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* 
TREATISE
  SPECIAL    AND    G.ENERAL

                ANATOMY.

                              ■  IS
              BY WILLIAM E. HORNER, M. D.
PROFESSOR OK ANATOMY IN THE UNIVERSITY OK PENNSYLVANIA—MEMBER OK THE IMPERIAL
            MEDICO-CHIRURGICAL ACADEMY OK ST. PETERSBURG—OK THE
                   AMERICAN PHILOSOPHICAL SOCIETY, &.C.
Multum adhuc restat operis, multumque restabit, nee ulli nato, post mille seecula
  pnecluditur occasio aliquid adjiciendi.
                                           SENECA, EPIST.
IN TWO  VOLUMES.
       VOL,. I.
FIFTH EDITION, REVISED AN© IMPROVED.
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LEA   &   BLANCHARD,
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1840. 
 21 tot
y<g4-o
    v.l
Eastern District of Pennsylvania, to wit:—
  BE IT REMEMBERED, that, on the seventeenth day of October, in the
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to wit:—

" A Treatise on Special and General Anatomy.  By William E. Horner, M. D.
  Adjunct Professor of Anatomy in the University of Pennsylvania, Member of
  the American Philosophical Society—Surgeon  at  the  Philadelphia Alms
  House, &c.  ' Multum adhuc restat operis, multumque restabit, nee ulli nato,
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     ♦
w
GRIGGS & CO., PRINTERS. 
PREFACE
To the First Edition, published in 1826.
  The many additions that, of late years, have been
made to Descriptive or Special Anatomy; the improved
views on the collocation of its objects; the alterations and
amendments in the method of description; and the now-
urgent call for some greater information on General Ana-
tomy than what is commonly introduced into the scho-
lastic systems; require in the English language, for the
benefit of the medical student and of the practitioner, a
new work on the structure of the body, executed by one
who is in the habit of pursuing anatomical inquiries by
constant dissection.  It would have been pleasant to me
if some gentleman, whose time, opportunities, qualifica-
tions, and spirit of research were better suited to the en-
terprise, had stepped forward for its accomplishment.
While meditating on this subject, I had a strong desire
to remodel the excellent work of Dr. Wistar,* on a plan
more suited to the actual state of the science; but, upon
reflecting that  it  was a justly  celebrated monument to
his reputation, I  became dissatisfied with the project of
cutting and carving it into a more modern figure.   In
addition to which consideration, having frequently de-
parted from his authority, the alternative was presented
either of suppressing his ideas to substitute my own, or
of giving currency to opinions differing from my own
convictions, neither of which  was agreeable.  The la-
  * A system of  Anatomy for the use of Students of Medicine.—
Philadelphia, 1817. 
 IV                   PREFACE.
 bour, moreover, of remodelling would have been almost
 equal to the writing of a new book.
   Neither is there  any work extant from the British
 press, which presents a good model for a body of Ana-
 tomy.   This assertion may surprise some, and  yet it
 is  entirely true, and  especially so in regard  to  the
 British  publications most circulated in this country:
 I allude to the Anatomy of  Mr. Fyfe,* and to that of
 Mr. Bell.f   The first, from  being unpretending, good .
 in its way, and having accomplished the object for which
 it was intended; to wit, as a general outline of anatomi-
 cal objects, requires for the present no farther comment.
 But the second, being presented to us in the imposing
 form of four  octavo volumes; illustrated by numerous
 diagrams and plates; abounding in strictures upon the
 opinions of others, and written  in a  fanciful pleasant
 manner; has had a much more powerful influence on
 the taste of the American student,  and is, therefore, a
 very proper subject for a short analysis.  It is not going
 beyond bounds, when I say, that there is no work which
 affords more  amusement to  the young student on the
 first perusal, or whose authority is viewed by him with
 more deference.  Its sprightly style; its confident man-
 ner of address; the many exploded, antiquated errors
 which have been disentombed from absolute oblivion,
 in order  to make the reader laugh at them; the gro-
 tesque dress put upon the valuable opinions of others;
 and their travestied doctrines; all contribute to make it
read like a production of the imagination, and to have
  * A Compendium of the Anatomy of the Human Body, intended
principally for the use of Students.  Philad. Ed. 1802.
  t The Anatomy of the Human Eody, illustrated with one hundred
and twenty-six engravings.  By John Bell, Surgeon. 
PREFACE.
V
the same sort of popularity which works of the latter
kind frequently enjoy.  As the real importance, how-
ever, of a work upon an exact science does not exist in
its wit and " bizarreries," but upon the wholesomeness
of its  truths, and  the accuracy with  which  they  are
stated; it is fair to expect that the writer should himself
be faultless, who  thus uses the weakness  of  others as
the foil upon which to display, most  advantageously,
his own presumed brilliancy and perfection.   It does
not require much scrutiny to ascertain whether the ex-
pectation is realized, and whether  this author does not
abound in inaccuracies, in  exaggeration, in obscurities,
and in irrelative matter.
   In regard to the inaccuracies of Mr. Bell, we give the
following as specimens, which we have got without far-
ther trouble than that of thumbing his pages.  " This
membrane (the Mediastinum) passes directly across the
breast from the sternum before, till it fixes itself in the
spine behind.  It is on the left side of this membrane, in
the left cavity of the breast, that the heart is placed."
" The Eustachian Valve is in general thick and fleshy."
"The Pericardium is formed, like the Pleura and Me-
diastinum, of the cellular substance."  " The Perioste-
um is merely a condensation of the common cellular sub-
stance, formed  in successive layers."   "The perioste-
um, tendons, fasciae  and bursa mucosa, are all of  one
substance and of one common nature."  " The socket,
(i. e. the acetabulum) is deepened by its cartilage, which
tips the edge of the socket, and stands up to a conside-
rable height.''  Some of these mistakes are glaring blun-
ders; others may perhaps be referred to the faulty phra-
                         1* 
Vi                   PREFACE.
seology of the author, from his imperfect notions of the
elementary tissues of the body; but their mischievous
effect is the  same.   Whatever may be  the surprise of
the student in  seeing  a popular author thus commit
himself, it will be increased to astonishment by an ex-
ample or two from his Principles of Surgery.*  "The
tendon of the rectus also takes its origin from the fore
part of the capsule,! aQd the capsule is at that part sin-
gularly thick; indeed, it is hardly at any part of its cir-
cumference less than half an inch in thickness, and is
of a gristly hardness"  " A poor man, who was by trade
a leech catcher, fell as he was stepping out of a boat,
and the long and pointed scissors which  are used in his
business, being in his pocket, pierced his hip, exactly
over the place of the sciatic notch, where the great iliac
artery comes out from the pelvis."  One  might suppose
in reading these passages, that  some peculiarities of
structure, from habits  of  life, had been manifested in
the subjects submitted to Mr. Bell's knife;  but in that
case we should have heard of such from other sources
also;  and as we have in this city  extensive and varied
opportunities of dissecting, we ourselves must have no-
ticed them; moreover, it is entirely unknown for modes
of life to alter the  course of the  arteries, and to bring
out the  Great  Iliac (Primitive  Iliac)  at  the  sciatic
notch, instead of its being confined to the usual course
and boundaries.
  Another circumstance to be noted in Mr. Bell, is the
extraordinary proceedings and modes of operating to
which his patients were subjected. The same unfortu-
nate leech catcher, with such an unusual distribution of
    * London, 1815.                  t Of the hip joint. 
                     PREFACE.                   Vii
the great iliac artery, had his miseries increased by the
formation of a "prodigious aneurism" at the part in-
jured ; " upon opening the tumour fully with an incision
eight inches long, and turning out the great clots, the
blood was thrown out with a whishing noise, and with
such impetus, that the assistants were covered with it,
and in a moment twenty hands were about the^tumour,
and the bag (aneurism) was filled with sponges, and
cloths of all kinds, they were insufficient to arrest the
bleeding.  Seeing, at this critical moment, that if he
was to be saved it was to be only by a sudden stroke, I
ran the bistoury upwards and downwards, and at once
made my incision, two foot in length."   This tale bears
with it a hyperbolical, romantic character, and if Mr.
Bell had also said, that he and the ten assistants had
been floated to the other side of  the "operation  room"
in the grand sluice of blood which followed the opening
of the tumour, we should  have considered the swim as
only an addition  to the figurative and oriental style, in
which his ideas are generally conveyed. But he checks
this indulgence to his manner, by a previous admoni-
tion for the reader not to think that he exaggerates the
difficulties of such operations.
   The irrelative  and exploded matter which Mr. Bell
introduces into his anatomy, is not one of the least re-
markable of its characters.  Thus, he tells of the opinion
of Hippocrates, that the water of the pericardium is the
drink that we swallow.—Of the dispute between Bardi-
us and Bartholin about the source  of the water that
flowed from our  Saviour's side, on the occasion of his
being pierced by the spear.—Of the theory of Des Car-
tes, of one portion of blood in  the heart acting upon 
Viii                   PREFACE.
another, like vitriol upon tartar, and thereby ejecting
itself through the aorta.—Of side passages in the heart
through  the septum  of  the  ventricles.—Of the cele-
brated general of the  Messenians, Aristomenes, known
equally well for his devotion and constancy to the cause
of his countrymen, having his heart filled with hair, a
proof of his invincible courage and daring.  Of the eel
which was found in the heart of a patient of Dr. May.
These matters may possibly be excused on the footing
of episodes, intended  to  diminish the tediousness of a
long story.
  The oddities of this writer are likewise entirely cha-
racteristic : thus, we have in his Principles of Surgery
a regular diagram of the resemblance between the thigh
bone  and a chariot with dished wheels.   "Polonius.
Very like a whale."
  The last comment which we have to make touching
this " popular writer " is on his anatomical illustrations.
I cannot enter into an analysis  of- them, but have only
time to say, that if ever a simple matter was perplexed
by illustrations, we have this feat to perfection in the
account of the Circulation, of Respiration, and of the
round of blood in the Foetus.*
  The character of the preceding vagaries may suit a
writer on common literary  subjects, where amusement
only is intended; but is totally unfitted to an instructor
in an exact science, where  words should be used only
according to their technical meaning, and where patient
observation is the only guaranty from ridiculous mis-
  * The preceding observations are principally applicable to the first
and second volumes of the  Anatomy of the Human Body; the third
and fourth have been executed in much better taste by Mr. Charles
Bell. 
PREFACE.
IX
takes.   But I must here stop, for I have never aspired
to the reputation of a critic, and to the equivocal friend-
ship with the rest of the world which such commenta-
tors generally have.   I have only been induced to point
out these faults, because it  appeared to me that the
writer alluded to, though now numbered with the dead,
has left a reputation tending to deprave the scientific
habits of such medical  students, and they,  I  believe,
are not a few, as read his works.   I am also checked
by the hint of Le Sage: " En verite sil y a bien de mau-
vais auteurs, il  faut convenir  q'il  y a encore plus de
mauvais critiques."*   I, therefore, conclude by sug-
gesting, that if an exact science require for the relief of
its student some dilution with the works of the imagi-
nation ; instead  of corrupting it with mere notions and
exaggerations, it would be much better for the student
to resort to productions of the first merit, and to hold in
one hand his System of Anatomy, and in the other a
Milton, or a Waverly Novel.,
   I should be extremely sorry to be understood as doubt-
ing the capability of the British anatomists to write  a
good treatise on this subject.   I indeed  feel persuaded
of the contrary; and, therefore, only mean  that as yet
they have not, in  this particular, done justice to them-
selves, or to the  literary reputation of  their country.
Any other opinion would be great injustice to them, and
would also be ingratitude for acts of friendship and civi-
lity received from many illustrious and enlightened in-
dividuals whom the profession  is proud to own; andal-

  * In truth, if there  are many wretched authors, one must confess
that there are many more wretched critics.— Gil Bias. 
X   -                 PREFACE.
legiance to whose doctrines has, moreover, been freely
avowed, in the present work, on proper occasions.
  To the profound anatomist, whose inclinations lead
him to study every fasciculus of fibres composing a mus-
cle or a ligament, and every minute nervous or arterial
ramification, the present Treatise on Anatomy will of
course, be a mere outline of the science. But to the stu-
dent of medicine and to the practitioner, who have only
time to dwell upon prominent and useful points, I trust
that it will appear sufficiently full formost professional
objects.  The anatomy of the human body is  of an ex-
tent much beyond the common conceptions of it, and is
rather a generic than a specific term.  A full treatise
on it would contain matter to twice or three times the ex-
tent of the present work, and would even then be in
many respects deficient; for it must not only give a full
description of parts in the adult body, but their first ap-
pearance in foetal life, and their  gradual development
into the perfect or adult state.  It must also  contain a
complete account of the properties of each kind of struc-
ture composing the human body, called, in technical lan-
guage, General Anatomy;  also  morbid alterations of
structure,  and finally varieties in shape, position, &c.
   It is here proper to  remark, that though every hu-
man body be  formed  on the same general mould, yet,
in  examining the details of structure in an individual,
varieties will be  met with  causing a difference  from
 all other individuals.  For as no  two leaves or two hu-
 man countenances are precisely alike, so the  interior
 organs of individuals differ in their phases, though the
 same end  is obtained.  Hence, it  becomes necessary 
                     PREFACE.                    Xi
for a system of anatomy to show rather what is of the
most frequent occurrence, than to pretend to universal
correctness; because, by the latter test, many of its ac-
counts are inexact.   Some of these departures from the
general rule are so infrequent as to deserve the name
of anomalies: in some cases, there is, indeed, only one
or two recorded instances; but, in others, the variation
is so frequent as to leave the anatomist in doubt, about
what mode of description is applicable to the majority
of cases.   From this  latter cause, we, in  consulting
different writers, sometimes find their opinions much
opposed; and to our surprise, the adage of quot homines*
tot sententia, as applicable to the science of anatomy,
as it is to one of an abstract and confessedly disputable
kind.   Anatomy, however,  in  its great outlines, is a
science surprisingly and sufficiently exact; the excep-
tions are too few to admit of hesitation about what is
right and what wrong: it is, therefore, perhaps, next to
mathematics in the precision of its indications, and in
the value and certainty of  its rules.   It  is, for  these
reasons, in every way suitable, that in an operation, or
in the treatment of a disease, where the  condition of
organs is to  be considered; that we should look with
full assurance for what is most common, rather than to
hesitate and  vibrate between two opinions; to  balk
about mere varieties.   Otherwise, a knowledge of the
 possibility of the latter will rather injure than assist
our exertions, and  our inefficiency will have the ap-
 pearance and effect of ignorance.
   Sensible of the importance  of reflecting upon, and
 of observing maturely the  matters treated of, I  have 
Xii                   PREFACE.
done my best to be accurately informed by repeated
dissections, and by-reference to the highest authorities.
The latter was happily put into my power,  by the
well-furnished library of the Alms House and,of the
Pennsylvania  Hospital;  and by a  private  collection,
containing many of the most  approved productions.
This balancing  of the opinions of others with one's
own dissections, is, unquestionably, best suited to cor-
rect inferences: to follow exclusively the one  or  the
other, is attended with great liability to error. ' An un-
due deference to approved authorities makes our opi-
nions habitually wavering  and  uncertain, from  the
discrepance of writers among themselves; while an in-
sufficient attention to  such  means of  information pro-
duces very serious mistakes in correctness of descrip-
tion, and  very false ideas of scientific  acquirements,
If we presume on our own  infallibility and originali-
ty,  we are apt to suppose ourselves possessed of sur-
passing skill, as floating triumphantly on an ocean of
discovery, as extending in every direction the bounda-
ries of the science and  giving  a new impulse to it;
while, on  the contrary, our faulty modes of examina-
tion, and neglect of competent writers, have  caused us
to flounder ridiculously on  common-place  and well
settled points.   It is thus that imaginary originality is
not unfrequently in an inverse proportion to the recent-
ness of one's induction into the science, and to the ex-
actness with which it  has been studied.
  In the absence of knowledge, the young and  enthu-
siastic, but heedless anatomist, is  frequently prolific,
from the  commencement, in  discoveries:  he  makes 
                     PREFACE.                  Xiii
them in such numbers, with such facility, and under
such unpremeditated circumstances, that he is filled
with admiration at his own abilities in such matters,
and  at the ignorance and inattention of his predeces-
sors  and cotemporaries.  In the  ready communication
of the result of his labours, he is disposed to use the
language of high attainment and of advanced reputa-
tion.  He hints at his anticipations of the* jealousy and
malice which are known to follow greatness and excel-
lence; not considering that there is  quite as much
proneness in an individual to overrate  himself  from
self-love, as there is in others to decry him unjustly.
He feels mortified at the supposed apathy of some per-
sons, and indignant  at others for not  placing  him at
once on the pinnacle of fame.  After  waiting  in vain
for such homage, he, at length, finds out that the mat-
ters  treated of have all the triteness of being very well
known;  or, if they be novelties, they are the offspring
of hasty and imperfect observation, and were rather
leading into error than conducting to  the  truth.   An
inattention to the writings of others has also the incon-
venience of exposing us justly to the  raillery and cri-
ticism of persons, who, not reflecting that it is scarcely
possible to bring new truths into vogue,  much  less er-
rors, and that such mistakes carry with them their own
seal of death, they drag them to  the block, there to die
by the hand of the public executioner.  Dr. W. Hun-
ter* has justly remarked, that " He that is in a hurry
to publish his discoveries,  will often have occasion to
repent his haste.  Reflection, and more favourable op-
            * Med. Comment, p. 57.  Lond. 1777.
   Vol. I.—2 
XIV                  PREFACE.
portunities of making inquiries, will at length bring
us back to the truth, if we have been misled, and will
confirm and improve our inventions, if they be right."
  The preceding observations are not intended to re-
press the  spirit  of generous enterprise, but rather to
assist it, by giving it a proper  direction.   There are,
unquestionably,  many things yet  to be discovered in
anatomy, as proved by the continued contributions of
its cultivators.  For, in  the language  of the motto,
" Multum adhuc restat  operis, multumque restabit,
nee ulli  nato, post  mille seecula prsecluditur occasio
aliquid adjiciendi."   These  remarks are only intended
as a salutary warning to the young votary of anatomy,
not rashly to  promulgate, by boastful writing or lan-
guage, that he considers his own  acquisitions as the
standard of the  science, and every thing beyond them
as in the region  of discovery.   Because, if he does, he
is sure to meet  with the most  mortifying  convictions
to the contrary;  and sometimes to find himself placed
below the degree of his actual acquirements, for mani-
festing a want of acquaintance with topics common to
others.   The  rule is undoubtedly a  good one: "Let
not him that putteth on  his  harness boast himself, as
he that putteth it off."

   Not thinking  that the present  treatise is a proper
field for discussion on controverted points, I have pur-
posely, excepting on a  few occasions,  avoided it, by
simply giving an opinion after my own views of cor-
rectness, without pretending to infallibility, or beino-
disposed to reject better  information when  offered.   I
 cannot, however, but feel the  strongest diffidence  of 
PREFACE.
XV
my powers  to  execute, in  a moderately satisfactory,
not to say a  proper manner, the enterprise of writing
a treatise on anatomy.   There are not many persons,
who, as they advance in the study of the  science, by
dissections and by reading, do not, after awhile, as in
the cultivation of high religious and moral attainments,
mistrust their acquirements; and find, that whatever
may have been the fancied  perfection of their know-
ledge during the  infancy of their studies, they were
then only on the threshold  of  the temple.  In begin-
ning the career  of anatomical inquiries, as an almost
exclusive profession, we have yet to appreciate the la-
bours; I may, indeed, say to read the writings of the
eminent men who have  gone before us.  We have yet
to learn the immense  multitude of  observations  by
which we are surrounded, and the great labour that it
requires to  master them all.  The fact is well  esta-
blished, that it requires  some years of hard  study be-
fore the anatomist becomes aware of his own weak-
ness, and of the many things that he has  yet to do in
order to be brought up to the actual  state of the  sci-
ence.
   Impressed by these convictions, I have constantly
endeavoured to ascertain and present the science of
Descriptive  or Special  Anatomy, as it stands at the
present day, without entering into all the  minutise of
details of which  it is susceptible.  I have, therefore,
neglected no fact bearing on the subject, which seemed
to be sufficiently authenticated or important to deserve
notice.  Owing,  however,  to  the expanded field in
which I have worked, and the many pressing engage-
ments which drew my  attention  from it, it is not im- 
Xvi                  PREFACE.
probable that I may have omitted some things worthy
of remark, which I may have subsequent reason to re-
pent my neglect of.
   By far the  greater part  of  this work has  been
wrought up in regular manuscript;  on several  occa-
sions, however, not wishing to make the text more pro-
lix, I have incorporated with it literal extracts from my
" Lessons in Practical Anatomy."   This is especially
the case in regard to the nerves of the extremities and
to the muscles.  The two works harmonize; yet  some
unimportant differences  may, in a few places, be ob-
served  by the attentive reader, owing  to improved
views in the present.  Simple typographical mistakes
have also given rise to discrepancies; but it is almost
impossible to avoid a contingency of this kind, owing,
sometimes, to the inevitable  hurry in which a proof-
sheet is corrected, and, at others, to the mechanical
derangements, to which the press is subject.
   The  great deficiency of the  English language in
terms suited to anatomical  description  and nomencla-
ture, and the difficulty of forming suitable compound
words from it, have induced me  to take some liberties
which I would gladly  have dispensed  with, under
other circumstances.  To  avoid periphrasis, and the
inconvenient repetition of sentences, I have, therefore,
frequently adopted French terminations, and sometimes
formed a word upon a Greek, a Latin, or a French
root; following, in these respects, the authority of the
Continental Anatomists.   But it is still a great deside-
ratum, for anatomy to be rather more algebraical  in its
characters and language, than it is at present. 
  PREFACE

To the Fifth Edition.
  The present state of Anatomy exhibits the propriety
of the motto adopted for  the  title of this work, at its
first edition in 1826, for on whatever side our attention
may be directed to the nations of the earth, most en-
gaged in the cultivation of human sciences and arts,
we find that Anatomy is still in progress, and will pro-
bably continue so to  the  end of time.  Contributions
of the most valuable kind have been made  in France,
in Germany, in Italy, and in  England, not  only in re-
gard to new observations, but in giving a greater perfec-
tion to modes of elucidation by plates—models—draw-
ings and injections.   In  all of  these states, improved
systematic treatises have appeared, besides numerous
monographs of an instructive kind.  In England the
science has taken on an aspect signally amended within
the last twenty years, so  that the disparity  once exist-
ing between her and  the states of the continent, strikes
the eye of the inquirer much less than it did  at a former
period; in fact several works of a high order of merit
have made their appearance.   Our own country has
manifested the same  spirit of advancement in the in-
crease of medical schools, and in the multiplication  of
highly instructed teachers of anatomy, and expert prac-
tical anatomists.  Though possessing less literary and
scientific leisure than any other of the polished and
                     ,   2* 
XViii                  PREFACE.
instructed quarters of the world; yet those limited op-
portunities have been fruitful in original observations,
in translations, in papers,  in  monographs, and  in  im-
proved editions of preceding works.
  The  several productions alluded to in the above
sketch, are too numerous for  distinct or individual no-
tice on the present occasion, they have, however, been
freely canvassed for the composition of this work, and
their  contribution to the general  cause  of  anatomy
claimed, to the extent that it  could be, keeping  at  the
same time this work within the precincts of what it is
intended for, to wit, a Text Book to the course of Lec-
tures on Anatomy in the University of Pennsylvania.
Some things may, however, be omitted as useless, which
strike the understanding of others as too important for
neglect; and other things on the ground of having a tes-
timony too defective, at present, of their real existence,
to justify their  being introduced into a code of De-
scriptive Anatomy.
          W. E. HORNER, M. D., Univ. Penn.
  Philadelphia, Oct. 1839.
4 
INTRODUCTION.
  The Science of Anatomy has, of late years, been di-
vided into Descriptive and General.   This distinction,
though faintly traced by preceding anatomists, owes its
present prominence to the labours of the celebrated Bi-
chat; and the daily observations of physiologists and pa-
thologists, are only renewed and concurrent evidences
of its importance and value in the practice of medicine.
Although the distinction is only coming into vogue in
this country, the tendency to it  is so great that in a
few years more, medical language  and ideas will be
universally tinged with it;  it is proper,  therefore, that
it should be defined in such  a manner,  that it may be
perfectly intelligible to the student.
  Descriptive Anatomy teaches the exterior form of or-
gans, their magnitude, their position, their connexions
with adjacent parts; and their intimate texture or or-
ganization.  As in this way every individual part is
brought under a strict review, it is this  division of the
science which gives skill to the surgeon. The term is
not entirely appropriate, because description means any
account whatever; the substitution of the phrase Special
Anatomy is, therefore, one of the improvements of the
present day, and  is very much resorted to.
  General Anatomy may be explained, as  its great 
XX
INTRODUCTION.
 founder, Biohat, himself has done it, by the following
 comparison.   Chemistry has its simple bodies, as heat,
 light, hydrogen, oxygen, nitrogen, carbon,  and so on,
 whose several combinations form all the composite bo-
 dies on the face of the globe. In the same way anatomy
 has its simple tissues, whose varied combinations form
 all the organs of the human  body and  of animals.
 These tissues are,*

   1.  The Cellular,     -     -     -      Vol. I. p. 317
   2.  The Adipose, or Medullary,      -     -     325
   3.  Vascular,   .     _     _      .     n.  p. 153, 280
   4.  Nervous,......313
   5.  Osseous,    -     -    -     -     -      I. p. 56
   6.  Fibrous, or Desmoid,  -                    257
   7.  Cartilaginous,.....351
   8.  The Fibro-Cartilaginous,    -     -     -    256
   9.  Muscular,......351
  10.  Erectile, or Spongy,  as Penis, &c.      II. p. 85
  11.  Mucous,.    ----__     50
  12.  Serous,     ----__     iq
  13.  Dermoid, or Skin,     -     -    _     I. p. 328
  14.  Glandular, as  Liver,  Kidneys, &c. &c.  II. p. 56

   The distinctions of tissue do not rest upon an imagi-
nary  basis, but have nature for their foundation.  The
organization of each has well marked and characteristic

  * Bichat admits twenty-one elementary tissues, but several of them
are but modifications of one and the same.  For example, the arterial,
the venous, and the absorbent, belong all to the vascular, and I have
thought it useful to concentrate them under one head; and so of some
others  where the analogy is equally evident.   As the  nature of the
work did not admit of the consecutive description of these tissues re
ference is made to the pages in which they are discussed  With this
guide they may be studied in immediate succession, by the person
dtesirous of an outline of General Anatomy. 
INTRODUCTION.
XXI
peculiarities, which "may be ascertained by their dis-
eases, and by the influence of different agents, as heat,
air, water, acids, alkalis, neutral salts, and putrefaction.
Each tissue has its particular strength, and its particular
mode of sensibility, upon which repose all its vital phe-
nomena, and the blood is but a common reservoir, where
each chooses what is in relation to itself.  An example,
however, will serve better for illustrating these several
points.  The stomach is composed of four laminae, one
is serous, another muscular, a third cellular, and a fourth
mucous.  Each of these laminae has its appropriate sen-
sibilities and mode of life, which may cause it to be dis-
eased, while all the others are healthy.  Peritoneal in-
flammation may invade  the first, the cramps of colic the
second or  muscular, the infiltration of dropsy the third
or cellular, and dyspepsia the fourth or mucous.
  It thus happens, that the diversity of the tissue of an
affected organ modifies the symptoms of its diseases, and
especially their duration. Hence, nothing is more vague
in medicine, in regard to duration, than the terms chronic
and acute.  An inflammation in one tissue will go na-
turally  through its stages in a few days, as, for exam-
ple, in the skin, cellular substance, mucous membranes;
while in the bones and ligaments, on a natural progress
being also observed, weeks and months are required for
its accomplishment.  It is  evident,  therefore,  that  a
time which is chronic in the first three tissues, is acute
in the last two.
  A chemical analysis of the body demonstrates only a
few elementary principles; and they are varied in their
combinations by a greater or less proportion of one or
the other.   Calcareous matter, the neutral salts, carbon,
hydrogen, oxygen, nitrogen, sulphur, iron, wrought up
by the powers of animalization into gelatine, albumen,
and fibrine, which again are elaborated into the  fibrous
and laminated tissue, constitute about the sum total of 
XXii               INTRODUCTION.
the results of the experiments of animal Chemistry.  It
has yet to find out the laws of the phenomena which
give to these elementary atoms the condition of blood,
and afterwards change this blood into muscles, nerves,
and other things.
   The whole body is formed of solids and of fluids.  The
former, when unravelled, consist of fibres, of  laminae,
and of molecules; their mechanical division does not ad-
mit of any greater separation.  Many of the laminae are
arranged into membranes, thus forming hollow viscera,
for containing either articles of food or the excretions;
others surround the different solid viscera and  separate
them from the contiguous parts.   Other laminae pene-
trate through the  most compact structure, and indeed
form the nidus in which its atoms or particles are de-
posited.  Many of these laminae consist of several thin-
ner laminae, placed together and united by filaments ar-
ranged into cells, which cells receive the ultimate par-
ticles  of the whole fabric, and constitute its base.  The
laminae also, by being wrought into cylinders, constitute
vessels of different kinds, which are distributed in such
numbers through the body, that by far the greater part
of its structure seems to be formed of them.  In regard
to the fluids, they are  extremely abundant  in number
and in quantity, and are found in the cells of the lami-
nated  tissue, and in the several vessels.  One not accus-
tomed to the process would be astonished to see, when
these fluids evaporate by exposure to the  air, that near-
ly all  parts of the body, except the skeleton, lose from
one-half to two-thirds of  their original bulk, and  some
parts even more.  The several solid parts of the  body
are then literally kept soaked during life in  the fluids;
which have for a principal constituent, simply water.
   There are some animals whose organization is so sim-
ple that they possess only the  power of sensation; and
of motion in one part  upon another.   This is perhaps 
                  INTRODUCTION.               XXlfi

the lowest degree in which animal life does exist, or
possibly  can exist,  without a  new  order  of things.
These qualities, sensation and motion, are of necessity
combined always; they constitute the first ingredients
in the composition of life, both in vegetables and ani-
mals, and by being modified in various ways by their
application to different organs, may be traced up to the
perfect animal, man.
   Nutrition is the first want of every being, and is one
of the modes of sensation; therefore, before any other ap-
paratus is provided for animal life, means are resorted to
to carry it on.  Vegetables are fixed to the soil, and are
furnished with great numbers of porous roots, which by
spreading in different directions, come  in contact with
the moisture of the  ground and by  simple absorption
conduct  it as the aliment of the plant. There are many
animals  which have a vegetative life almost as simple
as this, are fixed permanently to the spot  where they
 came into existence; others are permitted to change
 their places of abode, and  a provision for nourishment
 by roots would notanswer; hence comes the necessity
 of a stomach, or reservoir in the interior of the body,
 into which aliment may be introduced, and transported
 along with the animal. In many instances this stomach
 seems to constitute the whole animal, as in a hydatid:
 it receives such simple fluids as compose the medium in
 which it resides, and  carries on its  digestion, with so
 little change of the alimentary matter, that there seems
 to be nothing of an excrementitious kind, as commonly
 understood, thrown  off. These animals are  found abun-
 dantly in the waters of tropical regions, exist sometimes
 in the brain of man, and of sheep, in the uterus, and in
 almost every part of the body.   But, again, there are
 stomachs of a more complex kind, which have opening
 into them a great number of absorbing orifices,  called,
 in the striking language of Boerhaave, " genuine inter- 
Xxiv               INTRODUCTION.
nal roots."   These stomachs may admit fluids only, or
they may be large enough to receive considerable mass-
es of solid aliment.  In the latter case exists the neces-
sity of teeth, or some mechanical means of triturating
the solid food into such fine pieces, as will admit of its
beino- exposed by an extensive surface to the action of
the stomach.  But as much of the matter thus carried
in is unfit for assimilation, and there may be even more
of it than is required, an intestinal canal is provided,
by which it is carried out again.   Here then commence
the phenomena of a true digestion, with all its modifi-
cations and  stages.
   The very simple structure of a plant, and its perma-
nent locality is attended with a circulation of its juices
equally simple; which is performed and maintained by
the capillary attraction of its pores, and by evaporation
from its higher and more exposed parts. This circulation
is the more rapid as the evaporation becomes  greater:
but the latter may become changed into absorption by
the humidity of the atmosphere; and the circulation be as
a consequence reversed from the branches to the roots.
But it is evident that such animals as possess extensively
the powers of locomotion, besides having  organs more
numerous and more complex than the parallel fibrillae of
vegetables, will frequently find themselves in such con-
ditions of temperature and locality, that a similar circu-
lation of the nutritious fluid in them could not be main-
tained.  Hence it is necessary to have more powerful
and regular agents for  carrying on  the  circulation.
They, therefore, are furnished with innumerable blood
vessels, called arteries and veins, which have a common
centre, the heart, for propelling through them the blood
or nutritive fluid to all parts of the system.  From the
heart being furnished with valves, which are all in one
direction, the blood can flow only in a corresponding
course;  thus it is forced by the heart into the arteries 
INTRODUCTION.
xXv
and after moistening the most minute fibres it is received
into the capillary extremities of the veins and brought
back to the heart, where it receives another impulse, and
performs again the round of the body, and so on in suc-
cession.   This phenomenon is called the  circulation.
When it exists in animals, blood is always to be found;
for the most part red, but in many species white or trans-
parent.   The use of the blood in them is to receive from
the alimentary canal, from the skin and lungs, such
matter as  has been assimilated, and to convey it to eve-
ry part of the body, for  the purpose of repairing  its
waste, or  providing for its growth.   It  is  at the very
extremities of the arteries that this deposite occurs, and
the blood  getting, into the veins loses its bright vermi-
lion colour, becomes of a modena or dark blue,  and is
no longer  fit for the purposes of life till some of the prin-
ciples which  it has lost by this passage are restored to
it.  This  restoration takes place in the lungs, where a
sort of combustion is  performed by the absorption of
oxygen.   This process is called respiration, and  it ex-
ists in all things that live, under various modifications
of the apparatus  performing it.  In man it is performed
in two cellular air bags, which have a heart indepen-
dent of the one just mentioned, for propelling the blood
through the ramifications of their vessels.   In fish there
are gills, which have their surfaces exposed to the wa-
ter, and are aerated by the air contained in the water,
and the same heart which  supplies the general  circu-
lation, also fills a large artery, that is distributed very
minutely  through the gills.  But  in insects,  where
there are  no  blood vessels, and the nutritious fluid is
contained in cells, there are, distributed  over their bo-
dies, air tubes, which transmit atmospheric influence.
   The blood  vessels, in addition to the function of car-
rying nutritious matter, perform an essential part of a
very different character.   All  the atoms of which the
   Vol. I.—3 
XXVi               INTRODUCTION.
body is composed, after residing in it for a  time, be-
come no longer fit for use; their farther residence is, m
fact, injurious, and it is necessary to remove them.  A
system of vessels  is provided  for this purpose, called
the absorbents, which are the scavengers of the body.
Taking up, therefore, these  effete  atoms, they convey
them into the blood vessels, where they are mixed with
the common mass of blood.   Several organs  are pro-
vided, as the liver, the kidneys, the surface of the body,
and the lungs, through which these effete particles are
discharged from the blood in  the form of excretions;
as the bile, the urine, perspiration, and pulmonary ex-
halation.
   We have now sketched the human machine as far as
its internal existence, or self-preservation, is concerned
in the  functions of digestion, circulation, respiration,
and  excretion.   Let us proceed in the inquiry by a
rapid glance at those organs by which, it is put into a
relation wTith surrounding objects, and on which it de-
pends for the sublime operations of the understanding.
   Sensation is derived from the nervous system, com-
posed of the brain, the spinal marrow and the nerves.
The latter may be traced to many parts of the body,
and are supposed to be distributed to all.   They main-
tain its different sympathies, keep the. several organs
in one harmonious course of action, and, in  some in-
stances at least, are indispensable to the performance
of their functions.  In addition to these, many of the
nerves have at their  extremities organs of a particular
construction, each fashioned in the best manner for the
performance of its functions, in making us acquainted
with exterior objects.  The interior extremities of all
these nerves  terminate either  in the brain or  spinal
marrow; the external are the points intended by nature
to be affected by the objects around us; but it is indis-
pensable to consciousness, that their line of communi- 
INTRODUCTION.              XXvii
cation with the brain be not interrupted.  The sense
most extended is that of the touch, which is enjoyed
by all parts of the surface of the body; the others are
thought, by very respectable physiologists, to be ^nly
more  exalted modifications of it, and are susceptible of
more  delicate impressions.  It is scarcely necessary to
mention that the other sensations are executed by the
eye, the ear,  the tongue, and the nose.

  The Sense of Touch is the most important of all, and
the least liable to error in its reports.  To exercise it,
it is necessary for the body, under examination, to come
into contact with ours: hence, its operations are so me-
chanical, that but little is left to the imagination, and
they, therefore, serve to verify  and to  correct the im-
pressions on  the other senses, more particularly those
on the eye.   It is the sense of touch by which we learn
accurately the dimensions of bodies, and the figures of
.snr.h  as arp. bard.  Tho hand, or any other part, by be-
ino- applied to them in various directions, informs us
whether they are flat, round or  angular.  A greater or
less degree  of pressure informs  us whether  they are
soft or hard, and by rubbing, we ascertain  whether
they are rough or polished.   The resistance they make
to motion, teaches us whether  they can  or cannot be
moved, and their being impelled  against us shows the
momentum with which they act,  as well as  its direc-
tion.   Our ideas of heat and of  cold  are also derived
from this source.   It is not asserted that all parts of
the surface of the body enjoy equally the sense of touch;
on the  contrary, this sensibility is more or less active,
according to the organization  of  the  part, and as its
nerves are more or less numerous  and exposed; hence
we find it most  exquisite  and  perfect in the ends of
the fingers.   This, therefore, being the  most  import-
 ant of  the senses, the  magnitude of its influence on 
 XXVni             INTRODUCTION.
 the habits and intelligence of different animals is im-
 mense.
   Man, from the nudity and  the delicacy of the tex-
 ture of his skin, derives, from this source, a discrimi-
 nation  and refinement, in regard  to  the  nature of
 bodies, much superior to what many other animals
 possess.

   The Sight enables us to distinguish the colour, the
 quantity, and the direction of the rays  of light which
 proceed from aluminous  body;  or, in  other words, to
 ascertain its situation, size, and figure.   In each, how-
 ever, of the latter we are exposed to great deception;
 for the rays of light, by falling on a  mirror, or any
 other plane reflecting  surface, before  they reach the
 eye, will induce us to believe the  body to be  in that
 direction.  Bodies which are near, reflect more rays
 of light than such as are distant: we thus estimate dis-
 tance  by the- eye;  but it happens continually, that
 some bodies naturally reflect more rays than others;
 in consequence of which  a very luminous body, at a
 great distance, will frequently be thought to be much
 nearer to us, than such as are more within our reach.
 Mistakes  of this kind  can only be corrected by the
 sense of touch, and  our habitual reference  to it, and
 continued experience, finally enable us to form prompt
 and  just decisions.   The  eye, however, infinitely ex-
 ceeds the touch in the rapidity with which it commu-
 nicates ideas, and, also,  in the extensiveness of its ap-
 plication in a single moment.   It is, therefore, an organ
 of the first utility in making us  acquainted with sur-
rounding objects.   Man does not possess it to that
great perfection that some other animals do; he can nei-
ther  see as far as the vulture or eagle, nor so minutely
as the fly; yet his ingenuity has  enabled him to excel
both.   For, with the telescope, he examines worlds in 
INTRODUCTION.
XXIX
   the immensitity of space, which, under  common exa-
   mination, are  either invisible, or  form mere points in
;   the heavens.   And with the  microscope he sees the
   texture of the  most minute atom.

     The Ear, along wTith the powers of articulation, ena-
   bles the whole human family  to make a com mon stock
   of the knowledge which each individual may possess.
   As connected with the preservation of the individual,
   it is much less important than the eye or  the  touch;
   yet, considering it as a means by which we receive
   knowledge and impart it to  others, the  aggregate of
   human intellect depends for its present state and future
   improvement,  essentially upon  it.  In its acuteness,
   we are much inferior to many other animals; neither
   have we, by instruments, been able to do much in im-
   proving it: yet, by cultivation and by studying its most
   minute and delicate  impressions, an endless source of
   instruction and amusement has been  opened to us, in
   the intonations of language,  and in  the enrapturing
   strains of harmony.   It eminently qualifies man for
   the social state, occasionally warns him of danger, and
   allures him to  such things as are useful  to his  sub-
   sistence.

     In regard to  the Taste and to the Smell, they make
   us acquainted only with such  objects as are necessary
   to our subsistence.  They are enjoyed too imperfectly
   by man, for them to  become a fruitful source  of  his
   intelligence. As they principally lead us to filling the
   stomach, and to debasing the intellectual  man into the
   beast, that eats  and dies; the wisdom  of  nature is as
   fully demonstrated in the imperfection which she  has
   put upon these senses, and our inability to  improve
   them, as in  the exalted and varied degrees to  which
                          3* 
XXX                INTRODUCTION.
she has carried the others.   The keenness of the scent
of the hound, and the discriminating nicety of the bee,
in opening sources of  enjoyment merely physical,
would have degraded,  instead of elevating us;  by en-
grossing our time and ingenuity, in the development
of pleasures incompatible with  our constitutions and
destinies.

   Man being thus  constituted, it is worthy of inquiry
in what his life consists.  According to the celebrated
Bichat, it is  " the aggregate of those functions by
which death is resisted.   For such, indeed, is the con-
dition on which we live, that every thing surrounding
us has  a  tendency to  produce our  dissolution,  by the •
affinities  existing between  their atoms, and the atoms
of which  a living body is composed.  It is plain, there-
fore, that the principle of life, like all other principles
in nature, incomprehensible in itself, must be studied
by its phenomena,"*
   There are two remarkable modifications of  life: one
is common to the vegetable and to the animal, the other
is the exclusive attribute of the latter.   Under the first
modification, are included  assimilation and excretion,
which,  though  exercised under apparently different
circumstances in animals  and in plants, are probably
essentially the same  in both.  This  modification is
termed  by Bichat, Organic  Life.  By the second mo-
dification  of life,  the animal has  a  more extended
sphere of existence than the vegetable, is put  into a
certain relation with all the  objects that surround him,
is made the inhabitant of the whole world, and  not,'
like the vegetable, confined  for ever to  the  place of its
birth.   By it the animal feels, and is conscious  of ex-
ternal objects, reflects  upon them, moves voluntarily
* Recherches sur la vijjet I^a Mort„ 
INTRODUCTION.
XXXI
and can communicate, by the voice, his wants and ap-
prehensions, his pleasures and his pains.  The func-
tions  included under the  second modification,  are
termed, by Bichat, Animal Life.
  Each of these lives has two orders of functions, keep-
ing up its connexion with the  objects destined for  its-
existence.  In animal life, one of these orders may be
said to commence at the surface of the body, and to be
extended towards the centre, the impression of exterior
objects  affecting  first  the  senses, then the trunks of
nerves,  and lastly, the brain.  A second  movement,
constituting the second order of functions, is afterwards
made from the centre to the  circumference, by which
the influence of the brain is exercised on the organs of
locomotion and of voice.  These two functions, in ani-
mal life, are  perfectly equivalent  in their operations.
He who feels the most, will also act the  most.  Early
life is the period  of quick and multiplied sensations, so
is it  the period  of quick and multiplied movements.
 A  partial, or  a total privation of the sense of sight,
 causes  us to move  cautiously and  slowly  onwards.
 The suspension of our communication, through sleep,
with exterior objects, causes also   a suspension of the
faculties of locomotion and of voice.   In organic life,
the first order of functions  assimilates to the animal
-the substances which  must nourish him, and includes
digestion, circulation,  respiration,  and nutrition; under
the influence of which four functions, every thing must
 pass before it can  be assimilated. But, after a temporary
residence, the assimilated particles becoming effete and
 noxious, have to  be carried away out  of the body:  by
 which means the second order of functions in organic
 life is established, consisting, of absorption, circulation,.
 exhalation, and secretion.
   The  two functions of organic life differ, however,
 fifom those of animal life, in not observing, on all occa- 
 XXxii             INTRODUCTION.

 sions, an equivalence of action: the diminution of assi-
 milation does not involve a corresponding diminution
 in excretion; hence, follow emaciation and marasmus,
 conditions  in which, assimilation ceasing in part, dis-
 assimilation is exercised to the usual extent, or near it.
 From this sketch, it is seen that the circulation of the
 blood is the connecting link of the two orders  of func-
 tions in organic life, as the brain is the connecting link
 of the two orders of functions in animal life. The blood
 is, therefore, in fact, composed of two  parts or descrip-
 tions of matter: one is recrementitial, derived from the
 aliment, and subservient to the renovation and growth
 of parts; the other is excrementitial, derived from the
 wrecks of all our organs, and under  the  necessity of
 being cast away  as useless.
   M. Bichat thinks the division of life into animal and
 organic, fully warranted by their differing much from
 each other in the exterior shape of their respective or-
 gans,—in their mode of action,—in the duration  of their
 action,—in  the effects of custom or habit on them,—in
 their relation to the moral part of man, and in their vi-
 tal force.
   One of the most prominent differences in the two
 lives, is the symmetry and duplicity of the Organs of
 Animal Life, and the irregularity in shape of those be-
 longing to Organic Life.  The impression of Light is
 received  by two  organs exactly alike.   Hearing-
 Smelling—Touching—are likewise  performed by or-
 gans having their congeners on the opposite sides of the
 body; and even Tasting, though apparently performed
 by one organ, has  that organ divided  into two equal
 and symmetrical  parts, thus making it like the other
 organs.   The whole exterior surface of the body is, in-
deed,  manifestly divided into two equal parts, marked
off from each other by the fissure in the nose, the upper
lip, the chin, the raphe of the scrotum  and perineum 
INTRODUCTION.
XXXlll
the spinous processes, and the depression in the supe-
rior posterior part of the neck.  The Brain and Spinal
Marrow, as belonging to animal  life, consist  of two
halves, presenting corresponding arrangements in the
development of cavities and prominences, and so on,
and in sending similar nerves to the organs of locomo-
tion and of voice.
  The organs of organic life are marked, on the  contra-
ry, by the character of striking dissimilitude in their
two halves, as manifested in the liver, the spleen, the
stomach, the intestines, the heart, and the great  vessels
belonging to it.  There are, however, some organs of
organic  life in which the difference is less prominent,
as the lungs of the two  sides, the  pulmonary arteries,
the veins, the trachea, the kidneys,  the capsulae renales,
and the salivary glands.
   From what has been said, we are, perhaps, prepared
to admit with M. Bichat, that animal life is double; that
its phenomena being executed after the same manner on
both sides of the body, it is very possible for the  actions-
of one side to be suspended or destroyed while those of
the other go on.  This, in fact, happens in certain pal-
sies, where the sensibility and motion of one side are so
completely suspended, that it resembles a vegetable; all
relation with exterior objects being cut off, and nothing
but the  function of nutrition being preserved; whereas
the other side  retains all its animal properties.  For
these reasons Bichat has very quaintly observed that we
have a right life and a left life.   In organic life, on the
contrary, the functions of the two halves of any organ
are so allied, that the lesion of one affects the other.
The liver, in a disease on one side, has its functions im-
paired throughout: it is the same with the intestinal ca-
nal, and with  the heart.
   Congenital deformities are said to be more frequent in
the organs  of organic life than in those of animal life. 
Xxxiv              INTRODUCTION.

Several cases have occurred, and Bichat relates one
which happened in his own amphitheatre, where there
was a general displacement of the digestive, the circu-
latory, the respiratory, and the secretory viscera.  The
stomach, the spleen, the sigmoid flexure of the colon'
the point of the heart, the aorta, and the lung with two
lobes, were  all on the right  side.  But the liver, the
ccecum, the base of the heart, the venae cavae, the vena
azygos, and the lung with three lobes were  on the left
side.   All the organs placed  beneath the middle line,
as the mediastinum, the mesentery, the duodenum, the
pancreas, the division of the trachea, were reversed.
Latterly I have  had occasion to observe, in our  own
dissecting rooms, two cases of the caput coli removed
from the right iliac into the left iliac region; the colon
was of the common size and length, and being confined
to the left side  of the  abdomen, formed  there a loop,
which ascended into the left hypochondriac region, and
then descended as usual.  In these cases, as there was
no transverse mesocolon, tlie duodenum had  all the
coats of the other intestines;  and was not attached to
the front of the right kidney and to the spine.  One of
these was an adult female subject of considerable cor-
pulency, the other a corpulent male.
   Another difference between organic and animal life
exists in the mode of action of their respective organs.
Each of the organs of animal life being double, our sen-
sations are the more exact, as there exists between the
two impressions, from which they result, a more perfect
correspondence.  We see badly when the images trans-
mitted to the brain are derived through eyes  of unequal
strength.  Without knowing  this law as theorists, we
instinctively show its influence  in shutting  one eye
while looking through a convex glass; whereby we pre-
vent a confusion  of images arising from two impres-
sions of unequal force, concerning the same body: when 
INTRODUCTION-
XXXV
one eye is weaker than the other, we squint involun-
tarily, and it finally becomes a habit, in order to avoid
the confusion of perception from two unequal images
on the brain.  This accounts for squinting, both in early
life, from some congenital cause, and for that squinting
which is the result of inflammation, in more advanced
life.  A little reflection on this head will satisfy us; for
as a single judgment or perception is, for the most part,
formed from the two impressions, one on each eye, how
is it possible that this judgment can be accurate, when
the same body is presented at the same moment with
vivid or faint colours, accordingly as it was painted on
the strong or weak eye?
  The Ear is subjected to the same law as the eye. If,
in the two sensations composing the act of hearing, one
is received upon an  organ better  developed  than the
other, and more discriminating in its functions, it will
leave an  impression more clear and distinct; but the
brain being affected simultaneously by the unequal im-
pressions, will be the seat of  an imperfect conception.
This case constitutes a false ear in music, and from the
impressions being  continually confused, prevents the
individual from judging rightly between harmony and
dissonance.
  A similar reasoning has been founded by Bichat upon
the structure of the Nose, Mouth, and Organs of Touch.
He believes also that the brain itself, as the seat of the
mind, may become the cause of error in our ideas, when
the two halves of it are not perfectly alike; for example,
if one of the  hemispheres be  more strongly organized
than the other, better developed every where, and more
susceptible of a vivid impression.  The brain transmits
to the soul the impression or impulse derived from the
senses, as the latter transmit to the brain their- impres-
sions;  it is, therefore, to be believed that the soul will
perceive confusedly, when the hemispheres, being une- 
xxxvi
INTRODUCTION.
qual in force, do not blend into one, the double impres-
sion upon them.  In proof of this, it is common to see
mental derangements depending on the compression of
a hemisphere  by effused blood, by pus, by depressed
bone, and by an exostosis from the internal face of the
cranium.  Even where every sign of compression is
removed, the hemisphere occasionally takes a long time
to regain its action, so as to recover from the alienation.
  This harmony of action exists also  in the organs of
locomotion, and of voice;  and any thing which  inter-
rupts their symmetry destroys the precision with which
their functions are executed.
  Opposed to  this harmony in the shape and functions
of the organs  of animal life, the most striking differ-
ences may take place between the organs of organic
life, without much  disturbance in the general result.
For example, in disparities of the kidneys, of the lungs,
of the salivary glands,  &c, their functions are not, by
any means, the less  perfectly performed.  The circu-
lation remains the same in the midst of the  frequent
varieties of the vascular system on the two sides of the
body, whether those varieties exist naturally, or whe-
ther they depend upon artificial obliterations  of the
large vessels, as in aneurism.

  Another very striking difference in the two lives may
be observed in the duration of their action.  All the ex-
cretions proceed uninterruptedly, though not uniformly.
Exhalation and absorption succeed each other incessant-
ly;  assimilation and dissimilation follow the same rule.
On the other hand, every organ of animal life, in the ex-
ercise of its functions, has alterations of activity and of
complete repose.   The senses, fatigued by long  appli-
cation, are, for the time, disqualified from farther action.
—The Ear is no  longer sensible of sounds:__The Eye
is closed to Light;—Sapid bodies no longer excite the 
INTRODUCTION.
XXXV11
Tongue;—The Nose is insensible to odours;—And the
Touch becomes obtuse.  Fatigued by the continued ex-
ercise  of perception, of imagination, and  of memory,
the brain has to recruit its strength, by a state of com-
plete inactivity for some time.  The muscles, relaxed
by fatigue, are incapable of farther contraction, till they
have been permitted to rest; hence the  necessary inter-
mission, in every individual, of locomotion  and of voice.
   This intermission of action is sometimes extended to
all the organs of animal life at the same time; on other
occasions, only a part of them is affected by it.  It is
in this way that the brain frequently continues in the
active exercise of thought, while the senses, as well as
the powers  of locomotion and of voice are  suspended.

 ■  In addition  to the foregoing views,  it has also been
suggested by Bichat, that another striking difference
between organic and animal life, is found  in the epoch
 and mode of their origin.  Organic life exists from the
 first moments of conception; but  animal  life  does not
 commence  till after birth, when exterior objects are es-
 tablished in a certain relation with the individual.  It
 is more than probable, that the function of the  Eye, the
 Ear, the Tongue, and the Nose, does not  exist in such
 manner as to communicate their several  sensations in
 the foetus; and that the enjoyment of a  sort of indistinct
 sense of touch, arising from its striking against the pa-
 rietes of the womb, is the only circumstance which can
 give the latter any idea of its existence; it is, however,
 doubtful whether it has even a consciousness on that
 point.  The organic life, on the contrary, of a foetus,
 though not so complicated as  afterwards  is  still re-
 markable for the promptitude and vigour of some of its
 functions, particularly  of assimilation; and in a very
 short time  after birth, all the organs which it employs
 reach their highest degree of perfection, and thus pre-
    Vol. I.—4 
xxxviii
INTRODUCTION.
  sent a very different case from the organs of animal
  life.
    The distinction of the two lives is farther kept up in
  their manner of ceasing in old age. Natural death, says
  Bichat, is remarkable, in terminating animal life almost
  entirely, a long time before it does organic life.  The
  functions of the first cease successively.  The Sight be-
  comes dim, confused, and finally is extinguished.  The
  Ear receives the impression of sounds indistinctly, then
  faintly, and afterwards they are entirely lost upon  it.
  The skin becomes shrivelled, hardened, loses many of
  its vessels, by their obliteration, and is only the seat of
  an obscure and indistinct touch; the hair and  beard be-
  come white, and fall from it.  The Nose loses its sen-
  sibility to odours.   Of all the senses, it has been often
  remarked, that the Taste remains the longest, and ex-
  hibits the last efforts of animal  life.
    The powers of the mind disappear along with those
  of the senses. The imagination  and the memory are ex-
 tinguished; the latter, however, under striking circum-
 stances.  The old man forgets, in an instant, what was
 said to him, because, his  external senses being weak-
 ened, do not confirm  sufficiently the impressions on his
 mind: he is, however, able to recollect the transactions
 of early life, and sometimes retains a vivid impression
 of them.   He differs from the infant in this,  that the
 latter forms his judgments from what is passing, where-
 as,  the former forms his  from what has already past.
 Both are, therefore, liable to great errors;  for, the ac-
 curacy of knowledge, in regard  to things present, can
 only be obtained by comparing them with other things.
 Locomotion and voice also participate in the decline of
the other organs of animal life; their powers are intrin-
sically weakened; besides which, a certain  decree of
inactivity is imposed on them, by the previous decline
of the brain and senses. 
INTRODUCTION.              XXXIX
  If we now consider, that sleep retrenches about one-
third of the whole duration of animal life; that nine
months of it are first lost in gestation; and that the ex-
tinction of our senses is the inheritance of old age; it
will be seen how great  is the difference between the
whole duration of animal, and of organic life.
  It has been remarked by Bichat, that the idea of death
is painful to us only because it terminates  our animal
life, or those functions which put us in relation with sur-
rounding objects.  This is the privation which  plants
terror and  dismay on the borders of  the tomb.   It is
not the  pain of death that we fear, for many dying per-
sons would willingly commute death for an uninter-
rupted series of bodily suffering.  But if it were  possi-
ble  for a man  to  exist whose death would only  effect
the functions of organic life, as the circulation,  diges-
tion, and secretions, allowing the exercise of the senses
and the mind  to  continue, this man would view with
indifference the extinction of organic life, because he
knows that the happiness of living is not attached to it,
and that he would remain after this partial death, still
in a condition to appreciate all the delightful ties  of ex-
istence. 
 
TABLE OF CONTENTS.
VOLUME r.
                 BOOK  I.—SKELETON.


PART I.—General Anatomy of Natural Skeleton,
  Chap. I.—General Anatomy of Bones,
      Sect. 1.—Number and Texture of Bones,
           2.—Composition of Bones,
  Chap. II.—Sect. 1. Periosteum,
                 2.—Medulla,
  Chap. III.—Osteogeny,    ...
      Sect 1.—Development of Bones,
           2.—Growth of Bones,
           3.—Formation of Callus,
PART II.—Bones, individually,
  Chap. I.—Trunk,
      Sect. 1.—Spine,      -
           2.—Development of Spine,
           3.—Uses of Spine,
           4.—Ossa Innominata,
           5.—Pelvis, generally,
           6.—Development of Pelvis,  -
           7.'—Mechanism of Pelvis,
           8.—Thorax,
           9.—Cartilages of Ribs,
          10.—Development of Thorax,
          11.—Mechanism of Thorax,
  Chap. II.—Head,
      Sect. 1.—Cranium,    ...
           2.—Individual Bones of Cranium,
           3.—Face,       -
                            4* 
xftj                       CONTENTS.
Page
 149
 149
 156
187
189
193
  Chap. III.—General Considerations on Head,
      Sect. 1.—Sutures,.
           2.__Diploic Structure of Cranium,
           3 —Internal Surface of Cranium,     -             158
           4.—External Surface of Head,   -      -      -  161
           5—Nasal Cavities,                              165
           6.—Orbits of the Eyes,  -       -      -      -  167
           7._National Peculiarities of Face,    -       -     169
           8.—Development of Foetal Head,        -      -  177
  Chap. IV.—Os Hyoides,      -                           181
        V.—Upper Extremities,    -                       182
      Sect. 1.—Shoulder,       -       -       -             182
           2.—Arm,        -
           3.—Fore Arm,
           4.—Hand,       -
           5.—Development of Upper Extremities,     -     201
           6.—Mechanism of Upper Extremities,   -.      -  202
           7.—Motions of Shoulder,     -       ««.      -     204
           8.—Motions of Shoulder Joint,   -      -      -  205
           9.—Motions of Fore Arm.    -       -       -     207,
          10— Motions of Hand,    -      -      -      -  210
  Chap. VI.—Inferior Extremities,       ...     213
      Sect. 1.—Thigh Bone,        -      -      -      -  213
           2,—Leg,     .....     217
           3.—Foot,        .....  223
           4—Development of Inferior Extremities,     -     234
           5.—Standing,     .....  235
           6.—Locomotion,    ....     241
PART HI.—Articulations,    -       -       -       ...  251.
  Chap. I.—Cartilaginous System,       -       -       -     251
      Accidental Development of Cartilages,  ...  253
      Perichondrium,    -.---.     254
      Articular Cartilages,    -...._  255,
  Chap. II.—Fibro-Cartilaginous System,       -       -.     256
       III.—Ligamentous Tissue,    -       -       -       -  257
       Sect. 1.—  -      -      -      -      .       .     257
            2.—Ligaments of Joints,  -                       260.
            3 —Synovial Articular Capsules,    -       .     261
  Chap. IV.—Articulations of Lower Jaw,    -       -       . 263
          V.—Ligaments of Spine,      -      .       .     266
        VI.—Ligaments of Pelvis,   -                       274 
CONTENTS.                      xliii
                                                       Page
Chap. VII.—Articulations of Thorax,   ...      278
     VIII.—Articulations of Upper Extremities,   -      -  283
       IX.—Articulations of Lower Extremities,       -      299
                         BOOK II,

PART I.—Integuments of the Body, .....  317
  Chap. I.—Cellular Substance,  ....      317
       II.—Adeps,  -      -      -      -      -      -  325
PART II.—Dermoid Covering,   ....      328
  Chap. I.—Of the Skin, generally,  -                       328
    Sect. 1.—Cutis Vera,       ....      330
          2.—Rete Mucosum,      ....  332
          3.—Cuticula, -       -       -       -       -      336
  Chap. II.—Of the Sebaceous  Organs,      ...  340
       III.—Of the Nails,       ......      342
       IV.—Of the Hairs,   ......  344
                         BOOK III.

PART I.—Muscles,      .....     349
  Chap. I.—General Anatomy of Muscles,   -      -      - 349
       II.—Muscular Motion,   -       ...      .     355
       HI.—Shape of Muscles,       -                      359
       IV.—Tendons,    .....     359
PART II.—Special Anatomy of Muscles,    -      -.      - 363
 -Chap. I.—Muscles of Head and Neck,  --     -      -.     363
    Sect. 1.—Muscles of Face,      -                      363
          2.—Muscles of Neck, -       -      -      -     371
  Chap. II.—Muscles  of Trunk,      -      -      ..      . 380
    Sect. 1.—Muscles on Front of Thorax,     -      -     380
          2.—Muscles and Fasciae of Abdomen,     -      - 383
          3.—Muscles of Upper and Posterior part of> Abdo-
                 men,      -       -      .      .      -394
          4.—Muscles on Posterior Face of Trunk,     -     400
  Chap. III.—Of the Fasciae and Muscles of the Upper Extre-
                 mities, --     -.       -      ..      ,.     4J j
    Sect. 1.—Fascia,        --       -       -.      .      - 411
          2.—Muscles of Shoulder,      -      -_      .     414
          3.—Muscles of Arm,      -                      426
          4.—Muscles of Fore Arm,     -      -      .     430
          Sb—Muscles of Hand,     -      .      .      . 43Q 
xliv
contents.
                                                         Page
  Chap. IV.—Of the Fasciae and Muscles of
                 mities, -
       Sect. 1.—Fascia,
           2.—Muscles of Thigh,
           3.—Muscles of Leg,
           4.—Muscles of Foot,  -


                         BOOK IV.

Organs or Digestion,       -      -      -      -      -  467
PART I.—Organs of Mastication and Deglutition,        -      469
  Chap. I.—Mouth,  -      -      -      -      -      -  469
        II.—Teeth,      -       -       -       -       -      471
       Sect. 1.—Number of Teeth, and Subdivision,  -      -  471
           2.—Of the Texture and Organization of the Teeth,  474
           3.—Gums,      -       -      -      -      -  478
           4.—Formation of Teeth,.     -       -       -      479
           5.—Dentition,    .....  484
           6.—Irregularities in Dentition,       -       -      490
  Chap. III.—Tongue,       .....  493
      Sect. 1.—Muscles of Tongue,      -       -       -      493
           2.—Mucous Covering of Tongue,        -      -  495
  Chap. IV.—Palate,    .....      498
         V.—Glands of Mouth,      ....  500
      Sect. 1.—Muciparous Glands,      ...      500
           2.—Salivary Glands,     -      -      -      -  501
  Chap. VI.—Pharynx and Oesophagus,  -       -       -      504
      Sect. 1.—Pharynx,    .....  504
           2.—(Esophagus,     -      -      -       .      507,
the Lower Extre-
                  436
               -   436
                  442
               -   452
                  460 
VOIiUUIE II.
                        BOOK  IV.

                         CONTINUED.
                                                       Page
PART II.—Organs of Assimilation,    -       -       -       -   5
  Chap. I.—Abdomen, generally, -      -      -      -      5
       II.—Of the Peritoneum and Serous Membranes, gene-
                rally,   .....10
    Sect. 1.—Peritoneum,    -      -      -       -       -  10
         2.—Omenta,    -      -       -      -      -     13
         3.—General Anatomy of Serous Membranes,        -  18
  Chap. III.—Chylopoietie Viscera,      -      -      -     22
      Sect. 1.—Stomach,    -      -       -       -       -  22
           2. —Intestinal Canal,                             28
           3.—Minute Anatomy of the Mucous Coat of the
                 Alimentary Canal,                         41
           4.—General Anatomy of Mucous Membranes,     -  50
  Chap. IV.—Assistant Chylopoietie Viscera,                 56
      Sect. 1.—Liver, -      -      -       -       -       -  56
           2.—Spleen,   .....     64
           3.—Pancreas,    -      -       -       -       -  68


                        BOOK  V.

Of the Urinary  Organs, -      -      -      -            71


                        BOOK  VL

Organs of Generation,      -      -      -       -       -  85
  Chap. 1.—Male Organs of Generation,  -      -      -     85
      Sect. 1.—Penis,       -      -      -       -       -  85
           2.—Mucous Glands and Apparatus,                90
           3.—Testieles,    -      -      -       -       -  93
           4.—Muscles  and Fasciae of Perineum, -       -    100 
Xlvi                      CONTENTS.


  Chap. II.__Female Organs of Generation,
      Sect. 1.—Vulva,
           2.—Vagina,
Chap. III.—Breasts,
BOOK  VII.
Page
 106
 106
 110
3._Uterus, and its Appendages,  -       -      -  112
120
Organs of Respiration,     -       -      -      -      -  125
  Chap. I.—Larynx,     -----      125
       II.—Of the Trachea and Glands bordering upon it,   -  135
      Sect.  1.—Trachea,       -      -       -       -      135
           2.—Thyroid Gland,     -      -      .      -  139
           3. Thymus Gland,    -      -       -       -      141
  Chap. III.—Lungrs,        -----  143
                        BOOK VIII.

Circulatory System,     -       -       -       -       -      153
PARTI.—General Anatomy of Circulatory System, -      -  153
  Chap. I.—General Considerations,     -       -       -      153
       II.—Arteries, -      -      -      -      -      -165
       III.—Veins,      -V            -       -       -      171
       IV.—Blood,   --...-,  175
      Sect.  1.—Serum,   -----      177
           2.—Coagulating Lymph, -      -      -      -  179
           3.—Red Globules,    -       -       -       -      180
PART II.—Special Anatomy of Circulatory System, -      -  181
  Chap. I.—Heart,       -                                  181
       II.—Arteries,  ------  195
      Sect.  1.—Of the Aorta and the Branches  from its Cur-
                 vature,     -      -      -      .      -  195
           2.—The Carotids and their Branches,        -      198
           3.—Subclavian and Branches,    -      -         207
           4.—Branches  of Descending Thoracic Aorta, -      220
           5.—Branches  of Abdominal Aorta,.       -      -  222
           6.—Common Iliacs,   -       -       .       .      230
           7.—Internal Iliacs,       -                       230
           8.—External Iliacs,   -                           235
  Chap. III.—Of the Veins,  -                              249
      Sect.  1.—Veins of Head and Neck,        -       .      249
           ^•—Veins of Upper Extremities, -      -      .  258 
CONTENTS.
xlvii
                                                         Page
      Sect. 3—Veins of Lower Extremities,        -       -  261
           4.—Veins of Abdomen,      ...     263
           5.—Vena Portarum,    -                       268
 Chap. IV.—Peculiarities  of the Circulatory System in the
               Foetus,      -----  270
      Sect, l.—Peculiarities of Foetus,   -      -       -     271
           2.—Peculiarities of Circulation of Foetus,        -  275
 Chap. V.—General Anatomy of Absorbent System,     -     280
       VI.—Special Anatomy of Absorbent System, -      -  289
      Sect. 1.—Absorbents of Head and Neck,   -       -     289
           2.—Absorbents of Upper Extremities,    -       -  291
           3.—Absorbents of Inferior Extremities,       -     293
           4.—Deep Absorbents of Pelvis,   -       -      -  296
           5.—Absorbents of Organs of Digestion,       -     298
           6.—Absorbents of Viscera of Thorax,    -      -  303
           7.—Absorbents of Parietes of Trunk,        -     300
           8.—Thoracic Ducts,     -       -       -      -  309

                         BOOK  IX.

Of the Nervous System,    -      -       -       -      -  313
PART I.—GeneraT Anatomy of the Nervous System,    -      313
       II.—On the Special Anatomy of the Central Portion of
            the Nervous System,  -                        327
  Chap. I._Medulla  Spinalis, and its Membranes,       -      327
       Sect. 1.—Medulla Spinalis,    -       -       -      -  327
           2.—Membranes of Spinal Marrow,   -       -      333
           3._Blood Vessels of Medulla Spinalis,  -      -  337
  Chap. II.—Encephalon,       ...       -      338
       Sect.  1.—Membranes of Brain,        -       -      -  339
            2.—Medulla Oblongata,     -       -       -      349
            3.—Protuberantia Annularis,"    ...  353
            4.—Cerebellum,    ...       -      354
            5.—Cerebrum,   -----  357
            6.—Nerves of Encephalon,  -       -       -      373
            7.—Arteries of Brain,    ...      -  382
PART III.—Senses,     ...       -       -     387
  Chap. L—Nose,   -       -       -       -       -      -  387
       II.—Eye,.....397
       Sect. I.—Auxilliary parts of Eye,     -       -      -  398
            2.—Eyeball,        -              -       -     413 
xlviii                      contents.
                                                          Page
  Chap. III.—Ear,   -       -       -       -      -       *  433
      Sect. 1.—External Ear,   ...       -      433
           2.—Tympanum,        ...       -  438
           3.—Labyrinth,      ...       -      444
           4.—Nerves,     -----  450
PART IV.—Special Anatomy of Nerves,        -       -      453
  Chap. I.—Nerves of Encephalon,  ....  453
      Sect. 1.—Nervus Olfactorius,     ...      453
           2.—Nervus Opticus,     -                       453
           3.—Nervus Motor Oculi,   ...      454
           4.—Nervus Trochlearis,         ...  454
           5.—Nervus Motor Externus, -       -       -      455
           6.—Nervus Trigeminus, ....  455
           7.—Nervus Facialis,  ....      465
           8.—Nervus Hypoglossus,        ...  468
           9.—Nervus Accessorius,    -       -       -      469
          10.—Nervus Glosso-Pharyngeus,   -      -       .  470
          11—Nervus Pneumogastricus,        -       -      472
  Chap. II.—Sympathetic Nerve,    ....  477
       III.—Nerves of Medulla Spinalis,        -       -      489
      Sect.  1.—Upper Nine Spinal Nerves,   ...  4§9
           2.—Thoracic Spinal Nerves, -       -       -      500
           3.—Abdominal Spinal Nerves,    ...  503 
                          A


TREATISE   ON  ANATOMY.
BOOK I.
                       PART I.

              On the Anatomy of the Skeleton.

