyngeus is also a small fasciculus, within
the duplicature forming the posterior lateral half arch. It arises
from the middle of the soft palate near the base of the uvula,
and is inserted into the pharynx at the space between the mid-
dle and lower constrictors, behind the stylo-pharyngeus, and into
the superior posterior margin of the thyroid cartilage. It spreads
itself out considerably, so as to cover, along with the stylo-pha-
ryngeus, almost the whole lateral portion of the pharynx to its
lower part.
It draws the soft palate downwards.
500 ORGANS OF DIGESTION.
3. The Circumflexus, or Tensor Palati, is behind the pterygoid
process of the sphenoid bone. It arises from the spinous process
of the latter behind the foramen ovale, and from the contiguous
part of the Eustachian tube; it then passes downwards in con-
tact with the pterygoideus internus muscle, and terminates in a
broad tendon below, which winds around the hook of the inter-
nal pterygoid process, and is inserted into the soft palate near
its middle, and into the posterior lunated edge of the palate
bone.
It spreads out or extends the palate.
4. The Levator Palati is on the inner side of the last. It
arises from the point of the petrous bone, and from, the contigu-
ous part of the Eustachian tube, and passes downwards to be
inserted into the soft palate. This muscle, in the dissection of
the pharynx may be seen between its external edge, and the pte-
rygoideus internus muscle.
It draws the soft palate upwards.
5. The Azygos Uvulae is in the centre of the soft palate and
of the uvula. It arises from the posterior pointed termination of
the middle palate suture, and goes down into the uvula.
It draws the uvula upwards, and diminishes the vertical
breadth of the soft palate.
When the mucous membrane is removed, the upper constric-
tor of the pharynx appears between the anterior and the poste-
rior half arches.
CHAPTER V.
OF THE GLANDS OF THE MOUTH.
THESE glands consist in such as are muciparous, and in
such as are salivary.
SECT. I. MUCIPAROUS GLANDS.
These glands (GlandulcB Muciparce) are whitish, somewhat
oval and flattened, and are from the fraction of a line to two
SALIVARY GLANDS. 501
lines in diameter: they are found in great abundance beneath the
lining membrane of the mouth at several places, to wit: on the
lips, (Gland. Labiales;) on the cheeks, (Gland. Buccales;) and
also, as mentioned, at the posterior part of the upper surface of
the tongue, (Gland. Mucip. Linguce.) The layer of them, (Gland.
Palatines,,) which is found at the posterior part of the hard palate,
is also continued over the anterior and the posterior surface of
the soft palate, especially the anterior surface.
The Tonsils, (Tonsillce,MmygdaIce,) situated, as observed, one on
each side, between the half arches of the palate, are six or eight
lines long, four or five wide, and about three thick. They are
rather a collection of large mucous follicles, than a congeries of
glandular bodies, in consequence of which their surface is very
much reticulated. Owing to their being placed upon the upper
constrictor of the pharynx, their mobility is very striking and
considerable.
A great many small pores are observed on the internal sur-
face of the mouth, which are the orifices of the ducts of the
muciparous glands.
SECT* II.— SALIVARY GLANDS.
On either side of the neck, bordering upon the mouth, there
are three glandular bodies for the secretion of saliva; they are
the parotid, the submaxillary, and the sublingual. The fluid se-
creted from them is of great service in digestion, and is blended
with the food in mastication, and in swallowing. According to
Berzelius, it has a considerable affinity to oxygen; and consists
in a white mucous substance, holding, in a state of solution, the
saline articles usually found in the serum of the blood.
The Parotid Gland (Glandula Parotis,) is the largest of the
three, and, like the others, is of a light pink colour. Owing to
he space into which it is crowded, it is o a very irregular figure.
It fills up the cavity on the side of the head between the mastoid
process and the ramus of the lower jaw, extending beyond the
edge of the latter so as to cover the posterior margin of the mas-
seter muscle. It is somewhat pointed at its fore part. Its ver-
tical length reaches from the zygoma above, to the angle of the
jaw below; sometimes, indeed, a little lower down. In thick-
502 ORGANS OF DIGESTION.
ness it extends from the integuments externally, to the styloid
process, the styloid muscles, and the tendon of the digastricus,
internally, being there only separated from the internal carotid
artery by these parts. It is traversed from behind forwards by
the portio-dura nerve, and from below upwards along its inter-
nal margin by the external carotid artery and the temporal vein.
This gland has no appropriate capsule, but being covered, on
its external face, by the continuation of the fascia superficialis
of the neck, prolongations are sent from the fascia which pene-
trate it in every direction, and keep its lobules together.
Its duct (Ductus Stenonianus) departs from its anterior edge
a few lines below the zygoma, and traverses the outer face of
the masseter muscle, in a line, according to the observations
of Dr. Physick, drawn from the lobe of the. ear to the end of
the nose. It is about the size of a crow quill, is hard and ten-
dinous, with thick parietes. It lies close to the masseter mus-
cle, and at the anterior edge of the latter penetrates a pad of
fat commonly found there on the side of the cheek; it then
perforates the posterior end of the buccinator, so as to have
its oral orifice opposite the second large molar tooth of the up-
per jaw. On opening the mouth wide during a state of fast-
ing, a jet of saliva will sometimes indicate the position of this
orifice.
A small gland (Gland. Accessoria Parotidis) is sometimes found
between this duct and the zygoma; it varies in form and size,
and has a distinct excretory canal discharging itself into the
parotid duct,
The Submaxillary gland (Glandula Submaxillaris) is not more
than a third or one half the size of the last, and has a more re-
gular form in being somewhat ovoidal. It is accommodated
in the depression on the side of the neck formed by the body
of the lower jaw externally, by the mylo-hyoideus muscle
above, and by the tendon of the digastric below. The platys-
ma myodes intervenes between it and the skin. It almost
touches the parotid gland behind, being separated from it only
by a process sent in from the fascia superficialis, and continu-
ous with the ligament, going from the styloid process to the
ramus of the lower jaw. As it extends to the posterior margin
of the mylo-hyoideus muscle, it there touches the sublingual
SALIVARY GLANDS. 503
gland. The facial artery either passes through it or is very
much connected with it.
Its colour and appearance are the same with the parotid;
but its lobules are more easily separated, as they are held to-
gether only by weak cellular substance, which forms a sort of
capsule to them. Its duct, (Ductus Whartonianus,) which is
single, comes from the assembling and junction of branches
from the several lobes. It is much thinner, more extensible,
and larger in proportion than the parotid duct; and being di-
rected backwards, winds over the posterior edge of the mylo-
hyoid muscle, in order to get to the cavity of the mouth. It
then passes along the internal face of the sublingual gland, be-
low the tongue, and terminates by a small projecting orifice on
the anterior margin of the frsenum linguae.
A continuation of the substance of this- gland, of a few lines
in thickness, described by Bartholin, is found at the posterior
end of the sublingual gland, and has its excretory duct some-
times opening at the side of the duct of Wharton, and, on other
occasions, into one of the ducts which issue from the sublin-
gual gland. When this common duct exists, it is called the
canal of Bartholin, (Ductus Bartholinianus,) who first discovered
it in the lion, in 1684.
The Sublingual Gland (Glandula Sublingualis) is an oblong
body, covered by the lining membrane of the mouth, but visible
when the tongue is turned up. It is placed above the mylo-
hyoid muscle, along the under surface of the tongue, and is
readily distinguished by its ridged unequal surface, projecting
into the mouth. It is not so large as the submaxillary gland.
