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CONTRIBUTIONS     ^£T ^/i^
PHYSIOLOGICAL AND PATHOLOGICAL

           ANATOMY;
CONTAINING the
MADE AT THE
PHILADELPHIA ANATOMICAL ROOIYIS

          DURING THE SESSION OF 1824-25.

                        M
       BY JOHN D. (RODMAN, M. D.
LECTURER ON ANATOMY AND PHYSIOLOGY; ONE OF THE PROFESSORS OP
     THK PHILADELPHIA MUSEUM; MEMBER OF THE ACADElfY
         OF NATURAL SCIENCES ; OF THE AMERICAN
             PHILOSOPHICAI SOCIETY, &c. &c.
MEAETH* TO FIAN'
               iible.f /
To industry, all things are possible- / / ^ ^J  . - J J
PHILADELPHIA:
H. C. CAREY & I. LEA---CHESNUT STREET.
         William Fry, Printer.
              1825. 

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NATIONAL LIBRARY OF MEDICINB
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PRELIMINARY REMARKS
  From the earliest dawn of medical science to
the present hour, the importance of Anatomical
knowledge to all Physicians has been fairly set
forth, and fully illustrated; yet, strange as it may
appear, Anatomy has never been cultivated as it
should be, by the Profession at large,  neither
has society received  half of the  benefits this
science is capable of conferring, because of the
imperfect manner in which it  is generally un-
derstood.  It is true, that a great degree of per-
fection has been attained in this study in various
quarters,  by  numerous  individuals—but of the
great mass of Practitioners throughout the world,
it would not be  incorrect to state,  that at least
six out of ten have very vague, indefinite, and
unsatisfactory ideas on the subject, and of necessi-
ty can neither understand the diseases to which
the human body is liable, nor know how to ad-
dress themselves properly to their removal.
   This is, in a great degree,  to be accounted 
6
PRELIMINARY REMARKS.
 for, 1st. by the  actual difficulty of acquiring a
 thorough knowledge of Anatomy ;  2d. from the
 inveterate  prejudices existing in relation to this
 study; and, 3d.  from a  preposterously  absurd
 idea, that a man may become a good practitioner
 without being well acquainted with this science.
   The existence  of an actual difficulty, although
 it might suffice to deter  indolent and  irresolute
 persons from attempting  the study of medicine,
 can never serve  as  a justification to those who
 have assumed the responsibility; but it is unde-
 niable  that the time usually appropriated by stu-
 dents to this department is altogether inadequate
 to  the acquisition of more than a smattering,
 and must  ever  continue so, while preceptors
 are content that  a pupil  should devote to Ana-
 tomy not more than half the time that would be
 required for learning the  rudiments of Latin or
 Greek  grammar.   In relation to the prejudices
 generally existing against our science, they are
 obstacles of great magnitude, and can only be re-
 moved by  a gradual improvement in  the com-
 mon sense  of mankind:  in this country,  how-
 ever, the prejudice is nowhere so strong* as to

  *  Perhaps we should except that famous town in New Eng-
 land, where the people, instigated by their " enlightened" pas-
tor,  have recently exiled a  Physician for dissecting, and have
" resolved never to employ a Physician" who has dissected dead 
            PRELIMINARY REMARKS.          7

prevent a physician from  gaining a very valu-
able acquaintance with Anatomy.
   The third  reason given why anatomy is not
properly studied, is the common refuge of those
who  are willing to  shelter  themselves  in a
crowd, because too inactive to exert their own
strength.  It is true, there have been a few rare
instances of good Physicians who were not good
Anatomists; but how much better would these
have  been if they had possessed this knowledge ?
How painfully and slowly did they acquire their
ability to act  aright, and with  what an unneces-
sary  expenditure of  human  lives! advancing
with  faltering and undecided steps; guessing at
the condition of the various organs, and waiting
in anxious trepidation for the  result of their  ex-
periments :  for every thing  done by persons thus
deficient is no better  than an experiment, the
success  of which may  be hoped for, but cannot
be anticipated with certainty, as it is not based on
principle.   Allowing, however, that even at this
great and unnecessary expense of life, time, and
anxiety  of mind, a  few persons have at length
become expert, it is by no  means  applicable as

bodies, or assisted others in dissecting. We are confident
that on such terms, these good folks will never employ " a
Physician." Conduct like this, is a libel on the present times,
and on " a Christian land," professing to believe that the body
is corruptible—the soul, immortal—the  Eternal, omnipotent. 
 8          PRELIMINARY REMARKS.

 a general rule,  any more than that,  because a
 few men have become  celebrated without clas-
 sical education, all others may dispense with its
 assistance.
   The science of medicine is at least two centu-
 ries behind what it  ought to  be; and we may
 add, that mankind are equally in the rear of
 what they would have been, if anatomy had been
 properly persisted in by Physicians.   If after
 gaining in the schools an elementary acquaint-
 ance with the subject, they had,  on all proper
 occasions, taught those who employed them the
 irue value and application of this science, the
 reign  of prejudice would have long since been
 overthrown, and medicine raised  to its merited
 elevation.  Instead of having their worst pas-
 sions aroused, mankind would have learned with
 pleasure, that the bodies of their departed rela-
 tives were examined by their friend and Physi-
 cian—and  every benevolent  and  enlightened
 member of society would be rejoiced to think,
 that even after his decease he might contribute
to the prolonged and comfortable existence of
 those  he loves, by the aid of that  science which
interrogates death itself, in order to benefit the
living.
   The opposite  course  of conduct has entailed
 distrust of the Profession, and injury to the pa- 
PRELIMINARY REMARKS.          9
tient. The physician who does not know enough
of Anatomy to appreciate  and explain its uni-
versal  application to Medicine, is not qualified
to remove the prejudices against this study, and
while mankind continue to look on attempts to
examine the  dead, as an outrage, they  lock
the door against the improvement of their phy-
sicians : hence it results, that there is but this
difference between the parties—the practitioner
lives in, and the patient too often dies from, his
ignorance.
   We are, of course, speaking in the most exten-
sive and universal view of the subject, being per-
fectly  aware that a very admirable progress has
been made and  is still  making in this respect.
and the advantages thereof have already been
reciprocally experienced  by  the  profession and
society—witness the triumphantly successful in-
vestigation of diseases of the chest  and brain.
These, formerly the most mysterious  and ob-
scure  of our diseases, have, by the light of Ana-
tomy, been made plain and intelligible to all, and
every day is shedding a similar light over equally
interesting and difficult subjects  of medical  re-
search.
   Believing, as I do, in the necessity of a more
general and devoted attention to the study of phy-
siological and pathological anatomy, I may hope
                      B 
10         PRELIMINARY REMARKS.
 to be forgiven for thus pressing on the notice of
 practitioners the  importance of my favourite
 pursuit: 1 am willing to be called enthusiast, if
 those who examine the subject properly do not
 agree with me in opinion, though I have little
 fear of being censured by any one who has du-
 ly considered the  excellence  and  importance
 of this science.
   My own pathological  observations have been
 almost exclusively drawn from the inspection of
 bodies,  with the history of whose lives and dis-
 eases 1  was  unacquainted; connected with  a
 knowledge of the appearances exhibited previous
 to death, every fact remarked might have been
 of much greater moment,  What I  most wish
 to recommend  to  the serious attention of the
 profession, is, that they should endeavour to pro-
 fit by all the cases terminating unfortunately un-
 der their notice,  and by anatomical examination
 to connect the symptoms and diseased changes
 together—so  that on the recurrence  of similar
 affections, they may advance at once to the res-
 cue, guided by  an unwavering light, and with
that  self-possession which a consciousness  of
strength alone can bestow. 
              CONTRIBUTIONS

                    TO


PHYSIOLOGICAL AND  PATHOLOGICAL
  In my " Anatomical Investigations," recently
published, the fascia superficialis is described, as
it extends over the trunk, head, and neck, ante-
riorly and posteriorly,  and continues on to the
arms.  Subsequent examinations have confirm-
ed  these  dissections,  and have enabled me to
show, most conclusively, that the brachial fascia,
described heretofore as distinct, is a continuation
of the great superficial fascia.
  The fascia superficialis forms sheaths for all
the mucles of the trunk, neck, head, and arms.
It forms, in a manner analogous, the sheaths of
the muscles of the neck, and passing down into
the chest witli the great vessels, gives  the  im-
portant sheath called pericardium to the noblest
part of our muscular structure, the heart. 
12          SUPERFICIAL FASCIA.
  The fascia superficialis is a strong membrane, ex-
 tending over the abdominal muscles, and is placed
 nearly in the middle of the  cellular substance,
 between the surface of these muscles and the in-
 teguments, having a layer of fat above  and be-
 low it.   This fascia  is very readily perceptible
 in dropsical subjects, (in two  of which  we have
 recently demonstrated it,) as  in them the cellu-
 lar substance above and below the  fascia is fully
 distended with water, leaving  the fascia in its in-
 tegrity.*  The strength of the fascia superficia-
 lis is very great, for when freed of cellular  sub-
 stance,  and  raised continuously  from over the
 belly up to the shoulder, we can raise the upper
 part of the trunk  and superior extremities  of a
 large subject from the table by this  structure, as
 we have repeatedly shown to the Class, and as
 the dissectors at the Rooms are frequently in the
 habit of doing.
  The importance of this fascia can scarcely be
 comprehended without a fair  statement of what
 I have hitherto related on the subject: but as
 it is impossible for me, at  the present moment,
 to describe  all the physiological views I have
 formed in consequence of these researches, I

  * Sir Astley Cooper, who first observed this  fascia on the
belly, may be advantageously consulted on this subject. 
BRACHIAL FASCIA.           13
hope, at no distant period, to lay before the pro-
fession a work descriptive of the whole of the
relations and arrangements  of these structures.
systematically digested.  It  is now in my power
to state that the fascia of the human body are
three in number, the superficialis, lata femoris,
and interna abdominis—all of the sheaths of the
muscles, and  all the processes of fascise,  being
formed from them,  with  the exception of the
temporal, palmar,  and plantar  aponeuroses.
The three great fascise are all continuous at cer-
tain points, and might, without any effort,  be
considered as one,  though their differences of
density, &c. are sufficient to justify us in viewing
them separately.
   The brachial  fascia  is a  simple  continuation
of the superficialis, as  it may be traced from the
chest under the great  pectoral muscle,  or from
the back  on to the deltoid muscle.  The por-
tion from the under  surface of the pectoralis
major joins the part covering the deltoid, at the
inner  edge of the last muscle, and when the at-
tachments are broken through at this part, the
fair and uninterrupted continuity of the  super-
 ficial and brachial fascia is  made evident.
   We then  follow  the fascia upwards,  on the
 short  head of the biceps, and on the outside  of
 the arm, on the long  head  of the  triceps, up to 
14             BRACHIAL FASCIA.
 the edge of the acromion and glenoid cavity, as
 heretofore described.*
   This portion of fascia is external to the tendons
 of the muscles arising on the scapula, and insert-
 ed into the tubers at the head  of the humerus.
 Each of these muscles, the supra and infra spi-
 nati, teres minor, major, and subscapularis,  have
 a  sheath or double covering of fascia,  derived
 from the superficial fascia.  If we split the ex-
 ternal covering of these muscles, and cut the bo-
 dy of the muscle across, so as to  allow us to re-
 move it from its place, leaving the inferior layer,
 we shall find this inferior portion running to the
 edge of the glenoid cavity of the scapula, and
 thence  to the humerus, forming a layer of the
 capsular ligament.  Thus each of these muscles
 forms a  layer of the capsule, which, when raised,
 removes a part of the thickness of the capsule,
 and when we raise the lowest portions we open
 into the shoulder joint.
   It has been stated  that  these sheaths  of the