  The skeleton is the  bony frame-work of the human body;
and, by its hardness and  form, retains  in proper  shape the
whole fabric; affords points for the attachment of muscles; and
protects many of the viscera.  Anatomists call the bones, along
with their natural connexions of ligaments, cartilages, and sy-
novial membranes, a natural skeleton;  and the bones only, but
kept together by artificial means, an artificial skeleton.
  The bones are inflexible, and in a recent state are of a  dull
white colour, familiar to most persons from its being the same
in animals; but they may be made  of an ivory whiteness by
being properly macerated and prepared.
  The regional division of the skeleton  is into Head, Trunk,
Superior or Thoracic, and  Inferior or  Abdominal Extremi-
ties.
  If a vertical plane be passed from the top of the head down-
wards, through the middle of the skeleton, this plane will divide
the  latter into bilateral, or two equal portions, called, in com-
mon language, the right and the left side  of the body.  These
  Vol. I.—5 
50                        SKELETON.

two sides are perfectly alike in shape and size.*   Some  of the
bones are found in this  plane, being intersected  by it  into two
equal parts or halves: others are  somewhat removed from it,
and are in pairs.   This arrangement antagonizes the two sides
of the body, and qualifies it for all its motions.
                        CHAPTER I.

                 OF THE BONES, GENERALLY.

                  SECT. I.--NUMBER, TEXTURE.

  The number of the bones  is  commonly the same in every
person of middle age; but they are less numerous then, than in
infancy, from several of them having been originally formed in
pieces which coalesce.   The farther fusion in advanced life, of
contiguous bones into  each  other, diminishes still  more their
number.  It is, however, generally agreed to view  the follow-
ing as distinct-.—

  For the Head—An occipital bone, a frontal, a sphenoidal, an
ethmoidal, two  parietal;  two  temporal, each containing  the
small  bones of  the  tympanum;  two superior maxillary, two
palate, two malar or zygomatic, two nasal, two unguiform or
lachrymal bones, two inferior  turbinated, a vomer, and an  in-
ferior maxillary:

  * The exact harmony or symmetry of form and size, between the two sides of
the body, as a general rule, is rather hypothetical than real in nature.  It is a
point of general notoriety, that the right side enjoys more force than the left, and
this will be found attended with greater development.  There are few persons
that have not the  face and the spine somewhat out of shape from the bones on
one side growing  larger than on the other, the right, commonly, prevailing over
the left: hence we see a nose somewhat turned; and a spine curved, the convexity
of which is to the right side, with the attendant consequences on the position of
the ribs—the scapulss and the sterni m.  This condition of false growth is exhi-
bited, in all degrees, from a deviation almost imperceptible to one amounting to
deformity. The left side is said, also, to be more liable to diseases. Copious re-
ports on these several subjects as  well as on human stature, generally, at all
ages, have been made by the French Anatomists: for a summary exposition of
which, see Malgaigne, Anat. Chirurg. Vol. I. Chap. 1.  Paris, 1838. 
SITUATION OF BONES.                   51
  For the Trunk—Twenty-four true or moveable vertebras, one
sacrum, four caudal vertebras or bones of the coccyx, two inno-
minata, twelve ribs on each  side;  a sternum, in three pieces,
however, in the youthful adult:
  One hyoid, in three pieces, sometimes five in the adult, and
situated in the throat:
  The remaining  bones  compose the limbs, and are, therefore,
in pairs, or correspond exactly on the two  sides of the body.
They are,
  For the upper Extremities—The  clavicle, the  scapula, the os
humeri, the radius, the ulna, the eight bones of the carpus, the
five bones of the metacarpus, the two phalanges-of the thumb,
the three phalanges of each of the  fingers, the two, and some-
times more, sesamoid bones:
  For the lower Extremities—The os femoris, the tibia, the fibula,
the patella, the seven bones of the tarsus, the Jive  of the meta-
tarsus, the two phalanges of the big toe, the three  phalanges of
each  of the smaller toes, and the two, sometimes more, sesa-
moids.
  There are, therefore,  twenty-two bones to the  head, not in-
cluding those of  the tympanum;  fifty-six to the trunk of the
body; one insulated bone to the throat;  sixty-eight  to the  two
upper limbs; and  sixty-four to the two lower limbs.  In all, two
hundred and eleven.  The redundancy or the deficiency of the
sesamoid  bones,  in  a subject, may cause  this number to be
slightly increased or diminished.

  The situation of the bones varies; some are profound, while
others approach very near to the surface of the body.  They
are, as  stated, either symmetrical,—that is, consist of two late-
ral portions precisely alike,—or else in pairs, having a perfect
correspondence with each other.   The symmetrical or bilateral
bones are the frontal, the occipital, the sphenoidal, the ethmoidal,
the vomer, the inferior maxillary, the hyoid, the spinal, and the
sternal; and they are situated under the middle vertical line of
the body.  The pairs are on  the sides of the middle line, more
or less removed from it.
   The long bones (ossa  longa) are generally cylindrical or pris-
matic, and have their extremities  enlarged for the  purpose of
articulating with adjoining bones.  The broad bones (ossa lata) 
52                       SKELETON.

have their shapes diversified by muscular connexion and by the
forms of the viscera they contain.   The  thick bones  (ossa
crassa) are situated in the vertebral column;  and in the hands
and feet; and have their surfaces very irregular.
  The bones present, on  their periphery, eminences and cavi-
ties, a proper knowledge of which, is of the greatest importance
to the surgeon.   The former are called apophyses or processes,
and are extremely numerous and diversified: they serve for the
origin and  insertion  of  muscles, and  for furnishing articular
faces.  The cavities are also numerous: some of them are su-
perficial, and serve for articular surfaces; others for the origin
of muscles; for the enlargement of other cavities, as that of the
nose and ear;  and for purposes which will be mentioned else-
where.
  The articular ends of  the  long  bones are  called epiphyses,
from their  being  formed from  distinct points of ossification,
whereas, the shaft of the bone is its diaphysis or body, being
the part first formed.  The  epiphysis, therefore, as its name
implies, grows  upon the other.  Many processes grow after
the manner  of epiphyses, from distinct points of ossification,
though they are seldom called by the same appellation.  This
is the case with the trochanters of the  os femoris, with the pro-
cesses of the vertebrae, the crista of the ilium, and the tuber of
the ischium.
  Near the centre of some bones a canal is formed which passes
in an oblique direction, and transmits blood vessels to their in-
terior.   There are also, at the extremities of the  long bones, at
the different points of the thick ones,  and near the margins of
the  flat ones, a great many large orifices, which principally
transmit veins: in addition to which, a  minute inspection of any
bone whatever, will  show its whole surface studded with still
smaller foramina, also for the  purpose of transmitting blood
vessels.

  The density of bones is always well  marked, and exceeds
much that of other parts of the body.   It is, however, variable
in different  bones, and in different places of  the same bone:
hence their substance has been divided into compact and cel-
lular, of which the former is external and the  latter  internal.
  The cellular structure, or substance, grows  from the internal 
TEXTURE OF EONES.
53
surface of the  other, and is composed of filaments  and small
laminae, which pass in every direction, by crossing, uniting, and
separating.  The cells, resulting  from this  arrangement, pre-
sent a great diversity of form, size, and completion.  They are
all filled with marrow, and communicate very freely with each
other.   The latter may be proved in the  boiled bone, by the
practicability of filling them all with quicksilver from any given
point;  and, indeed, by the injection of any matter sufficiently
fluid to run.  The communications between them are formed
by deficiencies  in their parietes, after the same manner that the
cells of sponge open into each other.  This structure does not
exist in the earliest periods of ossification, when the  bones  are
cartilaginous almost  entirely,  but developes itself during the
deposite of calcareous matter.  The manner of its formation
is imperfectly understood, though it may possibly be the result
of absorption, and it is not completed in the bones, originally
consisting of several pieces, till they are consolidated into one.
  The compact substance is also formed of filaments and lami-
nae, which we find to be so closely in contact with each other,
that the intervals between them  are  merely microscopical in
the greater part of their extent:  they become, however, more
and more distinct, and larger, near the internal surface;  and at
the extremities  of the long bones.   The compact tissue  is gra-
dually blended  with  the cellular  structure,  or  lost in it.  Its
filaments are directed longitudinally in the cylindrical bones,
radiate from the centres of the flat ones, and are blended so as
to render it impossible to trace them  in the thick ones.  This
disposition in the flat bones is much better  seen in  early life;
subsequently, it becomes indistinct.   The compact tissue, par-
ticularly in the  cylindrical bones, has in it a multitude of k>n--
gitudinal canals, visible to the microscope,  and some of them
to the naked eye, which contain vessels and medullary matter.
Those  canals, originally  described  by Havers, are,  according
to the estimate  of M. Beclard, about one-twentieth of a line in
diameter, on an average; but they are, generally larger near
the interior than the exterior surface of the  bones, and have
frequent lateral  communications with the cellular structure, and
with the external surface.
  The campaot and the  cellular structures  present themselves
                            5* 
54                       SKELETON.

under different circumstances in the three species of bones.  The
compact  has an unusual thickness in the bodies or diaphyses  of
the long bones, and  is accumulated in quantities particularly
great in their middle, which, from its position, is more exposed
than their extremities, to fracture from falls, blows, and violent
muscular efforts.   But as this  texture  approaches the extremi-
ties of the bones it is reduced to a very thin lamina, merely suf-
ficient to enclose the cellular structure and to  furnish  a  smooth
articular face for the joints.   The cellular structure, on the con-
trary, in the long bones, is most abundant in their extremities,
constituting their bulk there, and is least so in their bodies.  It
is so scattered at the latter place as to  leave a  cylindrical canal
in their  middle, almost  uninterrupted  for some inches.  This
canal, cellular in its periphery, has its  more interior  parts tra-
versed in every direction by an  extremely delicate filamentous
bony matter, which, from the  fineness  of  its threads and the
wide intervals between  them,  has been, not unaptly, compared
to the meshes of a net, and  is, therefore, spoken of  especially
under the name of the reticulated structure or tissue of the bones,
in contra-distinction to the cellular.  It is  formed on the same
principle with the latter; and though the term, from that circum-
stance, has been rejected, upon high authority, as superfluous, it
appears worthy of retention, as it expresses a fact  of some im-
portance.  Too weak to contribute in an appreciable  degree  to
the strength of the bone, the reticulated tissue seems principally
useful in supporting the marrow and in giving attachment to  its
membrane.  The  extremities of this cylindrical canal gradually
disappear by becoming more and more cellular.
   In the flat bones, the compact structure  forms only their sur-
face or periphery, and is of inconsiderable but generally uniform
thickness; the space within is filled up with the cellular struc-
ture, which  is  rather more laminated  than it is in the long
bones.
   In the thick or round bones, the compact structure forms their
periphery also; but, generally, it is thinner than  in the flat: their
interior  is likewise filled  up-by the cellular structure, and does
pot present differences of importance, from the ends of the long
bones.
   A simple experiment on any of the cylindrical bones will prove
that the tumefaction  of their extremities does  not add propor- 
TEXTURE OF BONES.
55
tionately to their weight, as one inch or any other given section
of the compact part weighs very nearly the same with a section
of equal length from the cellular extremities.  The swelling at
the ends of the bones adds much to the safety of their articular
union, as the extent  of the  surfaces  is thereby much increased,
and, consequently, they are less liable to displacement.   The cy-
lindrical and the cellular cavities, thus formed in the long bones,
by increasing  the  volume of the latter,  add greatly to  their
strength beyond what would have occurred, had the same quan-
tity of material  been solid.   The late Dr. P. S. Physick demon-
strated  this  most  satisfactorily  by a  scroll of paper, which, on
being rolled  up successively, into cylinders of various  sizes, has,
like a lever, its power of sustaining lateral pressure on one of its
extremities, continually increased  as  its volume  or diameter  is
augmented, until the latter  reaches a certain extent.   The same
highly  distinguished teacher also pointed  out another very im-
portant advantage of the cellular structure.  It is that of serving
to  diminish, and in many cases to  prevent  concussion of the
brain, and of the other viscera,  in falls and in blows.   The opi-
nion was verified by his demonstrating the momentum, which is
 communicated through a series  of five ivory balls suspended by
 threads, when one of them is withdrawn from  the others, and
 allowed to impel them by its fall.  This momentum is so com-
 pletely transmitted through the series, that the  ball at  the far-
 thest end is  impelled almost to the distance, from which the first
 one fell.  This familiar experiment, used  as  a preliminary test
 to the  accuracy of his views, was immediately succeeded by his
 substituting  for the middle one  of ivory, a ball made of the cel-
 lular structure  of bone.   The  same degree  of  impulsion now
 communicated at one end of the series,  is almost lost, or rather
 neutralized, in fhe meanderings of the cellular structure of the
 substitute; and particularly if the latter be previously  filled with
 tallow or well soaked in  water, so as to bring it  to a  condition
 of elasticity resembling the living state.
    In persons of advanced age, the marrow of the bones becomes
 more abundant, and their parietes thinner; and we also observe
 then, that the  bones  break more readily, and  are more  crum-
 bling,  rotten, or soft, than  during the  anterior  periods of life.
 In women, after  the critical period is passed, these  traits are
 especially developed, and the compact centres of the long bones 
56                      SKELETON.              (

have their texture more or less approximated to the spongy tis-
sue.  Mr. Velpeau (Anat. Chirurg.) says, that  in the amphithe-
atres of Paris, he has often cut easily with a scalpel, the ends of
the femur, tibia, humerus, the bodies of the vertebrse and the
tarsal bones, when there was apparently  no morbid lesion in the
skeleton.

              SECT.  II.--COMPOSITION OF BONES.

  The bones under every modification of shape and mechanical
arrangement, are constituted by precisely the  same elementary
matters: the  principal of which are an animal and an earthy
substance, in intimate combination.   Their  minute analysis,
according to  Berzelius, when they are  deprived  of  water and
of marrow, affords 32 parts of gelatine, completely soluble in
water; 1  part of insoluble animal matter; 51 parts phosphate
of lime; 11 carbonate of lime; 2 fluate of lime;  1  phosphate
of magnesia;  1  soda and muriate of  soda.   There are some
other ingredients manifested in the analysis of Fourcroy and
Vauquelin, as iron, manganese, silex, alumine, and  phosphate
of ammonia.   The relative proportion of the above ingredients
is not uniformly the same, as the bones of the cranium, and the
petrous portion of  the temporal, in a remarkable (degree,  have
more calcareous matter in them, than the other  bones of the
same skeleton.  There is also a considerable diversity in  indi-
viduals, according to their age and to certain morbid affections.
  The earthy matter gives to  bones their hardness and want
of flexibility,  and is easily insulated from the other by combus-
tion; which,  in destroying the animal  part, leaves  the  earthy
in a  white friable state, but preserving the original form of the
bone.  If the heat be of a  high  degree,  the  calcareous part
becomes vitrified,  and its cells are blended  by  fusion.  The
action  of the  atmosphere, long continued, also  divests the bones
of their animal  matter, and the  calcareous  then falls into a
powder.  If  the bones  be kept  beneath  the surface  of the
ground, by which  they are less affected by changes in  tempe-
rature and moisture, the animal matter  remains for an immense
number of years.  I have seen in the  Hunterian Museum of
London, preparations of the teeth of the  Mastodon or Mam-
moth, in which the animal  matter  was exhibited entire, not- 
COMPOSITION OF BONES.
57
withstanding  the great lapse of years since it was in a  living
state:  and a  repetition here  of the same experiments  on the
teeth and  bones of the same animal has exhibited the same
result.  I  was  also informed by the late Mr. Say, a distin-
guished  naturalist, that animal matter has  been  detected in
fossil shells, the existence of which was probably anterior to
that of the human family.
   The phosphoric acid of bones gives them a luminous appear-
ance at night.   Bichat says, that in these cases he has found
an oily exudation on  the luminous points, probably from the
marrow  or  contiguous  soft  parts.  This  phenomenon  will
account for many of  the superstitions which in all ages have
affected ignorant minds, on the subject of burying  grounds.
   The immersion  of a bone in diluted muriatic acid is the best
method of demonstrating the animal part in a separate state.
The strong  affinity of the acid for the earthy  part, and  the
soluble nature of the salt thus formed, leave  the animal matter
insulated.   In this state  it preserves the original  form of the
bone, is cartilaginous,  flexible, and elastic.   The action of hot
water alone,  upon a bone, by continued boiling, will, from the
soluble nature  of the cartilage, separate the latter from the
earthy part,  and  convert it  into gelatine.   The gelatine may
be precipitated afterwards  from the water  by tannin.  The
mode of this combination of animal and of earthy matter  is
not understood,  but it  is generally supposed to exist by the ex-
tremely small cavities of  the former receiving earthy particles,
in the same way that sponge holds water.*
   There  are no means for investigating  the minute anatomy
of the bones more favourable than the removal of the earthy
   * If we conceive  the phosphate of lime and the other ear.thy materials of bone
to be in a state of solution in the blood and serum with which the cartilaginous
rudiment of the bone  is impregnated, any action which would precipitate the
earthy materials, would also, of course, impregnate the cartilage with them, and
this process may be considered as completed when the bone acquires its proper
consistence.
   Considering cellular substance as the parenchyma or primordium of all other
parts, it is probably a speculation not entirely groundless, that every peculiar
tissue or glandular texture has its elements precipitated from the circulating
fluid in a manner analagous to that of the calcareous part of bone.  This idea
also affords a clue to a result almost uniform in protracted macerations  of all
tissues, to wit, the  parts being  brought back to the primordial state, by the pe-
culiar depositee  in  them being dissolved in the water and removed. 
58                      SKELETON.

part by  an acid.   The  cartilage thus left  is the  complete
mould, in every particular of form, into which the particles of
calcareous matter were deposited.  In this state,  the compact
part of the bodies of the cylindrical bones may  be separated
into laminse; and these lamina?,  by the aid  of a pin or fine-
pointed instrument, may be subdivided into filaments or threads.
  The lamina;, though enclosing one another, are not exactly
concentric.  I  have observed, that  the  more superficial^ come
off  with  great  uniformity and  ease  in  the adult  bone, but the
intertexture continually increases towards the centre.  Bichat
has objected to this dissection of the  bones, that the laminae
are not  formed in nature, but  factitiously,  by the  art  of the
anatomist, and that their thickness depends entirely  on the
point at  which  one chooses to separate  them; they, therefore,
may be  made thick or thin at pleasure.  It does not appear to
me difficult to account for the manner in which this  laminated
arrangement is  produced.  The  longitudinal filaments  of the
bones adhere with more strength to each other  at their sides
than they do  to those above or below, in consequence of which
a plane of these filaments may be raised  at any  place and of
any thickness.   This fact does  not  involve the inference that
the bones are formed  by a successive  deposite of one  lamina
over another;  it merely  inculcates the  mode of union between
the filaments or threads.  I am,  however, inclined  to the opi-
nion that  the periosteum secretes  the  external laminae in the
adult  bone, inasmuch  as they  separate with unusual facility
from the subjacent  one.  We  know that the  periosteum has
the-power of this secretion, as a laminated deposite of bone on
the roots of the adult teeth frequently met with, proves  without
doubt, as also the phenomena of necrosis.
   The disposition  of  the cylindrical  bones to  separate into
 laminae, is constantly manifested in such as are simply exposed
 to  the atmosphere.
   The opinion of the  laminated  and filamentous arrangement
 of  bones  has  been  very generally adopted  by  anatomists.
 Malpighi, whose name is inseparably  connected with  minute
 investigations in anatomy,  taught  it.   Gagliardi, also} in ad-
 mitting  it, thought  he saw  pins of different  forms for holding
 the laminae  together.  Havers also saw  the laminated and
 thread-like structure.   In short, there are  few of the older 
COMPOSITION OF BONES.                 59
anatomists who have not adopted fully the opinion.  Among
the moderns, the late M. Beclard, the distinguished  and able
Professor of Anatomy in the  School of Medicine in Paris, says,-
that when the earth is removed from bones by an  acid, if they
be softened by maceration in water, the compact substance,
which previously offered no  apparent texture, is separated into
laminae, united by filaments;  the laminae  themselves,  at a later
period, separate themselves into filaments; which, by a farther
continuation of the process swell, and become areolar and soft.
A long bone examined after this process, divides  its  body into
several lamina?, the most external  of which envelops the rest;
and the remainder, by rarefying themselves towards  the  extre-
mities, are continuous with the cellular structure there.
   J. F. Meckel, of the University of Halle, has furnished the
following account in his General Anatomy of the Bones:—
   " The filaments and the laminae which constitute the  bones
are not simply applied one  against  the  other, so as  to extend
the whole length, breadth, or thickness of  a bone, or to go from
its centre to the circumference.  They lean in so many  differ-
ent ways, one against  another,  and unite  so frequently  by
transverse and  oblique appendages or  processes, that some
great anatomists, deceived  by this arrangement, have doubted
the, fibrous structure of bones.  Nevertheless, their  opinion is
not perfectly correct.  In spite of  those inflections and anasto-
moses of fibres, the fibrous  structure always remains very ap-
parent;  and one is warranted in  saying, that the dimension of
length exceeds the two others, in the texture of  many  bones.
This  predominance is chiefly well marked in the first periods
of osteogeny;  for,  at a  later time,  the  fibres are so applied
against each other, as scarcely to  be distinguished.  But these
longitudinal fibres never exist alone;  there are many oblique
or transverse ones  from the first  periods of ossification; and
lhey are  even  from the beginning so multiplied, that the num-
ber of longitudinal fibres does not prevail over them so much
as at a subsequent period, when the  fibres approach  nearer, in
such  way that the  transverse become  oblique;  until at last,
from the  increase of the bone, the  latter,  at first view, seems to
be composed only of longitudinal  fibres.  The transverse and
oblique fibres do not form a separate system;  but continue  un- 
\
60                        SKELETON.

interruptedly with the longitudinal, which  they unite to each
other."*
  The venerable Scarpa, some years  ago,  advanced  opinions
adverse to the laminated and  fibrous or filamentous  tissue of
bones :f the latter doctrine he was induced  to think a  mere
mistake, arising from careless observation.  Founding his own
views  upon what he had seen in the growing bone,—in the
adult bone when its earthy parts  were removed by an acid,—
and  upon  certain cases of disease attended with inflammation
of the bone; he denied, without reservation, the existence  of la-
mina? and fibres in bones, declaring that even  the hardest of
them were cellular or reticulated.  It  appears to  me, in  look-
ing over his paper, that a desire to overthrow old doctrines and
to establish new ones, has induced him to make one omission in
the report of his experiments, otherwise unaccountable in a man
of his general intelligence and  candour.  Having softened the
cylindrical bones in an acid, he next proceeds to a long conti-
nued maceration of them ; he finds, as other persons have done,
the animal part of the bone  finally resolving itself into a soft cot-
tony tissue.  He has made but one jump from  the immersion in
the acid to the last stage of the process of maceration.  Now, if
in a  short  time after the bone had been softened  in the acid, he
had  admitted an intermediate  observation, he would no doubt,
like all other inquirers, have found that the animal part of the cy-
lindrical bones was readily  separable into laminae; and that by a
pin or needle these laminae  could be split into fibres, the greater
part  of which  are longitudinal; and that pounding  the ends of
these fibres with a hammer would resolve them into a very fine
penicillous or  pencil-like structure.  There is no objection to
the^conclusion, that these laminae and filaments, as  a final con-
dition, produce a very fine microscopical cellular arrangement,
which may be  made more apparent in being distended by the de-
velopment of gaseous  substances, arising from putrefaction or
maceration; but there is reason for  a decided  opposition to the
assertion of there being no  fibres in bones, when we have  daily

  * Manuel D'Anat. Gen. Descr. et Path, traduit de L'Allemand  par Jourdan et
Breschct. Paris,  1825.
  * A Scarpa.  De peniliori ossium structura commentarius.  Lcips. 1795. See
also Anatomical Investigations, Philadelphia, 1824, by the kte J. D. Godman,
M. D., for an English translation of the same. 
COMPOSITION OF BONES.
61
under our eyes preparations showing them; some of which de-
monstrate the fibres running principally longitudinally, others
spirally, like the grain of a twisted  tree, and others having a
mixed course.  Upon the whole, the  description  cited from
Meckel, exhibits this subject in a just and accurate  manner.
   The more obvious arrangement of the cellular and compact
structures of the bones, indicates a  considerable difference in
their  intimate texture:  they are, nevertheless, closely allied;
for one structure is converted, alternately,  into another by dis-
ease,  of which specimens abound in the Wistar Museum.   In
both cases, from the fibres or filaments are formed cells which
exist  every where, and are only larger and more distinct in
what  we call the cellular structure;  but the compact  part has
also its cells, though they are smaller, more flattened, and  for
the most part microscopical.

   Organization of Bones.—The  blood vessels  of the bones,
though small, are very numerous.  This is well established, by
the success of fine injections, which in the young bone commu-
nicate a general tinge; and by scraping the periosteum from
living bones, whereby their surface in a little time becomes co-
vered with blood, effused from  the ruptured vessels.  In those
operations for exfoliation  from the internal surfaces of the cy-
lindrical bones, where it is necessary to excavate the  bone ex:
tensively, in order to remove all the detached pieces; unless the
general circulation of the limb be previously arrested  by the
tourniquet,  the  cavity of the bone is flooded with blood.  Bi-
chat has also remarked, that the blood vessels of the bones be-
come unusually turgid and congested, in cases of drowning and
strangulation.  The observations in  1832, on cholera  in Paris,
showed the same congestion of  black blood, to have been pro-
duced by that disease.
   The arteries which supply the bones, from their mode of dis-
tribution, are referred  to  three classes.  The most numerous
and the smallest, are those which penetrate from the periosteum,
by the capillary pores found over  the whole  surface  of the
bones.   The next are those which penetrate the larger forami-
na at the extremities of the long bones, and at different points
of the surface of others.   And  the third class, called  nourish-
ing, amounts to but one artery for each of the cylindrical bones
  Vol. I.—6 
62
SKELETON.
which penetrates by an appropriate canal, as mentioned, com-
monly near the centre of the bone.
  The arteries of the first two classes are generally extremely
small.  They ramify upon the compact and  cellular structure,
penetrating it in every direction.   At death, they are common-
ly filled with blood, which renders the injection of them diffi-
cult.  The third, or, as commonly called, the nutritious artery,
is of a magnitude proportioned to the bone to be supplied.  Be-
ing single in every instance, it passes through the compact tis-
sue, and having reached the medullary cavity, it divides imme-
diately into two branches; each of which in diverging from its
fellow, goes towards its respective extremity of the bone.  These
branches ramify into countless capillary vessels  upon the mem-
brane containing the  marrow,*  and  finally  terminate by free
anastomoses with the  extreme branches of the  two other sys-
tems.
  The veins of the bones are very abundant: they are uniform-
ly found in company with the branches of the  third, or nutri-
tious  arteries, and their common trunk  goes out  at the nutri-
tious  foramen into the general  circulation.  These ramifications
have  been long known, and bring back the blood from the me-
dullary membrane only.  The veins which receive the blood of
the other arteries do not attend them, and were first of all found
in the diploic structure of the  cranium, which led  to the disco-
very  of them in  all  the other bones.   The honour of the ori-
ginal  observation has been claimed respectively  by two very
distinguished men of Paris, MM. Dupuytrent and Chaussier.J
These veins issue from the  bones by numerous openings dis-
tinct from those furnishing a passage to the arteries.  This cir-
cumstance is remarkably well seen in the flat and thick  bones,
and at the extremities  of the cylindrical ones.  Having left the
bone, they terminate, after a short course, in the  common ve-
nous system.  They arise exclusively from the spongy and com-
pact structure, by extremely fine  arborescent branches, which,
uniting successively, form trunks;  these trunks penetrate the
compact tissue, and eseape from the bone by orifices which are

  * Would not this furnish a hint, that the arteries which secrete fat are diffe-
rent from mother arteries, and that this distinction may prevail generally?
  t Propositions sur quelques points d'Anatomie, de Physiologie, &c. Paris, 1803.
  | Exposition de la Structure de l'Encephale.  Paris, 1807. 
OF THE PERIOSTEUM.
63
uniformly smaller than the  bony canals, of which they are the
terminations.  The canals  are formed of compact substance,
continued from the external surface of the bone, and are lined
by the contained veins.   The  parietes of the canals are pene-
trated b}' smaller veins entering into  the larger.  M. Dupuy-
tren is of opinion, that only the internal membrane of the ve-
nous system exists in this set of veins;  that it adheres closely to
the bone, so as to be incapable of exerting any action upon the
blood; that it is very thin,  weak,  transparent,  and is thrown
into numerous valves.
  Lymphatic vessels are generally seen only on the surface of
the bones.   Mr. Cruikshank, however, on one  occasion, while
injecting the intercostal lymphatics, passed his mercury into the
absorbents of a vertebra, and afterwards saw them ramifying
through its substance;* a fact which, along with what is known
of the power of exfoliation in bones, proves sufficiently the ex-
istence of such vessels in them.  Nerves have also been traced
into them, accompanying the nutritious arteries.t
                     CHAPTER II.

               SECT. 1.--OF THE PERIOSTEUM.

  The membrane which surrounds the bones is called perios-
teum, and is extended over their whole surface, excepting that
covered by  the articular  cartilages.   As  this membrane  ap-
proaches the extremities of the bones, it is blended with the li-
gaments uniting them to each other, from which  the  ancients
adopted  the opinion, that the ligaments and periosteum were
the same.  Many fibres pass from the periosteum to the bone,
by which it is caused to adhere.   These fibres are more nume-
rous and stronger at the  extremities than in the middle of the
cylindrical bones; also upon the thick bones, than upon the flat
ones.  The blood vessels of the bones  accompany these fibres

          * Anatomy of Absorbing Vessels, p. 98.  London, 1790.
          t Beclard, Elemens d'Anatomb Generale. Paris, 1823, 
64
SKELETON.
 and contribute to the adhesion.   The periosteum is united to
 the muscles and to the parts lying upon it, by cellular substance.
   The adhesion of the periosteum to the bones varies in the se-
 veral periods of life.   In infancy it may be separated  from them
 with great facility: in the adult it adheres more strongly in con-
 sequence of its internal face having taken on a secretion of bone,
 by which it is blended intimately  with the bone  it surrounds;
 and in old age it is still more adherent, from the progress of its
 ossification.  It is thick and  soft  in the  infant, and becomes
 thinner and more compact as  life advances.
   The organization of the periosteum is fibrous, and  the fibres
 pass very much in the same  direction with the  fibres of the
 bones; excepting the flat bones, on which it is not radiated.
 These fibres  have different lengths, the  more  superficial are
 longer, while the more  deeply seated extend but a small dis-
 tance.  Inflammation developes the fibres in a striking manner,
 by occasionally making the membrane as thick as an aponeuro-
 tic expansion.
   The blood  vessels of the periosteum are  numerous, and can
 be easily injected.  They come from the contiguous trunks,
 and ramify minutely, into a vascular net-work, many of whose
 branches penetrate into the bone, and have the distribution al-
 ready mentioned.  A few lymphatic vessels have been observed
 in it.   Its nerves have not been clearly discovered, though the
 sensation of extreme pain, when violence  is done to it in an in-
 flamed state, may be  thought  a  proof of their existence.  In
 health its sensations are null, or extremely obscure.
   The periosteum receives  the insertion of tendons, of liga-
 ments, and of the aponeuroses.   In early life, owing to the
 slight attachment of this membrane to the bones, all these parts
 may be torn  from them, with but comparatively  little force.
 Bichat* having advocated the  opinion, that the internal lamina?
 of the periosteum become ossified in the adult, considered that
 as a means by which all the afore-mentioned insertions into  it
were identified with the bones.  This will account for the great
degree of tenacity with which they adhere, and the immense
force  they are capable  of sustaining, without  beino-  detached
from their insertions.   In this tendency to ossify, the periosteum
* Anatomie Generale. 
MEDULLA, AND ITS MEMBRANE.
65
manifests a great similitude to other fibrous membranes, as the
dura mater, the sclerotica,  and the tendons.
  The use of the periosteum is to conduct the blood vessels to
the bones, to protect the latter from the impression of the mus-
cles, and other organs, which come in contact with them, to
keep the ossification of the  bones within its proper boundaries,
to give shape to them, and  to secrete bone in the growing state
or in fractures;  and, finally, as has been suggested by the late
Dr. Physick, it exerts a very happy influence in  turning from
the bones suppurations in their vicinity, which would otherwise
be pernicious to them.

SECT. II.__OF THE MEDULLA,  AND ITS MEMBRANE, CALLED THE IN-
                    TERNAL PERIOSTEUM.

  A greasy substance, as already stated, fills the cells of the
bones: it does not, in its composition, differ from common fat:
its granules, however, seem to be somewhat finer.  From its re-
semblance in position to the pith of vegetables, it  has obtained
the name of medulla or marrow.  It  is contained in a very fine
cellular and vascular membrane, lining the internal cavities of
the bones, and sending into their compact substance very deli-
cate filaments.   The existence of this membrane  has been de-
nied, but it may be established by sawing a bone in two, and
approaching the cut end to  the fire, so as to melt  out the mar-
row, or by immersing it  in an acid, in which case the mem-
brane becomes crisp and  distinct.  Its delicacy is so extreme,
that it  can only be compared to a spider's web.  In this state it
may be traced, lining the whole cylindrical cavity of the long
bones,  and  extending itself to their extremities.  It also exists
in the  diploic or cellular structure of all the other  bones; but it
is scarcely possible  to demonstrate it  there in a  very distinct
manner, owing to its extreme tenuity.
  The medullary membrane is composed principally of the mi-
nute and numerous  blood vessels spent upon the  internal  sur-
face of the bones,  aided by a very fine, soft, cellular  tissue,
merely sufficient in quantity to fill up the meshes between the
frequent anastomoses of the vessels.  From the latter cause, it
is compared to the pia mater and to the omentum.  It has been
stated, that its blood was  derived from  the nutritious artery.
                             6* 
66
SKELETON.
which communicates freely with the other arteries of the bones.
This membrane is so arranged as to form along the course of
the blood vessels small vesicular appendages which contain the
marrow, and bear some analogy to  a thick bunch of grapes>
hanging from the several pedicles of the stem.
   Its nerves are extremely small; they enter  by the nutritious
foramen, and have been particularly observed by, Wrisberg and
Klint.*  They have not been traced  ramifying in the substance
of the bone, but follow for some distance the course of the prin-
cipal arteries.
   With the exception of Mr. Cruikshank's solitary injection of
a vertebra, no lymphatics have been observed satisfactorily on
this medullary membrane; and such trunks of the external peri-
osteum as are supposed to arise from the medullary membrane,
have not been traced nearer to it, than the orifice of the nutri-
tious canal.
   Some differences exist in the  nature of the contents of the
medullary membrane; {br  example, that part of it  which is re-
flected  over the  cells in the extremities  of the long bones, and
in the whole interior of the flat, and  of the thick ones, contains
a much more bloody and watery marrow, than what is found in
the cylindrical cavities of  the long bones: the latter, indeed, re-
sembles closely,  as just stated, common adeps, presenting no es-
sential  differences  from it.   These  circumstances  have given
occasion, without a material distinction of texture, to divide the
medullary membrane into  two varieties.
   That variety contained in the cellular extremities of the long
bones, and in the spongy bones generally, is in a superior degree
vascular.  The part within the meshes of its vessels is, however,
so imperfect, that Bichat declared his  inability  to  find  it, and
that the number  of the fine vessels was what gave, fallaciously,
the appearance of a  membrane; while, in faet, the intervals be-
tween them were large, to allow the fat  to  come  into contact
with the naked bone.   The probability of this deficiency is con-
firmed  by the circumstance, that no one pretends to have found
a membrane in the microscopical pores of the compact substance,
yet the existence of fat  in it is proved by its becoming greasy
when insulated and exposed to heat.  It is from the great abun-
dance of blood in this variety of the medullary tissue, that the
proportion of its  adeps is small.
                        * Beclard, loc. cit. 
                   DEVELOPMENT OF BONES.                 67

  The second variety of medullary membrane is displayed in
the cells and cylindrical cavity of the diaphysis or body of the
long bones.   Its membranous cells communicate freely with one
another when the membrane is entire; but, according to the ob-
servations of Bichat, not with such as are in the epiphyses of the
bones; and the line of demarkation is abrupt and well defined.
This is proved by attempts to inflate the one from the pther; the
air, in such cases, passes with  great difficulty.   The texture of
this medullary membrane, from its extreme delicacy in a natural
state, is rather obscure, but it  is occasionally well developed in
disease.  Its sensibility has  not been very apparent  in such
cases of amputation as I have seen/though it is said, by some,
to be  extremely exquisite.  In whatever degree its sensibility
exists in  different subjects, it is always more  apparent in the
middle than near the extremities of the long bones;  which may
be accounted for by its nerves always  entering  at the nutritious
foramen, and extending from  thence towards the extremities.
   The medullary  membrane, besides its  use  in secreting the
marrow,  is highly serviceable to the nutrition  of the bones, as
proved in  the  experiments of  Trojat, who, by destroying it,
produced their death, and  an  artificial  necrosis, which was cured
in the usual way by a new secretion  of bone  from the perios-
teum. The marrow which it  contains in the adult is  not per-
ceptible in the foetus.   Moreover, the quality of this marrow is
varied by disease; in consumption, dropsy, and other ailments
attended  with great emaciation, a considerable part of it is ab-
sorbed, and a serous fluid deposited in its place; a circumstance
well known to those who  clean skeletons.
                    CHAPTER III.

                      ON OSTEOGENY.

       SECT. I.—OF THE DEVELOPMENT OF THE BONES.

  At birth, though the skeleton is sufficiently solid to preserve
the shape  of the individual, yet it  is very imperfect in many 
68
SKELETON.
particulars, which will be pointed out more in detail hereafter.
At present it may be stated, that the ends of all the long bones
are cartilaginous—the carpus and  tarsus are nearly in the same
state—the vertebras, true and false, have their processes very
imperfect; and consist, each, in several distinct pieces, united by
the remains of the cartilaginous state.  Several  of  the bones of
the head are in the latter condition; and  the sutures are so im-
perfect that the flat bones readily ride over each other from the
thinness of their edges, and also have the angles rounded, which
occasions the vacancies called fontanels.

   From the early embryo state to the completion of the skele-
ton, three stages are observable  in  the  progress  of  ossification;
the first is mucous or pulpy, the  second  cartilaginous, and the
third osseous.

   I. The mucous stage is observable at a very early period after
the  embryo has  been  received  into the  womb, and  presents
itself under two modifications.   In the one, from  the  general
softness of the whole structure of  the embryo, and  from the
apparently homogeneous nature of  its  constituents, the mucous
rudiments do not distinguish themselves from the  other parts:
This condition, however, is soon changed into one,  and that be-
fore the expiration of the first month of gestation, in which they
assume a solidity  and colour, which mark them  off, both to
the eye and to the touch, from the  still softer parts surrounding
them.

   II. About the expiration  of the first  month the mucous stage
is converted into the  cartilaginous, and the  consistence  of the
bones then increases  continually by the accumulation of gela-
tine.  Bichat  makes  a  remark  on  this subject which has been
confirmed by the experiments of Scarpa, though erroneous de-
ductions have been made  by the  latter:, that we  do not sec,
during the formation  of  the cartilages, those longitudinal striae
in the long bones, radiated  in the  flat, and mixed in  the thick
bones, which distinguish the osseous state.  The cartilaginous
state presents another peculiarity worthy of observation:  all the
bones which in a more advanced stage are to be united by carti-
lage, as  the vertebra?,  those of the pelvis, and of the  head, make, 
DEVELOPMENT OF EONES.                  69
 in their groups, respectively, but one  piece; while those which
 are to be united by ligament, and consequently to be moveable,
 as the femur, the tibia, the clavicle, and so on, are respectively
 insulated.   In  the cartilaginous st?te the bones have neither cells
 nor medullary  cavities, and consist in a solid, homogeneous mass,
 the form of which is sufficiently definite; and  has  its surface
 covered  by periosteum.
   The flat bones of the cranium seem to be an exception to the
 general rule of a preliminary cartilaginous  state, and are com-
 monly thought to be such.   Their  appearance is delusive, from
 the cartilage being extremely soft  and thin, and concealed by
 the pericranium on  the  one side, and the dura  mater on  the
 other; but a careful dissection enables  one to distinguish it from
 this double envelope.*

   III. The osseous matter begins to be deposed when the rudi-
 ments of the bone have become entirely cartilaginous, with the
 exception of a few mucous points.   In certain bones this change
 is observable about  the  commencement of the  second montht
 after  conception: J.  F. Meckel  has placed it about  the eighth
 week.  The colour of the cartilage first  becomes deeper;  and,
 in the region  where ossification is to commence, is of a  well
 marked yellow.  The blood vessels, which before this carried
 only the  transparent  part of the blood,  now dilate, so as to admit
 the red particles, and a red point is perceived, called the punc-
 tum ossificationis, from its receiving the first calcareous deposite.
 This deposite is always near the very centre of the cartilaginous
 rudiment, and not at its surface: the portion of cartilage nearest
 to it is of a  red colour; but, a little farther off, opaque and  hol-
 lowed into canals.   The ossification increases on  the  surface of
 the cartilage, and in its interstices, by continual deposites, which
are always  preceded by that condition just mentioned.  The
 canals of the cartilage transmit the blood vessels, and are large
at the beginning of ossification; but, as  the process advances and
is completed, they diminish gradually,  and finally disappear.

  The progress of ossification is somewhat modified in the three
classes of bones.
* Bichat, loc. cit.
t Beclard, loc. cit.  Bichat, loc. cit. 
70
SKELETON.
  In the long bones a small ring is observed to form early near
their centre, and to be perforated on one side by the nutritious
artery.  This ring has its parietes thin, but broad, and its cavi-
ty is  the  beginning  of the medullary canal.   It is  formed of
very delicate fibres which advance towards the extremities of
the bone,* and at the same time increase in thickness; so that
at birth, the body or diaphysis is generally finished.   Common-
ly, at a period subsequent to birth, but differing in the several
bones, their cartilaginous epiphyses also begin to ossify, by the
development in their centre of points of ossification, which pre-
sent the phenomena  mentioned in the last paragraph but one.
The cartilaginous state  of the epiphysis gradually disappears
by retiring from the articular end of the bone towards its dia-
physis;  and, just before its complete removal, it appears as a
thin lamina, gluing the end or epiphysis of the bone to its body.
Several of the apophyses of the long bones are also formed from
distinct  points of ossification.
  The ossification of the flat or broad bones begins  by one or
more points, according to the bone being of a simple shape as
the parietal; of a  double shape or symmetrical, as the frontal,
where there are two points of ossification; or of a compound
shape, as  the occipital and temporal, where there are several
points.  The commencement  of ossification in them,  is also
manifested by the appearance of a red vascular spot in the
cartilaginous rudiment,  in which the  osseous  matter is depo-
sited, and from  which it progresses in  radiated  lines.  The
periphery of this circle of rays presents intervals  between the
fibres, giving it the appearance  of the teeth of a fine comb:
these intervals are subsequently filled up by the sections of radii
starting from  them,  and so on  successively till  the bone  is
finished.  In the infantile head the several radii grow with a
pace nearly equal; so that where the bones are  angular, the
angles being most distant from the  centre of ossification are
finished last of all, from which result the fontanels.  Where the
bones are intended  to  be kept distinct from each other, their
fusion is prevented by a membranous partition;  but when they
are to coalesce into one piece, only cartilage is found, which is
subsequently ossified.
* Bichat, loc. cit. 
GROWTH OF BONES.
71
  In some of the flat bones, as the  sternum and the sacrum,
there are, first of all, a great many distinct points of ossification,
which quickly unite into a  smaller number;  they then remain
stationary for a number of years, but finally all unite into but
one piece.
  The ossification of the thick bones  begins by one or more
points, according to the simplicity or complexity of their figures.
The bones of the tarsus and of the carpus, have each but one
point, while those of the spine have several.   The two former,
as stated, are almost entirely cartilaginous  at birth.  The re-
maining phenomena of ossification in these several bones are the
same as has been mentioned.

       SECT. II.--ON THE MANNER IN WHICH BONES GROW.

  After the cartilaginous condition of  the bones has been sup-
plied by the complete deposite of osseous matter, and they are
finished, with the exception of the epiphyses being fused into the
respective bodies, the bones still continue to grow till the indi-
vidual has reached a full stature. This  is effected by the succes-
sive addition of new matter to the old.   The long bones lengthen
at their extremities; this is proved  by the following experiment
of Mr. John Hunter.*   Having exposed the  tibia of a pig, he
bored a hole into each extremity of the diaphysis, and inserted
a shot; the distance between the two shots was then accurately
taken. Some months afterwards, when the animal had increased
considerably in size, the same bone  was examined, and the shots
were found precisely at their original distance from each  other,
but the extremities of the bone had extended themselves  much
beyond their first distance from the  shots.   The flat bones in-
crease in breadth by a deposite at their margins,  a circumstance
which has  been known a long  time, but it required the ingenui-
ty of Mr. Hunter to prove conclusively that the long bones in-
crease in length  by a similar process, and not by interstitial de-
posite, as  Duhamel thought.  This observation explains  most
satisfactorily the use of the cartilage between the diaphysis and
the epiphysis in  all bones;  that it  is  merely interposed for the

  *  Transactions of a Society for Improvement, vol. ii. London, 1800.  Experi-
ments and Observations on the Growth of Bones. 
72                      SKELETON.
purpose of offering the least possible resistance to the new os-
seous fibres, which grow from the epiphyses and from the dia-
physes: and that it is kept for this  end, without  any material
change in thickness, from the fourth or fifth year to the six-
teenth or  eighteenth,  when it disappears, because there is no
longer any use  for it, in  consequence  of the bones having at-
tained their full length.
  The epiphyses are  then manifestly  intended to favour the
elongation of the bodies and the development of the extremities
of the long bones, to suit the same  purposes in some of the fiat
bones, as those of the  pelvis, and to permit the general deve-
lopement of the bodies of the vertebrae.   The ossification of the
epiphyses  commences in some bones about fifteen days before
birth, as in the  inferior extremity of the thigh bone, and in
others, as those of the ossa innominata, not till  the fifteenth
year or thereabouts.   Many of the  processes from the bones,
are also epiphyses, as the trochanters of the  os femoris, the
tuber of the ischium, the acromion scapulae, the seven processes
of a vertebra, and so on,  and are developed in the same way.
The time  at which they all are thoroughly fused into the bones
to which they belong, extends from the fifteenth to the twenty-
fifth year; depending upon the individual bone, and upon vari-
eties of constitution in different persons: though this process
may be considered as completed, generally, in the  female at
the age of eighteen, and in the male at twenty-one.
  The increase  in thickness of every  bone depends upon a
continued secretion from the internal surface of the periosteum,
at first soft and  mucous,  then osseous: when this secretion is
arrested, the  bones  cease to grow  in  thickness, which com-
monly occurs  some time  after they have attained  their full
length.  The  changes  which subsequently take place in them
are those of interstitial deposite and absorption : the former is
well exemplified  in inflammation of the bones, and in spina
ventosa; the  latter in  the diminution of the bones in extreme
old  age, and in the loss of the alveolar processes.
  There is no period of life in which this interstitial absorption
and deposite is not continually occurring, but it is much more
rapid  in young and growing animals than in the adult and old.
The experiments of Mr.  Hunter and of Duhamel, show,  that
when  a growing animal is fed upon madder, (rubia tinctorum,) 
GROWTH OF BONES.
73
the bones  are  quickly coloured by  it; when the madder  is
withheld, the  bones become  again white; and  that  the  first
appearance of  the restoration of the latter is manifested by a
white lamina being deposited  on their surface.  The madder,
under such circumstances, is a  long  time in getting out of the
bones.  I  fed a young pig for one  month on it, mixed with
other food.  At the expiration of the succeeding five months,
the animal, having grown very considerably, was killed.   The
interior laminae of  all  the bones continued to be deeply tinged,
while their surface from the deposite of new bone had become
white.  From  this  it would appear that deposite is a very  per-
manent thing in bones: it, of course, must  prevail much over
absorption, else their growth would be arrested.
   At the same  time that the periphery of each bone is increas-
ing in its dimensions, the medullary canal  is also augmenting:
this  arises  from  an absorption going  on internally, while the
deposite is  making externally.  Duhamel* proved this  by a cu-
rious experiment.  He surrounded a  cylindrical  bone of  a
young animal with a metallic ring; on killing the animal some
time afterwards, he found the ring covered externally by a se-
cretion of  bone,f owing  to the growth of the latter, and the
medullary  canal  as large as the ring itself.  Notwithstanding
the obvious conclusion from this experiment, he made the  mis-
take of supposing that the bone had enlarged by expansion, and
not by a deposite externally with an absorption internally.
   As the individual advances in life, the cylindrical canal, in
the centre  of the long  bones, continues to enlarge in size by the
internal absorption : so that the parietes of the bones, which in
early life  were much  thicker than the canal, and in the adult
about the same diameter, become exceedingly thin in old age;
resembling thereby a stalk of Indian corn,  with the pith scoop-
ed out.J   The cells of the cellular structure in the  several
bones also  enlarge, whereby the whole weight of the  bones  is
much decreased in the very aged.  In  the parietes of the  cra-

  * Mem. de l'Acad. Roy. des Sciences, an. 1739-41-43-46.
  t If a string be tied around a growing tree, the same thing takes place, and it
is finally shut up in the ligneous part.
  X There are  several examples of this in the Anatomical Museum.  More rarely
the reverse takes place, and  the cavity is filled  up: of this there are also speci-
mens.
   Vol. I.—7 
74
SKELETON.
nium there is rather a tendency to the absorption of the diploe,
and the approximation of their tables.
   The bones, also, become more brittle in old  age, in conse-
qneuce  of the increase  of calcareous,  with  a  diminution of
gelatinous matter.   The reverse being  the  case  in  infancy,
they are more flexible than in the adult,  and  can even bear to
be twisted or bent without breaking.*


           SECT. III.—ON THE FORMATION OF CALLUS.

   As this is  a consequence of bones being fractured, and a mode
that nature takes  to  repair the  accident, there is some  resem-
blance between it and the primitive formation of  bone.   Owing
to the rupture of the blood vessels of the bone; of those of the pe-
riosteum, and of the medullary membrane; and frequently of the
vessels of contiguous  parts, the first effect  of the  accident is  an
effusion of blood  into the  cavity of the  fracture.   The several
contiguous soft parts then swell, become hardened and inflamed;
and, in the mean time, an absorption of the blood is  proceeding,
while an effusion  of coagulating  lymph from the ruptured ves-
sels occurs in the cavity  of the  fracture.   A ring,  the thickest
part of which is precisely over the seat of the fracture, is formed
by the lacerated parts ossifying:  there is also formed in the in-
terior of the bone a sort of osseous pin.   Till this moment the
bone itself remains unchanged, with the exception of a coating
of  coagulating lymph on  its broken faces;  but now its  extremi-
ties begin to coalesce  or fuse themselves into each other, the su-

  * The reported instances are now numerous, where, from a defective organiza-
tion of bone, fracture is produced from very trivial causes; and this state is not
confined to any particular  age, for it extends from infancy to advanced  life.  I
have attended a fractured os femoris in a child of two years, from a stumble in
walking across a carpeted floor.   In another child the os femoris was broken, so
far as could  be learned, by the nurse stooping to reach something from the floor:
the  same child  had both clavicles broken, without any one knowing when or
where: the  left side was flattened, from the fracture, probably a partial one, of
several  ribs, equally inexplicable.  In a third child  the tibia was broken from a
trifling fall on the floor, and the clavicle from striking the shoulder moderately
against the rounded back of a chair.
  In these several instances the fragility may arise cither from a defective rela-
tion of the constituents of the bone to each other, by a deficiency of animal mat-
ter, which diminishes the tenacity of the bone, or it may arise from attenuation
merely of the bone, leaving its points too thin for ordinary accidents. 
FORMATION OF CALLUS.
75
perfluous bony matter (the ring and  the  pin) being  no longer
necessary,  is  absorbed, and  the cavity of the bone with the
membranes of the latter is re-established.*   In this case it will
be seen that the deposite of coagulating lymph into the cavity
of the fracture, corresponds with the  mucous rudiments of the
foetal bone, and that the remaining phenomena of ossification are
the same.
   Some physiologists have attempted to give to the periosteum
the exclusive credit of the formation of callus: the view is erro-
neous, because experiments show, that even where the perios-
teum is stripped designedly from the  fractured  ends of bones,
they, nevertheless, unite, and  the periosteum is restored when
the callus is formed.  The probability then is, that all the blood
vessels (from whatever source they come) which penetrate the
organized coagulating lymph secreted  between the fractured ex-
tremities, convey and deposite calcareous matter.
   The celebrated Bichat and some others, were of opinion, that
in every case  of fracture where the ends of the bones are not
kept in contact, granulations spring up from the ruptured sur-
faces of the bone, and of its membranes; that these granulations
first receive into their interstices a soft gelatinous deposite, then
a cartilaginous one, and, finally, a calcareous one, by which the
bone is united.  This process, however, is much more  common
in compound  fractures which  suppurate, and may be considered
rare in simple ones.

   When the calcareous matter begins to take a place in a  form-
ing  callus, if the part be  much moved, the process  is  arrested,
the  blood  vessels no longer deposite even if they carry  calca-
reous materials, and an  artificial joint is formed.  The proper
period of restoration being once passed, the vessels sink into an
inactive state from which they have little or no disposition  to
rouse themselves.   Under these  circumstances,  Dr.  Physick
proposed,  many years ago, the introduction of a seton through
the  cavity of the fracture, and the retaining of it there for a long
time, for the purpose  of stimulating the vessels.  The plan has

   * J. Hunter, paper by Mr. Home, in Trans, of Society for Improvement. Lon-
don, 1800. 
76
SKELETON.
now been repeatedly tried, with complete success, on the cylin-
drical bones, and, in one instance, upon the lower jaw.*
  Callus is formed much more  speedily in  young persons than
in old:  occasionally, however, we  meet with cases in which the
rapidity of its deposite in the latter  is  remarkable.   I,  for ex-
ample, treated, in 1826, a  female  of  ninety, for a  simple frac-
ture of the os humeri, which  was  cured at  the  end  of  five
weeks.

  * Dorsey's Elements  of Surgery,  Philadelphia Med. and Phys, Jour. &c,
There is  now in the possession of Dr. J. Randolph, the  son-in-law of the late
Dr. Physick, the os  humeri upon which this experiment was first  tried, and
which shows, very satisfactorily, the state of union ; a hole is still left which
the seton occupied, 
*
BOOK I.
                       PART If.
                 Of the Bones, individually.

  The several textures of the body are so intermixed, that the
consideration of one alone, pursued through all its applications,
excludes for  the time, rather artificially, some one or more of
the others.  This circumstance, inseparable from  a clear ac-
count, has always perplexed writers on anatomy, and left them
under various impressions concerning the best point of depar-
ture and method for pursuing their descriptions.   Reasons of
value may be urged for almost any arrangement: each  one
will have some peculiar advantages that the others have  not,
and which will cause it to  appear to the understandings of its
advocates, superior to the rest.  For a course of study which
is intended to be physiological  and surgical in its combinations,
the usual practice of beginning  with the skeleton is, perhaps,
the most advantageous; the young  student will, however, un-
derstand that if the skeleton  have any natural claim to this
precedence, it is  principally from  its  furnishing  those land-
marks, as it  were, to which  we refer  the  situation of other
parts, and that it is only conceded, for the purpose of laying a
foundation for their more easy and intelligible description  sub-
sequently.  The human frame may be compared to an extend-
ed landscape, the multiplicity of whose features and the variety
of objects spread over whose surface, collectively, bewilder the
beholder; but by seizing first on its prominent outlines, marking
the course of its mountains and ridges, and determining the
bearings.of the several objects according to them, we become
able, at length, to  define not only to ourselves, but to others,
the precise position of each point, or each object  which may
become the subject of inspection.
                            7* 
78
SKELETON.
  Unfortunately,  the  minuteness with which the skeleton  is
described has been decried as useless, but the zealous and rea-
sonable student ought to bear in mind—that the only rational
plan of reducing a dislocated joint must depend upon a proper
knowledge of  its  articular faces; that many of the great phe-
nomena of life depend essentially upon the arrangement of the
skeleton; that  locomotion  is inseparably connected with  it;
and that, in short, it has a bearing upon almost every animal
operation.  With these facts impressed upon  him, he  will be
prepared to give  the history of the skeleton a full and' perfect
attention.
                       CHAPTER  I.

                       THE TRUNK.

  The trqnk is constituted by the Spine, the Thorax, and the
Pelvis.

                    SECT. I.--THE SPINE.

  The spine, (Columna Vertebralis, Rachis,) is  placed  at the
posterior part of the trunk, and  extends from the head  to the
inferior opening of the pelvis.  It consists of twenty-eight or
nine distinct pieces, of which  the upper twenty-four are true,
or moveable vertebras.   The twenty-fifth is the sacrum,  or the
pelvic  vertebra, which  is fixed; and the remainder are the
caudal vertebrae or the coccyx.
  On the posterior face of the spine, each  of the  true vertebrae
is seen to contribute, by a long process, to that ridge  which is
so readily felt beneath the skin, and from which, probably, the
name of spine was derived.   The spine increases gradually in
size from the first  to the last true vertebra.  The upper part
of the  sacrum  is extended laterally much beyond  the  latter,
afterwards the  spine diminishes abruptly to the extremity of
the coccyx.   The spine  has several curvatures, which are best
marked in the erect position.   For example, the lower part of
the cervical portion is convex anteriorly, and  concave behind—
the thoracic part  is concave in front, and  convex behind—the 
THE SPINE.                       79
lumbar portion is  convex in front, and concave behind—the
pelvic and  caudal  portion is concave in front, and convex be-
hind.   This arrangement is the result of the different degrees
of thickness in the bodies of the vertebrae, and especially in the
fibro-cartilages which unite them to each other.   Wherever
these  cartilages are  thin  at their  anterior margin, there is a
concavity; but where they are thick at the same  point, there
is  a convexity.
   There are seven vertebras  to the  neck,  called  cervical;
twelve to  the  thorax,  called  dorsal; and five to  the loins,
called lumbar.  In reckoning the number of the vertebrae, the
one next to  the occiput  is always the first; and so on, succes-
sively, to the last.   Albinus, however, has departed from this
rule, and counts them from below, upwards.


             General Characters of a Vertebra.

   A vertebra (vertebre)  consists in  a body, in  seven processes
or extremities, and in a canal or foramen for lodging the spinal
marrow.

   The body of a vertebra is at its fore part; it is somewhat cy-
lindroid  or oval, but varies  considerably from these figures ac-
cording  to its position in the  spine.   The anterior part of the
body  is convex; but the posterior part is concave, where it  con-
tributes to the spinal canal.   The superior and inferior surfaces
are flat,  with the exception of  a ridge of hard bone at the cir-
cumference, more elevated, and not so extended in some bones
as in others.   These ridges  are, in  young subjects, epiphyses.
There are  many foramina,  large and small, to be seen on the
front and back surfaces of the bodies.  They transmit arteries
and veins, and some  of them  are used for fastening the liga-
ments of the spine.  On the posterior face of the body there
are two  foramina  larger than  the  others, occupied by veins
coming from the interior of the vertebra.   These veins corre-
spond with the diploic sinuses in the head, and have been parti-
cularly described by M. Breschet, of Paris, in a thesis present-
ed to  the School of Medicine in 1819.

   The processes are placed at the posterior part of the vertebra. 
80
SKELETON.
Of these there are four oblique or articulating processes, which
articulate with the corresponding ones of the bones, above and
below;  two transverse  processes, which project, one on either
side, from between the oblique processes; and one spinous pro-
cess,  which is placed on the middle of the bone behind.   The
two oblique, and the transverse process on each side, come from
a common base or root that arises from the lateral posterior part
of the body, and  present collectively  a very irregular appear-
ance.  Their faces  and inclinations are much modified in the
several vertebrae.   The spinous process is also much modified
in regard to size, shape, and inclination.

   The body and processes form the periphery of the foramen
for the  spinal  marrow, and, by their  thickness and  strength,
afford an excellent protection to the latter.  This spinal fora-
men is of a triangular shape, presenting its base in front and its
apex behind.   It is considerably larger than the spinal marrow
of the part, including its vessels, membranes, and the nerves
that proceed from it; in this respect the foramen differs very
materially from the  cavity of the cranium, which is exactly
filled by the brain.
   At the upper part of the spinal foramen of a vertebra, between
the body and  the upper articulating,  or oblique process, is a
groove.   There is another groove between  the lower oblique
process and the body.  These grooves, by the approximation of
the contiguous vertebrae, are converted  into perfect holes, called
inter-vertebral foramina, and are  for  the transmission of the
spinal nerves and blood vessels.
   The bodies of the vertebrae are extremely light and spongy,
being formed principally of the cellular matter of bone, and are
covered, with the exception of their upper and lower surfaces,
with a very thin lamella of compact substance.  The processes,
for the most part, have a thick and compact  structure, enabling
them to sustain conveniently the weight of the body and the ac-
tion of the different muscles, as applied to them.

            Of the Cervical Vertebra, generally.

  The cervical vertebras differ among themselves, but are dis-
tinguished by certain  common properties from the other bones 
THE SPINE.
81
of the  spine.  Their bodies and processes are small, but the
spinal foramen is large, so as to admit of much motion, without
pressing on the spinal marrow.  The fore and back parts of the
body are more flattened.  The upper face is concave transverse-
ly, being bounded on each side by a ridge of bone; the lower
face is concave from before backwards, and is bounded by a
ridge before and behind.  This arrangement permits the bodies
of adjoining vertebrae to embrace each other in the dried bones,
and grants great facility of motion, in the living  body, by ths
interposition of the intervertebral substance, as well as securi-
ty in the attachment of the latter.
   The oblique processes have  their articular faces at an angle
of about forty-five degrees.   The superior face upwards and
backwards, the inferior downwards and forwards.  The spinous
process is short, triangular, nearly horizontal, and  bifurcated at
its posterior extremity, where it  terminates in two tubercles.
The transverse processes are short, and perforated by a large
canal for the transmission of the vertebral artery and vein; they
are concave above, somewhat convex below, and present two
points at their external extremities for the origin  and insertion
of muscles.   The inter-vertebral foramen is formed principally
by the lower of the contiguous vertebrae.


            Of the Cervical Vertebra,  individually.

   The first cervical vertebra, commonly called the Atlas, from
its supporting the head, presents the appearance of a large ir-
regular ring, much thicker at its  sides than elsewhere.   It is
deficient in body, owing  to the space allotted to that part in the
other vertebrae being occupied by the processus dentatus of the
second vertebra.  The place of body  is supplied by an arch of
bone.
   Its  oblique processes are peculiar, both in shape  and position.
The upper ones are concave and horizontal, their long diameters
being extended from within outwards and backwards, so as to
suit the direction  of the condyles of the occipital bone with
which they artieuJatc, the greatest depth of their  coneavity is,
therefore, internal.  The inferior oblique processes are smaller,
slightly concave, and  circular; they rest upon the shoulders of
the second vertebra.  At the internal margin of the oblique pro- 
82
SKELETON.
 cesses a rounded tubercle is found on either side of the  bone.
 The  transverse ligament of the neck is extended between the
 two tubercles, and keeps the processus dentatus in its place.
   The short thin bridge at the fore part of the bone, is marked
 in front by a  tubercle, and  behind by an articular face which
 touches  the processus dentatus.  The bridge  or  section of the
 ring forming the posterior part of the bone, is  much longer and
 more arched than the anterior.   It also has in its centre a tu-
 bercle, occupying the position of a  spinous process.  At the
 anterior extremity of this bridge, just behind the  upper oblique
 process, there is a groove, and sometimes a canal, made by the
 vertebral vessels, just before they enter the foramen magnum
 occipitis.
   The transverse processes of this vertebra are at the sides of
 the thick part of the ring.  From  their greater length, they pro-
 ject considerably beyond the transverse processes below, and
 are also perforated at their bases by the vertebral vessels, which
 have a very winding course from them into the cranium.
   The spinal canal of the first vertebra, excluding the space for
 the processus dentatus and transverse ligament, is the largest in
 the spine: by which ample provision is made against injuries of
 the medulla spinalis,  notwithstanding the great latitude of the
 rotation  of this bone upon the second vertebra.   A  considera-
 ble vacuity  is left between  the upper posterior margin of the
 atlas and the contiguous surface of the os occipitis, for the gin-
 glymoid motion of the head upon the atlas.

   The second vertebra of the neck is particularly remarkable
 for the elongation of its body above into the processus dentatus
 or tooth-like process.  This process rises as high as the superior
 margin of the atlas, and  almost touches the anterior margin of
 the foramen magnum occipitis.*  It presents an articular face
 in front* where it touches the first vertebra.  It presents also a
 smooth face behind, where it touches the transverse ligament.
Above the latter face, on each side, is a flat surface for the ori-
gin of the moderator ligaments, and the very  point above pre-
sents a small rough surface for the vertical ligament going to
the margin of the foramen magnum.
* Sometimes it even forms a joint with it. 
THE SPINE.
83
  On each side of the tooth-like process, this bone presents its
superior oblique process, as a shoulder, nearly horizontal, circu-
lar, and somewhat convex.   The  inferior oblique process has
nothing peculiar either in  its position or direction.  The  fora-
men of the transverse process is directed upwards and outwards.
The interior part of the body, like that of the  other vertebra?,
is cellular.
  The posterior part of the second vertebra is strong and broad.
The spinous process is longer than any other except the seventh,
and sometimes the  sixth;  it is also much larger,  is triangular,
presents a ridge above and a fossa below, and  is bifurcated at
its extremity.   Just behind the upper oblique process  there is
a very superficial  notch, scarcely discernible, for  the inter-
vertebral foramen.   The processus dentatus is the pivot or axle
upon which the head  revolves, and is stationary while  such
motions are going on.
  The vertebrae of the neck increase gradually in the size of
their bodies from the  second to the seventh; and there is suffi-
cient uniformity between  them, wth the exception of  the last,
to render the general description applicable,  though  it is not
difficult to observe some minute and unimportant points of dif-
ference.
  The spinous process of the sixth vertebra is long, and termi-
nates in a sharp point.
  The seventh cervical looks like a  dorsal vertebra, and has
some peculiarities which are well  marked.   Its body is larger,
its superior face is less concave than in the others, and its infe-
rior face is flat.  Its spinous process is the longest of all, is not
bifurcated, but terminates by a rounded tubercle easily felt be-
neath the  skin.  Its transverse processes are thrown somewhat
backwards, and though there  is a small foramen in them, it is
not large  enough to receive the vertebral vessels.   Sometimes
on the side of its body, at the lower margin, is a small  face, by
which it partially articulates with  the head of the first  rib.
  M. Portal*  reports, that in some rare cases he has seen only
six, and in others, eight cervical vertebrae, with neither of which
deviations have I ever met.
* Anat. Medicale. Paris, 1803, 
84
SKELETON.
                  Of the Dorsal Vertebra.

  General  or  Common  Characters.—The  dorsal vertebras,
amounting to twelve, being intermediate in position to those of
the neck and loins, are also intermediate in size.  They diminish
in the transverse diameter of their bodies from the first to the
third: afterwards, they increase regularly in size to the last.
  Their bodies are more  cylindroid than those of the neck, and
the most of them  are marked laterally on the upper, and also on
the lower margins, near the base of the processes, with a small
articular face, which receives one-half of the head of a rib. The
adjoining fossa of the contiguous vertebra, receives the other
half of the head of the same rib.   The superior of these articu-
lar faces is larger than the inferior.   The superior  oblique pro-
cesses are flat, and  present almost backwards; the inferior are
also flat and present as directly forwards.  The transverse pro-
cesses are directed  obliquely backwards: they are  long, termi-
nate in an enlarged  extremity, which presents an articular face
in front for the tubercle of the contiguous  rib. The transverse
processes as they descend are directed more backwards, and di-
minish in length.  The spinal processes are long, triangular, with
a broad base, and an extremity somewhat rough,  swollen, and
sharp-pointed, except in the  upper and lower vertebrae:  they
have a ridge above and  a fossa below; are directed obliquely
downwards,  and overlap each other.
   The spinal foramen is small and round.   The notch for the
inter-vertebral foramen  is formed principally by  the vertebra
above.

             Of the Dorsal Verlebrce—individually.

   These vertebras,  though they have many common points of
resemblance, yet some of them present distinguishing peculiari-
ties.  Of these, the first  and the two or three last, are  the most
remarkable.
   The first has a complete articular face on the  side of its body
 for the head of the first rib, and a partial surface at its lower
 margin for the head of the second  rib.  Its spinous process  is
 projecting and not so oblique as some of the others:  the flat-
 ness  of its body  makes it look much like a cervical vertebra. 
THE SPINE.
85
  The three lower dorsal vertebras approach in the form of their
bodies to  those of the  loins.   Frequently, but  not always, the
tenth has  the articular face for the head of the rib, equi-distant
from its upper and lower margins, and its transverse process so
short, and inclined backwards, that the tubercle of the tenth rib
does not form an articulation with it.  The eleventh and twelfth
vertebrae have also the fossae for  the heads of the ribs, in their
middle, at the sides of the roots  of  the processes; instead of a
partial pit at their upper and lower  margins.  Their transverse
processes are remarkably short, are directed almost backwards,
and do not touch  the ribs, and have therefore no articular marks.
The spinous process departs from the triangular  shape, becomes
flattened and vertical at its sides, is  not far from being horizon-
tal, and has  a tubercle at its extremity.
   The middle vertebrae of the back  have some minute points of
difference among themselves, the most of which it would be
useless to study.  They increase, as stated, gradually  in size as
they descend, and their spinous  processes are very near to, and
overlap each other, like shingles on the roof of a house.


                   Of the Lumbar  Vertebra.

   Common  Characters.—Their number has  been stated at five.
Their bodies are larger than those of the other true vertebrae,
and are oval on the upper and lower surfaces, with the long di-
ameter  transverse.  The epiphyses at the  margins  of  these
faces, are  larger and  more elevated.  The  spinal foramen is
triangular and more  capacious  than in  the  dorsal  vertebrae.
The inter-vertebral notches for the nerves to pass out, are  much
larger than  elsewhere in the spine, and are formed principally
by the upper of the two contiguous vertebrae, though the diffe-
rence is not very remarkable.
   The transverse processes arc very long, and stand out at right
angles.   The articular faces of the upper oblique processes ate
concave and vertical,  being directed very  much inwards, or
looking towards  each  other;  the lower oblique processes are
convex, and have  the  articular  faces directed very much out-
wardly.   The spinous  process is short, thick, and horizontal;
having broad, flat sides, and terminating by an oblong tubercle.
   Vol. I—8 
86
SKELETON.
               Of the Individual Lumbar  Vertebra.

    These bones are not so well marked among themselves as the
  other vertebrae.  They may be distinguished in a single set, by
  the successive increase in the size of their  bodies.   The first,
  therefore,  is known by its smallness; by the comparative short-
  ness of its transverse process, and by the deep concavity between
  the superior oblique processes.
    The  transverse  and  spinous  processes  of the three middle
  vertebrae are rather longer  than those of the others;  the third
  has them the longest  of all.  The last lumbar vertebra may be
  recognised by its greater size; by its body being flat, and deeper
  in front than behind, so as to give it somewhat of a wedge shape;
  by  the greater size of its spinal foramen; by the obliquity back-
  wards  of  the transverse process;  and by the wide interval be-
  tween the oblique  processes, as well as by  the lower of the lat-
  ter facing almost directly forwards.