Its lobules are smaller than those of the preceding gland, and
are also whiter and harder. Instead of having but one excreto-
ry duct, it has several; sometimes fifteen or twenty of them are
discernible: on other occasions, several of them are collected
into one or two principal trunks, (Ductus Riviniani,) and open
either directly into the mouth, or into the duct of Wharton.
These several openings are found along the bottom of the
mouth, on either side below the tongue. Several small saliva-
ry granulations or glands border on the sublingual.
The position of the salivary glands is such, that they are
much moved and pressed upon by the neighbouring parts in
504 ORGANS OF DIGESTION.
mastication, independently of the emission of their fluid being
provoked by hunger. Owing to the similitude of their struc-
ture, and to their not being regularly supplied like other glands
with capsules, their limits are occasionally so inexactly traced,
that they continue into each other by adjacent points, and form
thus an uninterrupted chain.*
They all are of the conglomerate kind, or, in other words, con-
sist in a congeries of smaller glands or lobes and lobules. They
are well furnished with arteries; which are branches, from the
external carotid, and go in several trunks instead of in a lead-
ing one. The parotid is commonly supplied by trunks coming
directly from the external carotid, the submaxillary is supplied
from the facial artery, and the sublingual gland from the lin-
gual artery. Their nerves come from the fifth pair, and from
the portio dura.
The retrograde injection of their excretory ducts shows how
the latter are formed by the assembling of branches from the
different lobules. These ducts consist of two coats, a fibrous
one externally, and a mucous one internally.
CHAPTER VI.
OF THE PHARYNX AND (ESOPHAGUS.
SECT. 1. — OF THE PHARYNX.
THE Pharynx (Pharynx) is a large membranous cavity,
placed between the cervical vertebrae and the posterior part of
the nose and mouth. It extends from the base of the cranium
to the lower part of the cricoid cartilage, or to the lower part
of the fifth cervical vertebra. It is in contact, behind, with
the vertebrae and the muscles lying upon them, being simply
attached there by loose cellular substance; above, it adheres
to the cuneiform process of the os occipitis, and to the point of
the petrous portion of the temporal bones; in front, to the pos-
terior part of the upper and of the lower maxilla near the ter-
* Bichat, Anat Descrip. vol. v. p. 24.
THE PHARYNX. 505
mination of their alveolar processes, to the cornua of the os
hyoides, the side of the thyroid and of the cricoid cartilage;
and below it is continued into the oesophagus. In consequence
of these several attachments the pharynx is kept open, or, in
other words, its sides are prevented from collapsing, and it is
drawn up and down in the motions of the tongue and of the
larynx.
The Pharynx consists in three coats: an external one, formed
by three muscles, on each side, one above the other, and called
constrictors; an intermediate cellular' coat; and an internal mu-
cous one.
1. The Musculus Constrictor Pharyngis Inferior, arises from
the side of the cricoid, and from the whole length of the side of
the thyroid cartilage. From these points its fibres diverge to
the middle vertical line on the back of the pharynx, where they
join with their congeners of the opposite side. The lower
fibres are nearly if not completely horizontal, and those above
increase successively in their obliquity upwards, so that the
upper ones are extremely oblique, and reach, at their termina-
tion, to within twelve or fourteen lines of the upper part of the
pharynx.
2. The Constrictor Pharyngis Medius, arises from the cornu
and appendix of the os hyoides, and from the ligament connect-
ing the posterior end of the latter with the upper cornu of the
thyroid cartilage. Its inferior margin is overlapped by the su-
perior margin of the last; its fibres there are also horizontal,
and, indeed, somewhat convex downwards; while the superior
fibres become successively more oblique in ascending. It is
inserted by the middle line behind, into its fellow of the oppo-
site side, and by its point above into the cuneiform process of
the os occipitis, just in advance of the recti majores muscles.
3. The Constrictor Pharyngis Superior, arises from the ptery-
goid processes of the sphenoid bone, at their lower end ; and
below them from the back part of the upper and under jaws be-
hind the last molar teeth, it is also connected at its anterior
margin with the buccinator muscle, and with the root of the
tongue between the anterior and the posterior half arches of
VOL. I.— 43
506 ORGANS OF DIGESTION.
the palate, being blended there with the transverse fasciculus of
the stylo-glossus muscle. It has its lower edge 'overlapped by
the constrictor medius ; and its fibres are more horizontal, ge-
nerally, than those of the preceding muscles. It is inserted
into its fellow by a middle line, the upper end of which adheres
to the cuneiform process of the os occipitis. The superior
margin of this muscle between the pterygoid process of the
sphenoid, and the cuneiform process of the occipital makes a
crescentic line, the concavity of which is upwards.
The constrictor muscles of the pharynx, by their successive
contraction, convey the food from the mouth into the oeso-
phagus.
The Stylo-Pharyngeus, which is mentioned among the mus-
cles of the neck, forms an interesting portion of the structure
of the pharynx, and may be considered on a footing with the
longitudinal fibres of the oesophagus and of the intestines; being
intended to shorten the pharynx by arising from, or having a
fixed point at the styloid process above, and by being jotned
into the pharynx below. Its fibres being first of all on the out-
side of the upper constrictor, are readily traced between the
lining membrane and the two lower constrictors to the poste-
rior margin of the thyroid cartilage ; into which, after spread-
ing out considerably, they are finally inserted.
The intermediate membrane of the pharynx is merely con-
densed cellular tissue, which joins the muscular to the mucous
coat.
The internal or mucous membrane of the pharynx, which
lines the last, is spread uniformly over it; the only irregularity
of its surface being made by the presence of mucous follicles
and glands, which are more abundant above between the pos-
terior margins of the two slylo-pharyngei than below. It is
covered by a very delicate epidermis, and is supplied with two
arteries on each side, the superior and inferior pharyngeal, the
first of which cornes from the internal maxillary, and the se-
cond from the external carotid. It exhibits a number of small
veins, which run into the internal jugular or some of its
branches.
(ESOPHAGUS. 507
The shape of the cavity of the pharynx is oblong and cylin-
drical, being somewhat larger at its superior end] at the latter
place, where it is attached to the petrous bone, it presents a
deep corner, which gives it a square appearance there, and has
a collection of muciparous follicles somewhat like the tonsil
gland. Anteriorly, and above, it is continuous with the Eusta-
chian tubes, and with the posterior nares; just below this, with
the fauces and mouth, and below the root of the tongue with
the cavity of the glottis or larynx. At its lower extremity,
where it terminates in the oesophagus, it is so contracted as to
suit the size of the latter cavity.
SECT. II. OP THE (ESOPHAGUS.
The ossophagus is the tube just i-n front of the spine and be-
hind the trachea, which conducts food from the pharynx into
the stomach. When inflated it is of a cylindrical shape, about
ten or twelve lines in diameter : it is nine or ten inches long,
and gradually increases in its size from above downwards: in
its state of repose it is flattened from before backwards. Its
descent is not entirely vertical, but at the lower part of the
neck it inclines somewhat to the left of the middle line, and is,
therefore, rather to the left side of the trachea than behind it.
It passes down the thorax in the posterior mediastinum, being
bounded on its left side by the aorta, and on the right by the
vena azygos. It keeps during the early part of its course in
this cavity, in front of the middle line of the spine; but lower
down it inclines again slightly to the left side, in front of the
aorta, in order to reach the cesophageal orifice of the diaphragm,
through which it penetrates into the abdomen. In all this pas-
sage the oesophagus is united to adjacent parts by a loose cel-
lular tissue.
The oesophagus is composed of three coats: the muscular;
the cellular or nervous; and the mucous.
The muscular coat is the external, and very strong. It con-
sists in two well marked lamina? of muscular fibres. The most
exterior is the thickest, and goes, longitudinally, from one end
to the other of the tube; commencing, according to J. F.