  * The ensuing details relative to the  brachial fascia, are re-
 quired to complete the description of the capsular ligament of
 the shoulder joint, as given in the "Anatomical Investigations."
  I have made several examinations of the connexions existing
 between the fascia sheathing the muscles of the leg, and holding
 their tendons in place, and the ankle joint, but have concluded
 to defer the publication of them, until by repetition of my dis-
sections, during  the ensuing season, the conclusions I have
drawn may be more thoroughly established. 
BRACHIAL FASCIA.           15
muscles are formed from the fascia superficialis,
which surrounds the muscles above and below.
When these layers are about to expand over the
joint so as to form the ligament, it is not possi-
ble to say how far the successive portions extend
from the point where they first reach the joint.
   The capsular ligament of the shoulder joint is
tolerably equal in its thickness, but where the
tendons  of the scapular muscles overlay the li-
gament,  the thickness is very much increased by
their attachments.   The principle on which this
joint  is formed from the  superficial (brachial)
fascia is  entirely analogous to that of the  forma-
tion of the capsular ligament of the hip joint, by
the fascia lata femoris.
   The  fascia superficialis  not only forms the
sheath of  the muscle,  but sends the little septa
through,  enwrapping the  bundles of  muscular
fibres.   These septa extend from the superior
to the inferior portion  of the sheath.  This ar-
rangement is very beautifully evident if we raise
 a part of  the  sheath of the muscle, and pull it
 upwards;  we shall  then see the exact manner
 in which these little partitions pass between the
 muscular bundles, and modify the direction of
 their actions.
    The  observations published relative to the
 muscle of the thyroid gland have been confirmed 
 16     MUSCLE OF THE THYROID GLAND.

 by  a great  number  of dissections;  we  have
 had  as  many as  five  instances  in the  Rooms
 at the same time, and 1  am still inclined to be-
 lieve that it occurs in almost every subject.   In
 examining several for this curious muscle, I have
 found it in an imperfect condition, or rather like
 the rudiment of a muscle coming off from the
 isthmus of the gland,* and running up but a very
 short distance before  it  became thin and indis-
 tinct.  It should be recollected that I have figured
 the exception to the general rule, which arose
 from both lobes, and was inserted directly in the
 centre of the os hyoides.    It  most frequently
 rises from the left lobe, and ascends a little on
 the left of the median line of the trachea, to be
 inserted into the basis of the os hyoides.  I shall
 hereafter be able to give a fuller and more inte-
 resting description of the  modifications observed
 in this singular  structure.
   The high  bifurcation  of  the  axillary artery

  * Fyfe notes such an  appearance, which he says may be mis-
 taken for a muscle.  He appears never to have  seen the fully
 formed muscle  of the thyroid gland, called levator glandulce
 thyroideai, by Haller.  It is only when the isthmus is prolong-
 ed upwards that the rudimental appearance is presented ; where
 the fibres come from one or both sides,  they cannot be mista-
 ken, and I have injected in several instances the distinct artery
appropriated  to this structure,  commencing its ramifications
above the thyroid cartilage, and being accompanied by a corre-
sponding vein. 
AXILLARY ARTERY.           17
has been found  this season so frequently as to
incline me very strongly to believe that some
modification of this arrangement occurs as often
as that usually described, below the bend of the
arm.   In  one or two  instances,  the bifurca-
tion took place as highi as the tendon of the pec-
toralis mi ior, in others, opposite the insertion of
the coraco brachialis, and in one case  the bifur-
cation was about two inches above the condyles
of the humerus.   Of seven instances of high bi-
furcation,  occurring within the  month of No-
vember, of the humeral artery, in but one did the
artery pass down external to the sheet of tendi-
nous  fascia,  connected with the tendon of the
biceps flexor cubiti.   This, and  my former ex-
perience, is entirely opposed to the statement of
the celebrated John Bell, who inferred, from
what  he had seen, that when the artery bifur-
cates  above the ordinary place, the vessels pass
to the forearm, external  to the expansion at-
tached to the biceps.   We wait, however, for a
more extended experience to enable us to ascer-
tain positively whether Mr. Bell's rule may not
be the most  general.
   The third  head of the biceps was found, dur-
ing November, in one instance, rising from the
middle of the  os  humeri, at the inner edge
of the bone, about four inches above  the ex-
                      C 
18         wounds in dissecting.
ternal condyle.   It was inserted  into the pro-
per tendon of the muscle, and not into the ten-
dinous fascia, as has been heretofore noted. This
third head of the biceps was, as far as I know,
lirst described by Douglass in his excellent com-
parative myography.   In the " Anatomical  In-
vestigations" I have made mention  of several
instances, though at that time I had no oppor-
tunity of knowing  that Douglass had observed
it.
   It may not be amiss to inform students of ana-
tomy of the means we adopt in the Philadelphia
Anatomical Rooms, to render wounds received in
dissecting entirely harmless.  Whenever the fin-
gers or hands are cut or punctured, the part is
speedily washed with warm water and soap, and
the wound sucked  forcibly for a  considerable
time, until thoroughly freed from any matter in-
troduced,- or  the  suction is continued till blood
flows  no longer.  A piece of fish-glue  (court)
plaster is placed  over the  orifice,  which is thus
kept covered until healed.  Such is the certainty
with which this process averts any evil conse-
quences, that the  students who adopt it, feel  no
uneasiness relative to cuts or punctures, which,
after the old mode of trusting to caustics, would
give rise to the greatest anxiety. Where the cuts
or punctures have been so slight as to escape ob- 
WOUNDS IN DISSECTING.         19
servation at the time they were made,  and the
severe irritation and  inflammation have com-
menced, all the unpleasant symptoms have been
entirely removed by this operation.
  The advantages given  us  by this mode of
treatment are very evident, on comparing the
present with the past season.   Last season seve-
ral  of my  class suffered  very severely; the at-
tendant on the rooms, from a slight scratch on
his thumb, nearly lost his life, and was only saved
by the suppuration of his axillary glands.   In
my own person,  1 three times suffered  dread-
fully ; in one instance, the whole arm swelled,
with  immense irritation, accompanied by the
most sickening sense of prostration, and several
weeks elapsed before I could use my hand.  In
every instance the injury was slight, and had been
promptly treated with caustic potash,  or butter
of antimony,  both of which, I believe, without
destroying the poison, added to the irritation.
   This season we have had fully as man cuts,
punctures, and scratches from dissecting instru-
ments, without the  least inconvenience.  One
member of my class  had slightly punctured his
finger under the nail, and had applied  the caus-
tic alkali; his finger  and hand were becoming
stiffened, and the peculiar irritation had begun
to affect his forearm.   1 pared the nail as closely 
20
WOUNDS IN DISSECTING.
 to the wounded surface as possible, and direct-
 ed him to suck it forcibly, which being done, a
 piece of court plaster was laid over the end of
 the finger, and a poultice kept on during  the
 night.   The next day the tension and irritation
 had disappeared.
  That such symptoms are not produced by the
 caustic, I know by full experiment; the caustic
 causes much irritation  at the moment of its ap-
 plication to surfaces injured in any way, except
 with anatomical instruments, but is not followed
 by any of the circumstances produced by the ter-
 rible poison of the putrefying human body.
  During this winter I have myself been wound-
 ed very frequently with a variety of instruments,
 even having my hand lacerated by a  long used
 and thickly coated saw. 1 have been punctured
 slightly and deeply in the  sides and extremities
 of the fingers, while dissecting bodies in various
 stages  of putrefaction, without being followed
 by the slightest injury, and which, without the
treatment mentioned, must have produced most
 serious if not fatal results.
  There is one instrument I hope to see banish-
 ed from the dissecting room and from the cases
of dissecting instruments; this is the hook, which,
whether single or double, is one of the most de-
testable poisoners that can be imagined. Being 
WOUNDS IN DISSECTING.
21
generally made with very sharp points, which are
more or less ragged on  their sides, it is hardly
possible to use hooks, especially at night, without
receiving  punctures, and these wounds are so
slight as not to be perceived until the mischief
is done.   They may be  entirely superseded by
the forceps  and fingers, or if a hook be consider-
ed necessary for holding up nerves or vessels, let
it be a blunt  one.   The double hook is still
more dangerous than the single one, and is to-
tally unnecessary,  as it  may be superseded by
using common straight pins.
   We frequently see,  in the periodical papers
and in dissectors,  directions  given for the pre-
servation  of anatomical subjects.  The materials
recommended  are mostly solutions of saltpetre,
common  salt, corrosive sublimate or pyroligne-
ous acid.   I have tried them all, and know that
they all are attended with one  very great  disad-
vantage,  that  of  destroying the edges of the
knives;  and unfortunately,  the  sublimate and
pyroligneous acid, the two best preservers  of the
fjesh, are  the speediest destroyers of instruments.
 A better  agent than any of the above,  and one
free from the great inconvenience of injuring the
knives, is common whiskey.  We fix a pipe into
a large artery, and inject the whiskey,  until no
more can be thrown in.  It does not flow  out by 
 22    INTRODUCTION OF THE CATHETER.

 the bowels or mouth, as the solution of common
 salt,  which may be attributed to the  action of
 the spirit contracting  the delicate extremities of
 the capillary vessels.   In this way, the whole of
 the muscular and cellular  system is acted on,
 and if the skin be then sponged with  impure py-
 roligneous acid,  the  body may be  kept for a
 great duration of time,  even in warm weather;
 the flies may be prevented from depositing their
 larvae in the cavities of the nose, mouth, fyc. by
 pouring  into  these some  spirit of  turpentine,
 which will prevent them from coming to life  if
 they have been already deposited.
   The impure pyroligneous acid is the most ex-
 cellent corrector of the bad smell of dead bodies,
 by merely sprinkling  or sponging with it.  The
pure acid is little  better than common vinegar,
 when compared with the impure.*
   Having received from  Professor  Brown, of
 the  Transylvania  University,  on   his  arrival
 from  Paris,  an  account  of  Civiale's  opera-
 tion  for  the removal  of stone,  with  the lithon-

  * I have heretofore expressed an opinion relative to the ina-
 dequacy of chlorine gas as a purifier of the air in dissecting
 rooms.  I am now inclined to believe, in consequence of some
 suggestions from a friend well versed  in chemistry, that my
 mode of disengaging the gas was not sufficiently  perfect to jus-
 tify the conclusions I drew.  Hereafter I hope to repeat the ex-
 periments, with proper attention to all the circumstances. 
      INTRODUCTION OF THE CATHETER.    23

triptor,  which is used through a straight tube
passed into the  bladder through the urethra, I
made some experiments to ascertain the practi-
cability of introducing a straight instrument  For
this purpose  I  chose the largest sized  flexible
metal catheter, which, though easily straitened in
the hand, cannot be bent by any degree of force
that could with  propriety be used on the  ure-
thra.   The diameter of this tube was three-
eighths of an inch.  My surprise was very great
to find  that  this instrument, perfectly straight,
could be introduced without any difficulty, the
subject being extended on its back on the table,
and the legs  bent, so as to allow their weight to
rest on the soles of the feet.  By passing it al-
most  perpendicularly,  until its  extremity  was
made to  project at the bulb of the urethra; then
drawing the penis up on the catheter, and slight-
ly withdrawing the instrument, and at the same
time depressing the point of the penis  for two
inches, or a little more, the catheter passed into
the bladder with ease.  The same  experiment
was repeated on all the male subjects then in the
Rooms, in which the  urethra was uninjured, and
has been since performed on several others.   It
is not to be expected that the same ease of in-
troduction will be allowed in the living  man, as
the irritability of the  parts will provoke a consi- 
 21    INTRODUCTION OF THE CATHETER.