                     Of the Pelvic Vertebra.

     The  os sacrum,  (sacrum,)  the largest by much of any of the
  bones in the spinal column, has obtained its name from the sup-
  position of its having been offered in sacrifice by the  ancients.*
  It  forms the posterior and  superior boundary of the  pelvis, as
  well as the pedestal of the spine, and may  therefore be properly
  studied along with eithtr  of them, though its  association with
  the spine seems more natural.   In its lateral boundaries it is tri-
  angular: it is also regularly concave  before, and  very irregularly
  convex behind.
     In its forming state this bone consists of five  pieces, separated
  by long narrow interstices filled with  cartilage.   It  is in this
  condition that its pieces bear a very strong resemblance to the
,  true vertebrae, and therefore have  obtained  the  name of false
  vertebrae.   They  are all fused into one by the  progress and de-
  velopment of the bone; but the marks of the original  separation
  remain, particularly on its front surface.
     Though the anterior face  of the  sacrum presents generally a
* Portal. Anat. Med. vol. i. 345. 
THE SPINE.
87
regular concavity; in some subjects, nevertheless, it is flat.  This
surface is pierced on each side by four holes, which communi-
cate with the spinal cavity and transmit the anterior nerves of
the cauda equina.   Beneath each range of holes is a notch, which
by the corresponding one of the  coccyx, is  converted occasion-
ally into a perfect foramen for the thirtieth spinal nerve, or for
the fifth of the sacrum.   These foramina diminish in size,  from
the higher to the  lower:  their orifices are funnel-shaped,  and di-
rected obliquely outwards.  Horizontal ridges of bone, marking
the original  separation  of the  false vertebras, connect the holes
of the two sides.                                          »
  The false  vertebrae decrease in size  from above, which  is ma-
nifested by the successive approach of the foramina, and  of the
horizontal ridges.   The first of them has almost the same verti-
cal diameter as the last of the  loins, besides its great increase of
magnitude by the lateral  extension of  its base.
  The posterior face of  the sacrum is very convex and  rough,
and is equally divided by its spinous  processes.  The processes
belonging to its three upper sections or bones, are for the  most
part well marked, and decrease in length from  the first.  The
fourth spinous process is  resolved into two  tubercles, and the
fifth  is fairly separated  also into  two tubercles, by an angular
fissure, with its base downwards and open.   This fissure, it may
be remarked, sometimes  invades the fourth spinous process, and
even the third, and in some rare eases runs the whole length of
the posterior surface of the bone, leaving a gap from one end to
the other.  The upper margin of the posterior face of the  sacrum
presents  on  each  side  an  oblique process for articulating  with
the lower oblique processes of the last lumbar vertebra.  Just
above the upper spinous process is a deep notch,  between  which,
and the last  lumbar vertebra, is a very large  vacuity, or gap, ex-
posing the spinal  canal.
  On each side of the spinous processes are also four foramina,
smaller and  thinner  than those  in front, and for the passing of
the posterior nervous cords from the cauda equina.   At their in-
ternal margins some  small and obscure risings of bone are per-
ceptible, which may be considered the rudiments of oblique pro-
cesses.   On the outer side of these foramina, there are  several
more strongly marked tubercles, from which the sacro-iliac liga- 
88
SKELETON.
ments arise.   After these the posterior surface of the bone slants
very considerably to its lateral margin.
   The base of the sacrum presents in its middle an oval surface
for articulating with the  last lumbar vertebra.  Between this
surface and  the oblique  process, may be remarked the groove
for the fifth lumbar nerve.  The base of the sacrum continually
thickens, from the side of the oval surface to the place of junc-
tion with the ilium.  The anterior margin of this expansion is
continuous with the linea  ilio-pectinea;  the  posterior margin is
elevated at its extremity, is a substitute  for a transverse process,
and is placed immediately below the transverse of the last lum-
bar vertebra.   The point  of  the sacrum is truncated where it
articulates with the os coccygis.   The lateral face of the sacrum
is thicker above than below; its  upper two-thirds present an ir-
regular,  and somewhat triangular face for joining the ilium; the
lower third is very thin, and contributes to form the sacro-scia-
tic notch of  the pelvis.
   The spinal canal of the sacrum is triangular, and diminishes
continually to  its lower extremity, where  it  terminates by a
small orifice, notched  behind, as mentioned, and  exposing the
last piece of the bone.  The  foramina  on the anterior and pos-
terior surface of the sacrum, communicating with this  canal, cor-
respond  strictly in their uses and positions with the inter-verte-
bral foramina of other parts of the spine.
   The sacrum is extremely light for its size, and  its texture is
in  a high degree spongy; but its processes and articular faces
are quite as compact as they are in other parts of the spine.


              Of the Coccyx or Caudal  Vertebra.

   The os coccygis (coccyx) resembles the sacrum in shape and
texture, and is so placed as to  continue forwards the line  of the
curvature of the sacrum.  It  consists in four pieces, sometimes
only three, united to one  another by fibro-cartilaginous matter,
and it corresponds with the tails  of animals.   These pieces  in
the progress  of life, are not only anchylosed together, but also
with the  sacrum; so that all the false vertebrae,  from the base of
the sacrum to the  point of the coccyx,  are joined into a single
bone. 
THE SPINE.
89
   The upper bone of the coccyx is the largest, and is the base
 of this little pyramidal  pile;  it is united, by its middle, to the
 truncated apex of the sacrum; and its sides, moreover, are, in
 the perfect specimen, elongated  several lines beyond this sur-
 face of contact.   From  the posterior surface of the first bone,
 of the perfect coccyx, a  tubercle arises on either side, which is
 curved upwards, and joins the bifurcated termination of the last
 spinous process of the sacrum: between the two bones an inter-
 vertebral foramen is thus left for the passage  of the fifth sa-
 cral nerve from the  canal of the sacrum.  Immediately below
 this tubercle is a notch, made by the sixth sacral nerve.
   The remaining bones of the coccyx are  much smaller  than
 the first, and diminish successively.  The surfaces which they
 all present to each other are somewhat concave in the centre.
 The lower end of the last bone terminates in a rough point, to
 which a cartilage is  appended.  These bones, are very spongy
 and light: their principal strength is derived from a ligamentous
 covering. To them are attached the sacro-sciatic ligaments, the
 coccygaei, levatores  ani,  and the glutaei magni muscles.


      SECT. II.—DEVELOPMENT OF THE VERTEBRAL COLUMN.

   This column is  much longer, in proportion to the limbs, at
 birth, than it is in adult life, and upon it depends the principal
 length of the individual at this period.   The head is  always in
 proportion to the length of the spine.   This  predominance  in
 the head and spine  is, no doubt, connected with the necessity
 of an early development in the nervous, respiratory, and ali-
 mentary systems, in  order to maintain the life of the individual;
 whereas, the use of the upper and lower extremities being called
 for only at a more advanced period,  their development  is not
 in proportion.  It is remarked, that in  adult life the principal
difference in the stature of individuals depends upon the length
of the  lower  extremities;  the  trunk, including the head, being
of nearly the same length  in all.   This rule, however, like most
others, has numerous  exceptions. The spinal canal and the inter-
vertebral foramina are, also, proportionably larger in the fcetus.
  The spine of the fcetus  is but badly suited to the purposes of
standing and walking.   Its spinous processes are deficient, in
consequence of which, the muscles which are intended to keep
                            8* 
90                       SKELETON
it erect, have their insertion so much in the line of motion, that
they perform their part very imperfectly, and the spine is con-
tinually bending  forwards,  from the erect  position.   All the
transverse processes are also  imperfectly developed,  those of
the loins are particularly deficient; those of the thorax and neck
are less deficient; as in the one case they have to form an arti-
cular surface for the ribs, and  in the other to allow passage to
the vertebral artery.  The bodies of the vertebrae are imper-
fectly ossified, and are separated by cartilage from the processes.
The epiphyses, or upper and lower surfaces of the bodies, are
in the state of cartilage: the bodies, therefore, are rounded both
above and below, whereby their  surfaces of contact are much
reduced in extent, and the line of support to the trunk rendered
much less firm.   When, at this  age, the vertebrae are macerated,
their bodies present themselves as small rounded tubercles; and
very nearly one-half the whole length  of the spine is  made up
of the cartilaginous epiphyses and the inter-vertebral cartilages«
The spine, in the fcetus, is almost straight, and scarcely  presents
 at all those curvatures, for which it is so remarkable in adult
 life.  This depends upon the rounded form of the bodies of the
 vertebrae, and the sameness of thickness in the  inter-vertebral
 matter at its anterior and posterior edge.

       SECT. III.—ON THE USES OF  THE VERTEBRAL COLUMN*

   The vertebral column performs three important offices in the
 animal economy.  It affords a secure lodgement  to the spinal
 marrow;  is a line  of support to  the trunk, in every variety of
 position; and is the centre of all  its movements.
   In standing, the spine also  supports the  head, which it can
 do very conveniently, from the horizontal direction of the con-
 dyles and their nearly central position on the occiput, and from
 the head being ahnost in equilibrium when we stand erect. The
 volume of the head is so much greater before the condyles than
 behind them, that upon a superficial  view one would suppose its
 preponderance in front to be very considerable.   This is, how-
 ever, less than it might see-m to be, for two reasons: one is, that
 the diameters of the head are  augmented behind the condyles,
 and, secondly, it is formed of solid matter; whereas, in front
 a great deal of it is hollow, foF the construction of the nose and 
VERTEBRAL COLUMN.
91
the sinuses bordering upon  it.   The  head, though  nearly ba-
lanced, has some preponderance in front, which is  manifested
by its falling forwards whenever we sleep in the erect position,
or when the sudden suspension of life destroys the contraction
of the muscles on the back of the neck.
  In the lower orders of animals, the obliquity of the condyles,
their situation at one end of the head, and the great length of
the face, acting as a weight upon a long lever, have  a continual
tendency to incline the head downwards; which is only par-
tially counteracted by the  largeness of the muscles and  liga-
 ments on the back of the neck.
   The horizontal direction of the condyles, and  their location
 near  the centre of the base of the head, have arrested the atten-
 tion of naturalists, and  established  for man characters distin-
 guishing him, from  all other animals, for facility in maintaining
 the erect attitude.  Bichat happily observes, that from this con-
 formation result the following peculiarities in his organization:
 1. Less strength in the muscles of the neck than in quadrupeds;
 2. Less projection in the occipital bone, where the muscles are
 inserted; and, 3. An imperfect development of the ligamentum
 nuchas.
   The thoracic and abdominal viscera, by being placed in front
 of the spine, and having no counterpoise  behind, have a conti-
 nued tendency to bend it.  This is only resisted by the mus-
 cles which fill  up the long  gutter on either side of  the spinous
 processes, and are inserted into the ribs, the spinous and the
 transverse processes.  The lumbar vertebras and the appertain-
 ing muscles  and ligaments, having an increased duty to per-
 form, from the lowness of their position, and the variety of their
 movements, become the soonest affected by fatigue and bodily
 weakness; and therefore manifest  sooner the sensation of las-
 situde, notwithstanding  the augmented volume of the bodies
 and  processes of the vertebras, and of the muscular masses in-
 serted into them.
   The mechanical arrangement of the spine permits it to per-
 form the motions of flexion, extension, lateral bending, circum-
 duction, and rotation.

    1. Flexion, or that posture in which  the spine  is  bent for-
 wards, is the most extensive of its  movements: the general me- 
92
SKELETON.
chanism of the human body disposes us to approach surround-
ing objects in that direction; and the muscles of the abdomen,
besides  their intrinsic strength, act most advantageously in pro-
ducing  it, by being removed to a great distance from the centre
or line  of motion.  In this position  the  inter-vertebral carti-
lages are diminished or compressed in front, and thickened be-
hind, the anterior vertebral ligament is in a state of relaxation,
while the posterior vertebral ligament and those which connect
the spinous processes are in a state of proportionate tension.

   2.  The motion of extension, on the contrary, is much more
limited  from several causes.   The muscles which act in this
case, by arising either from the posterior face of the pelvis, or
from the transverse  processes, and going upwards to be insert-
ed either into the ribs, the transverse or the spinous processes,
are much less advantageously placed than the abdominal  mus-
cles,  in regard to the length of the lever which  they employ.
Moreover, mechanical obstruction is opposed to this motion by
the spinous processes of the back and neck, being very near to,
and overlapping  each other.  The abdominal muscles also af-
ford a  strong resistance to its being  carried beyond a certain
point as any one may assure himself of, by the tension commu-
nicated to these muscles from placing a large billet of wood un-
der the  loins of a  subject; and, when they are cut through trans-
versely, the immediate consequence is, a great increase in the
posterior flexion  of  the spine, through the agency of the lower
dorsal and the lumbar vertebras.  The anterior vertebral and
the inter-vertebral ligaments, likewise, oppose the extension of
the spine, much more  than the elastic and the inter-spinous li-
gaments do its flexion.
o

  3. The  lateral  inclination of the spine is a motion of consi-
derable extent, and is obtained both by the very advantageous
position of the muscles  on the side of the trunk and neck, and
by the little mechanical resistance to it from  the shape and ar-
rangement of the parts concerned.  A principal impediment to
this motion being carried beyond a certain  point, is presented
by the ribs striking  against each other.   The transverse pro-
cesses of all  the vertebrae are so far apart, particularly in the
loins, that they scarcely deserve  to enter into the estimate  of 
VERTEBRAL COLUMN.
93
resistances.   As  the muscles of the one side produce the late-
ral curvature, so their resistance on the other limit it to a cer-
tain  extent, as may be  readily  ascertained by cutting  them
through.

  4. The circumduction of the spine is that  motion in which
the trunk is  caused to describe a cone, the base  of which  is
above, and the apex below.   It  is performed on the lower dor-
sal and the lumbar vertebras, and is a  succession of the move-
ments already described.

  5. The rotation of the spine is a very limited motion.   It  is
performed almost entirely on  the lower dorsal and the upper
lumbar vertebras, and presents in its analysis a series of minute
and oblique slidings of the body of one vertebra upon another,
the pivot being the oblique  processes.  The  action occurs by
the lateral yielding of the inter-vertebral  substance; it  must,
therefore, be  almost inconceivably small in any individual sub-
stance, particularly when the  latter has been hardened and ren-
dered  more fibrous by old age.  In  the very young subject it
is more appreciable.

       Of the Motions peculiar to each Class of Vertebra.

   1. The cervical  vertebras, as a whole, enjoy a  considerable
share of flexion, extension, lateral inclination: and of circumduc-
tion, as the result of the other motions.  Their rotation, or the
oblique sliding of one vertebra upon the other, is very limited.
The apparent facility with which they are  twisted upon each
other,  when the face  is turned  to  the shoulders alternately, is
almost wholly the motion of  the first vertebra upon the second,
the participation of the other vertebrae being very inconsidera-
ble.   The possibility of the dislocation of these vertebrae, with
the exception of  the  first,  is  very stoutly denied by authorities
of the first  standing in anatomy, on the score that too great a
resistance to this  accident is  afforded by the inter-vertebral and
yellow ligaments, by the inter-spinal and inter-transverse mus-
cles, by the inter-locking of the bodies of the vertebrae through
their reciprocal concavities and convexities, and by the shape
and extent of their oblique processes. 
94
SKELETON.
  Some years ago, I met with a case in which there was every
reason to believe that a  partial displacement or dislocation had
occurred about the fourth vertebra, in a boy of eight or ten years.
It rose from his struggling to extricate himself from  the grasp
of a school-mate, who held him near the ground by the back of
the  head, with  the  spine bent forwards.   This  position, it is
evident, was calculated to lift the oblique processes of the verte-
brae over each other; and an oblique force applied at the same time
consummated the accident, by twirling the  lower oblique process
over the upper  margin, and  in front of the one with which it
was articulated  below.   The  displacement was  manifested by
inability to move the neck; by a permanent inclination and turn
of the head to the side opposed to the injured  one; and  by an
inequality in the range of the  anterior points of the transverse
processes of the side affected.   I succeeded in replacing the bone
by lifting its  dislocated side over  the lower  oblique process,
communicating at the same moment  a  rotatory motion,  the re-
verse of that  by which  the  accident had happened.   In an in-
stant, the patient was relieved; from  extreme pain, fixed defor-
mity, and inability to move the neck, he performed with freedom
all  the motions  natural to the part.
   The principal motions of the head upon the  first vertebra are
those of flexion and extension: the power of the condyles to
slide horizontally from one  side to  the other in the cavities
formed in the atlas, is excessively restricted, both by the shape
of the proximate articular surfaces, and by the arrangement of
the ligaments: this motion is, in fact, so  inconsiderable as scarce-
ly to deserve notice.  Even flexion and extension appear greater
than they actually are,  in consequence of the lower  vertebrae
most commonly concurring in these motions.  When  simply
the head is flexed upon the atlas, while the other vertebras are
kept erect, the chin approaches the sternum, and the skin of the
neck is  thrown  into folds; but when all  the bones are flexed,
the head is thrown  forwards and the skin is kept tense.  The
flexion of the head  upon  the atlas is restricted by the ligamen-
tum nuchas, and by the  ligament  passing from  the  posterior
margin  of  the occipital foramen to the posterior bridge of the
atlas.  The  extension of  the head  is restricted by the vertical,
moderator, and anterior vertebral  ligaments.
  The motion of the atlas upon the  axis is  limited strictly to 
VERTEBRAL COLUMN.
95
rotation.   The confinement  of  the processus dentatus  by the
transverse ligament behind, and by the anterior bridge of the
first vertebra in front, prevents thoroughly both flexion and ex-
tension.  The horizontal direction and  the flatness of the cor-
responding articular  faces  of these  two vertebras, also prevent
any lateral inclination.  In compensation for these restrictions,
the rotatory motion is enjoyed to  great extent, and  is amply
provided for, by the extreme looseness  and thinness of the cap-
sular ligament of the oblique processes.   In this motion the arch
of the atlas and the transverse ligament rotate on the tooth-like
process to the right and left alternately; at  the  same time the
inferior oblique process of the atlas is  slid  either forwards or
backwards, according to the general  movement upon the upper
oblique process of the dentata.  This movement is checked, at
a certain  point, by the moderator ligaments, which, by the close
connexion of the  head and first vertebra, answer the same pur-
pose as if they were inserted into the latter.   It is also checked
by the capsular ligament, notwithstanding the general laxity of
the latter.   But  still  it is  not difficult  for it to exceed its natu-
ral bounds, and for the oblique process  of the atlas to pass com-
pletely beyond the margin of that of the dentata, and in return-
ing to  lock against it.  This, in fact, happens, in the great majo-
rity of instances, where violence from falls, and so on, has been
applied to the body, and results in injury  to the neck, particularly;
and when, in the abrupt turning  of the head, produced by the
action  of the muscles, the  individual finds himself incapable of
bringing  it back.   This articulation  is, unquestionably, less pro-
tected, and  more exposed  to accident, than  any  other in the
spine;  and, as just stated, is therefore supposed, by some, to  be
the only  one in the neck admitting of luxation.
  Most frequently, in this  luxation, when it  is produced by ex-
ternal  violence, death  is the  immediate result, from the spinal
marrow being pressed upon  and  disorganized above the origin
of the phrenic nerve.  The seat of the  principle of respiration
is in the  medulla oblongata, and its  agents are the phrenic and-
the intercostal nerves; the communication  with which being
thus cut  off, respiration, and consequently circulation, stop im-
mediately.  Bichat thinks, that, when  death is  thus  suddenly
produced, the processus dentatus, by rupturing its own ligaments
connecting it to  the occiput, slides  by the falling of  the  head 
96
SKELETON.
 forwards, beneath the transverse ligament, and presses upon the
 spinal marrow.   On the contrary, when it is  a  simple displace-
 ment of the oblique  processes, as the odontoid process remains
 within its boundaries, and its ligaments are only stretched, there
 is no danger of death.  Fatal accidents have happened to this
 articulation, by holding an  infant from  the ground, by the two
 hands applied to the head, from his struggles  to disengage him-
 self.   A posture-maker is  said  to have died on the spot, from
 communicating a rotatory motion to his trunk, while its weight
 was sustained by inverting  his head, and making the latter the
 base of support.  When the vertebras are displaced in such per-
 sons, as well as in  those  hung by the neck, it  is supposed that
 this sliding of  the  processus dentatus from  beneath  the trans-
 verse  ligament takes place; as, by experiments  on the  dead
 body, it is found that such displacement occurs much more rea-
 dily than the rupture of the transverse ligament.

   2.  The dorsal vertebrae are capable of but very little motion
 in any direction.  The rigidity and length of the  sternum pre-
 vent them from flexion, the  overlapping and  obliquity of  their
 spinous processes prevent them from extension, and the ribs pre-
 vent them from lateral inclinations.  It is, however, to  be ob-
 served, that as those  obstacles are diminished, successively, in
 the five lower dorsal  vertebrae, consequently they become more
 and more capable of motion upon each other.  Luxation  among
 them, at any point, is thought to be impossible, from the strength
 of their ligamentous attachments, and from the  arrangement of
 their articular faces.

  3. The lumbar vertebrae  move with  great  comparative  free-
 dom upon one  another; admitting, as  stated,  of flexion, exten-
 sion, and  lateral inclination.  Below, however,  they  are much
 more restrained  than they are above;  hence, it results, that the
principal seat of the motions of the trunk  upon the spine, is
about the connexion of the  lumbar and  dorsal vertebras.   Dis-
location  is  here,  also,  thought to  be  impossible,  from  the
strength of their ligamentous attachments, from the  great dia-
meters of their bodies, and  from the deep interlocking of the
oblique processes. 
OSSA INNOMINATA.
97
             SECT. IV.—OF THE OSSA INNOMINATA.

   (Os Coxaux, ou des Isles.)—These bones, two in number, are
 situated one at either side of the sacrum, and constitute the la-
 teral and anterior parietes of the pelvis; forming, along with the
 sacrum and coccyx, the whole of this latter cavity.
   The os innominatum, from  having been, in its original state,
 in three pieces, notwithstanding they subsequently coalesce firm-
 ly in the adult, and preserve  scarcely any vestige  of their pri-
 mitive distinction, is divided  by anatomists into ilium, ischium,
 and pubes.

   Os Ilium, (Ilion.)—This, the  largest of the three portions,
 forms all the upper rounded part of the os innominatum, and is
 the haunch bone of common language.   Its  superior margin is
 a  semicircle, rather thicker towards the extremities than in  the
 middle.   The inequality, when viewed from above, is very  ap-
 parent, as well as a slight curvature  resembling the letter  S.
 This margin of the bone is called its crest or spine, presents an
 internal lip for the origin of the transversalis abdominis muscle,
 an external  one for the insertion  of the obliquus externus, and
 an intermediate edge for  the origin of the obliquus internus.
 The anterior extremity of  the spine is terminated by a project-
 ing point, called   the anterior superior spinous  process, from
 which arise  the  tensor vaginas femoris, the sartorius, and the
 beginning of Pcupart's ligament.  The posterior extremity of
 the crest  is  also  projecting and  pointed, but less  so than  the
 other, and obtains  the appellation of the posterior superior spi-
 nous process.                                             k
   The anterior margin of  the os ilium is unequal, and divided
into two portions,  of nearly the same length, by a  strong, well-
 marked projection, the anterior inferior spinous process, which
 is  placed  an  inch and a  half below the anterior superior, and
gives origin  to the rectus femoris.   This margin joins with the
pubes by a large flattened elevation, called the ilio pectineal pro-
tuberance.  Between the latter and  the anterior inferior spinous
process, a concavity exists which  is  occupied  by the junction of
the psoas magnus and iliacus internus muscles,  where they pass
under Poupart's ligament.  Between the  two anterior spinous
   Vol. I.—9                                         i 
98
SKELETON.
processes is another concavity, from which the anterior edge of
the gluteus medius arises.
   The posterior margin of the ilium is also very unequal, both
in its direction  and thickness.   The posterior inferior  spinous
process is about sixteen lines below the posterior superior, and
terminates a cutting edge running between these two processes.
Just  below  it  we find the deep  excavation called the sciatic
notch, through  which pass out the pyriform muscle, the sciatic
nerve, and several blood vessels.
   The exterior face of the ilium, called its dorsum,  is generally
convex and rounded; its margins, however, are so elevated, that
partial depressions, or  sinkings  below the general surface, may
be remarked, especially at its back part.  Just above  the  two
 posterior spinous processes, a  flatness is observable,  from which
 a part of the  gluteus  magnus  arises.   A semicircular rough
 ridge begins  at or near the anterior  superior spinous process,
 and may be traced on  this surface  of  the bone  to the sciatic
 notch.  All that portion of the dorsum between this ridge and
 the spine, with the exception of the little fiat surface just above
 the posterior spinous processes,  gives origin to the  gluteus me-
 dius.   The dorsum terminates below at the acetabulum, and be-
 tween the latter and the semicircular ridge is the surface for the
 origin of the gluteus minimus.
    The internal face of the ilium, or that which looks  towards
 the belly, is called its costa or venter.  Its superior part, amount-
 ing to about two-thirds of the whole  surface, is very concave,
 and is the iliac fossa, which is  occupied  by  the iliacus  internus
 muscle.   The fossa is  continued forwards into  the hollow below
 the anterior inferior spinous process, and over the  acetabulum.
 The iliac fossa  is terminated below by a rounded ridge, a part of
 the linea ilio-pectinea  that separates the  greater from the lesser
, pelvis.   The remaining third of the costa of the ilium is very
 rough and unequal, and  is appropriated to the articulation with
 the sacrum, and to the origin of some of the muscles of the back.
 Immediately posterior to the sciatic notch is the surface  for the
 sacrum, which is somewhat triangular,  but irregularly so, and
 extends from the iliac  fossa  to the posterior inferior  spinous
 process.   Behind the  sacral surface is another, twice as large,
 strongly marked by its  roughness, and elevated  into a vertical
 ridge at its middle.  Anterior  to  this ridge arise  many of the 
OSSA INNOMINATA.
99
ligamentous fibres, fastening the ilium  to the sacrum;  but pos-
terior to it is the surface of origin to the multifidus spinas, and
the sacro-lumbalis muscles.

   Os Pubis, (Pubis.)— This  bone constitutes the fore part of
the innominatum, and is much the smallest of the three.   It is
composed by a body and two large branches from it, one run-
ning downwards to join the ischium, and the other backwards
and  upwards to join the ilium.
   The body of the pubes is joined  to its fellow on the opposite
side  by a flat surface, called the symphysis, which is eighteen
or twenty lines in its long diameter.   The superior part of the
body also presents  a flat surface, called its horizontal portion,
which is bounded  outwardly by the spinous process about an
inch from the symphysis.  The horizontal portion and the sym-^
physis form a right angle.  From the exterior face of the spine
two  ridges proceed outwardly;  the posterior is the crista; it is
sharp, elevated, and makes the anterior half of  the linea ilio-
pectinea; the anterior ridge is  lower down, increases in its
elevation as it goes along, is rounded, and runs nearly horizon-
tally to terminate in the anterior upper margin of the acetabu-
lum. Between the two ridges is a superficial triangular con-
cavity occupied by the origin of the pectineus muscle;  the base
of the triangle  is bounded by the  protuberance  formed at the
junction of the pubes  and  ilium,  and it  is exactly over this
part that the femoral vessels pass; its apex is the spine or spi-
nous process of the pubes.  The extremity of the upper branch
of the pubes is triangular, and much enlarged where it contri-
butes to  the acetabulum.
   The  inferior  branch of the  pubes,  technically called  its
ramus, is a flattened process about  an inch in  length, and, as
mentioned, descends to join the ischium.  Its exterior is plain,
and  has no mark deserving of attention; but the internal face,
near the anterior margin, is concave for attaching the crus of
the penis or of the clitoris.
   The body of the pubes in front is concave, and gives origin
to the adductor longus and  brevis muscles; behind, it is only
sufficiently concave to participate in  the general concavity of
the pelvis. 
100
SKELETON.
   Os Ischium, (Ischion.)—This bone forms the posterior infe-
rior portion  of the  os  innominatum, and is the next in size to
the ilium.  It is of a triangular  form,  and has  the  anterior
extremity bent  upwards to join  with the pubes.  The latter
part is its crus or ramus, and the remainder is its body.
   The body of the  ischium is a triangular pyramid, the inter-
nal side of which is smooth and uniform, but the posterior and
the external sides are very unequal.  The internal  side is broad
above and narrow below; at the middle of its posterior margin
is the spinous process, a projection of considerable magnitude,
and sharp-pointed, for attaching  the lesser sacro-sciatic  liga-
ment.   Immediately below  the spinous  process  is a smooth
concave surface, forming a trochlea, over which the obturator
internus muscle  plays.   Below this trochlea, and  forming the
most inferior internal  margin of the bone, is  a  long ridge,
somewhat more elevated  behind  than in front, into which the
great sacro-sciatic  ligament  is inserted.   The internal face of
the  ischium, though technically called its plane, departs from
the perfect regularity implied in that name, by participating in
the general concavity of the  pelvis.
   The posterior face of the ischium is swollen out, above, into
a rounded surface,  for the strengthening the posterior  parietes
of the acetabulum.  This  swell is bounded, below, by a trans-
verse depression or fossa; immediately  below which, is the
tuberosity  of the ischium, a large rough  surface extending
from the fossa to the beginning of the crus.   This rough sur-
face is subdivided into four, two above, and two below.   The
one above, which is external, and nearest to the  acetabulum,
gives origin  to  the semi-membranosus  muscle;  the other,
which is internal, gives origin to  the semi-tendinosus, and  to
the long head of the biceps flexor  cruris.  Of the two  flat sur-
faces below, the one which borders on the ridge for the inser-
tion of the great sacro-sciatic ligament,  is  the  part on which
we sit, and the last surface, which is exterior again to  this,
gives origin to a part of the adductor magnus muscle.
  The exterior face of the ischium, above, forms the lower part
of the acetabulum,  and is, therefore, very much  excavated;
below this  the surface is  flat, and sufficiently uniform to dis-
pense with  a  particular  description.
  The crus of the ischium is flattened internally and externally, 
OSSA INNOMINATA.
101
and in  the  adult it  is fused completely into the crus of the
pubes, so that very faint marks of their primitive  separation
are left.  The anterior margin of the crus  has, for the'origin
of the crus  penis and the erector penis muscle, an  excavation
continuous with that on the crus of the pubes.

   In examining the general features of the os innominatum, it
will be observed, that its outline is in some  degree like the
figure  8; the narrowing  in its centre being produced by the
sciatic notch below, and by the deep concavity above, between
the anterior superior spinous process and the symphysis of the
pubes.  The regularly rounded margin of the ilium  above, and
of the ischium below, contribute to the resemblance, but the
angle of the pubes interrupts it.  The narrowest part of the
bone, or its neck, is between  the top of the sciatic notch and
the fossa below the anterior inferior spinous process.  It will
also be remarked, that the posterior margin of the sciatic notch
is formed by the ilium, and the anterior by the  ischium.
  The acetabulum, or the cotyloid cavity, (cavile" cotyloide,)  is
placed immediately on the outside of the neck of the os  inno-
minatum.  In infancy one-fifth  of it is seen to  be made by the
pubes, two-fifths  by  the ilium,  and  two-fifths by the ischium.
It is a  very  deep hemispherical depression, having a sharp ele-
vated  margin  all around,  particularly at its  superior  part.
The inferior margin,  amounting  to  one-eighth of  the whole
circumference, is  comparatively shallow, and  is, indeed, con-
verted  into  a  notch, sunk much below the general  surface of
the brim.  The greater part of the acetabulum is smooth, and
incrusted with cartilage wherever the head  of the  os femoris
is applied to the  support of the trunk;  but  the very bottom,
with  the intervening  surface continuous  with the  notch,
amounting to rather more  than one-fourth of the whole cavity,
is rough, sunk below  the  general concavity, and is occupied
by a soft vascular fat.
  In the fore part of the innominatum a large deficiency, called
the  thyroid foramen, (foramen thyroideum,) exists between the
pubes and ischium.  In the male subject it  is triangular,  with
the  angles rounded ; but in the female it  is rather oval.  Lead-
ing from the plane of the ischium  is a groove, which  goes
along the superior end of the foramen, and appears  externally
                            9*
 
102                      SKELETON.

under the anterior ridge of the pubes.  It conducts the obtura-
tor vessels and nerve to the  inner side of the thigh.
  The texture  of the  os innominatum is  cellular internally,
with a condensed lamella externally.   It  is of very  various
thickness.  The ilium,  in its centre,  has the  external  and
internal sides so near one another, that in most adults the light
will  shine through it.  A large  foramen is seen on the venter
of the ilium, and another on  its dorsum, for the transmission of
nutritious arteries.   There  are  several others, smaller, at  va-
rious points of the os innominatum, for the same purpose, and
for the adhesion of ligamentous fibres.,
             SECT. V.—OF THE PELVIS, GENERALLY.

  The sacrum and  coccyx behind, and the ossa innominata at
the sides and in front, constitute, as observed, the whole cavity
called  pelvis, (bassin.)   Its position  is such, that, in the adult,
it divides the entire length  of the body into two parts nearly
equal, the head and trunk forming one part, and the lower ex-
tremities the other.  Generally, the  former are somewhat the
longest;  but in cases of unusual corporeal stature, the excess
depends upon an undue length of the inferior extremities.   On
the contrary, in persons of little height, the latter have not  been
developed in proportion to the trunk  of the body.
  The pelvis, as a whole, is a conoidal cavity, having its base
upwards, and the summit below.  Its internal surface forms an
irregular floor, on which the viscera of the abdomen are sus-
tained  in the erect  position; and its external surface, by pro-
jecting considerably at various places, establishes very favour-
able points for the origin of muscles.
  The internal  surface of the pelvis is divided by the projection
of the anterior margin  of the base of the sacrum, and  by the li-
nea ilio-pectinea, into two cavities; the upper one is the great
pelvis,  and the lower one, the little pelvis.   The great pelvis is
the base of the cone, and presents at its anterior  part a laro-e de-
ficiency,  which is supplied in the fresh subject by the abdominal
muscles.    The little pelvis  is a complete  bony canal, much
deeper behind and at the sides, than in front.  Its depth, behind,
$ formed by the whole length of the sacrum and coccyx; at the 
THE PELVIS.
103
sides, by the bodies of the ischia and a small part of the ilia;
and, in front, only by the length of the bodies of the pubes.
  The upper orifice of the lesser pelvis  is called its  superior
strait: it is somewhat oval, and looks obliquely  forwards and
upwards.  Its axis may be indicated by a line drawn from the
extremity of the coccyx to a point an inch, or  thereabouts, be-
low the  umbilicus.   The inferior orifice of the lesser pelvis  is
called the inferior strait.   Its margins in the naked skeleton are
very  unequal, for it presents three very deep notches, two late-
rally, and one in front.  The first are formed  by the  external
margins of the sacrum and coccyx, contributing to deepen the
sciatic notch, which already is formed in each os innominatum-
The third  one is formed  by the  convergence of the rami of
the pubes and ischia of the opposite  sides, and constitutes the
arch of the pelvis of authors, sometimes called the arch of the
pubes.   The axis of the  lower strait, it is  clear, must  have
a very different direction from the  axis of  the  superior, and
is indicated by a line drawn from  the lower part of the first
bone  of the sacrum, through the centre of this opening.   The
cavity of the lesser pelvis is increased considerably behind, by
the curvature of the sacrum; this, however,  is not uniform, as
the sacrum is much more curved, as well as longerin some indi-
viduals than in others.  The planes of the ischia are not paral-
lel  with one another, but converge slightly from above, in con-
sequence of which the transverse diameter of the  lower strait is
rather smaller than the transverse diameter of the superior strait.


       Difference of the Pelvis in the Male and Female.

  There are several well  marked peculiarities in the fully de-
veloped pelvis of either sex.
  The ossa ilia are larger, less concave, and  more horizontal in
the female.   The superior strait is also larger, and more round:
its  transverse diameter always exceeds the  antero-posterior;
whereas, the latter, in the male, frequently is found the longest.
The lesser pelvis is also more capacious in women.  The  crura  .
of the pubes and ischia, are not so long as in men; but they di-
verge more, and join at the under part of the symphysis pubis
by  a  large, regularly rounded arch; whereas, in  men, the arch
as  it is called, is merely an acute angle. 
104
SKELETON.
   The os sacrum in women is shorter, more concave, and is
also broader in proportion to its length.   The spaces, vertically,
between its foramina in front are very small, forming a sort of
ridges, which give to the bone the appearance of having been
compressed in its length.
   The distance between the upper and lower straits, or in other
words, the depth of the small  pelvis in women, is not so great
as in men: this arises from the  comparative  shortness in  the
length of the  pubes, of the ischia, and  of the sacrum, as just
mentioned.   The cartilaginous joining of the  pubes  is thicker
in women.  The diameters of the inferior strait, like those of
the superior, are longer  in females.
   Accoucheurs have attached  much importance to the direction
and length of the diameters of the small pelvis in well formed
women.   At an average they are  as follow.  The  superior strait
presents three diameters:   The first or antero-posterior extends
from the upper extremity of  the symphysis pubis, to the mid-
dle of the projection of the sacrum at its superior margin, and
measures four inches:  The second diameter, or the transverse,
crosses  the first at right angles, and extends from the middle of
one side of the strait to  the corresponding point on the other;
it measures five inches:  The oblique  diameter  extends from
the sacro-iliac junction of one side to the linea ilio-pectiniaover
the acetabulum of the other,  and measures four inches and a
half, sometimes more.*
  At the inferior strait, the antero-posterior diameter is from
the lower part of the symphysis  pubis to the lower end of the
sacrum, and  measures  five inches.!  As the coccyx, in child-
bearing women, is moveable, its projection forwards  is  not
taken into the account,  because  it recedes by the pressure  of
the child's head, and does not resist its passage:  in some cases,
however, it is unfortunately fused into the sacrum, and there-
fore perfectly rigid, which will  diminish this diameter at least
an  inch.  The transverse diameter of the  inferior strait  is
drawn from the middle of the internal margin of  the tuberosity
of one ischium, to the corresponding point on  the other, and
measures four inches.

  * See Dewees' System of Midwifery, 7th edition, 1835, p. 28.
  t Dr. Dewees says four.  Loc. cit. 
THE PELVIS.
105
  The depth of the little pelvis, in the female, at the symphysis
pubis, is an  inch and  a half; at the posterior part four inches,
or five if we include the coccyx; and at the side three inches
and a  half.   There are many other details connected with the
measurements of the pelvis, which are mentioned by systematic
writers on midwifery.


            SECT. VI.--DEVELOPMENT OF THE PELVIS.

  Three points of ossification are observable in the os innomi-
natum of the early fcetus: one is at the  superior part  of the
ilium, another is at the tuberosity of the ischium, and the third
is at the angle of the pubes.   The radii of ossification from
these  centres, have extended themselves considerably at birth,
so as to sketch out the forms of the bones to which they re-
spectively belong.  But these  bones  are separated from one
another by cartilage, and do not coalesce till years afterwards.
The union or fusion of the ilium and pubes  then occurs at the
ilio-pectineal eminence, over the acetabulum, and partly in this
cavity; the  ilium  and ischium join  in  the acetabulum princi-
pally,  and  the ischium and  pubes unite by  their respective
crura at the middle of the internal  side of the foramen ovale.
All the points of  the os innominatum, most remote from the
primitive centres of ossification, are cartilaginous at birth: as,
for example, the crest, the  spinous processes, the tuberosity,
and even the component parts of the acetabulum.  The latter
cavity has then a triangular shape, and from its very flexible
and yielding condition, is incapable of affording a strong point
of support to the trunk in the erect position.
  At  birth,  the middle parts of the os sacrum, which are em-
ployed in protecting the spinal  marrow, are more advanced in
their ossification than its lateral parts.   The five pieces which
compose it,  are, like  the  bodies  of the  true  vertebrae,  of a
rounded shape.  The  processes behind are cartilaginous^  The
coccyx is extremely small, and scarcely presents any ossifica-
tion whatever.
  The pelvis of the fcetus, at birth, is smaller in  proportion than
the superior  portions  of the trunk; this is one of the reasons
why the abdomen is so projecting.  The  lesser pelvis is  so 
106
SKELETON.
small and shallow, that the bladder, even in the undistended
state, cannot  be accommodated by it, but is contained princi-
pally by the abdomen.   Its transverse diameter is much short-
er than the  others.   The superior strait  faces  much more
forwards* than in the  adult.
         SECT. VII.--ON THE MECHANISM OF THE PELVIS.

  The pelvis has an important  part in the several actions of
standing and of locomotion;  besides its usefulness in giving a
support to the viscera of the abdomen, and in having attached
to, and contained within  it, the organs of generation.
  In standing, the pelvis  is impelled by two opposing forces, in
consequence of the  attachment  of the vertebral column at its
hind part, and of the ossa femorum at its anterior lateral parts.
The weight of the  head and of the upper parts of the body,
falling upon the sacrum, acts  upon a lever, which is represent-
ed by the  distance between-  the acetabula and the sacro-iliac
junction, and has a tendency to depress the posterior part of
the pelvis, by rotating it upon the heads of the thigh  bones.
This movement is obviated by the iliacus internus, psoas mag-
nus, and some other muscles,  which keep the front of the pelvis
from rising up.   It is also prevented  by the principal weight
of the trunk being in front of the spine, and therefore inclining
forwards, so that the centre of gravity, in the  erect position,
gives a continual tendency to fall forwards  instead of back-
wards.
  The wedge-like shape of the sacrum is highly favourable to
the erect position:  from having its base upwards, whenever
the weight of the trunk is thrown upon it, it  is driven down
between the ossa innominata, and has the tightness of its arti-
cular connexion, therefore,  muc«h  increased by the position
which it is intended to sustain.  In illustration of the usefulness
of the triangular or wedge-like  shape of the  sacrum, it may be
observed, that it is much less  so in animals which are intended
to go upon all fours than in the human subject.
  The articulation of the several bones of the pelvis with each
other, is so close as not to admit of any motion between them,
with the exception  of the os  coccygis,  and  of the relaxation 
THE THORAX.
107
peculiar to pregnancy.   The  pelvis, however, has  upon the
spine, flexion, extension,  lateral  inclination, and rotation; the
latter being ^performed by a series of very slight twists of the
lumbar vertebrae upon each other.   Like all other motions, it
is much extended by habit in early  life.  Of this  I have seen
an instance, in an  adult  Indian, who, from infancy,  had  been
deprived entirely of the use of the lower extremities; but who,
by being seated in a large wooden bowl, with a round  bottom,
and having his legs drawn up in a squatting position, could, by
alternate twists  of the spine, with the assistance of a short staff
in each hand, move with surprising speed over  a plain surface.
                SECT. VIII.—OF THE THORAX.

  The thorax is the upper part of the trunk, and is formed by
the dorsal vertebras behind, by the sternum in front, and by the
ribs with  their cartilages at the intermediate spaces.   It is of
a conoidal figure, flattened in front, somewhat concave behind,
and semi-cylindrical on the sides.  The interior circumference
corresponds with the exterior, with the exception of the poste-
rior part, where, owing to the projection of the column of dor-
sal vertebras, a partial septum exists which has a tendency to
divide it into two chambers.  The superior part  of the cone,
or its  summit, is much smaller  than  the inferior part or the
base,  and presents a very oblique  cordiform foramen, much
lower in front than behind, owing to the superior margin of the
sternum being lower than the first dorsal vertebra.   The base
of the thorax is a very large opening:  its lateral and posterior
margins,  formed by the ribs  and their cartilages, present  a
convexity downwards; but, in front, where the latter run up to
join  the sternum,  a large notch is formed  between  the carti-
lages of the opposite sides, into  the apex of  which notch the
third bone of the sternum projects.


                        Of the  Ribs.

   The  ribs, costae, (cotes,) are twenty-four in number, twelve
on either side.   Of the latter, the upper seven, in consequence 
108
SKELETON.
of their cartilages joining  the  sternum, are called the sternal
or true ribs, and the lower five, from their cartilages stopping
short of the sternum, are called the false or asternal  ribs.
Cases are recorded by several anatomists of there being eleven
or thirteen ribs on a side: the latter I have seen several times,
and  the former but once or twice.   In such cases, the dorsal
vertebrae correspond in number with the ribs.   In the instances
of redundance  which have come under my notice, the last rib
looked like a transverse process of unusual length, belonging to
a lumbar vertebra.   The superabundant vertebra constituted
the thirteenth dorsal; but was  formed like the first lumbar as
it commonly exists, and  the last lumbar vertebra was entirely
anomalous in its shape, being intermediate in form to a lumbar
vertebra, and to the first bone of the sacrum.
  All of the ribs  are so placed, that they run very obliquely
downwards and  forwards  from  their posterior  extremities.
This obliquity  becomes  the more striking as  the ribs increase
successively in  length.  The first rib, for example, articulating
by its posterior extremity with the first vertebra of the back,
has its anterior extremity nearly on a  horizontal line with the
lower part of the  third dorsal  vertebra.   The seventh rib has
its anterior extremity on a horizontal line with the lower mar-
gin of the last dorsal vertebra, notwithstanding its posterior
extremity articulates with the seventh vertebra.  The  same
sort  of comparison might be usefully instituted in regard to all
the ribs, in which case the rule will be found closely applicable,
with the slight exception of the  two or  three last ribs.   The
ribs are nearly parallel to each other in this obliquity, allowance
being made for the  effect which the obliquity of the sternum
has in causing a greater separation of their anterior extremities
from each other, than exists at their posterior extremities.

  Common points of resemblance  between the Ribs.—Each rib
is paraboloid; presents an external and an internal surface; an
upper and a lower margin; a  sternal and a  vertebral extre-
mity.
  The external surface of each rib is convex, while its internal
surface is concave.  The former presents, not far from the ver-
tebral extremity, an oblique ridge, occasioned  by the insertion
of the sacro-lumbalis muscle.  It is precisely at this line that a 
THE THORAX.
109
curvature somewhat abrupt, takes place, which is the angle of
the rib.   Between the angle and the transverse process of the
vertebra, each rib is rather more narrow and cylindrical than it
is in advance of the angle.  The superior margin of the rib is
rounded and somewhat rough, for the insertion of the intercostal
muscles, while the inferior margin is brought to a thin, cutting
edge.  Just within, and above the latter, is a fossa beginning
somewhat nearer to  the  spine than the angle of the  rib, and
ceasing about one-third of the whole length of the rib,  short of
its anterior extremity.  It contains the intercostal vessels and
nerve.  From the upper margin of this fossa arises the internal
intercostal muscle, and from the lower the external.

   The anterior extremities of the ribs are thin  and flattened,
in the upper eight there is some increase in  their breadth at
this point, and in all there is an oblong pit for receiving the end
of the corresponding cartilage.  The vertebral extremity of the
rib is its head, and presents two flat articular surfaces, separated
by a ridge.  This head is received into the inter-vertebral mat-
ter, and upon the articular faces of the adjoining margins of the
vertebras.  A small depression exists upon the posterior face of
the rib bordering on its head, for containing a little fatty mass.
About an inch beyond the head, at the posterior under surface
of the rib, is a tubercle, presenting a smooth articular face, for
connecting itself with the transverse process of  the vertebra.
Just beyond this, but bordering on it, is a much  smaller tuber-
cle, not unfrequently indistinct, for the insertion of the exter-
nal transverse ligament, and below it is a small pit for the lodge-
ment of fatty matter  near the joint.   The  space between the
greater tubercle and the head  of the rib is its neck, which is in
contact with the antero-superior face of the transverse process
of the vertebra, and has a sharp ridge on its upper margin, for the
insertion of the internal transverse ligament.
   The most of the ribs have  a very sensible twist in them,  by
which their spinal extremity is directed upwards, and the ster-
nal extremity downwards; from which it results, that the whole
length of  the rib cannot be brought into contact with a hori-
zontal plane.

   Differences in Ribs.—Though there are many common points
     Vol. I.—10 
110
SKELETON.
of resemblance among the ribs, yet  there are, also, some well
marked peculiarities.  The ribs increase successively in length
from the first to the seventh inclusively; they then decrease:
the last is not only the smallest, but not unfrequently the shortest.
The angles of the ribs increase in their distance from the spine,
from the first to the last rib.  The angle, however, of the first
rib, is  not well marked, from its being  so near  the  tubercle;
neither is the angle of the last, from its being so near the ante-
rior  extremity.  The oblique ridges constituting or marking
off the angles, are placed one above the other, in the same line.
This gives to the back of the thorax a  triangular flatness, the
base of which is below. The projection backwards of the angles
of the  ribs, along with that of the spinous processes of the ver-
tebras, forms  on each side of the latter the gutter, which is filled
up by the large muscles that keep the trunk erect.   This gutter
is, of course, broader below.
  The first rib is more circular than the others.   Its head is
spherical, instead of presenting  two articular surfaces.  This
rib is flat above and below; its margins are internal and exter-
nal.   It has  no  groove for the  intercostal vessels and  nerve.
About the middle, the upper surface  is marked by a superficial
oblique fossa, made by the subclavian artery; in  front of, and
behind which is a small rising, marking the insertion of the sca-
leni muscles.   The  second rib is considerably longer than  the
first, and has its flat surfaces  obliquely upwards and  down-
wards, so as  to round off that part of the thorax.   The four in-
ferior  ribs decrease at  their anterior extremities, or become
somewhat tapering.  The last  two ribs do not articulate with
the transverse  processes, and, consequently, have no  corre-
sponding tubercles.   As their heads  articulate with the middle
of the  bodies of their respective vertebras, instead of with  the
margins, they present only a  single and  somewhat convex sur-
face.   The eleventh rib is marked only for a short distance in
its middle by the fossa, for the intercostal vessels.   The twelfth
rib has no mark of the kind.
  There is an augmentation in volume from the  second to the
eighth  rib, inclusively; afterwards they decrease.   The angles
of the ribs are, successively, more and more obtuse.
  The structure of the rib is spongy, covered  with a lamella of 
THE THORAX.
Ill
compact bone.   The spongy structure predominates at the an-
terior extremity, for there the rib is comparatively soft.


                       Of the Sternum.

  This bone constitutes  the  middle front part of the thorax,
and, owing to the obliquity of the ribs, has its superior end on
a horizontal line with the third vertebra of the back, while its
inferior extremity is on a horizontal line with the eleventh dor-
sal  vertebra.  It is also placed in a slanting direction, so that
the lower part  recedes  from the spine much farther  than  the
upper.
  The sternum is  oblong, somewhat curved, like a bow,  so as
to be convex in front, and concave behind.   It is divided, in
the adult, into  three distinct pieces; an upper,  middle,  and
lower, which are held together by cartilage and by ligament;
but not unfrequently in  advanced life these pieces are all fused
into one, by bony union.  The first and middle parts join where
the second rib is articulated, and the middle and lower where
the seventh rib articulates.  At  these  points there is a well
marked  transverse ridge, both anteriorly and posteriorly,  and
between them on  the front of the  bone, there are  other ridges
not so strong, indicating the original separation of the bone into
several other distinct pieces.  The lateral margins of the ster-
num are somewhat elevated where the ribs articulate.
  The upper end of the sternum  is both thicker and broader
than the  lower end.  Where the  first and second parts join,
there is a narrowing of the two: the same occurs where the se-
cond  and third pieces unite.

  The first or  upper  bone  of the  sternum, has an irregular
square figure ;  it projects somewhat above, and is slightly hol-
low below.  It is scooped out at the superior margin, and pre-
sents  a point at each end of the scoop.   At the side of the  lat-
ter  is a concave and rounded surface, for articulating with the
clavicle; just below which is a rough surface, for the cartilage of
the first  rib.  The bone diminishes much in breadth from  this
point, and terminates by a narrow oblong face, joining it  to the
second piece.  At each side of this junction both pieces con-
tribute to a fossa for the cartilage of the second rib. 
U2                      SKELETON.

  The second bone of the sternum is longer and narrower than
the first.   At its lower part it increases somewhat in breadth,
and then terminates by being rounded off on either side, so that
its margins converge towards each other.  The sides of this
piece afford complete pits for the third, fourth, fifth, and sixth
ribs; the pit for the seventh is common to it and the third bone,
as the pit for the second rib is common to it and the first bone.
The sixth and seventh pits are in contact, the fifth is very near
the sixth, the fourth is about half an inch  above the fifth.  On
viewing the whole side  of the sternum, it will be observed that
the distances between the pits decrease, successively,  from the
first to the last.

   The third bone of the sternum, in the  young adult, is fre-
quently in  a  great degree or wholly cartilaginous, hence, the
name of xyphoid cartilage (cartilago xyphoides or ensiformis)
has  been applied  to it.   It is  thin, varies remarkably  in  its
breadth  in different individuals, and has  the  lower extremity
sometimes turned forwards and sometimes backwards, but most
frequently it is inclined only slightly forwards.  The base of
thispieee presents  a narrow oblong surface for articulating with
the second bone, at each end of which is the half fossa for the
seventh  rib.   The margins of the ensiform cartilage are thin,
and  have the transverse muscles of the abdomen inserted into
them.  Sometimes the lower extremity, instead of being point-
ed, is bifurcated.

   The sternum is  composed of a spongy texture, enveloped by
a  thin layer  of compact substance.   Its strength depends, in a
great degree, on its ligamentous covering.


         SECT. IX.--OF THE CARTILAGES OF THE RIBS.

   These are  placed at the anterior  extremities of all  the ribs,
the seven superior of which they unite to  the sternum by the
sychondrosis articulation.   The length, breadth, and  direction
of these cartilages are far from being uniform.
   The first costal cartilage is short; the following ones increase
in length, successively, to the seventh, inclusively.  The carti- 
CARTILAGES OF THE RIBS.
113
lages of the false or abdominal decrease, successively, in length
from the eighth to the twelfth, inclusively; the last  is a mere
tip to the end of the rib.  The breadth of the first cartilage is
considerable near the sternum; the  succeeding ones are not so
large at this point.  With the exception of the first three, the
costal extremities of the cartilages are larger than the sternal;
and they become more  rounded  as they advance  to  the  latter.
The cartilages, in  point  of magnitude, generally, will be found
in proportion to the size of the ribs with which they articulate.
The sixth and  seventh are joined together, and are spread out
at their middle, which gives  there an increase of  breadth, and
permits them to touch, and sometimes to coalesce.
  The first cartilage goes obliquely downwards in the direction
of the rib to which it  belongs,  in order  to  join  the sternum.
The second and the third  cartilages are  nearly horizontal, but
inclining  a  little upwards in their  progress;  the  fourth, fifth,
sixth, and seventh, pass, successively, more and more obliquely
upwards to the sternum, in consequence of the increasing length
of the ribs requiring them to traverse a longer space to reach
this bone.  From the direction of the cartilages being oblique-
ly upwards, while that  of the ribs is obliquely downwards, the
angle formed near the rib at the base of the cartilage, where the
latter begins first to turn upwards, is less obtuse  in the lower
cartilages than in the upper.   The obliquity of these cartilages
is also very manifest, by comparing  them  with the side  of the
sternum:  with  it they form a very acute angle below, and  a very
obtuse one above.
  The  cartilages  of the false  ribs, successively, decrease  in
length, to terminate in front by  small  tapering extremities.
The first  is united by ligaments, somewhat closely, to the last
true or sternal, and is  occasionally sent  forwards fully  to the
sternum.   The others are  united more loosely, in such  a way
that the anterior extremity of the one lies against the inferior
margin of that which is above.   The eleventh and twelfth  car-
tilages are generally too short  to  touch  the  ones above, they
therefore  are fixed principally by a connexion with the abdomi-
nal muscles.   Their ribs are  much more moveable than any
others, and have been called floating, from that cause.
   There is some difference between the two extremities  of the
cartilages; the posterior or costal  is  a small, convex, unequal
                             10* 
114
SKELETON.
surface, very closely united to the anterior extremity of the cor-
responding rib.  The other or sternal  extremity in the sternal
cartilages, offers a  smooth  articular  face, which  is angular or
convex, according to the shape of the cavity in the sternum with
which it has  to articulate.   The  three first absternal, and the
last sternal  eartilage, make, to the lower part of the  thorax, a
broad and well marked  margin, convex in front and  concave
behind.
  The cartilages of the ribs are, in persons of middle age, white,
flexible, and  very  elastic.   They  are dissolved very slowly in
boiling water; by which they, if young, are reduced to gelatine,
otherwise their solubility  is  very imperfect.  They  have a
structure differing, in some  respects, from other cartilages; when
dried, and  exposed to the  action of the  atmosphere,  they are
seen to consist of an immense number of small thin plates, placed
end  to end, and separated  by deep  fissures.  M. Herissant de-
scribes these plates as interlaced  one with another, and forming
a kind of spiral, the regularity of which is interrupted by small
cartilaginous  projections,  uniting the  plates to each  other.*
These cartilages have a great disposition to ossify, which is ma-
nifested in  most individuals somewhat advanced in life.  The
ossification begins in their centre, and  advances to the circum-
ference, and  is always preceded by a yellowish tinge.  When
they are fully ossified,  like the  ribs,  they are cellular within,
and compact externally, and are  continuous with  the ribs, there
being no interval:  in such  cases, the distinction  from the ster-
num is generally kept up by the preservation of the joint, with
the exception of the first, which is fused into it.   The complete
ossification of the first cartilage  is not uncommon; the others,
though there is generally in old persons a considerable deposite
of bone  in   them, are seldom fully ossified.   In neither case,
however, is it common  to see such a perfect continuity of bone
between the rib and sternum, that the  junction may not be dis-
solved at one point or  another  of this space  by the  action of
boiling water: at least, after very numerous observations on this
subject, I do not remember to have  met with  a single instance
of it.
* Acad, des Sciences, an. 1748. 
DEVELOPMENT OF THE THORAX.
115
       SECT. X.—OF THE DEVELOPMENT OF THE THORAX.

  In the fcetus the shape of the thorax  differs much from that
of the adult, in the greater  comparative extent of its anteropos-
terior diameter, and in the  projection of the sternum.   The state
of the thoracic viscera, at this period, calls  for such an arrange-
ment; as the heart and thymus gland, which are  in  the middle,
have a considerable extent, whereas, the lungs are still collapsed
from the emptiness  of their air cells.   The ribs are but little
curved at  their posterior  parts, the angle  being by no means
well formed, in consequence of which,  the fossa on each side of
the bodies of the vertebras, in the thorax, is  not so deep;  neither
is the fossa behind, on each side  of the spinous processes, so
fully  marked.  The superior  opening  of  the thorax is more
round from the increase of the antero-posterior diameter.  The
inferior opening is  extremely large, both from the elevation of
the sternum, and from the  pressure of the abdominal viscera, of
which the liver, from its great extent, is a principal agent.  The
vertical diameter of the thorax is small, from the ribs, particu-
larly the lower ones, being pressed up one against the other, by
the diaphragm, acted on by the abdominal viscera.

  The  bones individually are  in  the  following  state at birth.
The ribs are almost completed, the heads,  where they join the
spine, being in a state  nearly as perfect as at any subsequent pe-
riod of life, and not by any means in the condition of a  cartila-
ginous epiphysis, as is presented in the extremities  of  the cy-
lindrical bones generally.   These  bones, as Bichat very justly
observes, are destined to a function which  commences imme-
diately upon birth, and which requires  in them as much  perfec-
tion then, as they have in the adult.  For respiration is different
from locomotion, the latter requires a species of education, which
may be given gradually, whereas  one  respires from the begin-
ning as he will respire always.  The sternum, which is less im-
mediately  connected with  breathing, and  only contributes to
the general solidity of the  thorax by  completing its  circumfe-
rence, is in a state almost cartilaginous, and presents only nuclei
of ossification in its several pieces.
   At the instant of  birth,  a great change is produced in the di- 
116
SKELETON.
 mensions of the thorax.   The lungs, from being in  a  collapsed
 and solid state, suddenly suffer an expansion  of their  cells by
 the introduction of air  into them, and  increase  twice  or three
 times in magnitude.   This  is  accomplished by the  elevation
 of the ribs, and the consequent  increase  in the transverse  dia-
 meter of the thorax:  it becomes a condition that for ever after-
 wards remains, so  that the lungs, even upon  death, continue to
 have their air cells distended, and do not return  to  a  perfectly
 collapsed state.  The action  of the  diaphragm  is but small in
 the earliest periods of life, owing to the size and pressure of the
 abdominal viscera  against it;  respiration is then principally  car-
 ried on by the elevation and depression of the ribs, and by their
 being rolled  outwards, a  motion which the  flexibility of their
 cartilages and the looseness of their  articulating surfaces favour
 very much.
   At the age of puberty the  thorax  experiences a remarkable
 augmentation.   Its transverse diameter is  sensibly increased,
 and there is  a general expansion of its volume, indicative of a
 healthy and vigorous constitution.  Should this not  take place,
 and the sternum be projected, it  is supposed to  mark a  disposi-
 tion to consumption.  The enlargement  of the  thorax is  un-
 doubtedly also connected with a development of the organs of
 generation at the  same time.   The  exercise of the latter re-
 quires greater vital powers than  exist  in early life, and the pro-
 vision for it is manifested by  the general increase of  vigour  and
 firmness in the human frame;  but it  is not possible to point  out
 in  what manner the  sympathy  exists, which, on the develop-
 ment of the organs of generation, extends their influence to  the
 bony structure of the thorax.


        SECT. XI.--OF THE MECHANISM OF THE THORAX.

  The thorax performs  two very important  offices  in the ani-
mal machine: the  first is to contain and protect the organs of
circulation and respiration, the second to assist in the function
of respiration, and  perhaps that of circulation.*
  The mechanism  of  the thorax is such that the solidity of its

  *  A very interesting paper, on this subject, has lately been  presented to  the
French Institute by M. Barry. 
MECHANISM OF THE THORAX.
117
materials, and its rounded shape, present a very efficacious de-
fence to its viscera from the  influence of  rjlows on its outside.
The effects of the latter are  also materially diminished by the
thickness and contraction of the several large muscles which are
placed on its surface.   On its back part the thick longitudinal
muscles of the spine, as well as those running to the superior
extremities, fill up the gutters on each side of the spinous pro-
cesses, and make a fleshy protuberance, divided into two by the
raphe which extends the length of the back  over the spinous
processes.   In front it is less protected, owing to  the sternum
being immediately under the skin.  Nevertheless, when blows
are inflicted on this part, their effects are much diminished by
the elasticity of the cartilages of the ribs,  and by the direction,
obliquely  downwards, of the ribs themselves; both of which
dispose the sternum to retreat backwards, and to yield to the
impelling force.  The recession will take place more readily at
the moment of expiration; and when the muscles which elevate
the ribs are not on their guard.  In those deliberate exertions
of the strength of the  thorax, exhibited  by individuals lying
down on their backs, and sustaining a heavy weight on the ster-
num, the ribs are saved from injury by different means.  The
arched form, itself, of the front of the thorax, is of considerable
service in the resistance under such circumstances; this, how-
ever, would  be easily overcome, and  the ribs would break, if
the arch were not sustained in its elevation by the  contraction
of the large muscles on its sides; as the serratus major, the pec-
toralis major and minor, each of which,  by acting on the de-
pressed anterior  extremities of the ribs and their cartilages, has
a tendency to keep them elevated.  Fractures of the ribs, from
blows or force applied in front, are  not so liable to occur in the
part  stricken as  in the point feeling the greatest momentum,
which from the semicircular form of the ribs is in or near their
middle: this exhibits a true example of what the French  writers
call the contre-coup.   Bichat says, that the fracture by contre-
coup is much more common when  the individual being struck
unexpectedly, has not had time to throw his muscles into a state
of contraction, for the protection of the ribs.
   The lateral convexity of the thorax being greater than  that
in front or  behind, and having  the same assistance from the
muscles mentioned, presents  a stronger resistance when blows 
118                      SKELETON.

are inflicted directly on it.  Each rib represents an arch, the
summit of which is its centre, and the base its two extremities.
The abutments of the base are, the sternum at one end and the
spine at the other: a displacement from them  is completely pre-
vented by the  strength of the ligamentous attachments, as well
as by the form of the surfaces.  Under these  circumstances, as
fracture occurs preferably to dislocation, it is generally at the
point stricken.
  The abdominal or false ribs,  from their want of attachment
to the sternum, present a very different condition.  Their an-
terior extremities, therefore, yield readily, and  are driven in-
wards towards the abdomen.

   The second function of the thorax, relating to its influence on
 respiration, is executed by its dilating and contracting, whereby
 the air is received into, and expelled from it.   The spine is the
 fixed point for the motions of the ribs in respiration.  In the act
 of dilatation,  the capacity of the thorax is augmented in three
 directions, vertically, transversely, and antero-posteriorly, or
 from the sternum to the spine.  The vertical augmentation is ac-
 complished by the diaphragm; and, as mentioned, is much great-
 er proportionally in the adult than in the infant, from the greater
 comparative size of the abdominal viscera  in the latter.  The
 transverse augmentation is produced by the successive contrac-
 tion of the intercostal muscles, which raise the ribs upwards.
 The first rib is moved inconsiderably, in consequence of its short-
 ness and of its continuity with the sternum.  The attachment of
 the scaleni muscles to  its upper surface, serves rather to give a
 fixation to it, and to prevent it from being drawn down by the
 other ribs, than  to produce by their  contraction an elevation of
 it.  The first rib may,  therefore, be considered  as a fixed point.
 The first intercostal muscles contracting from it, draw up the se-
 cond rib, which, in its turn, becoming a fixed point for the  second
 intercostal muscles, they contract and draw up the third rib, and
 so on successively to the last.   It is the obliquity of the ribs from
 behind, downwards and forwards, which enables this elevation of
 them to produce an increase in the lateral diameter of the thorax:
 without such  obliquity, their elevation  would not have the ef-
 fect.   But the obliquity alone  could be of but  little service, if 
MECHANISM OF THE THORAX.
119
the anterior extremities of the ribs were not attached to the
sternum by cartilages, which have to ascend in order to reach
it; for it is obvious that the angle of the cartilage and rib, during
their elevation by the intercostal muscles, has a tendency to en-
large itself; and will, in doing so, increase the  horizontal dis-
tance between the anterior end of the rib and the sternum, and
consequently increase  the transverse diameter of the thorax.
The upper ribs, from the shortness as well as direction of their
cartilages, can do little or nothing in increasing this diameter.
   According to some anatomists, the capacity of the thorax is
also augmented by a  rocking motion  of the  rib, in which, the
two extremities being stationary, the  middle is  drawn upward
and outward.  It is not, however, very clear, that this motion
exists to much extent, in the adult, as the posterior articulations
of the thorax are opposed to it.
   While the transverse enlargement of the thorax is going on,
a simultaneous motion occurs in the sternum, and in consequence
of the oblique direction in which the ribs run  to it, the sternum
is caused, by the elevation of their bodies, to recede from the
spine.  But, as the ribs increase successively in length from the
first to the seventh, each  lower one,  in its elevation  from the
oblique towards  the  horizontal line, has its anterior extremity
carried  proporlionably farther off from the  spine; hence, the
sternum has a combined movement resulting from its several
attachments to the ribs: one motion elevates it as a whole, ano-
ther causes  it to recede  from  the spine  as  a whole: and the
third causes its lower end, from the increased length of the ribs
there, to be pushed farther from  the spine than the upper; giving
it, thereby, during respiration, a slight motion backwards and
forwards, resembling that of a pendulum.  This latter motion,
however,  though  its existence is clear, is not very considerable,
from the sternum being kept in check by the tendinous centre
of the diaphragm, as one may prove by examining  his own
body.  The enlargement of the thorax, in its antero-posterior
diameter,  is much more  considerable at  the anterior extremi-
ties of the ribs, because there they are comparatively free.  In
this case,  the cartilages of the ribs are bent forwards, besides
being elevated.
   In expiration,  the movements of  the thorax are exactly the
reverse of what they are in inspiration, and all its diameters are, 
120
SKELETON.
consequently, diminished.  Whatever may be said of muscular
influence in producing this change, it is much exaggerated.  It
is true, that there are certain muscles which may be applied to
this end, as the  abdominal, and also some on the back, as  the
longissimi dorsi  and sacro lumbales; but that they are actually
so engaged, under ordinary circumstances, is rather questiona-
ble.   In observing the phenomena of natural  respiration, when,
by position, all these muscles are put into a state of relaxation,
it does not appear that the process is at all impaired by their
being thrown out of action.  The only muscles, therefore, that
seem to be especially appropriated to produce expiration,  are
few and small:  they are the serrati inferiores postici, one on
either side of the spine.   But, when the lower ribs are fixed by
the several muscles inserted  into them, they become points of
support to the upper ones; and then the intercostal muscles may
officiate in expiration, by drawing  the ribs successively down-
wards, as they do, in inspiration, by drawing the ribs succes-
sively upwards.
  The elasticity  of the cartilages, by which these bodies are  en-
abled to return from the constrained state  in which they were
placed by inspiration, has also been supposed important to  ex-
piration, by  Haller, and others.  The  power thus  derived is
certainly of  some value; but has much  less than has been at-
tached to it.   It  unquestionably exists in early and  middle life,
but is lost in old age, when the cartilages ossify, and, therefore,
are deprived of elasticity.  The  true and efficient cause of expi-
ration appears to be  atmospheric pressure, upon the  external
parietes of the thorax, acting along with  the natural elasticity
of the lungs.  The lungs, it is well known, when in a state of
repose, and removed from  the  thorax, are much smaller than
the cavities which they fill during life.   They have, therefore, a
continual disposition, in the living  state, to return  to  the  size
which is most easy to  them; and, when they are dilated  by
inspiration,  they subsequently  contract.  These  positions  are
proved conclusively, by the condition of the inferior surface of
the diaphragm, in a healthy and  entire thorax; where this mus-
cle, in consequence of  atmospheric pressure from  without, is
driven high  up  into its cavity.   Its contraction in inspiration
draws it down, and the instant that the contraction ceases it is
impelled upwards again.  Now, the same power  is applied  to 
THE CRANIUM.
121
the whole periphery of the thorax: and its cavity being enlarged
by the contraction  of the several muscles appropriated to the
elevation of the ribs; the moment  this contraction  ceases, the
latter are impelled downwards.  From all this it will be under-
stood that the muscles, by creating a vacuum in the lungs, cause
the vacuum to be filled  by the introduction of air through the
trachea; and upon their ceasing to  contract, the several agents
mentioned cause the expulsion of the same air.  It is generally
believed, that the surface of the lung is every where in contact
with  the thorax; it appears, however, doubtful, whether  there
is not a space between the pleura pulmonalis and diaphragmalis,
particularly at the most posterior and inferior part  of  the dia-
phragm.   Certain it is, that adhesions there, are much less com-
mon than in other parts of the thorax.
  The ligaments at  the spinal extremities  of the ribs, by being
put on the  stretch in inspiration, have  also some tendency to
throw down the ribs  in  expiration.   In short, the contraction
of the thorax may be set down as the result of the joint action
of the atmosphere, the cartilages of the  ribs, the ligaments, the
contraction of the lungs, and the muscles.   When  the structure
of the lung is  so altered that  its  elasticity is impaired or de-
stroyed, expiration becomes then much more difficult.
                     CHAPTER  II.