Meckel, by three fasciculi above; one of which arises, tendi-
508 ORGANS OF DIGESTION.
nously, from the posterior face of the cricoid cartilage, and the
other two, one on each side, from the inferior constrictor of
the pharynx. These fasciculi descend for an inch or two be-
fore they spread out into a uniform membrane. The internal
muscular lamina consists in circular fibres, which may be con-
sidered as a continuation of the lower margin of the inferior
constrictor of the pharynx, and are either horizontal or slightly
spiral; they are rather deficient on the fore part of the ceso-
phagus for an inch at its superior extremity. Individually,
their length is short of the circumference of the ossophagus.
_ r
The cellular coat is next in order, and serves to unite the
muscular and the mucous together. It adheres much more
closely to the latter than it does to the former, has no adipose
matter in it, but is found to be abundantly furnished, more par-
ticularly towards its upper end, with small muciparous glands;
it also serves to transmit the blood vessels through the struc-
ture of the oesophagus.
The mucous coat of the oesophagus is the most internal; in
the undistended state it always presents many longitudinal
folds, going from one end to the other, but sometimes blending
with each other, owing to the contraction of the circular mus-
cular fibres. When suspended in water its fine villous ap-
pearance is very perceptible, as well as the mucous lacunae or
glands which open upon its internal surface. As it is a conti-
nuation of the mucous membrane of the pharynx, it has the
same general appearance, but is rather whiter. Its internal
surface is also covered by a delicate epidermis, which ceases
at the cardiac orifice of the stomach, and may be raised in
shreds by maceration and by boiling; in some pathological
conditions this epidermis becomes very distinct by acquiring
more thickness and solidity, than what belong to its healthy
state.
The arteries of the oesophagus are derived from the inferior
thyroidal, from the thoracic aorta, and from the gastric. Its
nerves come principally from the pneumogastric.
END OF VOL. I.
INDEX TO VOX. I.