 derable  disposition  to  spasm in the muscles of
 the bulb, perineum, and neck  of the bladder.
 Neither  do I think,  as  a general rule, that the
 catheter of the largest size can be used; still,
 the muscles may be  gradually accustomed to the
 action of the straight catheter,  or they may be
 relaxed and rendered quiescent by the injection
 of a  tobacco clyster into the rectum, the intro-
 duction of a suppository of tobacco, or possibly
 by the use of an injection of laudanum.  Whe-
 ther Civiale's operation be immediately followed
 with all the advantages expected  or not, we have,
 doubtless, reason to hope that the introduction of
 the straight catheter will be of great use in vari-
 ous affections of the bladder,  as it is more ma-
 nageable than the common curved instrument.
   Where there is no deformity of the urethra
 produced by stricture, ulceration,  or  tumours
 within the pelvis, there is never  any difficulty of
 introducing an  instrument into the bladder, pro-
 vided the operator knows the actual condition
 of the structure of the urethra.  In other words,
 where there is no deformity, the difficulty is pro-
 duced by a vague notion of the anatomy, and
 an indistinct idea of  certain mysterious manoeu-
 vres to be performed with the  catheter.   The
 catheter  curved in any proper degree, may be
introduced,  by  one  acquainted  with the struc- 
      INTRODUCTION OF THE CATHETER.    25

ture, in the living subject, without any very per-
ceptible change in the position of the instrument,
or movement of the penis.   In saying this, we
leave out of the account the difficulty produced
by spasmodic  disposition in the  muscles con-
nected with the urethra,  because this is  to be
overcome by patience, or by the use of antiphlo-
gistic or anodyne remedies.  In the common
introduction of the cathether, the point of the
instrument is passed down to the bulb, and then
the bulb is doubled against the triangular liga-
ment, or the operator, in attempting to execute
the grand  movement of depressing the  penis
and  catheter,  throws the point upwards, and
catching it on  the ligament, renders the intro-
duction impossible.  If it be recollected that the
membranous part of the urethra is continuous
with the line of the upper surface  of the ure-
thra, and in the natural condition, is always held
in the same place, there is nothing necessary to
be done in the introduction of the curved sound,
or catheter, than  to stand on the right side, and
with the catheter well oiled, pass it down the
penis, keeping the external part of the catheter
as much as possible in a line with the trunk of
the body, whether lying, sitting, or standing, in-
clined obliquely outwards, over the anterior su-
perior spine of the ilium.  When the curved part
                     D 
 26    INTRODUCTION OF THE CATHETER.

 of the catheter  is passed down low in the peri-
 neum, keeping the point  of the catheter gently
 pressed against the upper part of the urethra, we
 straighten the penis slightly on  the instrument,
 and pass it  onwards into  the bladder without
 difficulty.
   When the patient lies on his back, the knees
 should be bent,  letting the weight of the  limbs
 rest on the soles of the feet.  When he is sitting,
 he may rest his thighs on the edges of two chairs,
 and incline his body a little forward.  If standing,
 it is only necessary to make the same inclination
 of the body,  and separate the knees to a  short
 distance, also slightly bending the  thighs on the
 legs.  As to  the correctness of these directions,
 I  have nothing further to state, than that I have
 during the last winter taught students,  who ne-
 ver  used  a catheter in  their lives, to pass the
 instrument with ease and certainty in different
 subjects,  in a very short time.

          PATHOLOGICAL AN ATOM V.
   Diseased actions produce changes in the living
 body infinitely various and exceedingly  singular
in character,  which, in the present state of our
knowledge, are often altogether inexplicable.  It
is true, that in numerous instances we can  trace
the connexion between cause and effect, especi- 
             DISEASED  ACTIONS.           27

ally after acute or chronic inflammation has ex-
isted, where  manifest injury has been done to
important organs by external violence, or where
great irritation has been long continued in vari-
ous parts of the system.   But, in a great majori-
ty of cases, we have  no  guide  to a correct un-
derstanding f the mode in which such alterations
are produced,  nor can we form any satisfactory
opinion of the causes deciding their commence-
ment.   We frequently find tumours of peculiar
construction growing from textures of most dis-
similar nature, and we term them  diseased, ra-
ther from the situations they occupy, than from
any  want  of  organic  characters  in themselves.
If these bodies were more uniform in place and
appearance, we might consider them in the light
of parasite animals, deriving their support from,
but having no  continuity with, the body to which
they are attached.   Such animals  we  know to
exist; and not unfrequently they are  supposed
to be mere degenerations of natural structures,
though they are invariably characterized by a ge-
neric or specific resemblance, which is insepara-
ble from them, wherever they may be found.
Tumours, on  the contrary, cannot be otherwise
considered than as local  alterations occurring in
the regular structures of the  body, consequent
to some  peculiar  impression made  on  the 
28
DISEASED  ACTIONS.
nerves, and of necessity on the secretory or for-
mative vessels of the part.  Sometimes,  as  in
the case  I shall first relate, there is a regularity
of arrangement in these productions, which ap-
pears as  if they were d/signed for some import-
ant purpose, though this is by no  means to  be
admitted ;  in other instances, the structure is  so
very different from the  surrounding parts, and
so curiously organized, that we are led to infer,
that quite as much nervous and vascular energy
was necessary to their formation, as would be re-
quired for the growth and support of the great
organs of the  system.   Much,  however, re-
mains to be discovered, before we shall be able
to understand the  operation of the agents by
which tumours are excited, or the signs indica-
ting their origin within cavities of the body, al-
though it is at once evident how highly import-
ant and extensively useful such knowledge would
become.   Our present inability should not pre-
vent us from carefully observing and recording
every fact that may eventually be useful in elu-
cidating  this subject;  nor  should  we  consider
those labours lost, which barely place effects be-
fore us, without giving us the slightest clue,  by
whose  aid we may hope to arrive at their causes. 
ANCHYLOSES.               29
               OSSEOUS SYSTEM.
  The   spinal  column was  frequently  found
slightly curved laterally,  and in a few instances
anchylosed at the  anterior edges of the verte-
bra ; but the most frequent alteration discover-
able in the individual  vertebrae was a flattening
or apparent compression of their bodies, with an
irregular excurvation  of their superior and  in-
ferior margins.   That this was the result of  ab-
sorption of the bodies, and a simultaneous growth
of the edges, was proved by a similar peculiarity
being observable along  the external margin of
the crest of the ilium, which, in one or two  in-
stances, had the  anterior  superior spinous pro-
cess  prolonged, and terminating in an  obtuse,
roughened extremity.  In one instance, the right
sacro-iliac synchondrosis was entirely obliterated,
and the ilium smoothly continuous with the sa-
crum,*  being perfectly anchylosed, and appear-
ing as if it had been thus formed originally.

  * As the subject of nomenclature is of as much importance
 in anatomy as in any other  part of medicine, and we have the
 most stupid blunders handed down from one writer to another,
 in  consequence of misconception, I shall subjoin what I  have
 said in another work on the  meaning of this term.
   « We are told that the bone terminating the spinal column
 is called " os sacrum," because it was formerly offered in sacri-
 fice, and hence called "sacred or holy/" This fable is entirely
 the offspring of  ignorance.  The words " os sacrum" do no< 
30                  ANCHYLOSES.
   I am indebted to my friend Dr. J. R. Bakton,
for two interesting and very perfect instances of
mean " holy" or " sacred  bone," but great bone;  either be-
cause of its being made up of several  pieces, or from being the
base of the spinal column, or from the important organs placed
in its  immediate vicinity.   The  word  iee«i means  prwstans,
magnus, as well as sacer.   The word sacer is used in Latin for
great as well  as  holy.  Aretseus, speaking of the reason why
epilepsy was called " i^a» »a<ro»," morbus sacer, expressly states
that it was called so, not because of its being a judgment from
Heaven, but because  of its violence and distressing  character,
as the word sacred was used in the sense of great.  " K«< 'iEPOZ
yn to META'" \jre^t EmXtzro-tos; 6<£v *']  In like manner,
we have ignis sacer among the Latins ; and numerous instances
may be selected from the Latin poets, as in the common quota-
tion from Virgil:

              " ' Quid non mortalia pectora cogis,
                Auri sacra fames.'

  " Homer, speaking  of  the  manner  in which Patroclus, after
thrusting his spear through  the cheek of Thestor, draws him
from his chariot, says—

                  ------"' As when a man
           Seated on jutting- rock, drags from the deep
          With cord and shining hook, the mighty fish.'*

  " If we  desire  further  proof of the synonymous use of the
terms holy and great, we  may observe in  the Hebrew language


                       * '----- " U{ OTC TIC fUC,
           rifTf» eat in'foC^HC* xa9»,ufvoc IEPON i^8uy
           Ev aovTOio Supjt^f Xivu xai Woxi ^axu&i'"   IAIAA: n.

                —— "  Veluti cum vir
           Scopulo inprominenti sedem, SACRUM pit cent.
           Ex p>,nto foras lino et splendido are."   Giarkitts. 
ANCHYLOSES.                31
anchylosis, the one of the hip  and the other of
the elbow joint.  These are both so consolidated
as to be utterly immoveable, yet without any of
that irregularity which we most frequently see
after fractures,  or ulcerations resulting from
constitutional diseases.  In the hip joint, the head
of the femur is firmly united to  the upper part of
the acetabulum,  which seems  slightly widened
or  pressed  upwards at that  part.   A more re-
markable irregularity is to be perceived in the
anchylosis of the elbow, where the  union  has
been effected without the least alteration of the
articulating surfaces, if we except a considerable
elongation of the coronoid process  of the ulna,
and a gentle increase of thickness  on the mar-
gins of the bones.
   We should believe, with Dr. Barton, from these
there i9 this peculiar mode of expressing a superlative degree.
The word "]hn [Malach"] signifies a king; but to express a king
of great power and grandeur, the word rv [Yah~\ God, is pre-
fixed to it; "fm-TV God-King or Great King. The English epi-
thet godlike, refers the possession of more than human power
or energy of mind, and very seldom indeed to superior sanc-
tity."
  Accident has recently placed within my reach, a copy of Ga-
len's treatise n^< ««-«v, with a  commentary by the celebrated
Jacobus Sylvius, who makes the following remarks on the
title, rifg< t« ic^k os-k: " Os n^ev, id est sacrum et magnum, hoc
est, caeteris racheos ossibus maius (veteres enim /;g«, ftgytcXn
vocarunt,) vel wA*tv, id est latum."
* 
 .52        TUMOUR ON THE WOMB.

 appearances, that this anchylosis resulted from
 simple, or at most rheumatic,  inflammation of
 the joints.   The  importance of being vigilant,
 when there is danger of such anchylosis taking
 place,  to prevent the members from being im-
 properly flexed, is very obvious; for if we allow
 this union to form with the thigh flexed on the
 body, or the knee bent to a right angle with the
 leg, the deformity will be extremely unpleasant,
 and the convenience and comfort of the patient
 unnecessarily sacrificed.
   Among irregular growths of the osseous sys-
 tem, we may mention the occasional prolonga-
 tion of the crista  galli of the cethmoid bone; in
 one case it was almost an inch in breadth, and a
 plate of bone extended for some distance from
 its anterior part along the curvature of the fron-
 tal bone, becoming gradually obsolete in  its as-
 cent.