                       OF THE HEAD.

   The head is placed  upon the upper extremity of the verte-
bral column, and  consists in a considerable  number of bones,
which are either in pairs, or, if single, have the two sides sym-
metrical.  Some of these bones form a large cavity, the cranium,
for containing the brain; the others are employed in the forma-
tion of the nose; of the orbit for the eye-ball; and of the mouth.
The head, for the most part ovoidal, presents very striking va-
rieties of form between different  individuals and different na-
tions.  It is thought by physiologists, that the moral or intel-
lectual condition  of a people, their habits, climate, and  food,
  Vol. I.—11 
 122                      SKELETON.

 have a powerful influence in producing these diversities.   The
 head is divided into cranium and face.


                 SECT. I.--OF THE CRANIUM.

   The Cranium is composed of eight  bones.  The Os Frontis,
 the Os Occipitis, two  Ossa Parietalia, two Ossa Temporum, the
 Os Sphenoides, and the Os  Ethmoides.   The Os Frontis is  at
 the front of the cranium; the Os Occipitis is at its hind part; the
 Ossa Parietalia, one on each side, form its superior lateral parts;
 the Ossa Temporum, also one on each  side, form its inferior la-
 teral parietes; the Os  Sphenoides is in  the middle of its bottom
 part; and the Os Ethmoides is at the fore part of the  centre or
 body of the last bone.
   The cavity thus  formed  for  the brain, has  three diameters,
 which may be learned by sawing vertically through the middle
 line  of one skull, and horizontally through the cavity of another.
 The first diameter is  the longest, and  extends  from the lower
 part of the frontal bone to the protuberance on the middle of the
 interior surface  of  the  os occipitis; it is commonly about six
 inches and a half long.  The second diameter includes the space
 between the superior margins of the temporal bones, where they
 are most distant from  each other, and passing over the  middle of
 the great occipital foramen, is about five inches.  The third di-
 ameter is taken from the centre of the large hole in the occipital
 bone, to the centre of the suture between the parietal bones;  it is
 about five inches, also.  Rather more than one-third of the ca-
 vity of the cranium is placed  behind the second diameter, and it
 diminishes somewhat abruptly;  but in front of this diameter the
 cavity is finished  more gradually.
  When the face is separated from the cranium,  the exterior
 surface of the latter, excepting its base, represents tolerably ac-
 curately the form and  proportions of its  cavity: allowance being
made for the large sinuses in the lower  part of the frontal bone,
and  for the thinness of the upper parts of the temporal bones.
The  diameters mentioned, can  only represent what most  fre-
quently happens,  for daily observation  proves remarkable de-
partures from them.  Sometimes the transverse diameter is in-
creased at the expense of the longest, which gives to the head a
flatness before and behind.  On other occasions, the vertical di- 
THE CRANIUM.
123
ameter is increased, whereby the head receives a conical form.
In many individuals the first diameter is increased, which makes
the two  sides of the cranium more parallel and fiat than usual.
The elongation  of the transverse diameter is the most common,
and that of the  vertical the least so.   The capaciousness of the
cranium is much the same in adult individuals of the same sex;
from which it may be inferred that the excess of one diameter
is obtained generally at the  expense of the  other.  The  male
cranium is more capacious and thick  than the female.
  The female sex is less liable to variations in these proportionate
diameters than the male.   Stature has but little influence on the
capaciousness of the cranium, as giants and dwarfs have it of the
same size; hence, the  former seem to have very small  heads,
while the latter  appear  to  have very large ones, the eye being
deceived by the relative magnitude of their bodies.
  The fact seems to be  now well  ascertained, that continued
pressure, or rather, resistance in  a  fixed direction, made upon
the cranium of  a  growing infant will change  its natural form.
Peculiar ideas of beauty have induced certain tribes of savages
to adopt this barbarous and  unnatural  practice.   The  late Pro-
fessor Wistar* showed to his class, in 1796, a Choctaw Indian
having this peculiarity; and a tribe now existing near the sources
of the  Missouri, continues the practice of flattening both the oc-
ciput and the os frontis.
  In the Wistar Museum we have ten headst  of Peruvian  In-
dians, brought from the Pacifie Oeean, nine of which bear the
strongest evidence of having been flattened by pressure, on the
os frontis and on the  os occipitis.   The possibility of effecting
such a change in the form of the cranium has been strongly con-
tested; and  Bichat, who admits  it,  acknowledges that he  was
unable to produce like modifications in puppies, kittens, and
India pigs.   The  singular change, however, which  is wrought
upon the feet of Chinese ladies, strongly corroborates the opi-
nion of the head being also susceptible of artificial modifications
in its form.J

  * System of Anat. 3d edrt. vol. i. p. 73, 1824.
  t Presented by Dr. James Corneck, U. S. Navy, to the late Dr. Physick.
  t In an examination of an adult female of this nation, Among Foy, the mea-
surements were two inches and one-eighth from the heel to the end of the small
toe; four inches and three-quarters from the heel to the end of the great toe; and
the circumference of the ankle six inches and six-tenths. 
124
SKELETON.
    SECT. II.--OF THE INDIVIDUAL BONES OF THE CRANIUM.
            1.  Frontal Bone, (Os Frontis, Frontal.)
  The frontal bone forms the whole anterior, and a portion of
the superior,  lateral and inferior parietes of the cranium.   It is
symmetrical, and, occasionally, is completely divided into two
bones by the continuation of the suture  between  the parietal
bones.
  Its external face is convex, and the internal concave.  On the
former may be observed a line, or slightly raised ridge, running,
on the middle of the bone from above downwards, which is ex-
pressive of the original separation between its two halves.   The
front surface  of the bone is terminated on either side, below, by
the orbitary or superciliary ridge, a sharp  and arched elevation,
forming the  upper  anterior boundary to the orbit of the eye.
This ridge terminates outwardly by the external angular pro-
cess, and inwardly, by the internal angular process.  Just above
the internal half of the orbitary ridge the bone is raised, by the
separation  of its tables, into the superciliary or nasal protube-
rance or boss.  Between the internal angular processes a broad
serrated surface exists, by which the frontal bone is united to the
nasal bones, and to the nasal processes of the superior maxil-
lary bones.  The centre of this surface is elevated into the
nasal spine,  which  serves as  an abutment to the nasal bones,
and resists any force which might tend to drive them inwards.
On its exterior lateral surface,  behind the external angular
process, the frontal bone presents a concavity,  bounded above
by  a well marked  semi-circular ridge, and intended for the
lodgement of a part of the temporal  muscle.
  On each side of the front of the bone near its middle a promi-
nence exists, most frequently better marked in infancy than in
advanced life, and called by the French  the frontal protube-
rance.

  Proceeding backwards from the inferior part of the bone are
the two orbitar processes, concave  below and convex above.
They are much thinner than other parts of the  bone, and are
separated by an oblong opening which receives the ethmoidal
bone.  A depression, large enough to receive the end of a fin-
ger, is at the  exterior anterior part of  the orbitar process, be- 
THE CRANIUM.
125
ing protected by the external angular process: this depression
contains the  lachrymal gland.   Half an inch above the lower
margin of the internal angular process, a much smaller depres-
sion exists, occasioned by the tendon of the  superior oblique
muscle where it plays upon its trochlea.  In the orbitary ridge,
just without the latter depression, is the supra-orbitary foramen
or notch, for the passage of the  frontal artery and nerve.
  The internal margins of the orbitar processes are broad and
cellular, where they join  the ethmoid  bone; and at their fore
part is seen a  large  opening on each side leading into the
frontal sinus.  These  margins,  in common with the ethmoid
bone, form two foramina, one anterior, another posterior, and
called internal orbitary; the first transmits the internal nasal
branch of the ophthalmic nerve and the anterior ethmoidal
artery and vein, the  latter transmits the posterior ethmoidal
artery and vein.  Externally and behind, the orbitar  process
presents a broad  triangular  serrated surface for  articulating
with the sphenoid bone.
  The  interior or cerebral face of the os  frontis is  strongly
marked by depressions corresponding with the convolutions  of
the brain; on its middle exists a  vertical ridge, becoming more
elevated  as  it approaches the ethmoidal  bone. This ridge is
situated  below, extends about  one-half  of the length of the
bone, and terminates, above, in a superficial fossa, made  by
the longitudinal sinus  of the dura mater; at its lower extremity
is the  foramen coecum, common to it and  the ethmoid bone,
and which is occupied by a process from the great falx of the
dura mater, and also affords passage to some very small veins,
which go from the nostrils to the commencement of the longi-
tudinal sinus.*

  The frontal sinuses  consist  in one or more large cells, placed
beneath  the  nasal protuberances.  There  is  a very great
variety in their magnitude and extent; sometimes they proceed
as far outwards  as the external angular process, and back-
wards for half an inch  into the  orbitar plates.  In a few
instances  in the adult  they do not exist, but the cases are very
uncommon.  The cells of the opposite sides have a complete

                    * Portal. Anat. Medicale.
11* 
126
SKELETON.
partition.  They  communicate with  the  cavity of the  nose
through the  anterior ethmoidal cells..
  With the  exception of the inferior part, where the processes
and sinuses  exist, the os frontis is of a very uniform  thickness,
and the diploic or  cellular  structure is  found constantly be-
tween its external and internal faces.
  This  bone is united  to the parietal, ethmoidal, and sphenoi-
dal of the cranium;  and to several bones of the  face.
     S. Parietal Bones, (Ossa Parietalia, Os Parietaux.)

  These bones, it has been stated, form the superior and lateral
parts of the  middle of the cranium.  They are quadrilateral,
convex externally, and concave internally^  Their external and
internal tables are uniformly  separated by a diploic structure,
which, from  being  more abundant at the superior part of the
bones, occasions there an increased thickness.
  The external surface of the parietal bone is raised about its
middle into the parietal protuberance.  Just below this protu-
berance is an arched, rough,  broad, but slightly elevated ridge,
marking the origin of the temporal fascia and muscle, and
continuous with  the  ridge on the side of the frontal  bone.
The internal surface of the bone is marked by the convolutions
of the brain; there are also a number of furrows upon it, hav-
ing an arborescent arrangement, and produced by the ramifi-
cations  of the middle artery of the dura mater.  These furrows
all proceed from  two large ones at the anterior and at the infe-
rior part of the bone: not unfrequently at the latter point these
furrows are converted into perfect tubes, by the deposition of
bone all around  the  arteries.  Of these furrows, the foremost
may be traced from  the greater wing of the sphenoidal  bone,
and running  somewhat  parallel with the anterior margin  of the
parietal; and the other passing  from the squamous portion of
the temporal, is a little behind the middle, of the parietal, and
inclines towards its  posterior superior  angle.  The internal
face of the parietal bone also presents an imperfect fossa at  its
superior margin, which is completed by junction with its fel-
low, and accommodates the longitudinal sinus of the dura ma-
ter.  Near^ this edge it is not uncommon to see one or more 
THE CRANIUM.
127
small irregular  pits through  the  internal table, and  looking
somewhat ulcerated: these are formed by the glands  of Pac-
chioni, in the dura mater.   At the inferior posterior corner of
the bone, there  is also a fossa, which is made by the lateral
sinus of the dura mater.

   The superior, posterior, and anterior margins of the parietal
bone are regularly serrated, and nearly straight.   The inferior
margin is concave, presenting a thin, bevelled, radiated surface
before, for articulating with the squamous portion of the tem-
poral  bone: behind  this concavity, the angle of the bone is
truncated and  serrated, for articulating with the angular por-
tion of the os temporis.   The  anterior inferior  angle is the
most remarkable, from its being  elongated  so  as to  join the
sphenoid bone in the temporal fossa.
   A  foramen, called  parietal, is found at  the superior margin
of this bone, nearer to its posterior than to the anterior edge;
it transmits an artery between the integuments and dura mater,
and also a vein from the integuments to the longitudinal sinus.
M.  Portal says, that  in some protracted headaches  this vein
swells considerably;  and that he has seen much  good in such
cases, arise from the application of leeches to the  part: he has
also seen, in a child, its tumefaction the precursor of the pa-
roxysms of epilepsy.
   The parietal bone articulates with  its fellow, with  the fron-
tal,  the sphenoid, the temporal, and the occipital bones.


          3. Occipital Bone, (Os Occipitis, Occipital.)

   This  bone is  quadrilateral, resembling a  trapezium.  It is
 convex externally, and concave  internally; but both of these
 surfaces are much  modified by ridges  and  processes.  Its
 thickness is also very unequal;  though, like the other bones, it
 has two tables, with an intermediate diploe.  It is so placed as
 to form a considerable share of the posterior and inferior  pa-
 rietes of the cranium.

   The foramen magnum is found in  the  lower section of this
 bone, and constitutes a very conspicuous feature in  it.  This 
128
SKELETON.
hole is oval, the long diameter  extending  from before back-
wards. Its anterior inferior margin, on either side, is furnished
with  a  condyle, for articulating with  the  first  vertebra of
the neck.  These condyles are long eminences  tipped  with
cartilage,  which  converge  forwards,  so that lines  drawn
through  their length would meet an inch  in front of the fora-
men magnum; they recede behind: their internal  margins are
deeper than their external.  The condition of their articular
surfaces  is therefore such, that they  permit flexion and exten-
sion of the head,  but not rotation.   The anterior edge of the
foramen  is thicker than the posterior.  This foramen transmits
the medulla oblongata, the vertebral arteries and veins, and
the spinal accessory nerves.

   The external  surface of the occiput presents, half way be-
tween the foramen magnum and the  upper angle of the bone,
the occipital protuberance, from the lower  part of which a
small vertical ridge is extended  in  the middle line  to that
foramen.  Into the ridge is inserted  the Ligamentum Nuchas.
From either side of the  protuberance an arched ridge is ex-
tended to the lateral angle of the bone; it is the superior semi-
circular  ridge or  line, from  which arise the occipito frontalis
and the  trapezius muscles, and  into it is inserted a  part of the
sterno cleido-mastoideus.   Below  this about  an inch is the in-
ferior semicircular ridge,  more  protuberant, but  not so  dis-
tinctly marked  in  its  whole  course.  Into the inner space,
between  the upper and lower ridges, is inserted the  complexus
muscle, and into the outer space between the same, the sple-
nius muscle.   The lower ridge is principally occupied by the
origin of the superior oblique muscle of the  neck.
   The inner space between this ridge and the great foramen,
gives origin to the rectus posticus minor, and the outer space to
the rectus posticus major.   Into a small elevation, leading from
the outside of  the condyle directly to the margin of the bone,
is inserted the  rectus capitis lateralis.

  In a depression behind each condyle is the posterior condy-
loid foramen, which conducts a cervical vein to the lateral sinus.
Passing through the base of the condyle, and having its orifice
in front, is  the anterior condyloid foramen  for conducting the
hypoglossal nerve to the tono-nft. 
THE CRANIUM.
129
  That part of the bone before the condyles is the cuneiform or
basilar process: the base of which is marked by depressions for
the insertion  of the recti muscles,  which are situated on  the
front of the cervical vertebras; and its fore part, which is trun-
cated at the end, overhangs the pharynx, and is placed against
the body of the sphenoid bone.  The superior external part of
the os  occipitis is uniformly convex, being covered  by the  oc-
cipito frontalis.

   The internal surface of the os occipitis is strongly impressed
by ridges and  depressions.  On  that portion of it  behind  the
great foramen, is a rectangular cross, forming at its  centre a
large internal protuberance.  The upper limb of the cross is
marked by a fossa for the longitudinal sinus; the two horizon-
tal limbs are also marked, each  by its respective fossa, which
receives the corresponding lateral sinus.  The right fossa is fre-
quently the largest.  The inferior vertical limb of the cross has
attached to it the small falx of the dura mater, and is slightly
depressed by a small sinus.  The spaces  between the limbs of
the cross  are  much thinner than other parts of the bone, and
present broad concavities, the two superior of which receive
the posterior lobes of the cerebrum, and the two inferior,  the
lobes of the cerebellum.

   The superior face of the cuneiform process is excavated, lon-
gitudinally, to receive the medulla oblongata.  On each side of
the foramen magnum, a short curved fossa is observed, which
receives the lateral sinus just  before its exit from the cranium.

   The two superior margins of the occipital bone are regularly
serrated.   The inferior  margins have each, in their  centre, a
process termed the jugular eminence, in front of which is a
rounded notch, forming a part of the jugular fossa, which trans-
mits the internal jugular vein and the eighth  pair of nerves.
The edge of the bone above this eminence is serrated, but  be-
low it is  rather smooth and  rounded, being parallel with  the
temporal  bone, and having an imperfect adhesion to  the petrous
part of it, before the jugular fossa.

   The occipital bone articulates above with the parietal, lateral-
ly with the temporal; and in front with the sphenoid. 
130
SKELETON.
      4.  Temporal Bones, (Ossa Temporum, Temporaux.)

   These bones form portions of the inferior lateral parietes, and
 of the base of the cranium.
   Their figure is very irregular.  Their circular anterior por-
 tion is called  squamous: behind it is the mastoid, and  between
 the others is the petrous.

   The squamous portion is thinner than the other bones of the
 cranium that have been described, from the temporal muscle and
 its fascia covering it, so as to afford sufficient protection to the
 brain.  Its exterior surface is smooth and slightly  convex.  The
 interior  surface is formed'" into fossae by the convolutions of the
 brain.   At the  anterior inferior part of the latter surface,  a
 groove is  made by the middle  artery of the dura mater, imme-
 diately after it gets from the foramen spinale of the  sphenoid
 bone on its way to the parietal.   This  groove bifurcates, one
 branch runs backwards to join the posterior groove of the pa-
 rietal bone;  and the other ascends to join the anterior groove
 of the same, frequently, however,  impressing the top of the
 great wing of the sphenoid,  just before it reaches the parietal.
 The greater part of the circumference of this portion is sloped
 to a sharp edge, but  at the anterior inferior part it is serrated
 and thicker.  On the outside of the latter is the glenoid cavity,
 for articulating with the lower jaw: the length of it is trans-
 verse, with a  slight inclination backwards, so that a line drawn
 through  it would strike the foramen magnum occipitis.  The
 anterior margin of this cavity is formed by a tubercle, on which
 the condyle of the lower jaw rises when the mouth is widely
 opened.  The outer margin of the glenoid cavity is formed  by
 the root of the zygomatic process.  The zygomatic process has
 a broad horizontal root, from which  it extends outwardly, and
 then diminishing, runs forwards to join the malar bone.  Pos-
 terior to the  root of the zygomatic process, a small vertical
 groove may be seen occasionally, made by the middle tempo-
 ral artery.

  The mastoid portion of the temporal bone, is thick and cel-
lular.   Its upper part forms an angle, which is received between
the parietal and occipital bones: both margins of this angle are 
THE CRANIUM.
131
serrated.  Below, is the  mastoid process, a large conical pro-
jection eight lines long, into which are inserted the sterno-mas-
toid, and trachelo-mastoid muscles.  At  the  inner side  of its
base is a fossa affording  origin to the digastric muscle.   The
inner face of the mastoid portion is marked by a deep large fossa
for the lateral sinus of the dura mater.  In the posterior part of
the suture, uniting the mastoid portion and the occipital  bone,
or in the former bone near the suture, is the mastoid foramen,
for conducting a vein from  the integuments into the lateral
sinus.

   The cells in the mastoid bone are large and numerous, and
obtain the name of sinuses; they communicate with the tym-
panum by one large orifice.  On the outer side of these sinuses
a thin diploic structure is observable in some heads.

   The petrous portion of the temporal bone is a triangular py-
ramid, arising by a broad base from the inner side of the mas-
toid and squamous portions.  It is fixed obliquely forwards, be-
tween the sphenoid and occipital bones.   Its anterior surface is
marked by the convolutions of the brain.   Near the centre of
this surface, and having a little superficial furrow leading to
it, is a small foramen called the Hiatus Fallopii, through which
passes the  Vidian nerve.  The posterior surface of the petrous
portion presents a large foramen, the meatus auditorius internus,
through  which pass the seventh or the  auditory and the facial
nerve.   Half an inch behind  this orifice, is a very small one,
overhung by a flat shelf  of bone; this is said to be the aqueduct
of the vestibule.   Just above  the meatus  auditorius internus is
a  foramen  more patulous than the aqueduct, for  transmitting
small blood vessels.
   In the base of the petrous portion, between the mastoid and
zygomatic processes, is the meatus auditorius externus, a large
opening  conducting to the tympanum.  It is oval, about half an
inch deep, and varies much in its size in  different subjects: its
margin is called the auditory process, the  lower part of  which
is very rough, for attaching the cartilage of the external ear.

   The lower surface of  the petrous bone  is exceedingly irregu-
lar.  Immediately below the  meatus externus, is a depression 
132
SKELETON.
 which seems like a part of the glenoid cavity, and is improper-
 ly considered as such by anatomists, inasmuch as  it does not
 form a portion of the articular surface for the  lower jaw, but
 simply allows room for its motions, the parts which it contains
 (consisting of vessels, and a portion of the parotid gland) being
 pressed back when  the jaw opens.  Between this cavity and
 the glenoid is the glenoidal fissure, separating the petrous from
 the squamous bone.   In this fissure, leading  to the  tympanum,
 is a foramen which contains the processus gracilis of the mal-
 leus with its muscle, and the chorda  tympani.   The posterior
 margin of the depression just alluded  to in the petrous bone, is
 made by a long rough  ridge, called  processus vaginalis; just
 behind which, and partially surrounded by it,  is  the styloid pro-
 cess.   The styloid process is round, tapering, and an inch and
 a half long; but frequently absent in prepared skulls, from acci-
 dental fracture and from being in a cartilaginous state.  From
 it arise the styloid muscles.

   Behind the root of the  styloid process, is the stylo mastoid
 foramen, which transmits the portio dura or facial nerve to the
 face.  Just within the styloid process and the foramen is a deep
 depression, called jugular  fossa, large enough  to receive the
 tip of the little finger.  The fossa, along with a corresponding
 one  in the os occipitis, is occupied by the internal jugular vein
 and  the eighth  pair of nerves.  Immediately before the  lower
 end  of this fossa is the foramen caroticum, being the  lower ori-
 fice  of a crooked canal, which terminates at the  apex of the
 petrous bone, and transmits the carotid  artery and  the  upper
 extremity of the sympathetic nerve.   At the inner side of the
 carotid  canal, a superficial serrated groove is perceived, which
 receives the adjoining edge of the occipital bone.  Just in ad-
 vance of the inner part of the jugular fossa is a  small spine of
 bone, at the foot of which is a pit, containing the orifice of the
supposed aqueduct of the cochlea.  The spine  separates  the
eighth pair of nerves  from  the internal jugular vein.
  In the angle between the  squamous and petrous bones, within
the glenoid foramen, is the orifice of the Eustachian tube.   The
tube  is divided longitudinally, by a bony partition.  The upper
division  contains the tensor tympani muscle.
  A  small groove exists along the superior angle of the petrous 
THE CRANIUM.
133
bone, and another along the inferior angle, adjoining the basilar
process of the  occipital bone, and formed in part by it:  they
are made by the  superior  and inferior petrous sinuses.
  The temporal bone articulates with the occipital, the parie-
tal, the sphenoid, and the  malar.


        5. Sphenoid Bone, (Os Sphenoides, Sphenoide.)

  The  sphenoid  is  a symmetrical, but  very  irregular  bone,
placed transversely in the middle of the base of the cranium.
  It consists of a cuboidal body in the centre,  of a very large
process called the great wing, and spreading laterally to a con-
siderable distance on either side of the body,  and it has, also,
a number of angular margins and additional processes about it.
  In regard to the body  of  the  sphenoid bone, from its upper
anterior part arise, one on each side, the apophyses  of Ingras-
sias, or the little wings.   These wings have a broad horizontal
base, and extending themselves outwardly, terminate in a sharp
point.   Their anterior edge is serrated  for articulating with
the os  frontis: the posterior edge is smooth.  Between the two
wings, in front, is a prominence united to the ethmoid  bone.
The base  of the wing is perforated by the foramen opticum,
for  transmitting  the optic nerve with  the  ophthalmic artery.
Below and behind this foramen, the little  wing terminates in a
point, called the  anterior  clinoid process.   Between the  fora-
mina optica  is a  ridge of bone,  sometimes called processus oli-
varis,  and just above  the ridge a groove, made by the optic
nerves where they unite.  Behind the ridge  is a  depression,
the  Sella  Turcica, for containing the pituitary gland.   This
depression  is bounded behind  by a very elevated  transverse
ridge, called the posterior clinoid process.   At either extremi-
ty of the base of the latter, a groove (sulcus caroticus) is made
by the carotid artery, which groove may be traced  indistinctly
under the anterior clinoid process, where it forms a notch, and
 sometimes a foramen.
   The posterior  face of the body of the sphenoid bone, presents
 a flat  surface for articulating with the cuneiform process  of the
 occipital.  Most frequently, in  the adult, the bones  are anchy-
losed  at this junction.  The inferior part of  the body of the
sphenoid presents a rising, in its middle, called the sphenoidal
   Vol. I.—12 
134
SKELETON.
or azygous. process, for  articulation with the vomer, and with
the nasal septum of the ethmoid.   On each side of this process,
in front, is the orifice of the sphenoidal cell.  These cells con-
sist, most commonly, of one  on  each side, and are separated
by a  bony partition.  In  the very young bone  they are not
formed.  The body of the sphenoid undergoes so many changes
between early infancy and adult life, by the conversion of its
diploic structure into sinuses  or cells, and is also  so much mo-
dified in different  individuals, that a general description of it
will not answer for all specimens.
   The two great wings arise from the sides of the body of the
sphenoid, by a small irregular base.  From their lower part pro-
ject downwards,on either side, the twopterygoid processes called
external and internal.  These processes  have a common base,
are partially separated behind by a groove called pterygoid fossa,
and below by a notch.  The internal is the longest, and is termi-
nated by a hook, on the outer side of which is a trochlea made
by the tendon of the circumflexus muscle.  The external ptery-
goid process is the broadest.  By  applying together the temporal
and sphenoid bones, a groove, common  to the two, leading to
the Eustachian tube, will  be seen.   This groove is continued
 obliquely across the root of the internal pterygoid process, and
indicates the course of the cartilaginous portion of the Eusta-
chian tube.   The internal pterygoid process sends out from its
base  a small shelf of bone, separated by a fissure from the un-
 der part of the body  of the  sphenoid.   The  posterior edge  of
the vomer rests against this projection.  The fissure is filled up
in advanced life.
    The great wings of the sphenoid bone present three faces.
 One is anterior, and called orbital, from its forming a part of the
 orbit; another  is  external, and called temporal;  and the third is
 towards the brain, and forms a considerable part of the fossa
 for containing  its middle lobe.   The orbital face is  square and
 slightly concave.  The temporal face is an oblong concavity, at
 the lower part of which is a  triangular process, giving an origin
 to the external pterygoid muscle.   The cerebral face is concave
 and marked by the convolutions of the brain, as well as by a
 furrow made by the  principal trunk of the great artery of the
 dura mater as it passes from the temporal bone to the temporal
  angle of the parietal.  The inferior portion of the great wing is 
THE CRANIUM.
135
elongated backwards into a horizontal angle, called the spinous
process, which is fixed between the petrous and squamous portions
of the temporal bone.  From the point of the spinous process pro-
jects downwards the styloid process.   The great wing presents
a triangular serrated surface above, at its outer end, by  which
it articulates with the os frontis; just below this, in front, is a short
serrated edge, by which it articulates with the malar bone; and
externally, is a semicircular serrated edge, by which it articulates
with the squamous portion of the temporal bone.   The tip of the
large wing generally articulates also with the parietal bone.

   Between the apophysis of Ingrassias and the greater wing is
the foramen sphenoidale, called also foramen lacerum superius of
the orbit.  It is broad near the body of the bone, and becomes a
mere slit at the extremity of the little wing.  Through it pass
the third, fourth, the first branch of the fifth, and the sixth pair
of nerves.  Two lines below the base of this hole is the foramen
rotundum, for transmitting the seeond branch of the fifth  pair of
nerves.   Eight lines, or thereabouts, behind the foramen rotun-
dum, is the foramen ovale, for  transmitting the third branch of
the fifth pair of nerves.  Two lines behind the foramen ovale is
the foramen spinaie, for  transmitting the  middle artery of the
•dura mater.  In the under part of the bone, and passing through
the root of the pterygoid processes, is the foramen pterygoideum,
for transmitting the pterygoid nerve; it being a recurrent branch
of the second branch of the fifth pair of nerves.
   The sphenoid* bone articulates above and in front with the
 vomer, the  frontal, ethmoidal,  malar,  and  parietal bones : late-
rally with the temporal, behind with  the  occipital, and  by its
pterygoid processes with the palate bones.

          6. Ethmoid Bone, (Os Ethmoides, Elhmoide.)

   This bone is placed between the orbitar processes  of  the os
 frontis, and, as has been stated, fills the vacuity between them.
 It is  cuboidal, extremely cellular, and light.
   The horizontal portion between the orbitar processes is the

   * This bone is, by some anatomists, described in common with the os occipitis,
as the os basilare, in consequence of their early junction into a single piece. 
13ft
SKELETON.
cribriform plate called so from its numerous perforations.  This
is divided, longitudinally,  above and below, by a vertical pro<
cess;  and from the under surface on each side, is suspended the
cellular portion.

  The vertical process on  the superior face of the cribriform
plate  is the crista galli, which extends sometimes from the back
to the front of this plate, and is thickest in the middle.   The com-
mencement of the great falx arises from it, and occasionally it
contains a cell or sinus opening into the nose.  Between the front
of the crista galli and the os frontis, is  the foramen ccecum, al-
ready described.  On either side of the crista galli the cribriform
plate is  depressed into a gutter for holding the bulb of the olfac-
tory nerve,  and is perforated with many holes for transmitting
its ramifications.   The most anterior foramen on each side is
oval,  and transmits to the nose the internal nasal nerve,  after it
has got into the cranium through the anterior internal  orbitar
foramen. The margins of the cribriform plate show many im-
perfect  cells, which are completed by joining their  congeners
in the margins of the orbitar processes  of the os frontis.

  The  vertical process  below the cribriform  plate is called
nasal lamella.  It generally divides the nostrils equally, but is
occasionally inclined to one side.  It joins below, to the vomer
and the cartilaginous septum of the nose; in  front is in  contact
with the nasal spine of the frontal bone and with  the nasal
bones;  and  behind, with the azygous process of the  sphenoid.

  Each cellular portion of the ethmoid  forms, by its exterior, a
part of the orbit of the eye, which surface is called os planum.
The internal or nasal face forms part of the  nostril.   The fore
part of this  face is flat, but, posteriorly, in its middle, is a deep
sulcus, called the superior meatus of the nose.   The upper tur-
binated bone, a small scroll, constitutes  the  upper  margin of
this meatus.   The inferior internal margin of the cellular por-
tion of  the ethmoid, is formed by another scroll of  bone, run-
ning its whole length.  This  is  the  middle  turbinated  bone.
Moreover, from the inferior margin of the cellular portion, one
or more laminas, of an irregular  form, project so as to diminish
the opening into the  upper maxillary sinus. 
THE CRANIUM.
137
   The cells in the ethmoid bone are numerous and large, the
 posterior ones discharge, by one or more orifices, into the upper
 meatus.   The anterior discharge into the middle meatus of the
 nose by several orifices, concealed  by the  middle turbinated
 bone.   The most anterior of these cells  is funnel-shaped, and
 joining the frontal sinus, conducts  the  discharge of the latter
 into the  nose.

   In children of from three to eight years of age,  there is at-
 tached to the  posterior part of each cellular portion of the eth-
 moid, a  triangular hollow pyramid, consisting of a single cell.
 This pyramid arises, not only from the cellular portion, but also
 from the posterior margin of the cribriform  plate,  and  of the
 nasal lamella, by which it gains  a large and secure  base.  The
 processus azygos of the sphenoid bone is received between the
 two pyramids.  In  the base of the  pyramid, communicating
 with the  nose, is a foramen, which is known in adult life as the
 orifice of the sphenoidal sinus.   The pyramid, towards puberty,
 becomes a part of the sphenoidal bone, and then detaches it-
 self, by a suture at its base, from the ethmoidal.   As  life  ad-
 vances it is  greatly  developed, no indication of  its original
 condition remains, and it becomes fairly the sphenoidal cell;
 singularly differing  in shape from  what  it was in  the begin-
 ning.*

   Being  put upon the investigation  of this pyramid  by the late
 Professor Wistar, with  the view of ascertaining its  different
 phases of development, it has occurred to me to see  it in every
 stage, from  that of a simple triangular  lamina, arising from
 the posterior margin of the cribriform plate, to the perfect hol-
 low pyramidal state.   The  preceding  anatomists describe  it
 but imperfectly; it remained for that distinguished individual
 to elucidate its real history.

   Several of the articulations of the ethmoid have been men-
tioned; the remainder will be introduced with the bones of the
face.
              * Wistar's Anatomy, vol. i. p. 31, 3d edit.
12* 
138
SKELETON.
                  SECT. III.--OF THE FACE.

  The face being situated at the  inferior anterior  part  of the
base of the cranium, is  bounded above by this  cavity, laterally
by the zygomatic arches and fossas, and posteriorly by the space
occupied by the pharynx.  The  best  way of obtaining precise
information concerning  its form  and composition, is  from the
head of an infant, of  from five to ten  years, in  which the bones
can be easily parted.  In the adult, somewhat advanced  in life,
the bones  cannot be separated so perfectly, from  their  being
united more or less together by the obliteration of the sutures.
  The face is  composed by fourteen  bones, of which thirteen
enter into the upper jaw.  Twelve of the thirteen are in  pairs:
they are the ossa maxillaria  superiora, ossa malarum, ossa nasi,
ossa ungues, ossa turbinata inferiora, ossa palati.   The thirteenth
is the vomer.   A single bone, with corresponding or symmetri-
cal sides, constitutes the maxilla inferior.


1. Superior Maxillary Bones, (Ossa Maxillaria Superiora, Max-
                     illaires Supdrieurs.)

  These may be known by their superior size, and by their com-
posing almost the whole front of the upper jaw.  They are too
peculiar in their figures to admit of comparison with any com-
mon object.
  The superior face of  these bones is  formed by a thin triangu-
lar plate, the orbitar process, which is  the floor of the orbit.  In
the posterior part of  this plate is  a groove, leading to a canal
terminating in the front of the bone, at a foramen  called infra
orbitar.  This foramen  is situated  just below the middle  of the
lower margin of the orbit, and gives passage to  the infra-orbitar
nerve, and an  artery..  Externally, the  orbitar  plate is  termi-
nated  by a rough surface, the malar  process, which articulates
with the majar bone.

   The nasal process arises, by a thick, strong root, from the
front upper part of the  bone at its inner side.   Its front edge is
thin, the posterior margin is thicker, and the upper edge is short,
being serrated  for  articulating with the  os  frontis.  A  fissure 
THE FACE.
139
exists between the orbitar process and the nasal process, for ac-
commodating the os unguis, and  the lachrymal sac.   A groove,
leading to the nose, is  formed on the posterior face of the nasal
process, and marks the situation and extent of the lachrymal sac.
On that side of the root of the nasal  process, next to the  cavity
of the nose, a small transverse ridge is seen, to which is attached
the anterior part of the inferior turbinated bone.

   The under surface of the os maxillare superius is marked by
the alveolar processes  for lodging  the teeth.  These processes
are broader behind  than  before, corresponding in that respect
with the teeth.   Within the circle of the alveoli  is the palate
process, arising from the internal face of the body of the bone.
The palate process has a thick root,  is thin in the middle, and,
where it joins its fellow,, has its margin turned upwards towards
the nose into a spine or ridge, whereby its articular surface  is
increased.   It presents an oblong concave surface above, consti-
tuting the floor of the nostril; below, it, with its fellow, and the
alveolar processes, form one concavity, having a  surface some-
what rough, which is the  roof of the mouth. The palate pro-
cess does not extend the whole length of the superior maxillary
bone, but stops half an inch short of it, posteriorly, and with a
serrated margin for the palate bone.  When the  two maxillary
bones are in contact, we find in the suture, just behind the front
alveolar processes,  the foramen incisivum, which  bifurcates,
above, into each nostril.  This foramen contains a branch of the
spheno-palatine nerve, and a ganglion formed from it.

   In  front, just below the  infra orbitary foramen, the bone  is
depressed, which depression is filled up in the living state with
fat and  muscles.  But, behind, the maxillary bone  is elevated
into a tuberosity, between which  and the malar process is a broad
groove, in which the temporal muscle plays.

   The inner face  of the upper maxillary bone presents  a view
of the large cavity in the centre of it, called  Antrum Highmori-
anum.  The orifice by which  this cavity communicates with the
nose  is much diminished by the palate bone behind, the ethmoid
above, and the inferior spongy bone below.  When the antrum
is cut open a canal is seen on  its posterior part, which conducts 
140
SKELETON.
the nerve of the molar teeth to their roots, and a similar canal is
seen in front of the  antrum, for the nerves of the front teeth.
The nerves, in both instances, come from the infra orbitary.
The nerves, till they begin to  divide into filaments, are between
the lining membrane and the  antrum, but afterwards they make
complete canals in  the alveolar  processes.  The antrum fre-
quently  communicates with the frontal sinus, through the ante-
rior ethmoidal cells, which  circumstance  is omitted by most
anatomists.

   This  bone is articulated with  the frontal, nasal, unguiform,
malar, and  ethmoid, above;  to  the palate  bone  behind;  to its
fellow, and to the  vomer, at its  middle;  and  to the inferior
spongy bone by its nasal surface.


            2.  Palate Bones, (Ossa Palati, Palalins.)

   The palate bones, two in  number, are  placed at the  back
part of the superior  maxillary, between them and the pterygoid
processes of the sphenoid.
   For  descriptive  purposes  they may be divided into  three
portions—the horizontal or  palate plate, the vertical or nasal
plate, and the orbitar or oblique plate, placed at the upper ex-
tremity  of the latter.

   The palate plate is in the same line with the palate process
of the  superior maxillary bone,  and supplies  the  deficiency
caused by its abrupt termination.  It is square.   The inferior
surface is flat, but rough for the attachment of the lining mem-
brane  of the  mouth.  The superior surface is  concave, and
forms about one-third of ijie bottom of the nose.   The anterior
margin is serrated where it articulates with the palate process
of the maxillare superius.  The  posterior margin is thin and
crescentic.   The internal extremity of the crescent is  elon-
gated into a point, from which arises the azygos uvulas muscle.
The internal margin of the palate plate is thick and  serrated
for articulating with its fellow, the upper edge of it being  turn-
ed upwards to join the vomer.  The exterior edge touches the
internal  side of the maxillare superius, and from it  arises the
nasal plate. 
THE FACE.
141
  The nasal plate forms the posterior external part of the nos-
tril, and is much thinner  than the palate plate.  Its side next
the nose is slightly concave,  and is divided into two unequal
surfaces, of which  the  lower is  the smallest, by a transverse
ridge, that receives the posterior extremity of the lower turbi-
nated or spongy bone.  The external face is in contact with
the internal face of the maxillary bone, and presents a surface
corresponding  with it. The  nasal  plate of the palate  bone
diminishes the  opening into  the Antrum Highmorianum  by
overlapping it  behind.  Backwards it  joins the  pterygoid pro-
cess  of the sphenoid bone, and  overlaps its anterior internal
surface.

   At the inferior and posterior part of the nasal plate, where
the crescentic edge of the palate plate joins it, the  palate bone
is extended into a  triangular process,  called  the pterygoid.
This  process, on its posterior surface, presents  three grooves,
the internal of which receives the internal pterygoid process
of the sphenoid bone, and the external groove receives the ex-
ternal pterygoid process of the same bone.   The middle fossa
has its surface continuous with the pterygoid fossa of the sphe-
noid  bone, and may be seen,  in the articulated head, to contri-
bute  to  this  fossa.  The anterior surface  of  the pterygoid
process of the palate bone presents a small serrated tuberosity,
which is received into a  corresponding  concavity on the pos-
terior surface of the  maxillary bone,  and contributes  to  the
firmer junction of the  two.

   On the  external surface of the nasal plate,  between it and
the base of the pterygoid process, a vertical groove is formed,
which is converted into  a complete  canal  by  the  maxillary
 bone.  The lower orifice of this canal is  near the posterior
 margin of the palate.  It is called the posterior palatine fora-
 men, and  transmits the  palatine nerve and artery to  the soft
 palate.  Immediately  behind this  canal there is, not unfre-
 quently, a smaller one, running through the base of the ptery-
 goid process  of the palate bone, and transmitting a filament of
 the same nerve to the palate.

   The upper extremity  of the  nasal  plate  is formed  by two
 processes, one in front and the  other  behind, separated  either 
142
SKELETON.
by a round  notch or a foramen.  The posterior of the two,
called  also pterygoid apophysis, is inclined over towards the
cavity of the nose.  It is thin, and fits upon the under surface
of the body of the sphenoid  bone, and upon the inner surface
of the internal base of the pterygoid process of the same.   Its
upper edge touches the base of the vomer.  The anterior pro-
cess is the orbitar portion of the palate bone.
                      •/
   The orbitar portion  or  plate is longer than the pterygoid
apophysis, and is hollow and very irregular.   It may be seen
in the posterior  part of the orbit wedged in between the eth-
moid and maxillary bone.  The portion of it which is there
seen, is the orbital face, and is triangular.   On the side of the
ethmoid  bone its cells are seen, which are completed  by their
contiguity to the ethmoid and  sphenoid.  The cells, in young
subjects, are not always to be met with.   The posterior face
of the orbitar portion is winding and looks towards the zygo-
matic  fossa.

   The notch  between the orbitar portion and the pterygoid
apophysis is converted into a foramen, by that part of the
body of the sphenoid bone which is immediately  below the
opening  of the sphenoid cell.  Through this  foramen, called
spheno-palatine, pass the lateral nasal nerve,  the sphenopala-
tine artery and vein.

   This bone can scarcely be studied advantageously except in
the separated  head.  A single application of it to the maxillary,
will then show how it extends from the palate  of the mouth to
the  orbit of the  eye;  and how it is the connecting  bone be-
tween the  maxillary bone and the  pterygoid process of the
sphenoid.

   The palate bone articulates with six others.  With the  up-
per  maxillary, the sphenoid, the ethmoid, the  inferior spongy,
the vomer, and  with its fellow.  The  places of junction have
been pointed out in the description of the bone.


          3. Nasal Bones, (Ossa Nasi, Os du  Nez.)

   The ossa nasi, two in number, fill  up the vacancy  between 
THE FACE.
143
the nasal processes of the superior maxillary bones. They are
oblong and of a dense compact structure,  being so applied to
each other as to form a strong arch called the bridge of the
nose, which is farther sustained by the nasal spine and the
continuous oblique serrated surface of the os frontis.
   The ossa nasi are thick and serrated at their upper margins;
below, they are thin  and irregular.  The  surfaces by which
they unite with each other are broad, having their edges raised
where they join the nasal lamella of the ethmoid bone.  The
edge by which they join the nasal process  of the upper maxil-
lary bone is concave; the upper part of this edge is overlapped
by the nasal process, but the lower part of it  overlaps the na-
sal process.
   On  the  posterior face of the os  nasi is to be seen a small
longitudinal groove, formed by the internal  nasal branch of the
ophthalmic nerve, which nerve penetrates the foramen orbitale
anterius and the cribriform plate of the ethmoid bone.

   The ossa nasi articulate with  each other in front, with the
 nasal processes of the upper maxillary behind, with the septum
 narium  where they are in contact with one another, and with
 the  os frontis above.
     4. Unguiform Bones, (Ossa Ungues, Os Lacrymaux.)

  The unguiform is a very small  thin bone, placed at the in-
ternal side of the orbit, between the nasal process of the upper
maxillary and the os  planum of the ethmoid.  Its orbitar sur-
face is divided into a face which  is in a line with that of the
os planum, and  into an oblong vertical concavity, continuous
with the concavity on the posterior surface of the nasal  pro-
cess, for lodging the lachrymal sac.   Its inferior  anterior cor-
ner is elongated  into  the nose, so as to join with a process of
the inferior  turbinated bone, whereby the ductus ad nasum is
rendered a complete bony canal.
   This  bone lies on  the orbitar side of the most anterior eth-
moid cells, and completes them in that direction.
   An important  variety in the structure of this part of the or-
bit occasionally occurs, in which the whole fossa for  lodging 
144
SKELETON.
the lachrymal sac, is formed by the unusual breadth of the na-
sal process  of the upper maxillary bone.  In this case, the
only part of the os unguis which exists, is that in the same line
with the os  planum.  Several examples have come under my
own notice.   Duverney  has also mentioned it.   Sometimes it
is entirely wanting, in which case the os planum joins the na-
sal process.*  A variety still more uncommon is mentioned by
Verheyen, where the lachrymal fossa is formed exclusively by
the os unguis.
   This bone articulates very loosely with  the adjoining bones,
so that it is frequently lost from the skeleton.  It joins the os
frontis above, the os maxillare superius before and below, the
os planum behind, and the inferior spongy  bone in the nose.


 5. Cheek Bones, (Ossa Malarum, Jugalia, Os de la Pommette.)

   These bones, two  in number, are  also called zygomatic by
many anatomists.  They are situated at the external part of the
orbit of the eye, and form the middle external part of the face.
   The cheek bone is quadrangular, and has irregular margins.
It consists of two  compact  tables with  but little intermediate
diploic structure.
   There are three surfaces to it.  That which contributes to
the orbit is crescentic, and is called the internal orbitar process.
The one in front is convex, and forms part of the face; and be-
hind the latter is a third surface, which is concave, and forms a
part of the zygomatic fossa.  Of the four margins, two are su-
perior, and two inferior.   The anterior of the  first two is  con-
cave, and rounded off, to form the external and one-half of the
lower edge of the orbit.  The posterior upper border above,
is thin and irregular, and to it is attached the temporal fascia: it
terminates behind by a short serrated margin, for articulating
with the zygomatic process of the temporal bone.   The ante-
rior inferior margin, is serrated its whole length, for articulating
with the superior maxillary bone.  The posterior inferior mar-
gin gives origin to part, of the masseter  muscle.   Some anato-
mists admit, also, a fifth margin to this bone, which is towards
the bottom of the  orbit,  and articulates above with the great
wing of the sphenoid bone, and below with the superior maxil-

          * Berlin, Traite D'Osteol. vol. ii. p. 143.  Paris, 1754. 
                           THE FACE.                      145

  lary.  Between these two parts is a notch, forming the  outer
  extremity of the spheno-maxillary slit/
    The angles of this bone are called processes.  The upper one,
  which is continuous with  the external angle of the os frontis, is
  the superior orbitar, or angular process.   The orbitar margin
  terminates below, in the  inferior orbitar, or  angular process.
  That portion of the bone which joins with the zygoma of the tem-
  poral, is the zygomatic process; and the fourth angle is the max-
  illary process.

    The  os mate articulates with  four bones;  to wit, with the
  maxillary, frontal, sphenoidal, and temporal.
    There are some few small foramina in this bone, which trans-
  mit nerves and blood vessels.


 6.  Inferior Spongy Bones, (Ossa Spongiosa aut  Turbinata Infe-
                  rior a, Cornets Inferieurs.)

   This pair of bones is situated at the inferior lateral parts of
 the nose, just below the opening into the antrum Highmorianum.
 They are  very thin and porous, and their  substance is extreme-
 ly  light  and spongy.
   The internal face of the spongy bone is towards the septum
 of  the nose, and presents an oblong rough convexity.  The ex-
 ternal face has a corresponding concavity towards the maxillary
 bone.  The superior margin presents, in front, an upright pro-
 cess, which joins with the  anterior inferior angle of the unci-
 form bone, to form the nasal duct.  Just behind this, the margin
 of the bone is  turned over towards the antrum, forming a broad
 hook, which rests upon the lower margin  of the orifice  of the
 antrum, and diminishes its size. From the superior margin, also,
 one or two processes not unfrequently arise, whereby this' bone
joins the ethmoid.  The inferior margin  is  somewhat thicker
 than the  superior.
  The anterior  extremity of this  bone rests  upon  the ridge
 across the root of the nasal process of the upper maxillary. The
posterior extremity rests, in like manner, upon  the ridge across
 the nasal plate of the palate bone.*

  •  In some rare cases this bone adheres to the ethmoid, so as to become a part
of it.                                                   r
  Vol. I—13 
146
SKELETON.
                 The Ploughshare, (Vomer.)

  This single bone is placed between the nostrils, and forms a
considerable part of their septum.  It is frequently  more in-
clined to one side than to the other.  It is formed of two laminas,
between which there is a very thin diploic structure.
  The sides of the vomer are smooth and parallel.   It has four
margins.   The superior  is the broadest, and has a furrow in it
for receiving the azygous process of the sphenoid bone.   The
anterior margin being directed obliquely downwards and for-
wards, its front half joins the cartilaginous septum  of  the nose,
and the posterior half receives, in a narrow groove, the nasal
plate  of the ethmoid.
  The posterior margin  of the vomer is smooth and rounded,
making the partition  of the nostrils behind.   The inferior mar-
gin articulates with the spine or ridge of the  superior maxillary
and palate  bones, which  exist at their internal border.


   (Lower Jaw, Os Maxillare Inferius, Maxillaire Inferieur.)

  This bone forms the  lower boundary of the face, and  is the
only one in the head  capable of motion.  In early life, its two
halves are  separable, being joined at the  middle line only by
cartilage; but, in  the course of two or three years after birth,
they are consolidated, and the original cartilage disappears.
  It consists of a body or  region which  corresponds  with the
teeth, and two extremities or branches.
  The inferior part of the  body presents a thick and rounded
edge,  which is the base.   The upper part of the body is formed
by the alveolar cavities for receiving the teeth.   The  line of
union between the halves, being called the symphysis, is marked
in front by an elevated ridge, terminated below by the  ante-
rior mental tubercle a triangular rising.   In many sDbjects
this tubercle is bounded on each side by a rounded prominence
of bone, which gives to the  forepart of the  jaw an unusual
squareness  in the living subject.   Just above the latter promi-
nence, there is, on  each side, a transverse depression, from
which arises the levator muscle of the lower Up.   On a line
with this depression,  and removed a little distance  from its ex- 
THE FACE.
147
ternal extremity, under the interstice between the second small
and the first large molar tooth, is the anterior mental or maxil-
lary foramen, the termination of a large canal in either side of
the bone, and which conducts the inferior maxillary blood ves-
sels and nerve to the teeth.  The foramen is directed obliquely
upwards and backwards, and transmits the remains of  these
blood vessels and the nerve to the face.  The chin is that part
of the bone between the anterior mental foramina.   As the  al-
veolar processes do not exist in early life, and in very advanced
age when the teeth  are  lost, the anterior mental  foramen in
such cases is very near the superior margin of the bone.  At
it an obtuse ridge of bone commences, and which  ends in the
root or anterior edge of the coronoid process.  The alveolar
processes of the  last three molar teeth are  placed within this
ridge, and project over the internal  face of the bone.
  The internal or posterior face of the lower jaw is also marked
at the symphysis by a ridge passing  from the superior to the in-
ferior  margin.  At the lower part of this ridge is  a cleft pro-
cess, the posterior mental tubercle.  Below this tubercle, on ei-
ther side, is a shallow fossa, for receiving the digastric muscle.
Between the lower margin of the bone and the protuberance
occasioned by the alveolar processes of the larger molar teeth,
is an oblong large  fossa, made by the pressure of the sub-max-
illary gland.

  The alveolar processes form a semicircle,  the extremities of
which are carried backwards with  a  slight divergence.   The
parietes of the processes are thin, and  present eutting edges.
They of course correspond, in number and shape, with the roots
of the  teeth which they have  to  accommodate.   The anterior
ones are longer than the posterior.   As a general rule, the alve-
olar processes may be said to come and depart with the teeth;
but, when a single tooth is extracted, the alveolar cavity not
unfrequently is filled up with osseous matter, the edge of it alone
being  removed.   This occurs more frequently in the lower than
in the upper jaw.
  The base of the lower jaw does not  present many marks
worthy of attention.   It  should  be  observed, that  its anterior
part is thicker than the posterior; and that sometimes, just be- 
 148                      SKELETON.
 fore the angle of the bone, we see a concavity of this edge, but
 generally it is straight, or nearly so.

   The extremities or rami of the lower jaw are quadrilateral,
 and rise up much above the  level of the body.   The superior
 margin presents a thin concave edge, bounded in front  by the
 coronoid, and behind by the  condyloid process.  The coronoid
 process is triangular, and receives the insertion of the temporal
 muscle; its base is thick, but its apex is a thin rounded point.
 The condyloid process is a transverse cylindrical  ridge, directed
 inwards, with  a  slight inclination backwards, its middle being
 somewhat more elevated than the extremities.  It springs from
 the  ramus by  a  narrow neck.  There is a concavity at  the
 inner fore part of its neck for the insertion of the pterygoideus
 externus, and a convexity behind.
   The external face  of the ramus is flat, but  marked by the in-
 sertion of the masseter  muscle.   The internal face, at its lower
 part, is flat and rough, for the insertion of the pterygoideus  in-
 ternus.  At the upper part of this  roughness is  the posterior
 mental or maxillary foramen, through which the inferior maxil-
 lary vessels and nerve pass.   It is partially concealed by a spine
 of bone, into which a ligament from the os temporis is inserted.
 Leading from this foramen is a small  superficial groove, made
 by a filament of the inferior maxillary nerve.
  The angle of the inferior  maxillary bone,  formed by the
 meeting of the base and the posterior margin  of the ramus, pre-
 sents diversities well worth attention, at different epochs of life,
 and  in different  individuals.  In very  early life, and in very
 advanced, when the alveoli are  absorbed, it  is remarkably ob-
 tuse.   In most middle-aged individuals it is nearly rectangular.
 Besides which, its  corner is sometimes bent outwards and some-
 times inwards,  increasing or  diminishing thereby the breadth
 of the face at its lower part.
  The substance of this  bone, externally, is hard and compact.
Internally there is a cellular structure, through  the centre of
which runs the  canal for the  nerves and blood vessels.   From
this canal smaller ones are detached, containing the vascular and
nervous filaments which go to the roots of the teeth.   The max-
illare inferius articulates with the temporal bones, by means of
their glenoid cavities. 
'the sutures.
149
  Remarks. —The maxillare inferius has a greater influence on the
form of the face than any other bone entering into its composi-
tion.  Sometimes it is much smaller in proportion in certain in-
dividuals than in others.   Sometimes its sides, being widely se-
parated, cause a great shortening to the chin, and breadth to the
lower hind part of the face.   In many instances, the alveolar
processes, in  front, incline obliquely over  the  outer circumfe-
rence of the  bone, and thereby give to the chin the  appearance
of receding considerably.   In  others, the  alveoli  incline over
the inner circumference, which causes the chin to  project unu-
sually.
                    CHAPTER III.

          GENERAL CONSIDERATIONS ON THE HEAD.

  Having described the individual  bones of the head, it will
now be proper to consider it as a whole.


                 SECT. I.—OF THE SUTURES.

  Except in advanced age, the bones of the cranium and of the
face are very distinctly marked off and united by sutures.
  The latter are formed by the proximate edges  of  the  bones,
presenting a  multitude  of  sharp serrated points, and of deep
narrow pits, by which they are brought  into accurate and firm
contact.  Here and  there, in  the  sutures which  unite the flat
bones of the cranium, we find not  only sharp points, but com-
plete dove-tail processes of the one bone received  into corre-
sponding cavities of the  other.   The denticulation of the sutures
is much more common,  and much better marked, on the exter-
nal than on the internal  surface of the  cranium.   On the latter,
the union of the bones is, in several  instances, by a joint nearly
straight; in which case,  the denticulation is  almost exclusively
confined to the external  table and to  the diploic  structure.

  The Coronal  Suture,  (Sutura  Coronalis,)  so named from its
                            13* 
150                      SKELETON.
corresponding in  situation with  the  garlands worn by the an-
cients, begins at the sphenoid bone, about an inch and a quarter
behind the external angular process  of  the  os  frontis.   It in-
clines so  much backwards  in its  ascent, that when we stand
erect, with  the  head  in its  easiest position, a vertical line,
dropped from its point of union with the sagittal suture, would
pass through the centre of the base of the cranium, and would
cut another line drawn from one meatus auditorius  externus to
the other.  It unites the frontal bone to the two parietal.

  The Sagittal Suture (Sutura Sagiitalis) unites the upper mar-
gins of the two parietal bones, and is immediately over the divi-
sion between the hemispheres of  the  cerebrum.  It has been
stated in the account of the  os frontis, that sometimes it is con-
tinued through the middle of this bone down to the root of the
nose.

  The Lambdoidal Suture  (Sutura  Lambdaformis) is  named
from its resemblance to the Greek letter lambda,  and  consists
of two long legs united  angularly.   It begins at the posterior
termination  of the  sagittal suture,  and continues down to the
base of the cranium, as far as the jugular eminences of the occi-
pital bone.  Its upper half unites  the occipital to  the parietal
bones, and the lower half the occipital  to the temporal bones.
The latter half is sometimes called the Additamentum Suturas
Lambdoides.

  The Squamous Suture (Sutura  Squamosa) is  placed  on the
side of the head, and  unites the parietal  to  the temporal bone.
The convex semicircular edge of the  latter overlaps the concave
edge of the former.   The squamous suture is converted into the
common serrated one, where the upper edge of the  angle of the
temporal bone joins the parietal.  This portion is called the Ad-
ditamentum Suturas Squamosas.
  The squamous mode of suture unites, likewise, the great wing
of the sphenoidal to the temporal angle of the parietal.

   In  the upper part of  the  lambdoidal suture, particularly, we
find in many skulls one  or more small bones, connected to the
parietal  and  occipital  bones by serrated margins.  They are 
THE SUTURES.
151
called the ossa Wormiana or Triquetra.   They vary very much
in their magnitude, being in different subjects from a line to one
inch, or an inch and  a half in  diameter.   I have seen them  of
the latter size, and even larger, occupying  entirely the place of
the superior angle of the os occipitis.  Most commonly, but not
always, when one of these  bones exists on one side of the body,
a corresponding one exists on the other.   A congeries of these
bones, united successively, is sometimes found  in the lambdoidal
suture; in such cases they are, for the most part, small.  Com-
monly these bones consist, like the other bones of the cranium,
of two tables and an intermediate diploe,  and form an integral
portion of the  thickness of the cranium; sometimes, however,
they  compose  only the external  table.   M.  Bertin  says, that
he has seen them, also, composing only the internal table of the
cranium.
  All  the sutures mentioned besides the lambdoid, may exhibit,
at any of their points, the ossa Triquetra  or Wormiana.  I have
seen them in the  coronal, the sagittal, and the squamous, but in
such cases they are  small.  The lambdoid unquestionably has
them most frequently.  M. Bertin has seen a  large square bone
at the  fore part of the sagittal  suture, occupying the  place, and
presenting the form, of what was once the anterior fontanel: he
has also seen triquetral bones in the articulations of the bones of
the face.*

  The sutures described belong exclusively to the cranium, but
there are others common to it and to the face.  The sphenoidal
suture surrounds  the bone from which its name comes; the eth-
moidal suture surrounds the ethmoidal bone;  the  zygomatic su-
ture unites the  temporal and malar bones; the transverse suture
runs across the root of the nose, and also unites the malar bones
to the os frontis.   The other  articular surfaces of the face de-
rive their names  from the bones they unite, and do not merit  a
particular attention at this time, as enough has been said in the
description of the bones themselves.
   The base of  the cranium is remarkably different, in the man-
ner of its  articulations, from the upper  part.  The surface, in
the first place, is  very rugged, and much diversified by its con-
* Bertin, loc cit. 
152
SKELETON.
nexion with muscles and bones: besides which, there is a con-
siderable number of large foramina and  fissures  in  it for the
blood  vessels and  nerves.   To  guard against  the weakness
arising from the latter arrangement, nature has given  a very in-
creased thickness to the base, particularly where much pressure
from the weight of the head exists, and has applied  unusually
broad surfaces of bone  to  each other to secure them from dis-
placement by concussion, and different kinds of violence.  These
arrangements are particularly manifest at the junction of the
cuneiform process of the  occipital  bone with the body of the
sphenoid, which, in  middle age, is anchylosed;—at  the  lower
part of the lambdoidal suture;—and at the margins  of the pe-
trous portions of the temporal bones where they touch the con-
tiguous bones.  Whence it results that  the several fastenings of
the base  of the  cranium, and also of the upper maxilla, are  so
complete and strong, that they are most generally perfectly ex-
empt from  dislocation; and when the violence offered to them
is sufficiently great, the bones, in place thereof, are fractured.

  The use  of the sutures,  in the cranium and  upper maxilla, is
somewhat problematical;  for as none  of  the  bones  move, the
head might have been equally well arranged by being made  of
a single piece.  In proof of which it is only necessary to recol-
lect, that in the very aged there is frequently not a bone of the
cranium and upper maxilla to be  found in an insulated state:
they are  all fused into the  adjoining bones, by the obliteration
of their sutures.  The old notion that sutures existed for the
purpose of  arresting the course of fractures, and for opening  in
some diseased conditions of the brain, has been very justly ex-
ploded.  We know that a  fracture will traverse a suture readily,
and that the opening of  the  sutures from  hydrocephalus  is  an
occurrence  only of very early infancy, where the sutures have
not arrived at the serrated and dove-tail arrangement, by which
they are subsequently secured.   It is much more probable that
the true reason for the existence of sutures, is found among the
laws peculiar  to the growing state; and which most commonly
are  suspended after the several developments have been accom-
plished.  Thus, the head, in consequence of being separated by
sutures into many pieces, is more readily wrought from its form
and size in  the embryo state, to the form  and size required by 
THE SUTURES.
153
adult life.  This necessity of subdivision into many pieces, does
not depend so much on the size, as on the shape of the head.
For we  find the largest animal, as the elephant, having no
more sutures than the smallest, as the mouse.  This opinion is
also sustained by what we see in other bones.  Bones of a
very simple shape,  as those of the  tarsus and carpus, consist
from  the very beginning  of  but  one piece.  But where the
shape  of a bone is  complicated, we find  it, while  growing,
submitted to the same law as the head at large, and consisting
of  many pieces.   In such  cases these pieces are united by a
species of suture corresponding precisely with the form  of su-
ture observed between some of the bones of the cranium;  as,
for example, between the  occipital and  the sphenoid.  Thus,
the os femoris, till adult  age, consists of five pieces: its two ar-
ticular  extremities,  its body, its trochanter  major, and its tro-
chanter minor.  The cranium itself, before birth, and for some
time after, has several  of  its individual bones consisting each
of two or more pieces, which favours still more the idea.
   Some persons think that the sutures of the adult are only re-
mains  of an arrangement intended exclusively for the benefit of
the partarient state, by maintaining a plasticity of the head of
the fcetus, which admits  of its diameters accommodating them-
selves to the diameters of  the pelvis of the mother.   This the-
ory is  rather too exclusive, though it may be admitted that the
sutures in a fastal head have that use, and are in some cases of
parturition a most fortunate coincidence, by which the lives of
both parties are saved.   But  it should  be  observed that in a
great number of cases, the head of the foetus never changes its
form in passing through  the pelvis, because the passage is quite
large enough without it;  and, again, if the sutures  were intend-
ed expressly for the parturient state, we ought not to find them
in birds, and in such animals  as  are hatched, because the ne-
cessity for them there does not exist.*
   Upon the whole we may safely conclude, that the sutures of
the cranium and face are simply a provision for  the  growing
state, and that, like  all  other provisions  for this  state,  it  also
ceases at its appropriate period, and sometimes leaves not a ves-

  * A gentleman whose  anatomical writings have some vogue  in this country,
has cut the Gordian knot, by telling us that they are "accidental merely, and of
little use!! "—Anat. of the Human Body, by John Bell, Surgeon, Edinburgh. 
154                     SKELETON.
tice of its existence.  Occasionally, indeed, we  find the latter
to have occurred in one or more sutures, even before the  age
of puberty, as I have repeatedly witnessed  of the sagittal, the
squamous, and the lambdoidal sutures.

  The manner in which  the  sutures are formed is sufficiently
interesting: they are generally said to be made by the radii of
ossification, from the opposite bones meeting and passing each
other, so as to form a  serrated  edge.  This explanation may
account partially for the  shape of the edge of the sutures, but
not for their invariable position; inasmuch as we always find
the sutures in the same relative situation, and having the same
course.   If they depended exclusively on so mechanical a  pro-
cess, as the rays of one bone shooting across the rays of ano-
ther by their own force,  we ought to find, occasionally, the sa-
gittal suture more on one side of the head than on the other,
and not straight, because in  some instances ossification  is a
more rapid process on one side than on the other.  Moreover,
in all cases where bones  arise from different points of ossifica-
tion, and meet, the serrated edge should be formed; and parti-
cularly in the flat  bones.  Observation, however, proves  that
the os occipitis, which is formed originally  from  four points of
ossification, and therefore has as many bones composing  it in
early life, does not present these bones afterwards united by the
serrated  edge.   The acromion process of  the scapula, though
originally distinct from the spinous, never unites to it by suture,
but always by fusion.   The mode of junction in the three bones
of the sternum is always by fusion.   In short, the observation
holds good in  numerous other instances.
  Bertin and Bichat, reject fully the mechanical doctrine  con-
cerning the sutures, and  present one founded upon reason and
observation, and susceptible  of confirmation by any accurate
observer. The dura mater and the pericranium, before ossifica-
tion commences, form one membrane consisting of two laminae.
Partitions pass from one of these laminas  to the other, which
mark off the  shape, or constitute the mould of the bones  long
before they are perfected.   The peculiar  shape of the bony
junction, or, in other words, of the sutures or edges of the bones
in adult  life, depends, therefore, exclusively upon the original
shape of the partitions.   When the latter are serrated, the points 
THE SUTURES.
155
of ossification will fill up these serras; but when they are oblique,
the squamous suture will be subsequently formed.
  This theory also accounts for modes of junction intermediate
to the squamous and serrated suture;  for the formation of the
ossa Triquetra or Wormiana; for their existence, form, size, and
number, in some skulls, and their total absence in others.  The
inference will also be obvious, that in all ossifications from dif-
ferent nuclei, a suture will not be formed, where the membra-
nous partitions do  not exist; but that the bones will unite after
the manner of such as are fractured.  We shall also understand,
that when  these partitions are weak and imperfect, either from
their congenital condition, or from advanced age, as happens in
all sutures, but with some differences of time, the bones of the
opposite sides are fused together completely.

  The partitions which determine the places of the sutures, may
be demonstrated in a young adult skull by removing with mu-
riatic acid the  calcareous portion of the bones,  so as to  leave
only the animal part.  On opening the suture after this process,
it will be seen,  that the pericranium sends in its partition, which
is met by  the  partition  coming from the dura mater.   Or, if
either of these  membranes be peeled off, its contribution of par-
tition will  appear very plainly  projecting from its  surface, in
the form of a ridge.
   Owing to congenital hydrocephalus, the sutures of the vault
of the cranium have been known to remain open for years after
birth, from the  continued augmentation of the volume of the
brain.  In such cases additional  bones are  sometimes formed,
manifesting a strong attempt, on the part of nature, to cover the
brain with bone.   I obtained, some years ago,  a specimen of
 this kind belonging to a fcetus of nine months, whose head was
 as large as it is commonly in adult life, and in whom there were
 two ossa parietalia on  one  side.  Morgagni,* whose authority
 is proverbial in morbid anatomy, states, that a learned colleague
 and intimate friend of his, Bernardin Rammazzani, aged seven-
 ty, had the sutures open at that period of life.  He does not say
 at what time this  condition of them appeared.  I think it more
 probable that  they had never been closed, though Morgagni
* Causes and Seats of Disease, Letter 3d, Art. 8th. 
156
SKELETON.
leaves the reader to infer, that it was a circumstance which had
arisen from a violent hemicrania, with which the patient had
been seized when he was advanced in life.  Diemerbroek found,
in a woman of forty, the anterior fontanel not ossified. Bauhius'
wife,  aged twenty-six, had the sutures not yet closed.   Indeed,
there  is no deficiency of well  authenticated similar instances,
more of which it will be unnecessary to adduce.   It may be ob-
served here, that when from congenital hydrocephalus, attended
with much extension of the brain, the bones of the cranium are
compelled to  grow beyond their usual diameters, they  are un-
commonly thin, and the  diploic  structure  is very imperfectly
developed: which will account for their separation at any period
of life, from the fastening being so slight.


      SECT. II.--OF THE DIPLOIC STRUCTURE OF THE CRANIUM.

  The bones of the cranium, in the adult, consist of an external
and of an internal table;  united by a bony reticulated or cellu-
lar substance, which does not manifest itself very distinctly till
two, three, or even more years are passed, by the infant.  The
internal table of the skull is thinner and more brittle than the
external, and has obtained, from that cause, the name of vitreous
table.
  The cells of the diploic structure are not to  be confounded
with the large sinuses  that exist in the frontal, the temporal, and
the sphenoidal bones.  They are formed under different circum-
stances, and do not communicate with them.  The sinuses are
lined  by a mucous membrane, whereas the lining membrane of
the cells of the diploe  corresponds with the internal periosteum
of other bones.   I  have a preparation now before me, in which
the diploic structure of the os frontis exists between its sinuses
and the external table of the bone: in the same  head, a similar
circumstance existed in regard to the temporal bone; from which
we infer that the diploic structure, in these places, is  caused to
recede, and even to be partially obliterated, when the develop-
ment  of the sinus commences, which is not until some time af-
ter the evolution of the diploic structure.  The sphenoidal bone,
when  fully evolved in  its  body, is a remarkable  instance of the
recession of diploic structure for the purpose of forming  a sinus. 
STRUCTURE OF THE CRANIUM.
157
  In the diploe of the dried bones, several arborescent channels*
may be seen by the removal of the external table.  They were
discovered about the year 1805, by M. Fleury, while  he was
Prosecteur at the School of Medicine in Paris: and engaged, at
the instigation of the venerable Chaussier, in some inquiries re-
lative to the structure of the cranium.   The account given by
the latter  is, that these channels  are occupied in the recent sub-
ject, by veins, which, like all others, are intended to return the
blood to  the heart.  These veins  are furnished  with  small
valves, have extremely thin and delicate parietes, and commence
by capillary ramifications,  coming from the different points of
the vascular membrane, which  lines the  cells of the  diploe.
Their roots are at  first extremely fine and numerous, form by
their frequent anastomoses  a kind of net-work, and produce by
their successive junction, ramuscules, branches, and large trunks,
which, becoming still more voluminous, are directed towards
the base of the cranium.  Some  variations exist in regard to the
number, size, and disposition of these trunks; but generally one
or two of them are found on either side of the frontal bone, two
in the parietal bone, and one on either side of the occipital bone.
Anastomoses exist between these several trunks, by which the
veins in the parietal bone are joined to those in the frontal and
in the occipital.  Branches from the right side of the head also
anastomose with some  from the left side.  Besides the branches
already mentioned, one or two smaller than  the others  are di-
rected towards the top of the head, and terminate in the longi-
tudinal sinus.