Page
Abdominal Fascia, - 383
Abdomen, Muscles of, - 383
Abductor Pollicis Pedis, - 462
Abductor Min. Digit. Pedis, - . - 463
Abductor Pollicis Manus, 431
Abductor Indicis, 432
Abductor Min. Digit., 433
Adductor Pollicis Pedis, 462
Adductor Metacarpi Min. Digiti, - 433
Adductores Femoris, - - 445
Adductor Pollicis Manus, - - 432
Alimentary Canal, - - 467
Alveolar Processes, • 474
Americans, - - 177
Annuli Junct. Ligamentosi, - 424
Anconeus, 419
Ankle Joint, •. 309
Ankle, Ligament of, 440
Aponeurosis Plantaris, 441
Aponeurosis Palmaris, - - 413
Arm, Muscles of, 420
Articulations, - - 251
Articular Cartilages, - 255
Articulation of Wrist, - 291
Articulation, Sterno-Clavicular, 283
Astragalus, -~ - - 225
Auricularis, 428
Bones, - - 50
Composition of, 56
Carpal, - 193
Growth of, 71
Individual, ... - 77
Texture of, ----- 52
Vascularity of, - <H
Bi cepsFlexor Cubiti, - 416
VOL. I.— 44
510 MTDEX.
Page
Biceps Flexor Cruris, - - 451
Bicorn Ligament,. - - 286
Bordeu, » - - 320
Brachialis Interims, - 418
Bursa of Fingers, • 42&
Buccinator, - - - ~, - 368
Callus, - - - - - 74
Cartilages of Ribs, - 112
Carpus, 193
Caucasian Race, - 174
Cartilages, 251
Cartilages, Accidental, 253
Calcis, - 223
Calcaneo-Scaphoid Ligament, - 311
Carpal Articulation, - - 291
Calcaneo-Cuboid Ligament, 312
Cervical Vertebrae, * 80
Cellular Substance, - - 3 17
Cellular Atmosphere, -
Cervicalis Descendens, 406
Clavicle, - - - - - - 186
Coccyx,
Coccygeal Ligament,
Compressor Naris, - - 364
Complexus,
Conoid Ligament, - '- 285
Coracoid Ligament, - - - 286
Corrugator Supercilii, - 366
Coraco-Brachialis, - - -
Costo-Clavicular Ligament, 284
Cotyloid Ligament, 299
Cranium, -------
Cranium, Internal Face of, 158
Cremaster, - ... 389
Crurseus, ------ 444
Crucial Ligaments, - - 304
Cuboides, 226
Cuneiform Bones,
Cutis Vera, - ... 330
Cutis Anserina, - - - 332
Cuticula, _._.-. 336
Cyanosis, - - 335
Development of Skeleton, 67
Dermoid Covering, - 328
Depressor Labii Sup., - 367
Depressor Anguli Oris, .... 367
Depressor Labii Inferioris, - 368
INDEX. 511
Page
Deltoldes, 414
Dental Cartilage, - ' - 483
Dental Glands, - 484
Dentition, - - 484
Dentition, Irregularities of - .- 490
Diaphysis, - 52
Diploe, - 156
Digastricus, - - 376
Diaphragm, - 394
Digestion, Organs of, - - 467
Dorsal Vertebrae, 84
Dutrochet, 333
Elbow Joint, 288
Elain, - - - 326
Enamel, - - 474
Epiphyses, ----- 52
Epidermis, - 336
Ethmoides, - - - - 135
External Cellular Tissue, - - 320
Extensor Carp. Had. Long., - - 426
Brev. Digit. Pedis, - - - - 460
Carpi Ulnaris, 427
Carp. Rad. Brev., - 426
Digit. Com., - - 428
Long. Digit Pedis, ... 453
Metacarpi Pollicis, - 428
Pollicis Minor, et Major, - 429
Prop. Poll. Pedis, 454
Facial Angle, - 172
Face, ------- 138, 169
Fat, - - 325
Fascia Superficial Colli, 371
Fascia Superficialis Abdominis, 383
Fascia Profunda Colli, - 373
Fascia Transversalis, - - 390
Fascia Iliaca, ------ 339
Fasciae of Lower Extrem., - 436
Fasciae of Upper Extrem., - 411
Fascia Lata, - ... 435
Fasciae of Foot, r 446
Fascia Cruralis, - - 439
Femoral Bone, - 213
Fibro-Cartilage, .... 256
Fibula, 220
Finger Joints, ----- 298
Fingers, - - - - - 199
Flexor Carpi Radialis, - 420
Flexor Carpi Ulnaris, - - - - 421
512 INDEX.
Pago
Flexor Digitorum Subl., - 422
Flexor Digit. Profund., - - 422
Flexor Brev. Poll. Manns, - 432
Flexor Parv. Min. Digit , - 433
Flexor Long. Digit. Pedis, - 458
Flexor Long. Poll. Pedis, 459
Flexor Brev. Digit. Pedis, 461
Flexor Brev. Poll. Pedis, 462
Flexor Min. Digit, Pedis, - 463
Flexor Accessorius,
Flexor Pollicis Longus,
Foot, Motions of, 244
Foot, Bones of, - 223
Foot, Muscles of, 460
Foot, Articulations of, 310
Fontanels, 179
Fore Arm, Motions of, 207
Fore Arm, Muscles of, - 420
Fore Arm, Articulations of, 291
Prenuiae of Mouth, 470
Frontal Bone, ..... 124
Gagliardi on Bones, - 58
Gaultier, ... - - 333
Gastrocnemius, - 456
Genio-Hyoideus, - 378
Gemini, - 449
Glenoid Ligament, - - 288
Glutseus Magnus, 447
Glutaeus Minimus, -
Glutaeus Medius, 448
Gracilis, 445
Gums, - - ... 478
Hairs, - - - 344
Half Arches, of Palate, 499
Hand, Muscles of, 430
Hand, Motions of, - - 210
Hand, Bones of, - - 193
Head, Development of Fretal,
Head, External Surface of, - 161
Head, - . ^ - - 121
Key's Ligament, - - 438
Hip Joint, ... 299
Hunter,- - - 337
Humeral Bone,
Hyoides, - • » - » 18i
INDEX, 513
Page
Ilium, - 97
Iliacus Interims, - 399
Ilio Lumbar Ligament, - 275
Innominata, - - - 97
Inter vertebral Substance, * 266
Inferior Extremities, - 213
Inf. Extremities in Standing, - 235
Inf. Extremities in Locomotion, - 241, 246
Inf. Palmar Ligaments, 297
Inter-Clavicular Ligament,- 283
Integuments, - 317
Internal Cellular Tissue, 322
Intercostal Muscles, 382
Inter-Trans versarii, 410
Infra-Spinatus, - - - - - -415
Indicator, ... - 430
Interosseal Lig. of Fore Arm, - 290
Interosseous Ligament of Leg, - 308
Interosseous Muscles of Hand, 434
Interosseous Muscles of Foot, - - 464
Inter-Spinales, - 410
Itinera Dentium, 487
Ischium, - - - - - - 100
Joints, - 260
Knee Joint, - 302
Latissimus Dorsi, - - - - 401
Lateral Lig. of Knee, , - 304
Laeerti, of Muscles, 350
Leg, Motions- of, - 243
Levator Anguli Oris, 366
Levator Labii Sup., - - 366
Levator Labii Inferioris, - 368
Leg, Muscles of, - 452
Levator Scapulas, - 403
Levatores Costarum, - - 410
Ligamentous Tissue, ..... 257
Ligaments, Yellow, - - 269
Ligament. Alare, - - 307
Ligament. Mucosum, - - 307
Lig. Carpi Volare, 413
Lig. Carpi Dorsale,
Ligamenta Vaginalia, ....
Lips, - 470
Little Toe, Muscles of, - 463
Longus Colli, ------ 378
Longissimus Dorsi, ... - - 405
44*
514 INDEX.
Page
Lower Jaw, Articulations of, • - - 263
Lower Extremities, Joints of, . * •" - 299
Lumbar Vertebrae, - 85
Lumbricales Pedis,
Lumbricales, - - ' - - 431
Malar Bones, - • *- - - - 144
Maxillare Inferius, - -' ! - - 146
Maxillare Superius, - 138
Masseter, - - - * ' - 369
Medulla, - ... - £jtf\ - 65
Metacarpal Joints, - 295
Metacarpus, - - .. . .-y« 197
Metatarsus, - . - _ - - - - 229
Metatarsal Joints, -. 315
Membrana Musculorum, - 350
Middle Straight Ligament, 273
Moderator Ligament, 272
Mongolian Race, - ». 174
Mouth, - 469
Mouth, Glands of, - - ' - - - 50°
Muciparous Glands, 500
Multifidus Spinas, 408
Muscles, General Anatomy of,
Muscles of the Back, - i 400
Muscular Fibre, - - - - 351
Muscular Motion, - - 355
Mylo-Hyoideus, - - 377
Nasal Bones, - - - - '*>: 142
Nails, - - - - - - ^ - 342
Negroes, - 174
"Nose, - - - - - - - 1G5
Obliquus Ext. Abdominis, <•
Obliquus Int. Abdominis, - 386
Obliquus Capitis,
Obturator Ligament,
Obturator Externus, <-•••'; - - -^ - 450
'Obturator Internus, -
Occipito Vertebral Articulation, 270
Occiput, - 127
Occipito -Frontalis,
Omo-Hyoideus, -•-•.. " 376
Opponens Pollicis, '** - - 431
Orbits, - - 'V|j !;•* n 167
Orbicularis Oris, ^^
Orbicularis Palpebrarum, • • . 365
Orbicular Ligament, -.--»- 289
INDEX. 515
»