              GENITAL SYSTEM.
   Tumour on and within the uterus.—This sub-
ject was about thirty-five or forty years of age,
 having a considerable quantity of fat throughout
 the cellular texture,  and exhibiting no external
 peculiarity  of appearance,  except a projection
 of the abdominal muscles on the right side, the
 center of which was midway between the ante- 
TUMOUR ON THE WOMB.
33
rior, superior spine of the ilium and the median
line; the whole of the prominence occupying the
greater part of the right iliac region.  The ex-
ternal organs of generation were lax, and much
dilated, the vagina being covered with large quan-
tities  of mucous looking fluid, which on first
examination was supposed to  be  the result of
gonorrhoea.
   When the belly was opened, a singular ap-
pearance  was presented  within the  pelvis.  A
tumour, almost perfectly globular,  four inches
and a half in diameter,  occupied the greatest
part of the pelvis, compressing the rectum to a
considerable degree, and nearly hiding the uterus
from view.  The anterior surface of this tumour
was in contact, though not adherent, with the pe-
ritoneum, while its superior surface was  partly
covered by the ileon and head  of the  colon.
The bladder of urine, pressed to the left side,
small, flat, and empty, (of necessity,  as we shall
presently see,) was immediately between the an-
terior surface of the tumour, and  the internal
face of the pubes.   On closer inspection, and
drawing the tumour upwards, the fundus of the
uterus and the left Fallopian tube were seen low
down in the pelvis, turned so as  to  present to-
wards the spine of the ischium, having the rec-
 tum to pass down  behind it, concealing the right
                      E 
.3 1
1LM0CR ON THE WO MIL
tube and ovary.  Both ovaries were found alter-
ed, and apparently disorganized, though closely
resembling hydatids clustered together.
   When the tumour, bladder, womb, and rec-
tum were carefully removed from the pelvis, it
was evident that the tumour grew from within
the thickness of the cervix uteri, as the perito-
neal covering of the womb, and its peculiar tex-
ture, were observed extending over it, the ute-
rine substance becoming thinner as it approach-
ed the upper part.   The tumour was hard, in-
compressible, and remarkably spherical, having
very slight depressions or undulations on  some
parts of its surface.   On cutting through the ex-
ternal  covering derived from the peritoneum
and womb, which was about an eighth of an
inch thick at the base, and less than a sixteenth
above, I was surprised to find that the whole tu-
mour had a covering of bone,  about the twen-
tieth of an inch in thickness, so hard as to require
a saw for its division.  This bony envelope being
divided, the tumour was cut through the centre
with the knife,  and the sensation imparted re-
sembled that produced by cutting through a mass
of cartilage,  which the internal substance more
closely  resembled  than any thing else,  being
tough, dense, semi-transparent, elastic, and appa-
rently homogeneous.  This  whole tumour ap- 
TUMOUR ON THE WOMB.
35
peared perfectly sound throughout, exhibiting
no trace  of inflammation nor ulceration in any
part, neither was there any sign of increased vas-
cularity discoverable where it rose from the ute-
rus.   Its origin was three inches wide, and had
no communication with the cavity of the womb.
  The uterus being opened, the lining mem-
brane looked perfectly healthy and  unchanged,
The cavity would have been of the ordinary size,
but for the encroachment of another tumour, at
the upper and back part.  This  second  tumour
was also situate within the posterior thickness of
the womb, and  resembled  the larger one in its
structure,  except that it had none of the bony
matter.  The cavity of the womb was perfectly
natural from the lower part of this posterior tu-
mour to the  os tincse,  and  the depressions and
curved lines  on the anterior and lateral parts of
the  internal  surface of the cervix uteri, (called
arbor  vitce,) were  beautifully  and  distinctly
marked.
   When the vagina was opened from the back
part, a most unexpected circumstance was made
manifest.  The neck of the bladder was exten-
sively destroyed, and an aperture of three-fourths
of  an inch in diameter allowed the bladder to
communicate with the vagina, so that one or two
fingers could be passed at once from the vagina 
36
TUMOUR ON THE WOMB.
into that organ.   Every trace of meatus urina-
rius was gone, and the edges of the communica-
tion between the vagina and bladder were rounded
and smoothly cicatrized.  On close inspection,
the vagina showed no appearance of inflamma-
tion, though it was covered with tenacious mu-
cus, no doubt thrown out to defend the vagina
from the constant flowing of urine  over its sur-
face.   In all other  respects the parts seemed
natural; the rectum was but slightly compress-
ed, there being neither enlargement of the sig-
moid flexure, nor of the arch of the colon.
   In considering all the particulars  of  this inte-
resting case, the  destruction of the neck of the
bladder seems most remarkable.   If we recol-
lect the form of the tumour, and the manner in
which it occupied the pelvis, we might, without
much difficulty, suppose that the pressure of the
tumour had caused the bladder to  slough at  its
neck, as this organ would have been over-distend-
ed  by a  comparatively small quantity  of water,
on  account of the filling up of the pelvis  by
the  tumour,  and  because the situation  and
projection of  the tumour  would  deprive the
bladder of the assistance given under ordinary
circumstances by the abdominal muscles.  If we
reject this attempt to account for the destruction
mentioned, we might attribute it either  to lacera- 
            TUMOUR ON THE WOMB.          37

tion produced during labour, or to the improper
use of  obstetrical instruments.   If it had been
produced in the former way, we should have ex-
pected  some evidences of simultaneous lacera-
tion of the perineum, of which no trace was dis-
coverable.   It is possible that this injury might
have been caused by the use of obstetrical instru-
ments,  though we can scarcely see in what way,
unless by using improper violence. Dr. Dewees
has remarked, that the lock  of Haighton's for-
ceps sometimes  does injury by including a part
of the  labium, or the  capilli from the surface :*
none of these modes of explanation  can be  re-
sorted  to in this case, unless we knew whether
the destruction of the neck of the bladder pre-
ceded or followed the growth of the tumour.

   * To obviate the inconveniences produced by the lock of the
forceps, in October, 1824,1 caused a pair to be made for my friend
Dr. Morell, of Havana, by that excellent artist John Rorer, the
blades of which were like Haighton's, having in addition the su-
perior and inferior curvature of Baudelocque's forceps.  The
lock was made according the plan of Siebold, as commended by
Dewees, with the handles of wood in the usual way, but lighter.
This instrument,  that may well be called the composite forceps,
appears to be better suited to the purpose than any other, as it
combines the advantages of all the forceps hitherto introduced.
Mr. Rorer has further improved the excellent joint of Siebold,
by taking off the projection of the nut, and  giving a greater de-
gree of obliquity  to the notch.  This improved joint he now
makes on all the different forceps used by practitioners. 
48
TUMOUR ON THE WOMB.
   It is exceedingly probable that this tumour
 caused many symptoms which were  similar to
 those occurring  during gestation, and this idea
 should induce us to avoid pronouncing an opinion
 in cases where pregnancy is imputed, without in-
 quiring into the  possibility of the existence of a
 tumour on the womb, or within the pelvis.   In
 medico-legal investigations, the  appearance  of
 discharges from  the vagina cannot  be esteemed
 positive evidence that the lining membrane is the
 actual seat of disease, as such discharge as was
 found in  this subject might be caused in a simi-
 lar way,  or be produced by the fluids thrown
 out from a tumour in a state of ulceration.   In
 my " Anatomical Investigations" I gave an  in-
 stance where puriform discharge was produced
 by a fistulous ulcer, descending from the kidney,
 and opening through the cervix uteri into the
 vagina, in which  case, all the appearances must
 have deceived the physician as to the true seat
 of the disease.   In  the subject having the  tu-
mour above described, we  may readily discover
how fruitless must have been  all treatment for
the incontinence  of urine; and yet it is very pro-
bable that both the patient and physician might
have had  no idea  that this incontinence was pro-
duced by  a simple destruction  of the neck of the
bladder.   Nothing but a  careful  examination 
 
PL. 1R.
Drawn from Nature Jty J.Ltrayton 
hernia:
.39
could have led to such a conclusion ;  and it may
be well in all cases of doubtful character to  ex-
amine whether a loss of substance or malforma-
lion may not exist, the  discovery  of which,
would at least save the patient from severe and
necessarily fruitless use of medicine.

          Explanation of the Plate.
   Fig. 1.  A. pubes.
   B. bladder.
   C. tumour.
   D. womb.
   E. rectum.
   F. left Fallopian tube.
   Fig. 2.  B. bladder.
   C. tumour.
   D. womb.
   F. left Fallopian tube.
   G. diseased ovary.
   H. vagina.
   I. lacerated entrance into the bladder com-
 municating with the vagina.

    Hernia.—The subject of this investigation was
 the body of a well  formed and muscular man,
 who had committed suicide a day or two previ-
 ously.  A tumour,  somewhat pear-shaped, and
 about the size of the  doubled fist at the lower 
40
1IERMA.
part, occupied the right side of the scrotum, ex-
tending up to the external abdominal ring, grow-
ing smaller  in its ascent.   The testicle was to
be distinguished at  the under and back part of
the tumour; the sensation  imparted by touch-
ing the tumour resembled that  produced by
pressing on slightly elastic dough.  From  the
uniformity with which  this sensation was pro-
duced at all parts of the tumour, the conclusion
was drawn that this was a case of pure omental
hernia, or epiplocele.
  The integuments  being  removed  from over
the whole of the tumour, the fascia superficialis
came into view, strong and well defined; cover-
ing the whole of the tumour in the scrotum,
and being strongest immediately over the situa-
tion of the ring.
  When the fascia superficialis was raised from
the whole tumour,  the cremaster muscle pre-
sented,  though  its fibres were not distinct,  ex-
cept at the  upper part immediately below  the
ring.  The cremaster was attached with consi-
derable  force to the  whole of the anterior part
of the true hernial sac, or peritoneal envelope;
so that it would have  been impossible  to  cut
through the cremaster muscle without  at  the
same time laying open the sac,  if this  tumour 
                  HERNIA.                41