  The descending veins of the diploe communicate  in their pas-
sage with the contiguous superficial veins, and  empty into them
the blood  which they receive from the several points of the di-
ploe.  These  communications are passed through  small fora-
mina, which penetrate from the surface of the bone to the diploe.
The trunks of such diploic veins as are continued to the base of
the cranium, open partly into the sinuses of the  dura mater, and
partly into the venous plexus at the base of the pterygoid apo-
physes of the sphenoid bone, and  form there the venous commu-
nications through the foramina of the base of the cranium, called

    * Chaussier, Exposition de la Structure de l'Encephalef  Paris, 1807.
  Vol. I.—14 
158
SKELETON.
the emissaries of Santorini.  Moreover, there are communica-
tions sent from the diploic  veins, through the porosities of the
internal table of the skull, to the veins of the dura mater.  This
fact is rendered very evident by tearing off the skull-cap, when
the surface of the dura mater will be found studded with dots of
blood, and the internal face of the bone also, particularly in apo-
plectic subjects.  It appears, indeed, that the arteries of the
cranium  are principally distributed on its external surface, and
the veins on its internal surface and diploS.
  In the  infant, the diploic veins are small, straight, and have
but few7 branches: in the adult, they correspond with the descrip-
tion just given, and, in old age, they are still more considerable,
forming nodes and seeming varicose. In children, when the bones
are diseased, they partake of the latter character.  In order  to
see them fully, the external table of the  skull must be removed,
both from its vault and base, with a chisel and mallet.  This
operation will be much facilitated  by soaking the head  pre-
viously in water for  two days.


       SECT. III.--THE INTERNAL SURFACE OF. THE CRANIUM.

  The points for study in viewing the cranium as a whole, are
generally the same as have been presented in the detail of each
bone.  It is, nevertheless, useful to regard the structure in  its
connected state, as  new views are  thus presented of the rela-
tive situation of parts, and of the formation of the several fossas
and cavities.
  The cavity for containing the  brain is regularly concave
above, and is there called the arch or vault; but below, it is di-
vided into several fossas, and is called the base.
  The whole cavity is lined by the dura mater, and, in the adult,
presents  round superficial depressions made by the convolutions
of the brain.  These depressions are seldom deep enough to pre-
vent the  internal periphery of the vault and sides of the crani-
um, from being nearly parallel with their external surface.

  On the Vault, or arch, are to be seen, on the middle line, the
frontal spine, extending from the ethmoid bone halfway or more
up the os frontis: also, the gutter for the longitudinal sinus lead-
ing from this spine along the sagittal suture, and terminating at 
SURFACE OF THE CRANIUM.
159
the internal occipital protuberance.  On either side of this gut-
ter are the arborescent channels, made by the great middle ar-
tery of  the dura mater.   In this section, we also see the inter-
nal face of the os frontis, excepting its orbitar processes;  the
parietal bones; and the superior fossae in the occipital bone, for
the posterior lobes of the cerebrum.

  The Base of the cranium internally presents a very unequal
surface, abounding in deep depressions, processes, and foramina.
On its middle line, extending from before backwards, the follow-
ing objects should be remarked.  The  foramen ccecum at  the
front of the crista galli; and, at either side of the latter, the eth-
moidal gutter, perforated with holes.  These gutters are bound-
ed, laterally, by the internal margin of the orbitar processes of
the os frontis, and behind by the sphenoid bone.   At the fore
part of the gutter is the oblong foramen for transmitting to the
nose the internal nasal nerve, and about half an inch behind this
foramen, in the suture, with the os frontis, is the inner orifice
of the foramen, called  the anterior internal orbitar, which leads
the same nerve from the orbit.  Immediately behind the ethmoi-
dal fossae the sphenoid bone presents a plane surface, upon which
are placed the olfactory nerves and the contiguous part of  the
brain.  Behind this plane is the fossa, running from one  optic
foramen to the other, for lodging the optic nerves.  Behind this,
again, is the sella turcica  or pituitary fossa-, bounded at its two
anterior angles by the anterior clinoid processes, and behind by
the posterior clinoid process.  Posterior to the latter is a plane
square surface of the sphenoid bone, continuous with the inter-
nal surface of the cuneiform  process of the os occipitis.   On
the latter is the depression called basilar gutter, for receiving the
medulla oblongata, and which is  bounded  below  by the great
occipital foramen.  From this foramen to the internal occipital
protuberance, proceeds the  inferior limb of the occipital cross.

  On both sides of the ethmoidal bone is a convex-surface; called,
however, the anterior  fossas of the base of the cranium, and
formed by the orbitar processes of the  os  frontis and the little
wings of the sphenoid bone, for lodging the anterior lobes of the
brain.  This surface is terminated behind by the rounded edge
of the little wings, which is received into the fissure between the 
160
SKELETON.
anterior and middle lobes of the brain.  Just anterior to this edge
is the fronto-sphenoidal suture.

  On the sides of the sella turcica are the middle fossas of the
base of the cranium.  They are very wide  externally, where
they are boundedby the squamous portions of the temporal bones,
but narrow internally, where they are bounded  by the  Sella
Turcica.   The little  wings of the sphenoidal bone terminate
them in front, and form there a crescentic edge hanging over
their cavity.  Their  posterior margin is the superior ridge of
the petrous bone.  This bone is placed very obliquely, inwards
and forwards, and its point almost reaches the posterior clinoid
process.  At the anterior part of the fossa  is the sphenoidal
fissure or foramen, of the sphenoidal bone.  Just above the
base of this fissure is the foramen opticum, partially concealed
by the anterior clinoid process.   Just below the base of the fis-
sure is the foramen  rotundum.  At the point of the petrous
bone, by the side of the  posterior clinoid  process, is  the in-
ternal orifice of  the carotid canal.  On a line with the latter,
exteriorly, is the foramen  ovale.  Two lines behind the latter
is the foramen spinale.  The groove formed by the middle arte-
ry of the dura mater, may be traced from the foramen spinale
along the  anterior margin of the  squamous bone.  Near the
upper part of this bone the groove  bifurcates; the larger chan-
nel runs upwards into a groove on the tip of the great sphe-
noidal wing, into the principal groove of  the parietal bone,
which commences at the temporal angle of the  latter.  The
smaller groove runs horizontally  backwards, and just above
the base of the petrous bone is continued also into the parietal
bone.  On  the front of the petrous portion  may be seen the
hiatus Fallopii.  The sphenoidal suture runs through these fossas,
in the examination of which, the reception of the spinous pro-
cess of the sphenoid  bone, between the  squamous and petrous
portions of the temporal, will be readily understood.

  On each side of the foramen magnum occipitis are the two pos-
terior fossas of the base of the cranium, formed by the posterior
faces of the petrous bones, the angles of the mastoid portions of
the temporal bones and by that surface of the occipital bone be-
low its horizontal ridges. These two fossas are very partially se- 
SURFACE OF THE HEAD.
161
parated by the inferior ridge of the occipital cross. The lambdoi-
dal suture traverses these fossae.  At the junction between the
petrous bone and the basilar process of the occipital, in the course
of the suture, is a groove for the inferior petrous sinus.   The
groove conducts to the posterior foramen lacerum, which has a
small part separated from it by the little spine of the petrous bone,
which, with the assistance of the dura  mater, forms a distinct
foramen  for the eighth pair of nerves.   The posterior foramen
lacerum being common to the temporal and occipital bones, is oc-
casionally much larger on the right than on the left side:  in
which case, the groove that leads from it along the angle of the
temporal bone, the inferior corner of the parietal, and the hori-
zontal limb of the occipital cross, is  also larger.  Above the fo-
ramen lacerum are the meatus auditorius internus and the inter-
nal orifice of the aqueduct of the vestibule. Between the foramen
lacerum and foramen magnum occipitis is the anterior condyloid
foramen.  The two posterior fossas of the base of the cranium
contain the cerebellum.


       SECT. IV. — OF THE EXTERNAL SURFACE OF THE HEAD.

   Anatomists, of modern times, consider  the  external surface
of the head as forming or representing three ovals and two
triangles each of which constitutes a region.   The first oval  is
the whole superior  convex part of the cranium; or,  in  other
words, the external  surface of its vault.  The second oval  is
formed by the inferior surface of the cranium, and of the face.
The third oval is formed by the lower front part of the os fron-
tis, and by the face.   Each side of the head forms one of the
triangular regions.
  The superior region is so simple, and  its parts have been so
closely sketched,  that  it  is unnecessary to repeat the descrip-
tion.
  The inferior region or oval, extends from the chin to the oc-
cipital protuberance, and is bounded in its transverse diameter
by the superior semicircular ridges of the os occipitis, by the
mastoid processes, and by the rami and  base of the lower jaw.
This surface is subdivided into Palatine, Guttural, and Occipital
sections or regions.
  The Palatine region or  section, is  formed  by the superior
                            14* 
162
SKELETON.
maxillary and palate bones, above, and by the  inferior maxil-
larv bone, laterally and below.  It is a deep fossa, the circum-
ference of which is represented by the letter U, the open part
being behind.  The whole upper surface of the palatine region,
presents a number of small rough elevations and fossas, for the
attachment of the lining membrane of the mouth.   The surface
is divided into two equal parts by the long or middle palate su-
ture, which  is crossed at its posterior part by  the transverse
palate suture.   The posterior margin of the hard palate is con-
cave on each side of the  mouth;  and from it is  suspended the
soft palate..  The point in the centre of this margin gives ori-
gin to the azygos uvulas muscle.
  The foramina on  this  surface, are the anterior palatine or
foramen incisivum, in the long palate suture just behind the in-
cisor  teeth,  and on either side, behind, between the palate and
pterygoid process of the palate bone, bounded exteriorly by the
upper maxillary, is the posterior palatine foramen.  About one
or two lines behind this, is another foramen, in the base of the
pterygoid process of the palate bone, through which pass fibril-
las, of the same nerve that occupies the posterior palatine fora-
men.   The posterior palatine foramen also transmits an artery
to the soft palate, the mark of whose course may be seen at the
base of the alveolar processes for the molar teeth.
  The depth of the palatine  fossa depends on the state of the
teeth.  When they are removed  by old age, and the alveolar
processes also, what was palatine fossa is almost a plane sur-
face;  and in many instances of  extreme  old age, entirely so,
excepting the part formed by what  remains of the lower jaw.
The separation from the  nose is  also extremely thin, and not
unfrequently imperfect.  The transverse diameter of the mouth
is much decreased, in consequence of the  absorption of the al-
veolar processes taking place, from the outside towards the in-
side.
  The internal surface of the lower jaw has been sufficiently
described in the account of that bone.
  The Guttural Region of the base of the head is formed by the
cuneiform process of the os occipitis, in the centre; by the infe-
rior face of the petrous bones, laterally and behind; by the body
and great wing of the sphenoid  bone,  laterally and in front;
and by the several bones contributing to the orifice of the pos-
terior nares. 
SURFACE OF THE HEAD.
163
  It is bounded anteriorly by the pterygoid fossas and openings
of the nose, and behind by the mastoid and condyloid processes.
It consists, consequently, in one part, which is horizontal, and in
another, which is vertical.  In regard to the horizontal portion,
its inequalities, processes, and fossas, have been already stated.
The relative position of its foramina, cannot, however, be studied
except  in  the  united  bone.  The following  rules will afford
some assistance in determining their position, even on the liv-
ing body.
  A line passing from the anterior margin of one mastoid  pro-
cess to the corresponding point of the other, will  subtend the
stylo-mastoid foramina, and the posterior margin of the foramina
lacera; it will also touch the base of the styloid processes, and
cut into halves the condyles of the occiput.  A line, three-eighths
of an inch in advance of this, run through the middle of the
meatus auditorius  externus, will indicate  the posterior margins
of the glenoid cavities,*  and cut in half the inferior end of caro-
tid  orifices or foramina,  and touch the anterior margins of the
anterior condyloid foramina. Another line, one fourth of an inch
in advance of the latter, will cut through the  centre of the gle-
noid cavity, and subtend  the  styloid process of the sphenoid
bone, and  the bony orifice of the Eustachian tube in the tempo-
ral bone.  A line passing between the external ends of the tuber-
cles of the temporal bones, will subtend the foramina ovalia and
the foramina lacera anteriora.  The  foramen  spinale is about
equi-distant from the last two lines.
   The foramen lacerum anterius, being at the  point of the pe-
trous bone, is occasioned by the latter not filling up the space
between it and the  sphenoidal and occipital bones.   The de-
ficiency is supplied, in the recent state, by cartilage.   Precisely
opposite to the point of the petrous bone,  is the  posterior orifice
of the foramen pterygoideum, from which emerges the pterygoid
nerve, and penetrating this cartilage  immediately divides  into
two branches: one going to the carotid canal, and being one of
the  roots of the sympathetic nerve;  and  the other, ascending
into the cranium, becomes the Vidian nerve  or superficial pe-
 trous.
   The vertical portion of the Guttural Region presents  the pos-

  * By glenoid cavity is here meant the whole of the depression in the temporal
bone, and not merely the surface for the condyle of the lower jaw. 
164                     SKELETON.
terior orifices of the nostrils, separated from each other by the
vomer.   On each side are the pterygoid processes of the sphe-
noid bone, and above is its body.  The pterygoid fossa, formed
between the external and internal process, and the long unci-
form termination of the latter with the broader and shorter ter-
mination of the former, will also be observed.
  The Occipital region of the base of the head, placed imme-
diately behind the other, may be considered to include the mas-
toid processes, and the foramen magnum occipitis, and to  be
bounded behind  by the tuber of the  occiput and its  superior
transverse ridges.  Its marks have been sufficiently dwelt upon,
in the description of the os occipitis.

  The third oval will be described in detail in a short time.

  On the side of the head,  where we consider  the  triangular
region to exist, the arch formed by the malar bone and the zy-
gomatic process of the  temporal, forms a very conspicuous
feature.  The anterior  abutment of this arch is formed by the
greater part  of  the malar bone, and a considerable portion of
the malar process of the superior maxillary.  The posterior
abutment is formed by the root of the zygomatic process of the
temporal bone.  Its superior margin  is thin, for  the insertion
of the temporal  aponeurosis: the inferior margin  is  thick, and
is divided, by a projection in its middle, into an anterior and a
posterior surface, marking the origins of the two portions of the
masseter muscle.  There is a  very  considerable  vacancy be-
tween the zygoma and  the side of the  head, occupied by the
coronoid process of the lower jaw, the temporal and the exter-
nal  pterygoid muscles.   The coronoid  process is just within
the  zygomatic arch, and the  tip rises  three  or four lines above
its inferior margin.
  The large depression within the zygoma is the temporal fossa.
All  that portion of the side of the head beneath the ridge lead-
ing  from the external angular process  of the  os frontis, and run-
ning along the surface  of the parietal bone, is tributary to the
temporal fossa.  The bones, therefore, which form  it, are the
frontal, the  parietal, the temporal, the great wing and the ex-
ternal pterygoid process of the sphenoid bone, and the posterior
face of the superior maxillary and malar bones.  The arrange- 
NASAL CAVITIES.
165
ment of the squamous suture is well seen in this fossa, also the
junction of the pterygoid bone with the parietal and frontal, by
the overlapping of the great wing of the former. At the inferior
part of the latter, is the pointed process, from which one head
of the external pterygoid muscle arises.
   At the bottom of the temporal fossa there  is a narrow slit
partitioned from the nose by the nasal plate of the palate bone.
This slit, from its position, is called  the Pterygo-maxillary fossa.
It is triangular, the base being  upwards and the point down-
wards.   The base reaches to the  bottom of  the orbit.  From
the base there leads into the nose the  spheno-palatine foramen
for transmitting the lateral nasal nerve and blood vessels.  Ex-
ternally to this foramen, and somewhat above it, is the foramen
rotundum for the upper maxillary nerve.   On a level with the
spheno-palatine foramen, and running horizontally through the
base of the pterygoid process, is the pterygoid foramen for the
nerve of the same name.  Running vertically downwards from
the point of the pterygo-maxillary fossa, is the posterior pala-
tine canal for transmitting the  nerve  and  artery of the same
name.  The upper part or base of the pterygo-maxillary fossa,
is continuous with a large fissure  in  the bottom  of the orbit
called the spheno-maxillary.
              SECT. V.--OF THE NASAL CAVITIES.

  The nose consists of two large cavities or fossas, in the mid-
dle of the bones of the upper jaw, and has a very irregular sur-
face.   Its cavities are separated from one another by a vertical
septum, consisting in the vomer and in the nasal  lamella of the
ethmoid bone.  This septum  presents a surface which is per-
fectly  plane,  with  the  exception, that  in  some  subjects it  is
slightly convex on one side, and concave on  the other.  It  is
deficient in front.
  The upper  part of either nostril is formed by the cribriform
plate of the ethmoid bone;  in front of  this the surface is very
oblique, being made by the os nasi; posteriorly there is a ver-
tical gutter on the  body of  the sphenoid bone, in the middle of
which  is the  orifice of  the sphenoidal cell.  The distance be-
tween  the cellular part of the ethmoid and the septum nasi  is 
166                     SKELETON.

not more than three lines.  The double row of foramina in the
cribriform plate is very well seen, also the foramen at its ante-
rior part for transmitting the nasal branch  of the  ophthalmic
nerve; the groove formed by the latter on the posterior face of
the os nasi is also very distinct.
  The bottom of either nostril, called its floor, is formed by the
palate process of the superior maxillary and palate  bones; it is
somewhat concave, and about half an inch wide; its width, how-
ever, is not uniform, as it is sometimes wider or narrower in
front than it is in the middle.   In it is seen the upper orifice of
the foramen incisivum at the anterior point of the vomer.
  The external or orbitar surface of the nasal cavity is very ir-
regular, presenting  a number of projections and fossae, over
which the Schneiderian membrane is displayed.   It is  formed
by the upper maxillary, the ethmoid, the unguiform, the palate,
the nasal, the  lower spongy, and the sphenoid bones.  In the
middle of the posterior part of the ethmoid is the  upper  meatus
of the nose, a deep fossa, bounded above by the cornet of Mor-
gagni, and receiving the  contents  of the posterior ethmoidal
cells,  by one or more orifices.   At the posterior termination of
this fossa is  the spheno-palatine foramen.  The middle  spongy
bone forms the lower boundary of the ethmoid; between it and
the lower spongy or turbinated bone, is the middle meatus of
the nose, a fossa of considerable size, but of unequal surface.
At the fore part of  the middle meatus is a vertical projection,
formed by the ductus ad nasum and  lachrymal canal.  Just
behind this ridge, is  an  interval between it  and the anterior
part of the ethmoid, through which the  os unguis may be seen.
When the middle spongy bone is broken off, immediately be-
neath its anterior part a channel obliquely vertical, is seen in
the ethmoid, which leads to the frontal sinus, through the an-
terior ethmoidal cell.  This  cell, from  its peculiar  shape and
function, is called infundibulum.  Behind this  oblique channel
is another oblique channel, parallel, but smaller; in which seve-
ral orifices may be found of the anterior ethmoidal cells.  The
anterior channel has, indeed, for the ethmoidal cells other ori-
fices besides the infundibulum, which  are smaller, and below
the latter.  It is bounded, in  front, by a sharp, thin ridge of the
ethmoid, the lower extremity of which  contributes to close the
large  opening into the sinus maxillare. 
ORBITS OF THE EYES.
167
  Commonly about the middle of the middle meatus of the nose,
but varying very much in different subjects, is the orifice of the
sinus maxillare, or  antrum Highmorianum.   Its precise situa-
tion and direction are so very uncertain, that its orifice is found
with some difficulty in the fresh state, in great numbers of per-
sons.   Not unfrequently I have seen this orifice high up, under
the anterior extremity of the middle spongy bone.
   The  inferior meatus of the nose is  bounded above by the
lower spongy bone, and below by the palate processes.  It ex-
tends the whole length  of the nostril.   At the anterior part of
this meatus above, is  the orifice of the ductus ad nasum, which
communicates with the orbit of the eye.
   The nostril presents an increased width, anterior to the points,
where the spongy bones cease: this space  is bounded on the
orbitar side  by the nasal bone, and the  nasal process of the
upper maxillary.   There is an increase of transverse diameter
also at  the posterior part of the nostril, behind the points where
the spongy or  turbinated bones cease.   This space is bounded
externally by the  nasal plate of the palate bone, and by the  in-
ternal pterygoid process.
    The posterior nares, or orifices of the nostrils, are oval, and
 are completely separated by the posterior margin of the vomer.
 In the dried skeleton, on the contrary,  the anterior nares have
 a common orifice, from the deficiency  of the bony septum be-
 tween them.
               SECT. VI.—ORBITS OF THE EYES.

  The orbits of the eyes are the conoidal cavities in the face,
presenting their bases outwards and forwards, and their apices
backwards; so that the diameter of either  orbit, if continued,
would decussate that of its fellow in the pituitary fossa or sella
turcica.  Seven bones  form  the orbit, the os  frontis, the os
malas, the os maxillare  superius,  the  os planum, the os un-
guis,  the os sphenoides, and the os  palati.   Its cavity is some-
what quadrangular, besides being conoidal.  The angles are
particularly well marked, in most  subjects, at it's base  or ori-
fice;  which resembles an oblong,  having its long diameter in
some persons placed almost horizontally, and in others oblique- 
168
SKELETON.
 ly downwards and outwards.  Immediately within the orifice
 the cavity is enlarged, owing to the projection of the orbitary
 rido-e of the os frontis, and the elevation of the anterior inferior
 margin of the orbit, so that  the greatest diameter is  there ra-
 ther vertical  than  horizontal.   From this  point the orbit de-
 creases gradually in size to the sphenoidal fissure, or  the supe-
 rior foramen lacerum of the orbit which forms its apex.  The
 internal  walls of the  two  orbits are nearly parallel,  in conse-
 quence of the cuboidal figure  of the os  ethmoides,  which is
 placed between them.
  The superior  face or roof of the orbit is triangular  and con-
 cave :  it  is very thin, and presents but a slight septum between
 the eye and the  brain.   Almost the whole of it is formed by the
 orbitar process of the os frontis, its  point only being  made by
 the little sphenoidal wing.   The  depression for the lachrymal
 gland, at its external anterior  part,  is very  perceptible.   The
 trochlea for the superior oblique muscle  of the eye, is also well
 seen about three-quarters of  an inch above the point of the in-
 ternal  angular process of the os frontis.   Just  at the outer side
 of this depression is the foramen or notch for the frontal artery
 and nerve.  The optic foramen may be seen, very readily, pass-
 ing through the  little wing  of the sphenoid bone.

  The inferior face, or the floor of the orbit, is also triangular
 and concave,  and is formed by the orbitar process of the upper
 maxillary bone principally; being assisted, however, at its an-
 terior  external margin, by a portion of the malar bone; and, at
 its point  behind, by the orbitar process of the palate bone.   The
 latter cannot be seen very  distinctly in  the  articulated bones,
 owing  to its great  depth in the orbit; but, when the external
 side of the orbit  is removed with a saw, its position is placed in
 an interesting  light. The floor of the orbit is thinner than its
 roof, and forms a very slight separation from the maxillary sinus.
 It is terminated  behind by the  spheno-maxillary fissure, or in-
 ferior foramen lacerum of the orbit;  a  large slit, which, com-
mencing at the base of the sphenoidal fissure, separates the great
wing of the sphenoidal  bone from the ethmoidal, the palate, and
the  upper maxillary bones.  This fissure runs obliquely  out-
wards, so as to have its external  extremity  terminated by the
 malar  bone.   Near the external extremity is seen the  com- 
THE FACE.
169
mencement of the infra-orbitar canal, for  transmitting the su-
perior maxillary nerve and artery.
  The external face of the orbit is also triangular, and very ob-
lique.  It is formed by the malar  bone, and by the orbitar face
of the great sphenoidal wing.  It is defined  below by the spheno-
maxillary fissure,  and above by  the  suture which  unites the
frontal to the malar, and  to the great wing of the  sphenoidal
bone.  It is terminated, at the  apex of the orbit, by the sphe-
noidal fissure.
  The internal face of the orbit  is an oblong square, nearly
parallel, as mentioned, with the  corresponding face of the other
orbit.  It is  formed principally by the orbitar face of the eth-
moid, called the os planum, but at the apex of the orbit a small
portion of the body of the sphenoid  bone contributes to it, and
anteriorly is the os unguis.  It  is  bounded behind by the sphe-
noidal fissure, in front by the lachrymal ridge on the nasal pro-
cess of the os maxillare superius,  and above and below by the
upper and lower ethmoidal sutures.  In the upper of these su-
tures there are generally two, sometimes  three, foramina, the
anterior of which  transmits an  artery, a vein, and  a nerve, to
the nose; the posterior transmits,  also, an  artery and a vein to
the same.

  The lachrymal fossa is well worthy of attention: it is seen to
commence small at the upper part of the  os unguis, and to in-
crease in size till it is  formed into  a  complete canal,  the ductus
ad nasum, leading  to the nose, by  the upper  maxillary and the
inferior spongy bones.  The direction of the canal is almost ver-
tically downwards, inclining very  slightly  backwards.  It was
stated, that the fossa in the fore part of the os unguis  is some-
times supplanted by the increased breadth of the nasal process, a
fact of some importance to an operator for fistula lachrymalis.


SECT. VII.—OF THE  FACE, TOGETHER WITH SOME REMARKS ON THE
        FACIAL ANGLE, AND ON NATIONAL PECULIARITIES.

  The anterior oval of the head extends  from the frontal pro-
tuberances to the base of  the lower jaw,  and from  the malar
bone of one side to the malar  of the other  inclusively.   This
oval is divided into two symmetrical or equal halves, by the
  Vol. I.—15 
170
SKELETON.
vertical suture, which unites the bones of the opposite sides of
the face.
   In  the  infant, the frontal  protuberances are always well
marked, from their being the centres of ossification for the two
halves of  the os frontis; in the  adult, they are frequently not
raised above the common level of the bone.  The superciliary
protuberances just above the internal half of the orbitary or su-
perciliary ridges, are generally somewhat prominent, but they
vary very much in this respect in different individuals. Between
these  ridges the frontal bone is sometimes raised into a vertical
elevation, continuous with the dorsum of the nose, as is more
frequently seen in young persons.
   The nose, or pyramidal convexity, formed by the nasal pro-
cesses of the superior maxillary, and by the nasal bones, is con-
cave above, and extremely prominent below.  The prominence
of it depends upon the development of the ossa nasi.  I have
frequently seen the latter curtailed to about one-half, and even
one-third of their usual breadth, and also diminished in length;
which is followed by an unusual flatness of the nose : the pecu-
liarity had been presented to me till lately only in negroes; but,
since  then, I have also met with it in the skulls of white sub-
jects: it is, however, much more uncommon in the latter.  The
anterior orifice of the nose is cordiform, the base being below:
the centre of the base is marked by  a rough point, called the
anterior nasal spine.

   The cheek bones form,  on either side of the face, a conside-
rable  prominence, depending much upon the length of the ma-
lar process of the upper maxillary bones.  In savage  tribes, this
prominence is frequently a characteristic trait, and may depend
upon  the  greater development of the  upper maxillary sinuses,
probably from the more frequent or more intense  employment
of the organ of smelling.  The elevation of the cheek bone  is
always conspicuous in emaciated subjects, from the fat around
its base being absorbed.
  The alveolar processes with the teeth produce, in certain sub-
jects,  a very conspicuous projection in the face; varying, how-
ever, considerably in different individuals, and in different tribes
of human  beings.   There is but little doubt of the organization
of some men being more coarse and animal  than that of others, 
THE FACE.
171
even in members of the same family.  The circumstance occa-
sionally manifests itself by unusually large and long teeth, and
by alveolar processes  of corresponding dimensions.  Savage
nations have almost invariably this peculiarity, which is kept
up among them, not only by hereditary influence from  father
to son, but also by the actual habits of the individual being pro-
ductive of, and favourable to  this arrangement.  It would be
interesting to know whether from their articles of food general-
ly being harder to masticate than such as are used by civilized
people, they do not contribute to, or even produce a greater de-
velopment in the organs  of mastication.  Analogy is in favour
of the opinion, because the arms or the legs are always developed
in proportion to the vigour and  frequency of  the exercise to
which  they are put.  Ploughmen have large legs.  Blacksmiths
have large arms.  Persons whose habits of exercise do not call
into action any part of the body, to the exclusion of other parts,
have finer and more graceful forms than labourers.  It is there-
fore, probable, that the ease and gracefulness of movement, said
to mark the polished and accomplished man of fashion, depend
upon the harmonious action of his whole frame, derived from
this proportionate development of all its parts.  Besides the in-
fluence of exercise upon  the organs of mastication, the passions
or faculties of the mind  not unfrequently manifest themselves
there.   Individuals of unusual ferocity and savageness, have
frequently large teeth  and alveolar processes.  The gnashing
of the  teeth has, in  all ages, been considered one of the most
striking signs of anger.
  While speaking of these indications of man in a savage and
uncultivated state, it will be understood that  I allude to such
tribes as are engaged in the chase, and  in other  active modes of
subsistence, and whose habits are not settled down into the agri-
cultural or pastoral condition.   It is quite possible for one in the
latter  situation to be  equally uninstructed,  on every point of
mental improvement, and to be much inferior in capacity, to one
of the former; yet  his articles of food, and the sensations and
passions in which he indulges, will give no very prominent out-
line  to his face, but only mark it by the general expression  of
dulness and ignorance.

  The outline of the face is marked also by depressions or fossas. 
172
SKELETON.
Those for the eyes and for the nose have been studied, and ar-
rest at once the attention of the most superficial  inquirer.  Im-
mediately below the orbits are the  canine fossas formed in the
centre of the front of the upper maxillae.  Just above the incisor
teeth  of these bones are the superior incisive fossas.  Below the
inferior incisor teeth, on each side, also, is the inferior incisive
fossa.
   In  most adults the face projects somewhat beyond the crani-
um, but there  is a  considerable diversity in this respect between
different tribes of human beings.  Camper,* who has paid much
attention to  this arrangement, has designated it under the  term
of the facial angle, which he marks off by two straight  lines.
One is drawn from the lower front part of the frontal bone to
the point called  the anterior  nasal spine at the orifice of the
nose,  and between the ends of the roots of the incisor teeth of
the upper jaw; the other, from this latter point to the middle of
the meatus  auditorius externus,  or thereabouts.   The facial
angle  is included  between these  two lines.   In Caucasian, or
European heads, this angle is about eighty degrees. In the
negro, or  Ethiopian, it  is about  seventy degrees;  and in the
Mongolian  or copper-coloured man,  about  seventy-five de-
grees.
  An  invariable relation is established  between the extent of
the facial angle, the capaciousness of the cranium, and the size
of the nasal  and palatine cavities.   The nearer the approach is
to a rectangle, the smaller is the  cavity of the nose, and of the
mouth, and  the greater is that of the  cranium,  thereby mani-
festing a more voluminous and intellectual brain.   On the con-
trary, the more acute that the facial angle is, the smaller is the
volume of brain, and the larger are the nose and mouth.   This
is so frequently the case, that  Bichat considers it almost a rule
in our organization, that the development of the organs of taste
and smell, is in an inverse ratio to  that of the brain,  and con-
sequently to the degree of intelligence.
  This, like  other  general rules, is subject to exceptions, in con-
sequence of the facial angle varying in its size, from causes
which have  no connexion with the degree of development of
the brain.  Thus an unusual prominence and  thickness in the

  * Dissertation sur les Differences du Visage chez les Hommes.  Utrecht, 1791, 
THE FACE.
173
lower part of the os frontis, from an increased capaciousness
of the sinuses, will make the facial angle appear less acute-
The. absorption of the alveolar processes, after the loss of the
teeth, will produce the same result in our measurements of the
facial angle.   The heads  of infants, previously to the appear-
ance and full growth of the teeth, have always the facial angle
less  acute than the heads  of adults:  in some cases an angle of
ninety degrees is presented in them.   On the contrary, a growth
of teeth, and consequently of the alveolar processes, dispropor-
tionate to the size of the body of the upper jaw, will cause the
facial angle to project very considerably even in an individual
of the Caucasian race.   Similar objections  may be brought
against the indications of  the inferior line.  The  fair state of
this argument appears then to be, that the doctrine of the facial
angle, though correct in a majority of instances, has numerous
exceptions from  individual peculiarities, and  that there is no
race of human beings which does not present the facial angle
in all its ranges from seventy to ninety degrees.

   With the view to  meet  such objections and establish a  rule
of more uniformity,  M. Cuvier has proposed  to  ascertain re-
sults from a vertical section, by which  it appears that the  Cau-
casian cranium is four times the area of the face; whereas in
the negro the face is a fifth larger in proportion.

   In regard  to the various  configurations of the  human  face
and  stature, depending upon habits  and  circumstances conti-
nued through a long succession of  ages and generations, the
following views of one,* pre-eminently qualified to judge, will
not be uninstructive.

   "  Although there appears to be but one human species, since
all its individuals can couple promiscuously, so as to produce a
prolific offspring, we yet remark  in  it certain hereditary con-
formations, which constitute what are  called races.   Of them
there are three which are  eminently distinct in appearance:
they are, the white or Caucasian;  the  yellow or Mongolian;
the negro or Ethiopian.

     * P.egnc Animal, par M. lc Chev. Cuvier, torn. 1, p. 94.   Paris,, 1817,
                            15* 
174
SKELETON.
  " The Caucasian  race, to which we belong, is distinguished
by the beautiful oval form of the head; and it is this which has
given birth to  the most civilized  nations, and  to those which
have generally ruled over the others.  It has some differences
in the shade of the complexion, and in the colour of the hair.

  " The  Mongolian is  known by its prominent cheek bones,
flat face, narrow and oblique eyes, straight and black hair, thin
beard, and olive complexion.  It  has  formed vast  empires  in
China and Japan, and  has sometimes extended its conquests on
this side of the Great  Desert; but its civilization has always
remained stationary.

   The Negro  race is confined  to the south of Mount Atlas; its
complexion is  black, its hair woolly, its skull compressed, nose
flattish; its prominent mouth and  thick lips  make it manifestly
approach  the  monkey tribe;  the  people which  compose this
race have always remained in  a state of barbarism.

   " The race from which we are descended is called Caucasian,
because tradition and  also the lineage of nations, would appear
to trace it to the group of mountains situated between the Cas-
pian and the Black seas, (on the borders of Europe,) from whence
it has radiated in every direction.   The people of Caucasus, as
also the  Georgians and Circassians, are considered, even  at
the present day, the handsomest in the world.   The principal
branches  of this race are distinguishable by the analogies  of
language.  The Armenian or Syrian division, directed its course
towards the south, and  has given birth  to  the Assyrians, the
Chaldeans, and  the untameable   Arabs, who, after Mahomet,
were very near becoming masters of the world;  to the Pheni-
eians, the Jews, and the Abyssinians, which were Arabian colo-
nies ; and it is very probable that the Egyptians also are  de-
scended from  the same source.   It  is from  this branch, (the
Syrian,) always inclined to mysticism, that the most  widely
extended religions have sprung.   Science and literature have
flourished among them occasionally, but always  under fantas-
tic forms, and with  a  figurative style.
   " The Indian, German, and Pelasgic branch, is infinitely more
extended, and  was divided at a much earlier period; we, never- 
THE FACE.
175
theless,  recognise the greatest resemblance  between its  four
principal languages; which are, the Sanscrit, at present the
sacred language of the Hindoos, and mother of all the dialects
of Hindostan; the ancient language of the Pelasgi, which is the
common mother of the  Greek, the Latin, of many tongues
which are now extinct, and  of almost every language spoken
in the south  of Europe;  the Gothic or Teutonic, from  which
are derived the languages of the North and North West, such
as the German, Dutch, English, Danish, Swedish, and their dia-
lects ; and lastly, the language called Sclavonian, from which
come those  of the north-east, as  the Russian, Polish, Bohe-
mian, &c.
   " It is this great  and  respectable branch of the Caucasian
race, which  has carried farthest Philosophy, the Arts and  Sci-
ences, and which has been for ages the depository of them.
   " This branch was preceded in Europe by the Celts,  who
came from the north, and were formerly very much extended,
but are now confined to the most western parts; and by the
Cantabrians, who  passed from Africa into Spain, and are, at
present, almost confounded with the numerous nations whose
posterity has been blended in this peninsula.
   " The ancient Persians have the  same  origin with the Indian
branch; and their descendants, even at  the present day, bear
the strongest marks of affinity to the European nations.
   " The Scythian  or Tartarian branch,  first directing their
course to the north and  north-east, always led erratic lives in
the vast plains of those countries: and  they have only left them
to return  and  destroy the  more  comfortable establishments
of their brethren.   The Scythians, who,  at so remote a period
of antiquity, made  irruptions into  Upper Asia; the Parthians,
who destroyed there the power of the Greeks and Romans; the
Turks,  who  overthrew there that of the Arabs, and subjugated
in Europe the unhappy  remnant  of the Greek  nation,  were
swarms of this stock; the Finlanders  and the Hungarians are
colonies of it, in some measure astray among the Sclavonian
and Teutonic nations.  The north  and east of the Caspian Sea,
their original country, are still inhabited  by people of the same
origin,  and speaking similar languages;  but they are there in-
termixed with an  infinity of other petty nations, of different
origins  and languages.  The Tartar nation has always re- 
,176                     SKELETON.
 mained more unmixed in all that tract  of country, extending
 from the mouth  of the  Danube, to beyond  the Irtisch, from
 which they so long threatened Russia, and where they have at
 last been subdued by her.  The Mongolians, however, in their
 conquests have blended their blood with these people, and many
 traces of this intermixture  are  discovered, principally among
 the Western Tartars."

   " The Mongolian race commences to the east of this Tartar
 branch of the Caucasian, and prevails thence to the Eastern
 Ocean.   Its branches, the Calmucks and Halkas, still nomadic
 or unsettled, occupy the Great Desert.   Thence have their an-
 cestors, under Attila, under Genghis, and  under Tamerlane,
 spread far  and wide the  terror of their name.  The Chinese
 come from this  race,  and are not  only  the  most anciently
 civilized of it, but, indeed, of  any nation yet known.  A third
 branch, (the Montchoux) has recently conquered China, and
 continues to govern it.   The  Japanese and Coreans, and  al-
 most all the hordes which extend to the  north-east  of Siberia,
 under the domination of Russia, belong also  to it  in  a great
 measure.   If we except a few Chinese literati, the whole Mon-
 golian  race is universally addicted to the different sects of  the
 worship of Fo.
   " The origin of this great race appears to have been in the
 Altay Mountains,* as ours was in the Caucasian; but it is impos-
 sible to follow so well the clue of its different  branches.  The
 history of these wandering people, is as fugitive as their establish-
 ments;  and the records of the Chinese, from being confined to
 their own empire, afford us but short and vague accounts of their
 neighbouring nations.  The affinities of their languages are also
 but too little known to guide through this labyrinth.
   " The languages  of the north of the peninsula beyond  the
 Ganges, and also that of Thibet, bear some affinity to the Chinese,
 at least, in their monosyllabic nature, and the people who speak
them are not without traits of resemblance to the other Mongo-
lian nations; but the south of this peninsula is inhabited by the
Malays, a much handsomer people, whose race and language arc
spread over the coasts of all  the islands of the Indian Archipe-
* A range in the north of Asia, about 5000 miles long. 
FOETAL HEAD.
177
lago, and have occupied almost all those of the Southern Ocean.
On the largest of the former, especially in the uncultivated and
savage parts, we find other men, who have woolly hair, black
complexion, and negro visage, and who are all extremely bar-
barous.  The most known are the Papuas, a name  by which
they may be generally denominated.
   " It is not  easy  to refer either  the Malays or Papuas, to any
one of the three great races; but can the  former be plainly dis-
tinguished from their neighbours, the Caucasian Hindoos on one
side, and the Mongolian Chinese on the other?  We must con-
fess that we  do not find  them to possess  sufficient characteris-
tics to enable us to answer this question.  Are the Papuas ne-
groes, who formerly  straggled along the Indian Ocean?   We
have  neither drawings nor descriptions sufficiently clear to re-
 ply to this question.
   " The inhabitants  of  the north  of the two continents, the
Samoiedes,  the Laplanders, and the Esquimaux, sprung, ac-
cording to some authorities, from the Mongdlian race.  Agree-
ably to others, they are  but a  degenerate offspring of the Scy-
 thian and Tartarian branches  of the Caucasian race.
   " It is impossible to refer, satisfactorily, the Americans  them-
 selves to either of our races of the old continent;  and yet they
 have not characteristics precise and constant enough to con-
 stitute a distinct  race.    Their copper-coloured complexion is
 not sufficient; their hair, which is generally black, and their
 scanty beard, would lead us to refer them to the Mongolians,
 did  not  their well marked  features, and  their moderately pro-
 minent  noses, oppose such an  arrangement; their  languages
 are as innumerable as their tribes, and we have yet been un-
 able  to  discover  either  any analogies  among them, or with
 those of the ancient world."*

     SECT. VHL—OF THE DEVELOPMENT OF THE FCSTAL HEAD.

   The foetal head, in the very early stages of gestation, forms
 an oval vesicle, constituting the greater  part of the bulk of the

   * On this subject, see also Lectures on the Physiology, Zoology, and  Natural
 History of Man, by W. Lawrence. London, 1822.
   Dictionnaire des Sciences Med. tome XXI.  Paris, 1817.
   Histoire Naturelle de L'Homme, par Lacapede.  Paris, 1821.
   Blumenbach de Variet. Gen. Hum. Nat. 1794—also Decades, 1790—1814. 
178
SKELETON.
embryo, and at this period has the face scarcely visible.   The
parietes of this vesicle  are  formed by a thin membrane, con-
sisting of two layers, the external of which is the pericranium,
and the internal layer is the  dura mater.   These layers adhere
so closely  that they cannot be accurately separated by the
knife.
  About the third month of  the embryo, or even earlier,  ossifi-
cation may be seen at several points of the cranium, but more
extensively about its base.   These points are the centres  of os-
sification, which progressively increase towards  their respec-
tive  circumferences,  by the  deposite of  new  bony matter.
Generally the base of the cranium  begins to ossify before the
vault, and  is entirely ossified  at birth, with  the exception of a
few parts, as the clinoid processes and the ethmoid bone.
  The following nuclei of ossification show themselves between
the laminae of the foetal cranium, from the third to the fourth
month.  One at the anterior part, for the centre of either side
of the os frontis; one for the  centre of each parietal bone,  on
the upper side  of the head;  one on the side  of the head below,
for the squamous portion of the temporal bone;  and there are
several for the occipital bone.   These points extend themselves
in radii; and, as the intervals  between the latter become  wider
by their divergence, new radii, as observed elsewhere, are de-
posited between them.   In  some of the  bones, the radii, from
opposite points, in the progress of ossification before and after
birth, meet and coalesce: this occurs in the os frontis and in
the os occipitis.
  At birth the  contiguous margins of the flat bones simply ap-
proach each other, but have  not interlocked.   These bones con-
sist then of but one table, the edges of which  are very finely ser-
rated, and thereby show the radii of ossification.   The edges are
held together by the dura mater, internally, and the pericranium,
externally; but the fissure between them is very obvious, and so
large that it  allows very readily considerable motion  and the
mounting of one bone upon  the other by slight pressure.   It is
always to  be observed  that the base of  the cranium  is an ex-
ception to the latter rule, both from the breadth of its articulating
surfaces, and from its comparatively advanced ossification.  In
parturition, therefore, the vault of the cranium, by its mobility,
is adjusted to the contour of the pelvis, but the base does not 
FffiTAL HEAD.
179
yield in either of its diameters to the expulsive powers of the ute-
rus.   The latter provision, however inconvenient in parturition,
is of the greatest consequence immediately afterwards; for with-
out this immobility in the base of the cranium, whenever the
weight of the head was thrown upon it, the pressure of the ver-
tebral column would drive it upwards, to the injury of the brain
and of the nerves proceeding from it.  This resistance, it may
be added, is still farther assisted by the arched figure of the base
of the cranium.  On this subject, it is not a little remarkable,
that even the heads of hydrocephalic foetuses  have the bones
of the base fully ossified, and in contact, so as to support the
weight of the head in the vertical position.
   Fontanels.—In consequence of the flat bones of the cranium
ossifying always towards the circumference, their angles, as ob-
served, being the longest radii from their centres, are the last in
ossifying.  These angles are commonly incomplete at birth, and
the membranous spaces which represent them are the Fontanels.
Of these there are six, two on the middle line of the head, above,
and two on either side.   The  former afford highly important
indications to the midwife.
   The anterior fontanel  is the largest of all.   It is at the fore
part of the  sagittal suture, and is  produced by a deficiency in
the angles of the parietal bones, and  of the contiguous angles of
the os frontis.  It is quadrangular or lozenge-shaped; and the
anterior angle is generally longer  than the others.  This is re-
markably the case, when the sagittal suture is continued down
to the root of the nose.   The posterior fontanel is at the other
extremity of the sagittal suture, and as there are only  three
points of bone  defective there, two  for the parietal bones, and
one for the occipital, this suture  is  triangular.   In many chil-
dren, at birth, it is so far filled up as to be  scarcely visible; the
three  membranous sutures, however, which run into it, make
its position  sufficiently discernible by the finger.
   Of the two fontanels,  on either side, one is placed at the an-
gle of the temporal bone where it runs up between the occipital
and the parietal.  The other is in  the temporal fossa, under the
 temporal muscle,  at the junction  between the parietal  and the
 sphenoidal  bones.  These two fontanels are but little referred
to by the accoucheur in delivery, as they are irregular and in-
distinct.  The pulsations of the brain  may be readily felt through 
180
SKELETON.
 the fontanels.  They ossify  rapidly after birth, and are  fre-
 quently closed  completely by the end  of  the first year; but if
 there be an accumulation of water in the ventricles of the brain,
 they remain open for an indefinite period.
   The longest diameter of a  child's head is from the vertex or
 posterior extremity of the sagittal suture to the chin, and mea-
 sures five inches and a quarter.  From the middle of the frontal
 bone  to the tubercle of the  occipital  is four inches, from one
 parietal protuberance  to the  other is about three inches and a
 half.
   At birth the os frontis consists, most commonly, of two pieces,
 united by the sagittal  suture.  The parietal bone is a single
 piece, incomplete at its angles.  The temporal bone consists of
 three pieces: one is the squamous, the other is the petrous, and
 the third is a small ring which afterwards constitutes the  meatus
 externus;  it is deficient in styloid and mastoid processes.  The
 os occipitis is in four pieces:  one extends from the angle of the
 lambdoidal suture to the upper edge  of the foramen magnum;
 on either side of the foramen  magnum is another, with the con-
 dyle growing on it, and the cuneiform process  is the fourth. The
 ethmoid bone is cartilaginous.  The sphenoidal bone is in three
 pieces.  The body and little wings, being united, form one; the
 great wing and the pterygoid process, being also united, form
 on either side of the body another piece.
   At  birth there is  a great disproportion in size between the cra-
 nium  and face.  This disproportion diminishes in the progress
 of life, by the development of the sinuses and of  the alveolar
 processes  in the latter.  At birth, indeed,  there is no cavity ei-
 ther in the sphenoidal, the frontal, or the upper maxillary bones;
the orbitar and the palate plates are very near each other, and
the rudiments of the teeth are hidden  in the  bodies of the  up-
per and lower jaw bone.  The latter  consists of two  pieces,
 united by  cartilage at the chin, and its angle  is very obtuse. 
HYOID BONE.
                    CHAPTER  IV.

          THE HYOID BONE, (OS HYOIDES, HYOIDE.)

   The Os Hyoides is placed at the root of the tongue, within
the circle of the lower jaw.   It is an insulated bone, having no
connexion with  any other, except  by muscles and ligaments.
It is said, very properly, to resemble the letter U, and consists
of a body and two cornua.
   The body is in the middle; it is the largest part of the bone,
and forms nearly a semicircle.  Its anterior face is convex, and
its upper part is flattened by the insertion of the muscles from
the lower jaw.   The posterior face is concave.
   The cornua, one on either side, are about an inch long, and
are placed at the extremities of the body, being united to it by
the interposition of cartilage and ligamentous fibres. They are
somewhat flattened rather than cylindrical, and diminish to-
wards the posterior extremities, where they  terminate  in a
round enlargement like a head.
   At the cartilaginous junction of the cornu and body, on each
side, there is a small cartilaginous body three or four lines long,
fastened by ligamentous fibres.  It is frequently found ossified.
This is the appendix or lesser cornu.   A round ligament passes
from it to the extremity of the styloid process of the temporal
bone.
   The texture of this bone is cellular, with a thin compact la-
mina externally.  M. Portal says, that he has found it carious
from venereal contamination; in which case, the patient  had
been afflicted with violent sore throat and purulent expectora-
tion.  Sauvages  and Valsalva have met with a case, where,
from luxation of the cornu, the patient spoke with great diffi-
culty.  The ligament to the styloid process is, in  some rare in-
stances, ossified to a considerable extent, which produces diffi-
culty in swallowing and in talking.
Vol. I.—16 
182
SKELETON.
                    CHAPTER V.

               OF THE UPPER EXTREMITIES.

  This portion of the skeleton is divided on either side  of the
body, into shoulder, arm, fore arm, and hand.


                 SECT. I.—-OF THE SHOULDER.

  The shoulder consists of two bones, the clavicle and the sca-
pula, and occupies the superior, lateral, and posterior part of the
thorax.  Its shape and position are such, that it augments con-
siderably the transverse diameter of the upper part of the trunk,
taken as a whole: while the thorax alone, at this place, is actu-
ally smaller than it  is below.  The  clavicle  is longer, in pro-
portion, in  the  female than  in the male, which  increases  the
transverse extent  of the shoulder, and gives a greater space on
the front of the thorax  for  the  development of the mammas.
This coincidence  between the length of the shoulder and  the
development of the mamma, has been particularly noticed by
Bichat, who says that it is almost always well marked, that very
rarely a voluminous bosom reposes on  a small pectoral space,
or a small bosom is found upon a large  pectoral space.  In the
male, on the contrary, this diameter of  the trunk is increased
principally by the breadth of the scapula, which, from its posi-
tion on the thorax, and its great size, gives  the  bulky appear-
ance to this part.   It is evident that these modifications in the
frame-work of the shoulders, are connected with the natural des-
tinations of the two  sexes.  In woman the length of the clavi-
 cle is  adverse to  its strength, and it is  indistinctly marked by
 muscular connexions; whereas, in man it is short,  strongly
 marked, and large.  Anatomists who  are fond of extending
 such comparisons,  say,  also, very justly, that the pubes, which
 perform the same office for the lower extremities that  the cla-
 vicles do for the  upper, that of keeping the two apart, are, in
 the female, both  smaller and longer than in the male; that their
 shape is not so favourable to strength or locomotion, and has a
 special view towards the lodgement of the genital organs, and 
THE SHOULDERS.
183
to the passage of the child.   In man the increased size of the
whole  skeleton,  and the greater  development of the  muscular
system, indicate that he was intended for more laborious exer-
tion than the female.
   The thorax and the shoulder are connected by a reciprocal
development, both being indicative, when large, of a robust and
vigorous constitution, and when  small, of a weakly one.  As
both of these parts are acted on by the  same muscles, the ne-
cessity of this coincidence is sufficiently apparent.  The height
of the shoulder depends upon the scapula alone; its elevation,
therefore, is greater in males and in vigorous persons generally,
than in females and in weakly individuals.  The direction of
the shoulder is  such, that the articular face of the scapula for
the os humeri, looks outwards, thereby proving that the quad-
ruped position in man is unnatural; for by it, the weight of the
fore part of the trunk is directed upon the back part of the cap-
sular ligament of  the joint instead of  upon the glenoid cavity,
as in quadrupeds.  This, and many other circumstances, prove
 that the natural intention of the upper extremities in the human
 subject, is to seize upon objects, and not to maintain the hori-
 zontal position.


          Of the Shoulder Blade, (Scapula, Omoplate.)

    The Scapula is placed upon the posterior superior part of the
 thorax, and  extends from the second  to the seventh rib inclu-
 sively; its posterior edge is nearly parallel with the spinous pro-
 cesses of the vertebras, and not far from them.'
  ■  Its general form is  triangular.   It therefore  presents two
 faces, of which one is anterior, and the other posterior,—three
 edges, of which one is superior, another external, and the third
 internal or posterior—and three angles, of which one is supe-
 rior, another inferior, and the third exterior or anterior.
'   The posterior face of the scapula, or its dorsumris somewhat
  convex, when taken as a whole; and is unequally divided by its
  spine into two  surfaces or cavities, of which the lower is twice
  or three times  as large as the upper.   The spine is a very large
  process that begins at the posterior edge of the bone, by a smal
  triangular face;  rapidly increases in its elevation, and running 
184
SKELETON.
 obliquely towards the anterior angle, ceases somewhat short of
 it; it is then elongated forwards and upwards, so as to overhang
 the shoulder joint, and to form the acromion process.   The ca-
 vity above the spine is  owing principally to  the elevation of
 the latter, and is called the fossa supra-spinata; it is occupied
 by the supra-spinatus muscle.  The cavity below the  spine is
 the fossa infra-spinata, and is for the infra-spinatus muscle: it is
 bounded below by a rising of the external margin of the bone.
 The middle of this fossa presents a swell or convexity, which
 is a portion of the general convexity presented  by the posterior
 face of the bone.   The spine of the scapula is always promi-
 nent in the outline of the shoulder, and has a well secured base
 along the whole of its attachment to the bone,  to where it ter-
 minates in the acromion process.  It leans upwards, and from
 the increased breadth of its summit, is concave  both above and
 below.  The summit itself is somewhat rough, and has inserted
 into its superior margin  the trapezius  muscle,  while the infe-
 rior margin gives origin to the deltoid.   The  little triangular
 face at the commencement of the spine is made by the tendon
 of the trapezius muscle gliding over it.  The acromion process
 arises from the spine by a narrow neck, is triangular, nearly
 horizontal,  and overhangs the glenoid  cavity, being elevated
 about one inch above it.   It is slightly convex  above and con-
 cave below: the external and the internal margins are the long-
 est.  The posterior margin is continuous with the inferior edge
 of the spine of the scapula; and the internal is  on a level with
 the clavicle.  At the fore extremity of the internal margin, is a
 small, oval, articular face, by which  the  acromian unites with
 the clavicle.  The  margins of the acromion, with the excep-
 tion of the  internal, are  rough, and give origin to the deltoid
 muscle.

  The anterior or costal face  of  the scapula is concave, and
obtains the name of the sub-scapular fossa or venter.   It is oc-
cupied by the sub-scapular muscle;  the divisions of which, by
leaving deep interstices between them, produce corresponding
ridges upon the bone, that run obliquely upwards and outwards.
Along the whole posterior margin of this face of the scapula,
is inserted the serratus major anticus. 
THE SHOULDERS.
185
  The posterior or vertebral margin of the scapula is the long-
est of the three, and is called  the base.   It is not perfectly
straight, but  somewhat rounded, especially above the spinous
process; and has there varied degrees of obliquity in different
persons.  This margin, below the spine, receives the rhomboi-
deus major muscle, and above the spine, the levator scapulas;
at the part between  the other  two, the rhomboideus minor is
inserted.

  The external or axillary margin of the  scapula, also called
the inferior costa, is much the thickest of the three.   A superfi-
cial  fossa placed  somewhat posteriorly, forming  the  inferior
boundary of  the fossa infra-spinata, begins  about two  inches
from its inferior extremity, and running up to the neck of the
bone, lodges  the teres minor muscle.   On the exterior face of
the inferior angle is a flat surface, from which  the teres major
muscle  and  a slip of the latissimus dorsi arise.  At the fore
part of this surface the inferior costa is elongated into a  kind
of process.   Just below the glenoid cavity is a small ridge for
the origin of the long head of the triceps muscle.

  The superior margin or costa of the scapula, is the shortest
and thinnest  of the three, and is terminated in front by the co-
racoid notch between it and the coracoid process.  The notch
is converted into a hole by  a ligament, in the living state, and
through it pass the upper scapular nerve and blood  vessels.

  The glenoid cavity for articulating with  the os humeri, sup-
plies the place of the anterior angle of the scapula.   It is  very
superficial, and ovoidal, with the small end upwards.  Just at
the upper end is a small flat surface, from which the long head
of the biceps arises.   The glenoid cavity is fixed on  the cervix,
as it is called, at which a general increase in the thickness of the
bone occurs, in order to give a strong foundation to this cavity.
From the superior part of the  cervix arises the coracoid  pro-
cess, the base of it being bounded in front by the glenoid cavi-
ty, and  behind by the coracoid notch.  The base rises upwards
and inwards  for half an inch, and what remains of the process,
then, runs horizontally inwards and forwards, to become small-
er, and terminate in a point.  This point  is advanced beyond
                            16* 
186                      SKELETON.

the glenoid cavity, about an inch from its internal margin. The
upper surface of the coracoid process is rough and undulated;
below it is concave, forming an arch under which passes the
sub-scapularis muscle.   On the clavicular side of its base is a
tuberosity, from which arises the conoidal ligament.  The ex-
tremity is marked by three surfaces: the interior is for the in-
sertion of the pectoralis minor, the middle for the origin of the
coraco-brachialis, and the external for that of the short head of
the biceps.  The acromial margin of the coracoid process gives
origin to  the triangular ligament of the scapula, which is in-
serted into the acromion just below the face for the clavicle.
   The scapula is  composed of cellular and compact substance.
The two laminae  of the latter are in contact in the fossa supra-
spinata, and infra-spinata; from which cause the bone is diapha-
nous at these points.


            Of the Clavicle, (Clavicula, Clavicule.)

   The Clavicle is a long bone, situated transversely at the up-
per front  part of the thorax, and extends from the superior ex-
tremity of the sternum to the acromion of the scapula.  It is
cylindrical  in  its middle third, flattened  at  its external, and
prismatic or triangular at its sternal extremity.  Besides being
shorter, it is more crooked and robust in man than in woman,
and different individuals present it under considerable varieties
of curvature.   The sternal two-thirds of it are convex in front,
and concave  behind, while the humeral  third is concave in
front, and convex behind: this double curvature induces anato-
mists to compare it with the letter S, though it is by no means
so crooked.
   We have to consider its superior  and inferior face, its ante-
rior and posterior edge, and the two extremities.  The superior
face is smooth, and does not present any marks  of importance
excepting a depression near the sternum, for the origin of the
sterno-cleido mastoid muscle.   The inferior face, near the ster-
nal end, has a rough surface,  to which is  attached  the costo-
clavicular or rhomboid ligament: about fifteen  lines from  the
humeral extremity is a rough tubercle for the attachment of the
coraco-clavicular or conoid ligament.  Between the two ends, 
THE ARM.
187
a superficial fossa is extended for lodging the sub-clavius mus-
cle.  The sternal two-thirds of the anterior margin are marked
by the origin of the  pectoralis major; it is there thick: the other
part of  this margin is thinner, and gives origin to the deltoid
muscle.  The posterior margin presents, near its middle, one or
more foramina for the nutritious vessels.   The triangular inter-
nal end of the clavicle is unequal where  it joins the sternum,
and is elongated considerably at its posterior inferior corner.
The external flat end presents at its extremity a small oval face,
corresponding with that on  the acromion  scapulas.
   This bone is very strong from the abundance of its condensed
lamellated structure; but, like other round bones,  the cellular
matter  predominates at its extremities.


        sect. h.—of the arm, (Os Humeri, L'Humerus.)

   The  arm extends from  the shoulder to the elbow, and has but
 one bone in it, the  os humeri.  The latter, in  its  general ap-
 pearance, is cylindrical, with an enlargement of both extremi-
 ties; the superior end presents a general swell, while the infe-
 rior is  flattened out.
    The superior extremity of the os humeri, which is also called
 its head, is very regularly  hemispherical, and has  its axis  di-
 rected  obliquely upwards and backwards, to apply itself with
 more facility  to the glenoid  cavity of the scapula.  The base on
 which  the head reposes is termed neck, it is not more than four
 or  five lines  long,  and is marked  off by a superficial furrow,
 surrounding the bone.  This furrow is more conspicuous above,
 where it separates the head from two knobs called the tubero-
 sities.
    One of these tuberosities, the external, being  placed beneath
 the acromion scapulas, is much  larger than the other, and bears
 on its upper face the marks of the tendinous insertion of three
 muscles.   The most internal mark  is for the supra-spinatus
 scapulas, the  middle  for the infra-spinatus, and  the external, or
 posterior, for the teres minor.  The smaller tuberosity is inter-
 nal, and placed on a line with the coracoid process j it has but
 one mark, and that is on its upper face, for the tendinous inser-
 tion of the sub-scapularis  muscle.  The two  tuberosities  are 
188
SKELETON.
 separated by a deep fossa, named bicipital, from its lodging the
 tendon of the long head of the biceps muscle.  This fossa is
 continued, faintly, for some inches down  the  os  humeri; its
 lower part being bounded,  externally, by a rough ridge, indi-
 cating the insertion  of the  pectoralis major, and internally by
 another ridge, not quite so  strong or rough, indicating the in-
 sertion of the teres major and latissimus dorsi.

   The body of the os humeri is the part extended between its
 extremities.  The superior half presents a more cylindrical ap-
 pearance than the inferior, which is rather triangular.  On the
 middle of the bone, externally, two inches below the insertion
 of the pectoralis major, exists a triangular elevation into which
 the deltoid muscle is inserted.  At  the internal  margin of the
 bone, and on a line with the latter, is the insertion of the coraco-
 brachialis muscle; and between the two is the orifice of the canal
 for the nutritious artery.   The  front of the os humeri, in its
 lower half, is flattened on  each side down to  its inferior end; on
 these surfaces is placed the brachialis  internus muscle.  On a
 line with the posterior end of the greater tuberosity, and a lit-
 tle below it, an elevation is  formed for the origin of the second
 head of the triceps extensor cubiti.  The posterior face of the
 bone is flattened from this point down to its lower extremity,
 and accommodates the last named  muscle.

   The articular surface for the elbow joint is very irregularly
 cylindrical.  The part that joins the radius, presents itself as a
 small hemispherical head, placed on the front of the bone,  and
 with  its axis looking forwards.   Just above it, in front,  is a
small depression for the head of the radius in its flexions.  The
surface which is in contact  with the ulna, is more cylindrical,
but still irregularly so;  for  its  middle is depressed, while  the
sides  are elevated: the internal side is much broader and more
elevated  than the external.   The lesser sigmoid  cavity is just
above the front of the ulnar  articular surface, and receives  the
coronoid process.   The greater sigmoid cavity  is in a corre-
sponding place behind, and receives the olecranon process:  the
bone where it separates these cavities is  very thin: sometimes
it is even deficient. 
THE FORE ARM.                    189
  The external condyle is just above the radial articular surface;
it is continuous with a ridge of three or four inches long, form-
ing the external margin of the bone, and from it, and the ridge
together, arise the extensor  muscles of the  fore arm and hand.
The ridge, itself, is bounded, above, by a small spiral fossa, de-
scending downwards and forwards, made by the spiral artery
and the muscular spiral nerve.  The internal condyle is placed
just above the internal margin of the ulnar articular surface: it
is much more prominent and distinct than the external, and may
be readily felt beneath the skin.  A ridge also leads from it,
and extends  upwards as high as the insertion of the  coraco-
brachialis, but it is by no  means so elevated as the external
ridge, though it  is  much longer.   From the internal condyle,
and the adjoining part of the ridge, arise the flexor muscles of
the hand and fore arm.

  The os humeri  is composed of compact and cancellated sub-
stance; the latter predominates at the extremities, and the former
in the body.

                 SECT. III.--OF THE FORE ARM.

  The fore arm is placed between the arm and the hand, and
consists in two  straight bones, the Ulna and  the Radius, of
which the former is on the  same side with the little finger, and
the latter on that  of the thumb.


                  Of the Ulna, (Cubitus.)

   The ulna, though  nearly strait,  is not wholly so.   It is
much larger at the upper than at the lower extremity, and in its
general features is triangular.  It has to be considered in  its
humeral and  carpal extremities, and in its body.

  The humeral, or upper extremity, presents the olecranon pro-
cess at its termination; the  coronoid a little below and in front;
the greater sigmoid cavity between the two; and the lesser sig-
moid on the radial surface of the coronoid.

  The olecranon  process is rough on its upper face, for the in- 
190
SKELETON.
sertion of the triceps muscle, and terminates in front in a sharp
edge and point, which are received into the greater sigmoid ca-
vity of the os humeri.  The coronoid process is a triangular
sharp ridge, much elevated, and having a large base;  on the
lower front of the latter is a roughness for the insertion of the
brachialis internus muscle.  The greater sigmoid cavity forms
all the articular  surface between the margins of the two pro-
cesses.   It is divided, transversely, at its bottom, by a superfi-
cial roughness, which distinguishes the olecranon from  the co-
ronoid portion of it.  Besides which, a rising exists in its verti-
cal length, which is received into the corresponding depression
of the os humeri.  The lesser  sigmoid  cavity has its  surface
continuous with that of the greater, and presents itself as a small
semi-cylindrical concavity,  for articulating with the side of the
head  of the radius.  A small fossa, for fatty matter, exists just
above it.

   The carpal, or lower extremity of the ulna, presents, on the
side of the little finger, a  process of variable length, the sty-
loid, from which arises the internal lateral ligament of the wrist.
At the radial side of this  process is an articular face or small
head, one surface of which looks towards the wrist, and the
other is in contact with the radius, being semi-cylindrical.  On
the back of the ulna, between the styloid process and this head,
is a groove for a passage of the extensor carpi ulnaris.

   The body of the ulna is triangular, in  consequence of three
ridges, which extend from the brachial to the carpal extremity.
The most prominent of these ridges is on  its  radial  side, and,
beginning at the posterior end of the lesser sigmoid cavity, con-
tinues very distinct almost to the lower end; it then, however,
gradually  subsides.   From it  arises the interosseal ligament.
Within this ridge, on the anterior or palmar face of the bone,
is another, more rounded, which, beginning at the internal mar-
gin of the coronoid process, extends down to the styloid pro-
cess.  For the greater part of its length it gives origin to the
flexor profundus digitorum, but  just above the carpus, the pro-
nator quadratus arises from it.  The third ridge  begins at the
external margin of the olecranon, and runs in a serpentine way
to the inferior end of the ulna, but becomes almost indistinct at 
THE FORE ARM.
191
its lower part.  To the upper fourth of this ridge, is attached
the anconeus muscle, which reposes in a hollow between it and
the beginning of the first or outer ridge.  To the beginning of
this latter ridge, is attached the supinator radii brevis muscle.
On the posterior surface of the bone, just below the olecranon,
is a long sub-cutaneous triangular face on which we lean.
   The three ridges of the ulna divide it into as many surfaces,
which are each modified by the muscles lying upon them. The
anterior surface presents, just above the middle of the bone, the
canal for the nutritious artery, running obliquely upwards.

   The body of the ulna is compact, the extremities, and more
abundantly the upper, are cellular.


                   Of the Radius, (Radius.)

   The radius is shorter than the ulna, is placed  on its external
 side, and extends from the os humeri to the wrist.  It is smaller
 at the humeral than at the carpal extremity, and though nearly
 straight is somewhat convex outwardly.  It is to be considered
 in its extremities and  body.

    The  superior or humeral extremity presents a cylindrical
 head, which bears all around it the marks of a cartilaginous in-
 crustation, broader on the cubital than on the other side.  The
 broader part plays in the lesser sigmoid cavity of the ulna, while
 the other is in contact with the annular ligament.  A superficial
 fossa also exists on the upper surface of this head, which re-
  ceives the convexity of the articular  face of the external con-
  dyle of the os humeri.  The head of the radius is placed upon
  a narrow part called the neck, of about half an inch in length.
  Immediately below the neck, on the ulnar side, is a rough pro-
  tuberance or  tubercle, the bicipital, for the insertion of the bi-
  ceps flexor cubiti.

    The lower or carpal extremity of the bone, is augmented con-
  siderably  in volume, and  is flattened out transversely. The
  carpal surface presents a long superficial cavity, bounded ex-
  ternally by the styloid process, from which proceeds the exter-
  nal lateral ligament; and ending  on its  ulnar side, by a small 
IVZ
SH.Kl.IS 1AJ« .
 cylindrical concavity, for receiving the lower end of the ulna.
 The former or superficial cavity is divided into two by a slight
 ridge in its short diameter;  the division next  the  styloid  pro-
 cess receives the scaphoid  bone, and the  other the  os lunare.
 At this extremity also a  ridge  exists on the front of the bone
 for forming the margin of the articular face, and giving origin
 to the capsular ligament.  The posterior and external faces of
 the  bone, here, are rendered irregular by several  grooves  and
 ridges.  The large groove next to the cylindrical concavity for
 the  ulna, transmits the tendons  of the extensor communis digi-
 torum and indicator, also the tendon of the extensor major pol-
 licis, which forms a channel somewhat distinct, and on the sty-
 loid side of the groove. Next to this is another large groove for
 the  tendons of the extensor carpi radialis brevior and longior;
 and on  the styloid  side of the radius  is the third groove for
 transmitting the tendon of the  extensor minor pollicis, and  of
 the extensor ossis metacarpi pollicis.   The anterior margin  of
 this groove is formed by a small spine or  ridge, into which is
 inserted the tendon of the supinator radii longus.

   The body of the radius is somewhat triangular, and therefore
 presents three ridges. One, on  its ulnar side, extends from the
 bicipital protuberance to the lower end, and gives origin to the
 interosseous ligament: it  is  sharp and well  marked.  Another,
 on the outer or styloid margin of the bone, also begins at the
 bicipital protuberance, and  terminates  in  the styloid process.
 The upper part of this ridge is curved, has  the supinator brevis
 inserted into it, and a portion of the flexor digitorum sublimis
 arising from it;  at its  lower part the  pronator quadratus is in-
 serted.   The third ridge is on the posterior face of the radius,
 and, arising insensibly from below its  neck, is principally con-
 spicuous in the middle third of the bone: it runs down, however,
 to the carpal extremity, and, becoming  more prominent there,
separates the two larger grooves from each other.   This ridge
is shorter, and not so elevated as the other two.
  These three ridges  form as  many surfaces to the radius, of
which the anterior augmenting gradually in its descent, affords
attachment to  the flexor longus pollicis above, and to the pro-
nator quadratus below; at its upper part is a canal, slanting up-
wards, for the nutritious artery.  The posterior surface has the 
THE HAND.                     193
extensor muscles of the thumb and the indicator lying upon it.
The external surface presents a roughness, just above its mid-
dle, for the insertion of the pronator teres; and below it is  co-
vered by the radial extensors, which are crossed by the exten-
sor metacarpi pollicis and the extensor minor.
   The body of the radius is compact; its extremities are cel-
lular.