Page
Ossification, . . . • .68
Osteogeny, ..... 67
Osseous Part of Teeth, .... 475
(Esophagus, . . 507
Ossa Longa, Lata, Crassa, . .51
Palmaris Longus, . . . . . .421
Palate, Soft, ...... 498
Palmaris Brevis, ...... 430
Palate, Muscles of, . 499
Palate Bones, . . . . . .140
Papillae of Tongue, . . . . . 496
Papillae Tactus, ..... 230
Parotid Gland, . . . . . 501
Parietal Bone, . . . . . .126
Patella, . . . . . . 220
Patella, Ligaments of, . • 303
Pectoralis Major, . . . . 380
Pectoralis Minor, . . . . .381
Pectinalis, . - . . . . 445
Pectineal Fascia, -. . . . . 438
Pelvis, Ligaments of, . . . . 274
Pelvis, . . . . . 102
Development of, . . . . . 105
Mechanism of, . . . .106
Male and Female, . . . . 103
Pelvic VertebraR, . . . . .86
Periosteum Externum, . . . . 63
Periosteum Internum, . . . . .65
Perichondrium, . . . . . 254
Periglottis, ....... 496
Peroneo-Tibial Articulations, .... 307
Peroneus Brevis, . ... 455
Peroneus Longus, . . . . . 455
Peroneus Tertius, ' . . . . . 454
Pharynx, Muscles of, . . ••."«. 505
Pharynx, . . . x. . 504
Phalanges of Hand, ..... 199
Phalangial Articulations, . . .' . . 298
Platysma Myodes Muscle, . . . 372
Plica Polonica, . . . . . . 348
Plantaris, .... . 457
Posterior Ligaments of Knee, .... 303
Popliteus, „ 457
Pronator Quadratus . . . • . 425
Pronator Radii Teres, . . . . . 420
Psoas Magnus, ...... 398
Psoas Parvus, ...... 398
Pterygoideus Internus, . . . . . 371
516 INDEX.
Page
Pterygoideus Externus, - - , - 370
Pubic Ligament, - • • • • 278
Pulp of Tooth, -.--.- 480
Pubes, "V • -
Pyriformis,
Pyramidalis,
Quadratus Femoris, - - 450
Quadratus Lumborum, - - - 397
Radio-Carpal Articulation, # 292
Radio-Ulnar Articulation, - 291
Radius,- * - --^ 191
Rectus Abdominis, - - ••«*
Rectus Capitis,
Rectus Capitis Posticus, - - 409
Rectus Femoris, -
Rete Mucosum, -
Rhomboideus Major, - - -, 403
Rhomboideus Minor, .... 403
Ribs, - - 107
Ribs, Articulation of, 278
Round Ligament, - - 300
Sacrum, - - - - - 86
Sacro-Iliac Ligament, - 276
Sacro-Spinous Ligament, - - -XT*
Sacro-Lumbalis, | - - 404
Sacciform Ligament, 310
Salivary Glands, - 501
Sartorius, - - ; .» • • 442
Scalenus Anticus, - - '•* - - k379
Scalenus Medius, - - -«. 379
Scalenus Posticus, - - ' 380
Scaphoides, 226
Scapula, 183
Scarpa on Bones, - •< ~ 60
Scapulo-Humeral Joint, - * ' 287
Sciatic Ligament, - - 276
Sesamoid^Bones, - - - 201, 233
Semi-Lunar Cartilages, •*' - '•""' 305
Semilunare,' - ' -* •' * - - 194
Sebaceous Organs, - - -^ • 340
Serosity, - - 324
Semi-spinalis Cervicis, - - 407
Semi-spinalis Dorsi, * *'* - 408
Semi-membranosus, • 452
Semi-tendinosus, "•., - -,:f 451
Sella Turcica, ^ - I;.*'' -^ - W1 - 159
INDEX. 517
Page
Serratus Magnus, . . . 382
Serratus Inferior Posticus, - ... 402
Serratus Superior Posticus, . . 403
Shoulder, - - - - 182
Shoulder, Articulations of, - . 283
Shape of Muscles, . . . 259
Shoulder, Motions of, . 204
Shoulder, Muscles of, 414
Skin, . . 328
Skeleton, Anatomy of, - - - 49
Soleus, . . . 456
Sphenoides, - .... 133
Spinalis Dorsi, - ... 405
Spine, . 78
Spine, Uses of, - ... 90
Spine, Ligaments of, - 266
Splenius, 404
Spongiosum Inferius, . - 145
Stearin, - . . 326
Stenos Duct, . - - 502
Sternum, - 111
Sterno-Cleido Mastoideus, - 372
Sterno-Hyoideus, - 375
Sterno-Tliyroideus, - 375
Stylo-Glossus, - - 377
Stylo-Pharyngeus, - 377
Stylo-Maxillary Ligament, - 264
Subs cap ularis, - ... 416
Subclavius, ....... 382
Sublingual Gland, 503
Submaxillary Gland, - , - 502
Supinator Rad. Long., - - 425
Supinator Rad. Brev., - - 428
Supra Spinatus, - - 415
Sutures, Formation of, 154
Sutures, Uses of, - - 152
Sutures, - - - 149
Symphysis Pubis, . • 277
Synovial Capsules, .... 261
Temporal Bone, - 130
Thorax, - - 107
Articulations of, - - - 278
Development of, 1 15
Mechanism of, - 116
Triquetra, • • - - - - 155
518 INDEX.
Page
Tarsus, -
Tarso-Metatarsal Articulation, - 314
Teeth, - 471
Formation of, 479
Temporalis, 370
Tendons, - - - 360
Teres Major, 416
Teres Minor, - 415
Tensor Vagina?, ------ 442
Thumb, Articulations of, - 298
Thyreo-Hyoideus Muscle, - 375
Thigh, Motions of, 241
Muscles of, - - - 442
Tibia, ------- 217
Tibialis Posticus, - - 459
Tibialis Anticus, 453
Toes, Bones of, - - - - 232
Joints of, - - , 315
Tongue, - 493
Mucous Covering of, - 495
Muscles of, - 493
Trachelo Mastoideus, - 407
Transversalis Abdominis, - - 387
Transversalis Cervicis, - 406
Transversalis Pedis, 463
Transverse Ligament, - 272
Trapezoid Lig., 285
Trapezium, 194
Trapezius, - 401
Triceps Extensor Cubiti, 419
Triceps Surae, ... - 456
Triangularis Sterni, 383
Triangular Lig., - - 286
Trunk, - 78
Muscles of, - - * * 400
Ulna, - , - , - - 189
Unguis, , . . . - 143
Upper Extremities, 182
Articulations of, 283
Development of, - 201
Mechanism of, 202
Muscles of, 41 1
Vastus Externus, 443
Vastus Interims, - 443
Vertebra, - - 78
Development of, • • 89
Motions of, - 93
INDEX. 519
Page
Vertebral Ligaments, ... 266
Vincula Acce'ssoria, ... 425
Vomer, . - 146
Wrist, Articulations of, - - 291
Zygomaticus Minor, . . 357
Zygomaticus Major, - . 357
END OF VOL.
LEA & BLANC HARD,
HAVE RECENTLY PUBLISHED,
MIDWIFERY ILLUSTRATED,
BY FRANCIS H. RAMSBOTHAM, M.D.,
PHYSICIAN TO THE ROYAL MATERNITY CHARITY, AND LECTURER ON MIDWIFERY AT THE
LONDON HOSPITAL, ETC.
THE PRINCIPLES AND PRACTICE
OF
OBSTETRIC MEDICINE AND SURGERY,
IN REFERENCE TO THE
Process of Parturition,
ILLUSTRATED BY ONE HUNDRED AND FORTY-TWO FIGURES.
FIRST AMERICAN EDITION, REVISED.
In one large octavo volume.
From among numerous commendations of this work of Dr. Ramsbotham, the American
publishers append a few, and would particularly call the attention of the medical public to
the execution of the numerous plates, which form a most important feature in the volume.
The great expense they have incurred in its production calls for an extended sale, which they
trust the merits of the work will command.
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perspicuous form, and whatever is of importance is illustrated by first rate engravings. As a work convey-
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confidently recommend it either to the student or practitioner." — Edinburgh Journal of Medical Science.
" It is the book on Midwifery for students: clear, but not too minuto in its details, and sound in its prac-
tical instructions. It is so completely illustrated by plates (admirably chosen and executed) that the stu-
dent must be stupid indeed who does not understand the details of this branch of the science, so far al least
as description can make them intelligible." — Dublin Journal of Medical Science.
"There is so much in the practice of Midwifery which cannot be understood without pictorial illustra-
tions, that they become almost essential to the student; but hitherto the expense has proved an impediment
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very extensive." — Medical Gazette.
" We strongly recommend the work of Dr. Ramsbotham to all our obstetrical readers, especially to those
who are entering upon practice. It is not only one of the cheapest, but one of the most beautiful works in
Midwifery."— British and Foreign Medical Review.
" We feel much pleasure in recommending to the notice of the profession one of the cheapest and most
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practitioner who wishes to refresh his memory, as a most faithful picture of practical Midwifery; and we
can with justice say, that altogether it is one of the best books we have read on the subject of obstetrical
medicine and surgery." — Medico- Chirurgical Review.
" It is intended expressly for students and junior practitioners in Midwifery; it is therefore, as it ought
to be, elementary, and will not, consequently, admit of an elaborate and extended review. Our chief
object ROW is to state our decided opinion, that this work is by far the best that has appeared in this
country, for those who seek practical information upon Midwifery, conveyed in a clear and concise style.
The value of the work, too, is strongly enhanced by the numerous and beautiful drawings, by Bagg, which
are in the first style of excellence. Every point of practical importance is illustrated, that requires the
aid of the engraver to fix it upon the mind, and to render it clear to the comprehension of the student."—
London Medical Gazette.
" Among the many literary undertakings with which the Medical press at present teems, there are few
that deserve a warmer recommendation at our hands than the work— we might almost say the obstetrical
library, comprised in a single volume— which is now before us. Few works surpass Dr. Ramsbotham's in
beauty and elegance of getting up, and in the abundant and excellent engravings with whiefh it is illus-
trated. We heartily wish the volume the success which it merits, and we have no doubt that before long it
will occupy a place in every medical library in the kingdom. The illustrations are admirable; they are the
joint production of Bagg and Adlard; and comprise, within the series, the best obstetrical plates of our
best obstetrical authors, ancient and modern. Many of the engravings are calculated to fix the eye aa
much by their excellence of execution and their beauty as works of art, as by their fidelity to nature and
anatomical accuracy :'—Tkt Lancet.
THE PRACTICE OF MEDICINE,
OR A
TREATISE ON SPECIAL PATHOLOGY AND THERAPEUTICS.
BY ROBLEY DUNGLISON, M.D.,
PROFESSOR OF THE INSTITUTES OF MEDICINE, ETC. IN THE JEFFERSON MEDICAL COLLEGE,
PHILADELPHIA, LECTURER ON CLINICAL MEDICINE, AND ATTENDING
PHYSICIAN AT THE PHILADELPHIA HOSPITAL, ETC.