had been operated on during the life of the pa-
tient.
  The sac being opened from about an inch be-
low the ring to the extremity of the scrotum, the
contents  of the tumour were  exhibited, and
proved to be a great mass of the omentum, fold-
ed on itself in a singular and beautiful manner.
  Towards  the lower part the omentum was
much altered in structure, being thickened, load-
ed with fat, and studded with knobs of various
sizes, from that of a hazelnut to less than a pea.
Nearer to the neck of the  sac the structure was
more natural, though denser and firmer than the
ordinary character of this membrane.
  The external abdominal ring was very greatly
enlarged, so that  all traces of its usual appear-
ance were obliterated. The omentum, as it pass-
ed through the ring, was more than an inch in
diameter, and several adhesions existed between
the omentum and the surface  of the sac below.
The internal edge of the external ring, seen
when the muscle was detached in the middle,
and thrown downwards on the thigh, appeared
as if rolled  on itself.
  Nothing peculiar was observed in the cremas-
ter muscle within the external ring.  When this
muscle was  removed,  the fascia interna, (or fas.
                     F 
42
HERNIA.
cia transversalis,  as it has been incorrectly call-
ed,) through which the internal abdominal ring
is formed, came into view, being strongly mark-
ed, and most so immediately at the ling, though
without any circumscribed thickening.   It was
now seen  that the internal ring was almost di-
rectly behind the external one, a necessary con-
sequence of the  continual dragging of the  tu-
mour.
  When the fascia interna was split through at
the internal ring, the neck of the sac became fairly
visible, and  though covered only by the perito-
neum, this membrane was so altered immedi-
ately where it had been pressed on by the ring
as to appear firm and rounded, bearing consi-
derable resemblance  to an annular ligament.
Above this circular portion, the peritoneum was
removed,  and then a part of the arch  of the co-
lon was found immediately  above the neck of
the sac, being firmly held in this  situation by
the protruded omentum.
  The view was still more interesting when the
abdominal muscles were divided and  turned
back.  Then it  was  evident that almost  the
whole of the floating portion of the omentum
was thrust out.   The part of the bowel pulled
down to the neck of the sac, was the central por- 
HERNIA.
43
tion of the great arch  of the colon.  The sto-
mach was very  much and forcibly displaced,
being pulled down within a hand-breadth of the
pylorus, so as to form  a  sort of constriction, as
if there were two pouches to the stomach.  The
stomach was placed diagonally across the centre
of the body towards the right side  the lowest
portion being between the  constriction caused
by the weight of the  hernia,  and the pylorus.
This orifice presented almost directly upwards,
and instead of its usual place, occupied a situa-
tion immediately below the middle  of the gall
bladder.
   From this description  it is seen that the arch
of the colon, instead of crossing the centre of the
body through the hypochondriac and epigastric
regions, formed a semicircle crossing the lower
part of the abdomen,  and having the concave
part of its sweep upwards, or  towards the sto-
mach.
   The other  appearances were natural, if  we
except a  considerable  adhesion of the rectutn
along the upper part of the interior strait of the
pelvis, the more remarkable from the turgescence
or rather  the varicose state  of the  veins, at this
part, and nowhere else.  The mesentery was
very much charged with fat, and the large intes- 
44
PROSTATE GLAND.
 tines were peculiarly so.  The liver was studded
 with black spots of a small size, resembling the
 appearance of melanosis.
   The  ensiform  cartilage in this  subject was
 turned  directly upwards and outwards, resem-
 bling a spur, and  on a closer examination, a
 cushion of dense  fat was found, covering  the
 point of the cartilage.  This cushion was  full
 three-fourths of an inch in length.   I have re-
 cently seen a subject with two ensiform  carti-
 lages, as large as this cartilage usually is, and an
 inch and a half long.
   The  muscle of the thyroid gland was also
 found in this subject, distinctly marked, and being
 as we have most frequently found, to the left of
 the median line of the trachea, as  described by
 Soemmering.

   Prostate gland.—Some  time after  making
the experiments  on  the  introduction  of  the
straight catheter,  as related p. 22.  I  examined
one  subject,  in which there  were three perfo-
rations  between the posterior part of the bulb
of the  urethra,  and  neck  of  the  bladder.
When the catheter was introduced through  the
urethra to the first opening, it entered this false
passage very readily; when withdrawn and pass- 
PROSTATE GLAND.
45
ed onwards, it as readily passed into the second;
and in like manner,  when withdrawn from this
situation,  it lodged  in the  third:  when freed
from this  situation, and the  handle slightly de-
pressed, although it was of a large size, it entered
into the bladder with facility.  The prostate ex-
hibited no other appearance of disease than a
slight  enlargement,  perhaps owing to the lace-
rations, which, although irregular, were fairly
cicatrized.  The first perforation  was through
the membranous part of the urethra, and under
the prostate, in the direction of the curve of the
catheter;  the second was through the anterior
edge of the prostate,  reaching to the rectum;
and the third, entering a little  beyond the se-
cond, passed through the whole length of the
prostate,  inclining somewhat to the left side.
From  a careful examination of  the parts, there
was no evidence of stricture or other disease in
the canal, which  was of large size, although
every  one who saw  the  openings immediately
inferred that they had been produced by  vio-
lence exerted in attempting to pass the catheter.
Judging from all the circumstances, I should de-
cide that this was  one  of those  cases, (which  I
fear are not rare,)  in which some one totally ig-
norant of the structure, had attempted to accom- 
46
AiNEURlSM.
 plish by brute force, what can never be properly
 effected without a combination of anatomical
 knowledge and manual dexterity.


              ARTERIAL SYSTEM.

   Aneurism of the aorta.—Male subject,  appa-
 rently sixty years of age, strongly muscular.  A
 pipe was inserted in the right carotid artery, and
 the body injected.  On opening  the chest, the
 commencement of the aorta, uncommonly large,
 presented far towards the left side of the chest.
 A tumour  of  great size was found, extending
 from the origin of the  left  subclavian artery,
 down to the sixth dorsal vertebra, swelling out
 on the left side, so as to occupy the largest part
 of the left cavity of the chest.  The tumour ex-
 tended across  the spine at the upper part, over
 the first and second dorsal vertebrae, so as to be
 more than two inches within the right cavity of
 the chest.  When filled with injection, the com-
 mencement of the aorta lay immediately under
 the articulation of the upper ribs with their car-
tilages, attached  by a circular adhesion;  the an*
terior part of the tumour was within two inches
and a half of the inner surface of the chest.  Over
this part of the tumour the trachea and cesopha- 
ANEURISM.
47
gus were placed; the trachea being on the left,
and so much turned round as to have the membra-
nous or posterior part exactly on the right side. In
consequence the trachea was at this part flatten-
ed, having full one-third of its caliber obliterated.
The  oesophagus  was partially covered by the
trachea.   At the lower part, the left division of
the trachea doubled round the tumour to  reach
the left lung.  It was compressed flat, and its ca-
liber obliterated by  adhesion.  The left lung
was altogether consolidated, and occupied about
one-third of its proper space, being entirely hid-
den by the tumour.  In texture it resembled  a
very hard liver, and gave a sensation when cut
into, something similar to that produced by cut-
ting through a turnip.
   The continuation of the aorta came from the
 lower part of the tumour, opposite the sixth dor-
 sal vertebra, though  so  far to the  left as to  be
 considerably curved  toward the centre, before it
 reached the bodies of the vertebrae.   It was very
 much enlarged, far below its separation into the
 common iliacs.
    On removing the  ribs of the left side, a fair
 view was obtained of the tumour. It was firmly
 attached to the  pleura, over the heads  of the
 fourth,  fifth,  and sixth ribs.  On the right side 
18
ANEURISM.
 a similar attachment was observed over the bo-
 dies of the fourth, fifth, and sixth dorsal verte-
 bra.   When this attachment was  cut  through,
 the  back  part of the aneurismal tumour was
 opened.  This posterior part was filled with
 large clots  of blood, very firmly coagulated, and
 they rested on the vertebrae, without any inter-
 vening substance.  All the left half of the fourth,
 fifth, and sixth vertebrae was destroyed, as if by
 ulceration, and this destruction extended to the
 heads of the ribs which were within the tumour.
   Some specks of ossification were observable
 around the edges of the posterior part of the sac,
 where  adherent to the vertebrae.   The disten-
 tion produced by the aneurism had  consolidated
 the posterior mediastinum, in such a manner, as
 to render it impossible to distinguish any part
 of it.  The coats of the aneurism were of uni-
 form thickness, except at the edges adhering to
 the vertebrae, beyond which they were disconti-
 nuous.
  In Baron Ferrusac's Bulletin for 1824, the dis-
 section  of a celebrated comic actor is given.
 This man, throughout his life, had been subject
 to a singular hoarseness, which was thought to
 be owing to some disease about the glottis;  but
after his death, which suddenly occurred, it was 
ANEURISM.
49
discovered that  there was no original disease
in any part of the trachea, but  an aneurismal
tumour, very similar to that above described,
compressed the trachea for a considerable ex-
tent.   Although we  have no knowledge of the
symptoms which were present during the life of
our subject, we  are  much inclined to believe,
that his voice must have been much altered by
the compression of the left division of the tra-
chea.  As the oesophagus was also much  com-
pressed,  difficulty of swallowing very probably
existed.  The use of the stethoscope, too much
neglected in  this country, would  render  such
a  disease  unequivocally evident.   We should
suppose that  a physician who should treat his
patient for disease of the lungs,  or be engaged
in cupping and  leeching  his throat for chronic
bronchitis, during a long time, would be deeply
mortified to discover, by dissection, that  there
had been incurable disease of the heart, or  aneu-
rism of the aorta, which might have been  palli-
ated, if he had been better informed.
G 
50
ANEURISM.
           Explanation of the Plate.
   Fig. l.   Aneurism seen from above, the sub-
ject lying on its back;  sternum and part  of the
ribs removed.
   A. the heart.
   B. arch of the aorta.
   (*) Adhesion to the cartilage of the ribs.
   C. arteria innominata.
   D. left  carotid.
   F trachea.
   G. oesophagus.
   H. aneurismal tumour,  extending underneath
G and F  into the right side of the chest.
   I. descending aorta.
   J. coeliac axis.
   Fig. 2.   Lateral view of the  same aneurism,
the ribs of the left side taken away.
   A. clavicle.
   B. arch of the aorta.
   (*) Adhesion to the cartilage of the ribs.
   C. arteria innominata.
   D. left carotid.
   E. left  subclavian. .
   F. left  division  of the trachea.
   G. extremity of the oesophagus.
   HH. tumour.
   I. descending aorta.
   (ft) Coronary  arteries. 
PL. IV.
 
 
OSSIFIED ARTERIES.           51
  In two instances, I have found most extensive
ossifications of the arteries,  one subject being
nearly ninety, and the other more than seventy-
five years of age.  The patches of ossification
were largest in the neighbourhood of the heart;
and in the second case, the superior surface of
the aortic arch was literally lined with bone.  At
the origin of the great vessels, large irregular
patches of ossification  extended for  some dis-
tance within the caliber.  On the general inter-
nal surface of the aorta, the pieces of bone were
flattened rather concave, but irregularly incurv-
ed at their edges.  In  all instances, they were
placed between the middle and internal coats of
the artery, and though occasionally projecting,
were never uncovered.  In these cases the ossi-
fications were traced through all  the  principal
arteries, and many of  the smallest partook of
the same morbid condition.  In some parts the
incipient formation of bone was made evident
by  a cartilaginous thickening  very perceptible
in the coats of the artery.   In the elder subject,
the tricuspid, mitral, and semilunar valves, very
much occupied by patches of  bone, were thus
prevented from accurately closing the orifices of
the ventricles, as well as the mouths of the pul-
monary artery and aorta.
   Among the irregularities  observed in the ar- 
52
OSSIFIED ARTERIES.
 terial system since my last report, may be noted
 the high bifurcation of the brachial artery, which,
 in one case, divided immediately under the cla-
 vicle, and in four others, as high as the point
 where the musculo-cutaneous nerve enters the
 coraco-brachialis muscle.   But in none of these
 cases did either artery run externally to the apo-
 neurosis of  the biceps at the bend of the  arm,
 I have uniformly found where this high bifurcation
 occurs, that a large inosculaling branch crosses
 immediately from the radial to the ulnar artery,
 an inch below the bend  of the arm, and from
 the middle  of this, the interosseous artery is
 sent downwards.  The  more extended my ex-
 perience becomes on this subject, the more am
 I persuaded that this  high bifurcation occurs at
 least half as often  as the usually described ar-
 rangement.
  In two instances the right hepatic artery was
 the first branch of the superior mesenteric;
 being, of course, nearly an inch lower down than
 the right hepatic usually is, and occupying the
right side of the cord of vessels, ducts, §c. be-
longing to the liver.  It passed under the head
of the pancreas  and  duodenum obliquely  up-
wards, instead of being rather transverse to the
epigastric region,  as  under  ordinary circum-
stances.  In  the healthy  condition, this arrange- 
SINGULAR INJECTION.          53
ment would be of no great consequence: but in
case of an indurated pancreas, or other organic
change,  affecting  the  quantity of blood  sent
through the cceliac, this  branch from the supe-
rior mesenteric  passing behind the  pancreas
where but slightly subject to compression, would
supply the liver with the necessary quantity of
blood.
   In order to preserve a record of the fact, I will
here introduce the following singular result, ob-
tained, in the winter of 1823, by injecting from the
carotid artery.  I placed a pipe in the left carotid
artery of a tall, slender, and  emaciated  subject,
apparently thirty or forty years old, and having
thoroughly warmed it by immersion  in heated
water,  1 threw into  the body, with the ordinary
brass  injecting syringe, melted tallow, highly
coloured with fine King's yellow, which gave it
a very rich  hue.  The  syringe was filled, and
emptied through a tube in the artery, three or
four times.  On examination, I was very much
pleased to find that the fluid had returned through
the veins, so as to fill them very perfectly: but
 on more attentive observation, my surprise was
 increased, by discovering that the smallest veins
in both arms distinguishable by the naked eye,
 were filled with a material differing in colour
from that contained in the arteries. In fact, the 
54
ABSCESS OF THE LUNGS.
colouring matter was separated entirely from the
tallow during its passage from the arteries to the
veins; in the arteries, the colour was a rich yel-
low, deepening as- it approached their extremi-
ties, and in the veins, the pure white of the tal-
low was entirely free from  any admixture.   I
have  not since repeated this experiment, nor
was it in my power to preserve the specimens,
as this circumstance occurred the day before the
conclusion  of my winter course, at  a time when
I was obliged to remove,  at an exceedingly short
notice, from the house I then lectured in.  Al-
though the idea did not occur, until too late,  to
throw them into spirits, and subsequently dispose
of them at leisure, I induced some members of
the profession to examine them, who were well
qualified to ascertain the correctness of my ob-
servation ;  and 1 should have extended this in-
vitation to  many others, had it not been that I
have too often found invitations  of  this  kind
accepted and neglected with  chilling apathy.