                   SECT. IV.--OF THE HAND.

   The hand consists of carpus, metacarpus, and phalanges, and
has in its composition twenty-seven bones, to which number
may be added the  two sesamoids.


                   Of the Carpus, (Carpe.)

   The carpus, or wrist, is next to the bones of the fore arm.
Eight bones compose it, which are arranged into two rows, one
 adjoining the  fore  arm, and  the other the metacarpus:—they
 are called first and second rows.  These bones present very
 diversified forms, and a number of articular faces, which ren-
 der them difficult  to be distinguished from each other.
   The first or antibrachial row has in it the os scaphoides, lu-
 nare, cuneiforme,  pisiforme.   The second or metacarpal row
 has in it the  os  trapezium,  trapezoides,  magnum, and unci-
 forme.

               Of the Scaphoides, (Scaphoide,)

   This bone is on the styloid half of the end of the radius,  and
 is distinguishable  in a set by its greater  length.   It is convex
 above and concave below.   The convexity forms only  a  half
 of its upper surface, the  other half being rough, and making a
 knob at its extremity.  The concavity on the lower surface is
 large enough to receive the  end of a finger.  Between the
 concavity and the convexity, and on the dorsal surface  of the
 bone, at its outer end, is a second convexity, of an oblong shape.
 Between the two  convexities  is a small fossa for the capsular
 ligament.   The palmar,  or anterior face, shows a crook in the
   Vol.  1.^-17 
194
SKELETON.
 bone.   The knobbed extremity projects beyond the styloid pro-
 cess of the radius.  The other extremity, which is narrow,*joini
 the os lunare.

                 Of the Lunare, (Semilunare.)

   This bone is at the ulnar side of the preceding, and may be
 distinguished by the semi-lunated shape of the surface joining
 the scaphoides.  Its upper surface is convex where it articulates
 with the radius; the lower face is concavely cylindrical.   The
 ulnar side is a plain surface which joins the os cuneiforme.   It?
 dorsal side is rather thinner than its palmar.


        Of the Cuneiforme or Pyramidale, (Pyramidal.)

   This bone is placed at the ulnar side of the last, and may be
 distinguished by its representing somewhat a triangular  pyra-
 mid.   The surface next the lunare is plane, but  the other ex-
 tremity, being the boundary of the wrist in that direction, is
 rough.  Above,  it  presents a  small convexity, adjoining  the
 surface for the lunare, whereby it enters partially into the upper
 wrist joint.  Its inferior surface is concavo-convex, the con-
 vexity being towards the ulnar end.  On its palmar side it pre-
 sents a circular plane surface for the os pisiforme.


                Of the Pisiforme,  (Pisiforme.)

   This bone is placed on the front or palmar surface of the last,
 and may be distinguished by its  being smaller than  any  other
 in the  carpus, by its spheroidal shape, and by its presenting but
 one articular face, which  corresponds with  one on the cunei-
 forme.  It is always so prominent as to be-felt, without difficulty,
 at the  ulnar extremity of the wrist, and is very moveable.


                Of the Trapezium, (Trapeze.)

  This bone is placed at the radial end of the second row;  its
shape is exceedingly irregular, but it may be generally distin-
guished by being a bone of the third magnitude as regards  the
second row.  It is better for the student  to find out first  the 
THE HAND.
195
surface by which it articulates with the metacarpal bone of the
thumb, which he can do in a short time by a comparison of the
surfaces of the two bones.   This being successful,  will estab-
lish a clew to the other surfaces, and to the  relative  position of
the bone.  The thumb surface is a concave cylindrical trochlea,
placed on the radial side of the trapezium, and looking down-
wards and outwards.  On the reversed or upper side is a small
concavity, which receives the dorsal convexity of the scaphoid
bone.   Continuous with  this concavity is another on the ulnar
side, which receives  a corresponding  convexity of  the trape-
zoides.   Between  this concavity and the one for the thumb is
a small plane surface, by which the  trapezium articulates par-
tially with the metacarpal bone of the fore finger.  The dorsal
face is rough and  unequal.   The  palmar face is unequally di-
vided by a high ridge or process, at the ulnar side  of  whose
root is a deep fossa for the tendon of the flexor carpi radialis.

              Of the Trapezoides, (Trapezoide.)

   It is  placed at the ulnar  side of the last bone,  and is the
smallest in the second row.   There is no liability of confound-
ing it with any other bone of the carpus, as it  is the least of
any, excepting the pisiforme.  The greater difficulty is the ad-
justment of it in the separated bones: the following rule, how-
ever, will serve.  It is surrounded by articular faces on its sides,
but the dorsal surface presents  a  broad base, while the palmar
extremity is  reduced in  size.  Holding the bone with  a refe-
rence to these, it will be  observed that one side is very  crook-
ed and  concave, while the reversed or opposite one is convex.
The latter fits against the surface  of the trapezium which  has
been  indicated, while the former embraces the side of the os
magnum just below its head.   The metacarpal surface of the
trapezoides is long and elevated in its middle for being received
into  the root of the  metacarpal bone of the fore finger, while
the upper surface presents a long concavity for receiving a part
of the dorsal convexity of the scaphoides.

                Of the Magnum, (Grand Os.)

   It is placed at the ulnar side of the trapezoides, and, from its
being larger than any other  bone in the carpus, will scarcely 
196
SKELETON.
be mistaken.  Its ulnar side is flat, and presents a plane surface
for articulating with the unciforme.  The radial side is uneven
and rather indistinctly marked where it joins the trapezoides,
but the latter surface will be found near the middle of this side
just below the head.  The  upper surface of the magnum  is
formed into a spherical head, the radial side of which  reposes
in the concavity of the scaphoides, while the ulnar side is in the
concavity of the lunare.  Its metacarpal surface is triangular,
convex, and winding, by which it joins the metacarpal bone of
the middle finger.  On the radial side of this surface is a small
one continuous with it, whereby the magnum articulates par-
tially with the metacarpal bone of the fore finger.  The poste-
rior or dorsal face is broad, while the palmar is  more narrow.


               Of the Unciforme, (Os Crochu.)

   It is placed at the ulnar side of the magnum, is nearly of the
same size, but readily distinguishable from it by its long crooked
process as well as by its peculiar shape.   Its radial side is plane
where it joins the magnum; the reversed or ulnar side is brought
to a thin edge.  The metacarpal surface presents two distinct
concavities; the one next to the ulnar edge is for the metacarpal
bone of the little finger, and the other for that of the ring finger.
The upper surface is convex and winding, having its ulnar mar-
gin almost touching the surface of the metacarpal bone of the
little finger.  The most considerable portion of the upper sur-
face reposes upon  the  cuneiform, and  the remainder upon a
part of the concavity of the lunare.  The posterior face is broad
and rough, while the palmar is narrower.   From the ulnar side
of the latter, projects the unciforme process already alluded to.

   The two ranges of carpal bones, thus shaped, present, when
articulated or united together, an oblong body, the greatest dia-
meter of which is transverse.   Its posterior face is semi-cylin-
drical and arched, while the anterior  face is concave for the
passing of the flexor tendons.   Two protuberances are found on
each extremity of the palmar surface.  Those at the ulnar end
are the pisiforme, and the unciform process of the unciforme;
those at the radial end are the protuberance at the radial end of 
THE HAND.
197
the scaphoides and the sort of unciform process from the trape-
zium bounding the radial margin of its groove.  These several
prominences may, with a little attention., be readily distinguished
beneath the skin.   The  superior face of the carpus, which ar-
ticulates with the lower  end of the radius and ulna, presents an
oblong convex head formed by  the scaphoides, the lunare, and
very partially by the cuneiforme.   The inferior face of the car- •
pus presents a very diversified surface, subdivided  into five dis-
tinct ones, eaeh of which is  fashioned according  to the shape
of the metacarpal bone with which it has to articulate.

   The central joint of the wrist, formed between the two rows
of bones, is very deserving of attention.  The first row is con-
vex on its radial end, the convexity being formed  on one half
of the scaphoides: to the ulnar side of this there is a deep  con-
cavity formed  by the other half of  the scaphoides,—by the lu-
nare and the cuneiforme. The upper surface of the second row
fits very accurately upon the  lower surface of the first: its ra-
dial end is, therefore, a concavity formed by the trapezium and
trapezoides, which receives the  convexity of the scaphoid;  then
a very large prominent  head is formed by the magnum and
unciforme, and received into the  concavity of the first row.
The magnum reposes upon the scaphoides  and part of the lu-
nare, the unciforme upon the  remainder of the lunare, and the
whole of the cuneiforme.  The  carpal bones  consist of cellular
matter enclosed by condensed lamellated substance.


                    Of the Metacarpus.

   The metacarpus, is situated between the  carpus  and the pha-
langes of the fingers and thumb.  It consists of five bones, one
for the thumb  and  one for each finger.  The latter are parallel
or nearly so with each other; but the first diverges considerably,
and is so placed as  to  traverse the others in front during its
motions. These bones are rounded in their middle, and enlarged
at their extremities.   That of  the thumb  is  the  shortest, the
others decrease successively in  length from the fore to the lit-
tle finger.
                            1-7* 
198
SKELETON.
  Of the First Metacarpal Bone, or that of the  Thumb.—It is
placed upon the trapezium:  and besides  being the shortest, is
also the thickest  of any.  Its  upper end  is cylindrical and
slightly concave from side to side, to present a  fit  surface to
the trapezium.   Its lower end is slightly convex, and elongated
in front into a trochlea, on either side of which reposes a sesa-
moid bone.   The posterior face of its body is flat and straight;
the anterior is concave in its length, and is divided into two
surfaces by a middle ridge.  A  roughness exists on either side,
at its lower end, for the attachment of the lateral ligament.

   Of the Second Metacarpal Bone, or  that of the Fore Finger.—
The greater length of this bone gives  it a distinctive character.
It is placed upon the trapezoides, and articulates laterally also
with the trapezium, and the magnum.   Its carpal or upper end
presents, in the middle, a deep concavity for receiving the tra-
pezoides, at the radial side of which  is a small plane face for
articulating with the trapezium, and at the ulnar side  an oblong
surface, the upper margin of which joins the magnum, and the
remainder is in contact with  the third metacarpal bone.   The
lower end presents a convex head extended in front to concur
in the flexion of the  finger, on each side  of which  head is a
concave rough surface for the lateral  ligament.  The poste-
rior face of the bone presents a triangular flat surface, the base
of which is towards the finger or phalangial end.   The palmar
face is concave, longitudinally, and divided  by a  middle  ridge,
into two surfaces,  each of which is compressed by the interos-
seous muscles.   A tubercle exists on  the back of the bone just
below its carpal end for the insertion of the tendon  of the ex-
tensor carpi longior, and another in front for that of the  flexor
radiali?.

   Of the Third Metacarpal Bone.—This is a little shorter than
the last, and is nearly of the same size, but its carpal extremity
is very different.   The latter  is triangular,  and  is bounded on
its radial side by a sort  of styloid process, with a tubercle on
the posterior face  of it, into which the tendon of the extensor
radialis brevior is  inserted.  It is placed upon the magnum, to
which it joins by a slightly concave,  winding surface.  It also
presents, continuous.with  the same  surface, an  oblong face 
THE HAND.
199
which joins the second metacarpal bone, and, on the reversed
side, two round facets, which are contiguous to the fourth me-
tacarpal bone.  In regard to its lower or phalangial extremity
and body, this bone resembles closely the one last described.

   Of the Fourth Metacarpal  Bone.—This bone is placed upon
the unciforme, and has a very small  articulating surface with
the magnum: it is much smaller and shorter than  the third
metacarpal, and readily distinguishable by these circumstances.
The carpal surface, by which it joins the unciforme, is trian-
gular and slightly convex; its radial edge touches the magnum.
Continuous with this edge are two small faces, slightly convex,
which join the contiguous faces of the third metacarpal bone.
On the  reversed side of the fourth metacarpal is an oblong face
which joins the carpal end  of the fifth metacarpal bone.  In
regard  to its body and phalangial extremity, this bone resem-
bles the two preceding, and  therefore does not require a parti-
cular description.

   Of the Fifth Metacarpal  Bone.—It is placed upon the unci-
 forme exterior to the last, and is both smaller and shorter than
 the  fourth.   The carpal extremity presents  a cylindroid and
 slightly convex face, for articulating with the unciforme, at the
 radial margin of which is an oblong facet, for joining the fourth
 metacarpal: just below the outer margin is a small tuberosity,
 into which is inserted  the tendon of the extensor ulnaris.  The
 lower or phalangial extremity, like that of the others, presents
 a convex articular face, extended in front for the flexion of the
 first phalanx.  The body  also corresponds with that of the
 others, excepting that  it is  more flat in front.


                      Of the Phalanges.

   The fingers are named  numerically, beginning at the fore
 finger; they are  also named from their functions, as Indicator,
 Impudicus, Annularis, and Auricularis.
   Each finger has three bones in it, called its phalanges: the
 bone adjoining the metacarpus is the first phalanx, the middle
 bone is the second, and the other the third. 
200
SKELETON.
   The first phalanx is the largest.   Its posterior face is semi-
 cylindrical, the anterior  face  is flattened, and concave in  its
 length.  The two surfaces run  into each other by forming a
 ridge on either side, from which arises the theca  of the flexor
 tendons.  The  metacarpal extremity is enlarged, and presents
 a superficial cavity, which receives the end  of the metacarpal
 bone.  On either side of this end of the bone is  a small tuber
 for the lateral ligament.   The lower extremity is also enlarged
 and flattened at  its  sides.  Its  articular  face is extended  in
 front, and presents two condyles,  or  small  heads, for joining
 the second phalanx.

   The second phalanx is likewise second in size and length.   It
 is semi-cylindrical on its posterior face, flattened on its ante-
 rior,  which is somewhat concave in its  length, and the two sur-
 faces form a ridge, on either side, into which the tendon of the
 flexor sublimis is inserted, and from which arises the theca of
 the flexor  tendons.  Its  extremities are slightly enlarged: the
 articular face of the upper presents two superficial cavities for
 the condyles of the first phalanx: the articular face of the lower
 extremity presents a  trochlea, with a  slight  elevation at each
 side.

   The third phalanx is the smallest of the three, and is very
 different from the others.  Its superior extremity being en-
 larged, presents an articular face, having two superficial cavities,
 which adjust themselves to the corresponding face of the last
 described bone.   The  inferior extremity is semicircular, thin,
 and flattened, its margin being very rough, and somewhat ex-
 panded.  The posterior face of the body is  convex, and the an-
 terior flat.

  The phalanges  of the middle finger (Impudicus) are larger
 and longer than the others.  The phalanges of the fore finger
(Indicator)  are next in size, but not in length, as the ring finger
is rather longer than it.  The phalanges of  the ring finger (An-
nularis) are next in size, and those of the little finger (Auricula-
ris) the smallest  and shortest of any.
  The thumb (Pottex) having but  two phalanges, the  first cor-
responds sufficiently in its general  form with the  first one of 
DEVELOPMENT OF THE UPPER EXTREMITIES.        201
the fingers: it may be distinguished, however, by its shortness
and additional size.  The second phalanx of the thumb, corre-
sponding with the third of the fingers, is only to be distinguished
by its additional bulk and length.
   All the metacarpal and phalangial bones have condensed la-
mellated structure externally, and a cancellated one internally:
and, like other bones, are more compact in their bodies than at
their extremities.
   There are two  small  hemispherical bones, called  sesamoid,
placed upon the trochlea, at the lower extremity of  the meta-
carpal bone of the thumb.  They answer the purposes of pa-
tellas, and facilitate the action of the short flexor muscle.   The
metacarpal bones of some of the fingers are, in robust indivi-
duals, occasionally furnished in the same way.


   SECT. V.--OF THE DEVELOPMENT OF THE UPPER EXTREMITIES.

   At birth the upper extremities are larger in proportion to the
 lower than they are  at  any subsequent  period of life, owing,
 perhaps, to the umbilical arteries, which carry off to the placenta
 of the mother the greater part of the blood which afterwards
 goes to  the lower extremities.   The nearer a fcetus  may be to
 the embryo state, the more marked is this relative size of the
 extremities, which becomes  gradually less obvious till the age
 of puberty, when it almost entirely disappears.
   At birth, the ends of the clavicles are, in consequence of their
 advanced ossification, much less cartilaginous than those of the
 other cylindrical bones.  Its shape, also, approaches nearly to
 that of the adult state.
   The scapula is also in an advanced stage of ossification, and
 large.   The glenoid cavity, though  still cartilaginous, is well
 sustained  by a bony basement coming from the central point of
 ossification of the scapula, and is much farther ossified than the
 acetabulum.  The acromion, the coracoid process, and the an-
 gles, are still cartilaginous.
   The os humeri is cartilaginous  at both extremities, which are
 also larger, proportionally,  in  consequence of this state.  Its
 inferior extremity is remarkable for the size of  that portion  of
 it which articulates with the radius. 
202
SKELETON.
  In the fore arm the extremities of its bones are cartilaginous.
The ulna has the olecranon large, while its coronoid process is
comparatively small; the greater sigmoid cavity is, consequent-
lv, not so concave as in the adult.   The position of the radius,
at its upper end, is somewhat peculiar, for it is  much more an-
terior than  in the adult;  a circumstance depending upon the
greater size of the little head of the humerus, upon which it
rests.  This arrangement renders pronation more extended in
the  fcetus, as the radius always crosses the ulna with additional
facility, by being placed more anterior to it. This fact is strong-
ly exemplified in the bones of a fore extremity of animals.  Bi-
chat observes, that this greater extent of pronation exposes the
annular ligament to being stretched  considerably behind, and,
consequently, the radius to luxations at its head; an accident by
no means unfrequent among children.  The late Dr. Physick
says, that he has often seen it in consequence of nurses incau-
tiously seizing them by the fore arm to help them over gutters,
or to render them other assistance.  It happens while the arm
is in a state of pronation;  for the weight of the body, by hang-
ing from it,  increases, the  position distends the  ligaments, and
produces luxation.  As the bones of  the fore arm in  the  fcetus
are nearly straight, the  interosseal space  decreases gradually
from above  downwards.
  The carpus is entirely cartilaginous at birth, and consists in
the  same number of pieces that it does in the  adult.   Its arti-
cular cavities are well formed.  Its size is proportionate to what
it is in the adult: in this respect it differs from the cartilaginous
extremities  of the round  bones,  which are always larger from
being in this state*  The carpus, therefore, appears small  in the
fcetus.
  The metacarpus is cartilaginous at its extremities, but ossified
in the middle. The phalanges are in the same state.


   SECT. VI.--OF THE MECHANISM OF THE UPPER EXTREMITIES.

  The scapula and clavicle are for the superior extremity what
the  os innominatum is for the inferior; in consequence of which,
some anatomists consider them as la part of the trunk of the
body.  Though the convenience of anatomical description ge-
nerally requires them to be associated with the upper extremi- 
            MECHANISM OF THE UPPER EXTREMITIES.          203

ty, I shall depart from the rule on the present occasion, and
view them only as the basis of the attachments and motions of
the os  humeri, and of the remaining parts of the superior ex-
tremity.
  The upper extremities,  considering them as commencing with
the os humeri,  differ  materially in their  position from the
lower.  They are placed much farther behind; of which one
may be satisfied fully by  drawing a line from the middle of the
glenoid cavity, to the middle of the acetabulum of the same
side;  the body being perfectly erect at the time, the line will
be  found oblique.  The  advantage of  this  arrangement  is to
give greater latitude of motion to the upper extremity than if
it had been  placed more  in front.   Another important  benefit
is, that by the  bulk  of the shoulder being  placed  behind the
centre of gravity, the erect position is more easily preserved;
a different position of it, by throwing its  weight forwards, would
have had a  continually tendency to produce falls, and to effect
somewhat, in man, the same inconvenience  which is felt by the
quadruped in the erect position.   Another point, also of some
interest in the position of the  upper extremities, is the distance
to which they are separated from each other by the lateral pro-
jection of the scapulae, and, consequently, of  the glenoid  cavi-
ties.  A  distance owing to the length of the clavicles, and which
considerably exceeds the distance between the heads of the ossa
femorum.
   When the whole length of the superior is  compared with that
of the inferior extremities, the difference is  not so great as one
may suppose.   The former is ascertained by a line drawn from
the head of  the os humeri to the end of the middle finger: as the
hand is parallel with the bones of the fore arm, its length is also
included, which amounts  to a  considerable portion of the whole.
On die contrary, from the foot being articulated at right angles
with the  leg, only its thickness contributes to the length of the
lower extremity. As far, however, as individual bones are con-
cerned, those of the upper extremity, with the exception of its
phalanges, are uniformly shorter than the corresponding bones
of the lower extremity.  The os humeri is much shorter than
the os femoris—the bones of  the fore arm than the bones of the
leg—the carpal and metacarpal bones  than the tarsal and me-
tatarsal. 
204
SKELETON.
   The bones of the upper extremity are much less robust than
 those of the lower, a very certain indication of the difference of
 the uses for which they were intended.  Their articular surfaces
 are  arranged for great variety and extent  of  motion, in the
 seizing and handling of bodies; whereas in the lower extremity,
 they are fashioned so as to suit the comparatively limited num-
 ber  of motions requisite to progression, and to sustain the body
 firmly in the upright position.   The  carpus and metacarpus are
 much smaller than the tarsus  and  the metatarsus, because the
 latter are intended to support a great weight.  On the contrary,
 the phalanges of the fingers are much better developed  than the
 phalanges of the toes, because the latter are not destined to hold
 bodies and to examine  them, and  may be dispensed with both
 in standing and in progression.
   The  motions of the upper extremity are immensely varied,
 and by a short attention to them, some useful hints may be ob-
 tained in regard to dislocations.


         SECT. VII.--OF THE MOTIONS  OF THE SHOULDER.

   The  clavicle performs a very important office in the actions
 of the shoulder, by preserving it  in a fit attitude for the motions
 of the upper extremity.   The simple movements of the clavicle,
 of which the sterno-clavicular  articulation  is the  centre, are
 those of elevation, depression, advancing, and retreating, and a
 rapid succession of these produces circumduction.  The weight
 of the shoulder  is also  sustained by the clavicle, by the latter
 being fastened at the extremity next to the sternum, and having
 in the cartilage  of the first rib a fulcrum, intermediate to this
 attachment and  to the weight  at its other end.  This is proved
 conclusively by its fracture; for in that case the  shoulder inva-
 riably  falls  down, from the lever  being  broken which  kept
 it up.
   The clavicle,  also, by keeping the glenoid cavity at a dis-
 tance from the side of the thorax, and directed outwards, gives
 great facility and latitude to certain  motions in the human sub-
ject; and which  are performed with  difficulty, and very imper-
 fectly, in animals not having  a  clavicle.   A principal  one  of
 these motions is  circumduction, manifested by the elbow being 
MOTIONS OF THE SHOULDER JOINT.
205
turned inwards or outwards, and  in most persons extends to
three-fourths or even an entire circle.   This motion concurs in
the action which brings the hand to the mouth, in consequence
of which such an  action is performed with difficulty when the
clavicle is broken.  After an accident of the kind, the head, in-
stead of remaining stationary as usual, is advanced towards the
hand, without which the act cannot be accomplished.   A cer-
tain length in the clavicle seems indispensable to the vigorous
and perfect action of the shoulder  in particular movements;  if
the  clavicle be disproportionately long, as in females, these
movements are executed with inevitable awkwardness and im-
becility; as, for example, in throwing, a stone.

   The scapula presents a moveable basis, on which the mo-
tions of the arm are accomplished.  Its primary motions are
such as have  been assigned to the clavicle, in consequence of
the connexion between these bones; besides which, in all the
extreme motions of the humerus, backwards  or forwards, the
scapula is caused to  perform  a partial rotation, the  axis of
which is indicated by a  line drawn from the  end of the acro-
mion to the inferior angle.  When the arm is brought very far
forwards, the  inferior angle of the  scapula is carried outwards,
and somewhat elevated, while  the superior angle is  directed
towards the spine, and  somewhat depressed.  But, when the
arm is carried very far backwards, the inferior angle is direct-
ed towards the spine, and the superior angle  looks forwards
and upwards.  The clavicle in these cases moves inconsidera-
bly, as the scapula enjoys a pendulous motion, and its  point of
suspension is the outer end of the  clavicle; at which place the
oblong articular surfaces slide  laterally upon each other and
decussate.  The extreme degrees  of these motions tend to dis-
locate this  articulation, but the accident  is prevented by the
strong coraco-clavicular ligament, which, by its peculiar posi-
tion and conformation, resists firmly at a certain point.   In the
abduction'and adduction of the arm the scapula is motionless.


       SECT. VIII.--OF THE MOTIONS OF THE SHOULDER JOINT.

   The os  humeri  is  susceptible of elevation,  depression, ad-
vancing, retreating, circumduction, and rotation.
   Vol I.—18 
206
SKELETON.
  In elevation, the head of the os humeri slides downwards in
the glenoid cavity, and distends the lower part of the capsular
ligament.  In this motion the scapula is apt  to  follow it; in
which case there will be a less degree of distention in the cap-
sular ligament.  If  the os humeri be carried forwards, its ele-
vation is performed with much more ease, from the readiness
with which the scapula follows it; but if it be carried backwards,
 this facility is much diminished.   It is  in the  latter position,
 therefore, that dislocations downwards are most disposed to oc-
 cur when violence is offered to the joint.  If in every case the
 scapula could follow the motions of the os humeri, so as to pre-
 sent fairly its glenoid cavity, luxations would be comparatively
 rare; but generally the violence offered transmits its momentum
 so speedily to the  joint, that the  muscles of the  scapula are
 taken by surprise, and have not time to adjust properly the gle-
 noid cavity.
    In the depression of the os humeri, the parts  constituting the
 shoulder joint are in their most natural and easy position.  The
 capsular ligament becomes very loose below, and is somewhat
 stretched above.   Any degree of force which might be applied
 to the member, is warded off and its direction changed by the
 intervention of the  trunk of the  body.   Should,  however, the
 force be applied directly in  the axis of the bone, the projection
 of the acromion process, and the strength of the triangular liga-
 ment of the scapula, would  arrest the dislocation.
    When the os humeri  is advanced, the posterior part of the
 capsular ligament is put  upon the stretch; but the form and ar-
 rangement of the articular surfaces are somewhat favourable to
 this position, and accordingly it  is one  of but little inconve-
 nience.  When the os humeri is  retracted, its head, by being
 directed forwards,  exercises considerable force upon the fore
 part of the capsular ligament, and when assisted by an exter-
 nal  momentum is  disposed to dislocation,  forwards and  in-
 wards.                                      .   .  .,    ,   ,
    The motion of circumduction is very extensive m the shoul-
 der joint; and by it the os humeri describes  a cone, of which
 the glenoid cavity is the apex.  It is a regular  succession of
 the movements already mentioned, and  in consequence of all
 the motions forwards  of the os  humeri being more easy and 
MOTIONS OF THE FORE ARM.               20?
natural, the axis of the cone, instead of being directly outwards,
is somewhat forwards.
  By rotation, is meant the revolving of the  os humeri upon
itself.  The centre of this movement is-not the axis of the bone,
but is removed to one side of it, by the lateral  projection of the
head.  The neck, however, is  too short and thick to  permit
any great extent to  this motion;  it, accordingly, is limited in
such a way as never to amount to luxation.  Its greatest ex-
tent, in most persons, does not exceed the describing of half a
circle, which  maybe ascertained by applying  a  finger upon
the internal condyle of the os humeri.  By it the capsular liga-
ment is rendered,  alternately, loose and tense on its front and
back parts.   Bichat observes, that  in  the  anchylosis  of  the
elbow joint, this motion, by habit,  is much augmented, so as to
supply the want of rotation of the head of the radius upon the
ulna.  The scapula and the clavicle do not vary their position
in rotation.
         SECT. IX.--OF THE MOTIONS OF THE FORE ARM.

  There are two kinds of motion in the fore arm.  In the one,
the fore arm is flexed, or  extended  upon  the arm, and  in the
other, the radius only changes  its  position in regard to the
ulna.

  1. The ulna is the essential agent of the first, in consequence
of its manner  of articulation with the os  humeri; the radius is
only accessory, and is drawn by the ulna into a participation in
its motions.   These two bones, it will be recollected, are dis-
posed of in an inverse manner, the larger part of the ulna being
above, while the larger part of the  radius is below.   This  ar-
rangement causes the ulna  to present the  principal  articular
surface for union with the os  humeri, while the radius affords
the principal surface to  the carpus; it also gives  to the whole
fore arm a great uniformity in its transverse  diameter.  The
fore arm executes, upon the arm, flexion, extension, and lateral
inclination.
  Where the flexion is complete, the coronoid process is  re-
ceived into its cavity, on the front of the os humeri; and the ole- 
208
SKELETON.
cranon, having left its  cavity, is placed  below the  condyles.
In this state the capsular ligament is stretched at its posterior
part, while the anterior is  thrown into  folds, and  is  relaxed
along with the lateral ligaments.  In the demi-flexion of the
arm, there is a more equal degree of tension of the several li-
gaments.   When the os humeri is reposing in its most easy at-
titude, at the side of the body, if the fore arm be flexed, its line
of motion directs the hand towards the mouth; a circumstance
which is accounted for  by the  peculiar obliquity of the troch-
lea, on the lower part of the  os humeri, upon which the ulna
revolves, and is independent of any special act of volition.   It
is said that man, above  all other animals, has  the mechanism
of the upper extremity most particularly addressed to the latter
motion, to the perfection of which the clavicle is indispensable.
It is in consequence of this application of the clavicle, that if it
be broken, man, like animals which are entirely deprived of it,
will, in the flexions of the fore  arm, more easily carry the hand
to the opposite shoulder than to the mouth.
  In the full extension of the fore arm, the olecranon  process
being received into its  cavity, is much above the condyles of
the os humeri.  The lateral ligaments, as well as that  part of
the capsule on the front of the joint, are in a state of  tension.
When the  extremity is  in this position, a fall  upon  the hand
may produce a dislocation  backwards.  In this case the fore
arm being fixed, the coronoid process affords the surface upon
which the principal momentum of the fall is felt.  If the liga-
ments  on  the front of the joint be not strong enough to with-
stand the force, they are lacerated, and the articular surfaces,
passing each other, the  upper parts of the ulna and  radius are
driven behind the os humeri.   Bichat  asserts, that  nothing is
more  easy than to produce such a luxation on the dead body by
a similar proceeding, and that  he has repeatedly done it—that
it is about as easy to produce this dislocation, as it is difficult to
effect one  at the scapulo-humeral articulation.  In a  moderate
extension of the fore arm, produced by a small weight suspend-
ed on the hand at arm's length, there is a well marked pressure
of the inferior extremity of the os humeri against the ligaments
in front of the articulation, which is augmented by a  tendency
of the ulna  to  describe the arc of a circle, from aboveMown-
wards, and to separate itself from the os humeri.  In this case 
MOTIONS OF THE FORE ARM.
209
 the muscles which flex the fore arm are kept so much in  the
 line in which they contract, or are so little  removed from  the
 axis of their own motion, that they contribute but little to sus-
 tain the fore arm in situ; the weight is, therefore, actually sus-
 tained by the ligaments in front of the articulation.  But they
 being pressed and drawn in the manner mentioned, such great
 pain and weariness are produced as to render a continued sus-
 pension of the weight insupportable, the experimenter is, there-
 fore, in a short  time, under the  necessity either of casting  off
 the weight or of giving such a degree of flexion to the fore arm
 as will allow the muscles to contract more advantageously.
  Besides flexion and extension, the ulna has a sort of rocking
 motion when the fore  arm is only half bent;  but when  the lat-
 ter is at either extreme of the former positions, this motion is
 imperceptible, owing to the nature of the articular surfaces and
 the resistance of the ligaments.

  2. In the rotations of the radius upon the  ulna, the  latter is
 almost motionless, excepting the case specified in the last para-
 graph.  The position of the radius on a plane somewhat ante-
 rior to  the ulna, its small cylindrical  upper extremity,  and  its
 broad  lower one, all concur in  facilitating rotations forwards
 and  backwards.  It is owing to the hand following these mo-
 tions that the first is expressed by the term pronation, in which
 the palm of the  hand is directed downwards; and the second,
 supination, in which the palm is  upwards and the back of the
 hand downwards.
  Pronation is the most common, and, consequently, the easiest
 position to the fore arm, when not carried to an extreme: it is
 adopted involuntarily, simply by the action of the ligaments and
 the particular  shape of the articulating surfaces of the  bones.
 It is  the posture  most generally suited to  the examination and
 grasping of surrounding bodies.  In order that it may  be  ac-
 complished fully, the superior extremity of the radius rolls  on
 its own axis, in the loop formed by the  annular ligament and
 the lesser sigmoid cavity of the ulna ; while the lower extremi-
 ty revolves around the  little head of the ulna below.  The mid-
dle part of the radius crosses that of the ulna, and the interos-
 seous space is diminished.   An excess of this motion will  pro-
duce luxation either above or below, but more  easily at  the
                            18* 
210  .
SKELETON.
  latter place; both on account of the greater extent of motion
  there, and of the comparative weakness of the ligaments.
    In supination, a movement the reverse of what is described,
  takes place; the radius revolves outwardly, and is brought pa-
  rallel with the ulna.  If by any force it be carried beyond this
  line, a dislocation may occur, in which the  little head of the
  ulna, abandoning the sigmoid cavity of the radius, will be thrown
  in front of it.  An accident, however, said to be  very unusual.
    Bichat considers the cartilage between the ulna and the cu-
  neiforme as a principal obstacle to these luxations; but when it
- is insulated or separated from the cartilage of the radius, as
  sometimes occurs, the joint is very much weakened thereby,
  and more exposed to dislocations.


             SECT. X. — OF THE MOTIONS OF THE HAND.

    The hand, as a whole, performs upon the forearm, flexion,
  extension, lateral inclination, and circumduction. ' As it  only
  follows the motion of the  radius in pronation and supination,
  and does not contribute in the slightest  degree to either, its ap-
  propriate motions can all be performed  independently of them.
    In flexion the convex head, formed by the first range of car-
  pal bones, slides from before backwards in the concavity which
  receives  it.   The  posterior part  of the  capsular ligament is
  stretched, and the anterior thrown into folds, while the lateral
  ligaments remain at their ease.  In extension, with the excep-
  tion of the lateral ligaments, the phenomena are reversed.   This
  extension, as is well known, not only brings  the  hand into the
  same tine with the bones of the fore arm, but carries it beyond
  that line till it forms almost a right angle with it.   The wrist
  joint, in this respect, differs from the  other ginglymous articu-
  lations;  but what it gains  in extension  it loses in flexion,  as  it
  cannot be bent so much as either the elbow or knee.  The ar-
  rangement, however, gives great facility to the use of the hand.
    In the lateral inclinations of the hand, the capsule  in front of
  and behind the wrist, is  but little affected, but the lateral liga-
  ments are alternately relaxed and tightened.   As the articular
  surfaces are extensive in the line of these motions, dislocations
  in  the direction of either  of them are very uncommon, and
  when they do occur they are for the most part incomplete. 
MOTIONS OF THE HAND.
211
  Circumduction is produced  by a regular succession  of the
motions described; it, therefore, does not require a specific no-
tice.

   Of the Partial Motions of the Hand.—Well  marked changes
of position occur between the first and second rows of the car-
pus: these are principally flexion and extension.  Lateral in-
clination or abduction and adduction are extremely limited, and
circumduction does not exist.  The motions, such as they are,
are confined within much narrower limits than those of the ra-
dio-carpal  articulation, and have  for their main fulcrum  the
head of the magnum.
   The lateral articular surfaces of the several bones of the car-
pus, though they present the arrangement of joints, have not an
appreciable motion upon each other.  Whatever changes of po-
sition happen among them, are probably so obscure that they
never appear, except under the influence of great and sudden
violence.  The complexity of the mechanism of  the wrist,
seems to have a double object in view: for ordinary circum-
stances of impulse and motion, the flexion and extension of the
first row upon the second, as a whole, is sufficient; but when a
great momentum is communicated to the structure, the number
of pieces which form it, and the variety of their shapes and mode
of attachment,  diffuse the violence throughout the whole wrist,
and generally save it from dislocation or fracture. The fracture
of a single bone, excepting from gun-shot wounds, is a very un-
usual circumstance: I have, however, in possession a scaphoides
which was broken through transversely, and had probably been
in that state for a long time; as all appearance of inflammation,
 at the period of my finding  it, was absent, and as the fractured
 surfaces had become highly polished by rubbing against one an-
 other.

   The pisiform bone moves with much freedom inwardly and
 outwardly on the cuneiform, but its motion up and down is re-
 sisted by the muscles which are attached to it.  Owing to its
 articular cavity being insulated, and to its own remoteness, a
 dislocation of it, if it did occur, would interfere but little with
 the general uses of the hand.
   The metacarpal bone of the thumb has a very free motion on 
212
SKELETON.
 the trapezium, in flexion, extension, adduction, abduction:  and
 circumduction is the result of the other four.  In consequence
 of this variety of movement in it, of its position on  a plane an-
 terior to that of the  fingers, and of a corresponding obliquity
 of the trapezium, the thumb can, in  all cases of grasping  and
 examining bodies, antagonize the fingers.   The circumduction
 of the thumb resembles very much that of the wrist, or shoul-
 der joint, though the mechanism of the articular surfaces is dif-
 ferent.   In this motion, it describes a cone or circle, the ante-
 rior segment of which is larger, and  performed with more fa-
 cility than the posterior.

   The second and third metacarpal bones are so closely bound
 to the carpus, that their  motion  above is almost imperceptible;
 in consequence of their length, the motion is more appreciable
 below, but even there it  is very much restricted.   The fourth
 metacarpal bone has a limited ginglymous movement, which is
 sufficiently demonstrable, and the fifth has it in a considerable
 degree;  it also admits of a sort of adduction, by which it is
 brought nearer to the other bone.

   The first phalanges admit of flexion, extension, adduction, ab-
 duction; and circumduction, by  the successive performance of
 the others.  The first phalanx of the  thumb has the three last
 motions very much curtailed, in consequence of the necessity
 of great strength and stability in this joint, so as to antagonize
 firmly the fingers.   The remaining phalanges perform, simply,
 flexion and extension.   The latter, as in the knee and elbow,
 rarely goes beyond the axis of  the limb, whereas the former,
 from the extent of the  articular surfaces and  the particular me-
 chanism of the joint, permits the hand to be closed and dou-
 bled.

  From what has been said, it  will not be  difficult to form a
general  conception of the great variety of  motions resulting
from the number and arrangement of the pieces constituting
the upper extremity.   The os humeri  being the basis of them,
may be presented in any direction; the bones of the fore arm
may be alternately retracted or protruded, and by the revolving
of the radius, will permit the palm of the hand to apply itself at 
THIGH BONE.                     213
any point; and, again, the multiplicity of simple motions of the
hand, and the exhaustless variety of their compounds, contri-
bute to give to the upper extremity, in man, a perfection of me-
chanism  infinitely beyond any thing which can be devised by
the powers of art: a sentiment cogently expressed by the late
Professor Wistar: who remarked, that " The human hand, di-
rected by the human mind, is the most perfect instrument that
man ever saw or ever will see."
                    CHAPTER  VI.

             OF THE INFERIOR EXTREMITIES.

  The bones of the inferior extremities are the os femoris, the
tibia, fibula, patella, and a large number which enter into the
composition of the foot.


     sect. i.—of the thigh bone,—(Os Femoris, Femur.)

  This is the only bone in the thigh, and extends from the trunk
to the leg.  It is considerably the longest and largest bone in the
skeleton, and presents a conformation entirely peculiar.  For
the purposes of description, it is divided into the two extremities
and the body.
  The superior  or iliac extremity presents three well marked
eminences, the head, the great and the little trochanter.  The
head is the articular surface above, and forms rather more than
one-half of a perfect sphere.  Its smoothness indicates the exist-
ence, of a cartilaginous crust on it during life, and is  only inter-
rupted by a small pit a little below its centre,  which gives at-
tachment to the round ligament of the hip joint.  Its articular
surface is'more extensive above than below, as that part is chief-
ly employed in sustaining the trunk, and comes in contact  with
a corresponding surface of the os innominatum.  The head is sup-
ported on a branch of the os femoris called the neck, which, pro- 
214
SKELETON.
jecting from the internal face of the bone between the trochan-
ters, is directed inwards and upwards at an angle of about thirty-
five degrees, but varying in different subjects.  The neck is two
inches in length,  oval9 or resembling a flattened cylinder, the
greater diameter  of which is vertical; and arises by an exten-
sive  base along the upper end of the os femoris.   It has a great
multitude of foramina dispersed over it, which penetrate to its
interior, and give passage to blood vessels; the largest of them
are on its posterior surface.   Some of these foramina are also
occupied by fibres.  A superficial  horizontal fossa, formed by
the tendon of the  obturator externus, may be seen crossing the
posterior face of the base of the neck.

  The great trochanter is situated  at the  superior part of the
base of the neck, and though presenting a well marked, elevated
summit, rising straight upwards, does not reach the altitude of
the head, but falls short  of  it half an inch.  The trochanter
major rests upon  a broad base, has its surface much diversified,
is somewhat prominent in front and externally; but presents on
the side which is next to the head of the bone a deep rough con-
cavity, which is occupied by the insertion of the small rotatory
muscles on the back of  the  pelvis.  On its summit  is.a small
smooth spot, marked by the insertion of the pyriformis muscle;
below this, and also externally, is a broad surface, slightly con-
vex, into which the gluteus medius is inserted; below this, again,
is a second prominent and rounded surface, over which a part
of the tendon  of  the  gluteus magnus plays.   On  the front of
the trochanter, and just in advance of the insertion of the  glu-
teus medius, is an oblong surface, proceeding obliquely down-
wards and outwards, into which is inserted the  gluteus mini-
mus.

  The trochanter minor is much smaller than the other, and is
a conical process, placed on  the internal posterior  face of the
bone, at the lower end of the root of the neck. It receives the
common tendon of the iliacus internus and psoas magnus  mus-
cles.  A.broad elevated ridge joins the two trochanters on the
posterior face of the bone, and from  its middle half arises the
quadratus femoris muscle.  A much  smaller  ridge, and by no 
THIGH BONE.                      215
means so elevated, runs  in front, from the one process to the
other, and indicates the line of attachment of the capsular liga-
ment of the hip joint.

  The inferior extremity of the os femoris is  much more volu-
minous than the superior, and is divided  into- two parts, called
the internal and the  external condyle.  These condyles are of
very nearly the same size, but, being separated by a notch be-
hind, they  are  placed  somewhat  obliquely in regard  to  each
other; and the  internal, from being the most  oblique, and, con-
sequently,  the most  protuberant, also seems  to be  the larger.
If the os femoris be placed exactly vertical, the internal con-
dyle has the appearance of being the longest;  but, if it be placed
in its natural obliquity, the lower face of the  condyles is on the
same plane.  In front, the condyles unite to  form an articular
trochlea, on which the patella plays: this trochlea is unequally di-
vided by a vertical depression, so as to have  its more extensive
surface externally.  This latter surface is the anterior part of
the  external condyle, and is  much more elevated than the in-
 ternal part of  the trochlea, which belongs to the internal con-
 dyle.  Posteriorly, the internal condyle projects more  than the
 external, and both have the articular surfaces, there, so much
 elongated backwards and  upwards, as to admit of a very great
 flexion of the leg.

   Each condyle presents an internal and an external face. The
 internal condyle has on its internal face a tuberosity, from which
 proceeds the internal lateral ligament of the  knee; on its exter-
 nal face it forms one-half of the notch which separates it from
 the other  condyle, and at  its anterior part in the notch may be
 observed  a  small depression, from which proceeds the poste-
 rior crucial ligament.   The external condyle, also, has  on its
 external face a tuberosity, from  which  proceeds  the  external
 lateral ligament of  the knee, and just below  it a depression for
 the origin of the popliteus muscle.   Its internal face forms the
 other half of the notch just mentioned, and on the posterior part
 of  this face is a small depression for the attachment of the an-
 terior crucial ligament.   The inferior face  of the condyles is
 somewhat flattened, the transverse diameter of that of the ex-
 ternal being rather  longer than the other.   The inferior  extre- 
216
SKELETON.
mity of the os femoris is beset with foramina, large and small,
for the passage of vessels and the attachment of fibres.

  The body of the os femoris begins at the trochanters, and
terminates in the condyles.   It is slightly bent, so as to present
the convexity of the curve forwards.  Its size is gradually di-
minished to the middle; it then begins to enlarge, and continues
to augment till it terminates in the large inferior extremity.
The body is very nearly round, and departs  from that figure
only on its posterior  face,  where  an elevated  rough ridge is
found, occupying the superior two-thirds of the bone, and called
the linea aspera.  The linea  aspera begins broad, rough, and
flat, on a level with the  trochanter minor; it  narrows as it de-
scends, and becomes, at the same time, more  elevated.   Its
lower extremity bifurcates into  two superficial, slightly marked
ridges, one on each side, which may be  traced into the poste-
rior  extremity of its  corresponding condyle.  Between these
ridges the surface of the bone is flattened.  In the whole course
of the linea aspera, an internal  and an external margin is very
obvious.  The superior half of the latter is occupied by the in-
sertion of the gluteus  magnus, and the remainder by the origin
of the biceps flexor cruris.   This margin also gives origin to
the vastus externus.  The internal margin of the linea aspera
is mostly occupied by the insertion of the triceps adductor, and
by the origin of the vastus internus.
  In the linea aspera, near the middle of the bone, is the canal
for the nutritious artery, which slants upwards: occasionally
one or more canals, besides,  are found in it for the same  pur-
pose.
  The texture of the os femoris is compact  in  its body.   Its
extremities are  cellular, with the exception  of a thin lamina
forming their periphery: the cylindrical cavity in its middle,
like that in all the other  long bones, is reticulated.  The  ossa
femorum approach each other very closely at their inferior ex-
tremities, but are widely separated at their superior, in conse-
quence of the length of their  necks, and of the distance of the
acetabula  from one another. 
THE LEG.
217
                   SECT. II.—OF THE LEG.

  Two bones form  the  leg, the tibia and the  fibula, to which
may be added the patella, from its attachment to the tibia.
                    Of the Tibia, (Tibia.)

   The tibia is placed at the internal side of the leg, and extends
 from the thigh to the foot.  After the os femoris, it is the lono--
 est and the largest bone in the skeleton.   It is divided into the
 body and the two extremities.

   The superior extremity of the tibia is  oval, transversely, and
 presents an extent of surface suited to the articular face of the
 two condyles of the os femoris, to which it is joined.  It has
 here two superficial cavities for receiving the ends of the con-
 dyles;  one of them is internal and the other external.  The in-
 ternal is the deeper and more extensive  of the two, and, beino-
 oval, has its  long diameter in an  antero-posterior  direction.
 The external, besides being smaller and more  superficial, is
 more circular;  and, from the  want of elevation in its margins,
 scarcely presents at all the appearance of a cavity.  These
 two cavities, which approach  to within  half an  inch of each
 other,  are kept entirely separated by an elevated  triangular
 ridge, with a broad base,  called the spinous process of the tibia.
 The summit of the ridge presents  two tubercles, one at each
 end, separated by a pit, which serves to attach  the  posterior
 end of  the external semi-lunar  cartilage.   The ridge  is  placed
 nearer  the posterior than  the anterior margin of the tibia., Its
 base, in front, is depressed  by  the attachment of the anterior
 crucial ligament, and  just before this is  a rough, triangular
 space,  extending to the anterior margin  of the bone, and co-
 vered by fat in the  recent  subject.  Between the ridge and
 the posterior margin of the bone is a deep depression for the
 attachment of the posterior crucial ligament.

  The circumference of the superior part of the tibia, just be-
low its articular surface, is flat before, somewhat flat and con-
  Vol. I.—19 
218
SKELETON.
cave behind, and bulging at the sides.  The flatness, in front, is
triangular, having its base upwards and the apex downwards,
the latter terminates in a well  marked, broad, rough rising,
which is the tubercle of the  tibia, and serves for the insertion
of the tendon of the patella.  The concavity behind is made
by the popliteus muscle, and  slopes from  above obliquely  in-
wards and downwards.  The projection is great on the inter-
nal side of the upper extremity of the tibia, and at its  posterior
part has a depression made by the  insertion of the semi-mem-
branosus tendon.   The external projection is thicker in front
than behind; at the latter point it has a small  articular face,
looking downwards, for the head  of the fibula.

  The inferior extremity, of the tibia is much  smaller than the
superior.   It is terminated by a transverse quadrilateral cylin-
drical concavity, by which  it articulates with the astragalus.
This concavity is narrower and deeper internally than  external-
ly, and is traversed from before backwards by a low broad ridge.
It is bounded internally by the internal malleolus, a large pro-
cess of half an inch in length, the external side of which is a con-
tinuous \surface with the cylindrical  concavity, and forms part
of the joint.  The other side of the malleolus is superficial, being
just beneath the skin.  A shallow groove exists in its  posterior
part, which transmits the tendons of the tibialis posticus and of
the flexor longus digitorum pedis.  Inferiorly, the malleolus is
notched, or presents a depression, for the origin of the internal
lateral ligament, and just before  the depression it is elongated
into a point.  The lower end of the tibia presents, before and
behind, a slight swell, running transversely just above the arti-
cular  surface.   The posterior  swell is occasionally slightly
marked by the tendon of the flexor longus pollicis pedis.

  Externally, the  circumference  of the lower end of the tibia
presents, longitudinally, a concavity which is in contact with
the lower end of the fibula.   This concavity terminates insen-
sibly  above, but is deep below, where it is  bounded before and
behind by an elevated point of bone, of which the posterior is
the highest.  The concavity is placed nearly in the vertical line
of the little articular face for the fibula, on the  head of the tibia;
and at its lower margin, there is frequently a small lunated sur- 
THE LEG.
219
face, which is continuous with the articular surface for the as-
tragalus, and  is consequently  a part of the cavity of the ankle
joint.  Just above this lunated surface the bone is rough for the
origin of short ligamentous fibres, which unite it to the fibula.

   The body of the tibia commences just below the enlarged up-
per extremity, and terminates near the ankle.   In the front view
of it, it diminishes continually in descending, in its superior two-
thirds: afterwards it enlarges gradually to the lower extremity;
in the lateral view it diminishes downwards almost to the lower
extremity.  It is slightly bent forwards, and is generally prisma-
tic, more particularly above: one of its faces is internal, another
external, and the third posterior.  The internal face is rounded,
and, with the exception of its  upper part, where the flexor ten-
dons are inserted, it is only covered by the skin.  Its external
face is flat, excepting below, where it is rounded and is covered
by the muscles on the front of the leg.   The posterior face is
slightly rounded, except at its upper part where it is  crossed by
a line running obliquely from the articular surface for the fibula,
downwards and inwards: above which line, is  the superficial
triangular  depression for the popliteus muscle.

   The three sides of the tibia are marked off from  each other
by ridges of bone.  The anterior ridge, called the spine or crest,
begins at the external margin  of the tubercle for the insertion
of the tendon of the patella, and may be traced very distinctly,
in the form of an S very slightly curved, almost to the malleo-
lus internus: it is more elevated  in its  middle.   The external
ridge is a straight line running from one extremity of the bone
to the other; to it is attached one edge of the interosseous liga-
ment.  The internal ridge is rounded, but also runs the whole
length of the body of the bone, being more distinct below.  The
internal lateral ligament of the knee and the soleus  muscle are
attached to it, above; and below, the flexor longus  digitorum
pedis.
   Foramina  large  and  small, for blood vessels and  fibres, are
found on the circumference of  both extremities of the tibia.  On
its posterior face, about one-fourth of its length from the head,
is a  large canal sloping downwards, through which  passes the
nutritious artery.  Its structure, like that of the other long bones, 
220
SKELETON.
is cellular at its extremities; but compact in the body, where it
presents a cavity occupied by cancellated matter.  It will now
be understood how it articulates with the fibula, externally, at
both ends; with the os femoris above; and with the astragalus
below.

                   Of the Fibula, (PtronL)

  The fibula is placed at the external side of the  tibia, and ex-
tends from the head of the latter to the foot: it is much smaller,
and not quite so long as the  tibia, and is so articulated with it
as to  be on  a line with its posterior face.  It is to be studied in
its two extremities and in its body.

  The upper extremity of the  fibula  is considerably enlarged
and irregular.   It presents, above, a small articular  face  di-
rected upwards and very slightly concave, by which it joins the
corresponding face of the tibia.  This  surface is bounded be-
hind by a sort of styloid process, into which is inserted the ten-
don of the biceps flexor cruris.   The circumference of the bone,
in advance  of this, furnishes attachment to the external lateral
ligament of the knee.

  The inferior extremity of the fibula  is  also enlarged, being
flattened on its tibial  side, but more rounded externally.   This
part of the fibula is called the malleolus externus.  It descends
lower than  the internal ankle„ and is  also more prominent and
large.  Its tibial side presents, below,  a small triangular slightly
convex articulating surface,  which reposes against the  side of
the astragalus; behind, and somewhat below it, is a small rough
depression, which, with the adjoining inferior margin of the bone,
gives origin to the three fasciculi of the external lateral ligament
of the ankle.  Above the articular surface, the bone is rough
and slightly rounded  where it  is received into the side of the
tibia,  and  sends off many short ligamentous fibres to it.  The
anterior margin of this extremity of the fibula is thin and pro-
jecting, the  posterior surface is flat  and broad, and  is slightly
scooped out into a longitudinal groove, which transmits the
tendons of  two peronei muscles.  The  pointed  termination
below, of the malleolus externus, is sometimes called the coro-
noid process. 
THE LEG.
221
  The body of the fibula extends rjetween its extremities.   It is
irregularly triangular, somewhat  smaller  above than below,
thick posteriorly,  thin anteriorly, and slightly convex in its
length behind.

  There are three faces  to the fibula, one is  external, another
internal, and the third posterior.   The first is semi-spiral, and
turned forwards above; its superior third gives origin to the pe-
roneus longus muscle, and the middle third to the peroneus se-
cundus: its lower third  exhibits the semi-spiral arrangement
which may be traced into the groove on the posterior part of the
malleolus externus, and thereby indicates the course of the ten-
dons of these peronei muscles.   The internal face is directed to-
wards the tibia; it is divided by a low longitudinal ridge into
two parts, of which the anterior is the more narrow.  The ridge
itself, well marked in the middle two-fourths of the bone, is in-
distinct above and  below; and furnishes attachment to the inter-
osseous ligament.  The space in front gives origin to the exten-
sor proprius pollicis, and the extensor communis digitorum: and
the space behind gives origin to the tibialis posticus.  The pos-
terior face is also  somewhat semi-spiral, its superior end  being
outwards, and the inferior end inwards. The superior third gives
origin to the soleus muscle, and the remainder to the flexor lon-
gus pollicis pedis.

  The angles of the fibula which are formed  by the junction of
the three surfaces described, differ somewhat among themselves.
The anterior angle is frequently very sharp and elevated in its
middle half, and below it bifurcates into  two ridges, including
between them a triangular space, which is only covered by the
integuments.  The posterior angle is well  marked, and winds
so as to be external above, and posterior near the foot.   The
internal angle, formed by the union of the internal and the pos-
terior surfaces, is  only very well marked  in its middle  half.
The projection of  this angle gives to  the bone  the appearance
of inclining inwards  towards the tibia, besides which it has ac-
tually a little bend in that direction.

  Near the middle of the posterior face of  the fibula,  a canal,
sloping downwards, conducts the nutritious artery. The circurn-
                            19- 
222
SKELETON.
ference of the extremities, like that of the other long bones, pre-
sents a multitude of foramina for vessels and the filaments of
fibres to pass.  It  is composed in its extremities of cellular or
spongy structure, and in its body of compact matter, enclosing
a cavity occupied by cancellated structure.


                  Of the Patella (Rotule.)

  The patella is a small bone, intermediate  to the thigh and to
the leg, and  placed  on the fore part  of the knee  joint; it is
smaller in proportion in females than in males.
  Its anterior face is uniformly convex and rough, and is studded
with a considerable number of foramina for the passage of ves-
sels, and for  the attachment of fibres.   The  course of the longi-
tudinal fibres composing the front of the bone, is also well marked.
The posterior face of the patella is an extensive articular sur-
face, divided unequally by a broad longitudinal elevation, which
runs from the superior to the inferior margin of the bone.  The
part of this surface external to the ridge, is  the largest and the
most concave,  and is applied to the trochlea, in front of the ex-
ternal  condyle  of the os  femoris ; while  the smaller surface is
on the internal  side of the ridge, and is applied to the trochlea
of the internal  condyle.

   The circumference of the patella is  nearly oval,  the long di-
ameter being transverse.  Its thickness is  much  augmented
above, where it presents a rough, and somewhat unequal flatness
for the insertion of the tendon of the  rectus femoris.   Below,
the bone is thinner, and elongated into a conical  point, from
which proceeds the  tendon of the patella to  be inserted into the
tibia.  Laterally, the margins are  thinner still.

   The texture  of the patella is cellular, covered by a lamina of
condensed bony matter.  It is  developed in the tendon of the
extensors of the thigh, and with the exception of its posterior
face remains in a state almost entirely cartilaginous, for a year
or two after birth.  Its base is, therefore, fibrous, in which is
deposited, subsequently, the calcareous matter.  In its fracture
 union  is effected  more  frequently by  the  fibrous  base alone,
 than by perfect ossification.  In order  to put it into its proper 
THE FOOT.
223
position, turn the point downwards, and apply the greater sur-
face behind, to the trochlea of the external condyle.  The pa-
tella is said  to  be  to  the  tibia, what the olecranon is  to the
ulna; and is, therefore, a  sort of appendage to it, united by
ligament instead of being continuous with it, as is the case with
the olecranon.


                   SECT, HI.--OF THE FOOT.

   The foot forms the third section of the inferior extremity, and
is placed at a right angle to the bones of the leg.  The size of
its bones varies much  in different individuals, depending much
upon their modes of life, and dress: it  also varies much in the
two sexes,  being, for the most part,  smaller in  the female.
The foot is oblong, narrower behind than before; presents one
surface above,  which is its back, and  another below, which
is the  sole;  a posterior extremity  called the heel, and ap ante-
rior extremity called the point; also its internal margin is much
thicker, longer and more concave, than the external margin.

   The foot  is divided into Tarsus, Metatarsus, and Toes  or
 Phalanges.

                   Of the Tarsus, (Tarse.)

   The tarsus forms the posterior half of the foot, and is com-
 posed of seven distinct bones, which  are arranged on  a plan,
 and'present features having scarcely a single point of resem-
 blance with the carpus.   These bones are, the Os Calcis, the
 Astragalus, the Naviculare, the Cuboides, the Cuneiforme Ex-
 ternum, Cuneiforme Medium, and Cuneiforme Internum.


                Of the Os  Calcis, (Calcaneum.)

    The calcaneum, or heel bone, forms, almost exclusively, the
 posterior half  of the  tarsus, and  may be readily distinguished
 by its greater magnitude.  Its  shape is  very irregular.  Its
 greatest diameter is in the length  of the foot; it is also thicker
 vertically than transversely. 
224
SKELETON.
    The superior face is deeply scooped out, at its fore part, and
  is formed there into two articular surfaces, for joining with the
  astragalus: these faces are separated from each other by a rough
  fossa, which runs from within obliquely forwards and outwards.
  The anterior external part of this fossa is deep, broad, and tri-
  angular; the posterior part is narrow, is occupied by a ligament,
  and allows the two articular surfaces to come nearer.  Just
  behind the fossa is the first articulating  surface, lying parallel
  with  it; being oblong, convex, semi-cylindrical, and  looking
  obliquely upwards and forwards.   Before the fossa is the se-
  cond surface: it is oblong, much smaller than the first, and is
  very frequently divided into two by a transverse notch, and is
»  concave.  The part of the bone upon which this face is wrought,
  is called, by the French, the little apophysis.   I have frequent-
  ly remarked, that the face posterior to the first mentioned fossa
  is smaller and more vertical in the African than in the Eu-
  ropean;  the  os  calcis, behind it, is also smaller  and longer.
  The upper posterior face of the bone is somewhat concave.

    The under surface of the os calcis is slightly concave, longi-
  tudinally.  It is  bounded, behind, by two tuberosities, of which
  the internal is larger than  the external;  they both give origin
  to  muscles of the  sole of  the  foot  and to the  aponeurosis
  plantaris.  There is also a tuberosity bounding the same sur-
  face in front, from which arise the ligaments  that connect this
  bone with the adjoining ones.

    The anterior  extremity of the  os calcis forms the greater
  apophysis, and is terminated in front by a triangular and slight-
  ly concave surface, by which  it articulates with  the  os cu-
  boides.  The posterior extremity is convex  and rough:  con-
  stitutes the heel, and near its middle receives the tendo-achillis;
  the upper part is sloping and more smooth, in order to accom-
  modate this tendon in the flexions  of the foot.

    The external surface of the os calcis is flat, with the excep-
  tion of a gentle rising in its middle; it is  marked, occasionally,
  by  a  superficial groove, indicating the course of the peronei
  muscles.  The internal surface is very conpave, and obtains the
  name of sinuosity; along it pass the tendons of several muscles 
THE FOOT.
225
from the back of the leg, of which that of the flexor longus pol-
licis pedis makes a conspicuous groove on the under surface of
the little aphophysis.


               Of the Astragalus, (VAslragale.)

   This is the next in size to the os calcis, and is placed on the
superior part of the latter, between it and the bones of the leg.

   The astragalus presents, above, a semi-cylindrical surface,
by which it is put in contact with the tibia.  This surface is
narrower, and continued farther  behind  than .it is before; is
slightly depressed, longitudinally,  in its  middle,  and, conse-
quently, presents an elevated margin on either side, of which
the external  is the broadest and highest.  This articular face
continues on each side  of the bone, and is more extensive ex-
ternally, where it comes in contact with the fibula or malleolus
externus, than internally, where it touches the malleolus in-
ternus.

   The inferior face of the astragalus is traversed by an oblique
 rough  fossa, going  from within outwards and forwards, and
 corresponding in size with that on the upper face of the os cal-
 cis.  Behind the fossa, and parallel to it, is a  deep oblique se-
 mi-cylindrical concavity, suited to the adjoining face of the os
 calcis; and  before  the  fossa is a narrow oblong convexity,
 suited to the corresponding  articular  concavity of  the  same
 bone.   When the latter is divided into two facets, the concavi-
 ty of  the astragalus presents  also  two facets, separated  by  a
 small  ridge.

   The anterior extremity of this  bone is terminated  by a con-
 vex head, the horizontal diameter of which is the greatest.
 This head articulates with the  scaphoides, and is continuous
 with the surface that rests upon the little  apophysis  of the os
 calcis.  On the internal side of the head is a  small triangular
 surface, continuous with the others, that rests upon a  strong
 ligament going from the os calcis  to the scaphoides.  Above,
 immediately before the surface  for the tibia, is a small depres-
 sion, which, in the flexions of the foot, receives the anterior 
226
SKELETON.
margin of the articular surface of that bone.  The posterior
extremity of the astragalus is thin, and has a notch, or groove,
formed in it by the tendon of the flexor longus pollicis.


         Of the Naviculare, or Scaphoides, (Scaphoide.)

  It is situated at the internal side of the tarsus, between the
astragalus and the cuneiform bones, and has its  greatest dia-
meter  transverse.   Its  circumference is  oval, thicker  above
than below, and at its internal side presents a large tuberosity;
into which is inserted the tendon of the tibialis posticus.   Some-
times the external margin has a small articular face, where it
comes in contact with the cuboides.

  The scaphoides presents, behind,  a deep concavity,  which
receives  the head of the astragalus;  anteriorly, it is somewhat
convex, but this surface is  divided by small ridges into three
triangular faces, for the three cuneiform bones.  Of these faces
the internal is  broader below than above; the others are broader
above  than below.


                Of the Cuboides, (Cuboide.)

  It is situated at the external side of the tarsus, between the
os calcis and the metatarsal bones.  Its figure is irregular; but,
perhaps,  sufficiently indicated  by its name.  It  is  narrower
externally  than internally, and has  the  posterior extremity
oblique.

  The superior face  of the  cuboides is  rounded, but  rough.
The inferior face has in its middle a broad elevated ridge run-
ning almost transversely, but somewhat forwards.   The exter-
nal  extremity of this ridge  is marked by a trochlea, on  which
plays the tendon of the peroneus longus; the tendon is then con-
ducted along a groove between the ridge and the anterior mar-
gin of the bone.

  The internal face is flat, and has in its middle  a circular
facet where it comes in contact with the cuneiforme externum. 
THE FOOT.
227
The posterior face joins the os calcis, is triangular, and semi-
spiral.   The anterior face is oblong, transversely, and is  di-
vided by a slight vertical rising into two', for articulating with
the last two metatarsal bones.

      Of the Cuneiforme Internum, (Premier Cuneiforme.)

  It is placed at the internal  anterior extremity of the tarsus,
between the scaphoides and the first metatarsal bone, and may
be distinguished from the other cuneiforms  by its greater size.
Its  thickest part is below.

  The anterior face presents a long vertical convexity, which
joins the first metatarsal bone.  The posterior  face is not so
extensive, and is formed into a  triangular concavity, having
the broadest part below, which joins the internal facet of the
scaphoides. The internal side is semi-cylindrical and rough;
it is marked, anteriorly, near its  middle, by the  tendon of the
tibialis anticus.  The external side is somewhat concave, and
generally rough, and is marked just below  its superior margin
by two articular  facets, of which the anterior is the smaller,
and comes in contact with the  second metatarsal bone; the
posterior, from its concave obliquity, gives a slope to the upper
margin of the bone,  and is in contact with the cuneiforme me-
dium.

       Of the Cuneiforme Medium, (Second  Cuneiforme.)

  The middle or second cuneiform bone is  placed upon the
scaphoides, immediately on  the outside of the cuneiforme in-
ternum.  It may be distinguished  by being the smallest bone of
the tarsus.  Its figure resembles sufficiently well a wedge; the
base of which is above, and the edge below.

  Its posterior face is slightly concave where it joins the sca-
phoides; the anterior face is slightly convex, and  articulates
with the second metatarsal bone.   The internal  face presents,
superiorly, an oblong, slightly convex, and  oblique articular
facet, which touches the cuneiforme internum: what  remains
of this side is rough, for the origin of ligamentous fibres.  The 
228
SKELETON.
external face is somewhat concave, and presents, at  its poste-
rior part, a vertical articular face  for joining the cuneiforme
externum; but anteriorly, it is rough for the origin of ligamen-
tous fibres.
  In the articulated foot the lower part of this bone is almost
concealed between the other two cuneiforms.

    Of the Cuneiforme Externum, (Troisieme  Cuneiforme.)

  The external or third cuneiform bone is placed upon the sca-
phoides, between the second cuneiform and the cuboides.  Of
the three bones it is the second in size, and is  also appropriate-
ly named from its shape.  The base is upwards.

  The posterior face furnishes, on its superior half to join the
scaphoides, a quadrangular articular facet, sloping outwardly,
below which the bone  projects into the sole of the foot.  The
anterior face is flat, and  articulates with the  third metatarsal
bone.  The internal face presents,  above, two articular facets,
of which the one at the posterior corner is larger than the other,
and joins the second cuneiform; the other, at  the  anterior cor-
ner,  is very small,  and touches  the second  metatarsal bone.
Below these facets the bone is rough, and gives origin to liga-
mentous matter.  The external face, at the middle of the base,
forms an angular projection, behind which is  a small oval arti-
cular surface that joins the cuboides.  The remainder of this
face is rough, for the origin of the ligaments, with the excep-
tion of a very small articular facet at the anterior  superior cor-
ner, which joins the fourth metatarsal bone.
  The structure of the bones of the Tarsus is uniformly cellu-
lar  within, the cells being enclosed by a thin lamina of con-
densed matter.   The astragalus is rather stronger and more
compact than any of the  others.  I  have  seen  one instance,
however, in which it had  been separated into two pieces by a
transverse vertical fracture, going from the ankle  joint to the
articulation with  the os calcis.  The observation was made
after it had been boiled: the  callus had completely united the
two fragments, and no displacement had occurred. 
THE TOOT.
229
  If a vertical section of the os calcis and of the astragalus be
made, the parietes of these cells are found to radiate from the
upper articular surfaces  like  columns,  so as to .prevent the
tones from being crushed by the vertical weight of the body.

                Of the, Metatarsus, (Metatarse.)

  The metatarsus succeeds to  the tarsus, and is formed by five
long  parallel  bones.  They are called numerically, beginning
on the inner side, or that of the great toe.  There are four in-
tervals between them, which are filled up by the interosseous
muscles.

                Of the First Metatarsal Bone.

  Placed at the inner side of the foot upon the cuneiforme in-
ternum, and forming the base of the great toe, it may be readi-
ly distinguished in the separated bones by its greater size and
shortness.

  The posterior extremity presents an oblong articular conca-
vity, the greatest length of which is vertical, for joining the cu-
neiforme internum.  The internal  semi-circumference of this
extremity is convex, while the  external is slightly concave or
flat;  below, it presents a prominent tubercle,  into which  is in-
serted the tendon of the peroneus longus.

  The anterior  extremity, also called  the head, is roundod and
convex, forming an articular surface for the first phalanx of the
great toe.  This surface is continued far back below, and pre-
sents there, for the sesamoid bones, a  trochlea  with  a longitu-
dinal ridge in its middle.   The lateral surfaces of the head are
rough and concave, for the origin of the lateral ligaments.

  The body is much smaller than the extremities, and is  pris-
matic.  Its internal side is rounded, the external side flattened,
and  the  inferior side  concave, longitudinally, for lodging the
muscles of the great toe.
Vol. I.—20 
230
SKELETON.
               Of the Second Metatarsal Bone.

  This is the longest of any, and may be distinguished from the
others principally by that circumstance.

  The posterior extremity is triangular, the broadest part being
above.  It presents  a surface very slightly concave, almost flat,
which rests upon the cuneiforme medium.   The  sides of this
extremity being flattened, laterally, it is locked  in between the
internal  and external cuneiforms; on its internal side, above, is
an articular facet, where it comes in contact with  the cunei-
forme internum, and, externally, it has two articular facets.  The
posterior one of the latter  touches  the  cuneiforme  externum,
and the  anterior, which is  smaller, comes in contact with the
third metatarsal bone.  These two facets run into each other
by an angular rising.