CONTAINING
THE DISEASES OF THE ALIMENTARY CANAL,
THE DISEASES OF THE CIRCULATORY APPARATUS,
DISEASES OF THE GLANDULAR ORGANS,
DISEASES OF THE ORGANS OF THE SENSES,
DISEASES OF THE RESPIRATORY ORGANS,
DISEASES OF THE GLANDIFORM GANGLIONS,
DISEASES OF THE NERVOUS SYSTEM,
DISEASES OF THE ORGANS OF REPRODUCTION,
DISEASES INVOLVING VARIOUS ORGANS,
&x. &c.
In Two Volumes Octavo.
"This new work, from the press of Lea and Blanchard, forms a valuable addition to our Medical
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had long since created ; and we congratulate the profession in being put in possession of a work on the
practice of medicine, in which not only are found the latest and most approved views of Pathology,
united with the soundest practical deductions, but which is here interspersed throughout with the
most valuable recipes for administering the various medicines suggested.
"The object of the author has been, as he states, to incorporate the improvements and modifications
incessantly taking place in the departments of Pathology and Therapeutics, so as to furnish those to
whom the different general treatises, monographs and periodicals are not accessible, with the means
of appreciating their existing condition. The examination we have made of the work satisfies us
that in this aim he has been eminently successful, and that he has presented to the profession the
most complete work on the Practice of Medicine to be found in any language — for we know of no
similar work in which is embodied such an amount of scientific and practical information. INo one,
therefore, who desires to keep himself au nouveau du siecle, will fail to include in his collection a
work which thus brings before him the latest views of subjects, in which scientific investigations
have lately wrought so many changes.
"This is not the place of course, to speak in detail of the merits of such a work. We may there-
fore say that the two volumes before us give evidence throughout of extensive research, deep reflec-
tion, and abilities for which, indeed, the author's name is always a guarantee; and that we can con-
fidently recommend them to all who desire to keep pace with the progress of medical science." —
Bait. Pat.
" We hail the appearance of this work, which has just been issued from the prolific press of
Messrs. Lea &, Blanchard, of Philadelphia, with no ordinary degree of pleasure. Compri.-ed in two
large and closely printed volumes, it exhibits a more full, accurate, and comprehensive digest of the
existing state of medicine than any other treatise with which we are acquainted in the English
language. It discusses many topics — some of them of great practical importance, whuch are
entirely omitted in the writings of Eberle, Dewees, Ilosack, Graves, Stokes, Mclntosh, and
Gregory ; and it cannot fail, therefore, to be of great value, not onlv to the student, but to the
practitioner, as it affords him ready access to information of which he stands in daily need in the
exercise of his profession, It has been the desire of the author, well-known as one of the most
abundant writers of the age, to render his work strictly practical ; and to this end he has been
induced, whenever opportunity offered, to incorporate the results of his own experience with that
of his scientific brethren in America and Europe. To the former, ample justice seems to have been
done throughout. We believe this constitutes the seventh work which Professor Dunglison has
published within the last ten years ; and, when we reflect upon the large amount of labour and
reflection which must have been necessary in their preparation, it is amazing how he could have
accomplished so much in so short a time." — Louisville Journal.
" As a system of Practical Medicine, this work will meet a cordial welcome from all who know
the untiring assiduity and laborious habits in the pursuit of knowledge, of the author, who has
already presented the public with numerous excellent works, bearing the stamp of originality as
well as of profound research.
" The object of Professor Dunglison is to present, in as compact a form as was consistent with
accuracy and perspicuity, a history of all the affections which properly come under the care pt
the physician, with all the improvements and modifications which have taken place latterly in
Pathology and Therapeutics, so as to enable the student and practitioner ' to appreciate their present
condition,' and to avail themselves of knowledge scattered about in various journals and mono-
graphs.
"This task has been faithfully executed, and the work maybe recommended as a good class-book,
in which the soundness of the author's views and his freedom from exclusive opinions have enabled
him to select from the experience of others those facts and views, which, together with his own
experience, were to furnish the proper data for correct descriptions and for sound practical deduc-
tions."— New York American,
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HAVE JUST PUBLISHED
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OP
THE LIBRARY
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CYCLOPEDIA OF PRACTICAL MEDICINE, ETC.
WITH THE ASSISTANCE OF NUMEROUS CONTRIBUTORS.
THE WHOLE REVISED, WITH NOTES AND ADDITIONS,
BY
W. W. GERHARD, M.D.,
LECTURER ON CLINICAL MEDICINE TO THE UNIVERSITY OF PENNSYLVANIA, PHYSICIAN TO
THE PHILADELPHIA HOSPITAL, BLOCKLEY, ETC.
The whole Five Volumes of the former edition, now complete in Three large
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AND FOR SALE BY ALL BOOKSELLERS.
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other circumstances, have not the opportunity of keeping pace with the more recent improve-
ments in the most interesting and useful branch of human knowledge. To supply this defi-
ciency, is the object of THE LIBRARY OF MEDICINE ; and the Editor expresses the hope, that
with the assistance with which he has been favoured by Contributors, (many of great eminence,
and all favourably known to the Public,) he has been able to produce a work, which will form
a Library of General Reference on Theoretical and Practical Medicine, as well as a Series of
Text Books for the Medical Student.
It is intended to treat of each Department, or Division of Medicine, each SERIES forming a
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rate price, or it will constitute a part of THE LIBRARY OF MEDICINE. This arrangement is
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SERIES, the opportunity of purchasing such Volumes only, and thus avoid the inconvenience
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ADVERTISEMENT
OF
THE AMERICAN PUBLISHERS TO THEIR NEW EDITION
IN THREE VOLUMES.
The matter embraced in the Three Volumes now presented, was published in London in
five separate volumes, and at intervals republished in this country. The rapid sale of these
volumes, embracing as they do a History of Practical Medicine, is the best evidence of the
favour with which it has been received by the physicians of the United States. Embodying
as it does the most recent information on nearly every disease, and written by men who
have specially devoted themselves to the study of the disorders which form the subject of
their articles, the work is the most valuable for reference within the reach of a practitioner.
The arrangement of the Library into classes of diseases, grouped according to the cavities of
the body, is much more agreeable to the reader than the alphabetical order, and nearly as
convenient for reference.
The reader will not fail to perceive some inequality in the articles, even of the same
authors ; the subjects with which an author is most familiar, and upon which he had pre-
viously written, are usually the best treated and most elaborate. Among the most finished
treatises are those of Dr. Christison on the urinary organs, and of Williams and Joy on the
thoracic viscera ; several other essays are excellent monographs, and very few fall much
below the average standard of the series.
The object of the publishers in compressing the five volumes of the former edition into three
is to place the work at such a price as to be within the reach of every reader. There is no
abridgement or alteration whatever of the text of the former edition, and the general ap-
pearance of the volumes is scarcely inferior. The notes added to the last four volumes have
been revised, and some additions made to them. New notes have also been added to the first
volume, which was not revised in the former edition. For the note on Remittent Fever, the
American Editor is indebted to Dr. Stewardson, for those on Ophthalmia to Dr. W. P. Johnston.
The principal notes are one on Typhoid Fever, another on Remittent, one on Tuberculous
Meningitis, and a fourth on Delirium Tremens. It was neither intended nor wished to over-
load the work with annotations ; the notes refer either to some trivial errors which have crept
into the text, or to subjects which were treated less completely than they deserved to be ; they
are, therefore, comparatively few in number. Several diseases are, from the difference of cli-
mate, more frequent and severe in the United States than in Great Britain, and the articles
which relate to them required some additional matter.
The notes which appeared in the London edition are designated by the word Author. Those
of the American Editor are indicated by the letter G.