           RESPIRATORY SYSTEM.
  Abscess and suppuration of the lungs.—Subject
female, apparently twenty-five years of age, ex-
tremely emaciated, having a long neck, and veiy
narrow chest.  When the left cavity of the tho-
rax was opened, there was no part of the lung 
MORBID SECRETION.          55
apparent.   The space usually occupied by the
lung was void, and seemed to have been emp-
tied of a fluid previous to death, as some floccu-
lent matter, resembling whitish coagulated mu-
cus,  still adhered to the surface of the mem-
brane lining the chest, which was red, thickened,
and  universally  adherent to  the ribs.  At the
lower and back part of the chest, instead of lung,
there was a mass of brownish, ash-coloured mat-
ter, which had several openings communicating
with the cavity of the chest.  When cut into,
the substance seemed to be nothing more than a
collection of semi-coagulated, puriform substance,
intermingled with flocculi, resembling half-boiled
membrane.  The right cavity of the chest was
natural in  appearance.

              DIGESTIVE SYSTEM.
   The stomach of the same subject was in a con-
 dition  which is  often referred to by  medical
 writers as preventing the operation of medicines.
 The internal surface was lined with a thick in-
 vestment of mucus, so tenacious and dense as to
 appear like  an additional coat, and nothing but
 actual  experiment could have convinced me that
 such a vitiated secretion could be thus fixed on
 the villous coat.  In attempting to remove it, I
 inverted the stomach, and washed it, first in cold. 
56
MORBID SECRET10A.
 then in warm, and subsequently with soap and
 water, but without removing any notable quan-
 tity.  I next rubbed it between my hands, as if
 washing a cloth, by which a few flakes were de-
 tached, but the greater part of it still adhered.  If
 this condition of stomach frequently occurs dur-
 ing disease, it must be next to impossible that
 medicines can be administered with any advan-
 tage. There was a considerable quantity of ether
 mixed with the fluids in the stomach, but even
 this powerful agent might as well  have been
 placed in contact with dead matter, for  any ef-
 fect it could have produced on a surface coated
 as this was.   The same condition is  thought to
 exist in  cynanche trachealis', which  frequently
 renders emetics almost entirely unavailing, un-
 less the most powerful and stimulating  are ad-
 ministered.   In delicate females habitually cos-
 tive, and leading sedentary lives, I  have  several
 times suspected this state of stomach,  winch ren-
 dered the system almost utterly insensible to the
 presence  of medicines.  One instance  of this
 kind, which occurred in the practice of my much
 esteemed friend Dr. John W. Buckler,  of Bal-
timore, required the most violent emetics, at a
time when the patient appeared  so much pros-
trated that the slightest exertion must destroy
her. The emetic, after some very violent efforts. 
DISEASED LIVER.
57
caused the discharge of a thick, lining,  mucous
substance, resembling the inner coat of the sto-
mach broken into large flakes, and a great im-
provement in her state of health immediately en-
sued.  The extreme prostration in this case was
the consequence of want of nutrition, as the diges-
tive function must have been for some time al-
together suspended.   It would be of great mo-
ment if we could determine with any certainty
the condition of system leading to this state of the
stomach, which always must indicate the use  of
emetics, notwithstanding the apparent debility
may be truly alarming.

              BILIARY SYSTEM.
   A male subject about forty years of age, ex-
tremely emaciated, and seemingly dead of con-
sumption, was examined.  Both lungs were he-
patized, and adherent to the pleura costalis.  The
diaphragm was permanently and remarkably con-
vex  on the right side; slightly so on  the left.
Other viscera gave no signs of disease.   The li-
ver contained a great number of tumours, differ-
ing in magnitude, from the size of a middling ap-
ple,  to that of a hazelnut;  they were whitish,
firm, projecting above the surface of the liver,
and  rattier softer in the centre than at the edges.
They were readily separable  from the liver, and
                     H 
58            DISEASED LIVER.
 left a clean bed, without shreds or patches of at-
 tachment : some of the largest  might well be
 compared in consistence and colour to a rotten
 apple.  It would  be very interesting could we
 ascertain  the symptoms   accompanying  such
 cases, as well as how far the hepatization of the
 lungs  was dependent  on  the  diseased  liver.
 Nothing remarkable occurred in the  cystic or
 hepatic duct,  the gall bladder, or vena porta.
   The body  of a female, about  twenty-five or
 thirty years of age, was inspected, whose whole
 system was most perfectly imbued with the co-
 louring matter of the bile.   The bones, tendons,
 ligaments,  brain, and in short every part that
 could be seen, with the exception  of the nails
 and hair, were of a deep, bright yellow, resem-
 bling that made with chrome.  Contrary  to all
 expectation, there were  no biliary calculi;  there
 was no obstruction  of the ducts, nor disease of
 the liver,  nor peculiarity in the blood-vessels.
 The bile in the gall-bladder was in  moderate
 quantity, though the pori biliarii were rather
 full.  The  only remarkable circumstance in this
 subject besides the bilious colour, was the entire
absence of the left rectus capitis posterior, while
 its fellow of the right side arose and was insert-
ed with the most perfect regularity,  as regards 
MEDICO-LEGAL HINT.
59
its relation to the median line; being  only a
very little broader than usual at its origin.
  There is  one circumstance  not generally at-
tended to by persons engaged in the study of
medical jurisprudence, which is that appearance
produced on the dead body, very closely resem-
bling the effects of violence committed during
life.   We frequently find the bones of subjects
brought  for dissection  singularly  fractured;
sometimes the skull is broken and depressed, or
the pel vie junctions separated, with other injuries
of similar character.  These, if found on a body
submitted for medico-legal investigation, would
be readily enough attributed to violence  done
previous to death.  Perhaps the best mode of
deciding in these cases will be to  examine the
muscles, which  are usually broken in the dead
subject at the same time with the bone, and ex-
hibit no effusion of blood, whereas it would be
found in quantity, if the injury preceded death.
Those who  are accustomed to these appearances
can  distinguish  such injuries,  though they are
not  always perfectly easy to determine, except
by referring to  the circumstances  under which
the  body may have been  moved  after death. 
60          MEDICO-LEGAL HINT.

Wherever the  cuticle  is destroyed, or  much
compressed, in a dead body, it will in a short
time have all the appearance of a very serious
injury, done during the life of the subject. 
NOTE
THE ACTIONS
SSWS©Wa^m STSV3E1U
   During a great lapse of time, the muscular
system has been carefully studied by numerous
intelligent and acute observers,  in all countries
where science has been cultivated, yet, notwith-
standing their important labours, much remains
to be known and explained, relative to the struc-
ture of the muscles and their modes of action.
It is not with an expectation of supplying what
is wanting  to complete our knowledge of the
muscular system, that this note is written, but
to invite attention to* some interesting particu-
lars which have been singularly overlooked, by
those who have  heretofore treated of muscular
action.
   However rough and  irregular the skeleton
may appear when entirely denuded, it is most 
t>2
NOTE  ON THE
 admirably formed for giving support and proper
 attachments  to  the  soft parts designed for the
 growth and motion of the frame, and in the liv-
 ing condition, the adaptation of the soft textures
 to  the bony fabric is productive of every variety
 of beautiful outline,  whether the body be in a
 state of exertion or of repose.
   In various  parts of the system, beauty of con-
 figuration is obtained at the expense of power;
 the motive instrument  is not placed in a situa-
 tion where it can exert the greatest possible de-
 gree of force, neither is  the lever  it operates on
 the most advantageous for raising a given weight:
 still the effect is produced with the least sacrifice
 of convenience and beauty, and all apparent dis-
 advantages are fully compensated by the com-
 bined action of different muscles.   This is very
 evident when we reflect that the lever of the third
 order is the one most universally employed in
 the human body; the lever itself being the least
 efficient of all, yet allowing an arrangement of
 muscles, §c. about the bone, the most conducive
to symmetry and convenience, while the  want
 of absolute power from  the use of this lever is
compensated by  the greater number of muscles
brought into action, and the  much  greater va-
riety of motions to be performed in consequence
of the peculiar relations  of the bones. 
MUSCULAR SYSTEM.
63
  In addition  to  the general attention to sym-
metrical arrangement displayed in the muscular
system, there are very numerous instances  of
wonderful design exhibited in the combinations
effected for the purpose of modifying and direct-
ing muscular action, and to these  I more  especi-
cially wish, at present, to refer.   The study of
these modifying causes opens a wide field of ob-
servation to the physiologist and  rational anato-
mist, and confer on the muscular system a de-
gree of interest sufficient to repay one for all the
labour endured in gaining an acquaintance with
its minutise.
   It has no doubt forced itself on the mind of
every one who has attempted the study  of ana-
tomy, that the mere enunciation of a muscle aris-
ing at one point and being fixed to another, is,
to say the least,  a very dry and  uninviting task
for the memory.  When  such an enunciation is
coupled with  an apophthegmatic sentence, de-
claring the use of the muscle, as a general rule,
it is received as a thing to be believed, because
it is said, rather than as a proper consequence of
the origin and insertion before stated.  There is
a great deal wanting to  the establishment of a
proper conclusion in the mind  of the learner,
and for a  good  reason,  the  action ascribed to
three-fourths of  the muscles could not possible 
64
NOTE ON THE
take place, if it were not for the peculiar causes
which modify and direct the exertion of their
powers.   These, both in books and public lec-
tures, are as entirely left out of sight, as if they
did not exist, or rather as if they were utterly
unknown to writers and teachers;  the latter in-
ference may be  considered fair, for we believe
that no man  knowing  the circumstances would
pass them by in  silence.
  The circumstances modifying muscular action
have been my favourite study  for  some years
past; this study has led to all the observations re-
lative to the fasciae, heretofore published in the
Philadelphia Journal, and to all the discoveries
made known relative to the capsular ligaments
of joints, §c. in my "Anatomical Investigations."
  I shall at this time take a view of the modifiers
of muscular action, under the following heads:
  1st  Fasciae and sheaths.
  2d. Position in regard to bones;  relation  of
muscular fibres to tendons.
  3d. Modifying muscles.
  4th. Modifying tendinous connexions.
  5th. Special modifying constructions; annular
ligaments, trochleae, §c.