  The anterior extremity is convex and rounded; its vertical
diameter is more considerable than its transverse, and the  arti-
cular face which it furnishes to the second toe is continued  con-
siderably below, in order to assist the flexion of the first phalanx.
Its circumference is rough and flattened laterally, for the origin
of the capsular ligament.

  The body is  smaller than either of the extremities, and de-
creases  gradually from behind forwards.  It is flattened on each
side, and elevated longitudinally above and below, into a ridge.
There is a curvature in its length, which makes it convex above,
and concave below, for the lodgement of muscles.


               Of the Third Metatarsal Bone.

  This  is rather  shorter than  the second, but  has very much
the same shape.

  Its posterior extremity, or base, is triangular, has the broad-
est part above, and  articulates with the third cuneiform; the
surface  for the latter, slopes outwardly.  Its circumference  is
flattened laterally, and presents, internally, at its superior cor- 
THE FOOT.
231
ner, a  small face, which articulates with the second metatar-
sal ; externally, it also presents, at its  superior corner, an arti-
cular facet, which joins the fourth metatarsal.

   Its body and anterior extremity, do not present any essen-
tial points of difference from the second metatarsal.


                Of the Fourth Metatarsal Bone.

   It is somewhat shorter than the third, and is placed upon the
internal of the  two anterior faces of the cuboides.

   The posterior extremity, or base, is more quadrangular than
the base of the preceding bones.  It presents an articular face
to the cuboides, which is also square or nearly so, flat, and slopes
outwardly.  On its sides it is irregular; internally, at the superior
margin, it has two articular facets, continuous with each other,
but forming thereby an obtuse angle; the anterior joins the third
metatarsal; and the posterior, which is much the smaller, touches
the cuneiforme externum.   Below these, the surface is rough.
The articulation with the cuneiforme externum is occasionally
deficient.  I have observed the latter, particularly in the negro,
and it seems  to arise from the unusual development of  the cu-
boides.  The  external  surface of the  base has  at its superior
corner an articular facet for the  fifth metatarsal bone, and be-
low it an oblique deep fossa, before which is a tubercle.

   The anterior extremity  and the  body of this  bone,  though
smaller than those of the preceding, do not present any essen-
tial points of difference.


                Of the Fifth Metatarsal Bone.

   This is shorter than any of the others, excepting the first, and
is placed on the front of the cuboides,  externally.

   Its base is remarkable, and distinguishes it strongly, by being
projected considerably beyond the external margin of  the cu-
boides, and forming there a  large tubercle, into the superior part 
232                     SKELETON.
of which is inserted the tendon of the peroneus tertius, and into-
the posterior part, the tendon of the peroneus secundus.  The
base, also, has a triangular  flat  surface, sloping considerably
outwards, which articulates  with the cuboides.   On the inter-
nal side is the articular facet, whereby it joins the base of the
fourth  metatarsal bone.  The base is flattened below, rough,
and somewhat convex above.

  The anterior extremity is more rounded than that of the other
metatarsal bones, but in other respects similar.  The body is
prismatic; being flat below, flat internally, and slightly rounded
sxternally.

                        Of the Toes.

   The toes are five in number, and named numerically, by be-
ginning at the great one.  They each are formed by three bones
called the phalanges, with the exception of the great toe, which
has but two of them. The phalanges are distinguished into first,
second, and third.  In these several respects the toes correspond
with the fingers.

                 Of the First, or Great Toe.
   The first phalanx of the great toe is longer and much larger
than any other.  Its base is large, and forms a deep concavity
for receiving the end of tke metatarsal bone.  Its anterior ex-
tremity is formed into two small condyles, for being received
into the second phalanx.  This bone is broad and strong, being
semicylindrical above, and fiat below.

   The second phalanx corresponds in its appearance with the
third of the other toes, but is much larger than any of them. Its
base is broad  and flat, and has two superficial  cavities for the
condyles of the first phalanx.   The anterior extremity is ex-
panded semicircularly, and converted into a very scabrous sur-
face, for the firmer  attachment of the soft parts about it.  The
body  of this  phalanx is constricted  in  the  middle,  rounded
above, and flat below.

   Connected with the great toe, are two small  hemispherical
bones, lying upon the trochlea of its metatarsal bone, and im* 
THE'FOOT.
233
 bedded in the tendons of the small muscles which move the first
 phalanx.  They are the sesamoids, and present, superiorly, an
 articular  surface, covered with cartilage, which enters into the
 composition of the joint; and below, a rounded surface, which
 has nothing remarkable.

   The sesamoid bones, though generally appropriated solely to
 this joint, are yet frequently found elsewhere. For example, in the
 second joint of the same toe—in the first joint of the other toes
 —in the articulation of the first phalanx of the thumb, with its
 metacarpal bone—in the first joint of the fingers—in the knee
 joint, behind each condyle—and, in advanced life, in tendons
 where they slide upon bones.   Ancient luxations  give a dispo-
 sition to their  development in the capsular ligaments of the gin-
 glymous joints, of which a very interesting specimen  may be
 seen in the Anatomical  Museum, occasioned by an external la-
 teral dislocation of the elbow.


                     Of the Smaller Toes.

   Their phalanges bear a general resemblance with those of the
 fingers, but  are neither  so large nor so long.

   The first phalanges are successively diminished to that of the
 little toe,  and  are almost precisely like each other.  Their pos-
 terior extremities,  or bases, form  a cavity deeper in proportion
 than in  the  fingers, for receiving the  ends of the metatarsal
 bones.  The anterior extremities  are fashioned into two small
 condyles forforming a hinge-like joint with the second phalanges.
 The bodies are smaller  than the extremities, more rounded and
 narrower than in the fingers.

   The second phalanges are very short, the extremities being
so near each other that the body is of inconsiderable length, par-
ticularly as regards the last two, where it forms a mere line of
separation.  The posterior end has two superficial cavities for
receiving  the first phalanx; the anterior end is imperfectlv fa-
shioned into two little condyles for joining  the  third phalanx.

  The third phalanges have a well-formed articular surface for
                           20* 
234
SKELETON.
joining the second.  The anterior extremity is rough, for the at-
tachment of the adjoining soft structure.  This phalanx of the,
fourth and fifth toe is frequently very imperfectly developed, be-
ing a mere tubercle with an articular face at one end.

   The structure of the metatarsal  and phalangial bones resem-
bles that of other  long  bones.   Porous and cellular at the ex-
tremities, their bodies are composed of compact lamellated mat-
ter, enclosing a cancellated texture.
 SECT. IV.—OF THE DEVELOPMENT OF THE INFERIOR EXTREMITIES.

  The comparatively small quantity of blood which is sent to the
lower extremities of the fcetus, is the cause of their not being so
large in proportion to the upper, at the time of birth, as they are
subsequently. • Our wants immediately  after  birth, and  during
the first months of life, are naturally such as to require but little
service from the  lower extremities, in which is seen a striking
correspondence between the internal arrangements of the animal
economy and its actual necessities; or, in  other words, a conti-
nued and rigid adaptation of means to produce a certain effect.

  The os femoris  at birth presents several peculiarities.  The su-
perior extremity being in a cartilaginous  state, is placed more at
a right angle to the body of the bone than it is in the  adult.   The
neck is short, which by diminishing the base  of support to the
trunk, makes the progression of infants more tottering and infirm.
The lower extremity is also cartilaginous and large. The body
of the bone has but a very slight degree of curvature, which like-
wise increases the difficulty of standing and walking in  very
young subjects.   The patella is cartilaginous.
  In the leg the bodies of the tibia and fibula are  ossified, but
their extremities  are cartilaginous.   The bones of the  tarsus,
with the exception of parts  of the os calcis and of the astragalus
are cartilaginous.  The metatarsus and the phalanges are ossi-
fied in their middle, but cartilaginous  at their extremities: their
development is not so  complete as that of the corresponding
bones of the hand. 
           MECHANISM OF THE INFERIOR EXTREMITIES.        235

  About the fifteenth year, the bones of the lower extremities
have very nearly the same forms as in the adult: they are all fully
ossified, with the exception of their  extremities not being fused
or joined to their bodies; but still in the state of epiphyses, and,
therefore, separable either by boiling or long-continued macera-
tion.  Exclusively of this condition, which sometimes remains to
the twentieth or twenty-fifth year, the epiphyses are as fully os-
sified as at any subsequent period of life.  •
 SECT. V.—ON THE MECHANISM OF THE INFERIOR EXTREMITIES IN
                    REGARD TO STANDING.

  The os femoris is well adapted by its shape and position to
the  erect attitude.   The curvature which its body  makes in
front has the effect of advancing the lower part of it, and there-
by keeping it in a line with the centre of the trunk; but if it had
been perfectly straight, the erect position would have been main-
tained with  great difficulty, owing to the centre of  the trunk
being in advance of this bone.   Under the latter circumstances,
an incessant tendency to fall forwards would have manifested
itself, which could have been obviated only by flexing the ossa
femorum very much at the hip joint, or by keeping one foot al-
ways in front of the other.  Even under the actual arrangement
)f the skeleton, when muscular support is withdrawn from it sud-
denly, it falls forwards, owing to the weight of the parts anterior
to the spine being greater than  that  of the parts posterior to it.
When muscular action is weakened or badly regulated, the same
tendency to fall forwards  is manifested: children continually
tumble in that  direction: a person  in  a state of intoxication,
somewnat short of the entire loss of locomotion,  not being able
•■) sustain the trunk of  the body erect by the muscles of the
back, inclines forwards, and would be precipitated to the ground,
were it not that at this crisis one leg is involuntarily advanced,
so that the base of support is much  augmented.   But if the in-
dividual attempt to walk, the continued necessity of keeping a
large basis of support to prevent the body from falling forwards,
urges him into a slow running or trotting gait.

  The arrangement  of the  whole upper extremity of  the os fe- 
236
SKELETON.
moris is also highly favourable to the erect attitude and to loco-
motion.   The neck of the bone, by its length and oblique posi-
tion in regard to its body, enlarges transversely the base of its
support, and gives great stability in preventing the trunk from
falling either to the right or left; while it contributes at the same
time to the facility of progression, in permitting the os femoris to
bend forwards and backwards. The lateral or transverse extent
of the base, thus obtained, cannot be supplied with equal effect
in any other way, as a certain proportion between the diameters
of the pelvis and the length of the neck of the thigh bone is in-
dispensable.   In females, where the transverse diameter of the
pelvis is greater than in males, though standing is equally secure
as in the latter, yet their progression is always marked by a
want of firmness strongly characteristic of the sex.  The strength
of articular connexion of the os femoris with the innominatum is
confirmed by the acetabulum being placed where the  latter is
re-enforced by the linea ilio pectinea, and  by the anterior infe-
rior spinous process;  and as the principal weight of the trunk is
sustained by the acetabulum, immediately below the latter pro-
cess, we accordingly find it at this point of the greatest depth.
It is also to be stated, that the capsular ligament at this part is
stronger than elsewhere, thereby conforming strictly to the gene-
ral purposes of the articular connexion.   The capsular ligament
is assisted by the ligamentum  teres, which, by arising from the
lower margin of the acetabulum and passing upwards  to the
head of the os femoris, prevents the head from sliding upwards,
while it permits  it to swing freely backwards and forwards in
its socket.

  In erection, the bones of the leg are in a line with the vertical
diameter of the trunk: in this respect they differ very materially
from the os femoris, which not only inclines forwards in its de-
scent, but also leans towards  its  fellow internally, and almost
touches it at the knee.   This  relative position of the  leg and
thigh is obtained by the greater length of the internal condyle of
the os femoris, and also by the other peculiarities of form in the
latter; whereas the tibia is nearly straight in the direction of its
long diameter,  and has a  horizontal articular surface above,
whereby it and the os femoris make an entering angle externally
and a salient one internally.  Under common circumstances, the 
MECHANISM OF THE INFERIOR EXTREMITIES.          237
weight of the trunk is transmitted to the foot exclusively through
the tibia, owing to'the fibula not entering into the composition of
the knee joint, and not being sustained by any bony basement at
its inferior part.  The fibula is principally intended for the origin
of muscles, and for the lateral security of the ankle joint;  and
may be broken without the accident suspending either erection
or locomotion.

  The position and shape of the  foot concur largely in the gene-
ral object of maintaining the human being in the erect attitude.
Fixed at right angles to  the leg, and articulated by a surface in
the centre of its most solid structure, the tarsus, it receives the
weight of the body perpendicularly upon the astragalus.   The
latter  being  the key-stone  to  the arch, diffuses the pressure
through the remainder of the structure, so that the whole foot is
planted against the ground, an attitude more fully executed by
man than  by  any other animal.   The tendency of the body to
fall forwards, requires a very considerable elongation of the foot
in front of the tarsus, in order to increase the  extent of the base
of support in that direction,  We accordingly find the metatarsal
bones not only forming bases for the flexion of the phalanges; but
also by their great length, by the flatness of the articular faces
which they present  to the tarsus, and  by their consequent im-
mobility at these points,  extending and securing the base of the
body in that direction to which its gravitation  most inclines
it.  The first metatarsal bone, though corresponding in place
with the first  metacarpal,  is very unlike it in other respects.
Of predominating magnitude, but parallel with the other bones
and immoveable at its base, it is  obviously intended for sustain-
ing the body, and least of all for prehension and for antago-
nizing the other bones, as is the esse with the thumb.

  The points on which the foot is particularly pressed when we
stand, are the tuberosity  of the os calcis, the tuber of the base
of the last metatarsal bone, with the under surface of the cuboi-
des, and the  anterior  extremity of the  first metatarsal bone.
The arch of the foot, upon which this depends, may be considered
in two ways: one is in the longitudinal direction, and has its abut-
ments in the os calcis behind, and in the  ends of the metatarsal
bones in front,  the other is transverse, is but slightly elevated 
238
SKELETON.
externally, indeed almost flat, while it is raised to a considerable
height internally.   This double arrangement is eminently ser-
viceable in many respects: it permits a concavity in which the
muscles of the toes may repose and act without being pressed
upon by the superincumbent weight of the body—it also  per-
mits a free flow of blood and of nervous energy to this struc-
ture, gives a very elastic base to the whole body, and allows
itself to be applied to such inequalities of surface as it meets
with.

  It has  been agitated, by some ingenious inquirers into the
original condition of man, whether the erect attitude is natural
to him and not the result of an advancement in civilization.
Independently of the proofs derived from the authentic reports
of travellers concerning the varieties of the human family, from
none of whom have we reason to believe that the latter have
any where been found adopting habitually the attitude of quad-
rupeds ; there are evidences derived from the general mechan-
ism of the skeleton, still more conclusive, that standing is fully
natural to us.   For example, 1st, The  position of  the foramen
magnum  occipitis, evidently farther forwards in  man  than in
animals, Indicates that his voluminous head is to be kept in equi-
librium by a vertical line of support near the centre of its base.
2d. The ligamentum nuchas, weak in man, is strong in quadru-
peds.  3d. The curvatures of the spine are so varied as to di-
minish the tendency to fall forward  when we are  erect.  4th.
The direction  of the  orbits of the eyes,  which looking for-
wards, when we stand, and enabling the eye to apply itself to
a vast circumference,  would, in the  quadruped position, be di-
rected towards the ground, and thereby have the sphere of ob-
servation  reduced to a few yards.  5th. The opening of the
nostrils, when  we stand, permits odours to ascend easily into
the nose;  in the other  attitude this opening would be directed
backwards.  Such are the circumstances, in connexion with
the head only,  which indicate the necessity of the biped posi-
tion for the full enjoyment of the functions which the Creator
has given to us.   But  there are, also, others equally evident
in the  mechanism of the extremities,  and of the  parts of the
trunk to which they are attached.  Thus, 1st, The breadth of
the pelvis, and  the  slight obliquity of its superior strait, in re-- 
MECHANISM OF THE INFERIOR EXTREMITIES.         239
gard to the spine, prevents us from falling to one side, and, at
the same time, brings the lower  extremities immediately in a
line with the spine.  2d. The length  of the neck of the os fe-
moris, and the size of its condyles.  3. The articulation of  the
knee, which  permits the leg to be brought into a line with  the
os femoris, a position impracticable in quadrupeds.  4th. The
foot being articulated at a right angle with the leg, and having
its tarsus  and metatarsus so well developed.   5th. The predo-
minance of the transverse diameter of the  thorax over the ver-
tical, which,  with the  great  length of the clavicle, and  the
shape of the scapula, unfit the latter for assisting much in pro-
gression.   6th. The  shape of the hand, calculated to seize upon
objects, but from the length of its phalanges not suited to sus-
tain the body.  7th. The  mode  of articulation at the wrist,
which, from its mobility and weakness in the direction to which
the weight of the  body would be applied to  it, could not  be
brought to support it advantageously.  And,  lastly, the  great
disproportion  of length, in the adult, between the upper and
lower  extremities, when an attempt is  made  to walk  like the
quadruped.

   In  considering the skeleton of the very young child, it is
worthy of remark how closely its mechanism, with the excep-
tion of the head, corresponds with  the  habits  of early life.
A spine, nearly straight, and  a  pelvis, the lateral diameter
of  whose cavity  is so  small  that  the  transVerse  base  of
support is much  diminished,  render erection  inconvenient.
Lower extremities shorter  in  proportion  than the upper ones,
having thigh bones  nearly  straight; also, the articulations
of  the  knee  not  admitting  of a  full  extension  of the leg.
All these circumstances  prove  that the  quadruped position,
inconvenient  and  intolerably irksome  when  continued  for a
length of  time in the adult, is natural  to the young infant.

  The space between the ossa femorum,produced by the breadth
of the pelvis and the length of their necks, and, therefore, always
considerable above, varies below in different individuals. A cer-
tain distance at the latter point seems to be  indispensable to con-
venient and graceful  progression.   Thus, when it is in excess, it
produces the deformity called bandy legs, and causes a totter- 
240
SKELETON.
 ing gait, such as may be mimicked, at  any time, by walking
 with the legs in a state of abduction: but, when diminished, it
 is called knocked knees, and interferes with  the firmness of the
 step by causing the centre of gravity to pass, alternately, through
 the internal condyles of the ossa femorum, instead of falling ex-
 actly between them.

   The firmest position in which we can stand is that in which
 the feet are perfectly straight and parallel with each other, so as
 to form a square base for the support of the trunk.  If from this
 position the toes be turned either inwards or  outwards, the con-
 sequent reduction of the antero-posterior diameter of the base,
 causes less  resistance to the natural inclination of the trunk for-
 wards.  Whatever may be the grace and the ultimate intention
 of the first  position in dancing, to wit, that of having the  feet
 nearly in the same line, with the heels touching and the toes out-
 wards, it is certainly the most unfavourable attitude for ease in
 keeping the body erect that can be adopted; for the base of sup-
 port being diminished, both by the length of the body of the os
 calcis, and  by that of  the foot,  anterior to the ankle joint, the
 trunk is continually inclining either forwards or backwards, and
 is prevented from falling only  by the alternate  action  of the
 muscles behind and in front.

  When we are upon  the  knees, the base of support for  the
 trunk being entirely withdrawn in front, it is necessary, in order
 to maintain the  position, and to prevent falling forwards, that
 the hip joint be flexed so as to throw the weight of the body en-
 tirely behind the thigh bones.   The position is one of so much
 restraint and fatigue upon the muscles, that it can be maintained
 for a long time, only by some artificial support in front, or by
 the buttocks falling down upon the legs, and resting against them.

  The position we assume on  being seated  in a chair, is the
easiest of any of those in which the trunk is kept erect, or nearly
so.   The length of the  lever, represented by the whole length of
the skeleton, is then diminished one-half; consequently, any pre-
ponderance of it at particular points, above, bears with less force
upon the base.  The base itself is much augmented by the ampli-
tude of the buttocks,  and by the horizontal position of the thigh 
MECHANISM OF THE INFERIOR EXTREMITIES.         241
bones in front;  and may be  also increased, at pleasure, by the
extension of the legs.   If, under such circumstances, the trunk
of the body be slightly advanced, its equilibrium is so easily main-
tained as to require but a very little muscular action to continue
it.  The most exposed part of the base is backwards; and, if the
trunk be kept perfectly erect, there is some tendency of it to fall
in that direction.   Hence; the utility of backs to seats, and the
fatigue from such as have not.
  SECT. VI.--ON THE MECHANISM OF THE INFERIOR EXTREMITIES IN
                   REGARD TO LOCOMOTION.


              1. Of the Motions of the Thigh.

   These, like the motions of the os  humeri, upon  the scapula,
 consist in extension, flexion, abduction, adduction, rotation, and
 circumduction; but, in consequence of being performed upon an
 immoveable basis, the acetabulum, they are much less extensive.
 In order that they may be understood well, it will be useful to
 assume certain points of reference in  the os innominatum and
 femoris.  These are  the trochanter major, the pubes, and the
 anterior superior spinous process of the ilium.  In standing, the
 lower external part of the trochanter major, where it forms a
 bulge on the  side of the thigh bone, is on a horizontal line  with
 the upper part of the symphysis pubis.  A triangle, described by
 lines drawn from the anterior superior spinous process  to the
 symphysis pubis—from the latter to the point mentioned of the
 trochanter, and from the latter to  the anterior superior spinous
 process, will  be nearly a rectangle, of which the base is above,
 and the shortest side behind.

   The flexion of the os femoris is that motion in which its lower
 extremity is carried forwards.  It is  performed with great ease
 and freedom, in consequence of the arrangement of the articu-
lar surfaces of the bones, and of the capsular  ligament.   The
head revolves freely in the acetabulum, the ligamentum teres
is put into a slight tension, and the end  of the trochanter major
  Vol. L—21 
242
SKELETON.
approaches the sciatic notch.  The extreme point of this mo-
tion is the one preserved by the os femoris of the fcetus utero.
  Extension is the reverse  of flexion.  When the latter has
been performed, extension restores the thigh bone  to its verti-
cal position, and carries it some degrees farther, but cannot be
executed to the same extent behind, that flexion  is in front.
When pushed to an  extreme, it brings  the trochanter major
under the inferior anterior spinous process of the ilium, and the
round ligament is put very much upon the stretch;  it is, finally,
arrested by the lower part of the neck of the os femoris lodging
against the posterior elevated  margin of the acetabulum, and
by the thickened part of the capsule, in front and above, being
so much distended as not to yield farther without laceration.

   Abduction is the act by which the thigh bones are separated.
When carried to an extreme, the under part of the head of the
os  femoris  leaves the  acetabulum, and  distends very forcibly
the capsular ligament at  this  point.  The superior fasciculus
of the round ligament  is strongly extended;  but  the inferior
fasciculus is kept easy, and, indeed, somewhat relaxed.  This
 motion is arrested by the trochanter major striking against the
 ilium; without which it would be much  more  extensive, as the
 capsular ligament is strained at  its weakest point, and relaxed
 at the strongest.

   Adduction is the reverse of the last.   The  muscles which
 produce it, the adductors, from  their situation and course, are
 unable to give an extent to  this motion much beyond the act of
 reinstating the thigh when  it  has been abducted.   In this re-
spect they are much less  influential than the  great pectoral
muscle  which  adducts the os  humeri.  The  articular sur-
faces of the bones are suited to a much greater latitude of this
movement, but it is arrested both by a deficient power in the
muscles, and  by the strong upper part of the capsular ligament
being put upon the stretch.

   Circumduction is the  regular succession in a  circle of the four
preceding motions, and  is much less extensive  in the os femoris
than in the os humeri, for the  reasons stated.   The centre of
 the circle, or cone, thus described, is the  head  of the bone, and 
           MECHANISM OF THE INFERIOR EXTREMITIES.         243

it is much more extensive anteriorly and externally than pos-
teriorly and internally.

  Rotation, owing to the length of the neck of the os femoris,
is  extremely well marked, and is indicated by the trochanter
major moving backwards  and forwards.   The radius  of the
circle thus described, is the distance between the centre of the
head  of the os femoris and the bulging external part of the tro-
chanter major.  The rotation  outwards or backwards is more
fully  and easily performed than the reverse, owing to the num-
ber and favourable position of the muscles causing it, many of
which are specially appropriated to  its production, and some
others partially so.   This movement is arrested by the neck of
the bone striking against the  acetabulum  behind, and by the
tension of the capsular ligament in front.  Rotation, forwards,
having but few muscles  to produce it, and they neither special-
ly devoted to it, nor  acting very advantageously for the pur-
pose,  is  arrested by the  neck of the  bone striking against the
fore part of the acetabulum, by the tension, behind, of the cap-
sular  ligament,  and  also, by that  of the  ligamentum  teres.
When the convexity and the neck  of the  os femoris look di-
rectly forwards, it is indicated by the great toe pointing in the
same  direction.

                2. Of the Motions of the Leg.

  The movement of the leg upon the thigh is that of flexion,
of extension, and a very partial degree of rotation.

  In flexion, the head of the tibia  slides backwards  upon the
condyles of the os femoris, which are prolonged behind, for the
purpose of extending this motion.  It is checked, when carried
to an  extreme, by the posterior margin of the tibia  striking
against the os femoris, and by the tension  of the ligament of
the patella.  In the mean time, the lateral, the crucial, and the
posterior ligaments are relaxed.  The patella, always station-
ary, and at the same relative distance in regard to the head of
the tibia, slides downwards upon the trochlea of the  os femo-
ris, and in the flexed  position sinks between  the condyles, so as
to come in contact with the ligamentum mucosum. 
244
SKELETON.
    In extension, the patella rises upon the condyles, and becomes
 prominent; the lateral ligaments are rendered somewhat tense,
 and the motion is finally checked, by the resistance of the cru-
 cial and of the posterior ligaments of the articulation.

    The rotation of the bones of the leg can only be performed
 when they are flexed, and the ligaments, generally, thereby re-
 laxed, in  which position  a  very limited  motion, inwards  and
 outwards, is perceptible.  The motion, outwards, is the more
 extensive of the two, in  consequence of the arrangement of the
 crucial ligaments, which are separated from each other by it.
 The motion,  inwards,  is limited  by  these  ligaments  being
 brought immediately by it into close and resisting contact with
 each other.   In either case, however, the posterior and the la-
 teral ligaments all contribute, ultimately, to arrest the motion.

    In all these conditions of the  leg, the semi-lunar cartilages
 slide somewhat upon the head  of the tibia.
    The articulation between the tibia and the fibula is  such as
 to admit of  no motion whatever below; but, above, a limited
 sliding backwards  and forwards is  performed  by the fibula
 upon the tibia. This movement is made  more perceptible in
 eases of extreme emaciation, and in general relaxation of the
 muscular  system.

                3.  Of the Motions of the Foot.

   The general motions of the  foot upon the  bones of the  leg
 are flexion, extension, and an inconsiderable inclination inwards
 and outwards.

   In flexion, the  astragalus rolls backwards  in  the articular
 cavity formed by the tibia and the fibula, and is arrested by the
 anterior upper part  of the astragalus  coming in  contact with
 the articular  margin of the tibia.  The ligamentous fibres and
 the synovial  membrane, in front of the articulation, are re-
 laxed;  those  behind  are in a state of tension, as well  as the
tendo-achillis, and  the other tendons there.   Luxation from  an
excess of this motion is impossible. 
MECHANISM OF THE INFERIOR EXTREMITIES.         245
   In extension, the foot is brought with the point downwards,
so as to have its  upper surface almost on a line with the .bones
of the leg.  The  astragalus glides forwards; the tendons, on the
back of the joint, are very much relaxed.   The joint itself is in
a state  the reverse of the preceding.

   In the lateral motions, the  sole of the foot is caused  to pre-
sent itself either obliquely inwards  or outwards,  whereby it
may be accommodated  to any inclined surface  on which we
walk.   The first position is checked by the internal malleolus,
and the tension of  the external lateral ligaments; the second,
by the external malleolus, and by the tension of the internal
lateral  ligament.   These motions constitute the adduction and
the abduction of the foot; and by a regular succession with its
flexion  and extension, communicate a very limited and embar-
rassed species of circumduction.

   The bones of the tarsus, for the most part, have  a very ob-
scure motion upon each other, with the exception of the  arti-
culation between the astragalus and the  scaphoides, and be-
tween the os  calcis and cuboides.   At these points the move-
ment upwards and  downwards, makes a  sort  of flexion and
extension  of  the fore part of  the foot, which  is very distinct.
A species of twisting, or oblique gliding; is  also slightly percep-
tible there.

   The bones of the metatarsus are susceptible of a slight eleva-
tion and depression, which, almost imperceptible at their bases,
become sufficiently obvious at their anterior extremities.  They
also may be slightly approximated, at their fore  parts, by the
action of muscles, and by external  compression.  When the
weight  of the body is thrown upon  them,  they separate from
each other, and the metatarsus loses, in some degree,  the arched
form of its anterior extremity below.

  The phalanges  of the toes have the same motions  with those
of the fingers, except  that they are more restricted.   The first
ones, therefore, perform flexion, extension, adduction, abduction,
and circumduction; the last two have only flexion and  exten-
sion.  The extension  of the first phalanges is  more extensive
                           21* 
246                     SKELETON.
than their flexion, from whence results an important advantage
in walking or in standing upon the toes.   The shortness of the
second and third phalanges of the small toes, together with the
thickness of the sole of the foot contiguous to them in their ex-
treme flexion, causes them rather to be doubled up on them-
selves, than on the sole of the foot.


      On the General Motions of the Lower Extremities.

  These may be resolved into three; walking, running, and
leaping.

  In walking, though the first step may be taken in a  variety
of relative positions of the lower extremities to each other, yet
it will make the investigation more clear to suppose the indivi-
dual standing erect, with the two feet precisely on the same
plane, and giving equal support to the trunk.  The first step is
then taken, by detaching the foot of one side from the ground;
in order to do which, the thigh is bent upon  the trunk, the leg
upon the thigh, and the limb by being thus elevated becomes
shorter.   At  this period the ankle joint remains at rest, with a
slight inclination of the toes downwards.  By the subsequent
relaxation of the muscles of the limb advanced, with an incli-
nation of the trunk to the same side, the limb is caused to de-
scend upon the ground.  These are the only  motions when the
step is short and easy; but, when a long stride is taken, by which
the limb is put very  much in advance of its fellow, in order to
bring it to the ground, the pelvis is caused to rotate forwards
on the head of the stationary thigh bone, whereby the trunk of
the body, instead of presenting the sternum forwards, has it
turned to one side.
   When a step has been taken so as to leave one inferior extre-
mity advanced before the other, for example the  left,  the limb
behind is brought forward by  the following mechanism :—The
left foot, remaining fixed, becomes  the point of support to the
trunk; and the right, which is behind, is elevated  successively,
from the heel to the toes, by the action of the muscles on the back
of the leg, and  rests  upon the phalanges.   The effect of this po-
sition is to elongate the right inferior extremity to the  amount
of the distance between the fore part of the ankle joint  and the 
MECHANISM OF THE INFERIOR EXTREMITIES.         247
anterior extremity of the metatarsus, whereby that side of the
pelvis is pushed forwards, and a rotation in advance impressed
upon it.  By the latter impulse, the foot of that side is wholly
detached from the ground, the thigh being flexed at the same
moment  at  the hip joint, and the leg flexed at the knee, the
whole extremity is carried forward and fixed upon the ground,
after the manner described in the first step.   Ordinary progres-
sion results, then, from the regular succession of the last mo-
tion in the two extremities.   In regard to the impulsion of the
pelvis  from the  foot  behind, this will probably take place in
every case,  more or less; it  may however, be reduced  very
much by a certain extent of flexion at the knee joint; and the
want of it not be felt, because other powers concur to produce
the same impulsion;  as certain muscles, and  also the momen-
tum of swinging the lower extremity forward.
  An equality of length in the lower extremities is indispensa-
ble to graceful  and regular  progression.   If one of them be
shortened from any cause whatever, it is manifested in the gait,
by  an unusual sinking of the pelvis on the defective side, at the
moment the foot is brought to the ground, and from the conti-
nuity of the pelvis with the upper parts of the body, a conside-
rable lateral inclination  is communicated  to the latter in the
same instant. The  pains frequently taken  to conceal  this de-
fect, disguise it very imperfectly, unless the shortness  be only
such as  may be  supplied by a shoe with a sole  thicker than
that of the other foot. Where the shortness arises  from luxa-
tion upwards of the os femoris, a crutch is the best substitute
for sustaining that side of the pelvis.

   In running, the position of the feet is somewhat different from
what it is  in walking; they are extended so as to support the
trunk on the phalanges alone, instead of on their soles: whereby
a double advantage is obtained, that of keeping the lower extre-
mities at their greatest possible length, and also of enabling them
to detach themselves quickly from the ground.   The velocity
here is the principal difference between it and walking, yet there
are some peculiarities.
   The trunk of the body is kept continually and largely inclined
forwards, which enjoins the necessity of a quick successive ad-
vance of the lower extremities to prevent it from falling.  This 
248                      SKELETON.
position, also, by advancing the bony points, from which arise
several of the muscles used in the extension of the thigh, removes
these muscles more from the line of their contraction, and there-
by enables them to act more advantageously and promptly.  As
each pace on these occasions is taken to the fullest stretch, the
pelvis is rotated forwards from side to side, alternately upon the
head of the os femoris,  which  may be fixed at the time.  The
face being directed forwards, whatever rotation in the vertebras
can occur, is then performed.  As the pelvis communicates its
motions to the trunk, so the latter carries its own  to the upper
extremities; which are  thereby slung,  alternately, backwards
and forwards, and are brought, continually, to adjust the centre
of gravity, which is  then more in danger of being lost than in
ordinary walking.
  The ascent of an inclined plane, either by walking or running,
is attended with unusual fatigue and difficulty, for the following
reasons: In order to advance the thigh, it is necessary to give it
great flexion at the hip join);, the knee must also be bent in an
equal degree, and the foot be flexed, in order to adjust it to the
surface against which it reposes.  To bring forward the other
extremity, it requires an equal flexion at the hip  and knee; be-
sides which, its heel being below the phalanges, the foot must
perform a  full  rotation at the ankle joint.  The  difficulty is
somewhat diminished by stepping only on the phalanges. As, in
these cases, the trunk of the body, to preserve its  equilibrium,
must be inclined forwards, there are certain acclivities, which,
though they furnish  a base sufficiently large  for the  foot, are
yet impracticable from not allowing  the trunk to be thrown for-
wards.
  The descent of an inclined plane is more easy, because it re-
quires but little flexion, in the articulations mentioned, to bring
the extremity behind on a line with that in front;  and its subse-
quent descent is  produced by  keeping it  almost straight, and
shortening the extremity which is fixed.  Running is  then at-
tended with some  inconveniences, for the impulsion, forwards,
which this motion communicates to the trunk, assisted by the in-
clination of the plane in that direction, determines a fall, inevita-
bly, without a successively accelerated advance of  the hind leg.
We see frequently, in the descent of a very inclined hill, a step,
at  first guarded and leisurely taken, converted, unavoidablv, 
MECHANISM OF THE INFERIOR EXTREMITIES.         249
into a full run, to prevent the body from being precipitated for-
wards to the ground.

   In jumping, the  whole body is projected abruptly from the
ground, either in a vertical or oblique direction.
   In the first, the lower extremities are shortened by a general
flexure of their articulations, and, by a very sudden and simul-
taneous extension of them, the resistance of the ground causes
the whole frame to mount upwards, till its gravitation causes
the momentum to cease; it then descends on the same principle
with projectiles, generally.   In  the  oblique leap, there is the
same flexion  in all the  articulations of the  lower extremities,
with the addition of an inclination, forwards, of the  trunk.  At
the moment when the limbs  straighten  themselves, the trunk is
projected, not only upwards, but forwards, owing to its inclina-
tion, and describes in its ascent and descent a parabola., In this
effort, the space traversed will be more considerable, if a pre-
vious horizontal momentum has been communicated to the trunk
by running  several steps before the leap be made.
   The more oblique the  leap is, the greater will be its extent,
to effect which the trunk must be  inclined proportionably for-
wards.  But,  to obtain this inclination without falling, it is ne-
cessary for  one of the lower extremities  to  be very much ad-
vanced at the moment of springing with the other, so as to con-
vert the motion into  a very long step.  With this  position of
the lower extremities, a much longer space can be cleared than
if they were kept together.*

  * For a farther exposition of the principles of locomotion, see Joh. Alph. Bo-
relli de'Motu Animalium, 1710.  Haller, Element. Physiol torn. iv. 1757.  Bi-
chat, Anat. Descript. 1801.  Barthez, Nouvelle Mechanique des Movemens de
THomme et des Animaux, 1798. 
 
BOOK  I.
                       PART III.



                     CHAPTER  I.

                      ARTICULATIONS,

                OF THE CARTILAGINOUS SYSTEM.

  Cartilages (Cartilagines, Systbme Cartilagineux,) supply the
place of bone in many parts of the human skeleton, as in the
space between the  ribs and sternum, in the larynx, in the ex-
ternal ear, in the nose, and elsewhere.  They are also to be
found in all the moveable, and  in several of the immoveable ar-
ticulations.  Wherever placed they may be recognised by their
whiteness, by  their  flexibility,  by their great elasticity, and by
a hardness only short of that of the bones. . There are many ani-
mals whose skeletons  are entirely cartilaginous, as the chon-
dropterous or cartilaginous fishes, so excellent a substitute  is
cartilage for bone.
  Cartilages have neither canals nor cells in them. They appear
homogeneous; and,  upon a superficial inspection, present neither
laminas nor fibres.  The immersion of  them in boiling water
dissolves into a jelly, such as are found  upon the articular sur-
faces of the bones,  and a few others; but, such as  supply the
place of bone, though softened by the process, are not rendered
by any  means so gelatinous.   Their chemical analysis, accord-
ing to Mr. I. Davy, is gelatine, 44.5; water, 55.; phosphate of
lime, 0.5. The testimony of different experimenters, upon the
latter point, does not coincide, and their results must vary ac-
cording to the kind  of cartilage, and the period of life.
  Cartilages are  composed of a tissue exclusively their own, 
252                      SKELETON.
 and of parts which they have in common with other organs.
 The first has  some very distinguishing properties.  It resists
 putrefaction, either with or without maceration, longer than any
 other tissue, except the bones.  In the midst of gangrene it pre-
 serves its appearance almost unchanged.  Boiling gives it a yel-
 low colour, causes it to swell, and, if protracted, the gelatinous
 portion is dissolved.   When dried, it becomes of a semi-trans-
 parent  yellow, diminishes in bulk, and loses its elasticity; in
 these respects  resembling ligaments and tendons.
   Cellular substance exists, in very small  quantities, in  carti-
 lage, and is therefore, not readily demonstrated; it is, however,
 made manifest by maceration, and by the action of boiling wa-
 ter: the latter, by  dissolving the gelatinous portion,  leaves  a
 membranous and cellular structure.  It is also stated, that in
 certain diseases, the gelatinous portion being less abundantly
 secreted, the cellular is left in a soft spongy condition.
   In a healthy state, no blood vessels can be seen in cartilages;
 yet there are the strongest proofs of a species of circulation go-
 ing on in them, either by very fine capillary vessels, or an in-
 terstitial absorption.   All experienced anatomists have seen, in
 subjects affected with jaundice, the entire cartilaginous system
 losing its brilliant whiteness,  and becoming of  a light yellow:
 also, the conversion into bone, in extreme old age, to which all
 cartilages, with but few, perhaps no exceptions, are subject; and
 this ossification sometimes beginning in the centre of the carti-
 lage, prove that the calcareous matter has been  conveyed there
 by some kind of channel.
   Neither absorbents nor nerves have been traced into them,
 and it is not possible to prove conclusively, their  existence by
 the circumstances of disease.   We only know, that in inflam-
 mations of the  joints, terminating by  anchylosis, the cartilages
 are absorbed; and that in some cases, even without evident in-
 flammation, the cartilage is removed from a joint as if it had
been worn away.  Ulcerations of the arytenoid cartilages are
spoken of as common, by the French anatomists;* but it has
not occurred to me to see either them or any others in this
state: the late Dr. Physick's experience  is also the same with

  * I have, since the first edition of this work, seen several instances in chronic
Laryngitis. 
DEVELOPxMENT OF CARTILAGES.
253
my own.   Possessed  of no animal sensibility  in the natural
state, it is doubtful whether they ever have it, or can inflame,
as the pains in  inflammations of the joints may arise from the
synovial membranes.
   In  the embryo, the osseous  and cartilaginous systems are
confounded, so  as to present a homogeneous, mucous or pulpy
appearance;  they only become distinct by the deposite of cal-
careous matter in the bones: when the latter are somewhat ad-
vanced, the cartilages,  which  are to  remain such, have also
additional consistence, and more of a proper cartilaginous look;
but the appearance is generally unsatisfactory, by which one
can learn to distinguish the cartilages  that are to remain such,
from  the cartilaginous rudiments of the bones.  The following
circumstance, however, is pointed out by Bichat:  in the carti-
lages of ossification, there is a vascular  net-work between the
cartilage and the ossification which has  occurred, and owing
to the interposition  Of it, the  two may be  easily separated.
But, in the permanent cartilage, this net-work  does not exist
between the  proximate  surfaces, consequently they  adhere
with a tenacity not admitting of a  rigid  separation from one
another.
   As  the individual reaches adult age, the. cartilages acquire
the strength,  whiteness, and great  elasticity which distinguish
them.   In  old  age  they become  yellowish, more  brittle, and
are, as said, generally disposed to  ossify.  Those of the ribs
and larynx are  frequently ossified at forty years of age.  The
ossification of those of the moveable joints is rare, and begins
at a more advanced period.  In the first  two it begins com-
monly near their centre, and in the last on the surface.
           ACCIDENTAL DEVELOPMENT OF CARTILAGES.

  The unnatural development of cartilages, in the tissues and
organs of the body, to which they are very slightly allied in
their nature, is  a  circumstance by no  means uncommon, and
is met with annually, in most of its varieties, in our dissecting-
rooms.   As there is a great disposition in  such cartilages to
ossify, they are presented in the several gradations from a soft
gelatinous body to  that of perfect  bone.   They occur in the
  Vol. I.—22 
254
SKELETON.
 articulations; in the lungs, and form  there fistulous passages;
 very frequently on the surface of the spleen;  in the pleura;  in
 the fibrous coat of the large arteries, particularly the arch  of
 the aorta; and in the semi-lunar valves of the same; in the ova-
 rium, when it becomes dropsical; and also in  many other parts
 of the body.
   The cartilages which are found loose in the joints and float-
 ing about there, begin, for the most part, in the fibrous struc-
 ture* exterior to the synovial membrane; the latter is protruded
 inwards by them, and gives  them  a  covering resembling the
 finger  of a  glove.  As these bodies are  small and rounded,
 when they protrude into the joint the synovial membrane forms
 a pedicle or base to them, which is finally ruptured, and then
 the cartilage becomes loose.  These bodies are generally ossi-
 fied in their centre, of course they have gone  through the usual
 progress  and phenomena  of ossification.   The  other forms  of
 preternatural cartilage are much disposed to  ossify in the arte-
 ries, but not so much so  in the  other organs.  In these cases
 they are  laminated and adhere by their surfaces, very closely,
 to the contiguous structure, so as to  be membranous.  M.
 Laennec  has seen a cartilaginous transformation of the mucous
 membrane of the urethra; M. Beclard of the mucous membrane
 in the vagina, attended with prolapsus uteri, and also  of the
 prepuce of an old man who had a phymosis from birth.


                   OF THE PERICHONDRIUM.

   All the cartilages, except the articular ones, are invested by
 a membrane  called perichondrium, (perichondre.)  It  is best
 seen on the larynx, and on the cartilages of the ribs.   Its struc-
 ture is fibrous, and corresponds so fully with  that of the peri-
 osteum that it may be considered the same sort of membrane.
 It is, however, less vascular than the  periosteum, and adheres
to the cartilages with less force, owing to the fibrous connexion
between them being not so abundant.  Bichat's  experiments
prove that the cartilage is  much less affected by the loss of this
membrane, than the bone is by that of the periosteum: its uses
are no doubt the same.
* Beclard, Anat. Gen. 
ARTICULAR CARTILAGES.
255
                OF THE ARTICULAR CARTILAGES.

  To this class we refer, exclusively, such as  adhere by one
surface to the articular facings of the bones, and present  the
other surface to the cavity of the joint.  Every moveable, and
some of the immoveable articulations, have their surface uni-
formly thus incrusted, to a thickness varying  from the fraction
of a line in the smallest joints, to one  line in the largest.   The
cartilage itself is rather thinner near the margin of the articular
surface, when the latter is convex, than it is  near the  centre;
on the contrary, when the surface is  concave, the cartilage is
thickest near its periphery.
  These cartilages, when subjected  to  a maceration  of six
months, are stripped of the reflection of  synovial membrane,
which covers their articular surfaces, and are resolved into
fibres, one end of which adheres to the bone and the other end
points to the joint.  If the preparation be then  dried, the dis-
tinction of fibres becomes more manifest.
  The most successful injections, closely examined  with  a mi-
croscope, demonstrate the defect of blood vessels  in them.  The
vessels are uniformly seen to terminate at  the circumference of
the cartilage and at the face which adheres  to  the bone, but
never to penetrate it.  Their organization  is,  therefore, ex-
tremely simple, and such  as  subjects them to but few morbid
alterations.   When partially removed from the bone the  latter
occasionally reproduces them, but the edges of the new and of
the old production do not unite.  I have, in cases of inflamma-
tion of the joints, seen the fibres of these cartilages much longer
than usual and  detached from each other.   When  a joint is
laid  open by a  wound, and suppurates, the  cartilage softens
and disappears from the circumference to  the centre.*

  * Bichat, Anat. Gen.  The same author speaks of the idiopathic ulceration of
the cartilage, as a result of its inflammation.  The late Dr. Physick, whose ex-
perience is equal, denies both. 
256
SKELETON.
                    CHAPTER  II.

   OF THE FIBRO OR LIGAMENTO-CART1LAGINOUS SYSTEM.

  This  set  of  organs (Sysieme fibro-cartilagineux) has been
placed by anatomists, indiscriminately in  the  cartilaginous or
in the ligamentous system, in consequence of its participating
in the characters  of both; it, however, from its importance,
should have a  distinct position.  There are  three varieties of
this system.  The  first presents itself in  a membranous state,
and is represented by the  external ear, by the alas of the nose,
by the cartilage of the eye-lids, and  by the trachea.  The se-
cond is represented by the  inter-articular cartilages of the move-
able articulations, as of the knee, the wrist, lower jaw, and also
by the inter-vertebral matter which holds the bodies of the ver-
tebras together.  And the  third is  represented by the trochleas
and shealhs, formed on the surface of bones for the gliding of
tendons.
   The principal constituent of this system is a strong fibrous
matter, which is intermixed with the cartilage, and has in some
places its surface  covered by the  latter.  The fibres even by
superficial observation may be traced  in various directions: in
some places they are parallel; in others intermixed and crossed
very much; in others concentric.  Their strength is of the first
degree.  The cartilaginous part fills up the intervals between
the fibres, and  gives to the whole structure  its whiteness  and
elasticitj'.
   The Fibro-cartilages may be converted by the action of hot
water into gelatine, but the process is slower than in the sim-
ple cartilage.   The membranous, or first variety, differs how-
ever from the other two in this respect; for if it can be reduced
at all into gelatine, the quantity it yields is not perceptible.
  This  system  is  destitute of  perichondrium, with  the excep-
tion of the first variety, in which it is  distinguishable; but the
others either adhere to the bone, or are covered by a synovial 
LIGAMENTOUS TISSUE.
257
reflection;  their margins  adhering in such cases to the conti-
guous ligamentous structure.
  There is a very small quantity of cellular tissue in this sys-
tem.  Artificial injection manifests but few blood vessels in it;
if the animal, however, be strangled for the purpose, the blood
by accumulating  in the capillaries  becomes  sufficiently appa-
rent.
                    CHAPTER III.

         OF THE LIGAMENTOUS OR DESMOID TISSUE.

                          SECT. I.

   The Desmoid Tissue, (Textus Desmosus, Systkme Fibreux,)
is very generally diffused in the  human body, has a very close
connexion with the cellular texture, and is continuous with it
in divers places.  It may be  known by its whiteness, the firm-
ness and unyielding nature of its materials, and its fibrous ar-
rangement.  It  is most commonly employed in fastening  the
bones to each other  at their articulations, and in enveloping
the muscles, but it is also applied in many other ways.  Its ap-
plication in the former is our present object, but before that is
particularly noted, it will be  useful to enter into some general
considerations in regard to its intimate structure, and the  ob-
servations  now  made  can be applied on all other  occasions
when this tissue is in question.

   A desire  to generalize,  and consequently to simplify, has in-
duced  anatomists to  seek for  some  fountain or source from
which all the reflections and  applications of the desmoid tissue
might be traced.  The Arabians thought that  the dura mater
was this  source;  and  the error was sanctioned  for a long time
by the authority of Sylvius.   The celebrated Bichat, in  ob.
serving the connexions of this tissue, finding that all its points
of application might be traced either mediately or  directly to
the periosteum, considered the latter as its  centre, as the heart
                            22* 
258
SKELETON.
 is the centre of the circulation,_and the brain of nervous ener-
 gy ; not that he thought the periosteum radiated its influence
 on all its dependent organs, but because anatomical inspection
 demonstrated all the fibrous organs to be connected with it, and
 communicating through it  with eaeh other.   The late  Profes-
 sor Bonn, of Amsterdam, reversed the idea of Bichat, and con-
 sidered  the aponeuroses of the extremities, and  of the trunk,
 which send their partitions  between the muscles, and down to
 the periosteum and joints,  as the  much desired  centre of the
 desmoid  system.   The latter  idea  has been reiterated by
 others, and the supposed emanations from the superficial apo-
 neuroses diligently traced.  As means of studying the position
 and connexions of parts, notwithstanding the  construction is a
 very forced one,  which makes desmoid tissue cellular mem-
 brane,  and cellular  membrane desmoid tissue, alternately, so
 as to suit the arrangement of the anatomists, instead of that of
 nature;  yet, any or  all of these plans have their use, and  may
 be followed advantageously, after the study at large of the hu-
 man fabric.
   The desmoid tissue  is essentially fibrous,  but without a uni-
 form arrangement, as  its fibres are either parallel, crossed, or
 mixed.  In some places the fibres are very compact, and sepa-
 rate with  difficulty, but generally prolonged  maceration  will
 cause them to  part into filaments as  fine as the thread of the
 silk-worm.  Anatomists differ in regard to the ultimate struc-
 ture of these fibres.   By M. Chaussier they are thought to be
 primitive and  peculiar; Mascagni* supposed that they were
 lymphatics enclosed in  a vascular web; Isenflam, that they were
 cellular  substance imbued with gluten and albumen.  And M.
 Beclard, observing that maceration resolves them into a  spe-
 cies of mucous or cellular substance,  teaches that they are the
 latter in a condensed state.  Bichat's opinion is probably correct
 that the tissue is peculiar, and that maceration only brings into
 view the cellular substance which  unites its fibres.   Though
 maceration  and chemical  management  evolve some striking
 coincidences with  cellular membrane, yet in the  natural  and
 ordinary state there  are some very strong points of difference
from it.   Among these  may be remarked its great want of elas-
* Prodromo della Grande Anatomia. 
LIGAMENTOUS TISSUE.
259
ticity, which causes it to tear sooner than to stretch; and in
general anasarca, its being only very partially affected, merely
rendered  a little more moist and tumid, which even then may
arise  from the small quantity of cellular substance in it.   Many
parts of it, however, are unaffected  in the latter way, as  the
tendons and their sheaths.   This  tissue  naturally contains a
considerable quantity of water, which it loses by exposure to
the air; it  then is much reduced, and becomes hard and yellow-
ish, and is made semi-transparent by being put into  spirits of
turpentine.
  The desmoid tissue, by being subjected to the heat of boiling
water, contracts, becomes more solid, and is elastic; but if it be
continued there, it gradually softens, becomes semi-transparent,
and gelatinous.   The mineral acids reduce it to a pulpy state,
and if concentrated, will dissolve it entirely.  The alkalies loosen
its texture, cause the fibres to separate easily, and to assume a
diversity of colours.  It  putrefies but slowly, in this respect be-
ing next to the cartilages.
  The strength  of this texture is remarkable, and adapts it to
the sustaining of enormous weights; a faculty which is  conti-
nually in  requisition, both to retain  the  articular surfaces of
bones in contact, and the muscles and tendons in their places.
It is well known that the patella, the olecranon, and the os cal-
cis, break  frequently before their tendinous attachments  will
give  way.  In the history  of punishments, where criminals
have been fastened to four horses, it is said that it has been found
necessary to use a knife  to  assist  in their disarticulation.  All
these  phenomena occur when abrupt violence is resorted to, so
little are the ligaments disposed to yield;  but when the  causes
of distention act slowly  and gradually, as in dropsies  of the
joints, the fibres separate, and are sometimes  completely disu-
nited.   When the distending cause ceases to operate in the lat-
ter case, the ligaments have the  power of contracting in the
same  gradual way, and of restoring themselves.
  Some of the desmoid tissues, besides having their  fibres sur-
rounded and their interstices occupied by cellular substance,
contain a  very  small quantity of oily or  fatty  matter.   This
is not very obvious in their  recent slate;  but, by drying them,
it will be seen in small quantities on their surface, like a greasy
exudation:  this probably comes from the  cellular substance in 
260
SKELETON.
them.  They are furnished but sparingly with  blood  vessels,
which for the most part, are capillary.  The periosteum and
the dura mater are, however, exceptions to  this rule.  Lym-
phatic vessels have  been  observed in some  of  them, but it is
doubtful whether they generally have nerves.1'
  The sensibility of this system is extremely obscure, and is not
manifested under the usual mechanical and chemical irritants;
it may, however, be elicited by communicating to the joints a
twisting motion, as the experiments of Bichat prove.  Inflam-
mation augments their sensibility, in which case it becomes ex-
tremely acute, as in gout and rheumatism, or any other cause
productive of it.
          SECT. II.—OF THE LIGAMENTS OF THE JOINTS.

   The ligaments, (ligamenta,) properly speaking, are those or-
gans which tie the bones together, and in the moveable joints
are  either capsular (capsules fibreux) or funicular, (ligamens
fibreux fasciculaires.)   The  first are like a bag open at the
ends, at either of which the articular extremity of a bone is in-
cluded.   These are much more complete in  some joints than in
others; the shoulder and the hip  joints afford the most perfect
examples; in other joints they are divided into irregular fasci-
culi of fibres, permitting the synovial  membrane to appear in
their interstices, and sometimes they are still  more widely se-
parated.
   The funicular ligaments are mere cords, extending from one
bone to another; some of them are flattened, some rounded, and
others oval or cylindroid.   They are variously placed; in some
instances  they are within the capsular ligament, and in others,
on its outer surface, and sometimes so blended with it as not to
be separated without an artificial  dissection;   Their names are
derived either from their position or shape,  and are generally
sufficiently appropriate.
* Beclard, Anat. Gen. 
SYNOVIAL ARTICULAR CAPSULES.
261
        SECT. III.--OF THE SYNOVIAL ARTICULAR CAPSULES.

   Each moveable articulation is lined by a membrane, (Mem-
 brane Synoviale,) reflected over  the internal face of the capsu-
 lar ligament and the articular cartilages.  This  membrane is
 a perfect sac;  and unlike the capsular ligament, has no opening
 in it.  It is remarkably distinct where it is not  attached to the
 articular cartilages; and, by being inflated, is caused to protrude
 in small vesicles, or pouches, "between the fasciculi of the liga-
 mentous  structure.   Its connexion with  the cartilage, and its
 continuation over it, are not quite so obvious, and require more
 management to demonstrate: it is, indeed, so thin  and transpa-
 rent at this part, and adheres so closely, that its  existence there
 has been  questioned, but may be proved in a variety of ways.
 By maceration it becomes so loose, that, with a  pair of forceps,
 shreds of it may be raised along  the whole extent  of  the carti-
 lage.  If a flap of cartilage be raised up by a knife, its base
 being left attached, in attempting to tear away  the base it will
 be found that  the synovial membrane is continued  from  this
 base  to the contiguous cartilage.  Saw a bone  through to its
 articular  cartilage, then tear through the cartilage gently, in
 which case the continuity of the synovial membrane will also
 be manifested.
   From these several proofs the fact is established, that the sy-
 novial membranes are bags, closed at both extremities, and dif-
 fer thereby from the capsular ligaments.

   The synovial capsules are liable to a fungous degeneration
 which occurs equally upon the cartilaginous and capsular por-
 tions of them.  Factitious bridles sometimes form in the joints,
 attached indiscriminately to either portion of the  synovial mem-
 brane.  M. Beclard says, that  protracted inflammation will,
 finally, redden the cartilaginous portion, and that  it extends from
the circumference to. the centre,  the hues  being  lighter  the
nearer it is to the latter.  It has not occurred  to  me to meet
with this  proof;  though I have  made frequent  dissections  in
subjects, of inflamed joints, the redness  has  always ceased at
the margin of the articular cartilage. Dr. Physick's experience, 
262                      SKELETON.

most valuable on all occasions, affords support to my own.—
Some years ago I had an opportunity of investigating, some-
what fully, this point, in a subject, all of whose large joints were
in a state of inflammation.

   These synovial capsules, or membranes, are white, thin, se-
mi-transparent, and  soft.  Wherever  there  is  a deficiency of
capsular ligament, they adhere to the contiguous cellular sub-
stance,  and are so blended with it as to appear absolutely con-
tinuous. Dissection, inflation, and maceration, prove them to be
laminated, and develop their structure in such a way that it re-
solves itself into a cellular tissue, the  more  interior layers of
which had been in a very compacted state.   In all this they re-
semble the serous membranes, generally, and are ranked  among
them; Bichat, therefore, considers them only as an interlace-
ment of absorbents,  and of exhalents.  But, for the farther ex-
position of this point, see the article on the Serous Membranes.

   The synovial sacs have, on their outer surface, but projecting
into the cavity of the joint, adipose cushions  of different sizes,
called the Synovial Glands of Havers, from which, till lately, it
was supposed that the lubricating liquor of the  joints is  exclu-
sively secreted.  These cushions have their projecting margins
fringed  and  unusually vascular, and occupy the small  spaces
left between the articular faces of the bones.  As they are co-
vered by the synovial membrane, they no doubt assist  in the
secretion of the synovia.

   The moveable articulations are all furnished with the fluid
called Synovia; this  name was given to it by Paracelsus, from
its resemblance to the  albuminous part of an egg, to the con-
sistence and colour of which  it has a close affinity, and,  like it,
is thick, ropy, and somewhat yellowish.  The chemical analysis
of it indicates the presence of water, albumen, and a kind of in-
coagulable mucus.   It was once supposed  to be a mixture of
serum, with the adipose matter of the bones, which found its
way into the joints by transudation; but as it contains upon ex-
periment no  oil, the  opinion is  evidently erroneous.   It  is  se-
creted from the whole internal surface of the  synovial  mem-
brane, and, perhaps, in greater quantities from the fringed fatty 
               ARTICULATION OF THE LOWER JAW.           263

cushions in the  joints in consequence of their increased vascu-
larity.   M. Beclard teaches, that it is neither a follicular nor a
glandular secretion, nor a  transudation, but a perspiration, in
which a perfect equilibrium is kept up between its exhalation
and its absorption.  Its use is  to diminish friction, and, conse-
quently, to facilitate the sliding of the bones upon each other.
                   CHAPTER  IV.

            ARTICULATION OF THE LOWER JAW.

  The articular connexion, here, is formed by that portion of the
glenoid cavity anterior to the fissure, and by the condyle of the
lower jaw.  Each surface  is covered by thin cartilage; and a
thin, loose, irregular, fibrous, capsular ligament, arises from the
articular margin of one bone, to be inserted into that of the other.
Besides this, there are four other ligaments  for strengthening
the joint, an inter-articular cartilage, and  two synovial mem-
branes.

  The External  Ligament (Membrana  Articularis  Ligamen-
tosa) arises from the inferior  margin of the root of the jugal or
zygomatic process of the temporal bone,  and  from the anterior
side of the meatus externus, and is inserted into the neck of the
condyloid process.  It is somewhat triangular, having the base
upwards.  Just in advance of this, and separated from it by a
small fissure, is another triangular ligament, the discovery of
which is claimed by Caldani.*  It arises from the anterior part
of the inferior margin of the zygomatic  process of  the tempo-
ral bone, and is inserted into the neck of the bone in advance
of the other.

  The Internal  Ligament  (Lig. Maxilla Lalerale) arises from
the extremity of the spinous process of the sphenoid bone, and
from  the posterior margin of the glenoid  cavity, that is the pro-
cessus vaginalis, and going downwards and outwards, is inserted
* Tabul. Anat.  Venetiis, 1802. 
264
SKELETON.
 into the spine bordering the posterior mental foramen, and for
 some distance lower down on the ramus of the jaw.  It is placed
 between the two pterygoid muscles, and  is in contact with
 the maxillary vessels and  nerves, as they run between it and
 the condyle to the posterior mental  foramen.   It is thought by
 Caldani to be not so useful in restricting the motion of the jaw
 forwards, as in holding the vessels and nerves, and regulating
 their  position,  lest in the  various  motions of the lower jaw
 they should be displaced and injured.

    The Stylo-maxillary Ligament is  thinner than the above.  It
 arises from the external side of the  styloid process,  and  is in-
 serted into  the posterior margin of  the jaw, near its angle, be-
 tween the masseter and internal pterygoid muscles.   The sty-
 loglossus muscle is much connected with it, and is thereby as-
 sisted in elevating the base of the tongue, the fascia  profunda
 of the neck is in continuation with it.

    There are two synovial membranes, the one reflected be-
 tween the  glenoid cavity and  the  upper surface of  the inter-
 articular cartilage, and the other between this latter substance
 and the condyle of the lower jaw.   They may be seen at differ-
 ent points protruding  between  the fibres of the capsular  liga-
 ment.

    The Inter-articular cartilage, by  being placed between the
 two synovial membranes, separates completely the two bones.
 Above, its surface corresponds to  the convexity of the tubercle
 of the temporal bone, and  to the glenoid cavity; below, it is
 simply concave for receiving the condyle.  It is thicker at the
 circumference than in its middle, and at the posterior than the
 anterior margin.  Sometimes it is open in the centre, in which
 case the two synovial  membranes run  into one another.   Its
 structure is fibrocartilaginous.  It  moves very readily back-
 wards and forwards.

  On the posterior face of the capsular ligament, I have found,
in several cases, indeed, on all occasions of special examination
for  it, since the first observation, an erectile tissue or structure
resembling  the corpus cavernosum  penis.  It has  not  been 
LIGAMENTS OF THE SPINE.
265
filled with  blood like the latter, but is, probably, an arrange-
ment for giving great mobility forwards to the lower jaw.

  The movements  of this  bone may be simply hinge-like, by
its depression, in which the mouth is regularly opened;  or, by
the action  of the pterygoid muscles, it may be  slid forwards.
When the  muscles of but one side act, a species of rotation is
communicated; in which one condyle advances on the tubercle
of the temporal bone, while the other reaches to the back part
of the glenoid cavity.  The looseness and length of the capsu-
lar ligament of the articulation, along with the extreme facility
of motion from the interposition of a moveable cartilage, con-
tribute very materially to this  movement.   The sliding  back-
wards and  forwards of the intermediate cartilage of this arti-
culation, during mastication, sometimes produces a cracking;
audible to the by-standers, and  extremely annoying to the  in-
dividual who is the  subject of it, from the noise being so near
his ear.
  Some persons are liable to a  spontaneous dislocation of this
bone, from  yawning too widely.   I am disposed to believe, that,
in such cases, the accident arises from the  posterior boundary
of the glenoid cavity, (as established by that margin of the
temporal bone which  is  continuous with the vaginal process,
and forms a part of the meatus externus,) being more advanced
and higher  than usual; in consequence of which, whenever the
bone is depressed to a certain  point, its neck strikes against
this ridge, and not being able to go farther back, the ridge acts
as a fulcrum, and starts  the condyle over the tubercle of the
temporal bone into the zygomatic fossa.  The fact  is certain,
that very strongly marked .differences of the glenoid cavity, in
this particular, occur in different individuals.
Vol. I.—23 
266
SKELETON.
                    CHAPTER V.

            OF THE LIGAMENTS OF THE SPINE.

          Ligaments of the Bodies of the Vertebra.

  1.  Inter-vertebral Substance, (Ligamenta Inter vertebr alia,
Ligamens Intervertebraux.)—The bodies of the true vertebras
are united by a substance blending the nature of ligament and
that of cartilage, and, therefore, called fibro or ligamento-carti-
laginous matter.  It occupies all the space between the conti-
guous bodies of the  vertebras, and adheres most closely to their
substance.   This inter-vertebral matter increases successively
in thickness, as it is placed lower down on the  spine, whereby
the lumbar vertebras are mutually at a  much  greater distance
than  any others.  The  curvatures of the spine,  as formerly
stated, depend considerably upon the arrangement of this sub-
stance: between the vertebras  of the  neck it is thicker at its
anterior margin than at the posterior; on the contrary, between
the dorsal vertebras it is thinner  in front.  In the loins, it is
again much thicker in front than behind, and this feature is un-
usually marked between the last lumbar vertebra and the sa-
crum.
   This inter-vertebral  matter is formed of concentric lamellae,
the texture of which is ligamentous.   These lamellas are more
abundant anteriorly and laterally than behind.  Their  fibres
cross in  every direction, leaving  between  them interstices or
cells, filled with a soft, pulpy substance: this substance is not
very obvious near the  circumference,  but  in approaching the
centre, it becomes more  and  more abundant, as the interstices
are larger, until the centre seems to be constituted almost en-
tirely by it.   The pulpy mass in the centre is in a state of con-
siderable compression, which may be proved by separating the
bodies of adjoining vertebras, or by making a  vertical section
through them; in which case the pulpy mass will be freed from
compression, and will rise up into  the  form of a  cone.   This 
LIGAMENTS OF THE SPINE.
267
experiment will  succeed remarkably well in  the loins; from
which it is evident, that this mass is a soft and elastic ball, on
which the bodies of the vertebras play.
  The pulpy matter is proportionately much more abundant in
infancy than in the subsequent periods of life; it  is also  much
softer, whiter, and more transparent.  In advanced life there is
great diminution  of its volume, as well as of its  elasticity,
which accounts, in some measure, for the comparative stiffness
of the spine in old people.  The fibrous part in them is always
more abundant, and  is much disposed to ossify.  When the
trunk is kept erect for several hours in succession, it becomes
shorter, from its weight bearing upon the inter-vertebral  mass;
but a short period of rest in the horizontal position, restores it
to its original length.

  2. Anterior  Vertebral Ligament, (Fascia Longitudinalis An-
terior, Ligament Vertebral Anterior.)—This ligament is placed
on the front part of the spine, and extends from the second
vertebra of the neck to the first bone of the sacrum, inclusively.
It increases gradually in breadth, from its commencement  to
its termination, but is not every where of the same thickness;
for  it is thin on the neck, thicker in the thorax, and  again be-
comes thin in the loins: in the latter, however, it is strengthened
by an accession of fibres from the tendinous crura of the dia-
phragm.
  This  ligament  adheres very closely  to the inter-vertebral
substance, and to the projecting margins of the bodies of the
vertebras, but less closely to the  middle or concave parts  of the
latter.  Its fibres do not run out its whole length, for the more
superficial extend from one vertebra or inter-vertebral substance,
to the fourth or fifth below:  the middle  ones extend to the se-
cond or third below;  and the  deepest  seated  are applied be-
tween the proximate vertebras only.  In general, more of the
fibres are inserted into, and arise from the fibro-cartilaginous
matter  than the bones.   In several parts, but particularly in the
neck, small  slips are sent off obliquely to the vertebra below.
The laminas of this ligament leave intervals between them for
the passage of blood vessels.
  Beneath the  anterior vertebral ligament are found a  great
many short and insulated ligamentous fibres, extended oblique- 
268                      SKELETON.
ly from one vertebra, to another which is  contiguous.  These
fibres have different directions, and cross each other at acute
ancrles; they adhere very closely to the fibro-cartilaginous mat-
ter, and leave interstices between themselves, through which
the anterior vertebral ligament  adheres to the same substance.
Moreover, there are at the sides of the bodies of the vertebras,
a number of short straight fibres, passing from the edge of the
bone aboye  to the edge  of the bone below.

   3.  Posterior  Vertebral  Ligament,  (Ligamentum Commune
 Posterius, Ligament Vertebral Posterieur.)—This is placed  on
 the  hind part  of the bodies of  the vertebrae, within the spinal
 canal, and  extends  from the cuneiform process of the occiput
 just beyond the  foramen magnum, to the os  coccygis.  It is
 more narrow and thick in  the thoracic vertebras  than  else-
 where.   At each  inter-vertebral substance  it  increases  in
 breadth and adheres more closely, whereas, opposite the body
 of a vertebra it is narrower and more  loose, by which arrange-
 ment a kind  of  serrated or  unequal  edge is formed on  each
 side.
   This ligament is  more dense  and compact than the anterior,
 and presents a smooth, shining  surface, resembling a tendinous
 expansion.   Its  fibres, also,  do  not run  individually the whole
 length of the spine, but  are in laminas; the more superficial of
 which have their fibres inserted into the fourth or  fifth inter-
 vertebral substance or vertebra, below their origin.   The mid-
 dle laminas are inserted into the second or third below, and the
 deeply seated into  the first below.  The blood vessels do not
 penetrate the ligament, but pass by its sides into the vertebras.
The superior extremity of  this ligament going from the second
vertebra to the margin of  the foramen magnum, is sometimes
considered as distinct.

          Ligaments of the Processes of the Vertebra.

  1.  Articulation of the Oblique Processes.—-These processes
are faced with cartilage, and a synovial capsule is displayed
upon them so as  to shut  up completely the cavity of the  articu-
lation.  The capsular  ligament is  not  uniform and fully deve- 
                   LIGAMENTS OF THE SPINE.                269

 toped, but is represented by a few irregular fibres, passing from
 one bone to the other.

   2. Articulation of the Spinous Processes.—With the exception
 of the neck, ligamentous fibres are found to occupy the spaces
 between all the spinous processes, by passing from the spinous
 process above, to the spinous  process below.  Muscles supply
 their places in the neck, and  in the upper part of the thorax.
 These ligaments have much of a cellular structure above, but
 in their descent they  become more ligamentous  and  large, till,
 in the loins, they assume a very decided character, and have a
 quadrilateral shape.
   At the extremities  of the spinous  processes there  is, also, a
 ligamentous band, belonging  to the dorsal and  lumbar verte-
bras;  commencing at  the seventh cervical, it  terminates on the
 spinous processes of the sacrum.  It is thin in the back, buf on
 the loins it  is very thick, and  so blended with  the  tendinous
 origins of the muscles, that it  is not very distinguishable from
 them.  The fibres  of  which it consists are of unequal lengths,
 being extended between two, three, four, or five  vertebrae,  ac-
 cordingly as the fibres are superficial  or  deep-seated.