The Editor of this edition did not feel himself at liberty to make any change in the for-
mulas of the prescriptions, which are published towards the end of the last volume, believing,
as he does, that very strong reasons alone can justify such use of a scientific work. One
alteration, which adapts them to the custom of this country, was, however, made ; — that is, the
translation of the directions for the doses and administration of the prescriptions from Latin
into English : there is an obvious convenience in this change.
The Three Volumes now presented contain the first series, that on Practical Medicine, of a
Library of Medicine, edited by Dr. Tweedie, and now in course of publication, and are com-
plete in themselves. The series will be continued in London, embracing works on Midwifery,*
Surgery, Anatomy, and the other Departments of Medical Science. Such of them as may be
deemed worthy of republication will be issued here with notes and additions, each work under
its particular title, but in a style and manner to match this work.
* The work on Midwifery, by Edward Rigby, with numerous wood cuts, has lately been issued by the pub-
lishers of these volumes.
LEA & BLANCHARD,
PHILADELPHIA,
HAVE RECENTLY PUBLISHED
A NEW SERIES OF
THE
AMERICAN
JOURNAL OF THE MEDICAL SCIENCES,
EDITED BY
ISAAC HAYS, M. D.
COMMENCED ON THE JST OF JANUARY, 1841.
TERMS.
Each number contains 260 pages, or upwards, and is frequently illustrated by coloured
engravings. It is published on the first of January, April, July, and October. Price Five
Dollars per annum, payable in advance.
Orders, enclosing the amount of one year's subscription, addressed to the publishers, or
any of the agents, will receive prompt attention. The year of this work commences with the
January number.
Persons sending Twenty Dollars will be entitled to five copies of the work, to be forwarded
as they may direct. All persons desirous of advancing the interest of medical science, are
requested to use their efforts to increase its circulation.
The postage per number is, within 100 miles, about 16 cents; over 100 miles, about 28
cents.
A few complete sets of the old series may be had at a large discount from the subscription
price. Odd numbers can be furnished to complete sets.
PRACT ICAL
GEOLOGY AND MINERALOGY,
WITH INSTRUCTIONS FOR
THE QUALITATIVE
ANALYSIS OF MINERALS.
BY JOSHUA TRIMMER, F.G.S.
WITH 212 WOOD CUTS.
A handsome Octavo Volume bound in Embossed cloth.
This is a systematic introduction to Mineralogy and Geology, and admirably calculated to
instruct the student in those sciences. The organic remains of the various formations are
well illustrated by numerous figures which are drawn with great accuracy.
THE BRIDGEWATER TREATISES, COMPLETE IN SEVEN VOLS., OCTAVO.
EMBRACING,
I. The Adaptation of External Nature to the Moral and Intellectual Constitution of Man.
By the Rev. Thomas Chalmers.
II. The Adaptation of External Nature to the Physical Condition of Man. By John Kidd,
M. D.,F.R.S.
III. Astronomy and General Physics, considered with Reference to Natural Theology.
By the Rev. William Whewell.
IV. The Hand : Its Mechanism and Vital Endowments as Evincing Design. I>y Sir
Charles Bell, K. H., F. R. S. With numerous wood cuts.
V. Chemistry, Meteorology, and the Function of Digestion. By Wm. Prout, M. D.,
F. R. S.
VI. The History, Habits, and Instincts of Animals. By the Rev. William Kirby, M. A.,
F. R. S. Illustrated by numerous engravings on copper.
VII. Animal and Vegetable Physiology, considered with Reference to Natural Theology.
By Peter Mark Roget, M. D. Illustrated with nearly Five Hundred Wood Cuts.
VIII. Geology and Mineralogy, considered with Reference to Natural Theology. By the
Rev. William Buckland, D. D. With numerous engravings on copper, and a large coloured
Map.
ICT The work of BUCKLAND, KIRBY and ROGET, may be had separate.
THIRD EDITION BROUGHT UP TO 1841,
OF
NEW REMEDIES.
THE METHOD OF PREPARING AND ADMINISTERING THEM;
THEIR EFFECTS
UPON THE
HEALTHY AND DISEASED ECONOMY, &c. &c.
BY ROBLEY DUNGLISON, M. D.
Professor of the Institutes of Medicine and Materia Medico, in Jefferson Medical College of
Philadelphia; Attending Physician to the Philadelphia Hospital, Sfc.
IN ONE VOLUME, OCTAVO.
[Extract from the Preface to the Third Edition.]
" This edition has been subjected to an entire revision, and the author has modified in cer-
tnin respects the arrangement, and altered the nomenclature so as to cause it to correspond
more nearly to that adopted in the Pharmacopoeia of the United States."
THIRD EDITION BROUGHT UP TO 1842,
OF
DUNGLISON'S DICTIONARY
OF
MEDICAL SCIENCE AND LITERATURE:
CONTAINING
A concise account of the various Subjects and Terms, and formula for various officinal and
empirical preparations, fyc.
IN ONE ROYAL OCTAVO VOLUME.
This new Edition includes in -the body of the work, The Index, or Vocabulary of Syno-
nytnes that was in the former Editions printed at the end of the Volume, and embraces many
corrections, with the additions of many new words.
FOURTH EDITION, IMPROVED WITH ADDITIONS UP TO 1842,
OF
DUNGLISON'S HUMAN PHYSIOLOGY:
ILLUSTRATED WITH NUMEROUS ENGRAVINGS.
IN TWO VOLUMES OCTAVO.
THE MEDICAL STUDENT;
OR, AIDS TO THE STUDY OF MEDICINE.
Including a Glossary of the Terms of the Science, and of the mode of Prescribing; Biblio-
graphical Notices of Medical Works; the Regulations of the Different
Medical Colleges of the Union, &c.
BY ROBLEY DUNGLISON, M. D., &c. &c.
la One Volume, Octavo.
THE FIRST PRINCIPLES OF MEDICINE.
BY ARCHIBALD BILLING, M. D. A. M.
Member of the Senate of the University of London, Fellow of the Royal College of Physicians,
$c. $c.
In One Volume, 8vo. First American from the Fourth London Edition.
"We know of no book which contains within the same space so much valuable informa-
tion, the result not of fanciful theory, nor of idle hypothesis, but of close persevering clinical
observation, accompanied with much soundness of judgment, and extraordinary clinical
tact." — Medico-Chirurgical Review.
A NEW EDITION (THE SIXTH) OF
THE MEDICAL FORMULARY OF DR. ELLIS,
This edition is completely revised, with many additions and modifications, and brought up to
the present improved state of the Science,
BY SAMUEL GEORGE MORTON, M. D.
Professor in the Pennsylvania College of Medicine, fyc. &c.
A PRACTICAL TREATISE ON THE HUMAN TEETH,
Showiflg the causes of their destruction and the means of their preservation. By VVm.
Robertson. With plates. First American, from the second London
edition. In One Volume.
OUTLINES OF A
COURSE OF LECTURES ON MEDICAL JURISPRUDENCE.
BY THOMAS STEWART TRAILL, M. D.
From the Second Edinburgh Edition, with American Notes and Additions.
ARNOTT'S ELEMENTS OF PHYSICS.
Complete in One Volume.
A New Edition of Elements of Physics, or Natural Philosophy, general and medical, writ-
ten for universal use, in plain or non-technical language, and containing New Disquisitions
and Practical Suggestions, comprised in five parts:— 1st. Sornatology, Statics and Dynamics.
2d. Mechanics. 3d. Pneumatics, Hydraulics and Acoustics. 4th. Heat and Light. 5th.
Animal and Medical Physics. Complete in one volume, by Neil Arnott, M. D., of the Royal
College of Physicians. A new edition, revised and corrected from the last English edition,
with additions, by Isaac Hays, M. D.