  1st.  Fascia and sheaths.—The fasciae  cover-
ing the extremities of the body will be the fair- 
MUSCULAR SYSTEM.            65
est exemplification of this part of our subject, be-*
cause they are the most obvious and generally
known.  They are strong, dense,  and inelastic
fibrous membranes, stretching from the bones
over the muscles, so as to give them an uniform
external covering, and thus lar the fasciae were
studied previous to my researches.   In addition
to the external covering,  sheets or layers are
sent off from the great  exterior sheet, by which
each of the muscles is enwrapped or included in
a distinct  sheath, the layers of which terminate
on  and around  the  joints for the formation of
their capsular ligaments.   In consequence, the
muscles thus covered, instead of swelling during
their contraction in a single mass,  resisted only
by the general external covering, contract and
swell within their own particular sheaths be-
sides, and these being fixed to the bone as well
as to the external fascia, direct the form of the
muscle to  the greatest possible advantage.  The
same circumstance of the sheaths for the indi-
vidual muscles being formed from the great com-
mon fascise, enables us to understand how mus-
cles apparently very similar in place and  appear-
ance, are  capable of performing very different
actions.
  Let us, to  make  the idea  clearer, consider
some of the muscles individually.   The sarto-
                      } 
66
NOTE ON THE
rius arises from  the  anterior  superior  spine
of the ilium and is inserted into the tuber of the
tibia, its use being to cross the legs on each other,
as is done by tailors when seated at their work,
whence the muscle has its name.   But the sar-
torius is the longest muscle in the human body;
its origin  is very nearly over the median line of
each thigh; to reach its insertion it passes  un-
der the inside of the knee to arrive at the tibia.
When the muscle contracts, it makes an effort to
straighten itself, and if it were not forced by some
cause to contract in the line  corresponding to
its course while in a state of repose, it could not
produce the movement above mentioned. What
is this necessary modifying power?   It cannot
be the general or external fascia lata, because,
if this were all, it might compress the muscle
during its contraction,  but could not prevent it
from  being drawn  towards the middle of the
thigh, or even from starting over the inner con-
dyle of the femur.  On examination, we readily
discover the modifying cause to be the sheath or
double layer of fascia in which this muscle is
included;  and this,  together  with the general
fascia, so binds it to its place, as to prevent it
from starting in any directibn, or producing in-
convenience or deformity.  The efficacy of the
sheath is distinctly manifest in this case, but not 
             MUSCULAR SYSTEM.          67

more so than it is in all the muscles belonging to
the extremities.
  There are a few instances where muscles have
their actions modified by the agency of a single
sheet of fascia on their exterior, though in these
cases the term aponeurosis is most applicable to
the modifying membrane.   Such is the aponeu-
rosis of  the temporal muscle,  the  palmar and
plantar aponeuroses,  which are the only parts
not belonging to the great general fasciae of the
body.   The mass  of the temporal muscle arises
on the side of the skull,  but a layer  of muscular
fibre concerned in modifying the action of the
whole muscle,  arises  from the inner surface  of
the aponeurosis, external to the beautiful  ten-
don of the  temporalis.  These fibres, generally
slighted or overlooked in the  description,  and
almost universally cut  away in the demonstra-
tion of this muscle, serve the purpose of aiding
the aponeurosis to resist the swelling of the  mus-
 cle, by contracting from  its internal surface to-
 wards the tendon, or the skull, at the same mo-
 ment that the powerful part of the muscle is con-
 tracting and swelling outward  against the  apo-
 neurosis.   The aponeurosis of the palm serves
 a very important purpose, not only by strength-
 ening the connection of the bony structure, but
 by binding down  all  the tendons flexing the fin- 
68
NOTE ON THE
gers, and compressing the inter-osseous and other
palmar muscles situate beneath it.  The plantar
aponeurosis bears a very striking resemblance
to the fascia lata in its structure, and relation to
the muscles, and to the temporal aponeurosis in
the manner of giving origin to muscular fibres.
It forms three grand divisions, in the first place
to embrace  the  central,  external, and internal
muscles of the sole, and on the inner surface of
the central portion, the flexor brevis digitorum
pedis derives a  very considerable part of its
origin.
  If the coverings of the scapular muscles were
not to be traced  continuously with the brachial
fascia, we  should be disposed to class them with
the temporal, plantar, and palmar aponeuroses,
as they are in various circumstances analogous
to them, being much thickened by successive ad-
ditions of tendinous fibres, and because the infra
spinatus has a series of modifying muscular fibres
arising from the inner surface  of the  fascia.
This attachment of muscular fibres is very  dif-
ferent from what we observe in the origin of the
muscles of the forearm and leg, where a part of
the main body of the muscle arises from the fas-
cia ;  in the case  of the temporalis and infra  spi-
natus it is a layer of fibres distinct from, and ex* 
              MUSCULAR SYSTEM.           69

ternal to the common mass of the muscle,  and
serving the purpose heretofore specified.
   2d. Position; relation of fibres  to tendons,  &c.
—The effect of position as a modifier of action,
may be  very fairly illustrated by the origin of
the flexor longus pollicis,  and the flexor longus
digitorum pedis.   The long flexor of the great
toe, arising from the posterior and inner part of
the fibula, and passing under the inner ankle to
its insertion, flexes the great toe in a line corre-
sponding with the inner edge of the foot, or a
line drawn from the  under surface of the toe to
near the centre of the heel.   The long flexor of
the toes, on the contrary, rising from the outer
and back part of the  tibia, and running to be in-
serted in the smaller  toes, contracts so as to draw
them inwards, or towards a line obliquely cross-
ing the sole of the foot from the outer to the in-
ner side.  It would  be natural enough for  one
who was unacquainted with the structure, to ex-
pect that the common flexor of the toes should
rise from the bone most immediately in a  line
with the toes to  be flexed; that the flexor of the
great toe should come  from  the tibia,  and not
from the fibula,  and  the contrary of the com-
mon flexor.   We shall hereafter  see some addi-
tional modifying circumstances  connected with
these two muscles of great importance and beau- 
70
NOTE ON THE
ty. An instance of a corresponding arrangement
may be observed in  the relative  positions and
actions of the extensor longus, and extensor bre-
vis digitorum  pedis.   Other  instances of the
adaptation  of situation to the direction of action
will present themselves to any one engaged in
studying the subject.
   The relation of muscular fibres to the tendons
through which they are to act, is another admi-
rable provision for the modification, or rather
direction of their action.   This  is   beautifully
seen in all the penniform muscles, especially those
belonging to the motions  of the foot.  They
arise by narrow origins,  and their  fibres run ob-
liquely outwards to receive a tendon on the edge
of the muscle, and not at the inferior  extremity.
Hence, as the  successive portions of these mus-
cles come into action, the motion of the foot is
effected, and the whole tendon is more and more
closely drawn  in towards the bones.   From the
very nature of the space the tendons of the upper
part of the foot have to traverse, they could not,
under any other circumstances, act to advantage,
although they  were  furnished  with fasciae and
annular ligaments.  Another excellent instance
of modification, owing to the relation of fibre to
tendon, may be observed in the semimembrano-
sus, one of the great flexors of the leg on the 
MUSCULAR SYSTEM.
71
thigh.  The origin of this muscle from the upper
and posterior part of the tuber ischii, is a broad
flat tendon,  lying  between  the biceps and the
semi-tendinosus.   As it is passing through the
thicker part of the thigh, this flat tendon has the
fleshy  fibres attached to it,  beginning by short
fibres  running  obliquely,  gradually  growing
thicker and longer for a few inches; then, short-
ening again, With the same obliquity of fibre, the
muscle receives the terminal broad tendon, which
is to be inserted into the inner and back part
of the head of the tibia.   Hence this muscle is
able to co-operate in the flexion of the leg on the
thigh, bringing it directly backwards, and at the
same time by its figure aiding in giving symme-
try to  the thigh; whereas, if its fleshy fibres were
direct, or corresponding to the course of its ori-
gin and insertion, it could do neither.
   3d.  Modifying muscles.  This is a very ex-
tensive source of modification  in  muscular ac-
tion,  and the design  of the modifying portions
is unequivocally evident.  We shall select a few
of the most obvious instances as sufficient for the
present.   The long flexor of the thumb arises
on the upper part of the radius below its tuber,
and for a considerable distance along that bone
towards  the wrist.  The fibres are necessarily
penniform,  and the tendon received on the outer 
72
NOTE ON THE
 edge of the muscle; according to what we have
 observed on the penniform muscles, this arrange-*
 ment will  draw the tendon more  immediately
 toward the bone,  and if this arrangement were
 the whole of the muscle, the flexion of the thumb
 could not take place as advantageously as it now
 does.  But a modifying muscle, having direct fi-
 bres, and terminating in a distinct tendon, acted
 on by all its fibres at one, arises from the internal
 condyle  of the humerus, and is fixed into the
 commencement of the tendon belonging to the
 radial or penniform portion, and as its origin is
 much more favourable to the proper flexion of
 the thumb, it  modifies the  action of the lower
 part of the muscle.  It may be said that this mo-
 difying portion is not always present—this may
 be said of various parts whose  uses are  unequi-
 vocal :  but this part of the muscle is  not fre-
 quently absent, perhaps once in ten times, if so
 often.
  Another and more striking instance of modify-
 ing muscle, is found in the second head  of the
 biceps flexor cruris, the only muscle inserted into
 the fibula for the flexion of the  leg on  the thigh.
 This biceps derives its principal origin from the
 tuber ischii, in immediate  company with the
semi-tendinosus, which goes to  the inside of the
leg.  Whoever examines the origin of the biceps, 
              MUSCULAR SYSTEM.           73