A PRACTICE OF PHYSIC.
Comprising most of the diseases not treated of in Diseases of Females and Diseases of
Children, second edition. By VV. P. Dewees, M. D., formerly adjunct professor in the Uni-
versity of Pennsylvania. Iu one volume, octavo.
A COMPENDIOUS SYSTEM OF MIDWIFERY.
BY DR DEWEES.
Chiefly designed to facilitate the Inquiries of those who may be pursuing this branch of
study. Illustrated by occasional cases and with many plates. The ninth edition, with addi-
tions and improvements. In one vol. 8vo.
DEWEES ON THE DISEASES OF FEMALES.
The seventh Edition, Revised and Corrected. With Additions and Numerous Plates.
In One Vol., 8vo.
DEWEES ON THE PHYSICAL AND MEDICAL TREATMENT OF CHILDREN
With Corrections and Improvements. The seventh edition. In one volume, 8vo.
A FLORA OF NORTH AMERICA.
With 108 Coloured Plates. By W. P. C. Barton, M. D. In three volumes, quarto.
A Treatise on Special and General Anatomy. By W. E. Horner, M. D., Professor of Ana-
tomy in the University of Pennsylvania, &c., &c. Fifth edition, Revised, and much im-
proved. In two volumes, 8vo.
This work is extensively used as a Text Book.
A System of Midwifery, with numerous wood cuts, by Edward Rigby, M. D., Physician to
the General Lying-in Hospital, Lecturer on Midwifery at St. Bartholomew's Hospital, &c.,
with notes and additional illustrations by an American Practitioner. In One Volume.
Extract from the Editor's Preface. — "This System of Midwifery, complete in itself, was
published in London, as part of Dr. Tweedie's 4 Library of Medicine.' The first series of the
Library, that on • Practical Medicine,' recently completed, has been received with extraordi-
nary favour on both sides of the Atlantic, and the character of the publication is fully sus-
tained in the present contribution by Dr. Rigby, and will secure for it additional patronage.
"The late Professor Dewees, into whose hand this volume was placed, a few weeks before
his death, in returning it expressed the most favourable opinion of its merits, and the judg-
ment of such high authority renders it supererogatory to add a word farther of commenda-
tion."
A Treatise on Pulmonary Consumption, comprehending an inquiry into the Nature, Causes,
Prevention, and Treatment of Tuberculous and Scrofulous Diseases in General. By James
Clark, M. D., F. R. S.
Essays on ASTHMA, APHTHA ASPHYXIA, APOPLEXY, ARSENIC, ATROPA,
AIR, ABORTION, ANGINA-PECTORIS, and other subjects Embraced in the Articles
from A to Azote, prepared for the Cyclopaedia of Practical Medicine. By Dr. Chapman,
and others.
Each article is complete within itself, and embraces the practical experience of its author,
and as they are only to be had in this collection will be found of great value to the profes-
sion.
%* The two volumes are now offered at a price so low, as to place them within the reach
of every practitioner and student.
A Practical Treatise on Medical Jurisprudence, with so much of Anatomy, Physiology,
Pathology, and the Practice of Medicine and Surgery, as are essential to be known by Mem-
bers of the Bar and Private Gentlemen; and all the laws relating to Medical Practitioners;
with explanatory plates. By J. Chitty, Esq. Second American edition : with Notes and
Additions, adapted to American works and Judicial Decisions, 8vo.
Abercrombie's Pathological and Practical Researches on Diseases of the Stomach, the In-
testinal Canal, the Liver, and other Viscera of the Abdomen. Third American, from the
second London edition, enlarged. In 1 vol. 8vo.
A Treatise on Fever. By Southwood Smith, M. D., Physician to the London Fever Hos-
pital. Fourth American edition. In I volume, 8vo.
The Anatomy, Physiology, and Diseases of the Teeth. By Thomas Bell, F. R.S., F. L. S.,
&c., Third American edition. In 1 vol. 8vo. With numerous plates.
A COMPENDIOUS SYSTEM OF MIDWIFERY.
BY DR DEWEES.
Chiefly designed to facilitate the Inquiries of those who may be pursuing this branch of
study. Illustrated by occasional cases and with many plates. The ninth edition, with addi-
tions and improvements. In one vol. 8vo.
DEWEES ON THE DISEASES OF FEMALES.
The seventh Edition, Revised and Corrected. With Additions and Numerous Plates.
In One Vol., 8vo.
DEWEES ON THE PHYSICAL AND MEDICAL TREATMENT OF CHILDREN
With Corrections and Improvements. The seventh edition. In one volume, 8vo.
A FLORA OF NORTH AMERICA.
With 108 Coloured Plates. By W. P. C. Barton, M. D. In three volumes, quarto.
A Treatise on Special and General Anatomy. By W. E. Horner, M. D., Professor of Ana-
tomy in the University of Pennsylvania, &c., &c. Fifth edition, Revised, and much im-
proved. In two volumes, 8vo.
This work is extensively used as a Text Book.
A System of Midwifery, with numerous wood cuts, by Edward Rig-by, M. D., Physician to
the General Lying-in Hospital, Lecturer on Midwifery at St. Bartholomew's Hospital, &c.,
with notes and additional illustrations by an American Practitioner. In One Volumo.
Extract from the Editor's Preface. — "This System of Midwifery, complete in itself, was
published in London, as part of Dr. Tweedie's ' Library of Medicine.' The first series of tho
Library, that on ' Practical Medicine,' recently completed, has been received with extraordi-
nary favour on both sides of the Atlantic, and the character of the publication is fully sus-
tained in the present contribution by Dr. Rigby, and will secure for it additional patronage.
"The late Professor Dewees, into whose hand this volume was placed, a few weeks before
his death, in returning it expressed the most favourable opinion of its merits, and the judg-
ment of such high authority renders it supererogatory to add a word farther of commenda-
lion."
A Treatise on Pulmonary Consumption, comprehending an inquiry into the Nature, Causes,
Prevention, and Treatment of Tuberculous and Scrofulous Diseases in General. By James
Clark, M. D., F. R. S.
Essays on ASTHMA, APHTHA, ASPHYXIA, APOPLEXY, ARSENIC, ATROPA,
AIR, ABORTION, ANGINA-PECTORIS, and other subjects Embraced in the Articles
from A to Azote, prepared for the Cyclopaedia of Practical Medicine. By Dr. Chapman
and others.
Each article is complete within itself, and embraces the practical experience of its author,
and as they are only to be had in this collection will be found of great value to the profes-
sion.
%* The two volumes are now offered at a price so low, as to place them within the reach
of every practitioner and student.
A Practical Treatise on Medical Jurisprudence, with so much of Anatomy, Physiology,
Pathology, and the Practice of Medicine and Surgery, as are essential to be known by Mem-
bers of the Bar and Private Gentlemen; and all the laws relating to Medical Practitioners;
with explanatory plates. By J. Chitty, Esq. Second American edition : with Notes and
Additions, adapted to American works and Judicial Decisions, 8vo.
Abercrombie's Pathological and Practical Researches on Diseases of the Stomach, the In-
testinal Canal, the Liver, and other Viscera of the Abdomen. Third American, Irom the
second London edition, enlarged. In 1 vol. 8vo.
A Treatise on Fever. By Southwood Smith, M. D., Physician to the London Fever Hos-
pital. Fourth American edition. In I volume, 8vo.
The Anatomy, Physiology, and Diseases of the Teeth. By Thomas Bell, F. R.S., F. L.S.,
&c., Third American edition. In 1 vol. 8vo. With numerous plates.
145243
QM22
H6
1340
v.l
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