 and observes the obliquity of this first head, com-
 pared with its insertion, will  see that  if this
 greater part of the muscle were alone, it would
 rather pull the leg towards the inside, like the
 semi-tendinosus, than towards the outside.  But
 a second portion of muscle comes off from the
 outer part of the posterior surface of the thigh
 bone, beginning below the insertion of the glu-
 taeus  maxim us, into the rough line. This second
 head has its fibres running obliquely outwards
 and downwards, and it lays hold of the proper
 tendon of the biceps on the inside;  when the
 larger portion of the muscle contracts, this short
 head  operates on the tendon, drawing it  in the
 immediate line of the bone, thus correcting the
 obliquity  of flexion which would be produced,
 if the upper portion coming from the tuber, were
 to act alone.
  A  modifying structure having  considerable
 analogy with this, exists in the relation  of the
 gastrocnemius and soleus.  The gastrocnemius
 arising from the condyles of the femur is nearly
 immediately in a line with the os calcis, and by
 the projection of the condyles, has great power
 in commencing the extension of the foot on the
leg, though it could not,  from the  very circum-
stance of the slenderness of its origin, suffice to
                     K 
74
NOTE ON THE
 sustain much of the weight of the body.   The
 soleus, arising from  the head of the fibula and
 posterior and upper part  of the  middle of the
 tibia, and acting on the common tendon fixed to
 the os calcis, completes the action,  draws the
 heel directly upwards and inwards, in a line with
 the bones, and  thus the whole muscle is enabled
 to sustain a  great weight.
   The last instance I shall mention of  modify-
 ing muscle, is the accessory of Sylvius, in the sole
 of the  foot.  The situation of the long flexor of
 the toes  has already been referred to, and it has
 been stated that the  object of the flexion is to
 bring the toes downwards and inwards; but in
 passing under the  os calcis from the posterior
 part of the tibia, the tendon passes rather ob-
 liquely across the sole,  and would draw the  toes
 too directly  or  violently inwards.   This evil  is
 prevented by the  intervention of a small but
 strong  mass of  flesh, arising from the sinuosity
 on the inside of the os calcis, and terminating
by an  oblique  insertion into the tendon of the
long flexor just  where it separates into four ten-
dons for the  lesser toes. This accessory muscle
contracting in  the direction  of a straight  line
drawn through the middle of the sole, at the time
when the long  flexor tendon is drawn immedi- 
MUSCULAR SYSTEM.           75
ately inwards, produces that modification of ac-
tion which is intermediate to what either portion
would separately produce.
  4th. Modifying tendinous connexions.  These
will be sufficiently obvious to every anatomist j
it will  be enough to refer to  a few of them.
Among the  most important may be mentioned
the splitting of the tendon of the obliquus inter-
nus abdominis, which, with the external, oblique
and transversalis, constitutes the sheath of the
rectus abdominis. This muscle  in consequence,
has its power of flexing the trunk vastly increas-
ed, inasmuch as it is affected by every degree of
contraction  which occurs in the other abdomi-
nal muscles, at the same time that its own con-
tractions are performed.   In addition, this mus-
cle is broken into portions by tendinous matter,
which  gives it something of the character of se-
veral distinct muscles.
  There is a strong tendinous connexion exist-
ing between the tendon of the long flexor of the
great toe, and the tendon of the long flexor of all
the other toes.  This tendon enables the flexor
of the great toe to participate in the modifying in-
fluence exerted by the accessory muscle of Syl-
vius, recently mentioned under the third head.
Various other instances will be recollected, more
or less analogous to these. 
76
NOTE ON THE
   5th. Special modifying  constructions, &c.—
The most beautiful of these are the trochleae in
the orbit of the  eye  for the obliquus superior,
and the hook on the  internal pterygoid plate of
the sphenoid bone for the circumflexus palati,
both of which are so obvious as to need nothing
beyond a mention.  The interposition of the pa-
tella, by which a pulley is formed at the knee
joint, and of the sesamoid bones, occurring in the
tendons of the short  flexors of the thumbs and
great toes, are also well known.
   The annular ligaments of the wrist and ankle
are also peculiarly worthy of attention as  modi-
fiers of muscular action, and without which our
present construction of muscles would be almost
useless.  If any one wishes to  ascertain how far
these instruments direct the action of the mus-
cles, let him cut them through, and he will at
once see, from the starting forwards of the ten-
dons, that without the aid of these  annular liga-
ments, the motions of the extremities could not
be properly effected.   The same principle is re-
sorted to by nature for confining the tendons of
the fingers in place, only that in this case the ma-
terial used is much stronger than  that of com-
mon annular ligament.
   I have not leisure to pursue these investiga-
tions further at this time, and  am  conscious of 
             MUSCULAR SYSTEM.           77

their manifold imperfections, yet I hope that
these remarks may not prove uninteresting to
those who are engaged in the study of anatomy,
because they appear to me to have a very useful
bearing on the physiology and pathology of the
muscular system.  Some happier genius, by a
more extended inspection of all the existing re-
lations of the muscles, may be enabled to explain
very  many  circumstances,  which now  appear
dark and difficult, concerning their functions. 
 
DESCRIPTION
         OF

THE MASTODON.
Read before the Academy of Natural Sciences of Philadelphia, June 6,1824.*
  The Os Hyoides  is one of the few parts of
the bony system,  belonging to this interesting
genus, which has not yet been described.
  The specimen, from which this description is
made, consists of the whole of the basis, with the
posterior cornu and styloid apophysis  of  the
right side.   The  posterior cornu and styloid
apophysis of the left  side  were  either   not
found originally,  or have been lost since the
erection of the fine skeleton in the Philadelphia
Museum, to which this os hyoides  belonged.
But as we have the right side nearly entire,  with
the whole of the basis or central anterior portion,
there is no difficulty in forming a sufficiently ac-
curate idea of the character of this bone.
* Extracted from vol. iv. of the Academy's Journal. 
80
OS hyoides
   The figure of the  basis bears a considerable
 resemblance  to  the ordinary shape  of the  os
 hyoides in man and other animals at the anterior
 part, being curved  at the  extremities,  so that
 both the outside and inside of the bone have a
 semicircular outline.
   The basis or inferior portion is thick, strong,
 and convex externally; the whole surface, espe-
 cially in the centre, being rough and  irregular,
 as if for the attachment of muscles.  At  the up-
 per and anterior part, the rough bone rises in the
 centre about the eighth of an inch above the con-
 vexity of the  inside of the bone, having,  at both
 extremities, a groove, which is perceptible nearly
 all round at the base of this projection.
   On the inside of the basis, and immediately
 below the projection at the  upper edge, the sur-
 face is rounded and smooth, having  no other
 markings than slight furrows for nutritious ves-
 sels ; the thickness increases until within  half an
 inch of the lower edge, where there is a project-
 ing line, which forms an irregular semicircular
 sweep towards both the articulating  surfaces.
 A little to the right of the centre of this  line,  a
 depression  commences, which is about an inch
 in length, and gives the greatest degree of depth
 to the inside of the basis, as will be seen in the
subsequent  measurements. 
              OF THE MASTODON.            81

   The articulating surfaces both descend below
the level of the body of the  basis, so that if the
bone be placed on a plane,  and inclined  back-
wards, it is supported on these extremities, form-
ing an arch, whose centre is that of the depres-
sion before  noted.   When the basis is  placed
fairly on a plane, it rests on an obliquely flatten-
ed inferior surface.
   The articulating surfaces are rough, that of the
right side most so; both are obliquely  curved
inwards towards the  upper  edge of the bone;
the right side presenting most of this obliquity.
The upper edge of the  right articulating surface
projects more than the left,  forming at its ante-
rior part an evident tuberosity.
   The posterior cornu of the  os hyoides has, at its
anterior extremity, a deep  and rough surface,
the  cavity appearing as if an epiphysis had been
broken off.*  This extremity is placed  obliquely
on the  extremity of the bone, the outer part of
which,  in  approaching the  basis, forms  an in-

  • The appearance of the extremities of the basis and posterior
cornu is such as to induce the belief that an epiphysis had been
removed from each. There are no data on which we can found
an opinion of the exact amount of substance lost, although it is
probable that from one to three inches have thus been removed
from  the total extent of the os hyoides.
L 
82              os hyoides
 clined plane of an inch and a half in breadth on
 its inferior surface, gradually blending with the
 middle line of the bone on the outside.  Above
 this, the bone is flattened toward the perpendicu-
 lar, being continuous with the posterior edge of
 the whole shaft.  The posterior edge of the pos-
 terior cornu, at a short distance from  the ante-
 rior articulation, becomes gradually sharp, and
 this sharpness increases till it ends at the supe-
 rior articulation.  The outside of the posterior
 cornu is regularly convex, until within  three
 inches of the superior extremity, where it ex-
 pands to more than twice the breadth of the shaft.
 The inside  of this cornu is  compressed at the
 centre of the shaft, entirely flattened, and slightly
 concave from within three inches of the superior,
 and also flattened at the inferior extremity, ex-
 cept where the articulating surface is strengthen-
 ed by the bone being continued for the distance
 of two inches, projecting at first about the fourth
 of an inch, and terminating imperceptibly in the
 sharp anterior edge of this bone.
  The figure of the  superior extremity of the
posterior cornu is that of  about one-third of an
irregular segment of a circle, two inches in dia-
meter ; the anterior part  being the most regu-
lar ; the superior being broader and rougher, and
terminating above  in a round and smooth tuba- 
OF THE MASTODON.
83
rosity.  Immediately anterior to this, there is
on the outer surface a curved indentation, appa-
rently forming a part of a small articulating sur-
face at the superior and outer portion of the su-
perior extremity of the cornu.
  The styloid apophysis differs from the base
and posterior cornu by having but one articula*
ting surface on its anterior extremity, which is
irregularly triangular, deep, and unequal.   Im-
mediately behind the  articulation it is almost
cylindrical, but gradually grows flatter towards
the posterior edge, terminating at length by a
broad and flattened  surface,  two inches and a
half from the articulation, curving inwards slightly
at the inner edge.   The rest of this apophysis
forms a considerable angle with this part of the
bone, rising upwards, gradually becoming smaller,
continuing to the posterior  extremity thinner on
its posterior, and rounded  on its  anterior sur-
face.   On  the  inside,  and near the posterior
part, the inner surface rises so as to form a pro-
minent line.  The whole of the basis, posterior
cornu, and styloid apophysis, have not been fos-
silized, but still retain the characters of bone.
   I am indebted to Mr. Rembrandt Peale, who
was particularly engaged in the exhumation of
the two most perfect skeletons of the Mastodon
that have yet been obtained, for the following 
84
OS HYOIDES
 particulars.   The morass, which  contained the
 Mammoth bones, was sounded by means of long
 pointed rods, shod with iron.  On the removal
 of the mud, after finding some resistance made
 to the rod, an entire under jaw bone was disco-
 vered, over the top of which the scapula of the
 animal was so placed as to form a covering to the
 space between the rami of the jaw.   When the
 scapula was raised,  the bones of the os hyoides
 were found lying within the jaw,  thus  being
 protected from  the fluctuations which had
 scattered the other  small bones to various dis-
 tances, previous to the hardening and fixing of
 the mud.

               Measurements.
   Of the Basis.—From the  commencement of
 one articulating surface to the other, over the
 middle of the bone,  on the outside, four inches
 and three-eighths.
  In like manner on the inside, three inches and
five-sixteenths.
  Depth of the bone measured in  the centre on
the inside, one inch and a half.
  Depth on the  outside,  one inch  and  one-
eighth.
  Height of right articulating surface, one inch
and three-eighths. 
OF THE MASTODON.
85
  Breadth of the same, seven-eighths of an inch.
  Perpendicular height of left articulating sur-
face, one inch and one-eighth.
  Diagonally, from the upper and inner to the
lower and anterior edge, one inch and  three-
eighths.
   Of the Posterior Cornu.—-Length, seven inches
and three-eighths  on the outside.
  Length on the inside, six inches and a half.
  Height of anterior articulating surface,  one
inch and five-eighths.
   Breadth, one inch and one-eighth.
   Posterior articulating surface,  measuring  the
whole semicircle, two inches and seven-eighths.
   Breadth  of the same, seven-sixteenths of an
inch.
   Circumference in  the centre, two inches  and
 one-eighth.
   Breadth (externally)  behind  the  anterior
 articulating surface, one  inch and eleven-six-
teenths.
   Breadth (externally) just before the posterior
 articulating surface,  one inch and thirteen-six-
 teenths.
    Of the Styloid Apophysis.—Length,eight inches
 and one-sixteenth on both  sides.
    Breadth through the angle, one inch. 
86            OS HYOIDES, §C.
   Circumference midway between the angle and
articulation, one inch and a half.
   Circumference midway between the angle and
extremity, one inch and one sixteenth.
   At the posterior extremity, five-eighths of an
inch.

          Explanation of the Plate.
   Fig. i.  Basis, front view.
       2.  Posterior cornu.
       3.  Styloid apophysis.
   The whole reduced to two-thirds  of the natu-
ral size. 
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