   3.  Owing to the shortness  of the spinous processes of  the
 neck, an arrangement exists there called Ligamentum Nuchas,
 (Ligament Cervical,)  or the Descending  Ligament of Diemer-
 broeck.  This  ligament, though continuous with the  one last
 described, may be considered, for the sake of perspicuity, as
 distinct.  It begins, therefore, at the seventh cervical spine, as-
 cends between the muscles of the Opposite sides of the neck, and
 is inserted into the posterior occipital protuberance.  It is blend-
 ed very much with the tendons of muscles, and is distinguished
 from them with some difficulty, occasionally.  Its posterior mar-
 gin is thick, but the anterior is a thin  membranous expansion,
 which runs  to the ends of the spinous processes of the cervical
 vertebras, and to the vertical ridge of the occipital bone,  lead-
 ing from the occipital protuberance to the foramen  magnum.
 The ligamentum nuchas, therefore, forms a complete septum be-
 tween the muscles of the opposite sides of the  neck, and is con-
tinuous with the sheaths in which they play.   In  quadrupeds it
is remarkably strong; but in man, who, from  the proportions
                           23* 
270
SKELETON.
of his  head  and his erect position, keeps the head nearly in
equilibrium, it is comparatively feeble.

  4. Articulation of the Bony Bridges of the Vertebra.—The in-
tervals between the vertebrse, at  the posterior part of the spinal
canal, are filled up by the Yellow Ligaments, (Ligamenta Flava>,)
so called from their peculiar colour.  These intervals exist be-
tween all the true vertebras, being bounded  laterally by their
oblique processes, and are very  considerable in  the loins, par-
ticularly that below the last vertebra;  they  are not so large in
the neck, and are still smaller  in the back; and their shape  va-
ries considerably in the several portions of the spine.
   The yellow ligaments are two in number, forming a pair in
each of these intervals: the two approach, behind, at an angle,
in a line with the spinous processes, but are  kept separated by
a small vertical fissure filled up with cellular substance.  They
extend to the oblique processes laterally;  are connected  to  the
 anterior face of the bony bridge of the vertebra above; where-
 as, they are inserted into the superior margin of that of the ver-
 tebra below.  From this arrangement, the  yellow  ligaments
 may be best seen on the side  of the spinal  canal.  The angle
 which they form, behind, is continuous with  the ligaments  be-
 tween the spinous processes.
   These yellow ligaments are smooth and shining on their an-
 terior surfaces, but behind they are rough and unequal.  Their
 fibres are numerous and extremely compact, their strength is,
 therefore, very great.   Their  elasticity is well marked and pe-
 culiar to them, and  assists greatly in erecting the spine when it
 has been curved forwards.  Bichat says  that there is but little
 cellular tissue between their fibres: that they are dissolved with
 extreme difficulty in boiling water, and resist its  action to such
 a degree, that it is manifest they contain much less gelatine than
the greater number of analogous organs.
   The first pair of yellow ligaments is between the second and
third cervical vertebras, and the last between the  last lumbar
and the sacrum * there are, consequently, only twenty-three pairs
in all.
             Particular Articulations of the Spine.

   1.  Articulation of Occiput with Atlas.—The Anterior Ligament
 s placed at the  anterior part of the occipital foramen, and ex- 
LIGAMENTS OF THE SPINE.
271
 tends from it to the corresponding edge of the atlas.   On  its
 centre in front is a  fasciculus, which being  narrow and some-
 what rounded, descends from the middle of the cuneiform pro-
 cess to terminate in the tubercle on the front of the atlas; and
 consists in parallel fibres.  The remainder is called by Caldani,
 Membrana annuli anterioris atlantis, (Ligament occiptto-atloidien
 anterieur.)   It occupies and shuts up the whole space between
 the basilar  process  of the os occipitis, from which it takes  its
 origin near the occipital foramen; and the anterior arch of the
 atlas, in the superior margin of which it is lost: in it  are many
 oblique fibres, which run from within  outwards.
   The posterior Ligament is placed at the back part  of the oc-
 cipital foramen,  and extends from it to the corresponding edge
 of the atlas.  It  is called by Caldani, Membrana annuli poste-
 rions atlantis, (Ligament occipito-atloidienposterieur;) and arising
 from the whole posterior margin of the  occipital foramen be-
 tween the condyles,  it is extended to the upper contiguous mar-
 gin of the atlas,  so as to fill up completely this space.  Bichat
 says that it also  consists in two laminas,  the anterior  of which
 is fibrous, and runs into the dura mater of the spine instead  of
 into the bone: the posterior is of a much looser texture, and re-
 sembles common cellular substance.   A part of this membrane
 runs obliquely from  the transverse process of the atlas to the
 part of the  occiput just beneath  the insertion of the rectus pos-
 ticus minor.

   The articulating surfaces of the  condyles, and the  superior
 oblique processes of the first vertebra, are covered with carti-
 lage, and furnished  with a synovial  membrane arising from
 their margins.  On the exterior of the synovial membrane there
 are irregular ligamentous fibres going  between the bones, and
 forming a capsule.

  2. Articulation  of  the second Vertebra with the Occiput, and
 with the first.—The  second vertebra has no  articular surface
joining the occiput, but some strong ligaments are passed  be-
 tween them.   When the posterior vertebral ligament is  removed
 at its commencement from the occipital bone, we see  on  each
side of it, and beneath it,  ligamentous bands (Lacerti Liga-
mentosi,) coming from the internal face of the os occipitis, to 
272                      SKELETON.
 be affixed to  the body of the second  vertebra Jpehind.  Some
 of these fibres arise from the margin of the  occipital foramen,
 and others from the internal face of the condyloid processes.*
 They are joined at their external margins by a few fibres from
 the first vertebra, near its upper oblique process.

   The  Transverse Ligament (Ligamentum Transversale At-
 lantis, Ligament Transverse,) is placed immediately behind the
 processus dentatus, and divides the atlas into two unequal rings
 by being stretched from one side to the other.   It is larger in
 the middle than at the extremities, and  has the latter inserted
 into the  little  tubercle  at the internal side of  the atlas, between
 the upper and the lower articular surfaces.  It is a thick, strong
 fasciculus of fibres, and binds the processus dentatus so as to form
 for it a sort of collar, amounting to about one-fourth of a circle.
 The superior  appendix of this ligament arises by a broad base
 from the anterior  margin of the foramen magnum, and termi-
 nates below by a narrow end in the upper margin of the trans-
 verse ligament.  The  inferior appendix arises  from  the lower
 edge of  the transverse ligament, and  is attached, by a some-
 what converging end,  into the posterior face  of the body of the
 vertebra dentata.
   The surfaces of contact belonging to the processus dentatus,
 and to the anterior ring of the atlas, are covered with cartilage,
 and have a synovial membrane, so as to form a perfect joint
 called the vaginal ligament.  A joint with a distinct synovial
 membrane is, in like manner, formed between the posterior face
 of the processus dentatus and the anterior of  the transverse li-
 gament,  where they come into contact.

   The Oblique or Moderator Ligaments (Lig. Lateralia, Liga-
 mens Odonloidiens) are two, one on  either side of the tooth-like
 process.   They may be seen most advantageously by cutting
 through  the transverse ligament, and arise from the side  and
 summit of the processus dentatus, to be inserted into  the inter-
 nal margin of the occipital condyle.  They are thick, short, and
strong, and consist in parallel fibres; their lower margin has been
considered as  a distinct ligament by Weitbrecht, and described
* Caldani, Icon. Anat. Explicatio, vol. i. p. 255. 
LIGAMENTS OF THE SPINE.               273
 by him as coming from the neck of the process.  There is some
 cellular tissue at the front, in which the process revolves.

   The Middle Straight Ligament, (Lig. Medium Rectum, Liga-
 ment  droit  Moyen,) or Occipito-Dentate, arises from all that
 part of the summit of the processus dentatus  anteriorly which
 is between  the moderator ligaments, and is inserted into all that
 part of the  interior circumference of the foramen magnum be-
 tween the insertion of  the moderator ligaments.  It  is a thin
 ligamentous membrane, disposed  to form in its middle a verti-
 cal fissure,  separating its two halves.   It cannot be seen well,
 unless the whole membrana annuli anterioris be dissected away,
 and the anterior bridge of the first vertebra sawed  off; it will
 then be found  immediately behind the  bursa of the processus
 dentatus.  It is separated from the superior  appendix of the
 transverse  ligament by a layer of condensed fatty substance.
 This ligament should not be confounded with the superior ap-
 pendix of the transverse ligament, nor with the beginning of the
 posterior vertebral ligament, as has been done by Bichat and
 others.  The difference is well established by Caldani, as it lies
 deeper than either of  them when viewed from  the  vertebral
 cavity;  though, from the close  connexion of the fibres of the
 ligaments among themselves, as well as with others, the mistake
 may readily occur.*

   The Articulation between the oblique process of the  first and
 of the second cervical vertebras is very moveable, as  the atlas
 is permitted to revolve around the processus  dentatus to  the
 amount of one-fourth of a circle at least.  This articulation has
 a synovial capsule which  is strengthened by an anterior and by
 a posterior  ligament.
   The anterior ligament of the articulation between the oblique
 processes arises from the inferior  margin of the atlas and from
 its anterior tubercle, and  is inserted into the base of the  pro-
 cessus dentatus, and into the  front  of the body of the second
 vertebra.  The fibres of the latter insertion are long  and fre-
 quently distinct from the first.

  * Its  existence is, however, scarcely to be considered uniform, as it is often
wanting where the processus dentatus is very long, for example when it reaches
the anterior part of the foramen magnum and forms a joint there, as it sometimes
does. 
274
SKELETON.
  The posterior ligament is placed between the first and second
vertebrse behind, and is connected to their contiguous margins
so as to fill up  the interval between them, and to supply the
place of the yellow ligaments.   It is extremely loose and thin,
so as not to interfere in the  movements of the vertebrae, and is
almost of a cellular structure.
   The synovial  membrane of these oblique processes is unu-
sually lax, and is reflected from the margin of the one articular
surface to the other.   It is in contact in front with the anterior
ligament; behind with the  posterior and with much cellular
substance; internally with the ligaments within the spinal canal,
and externally with the carotid artery.   The latter obtains from
it a  serous covering, without which,  according to  Bichat, it
would be bathed in the synovial fluid.
                    CHAPTER  VI.

            OF THE LIGAMENTS OF THE  PELVIS.

   The mode of junction between the sacrum and the last lum-
bar vertebra, is, in  every respect, the same as that described
for the bones of the spine generally, with the addition of a liga-
ment on each side, sometimes met with, called Sacro-vertebral,
which  arises from the  transverse process of the last  lumbar
vertebra, and going obliquely downwards, is inserted into the
superior part of the sacrum by blending itself with the anterior
fibres of the sacro-iliac junction.

  The Sacrum is  united to the coccyx by a fibro-cartilaginous
substance, resembling that between the bodies of the true ver-
tebras, with the exception of  there being less pulpy matter in
its centre, and of its fibrous lamellas being more uniform.  The
bones of the coccyx are also united with  one another in the
same way; in consequence of which they are very flexible till
the approach of old age.

  The Anterior Coccygeal Ligament,  (Lig. Sacro-coccygeum 
LIGAMENTS OF THE PELVIS.
275
Anterius) is placed on the forepart of the latter bone; runs its
whole length, and arises from the inferior extremity of the sa-
crum.   Its fibres are rather indistinct, from their being blended
with fat: on the lateral margins of the coccyx they are rather
better marked.

  The Posterior Coccygeal Ligament, (Lig. Sacro-coccygeum
Posterius,) as its name implies, is placed on the back part of the
coccyx.   It arises from the inferior margin of the spinal canal
of the sacrum, and  forms a  sort  of membranous  expansion,
which passes the first bone of the coccyx, and is inserted into
the second.  There are also a few other ligamentous fibres con-
necting the bones of the coccyx.

  The Ilio Lumbar ligament (Lig. Ilio Lumbare) arises from
the transverse process of the last lumbar vertebra, and from its
inferior oblique process, and going outwards is inserted for two
inches into  the crista of  the ilium.  It is often blended with
adipose matter, which separates it into several fasciculi.   Cal-
dani describes it as two ligaments, making a distinction between
the one part from the transverse, and the  other from the ob-
lique process.

   The Sacro-Iliac Articulation is formed by the corresponding
surfaces of the sacrum and ilium.   Each bone is incrusted with
its  own cartilage, the one on the sacrum being somewhat more
thick.  Their  surfaces are slightly rough, and between them
exists a  thick yellow fluid in a very small quantity, which lu-
 bricates them, and is more abundant in early life.

   The Sacro-Spinous Ligament  (Lig.  Sacro Spinosum)  is
 placed superficially on  this articulation  behind.  It is  very
 strong, flat, long, and perpendicular.  It consists of two laminas,
of  which the  more  superficial arises  from the posterior supe-
rior spinous process of the ilium, and is inserted into the fourth
transverse process  of the sacrum.  The deep-seated  lamina
 arises from the same point, and is inserted  into the  third trans-
 verse process of the sacrum.   Bichat describes, connected with
the inferior margin of this ligament, a  fasciculus, which comes
from the posterior inferior spinous process of the ilium. 
276
SKELETON.
  The Sacro-Iliac Ligament (Lig. Sacro-lliacum) is next to the
articular faces of the bones.   It surrounds the joint, but is much
stronger on its posterior face.  It consists in an assemblage of
ligamentous fasciculi, some of which have obtained, by  the
writers on Syndesmology, particular names, but which it would
scarcely add to the student's information to  designate.  On the
front of the joint this ligament is  uniform, and consists of a
plane of short,  strong fibres, passing from  the margin of one
bone to that of  the other.   But, on the posterior surface, it is
much more irregular, and  arises from the first two eminences
near the lateral margin of the sacrum, and from that surface of
the  sacrum between these eminences and  its articular face.
From thence the sacro-iliac ligament goes  to be inserted  into
the rough surface of the ilium, immediately  behind its articular
face; it fills up there a considerable space,  and, from its posi-
tion, must be extremely irregular.  Its  strength  is so great,
that in forcing the joint the ligament does not rupture, but parts
preferably from the surface of the ilium, and sometimes brings
 with it a lamella of bone.
   The bones of the pelvis  are also  fastened by two other very
 strong ligaments, the sacro-sciatic.

   The Posterior Sacro-Sciatic (Lig. Sacro-lschiadicum majus)
is the most considerable of the  two.  Itarises from  the poste-
rior inferior spinous process of the ilium, from  the margin of
the sacrum below this bone, and somewhat from  its posterior
surface, and from the first  bone of the coccyx.  It goes down-
wards and outwards, becomes thicker in its  middle, but  nar-
row; it then spreads out, and is inserted along the internal mar-
gin of the tuberosity of the ischium.  Its anterior  extremity is
extended along  the internal face of the crus of the ischium for
some distance, and has the obturator internus muscle adhering
to it.   Its fibres, where they converge from  their origin,  are
separated into planes by masses of fat and by blood  vessels.

   The Anterior Sacro-Sciatic Ligament (Lig. Sacro-Ischiadi-
cum minus) is much  smaller than the other, and  is placed in
front of it.  It arises from the margin, and somewhat from the
posterior surface of the sacrum, below the ilium; and from the
lateral margin of all the bones of the coccyx.  The fibres  con- 
LIGAMENTS OF THE PELVIS.
277
verge, and are inserted into the spinous process of the ischium,
by embracing it.  The fibres constituting its base, have their
fasciculi separated by cellular adipose matter and by vessels,
and are also intermingled with the fibres of the coccygeus mus-
cle, and of the posterior sacro-sciatic ligament.
  The two sacro-sciatic ligaments supply, in some degree, the
place of bone, and form a part of the inferior lateral parietes of
the pelvis.   They convert the sciatic notch into a foramen, or,
rather,  form with it  two foramina; the upper and  larger of
which transmits the pyriformis  muscle, the sciatic nerve, and
the gluteal  blood  vessels;  while the  lower, placed  between
the insertion of the two  ligaments, transmits the obturator in-
ternus  muscle, and brings the internal pudic artery into  the
pelvis.

  The Obturator Ligament (Membrana Obturatoria) is extend-
ed across the foramen thyroideum, so as to close it  up, with
the exception of a foramen at its upper  part, for transmitting
the obturator vessels and nerves.   It is a thin, but strong mem-
brane, having its fasciculi of fibres passing in various directions,
and arising  from  the margin of the foramen.   It affords origin
to many of the  fibres of the obturator  muscles.  Sometimes
portions of it are defective.

  The Articulation of the Pubes is formed between the bodies
of the two  ossa pubis.  It consists principally in a fibro-carti-
laginous matter, which has a strong resemblance to that of the
vertebras.   When  the bones are torn  apart by bending them
forwards, the fibrous arrangement becomes very apparent, and
is seen to consist in concentric lamellas, the fibres of which cross
one another.  Sometimes in the  male, but  most frequently in
the female, the posterior third of the articulation is deprived of
these  fibres, in place  of which we find, in  the middle of  the
cartilage,  a  small  longitudinal cavity,  the surface of which is
smeared with a kind  of mucosity.  There is no central pulpy
matter in this articulation, as there is between the vertebras.  On
its posterior surface it often makes a ridge projecting into the
cavity of the pelvis.  From frequent  observations made in our
dissecting-rooms, I have no doubt  that this articulation is al-
ways  very much relaxed in the parturient and pregnant female,
  Vol. I.—24 
278                      SKELETON.
which is manifested not by the bones separating, but by their
sliding upwards and downwards with great readiness.  The sa-
cro-iliac junction also becomes relaxed.   It was upon the ob-
servation of these facts, that the clebrated, but now exploded,
Sigaultian operation was founded.

  The Anterior Pubic ligament is not very distinct.  It lies in
front of the last articulation, and consists in a few oblique and
transverse fibres going from the one bone to the other.

  The Sub or Inter-Pubic Ligament (Lig. Pubis  Inferius) oc-
cupies the summit  of the arch  of the pelvis.   It is of a trian-
gular  form, about half an inch in breadth, and passes from the
margin of. the crus of the pubes of  the one side, to a  corre-
sponding line on the other.   It is remarkably strong, and is ra-
ther more so below than above.  It seems rather an extension
of the ligament of the  symphysis pubis, than a distinct struc-
ture.
                   CHAPTER   VII.

             ARTICULATIONS OF THE  THORAX.

              Posterior Articulations of the Ribs.

  As mentioned, in the account of the bones, the articulations
here are double; being formed at one point between the heads
of the ribs and the bodies of the vertebras with the inter-verte-
bral matter; and at the other,between the tubercles of the ribs
and  the transverse processes.  In either  case the  respective
surfaces are  covered by articular cartilage, and have a syno-
vial  membrane.   The first joint is the Costo-vertebral, and the
second the Costo-transverse.

  1. The Costo-vertebral articulation presents an anterior liga-
ment, an inter-articular ligament, and two synovial membranes.
The Anterior or  Radiating Ligament, (Lig. Capituli  Costa- 
ARTICULATIONS OF THE THORAX.
279
rum,) is  fixed, as its name expresses, in front of the joint.  It
arises from the margin of the head of the  rib by the whole
breadth of the latter, and diverging towards the spine, is fixed,
by its superior fibres,  into the vertebra above; by its inferior
fibres, into the vertebra below; and, by its middle fibres, into
the inter-vertebral substance.   It  is a thin, flat, fibrous mem-
brane, leaving intervals in  it for the passage of blood vessels,
and  may, indeed, be considered as a capsule to the  articula-
tion, and is frequently described as such.   The inter-articular
ligament passes from the ridge on the head  of the rib, to a cor-
responding line  of the inter-vertebral  substance.   It is  short
and  strong, and  divides the articulation of  the head of the rib
into  two cavities, which  have  no communication.  It  is  in
consequence  of the latter,  that there are two synovial mem-
branes to the head of every rib which has a double articular
face; but the ribs which are articulated with a single vertebra,
as the first, the- eleventh, and  the  twelfth, have not the inter-
articular ligament, and, therefore,  only  one synovial mem-
brane.
  The synovial membranes are  not very apparent, neither is
the fluid abundant; the cavity is  occasionally very small from
the encroachment of the inter-articular ligament.   Anchylosis
occasionally  takes place here, but  it  is  much less frequent  than
in the anterior articulations of the  thorax.

  2. The Costo-transverse articulation has, in addition  to the
joint formed between the tubercle of the rib and the end of the
transverse  process, several ligamentous fasciculi which pass in
varied directions.
  Its synovial membrane is much more distinct than in the pre-
ceding articulation, and contains more synovia.   The joint is
more loose, and is never anchylosed, except by disease.   There
are a few fibres around it having the semblance of a capsule.
  The Internal Transverse Ligament  (Ligamentum  Transver-
sarium Internum, or Costo-Transversarium Inferius,) arises from
the inferior margin of  the  transverse process, between its root
and  external extremity, and  proceeding  downwards and in-
wards, is inserted into  the upper margin of the neck of the rib
below.   In many of the ribs there is a plane of  ligamentous
fibres parallel with this ligament, but just  behind, and arising 
280
SKELETON.
from a more posterior situation of the transverse process to go
to the neck of the rib, somewhat more towards the tubercle of
the latter.  It  is  designated by some writers as the posterior
transverse ligament, but the distinction between it and the lig.
trans, internum is so slight that it scarcely seems necessary to
consider them apart.  The  Internal Transverse Ligament is
much more conspicuous in  the  middle eight  ribs, and  in  ex-
tremely emaciated subjects; in  others, it is obscured by cellu-
lar adipose matter around the heads of the ribs.
  The External Transverse  Ligament (Ligamentum Transver-
sarium Externum, or Costo-Transversarium Posterius) is a well-
marked quadrangular plane of ligamentous fibres, placed on the
posterior surface of the costo-transverse articulation.   It arises
from the extremity of the  transverse  process, and going out-
wardly, is inserted into the  proximate rib, just beyond its arti-
cular tubercle.
  The Middle Costo-Transverse Ligament (Ligamentum  Cer-
vicum Coslarum, or Costo-Transversarium Medium) is extended
between and concealed by the neck of the rib and the contigu-
ous transverse process, and cannot be seen well without sepa-
rating them, or by sawing through their length.   It is a collec-
tion of fibres, somewhat irregular, resembling condensed cellu-
lar substance,  and slightly red.
  These posterior articulations all require  a patient dissection,
as they are surrounded  by small masses  of adipose matter,
have the intercostal nerves  and blood vessels in contact with
them before, and the muscles of the spine  behind.   The  liga-
ments  between the transverse  processes and the  ribs are, of
course,  not found in the eleventh  and twelfth, from the bones
not touching there.
  Besides what  has  been described,  an aponeurosis  or  liga-
mentous membrane is extended  from  the transverse process of
the first and second lumbar vertebras, to the inferior margin of
the last rib.   A ligamentous membrane is also found near the
spine, extended  between the contiguous  margins of  the  last
two ribs.
# 
ARTICULATIONS OF THE THORAX.             281
               Anterior Articulations of the Ribs.

   The surface of each pit in the side of the sternum is covered
 by a thin cartilaginous plate, to receive the corresponding car-
 tilage of the rib, and the articulation  presents an anterior and
 a posterior ligament, also a synovial capsule.

   The anterior ligament arises from the extremity of the car-
 tilage, and, going over the front of the sternum, radiates very
 considerably in every direction.  Some of its fibres are con-
 tinuous  with  the corresponding fibres of the  opposite  side;
 others are lost in the periosteum and in the tendinous origin of
 the great pectoral muscle; others join the fibres of the ligament
 above, and of that below.  The more superficial the fibres are,
 the longer they become;  but the more deeply seated pass only
 from the margin of the cartilage to the margin of the cavity in
 the sternum.  The thick ligamentous covering  found  on the
 front of the sternum, may be considered as only the continua-
 tion of these anterior ligaments.  The fibres from the two lower
 articulations on  the  opposite  side, form, by their  junction,  a
 striking triangular ligamentous plane, just On the lower end of
 the second bone of the sternum.  Besides which, there  are se-
 veral strong ligamentous fasciculi running in a great variety of
 directions.

   The posterior ligament has a similar arrangement with the
 anterior, in  the radiation  of its  fibres into  the contiguous liga-
 ments, and in their origin from the costal cartilage.  Altogether
 they form, on the posterior face of the sternum, a strong, smooth
 covering, the fibres of which do not run in fasciculi, but present
 a uniform polished membrane, and are closely interwoven with
 each other.  Some  of these  fibres are longitudinal, and, of
 course, cannot be referred to the posterior ligaments, but are
 independent of them.

  The synovial membrane, though  its existence is admitted, is
 not in a very distinct state.  It  scarcely gives a polish  to the
articular surfaces, and has so little looseness in  its reflection
from the one to the other, as to indicate clearly that but an in-
                           24* 
282
SKELETON.
considerable motion is admitted in these joints.   The  synovia
is in very small quantity, not abundant enough for satisfactory
examination, and its character is rather  inferred than proved.
The first cartilage  is continuous with the sternum, and not se-
parated from it by any joint, except in  rare instances.  The
second cartilage has its joint with the sternum,  separated into
two, one above and the other  below, by a  ligamentous parti-
tion resembling that at the heads of the ribs.  The lower arti-
culations become, successively, more moveable than the upper.
  Besides the attachments mentioned as connecting the carti-
lages of the true ribs to the sternum, there  is one  superadded
to the  seventh  cartilage, called  the Costo-Xiphoid  Ligament.
It arises from the inferior margin of the seventh cartilage, near
the sternum, and going obliquely downwards and  inwards, is
inserted into the anterior face  of the xiphoid cartilage, arid has
its upper fibres  running into the corresponding fibres of its fel-
low.  It is, of course, placed behind the rectus abdominis mus-
cle, and fills up, in some measure,  the angle between the  se-
venth cartilage  and the third bone of the sternum.
  At the surfaces where the sixth and seventh cartilages come
into contact by their edges, also the seventh and eighth, a sy-
novial membrane exists.  A similar articulation is  sometimes
found between the  fifth and sixth, and the eighth and ninth car-
tilages, but not uniformly.  These synovial  membranes are co-
vered by strong fibres.
  It has been already stated that the anterior extremity of each
of the first three cartilages of the  false  ribs, is  united by liga-
mentous fibres  to  the  cartilage  above.   These ligaments are
strong and extensive, and give great solidity to the  common
margin  of the cartilages.  The last two cartilages being much
smaller than the others, no ligaments pass from them; but they,
with their ribs, are held in their position by the  intercostal and
abdominal muscles.
  The cartilages adhere very closely to their respective ribs,
which receive them into the oblong  fossas, at their anterior ex-
tremities.  The periosteum of the  rib is continuous with the
perichondrium of  the cartilage, and the membrane, which  is
m fact,  one and the same, adheres very closely  to the margins
of the articulation; it is also re-enforced by some ligamentous
fibres beneath it.   No motion whatever  is admitted at this  ar-
ticulation. 
ARTICULATIONS OF THE UPPER EXTREMITIES.        283
                   CHAPTER  VIII.


    OF THE ARTICULATIONS OF THE UPPER EXTREMITIES.


             Of the Articulations of the Shoulder.

  These articulations consist in the junction of the clavicle to
the upper part of the sternum, and to the first rib; of the scapula
to the clavicle, and of the os humeri to the scapula.


           1. Of the Sterno-Clavicular Articulation.

  The uneven triangular face of the internal end of the clavicle,
and the concavity of the sternum, at its upper corner, form the
surfaces which enter into this articulation.  The first is  much
more extensive than the  articular surface of the sternum, pro-
jects on every side beyond its margins, and is very prominent
in case of extreme emaciation.  The two surfaces are covered
by cartilage, of which that on the clavicle is the thickest,  and
serves to fill up  its inequalities; while the one on the sternum is
thin and smooth.
   The joint is invested by a thick fibrous capsule, the anterior
portion of which presents a strong fasciculus of fibres, somewhat
separated by small interstices.  This portion, called by some
the radiated ligament, arises from the anterior extremity of the
clavicle, and, going downwards  and inwards, is  inserted  into
the margin of the  articular cavity of the sternum.   It is placed
just behind the origin of the sterno-cleido mastoid muscle. The
capsular ligament is also strengthened on its posterior surface
by additional  fibres, not  so distinct as the preceding, but ob-
taining the name of the posterior ligament.

   Of the Inter-Clavicular Ligament, (Lig. Inter-Clavicular e.)—
Closoly connected with the capsule of the  preceding joint, this 
284
SKELETON.
ligament is placed on the superior end of the sternum, and ex-
4ends from the internal end of one clavicle to that of the other.
It is flat before and behind, thin and  narrow, is blended with
the contiguous ligamentous structure of the sternum, and might,
with propriety, be considered only an  appendage to the capsu-
lar ligaments,- or a  process sent between them.   In front it
corresponds with the integuments, and behind with the sterno-
hyoid muscles.

   Of the Inter-Articular Cartilage.—When the capsule of the
joint is cut open, this is brought into view.  It separates the
bones completely from each other by its extent, and supplies by
its shape the want of correspondence  in their  articular faces.
It is thicker above than below;  its centre is thin, and sometimes
perforated.  Its margins adhere closely to the capsular ligament;
it is also fixed by adhesion to the upper posterior  margin of the
surface of the clavicle, and below to the union of the sternum
with the first rib? in consequence of which it has but little mo-
tion, and in  luxations must be lacerated.  Its structure is fibro-
cartilaginous.

   Of the Synovial Membranes.—There  are two of these, one on
each side of the inter-articular cartilage; in consequence of
which, a double cavity exists in this articulation, excepting the
cases where  the cartilage is perforated.   These membranes
contain but little synovia: they adhere closely to the adjoining
surfaces, and  cannot be made very distinct, except in points
where there are small interstices in the  capsule, when, by press-
ing the bones strongly together, they protrude in little vesicles.

   Of the Costo-Clavicular Articulation.—It consists  in a short
fasciculus of ligamentous fibres, frequently called the Rhomboid
Ligament, which, arising from the upper surface of the cartilage
of the first rib, ascends obliquely outwards, and is implanted into
the roughness on the inferior face of the clavicle, near its sternal
end.  Its fibres are parallel, all oblique,  and longer at its external
than at  its internal margin.   It corresponds in front with the
origin of the subclavius muscle, and behind with the subclavian
vein.   It has for its object the strengthening of the junction of
the clavicle with the sternum. 
           ARTICULATIONS OF THE UPPER EXTREMITIES.         285


          2.  Of the Scapulo-Clavicular Articulations.

  These exist at three places; the first by a junction between
the acromion scapulas and the external end of the clavicle;  and
the last two by ligaments sent from the coracoid process to the
under surface of the clavicle.

  The Acromio-Clavicular Articulation presents, on each bone,
a small oblong face, covered with cartilage.  The fibrous cap-
sule which invests it is very strong and thick, so as to give the
appearance of a much greater extent to the articular faces of
the bones than really exists.  This capsule is strengthened by
additional fibres on its  upper surface, passing from one bone to
the other, and sometimes called the superior ligament: they are
parallel to each other, and somewhat blended  with the tendi-
nous fibres of the deltoid and trapezius muscles.  The capsule
is also strengthened on its lower face, by additional fibres, con-
stituting the inferior ligament; they are not so abundant as the
superior, and pass from the margin of one bone to that of the
other, after the same manner.  A synovial  membrane is reflect-
ed over these articular surfaces, and  contains but a very small
quantity of fluid.  In some  instances, an  inter-articular  fibro-
cartilage is found in this joint;  as in the  sterno-clavicular; in
such case there is a double synovial membrane.

   Of the Coraco-Clavicular Ligament.—This ligament is double,
one part being called the Conoid (Lig. Conoides,) and the other,
the Trapezoid (Lig. Trapezoides.)  It arises from the roughness
at the root of the coracoid process, and is attached to the under
surface of the clavicle.  The conoidal portion, having its base
upwards, is inserted into the tubercle, near the external end of
the clavicle.  Its fibres are compact, strong, and diverging.  The
trapezoid is placed at the acromial side of the other.  It is qua-
drilateral, longer, broader and thinner than the other, having its
fibres separated by small interstices;  and  arising also from the
root of the coracoid process, it is inserted into an oblique  line
leading  from the  tubercle of the clavicle to its acromial  end.
The union of these two portions behind forms a projecting angle;
in front  there is a depression between them filled with fat  and 
286
SKELETON.
cellular substance, also a bursa mucosa.   These ligaments are
bounded in front by the subclavius, and behind by the trapezius
muscle.

  The Bifid Ligament (Ligamentum  Bicorne) is placed in front
of the subclavius muscle.   It arises from the root of the cora-
coid process, at the sternal side of  the conoid ligament; and
proceeding with but  little elevation,  inwards and upwards, in-
creases in breadth and  bifurcates.   The superior  horn  is in-
serted  along the under margin of the clavicle, to near the rhom-
boid or costo-clavicular ligament; but the lower one goes to
the  end of the first rib, under the tendon of the subclavius mus-
cle.  This ligament is a sort of fascia placed over the subclavius
muscle, to bind and strengthen it.*  Some of the fibres of the su-
perior  horn sometimes proceed farther, and leaving the clavicle,
go with the rhomboid ligament into the cartilage  of the first
rib.t

  The Coracoid Ligament (Lig. Coracoideum) stretches across
the notch on the superior  costa of the scapula, and converts it
into a foramen.  It runs from the posterior margin of the notch
to the  base of the coracoid process,  and has some  of its fibres
blending with the conoid ligament.   It consists of a small fasci-
culus of fibres, and is  of very little consequence, excepting in its
relation to the  superior scapular vessels and nerves.

  The Triangular Ligament (Coraco-Acromialis) of the Scapula,
as its name implies, extends from the coracoid  to the acromion
process above the shoulder joint.   It arises  from nearly the
whole  superior margin of  the coracoid process, in two divisions,
separated partially by cellular  tissue.  Its fibres converge in
their progress, by which it becomes  thicker, and is inserted into
the  point of the  acromion process, just beneath  its junction
with the clavicle.   This ligament is covered by the deltoid mus-
cle  and the clavicle, and has the supra-spinatus beneath it.  Its
anterior margin is continuous with a condensed cellular mem-
brane beneath the deltoid.

  •  This ligament is called the clavicular fascia by M. M. Velpeau and Blandin,
in their treatises on surgical anatomy.
  f Caldani, Plate XLI. 
           ARTICULATIONS OF THE UPPER EXTREMITIES.        287


            Of the Scapulo-Humeral Articulation.

  The glenoid  cavity of the scapula, and the head of the os
humeri form this joint.  As  usual,  each articular surface  is
covered with cartilage, of which that on the os humeri is thick-
er in the middle than near its circumference, while the reverse
occurs on the scapula.  From  the shallowness of the glenoid
cavity and the much greater  size of the head of the os humeri,
but very few points of their opposed surfaces  can come into
contact at the same moment,  though they may all do so in suc-
cession: hence,  a considerable portion of the head of the os hu-
meri is always against the capsule of the joint.  The remaining
parts  of this articulation are the capsular ligament, the synovial
membrane, and the glenoid ligament.

  The capsular ligament invests completely this joint, though it
is thinner in some places than at others.  It arises from the mar-
gin of the glenoid cavity, and is inserted into the neck of the os
humeri, including a larger space of the neck below, than it does
above.  The tendons of the muscles which arise from the ex-
ternal and internal  surface of the scapula, to be inserted into-
the tuberosities of the os humeri, as  they approach their points
of insertion adhere very closely to the capsular ligament, and
are, indeed, more  or less blended with it.   Bichat considers,
that the tendon of the sub-scapularis muscle  supplies the place
of the capsular  ligament entirely at  its  lower part.  This liga-
ment  is formed by fibres, which are very much intermixed with
one another, and have a greater degree of thickness above than
below, or, indeed, at any other point.   The former is due to a
thick  fasciculus, the Coraco-Humeral Ligament, also called by
some Ligamentum Adscititium, which takes its origin from the
posterior and external margin of the coracoid process,  and pro-
ceeding beneath the triangular ligament to the upper part of the
os humeri, joins the capsular ligament, and adheres very firmly
to it.  This ligament keeps the head of the os humeri on  its
proper level in regard  to the glenoid cavity; but the moment it
is cut, the length of the capsular ligament permits the head of
the os humeri to fall about an inch, and, indeed, to suffer a par-
tial dislocation.   The  strength of the  joint however depends 
288
SKELETON.
 essentially upon the muscles which surround it, as the deltoid,
 supra-spinatus, infra-spinatus, teres minor, sub-scapularis, long
 head of triceps, and  some others, which are farther removed
 from it.

   The synovial membrane  is a perfect  sac, which  covers the
 glenoid cavity, the  internal face of the capsular ligament, and
 the neck and head of the os humeri.   On the lower  part of the
 neck it is reflected over some small fatty masses, commonly called
 glands. Just beneath the root of the coracoid process, from there
 being a deficiency of the capsular ligament, the synovial mem-
 brane covers the articular side of the  tendon of the  sub-scapu-
 laris, and is reflected for ten or twelve lines, between it and the
 scapula, forming a  sort  of pouch, resembling a bursa mucosa.

   The tendon of the biceps muscle runs through this articulation
 from the superior end of the glenoid cavity.  The cavity itself is
 deepened by a fibrous margin all around, called the glenoid liga-
 ment; a considerable part of whose fibres may be traced from
 the tendon of the biceps by its bifurcating.  The tendon is bound
 down in the bicipital groove by fibres passing  from  one to the
 other of the bony  margins, and  which  may be considered a
 continuation of the  capsular ligament.  As the tendon is about
 emerging from the groove at the lower margin of the tuberosi-
 ties, the synovial membrane which lines the groove  thus far, is
 reflected from it, to the surface of the tendon, and continues to
 cover and enclose it up to the origin at the glenoid cavity. It is
 thus evident that though the tendon passes through  the joint,
 the cavity of the synovial membrane is kept entire.


                     Of the Elbow Joint.

  This articulation  is formed by  the lower end of the os hu-
 meri and the upper end of the ulna and of the radius.  The ar-
ticular faces which were described  in  the  account of these
 bones are covered, as usual, with cartilage, the particular ar-
rangement  of which will be presently pointed  out.  A strong
capsular ligament, an annular or coronary ligament, and a syno-
vial membrane, hold these several bones together.
  The Capsular Ligament invests completely the articular ex- 
           ARTICULATIONS OF THE UPPER EXTREMITIES.        289

tremities of these bones, and conceals them  from view.  It is
attached (o the sides of the os humeri at the lower part of its
condyles near the articular surface; but in front it arises some
distance from the articular face at the upper margins of the lit-
tle cavities, for the head of the radius and for the coronoid pro-
cess of the ulna: behind, it arises in like manner from the upper
margin of the cavity for receiving the olecranon process ; so
that the depressions, both before and behind, are included with-
in the circumference of the  articulation.  The  lower part of
the capsular ligament is inserted into the margin of the articu-
lar surface of the ulna, all around, including, also, the whole of
the  head of the radius, and the  upper part of its neck.
   This capsule is strengthened very much at particular points,
and  as the joint is  hinge-like, the  strengthening is  more  abun-
dant at its sides, constituting lateral ligaments.

   The external Lateral, or the Brachio Radial Ligament, (Lig.
Cubiti Externum,) is  connected above to the lower part of the
external condyle, and is fixed below into the  annular ligament
which surrounds the neck of the radius.  It is very much con-
founded with the tendinous mass common to the muscles at this
part of the arm, more particularly that  of the supinator radii
brevis. It is a round fasciculus of parallel and condensed fibres,
spreading somewhat below into  the annular or orbicular liga-
ment.  The Internal Lateral or the Brachio  Ulnar Ligament,
(Lig. Cubiti Internum) arises from  the lower part of the inter-
nal condyle, and spreading out so as to assume a triangular
shape, divides into two portions, one  of which is inserted into
the internal margin of the coronoid process of the ulna, and the
other into the internal margin of the olecranon process.   It also
is much blended with the tendons of the muscles which lie over
it.   Intermediately to the lateral ligaments, both before and be-
hind, the fibrous structure of the capsular ligament is very dis-
tinct, but  thin, in order to accommodate the motions of  the
joint; some of the fibres are insulated, and have interstices be-
tween them filled with fat.   Some of these fibres are  oblique,
and  others straight: they are called, generally, accessory liga-
ments.

  The Coronary Ligament of the Radius (Lig. Radii Orbiculare)
     Vol. I.—25 
290
SKELETON.
is brought more distinctly into view by cutting open the joint.  It
is then seen to arise from the anterior margin of the lesser sig-
moid cavity of the ulna, and surrounding two-thirds of the neck
of the radius, to be inserted into the posterior margin of the same
cavity.  It is a strong, flat, narrow fasciculus, the fibres of which
go in a circular direction.  Its superior margin is blended with the
external lateral ligament; its inferior margin is loose, being con-
nected with the lower part of the neck of the radius only by a
reflection of the synovial  membrane, with the exception that a
few fibres pass from it behind, to the contiguous part of the ulna.
Its density is very considerable, sometimes almost cartilaginous.

  The Synovial Membrane lines the whole internal face of the
capsular ligament, from which it is separated behind by  a large
mass of fat in the olecranon depression of the os humeri, and in
front by another mass in  the  coronoid depression.  A  small
circular ridge of fat also projects into the joint around the head
of the radius, and there is  another at the internal margin of the
olecranon.   The object of these masses seems to be to fill up
the partial vacancies which exist between  the  articular faces
of the bones, and they are all so directed by their attachment
to the capsular ligament, as to be preserved from being pinched.
The synovial membrane is also reflected from the  capsular li-
gament to the articular faces of the bones, so as to line the se-
veral depressions on the os humeri, and to include the neck of
the radius.

  The head of the radius is completely invested with cartilage.
The greater sigmoid cavity of the  ulna has the cartilage sepa-
rated transversely into two portions, by a small mass of fat
traversing its bottom.  The cartilage elsewhere is uniformly
spread over the articular surfaces of the bones.

  Of the Interosseal Ligament, (Membrana Interossea.)—It fills
up the space between the two bones of the fore arm almost en-
tirely, by  commencing just below the  tubercle of the  radius
and ending near the wrist.  It consists in oblique and parallel
fibres, which pass from the ulnar edge of the radius  downwards
to the radial edge of the ulna.   It is thin, but extremely strong,
being covered in front by the flexor muscles; and behind by the 
           ARTICULATIONS OF THE UPPER EXTREMITIES.         291

extensors, and, as Mr. Boyer observes, seems to be intended
rather to afford origin to muscles than to  unite the bones.  Its
superior part is thinner above, and a large opening exists there
for the passing of the interosseal vessels to the back of the fore
arm.   Its inferior part is  thicker,' where  openings  also exist,
but small, for the passing  of vessels.  There are some other
smaller perforations in this  ligament, but  of less note than the
preceding, also for vessels.   On its posterior face there are one
or two bands, the fibres of which decussate the other fibres.
   Beside  the interosseal ligament, there  is one  called round
(Teres,) situated obliquely  between the two bones at the upper
part of the interval which  separates them.  It arises from the
base of the coronoid process, just below  the  insertion of the
brachialis internus; and descending  obliquely outwards, is in-
serted into the radius below its tubercle.   Its  object is to bind
the bones together, at a point which is weakened by the  defi-
ciency of the interosseal ligament.  This deficiency is, in fact,
much larger than the simple passing of the vessels requires;
for it is also large enough to allow the tubercle of the radius to
rotate freely, a motion which would  have been checked by the
presence of the ligament.

               Of the Articulations of the Wrist.

   Several articular cavities present themselves  at this point.
One is between the lower part of the ulna and the radius, ano-
ther between the carpal bones and those of the fore arm, and
a  third between the two rows of carpal bones.  One  general
capsule invests these parts.

   1.  The Lower Radio-Ulnar Articulation—is  surrounded by a
section of the fibres belonging to the general capsular ligament
of the wrist: their attachment, however,  is so loose, that they
allow the bones to rotate freely upon each other, besides which
they are not  so abundant as in other places.   When this  joint
is  cut open, it will be seen  that the head of the ulna is  covered
with cartilage, and that the cartilage which covers the carpal
articular face of  the radius, projects between the ulna and the
os cuneiforme; and covers also the sigmoid cavity of the radius;
so that a  cavity for receiving the convex head of  the ulna  is 
292
SKELETON.
formed by the cartilage  of the radius.  The  margins of  this
projecting point of the radial cartilage are fibrous, which has
induced the French anatomists to  speak of it under the name
of triangular ligament.   It is, in  fact, an inter-articular  fibro-
cartilage, and is said  to be occasionally detached from the ra-
dius, but I have not seen it in that state:  its centre not unfre-
quently is perforated, so that a communication exists between
this joint and the next of the wrist.   Its margins adhere very
closely to the capsular ligament, and its point  is fixed  into the
depression which separates the styloid process of the ulna from
its head.  The synovial  membrane which  lines this cavity is
unusually loose, both  before and behind, in consequence of the
great motion of the bones: it is also very loose above.  This
joint is sometimes called the  Sacciform, from its looseness.

  2. Of the Radio-Carpal Articulation.—The radius above, and
the scaphoides, lunare, and cuneiforme below, form the basis of
this articulation.   An oblong, elliptical cavity, the ulnar extre-
mity of which is made by the projection of the cartilage of the
radius, receives the convexity of  the bones of the wrist.   The
scaphoides and the lunare come  in  contact with the radius,
while the cuneiforme  rests against  the projecting  cartilage.
There is a slight elevation of the radial cartilage opposite to
the interstice between the first two bones.  The oblong ellipti-
cal cavity is filled by  a corresponding  head, on the part of the
bones of the carpus just enumerated.   Each of the latter bones,
in a fresh state, is covered by its  appropriate cartilage.   The
cartilages are connected, or rather continued into one another,
by a narrow fibro-cartilaginous substance placed at the margin
of the interstice between these bones. This substance sepa-
rates the cavity of the radio-carpal articulation from that of the
proper carpal articulation.

  The Capsular Ligament arises, before  and behind, around
the margin of the articular face of the bones of the fore arm,
from the styloid process of the radius to that of the ulna,  ad-
hering very closely to the margins of  the  fibro-cartilage insi-
nuated between the ulna and the   cuneiforme.   It is inserted
belowT, into the circumference of the head formed by the sca-
phoides, lunare, and cuneiforme, though many of its fibres may 
           ARTICULATIONS OF THE UPPER EXTREMITIES.        293

be traced to the bones of the second  row.   It is a loose and
thin membrane, the fibrous fasciculi of which leave interstices
at several points between  them, through  which the synovial
membrane may be seen.  The capsular ligament is strengthened
at particular places, by additional fasciculi of fibres having ap-
propriate names.  For example, the  internal lateral ligament
arises from the styloid process of the  ulna, and is inserted into
the cuneiforme, some of its fibres being extended to the ante-
rior annular ligament, and to the  pisiforme.  The external la-
teral ligament arises from the styloid process of the radius, and
is inserted into the radial end  of  the  scaphoides; some of its
fibres being continued on to the trapezium,  and to the anterior
annular ligament.   The anterior ligament arises from the vici-
nity of the styloid process of the radius, and passing obliquely
downwards and inwards, is inserted  into the anterior face of
the scaphoides, lunare, and cuneiforme.  Its fibres are not very
evident or well marked.  The posterior  ligament is not so
broad as the last, and is more distinct.  It also arises from the
radius, by and near its styloid process, and descending oblique-
ly inwards, is  inserted into the lunare  and cuneiforme.  The
last two  ligaments have no connexion with the ulna, the rota-
tion of the fore arm is, therefore,  unimpeded by them.

   The synovial membrane of the  radio-carpal articulation  is
displayed on the articular faces of the bones and their interme-
diate fibro-cartilage, and lines the internal face of the capsular
ligament.  When the joint is pressed upon, this  membrane  is
protruded, in the form of little vesicles, in the interstices be-
tween the fasciculi of the capsular ligament.   A fold of it con-
taining a small quantity of adipose matter is observed on the
back of the cavity of the joint, passing from the junction of the
scaphoides and lunare to  the corresponding point of the radius;
it  is the ligamentum mucosum of some writers.

   3. Of the Articulation between the two rows of the  Carpal Bones.
—The scaphoides, lunare, and cuneiforme of the  first row, and
all the bones of the second row, are the foundation of this joint,
the surfaces of which have been  described already.  These
surfaces  are covered with cartilage, each bone having its ap-
propriate cartilage, which is continued on  its  side where the
                           25* 
294                     SKELETON.
i
bone touches-the adjacent one.  The joint is furnished with a
capsular ligament and a synovial membrane.

  The Capsular Ligament surrounds the articulation, passing
on every side from the upper to  the lower row, and adhering
strongly to the bones.  It is in a great degree a continuation
of the capsule of the radio-carpal joint, and has, at the same
points, an increase of thickness, called after the same names.
The internal lateral ligament is attached by one end to the cu-
neiforme, and by the other to the side  of the unciforme.  The
external lateral ligament arises from the extremity of the sca-
phoides, and is inserted into the side of the trapezium.  The
posterior and anterior ligaments have the course of their fibres
more distinctly seen  on the side of the  synovial  membrane.
The first consists in many fibres arising from the bones of the
first row and going to the second row; its  fibres  are  shorter
and more compact.  The anterior arises and is inserted  after
the same way, some of them terminating in the anterior liga-
ments of the hand.

   The Synovial Membrane is not only displayed on the oppo-
site surfaces of the two carpal rows, but also is reflected upon
the lateral faces of the bones belonging to each row.  It, there-
fore, sends processes, two of which are found, above; one be-
tween the scaphoides and the lunare, and the other  between
the lunare and cuneiforme.   These processes are arrested at
their upper extremities by the  fibro-cartilaginous  matter  be-
tween the bones, which was spoken of in the radio-carpal ar-
ticulation.  It also sends three processes downwards, one  be-
tween the trapezium and the trapezoides, another  between the
latter and the  magnum, and the  third between the magnum and
the unciforme.  Those latter processes communicate with  or
are continuous with the synovial  membrane, between the car-
pal and Liie metacarpal bones of the fingers.*   The connexions
and reflections of this membrane  are of the  greatest impor-
tance, as they form a communication from the top  of the wrist
to the base of the metacarpal bones; not only covering the ar-
ticular surfaces, but  being prolonged in some instances beyond
* Bichat, Anat. Descr. 
           ARTICULATIONS OF THE UPPER EXTREMITIES.       295

them, as on the back of the os magnum, where it answers  as
a periosteum.
  In addition  to  the articulation just described, between the
two rows qf carpal bones, the individual bones of each row have
partioular fastenings of ligamentous fibres,  which run  trans-
versely from the margin of one bone to the margin of the next.
These fibres, from their position, are called dorsal and palmar
ligaments.   The  upper row has one dorsal  ligament between
the scaphoid and lunar, and another between the latter and the
cuneiform—it has in the  same way two palmar ligaments  on
its front surface.  The lower row has, after  the same plan,
three dorsal and  three palmar  ligaments between  its bones.
These several ligaments are best seen on the side of the syno-
vial membrane, as externally  their fibres are very much mixed
with those  of the capsular  ligament.  It  is obvious  that they
are highly useful in preventing the  bones from  sliding laterally
on each other, except to a  small extent.
  The  Pisiform Bone  has  an articulation with the  cuneiform
completely  distinct from  any other.  The  articular faces of
this joint are covered with cartilage and invested by  a synovial
membrane  and  a capsular ligament, which allow, from their
looseness, considerable motion.  The capsule,  though general-
ly thin, is  strengthened  by accessory fibres,  which are well
marked below.  These fibres arising from the inferior extremi-
ty of the pisiform, some of them are attached to the extremity
of the unciform  process of the os unciforme, and others to the
base of the  fifth  metacarpal bone.   The insertion of the tendon
of the flexor carpi ulnaris answers as a ligament to this bone
above, and there is a very strong fasciculus of ligament, passing
from the pisiforme to the end of the unciform  process, and by
that means conveying  the action of. the flexor ulnaris to it.  It
has but little motion from above downwards, and a good deal
laterally.

            Of the Carpo-Metacarpal Articulations.

   The  bony articular  surfaces, here, as well as all  the  others
of the hand, have been sufficiently described and are in the recent
state covered with cartilage.   It will therefore be unnecessary
to renew the observations on these subjects. 
296
SKELET6N.
   The first of these articulations, or that of the metacarpal
bone of the thumb, with the trapezium,  is much more movea-
ble than any of the others, and presents some peculiarities.  It
is entirely distinct, slightly removed from the next, and is sur-
rounded by a capsule which is attached by its ends to the ar-
ticular margins of the bones.  This capsule is strengthened by
additional fibres, which are particularly distinct and abundant,
posteriorly  and externally.   The  synovial membrane is dis-
played, as usual, on the internal face of the capsule, and over
the articular faces.
   The other four metacarpal bones are articulated as follows:
The second one is joined to the trapezoides, trapezium, and mag-
num—the third unites to the  magnum alone—the fourth  to the
unciform, with a small  portion of the magnum—and the fifth
to the unciform.   The ligaments are placed before and behind,
and may also be termed dorsal and palmar.

   The dorsal ligaments descend from the carpal to the metacar-
pal bones.  The second metacarpal bone receives two ligaments,
one from  the trapezium, and another from the trapezoides—
the third receives  one from the  magnum—the fourth receives
two, one from the  magnum, and the other from the unciform—
the fifth receives  one from the unciform.  Transverse  fibres
pass between these dorsal ligaments to connect the bases  of the
metacarpal bones.
   The palmar ligaments are arranged on a plan corresponding
with that of the dorsal; but, from the length of  their superficial
fibres, are  not so distinct from each other.  Transverse  fibres
pass also between the metacarpal bones of the  fingers at their
base,  and form interosseous  ligaments   which keep  them to-
gether.
  The articulations thus formed and held together, are covered
by two synovial membranes, being processes from that between
the two rows of carpal bones.  One of these processes, sent  down
between the trapezoides  and the  magnum, displays itself over
the inferior surface of these bones and the head of the metacar-
pal bone of the fore and of the middle  finger.  The second pro-
cess which is sent down between the magnum and the unciforme,
is  reflected  over the two last carpo-metacarpal articulations.
These processes have a septum between  them, at the ulnar side 
           ARTICULATIONS OF THE UPPER EXTREMITIES.       297

of the base of the third metacarpal bone, and do not communi-
cate with each other, except through the proper carpal articu-
lation.   The specification of this arrangement is overlooked by
anatomists generally.

  The Inferior Palmar Ligaments are three in number, and are
between the lower ends of the metacarpal bones of the fingers,
each one consists in a transverse fasciculus, placed between the
flexor tendons and the interosseous muscles,  and on a level
with the anterior part of the first joint of the fingers.  Their
more superficial  fibres may be traced across the bones, and are
somewhat blended witb. the capsular ligaments; the more deep-
seated are short, and pass from one bone to the other.


         Of the  Metacarpo-Phalangial Articulations.

  These are formed by the lower ends of the metacarpal bones,
and the upper ends of the first phalanges.   Each one presents
an anterior  ligament, two lateral  ones, and a synovial mem-
brane.
  The anterior Ligament*  is a flat fibrous semicircle, on the
front of the articulation, of considerable thickness.  It goes trans-
versely, and has its two  extremities attached to the  ridge on
either side of the articular margin of the metacarpal bone.  Its
inferior margin descends  a little, and comes in contact with the
synovial membrane.   In  front, many of its  fibres are obtained
from the ligamento-cartilaginous sheath of the flexor tendons,
so that it may be considered as made by two planes—the pal-
mar one facing towards the tendons, and forming the trochlea,
in which they play, and the other being next to the joint, and
continued to the  lateral ligaments.   The thickness of the ante-
rior ligament, besides communicating great  strength to the joint
is useful in removing the  tendons from the line of motion of the
phalanges, and thereby giving increased power and delicacy of
motion to  the muscles.  Bichat  considers himself to have first
indicated particularly this structure, which  he thought was in-
tended to protect the articulation from the impression of the ten-
don: he ought to have added, in the firm grasping of bodies, and
to make the movements of the joint more delicate.   On the sides
* Bichat, loc. cit. 
298
SKELETON.
of this ligament belonging to  the thumb, and in its  thickness,
are developed the sesamoid bones.

  The Lateral Ligaments are situated one on each side.  They
arise from the  sides of the metacarpal bone behind the former,
and in connexion with it, and, descending obliquely forwards, are
fixed into the sides of the upper end of the first phalanx.   They
are round, distinct, and strong, and are formed  from numerous
parallel fibres.

  The Synovial Membrane lines this articulation,being displayed
over its lateral and anterior ligaments, and on the articular faces
of the bones.   It is reflected on the metacarpal bone, some little
distance from the  margin of its cartilage in front, whereby the
cavity is enlarged, and the flexion of the fingers  is favoured.   It
is in contact, behind, with the tendon of the  extensor  muscle,
which there supplies the place of ligament.
               Of the Phalangial Articulations.

  There are  two of these to each  finger, and one only to the
thumb.  They are provided with an anterior ligament, a lateral
ligament on each side, and a synovial membrane.

  The anterior Ligament corresponds so exactly with what has
been said in the preceding article on  the same structure, that,
with the exception of its being smaller, the description already
given, will  suffice.  It seems to answer, in every respect, the
same objects.

  The Lateral Ligaments, also, arising from the sides of the pha-
lanx above, run downwards and somewhat forwards to be insert-
ed into the  upper part of the sides of the phalanx below.

  The  Synovial Membrane has reflections corresponding with
those of the preceding articulations, with the addition that it co-
vers more of  the anterior inferior face of the first and second
phalanges.  Thus, by cutting  through the  anterior ligament,
longitudinally, and turning it aside, it will be seen that the cavity 
           ARTICULATIONS OF THE LOWER EXTREMITIES.       299

of the second and third joints of the finger is, by this reflection
of the synovial membrane, extended upwards between the pha-
lanx and the flexor tendons nearly one-third of the whole length
of the phalanx,* a circumstance worth attending to in the ac-
cidents of the  part.
                    CHAPTER IX.

   OF THE ARTICULATIONS OF THE LOWER EXTREMITIES.

           Of the Mo-Femoral, or Hip Articulation.

  The basis of this articulation is laid by the head of the os fe-
moris being received into the acetabulum.   Both  surfaces are
covered by thick cartilage: in the former it is interrupted, how-
ever, by the depression near  the centre, and becomes very thin
near the margin;  and, in the latter, the cartilage is deficient in
the whole extent of the rough surface at  its lower part.  A
cotyloid ligament, a  fibrous  capsule, the round or inter-articu-
lar ligament, and  a  synovial membrane,  are  moreover, con-
cerned in  this joint.

  The Cotyloid Ligament (Lig. Cotyloideum) is a  fibrous  pris-
matic ring which  tips the margin of the acetabulum, and there-
by increases its depth; it can only be seen  by cutting open the
capsule.   Its thickness  is unequal, being  considerable  on the
anterior third of the  circumference of the acetabulum, where
it assists in converting the  notch into a  foramen, but not  so
much so elsewhere.  Just below the anterior  inferior spinous
process, the acetabular head of the rectus femoris sends some
tendinous  fibres to it.   Its base is broader  than its margin, and
is  marked off from the articular  cartilage by a line, or narrow
groove, between them.  Its  acetabular side is  covered by the
synovial membrane;  the other  side  has the capsular ligament
* Bichat, loc. cit. 
300
SKELETON.
 adhering to it; and the third side adheres to the bone.   Where
 it subtends the notch of the acetabulum, the cotyloid ligament
 is re-enforced by additional ligamentous fibres, placed beneath
 it, and going from  the upper  to the lower end of the  notch.
 These fibres consist of two planes, one internal and the other
 external, partly crossing  each other, and  adhering closely to
 tbe cotyloid ligament.

   The  Inter-Articular, or Round  Ligament, (Lig. Teres,) is a
 true ligamentous band, which is attached at the one end to the
 pit on the head of the os femoris, and afterwards by a  slight
 dissection, is easily separated into two fasciculi.  Of these, the
 lower one  may be  traced to the inferior end  of the cotyloid
 notch, where, winding around the prominence of bone, it begins
 to adhere  to  the  ischium, and continues to  do so from  that
 point along the anterior  face of  the  ischium, just below the
 acetabulum, to a  point between the latter  and  the upper ante-
 rior part of the tuber.  The other portion  is directed towards
 the superior end of the notch, and is attached there by two ex-
 tremities, one near  the margin of the acetabulum, and the other
 three or four lines  from  it within.* The fibres of the round
 ligament are somewhat intermixed also with those of the coty-
 loid ligament subtending the notch.

   The Capsular Ligament (Capsula Fibrosa) is  the strongest in
 the body, and represents a conoidal sac, open at both extremi-
 ties, by which it adheres to the bones.   It  is  fixed by its base
 to the circumference  of the acetabulum, beyond  the  cotyloid
 ligament, and to this ligament itself, where the latter subtends
 the notch.   It embraces that part of the head of the os femoris
 which projects above the margin  of the acetabulum, and de-
 scends along the neck to its root.   It is longer in front; is fixed
 there to the oblique line which runs between the two trochan-
ters, and, behind, into the root of the neck, a little in advance
of the posterior oblique ridge, and in such a  manner as to leave
a small part of the neck of the os femoris bare below it. Above,
it is fixed to the neck, just below the rough fossa  in  the  tro-
chanter  major; and on the under surface of  the neck it adheres.
* Antonius et Caldani, Tubula II. 
            ARTICULATIONS OF THE LOWER EXTREMITIES.        301

just above the trochanter minor.  It is strengthened in several
places by processes from the fascia lata femoris, which descend
to it between the muscles surrounding the hip joint.*  Its thick-
ness is  considerable,  but variable.   In front, and  above, it is
remarkably strong, is two or three lines thick, where  it is  re-
enforced by a large fasciculus  of  fibres coming from the ante-
rior inferior spinous process of the  ilium, and descending, lon-
gitudinally,  to  the anterior oblique ridge of the  os  femoris.
The internal and posterior portions of the orbicular or  capsular
ligament are not so thick; it is, indeed, very thin near the pos-
terior ridge of the os femoris, not more  than half a  line, and
has a number of holes in it for  the  passage of vessels.  It is
strengthened, internally, by some fibres coming from the supe-
rior margin of the thyroid foramen.
   This capsular ligament keeps the bones  closely applied  to
each other,  and is by no means so  loose as the corresponding
one of  the shoulder joint.  Its  fibres are very irregular, gene-
rally, in their course, and difficult to follow.
   The  strength  of this articulation  depends principally on  the
muscles which surround it, of  which the  rectus femoris, and
the iliacus internus and psoas magnus united, are in front;  be-
tween  the  latter  two and  the capsule,  is a  bursa  mucosa.
Within, are the pectineus and the obturator externus; behind,
are the quadratus, the gemini,  the obturator internus, and  the
pyramidalis; above and behind, are  the glutei.

   The  Synovial Membrane is  a complete sac, displayed over
the articular surfaces of the bones, and the internal face of the

  * Soemmering, De Corp. Hum. Fabrica, vol. ii. p. 61, 1794  Andrew Fyfe,
Compendium of Anat Philad. 1807, vol. i. p. 179.
  For an interesting account of the connexion  of this capsule with the f scia fe-
moris, see Anatomical Investigations,  by J.  D. Godman, M.  U., Philad. 1824.
The author, in following the sheaths of  the muscles, or,  in other words, the  pro-
cesses of the fascia lata, between the muscles, to the capsule, with great attention,
has been brought to the conclusion that thra capsule is formed entirely from tlem,
He has presented the same views  in regard  to the shoulder joint, and others
Though not disposed to concur in so general an inference on the source of  cap-
sular ligaments, inasmuch  as their peculiar texture is opposed  to it, and many
other circumstances in their anatomical arrangement, I  have  yet  to express
great satisfaction in the fidelity with which these connexions of the larger joints
have been traced.
   Y^ql. I.—26 
302
SKELETON.
 capsule.  It is separated from the roughness at the bottom of
 the acetabulum, by the existence there of a pad of very vascu-
 lar, fine, fatty matter, from which, according to Bichat, it may
 be raised by blowing beneath the ligament of the notch, at the
 point where the blood vessels enter.  Coming from the aceta-
 bulum, it covers the articular face of the cotyloid ligament, and
 is then reflected to the capsule, to which it gives a polished in-
 ternal face, and from which it may be dissected. On reaching
 the root of the neck of the os femoris, it forms small duplica-
 tures, and  is reflected  upwards along the  neck to the head,
 being separated from the neck by periosteum, or by a fibrous
 tissue, which M. Boyer considers a continuation of the capsule.
 It covers all the head, except the point of attachment for  the
 round ligament, and to the latter it  gives a  sheath, which, at
 the other end, is continuous with the part of the synovial mem-
 brane covering the fatty matter. From the latter circumstance,
 arises a deceptive appearance of the round ligament being in-
 serted into the  roughness in the bottom of the acetabulum.*


                       Of the Knee Joint.

    It is formed by the os femoris, the tibia, and the patella,  the
 particular modelling of whose  surfaces,  for  the purpose, has
 been  described.   These surfaces are all covered by a uniform
 lamina of cartilage, and  are held together  by an  apparatus
 which for the number of its parts and their arrangement, makes
 this the most composite joint  in the skeleton.
   The most superficial layer  of the knee joint is the fascia lata
 of the lower extremity, which, in passing  down from the thigh
 (o the leg, is so near the  cavity of the  articulation on each side
 of the tendon of the patella, that it is by Weitbrecht spoken of
 under the term of  Common Investment (Involucrum Generate.)
 It is here not only  a continuation of the fascia femoris, but this

  * I have found, in one instance, Dec. 10, 1838, the capsular ligament of this
joint with a large opening, nine by eighteen lines, in front, and the synovial
membrane communicating through it with the bursa between the trochlea of the
ilium and Ihe iliacus internus muscle.  A similar arrangement existed on both
sides of the body, every thing else being normal.  Such a condition must, of
course, favour, under suitable circumstances, the internal  dislocation of the  os
 emoris.  It was repeated in another subject, Jan, 2, 1839. 
           ARTICULATIONS OF THE LOWER EXTREMITIES.        303

fascia  is increased and thickened by an  aponeurosis, which
springs from the inferior extremity of the extensor muscles on
the thigh.  The membrane thus formed covers both the patella
and its ligament, and extends on each  side  to the lateral liga-
ments  of the joint, to which it adheres;  it may be traced even
behind them, but there it becomes  indistinct, loose, and blended
with common cellular and  adipose  membrane.  The  involu-
crum adheres strongly to the internal and  external condyle?,
and to the  head of the tibia; it has oblique fibres on the patella,
transverse  ones on the ligament of the latter, and longitudinal
ones on each side.   It  is in  contact with the synovial mem-
brane of the joint, except in  the middle portion, where it is se-
parated from it  by the patella, and its tendon, and some adi-
pose matter.   It may be dissected without difficulty from the
subjacent parts, by which the ligament of the  patella, and the
synovial  membrane are brought into view.

  The Ligament of the Patella being situated  at  the fore part
of the  articulation, though separated from the extensor muscles
by the intervention of the patella, is, neverlhless, their tendinous
insertion into the leg.   It arises from the whole inferior margin
of the  patella, and  is inserted into the tubercle of  the tibia.   It
consists in  longitudinal, closely compacted fibres, of a character
entirely tendinous; the more superficial of them give a layer to
the front of the patella, and in the  fracture of the latter some-
times prevent a separation of its fragments.  In front, as  just
mentioned,  it is in contact with the involucrum generale; behind,
is a large mass of fat placed between it and the synovial mem-
brane of the joint; and  on the same surface, but lower down, it
is in contact with a bursa mucosa fixed between it and the tri-
angular flatness of the tibia above the tubercle.

  A posterior ligament, an internal and an external lateral liga-
ment, two  crucial  ligaments, two  semi-lunar cartilages, and a
synovial  membrane, compose the  remaining apparatus of the
joint.

  The Posterior Ligament (Lig. Poslicum,) is a fibrous expan-
sion on the  back of the knee joint, which may be considered as
the proper capsular ligament at this point, and has its fibres ex- 
304
SKELETON.
 tending obliquely from the external condyle of the os femoris
 to the posterior part of the head of the tibia.  It is frequently
 called the ligament of Winslow, and by the French anatomists
 is considered as one of the divisions of the tendinous insertion of
 the semi-membranosus muscle, in consequence of its close con-
 nexion with it.  There are several foramina or interstices in it,
 which  permit  a passage of blood vessels  to the fatty matter
 placed between it and the crucial ligaments; and  beneath it
 there are some transverse  fibres.

   The Internal Lateral Ligament (Lig. X>alerale Internum)  is a
 flattened  fasciculus of fibres placed at the internal side of the
 joint.   It arises from the tuberosity on the  inner side of the in-
 ternal condyle, and descending vertically is slightly attached to
 the inner semi-lunar cartilage, and is then  inserted into the su-
 perior margin  and the internal face of the head of the tibia for
 two inches or more, increasing in breadth as it descends.  On
 the one side it  is in contact with the synovial membrane, and on
 the other, with the involucrum and the tendon of the sartorius,
 the semi-tendinosus, and the gracilis.

   The External Lateral Ligament (Lig.  Laterale Externum
 Longum,) placed on  the external side of the joint, is nearer  its
 posterior  face  than the  internal ligament.  It arises from  the
 tuberosity on the outer face of the external  condyle, above and
 behind the tendinous origin of the popliteus muscle, and  is in-
 serted into the  external part of the superior extremity of the
 fibula, being covered in  almost its whole extent  by the tendon
 of the biceps.   Its inner face is in contact with the synovial
 membrane, and the articular vessels.  Its  rounded form and
 shining appearance make it look very much like a tendon.  Be-
 hind it, occasionally, is a small fasciculus, called by some the
 short external lateral ligament, which passes from the external
 condyle to the head of the tibia.

  The Crucial Ligaments  (Lig. Cruciata,) two in number, are
 named from their crossing  one another laterally, and thereby
 forming a figure, resembling the letter X,  or a Malta cross.
They are situated at  the posterior part of the articulation be-
 tween the posterior ligament and the synovial membrane.  One 
           ARTICULATIONS OF THE LOWER EXTREMITIES.       305

of them is called anterior, and the other posterior, from their re-
lative situations to each other.   The first arises from the inter-
nal face of the external condyle, by a depression near the bot-
tom of the notch and just at the margin of the articular surface;
it descends  forwards, and is  inserted immediately in front  of
the little ridge between the articular  faces of the tibia.   The
second arises from the bottom of the notch between the condyles,
just behind the trochlea for the patella, upon a surface that  may
be considered as belonging to the internal condyle: it descends
backwards, and is inserted into the rough surface behind the
aforesaid  spine or ridge of the tibia.  The crucial ligaments are
large, round, and composed of parallel fibres very closely com-
pacted; their strength is very considerable, and they serve not
only to limit the extension of the leg, but  also  to cheek  any
thing like rotation inwards.
   The Semilunar Cartilages  (Cartilagines Semilunares,  fal-
cata,) are two in number; one placed  on either side of the su-
perior face of the tibia, between it and the condyles  of the os
femoris.   Their shape is  sufficiently indicated by their names,
and as they are placed on the circumference of each articular
surface of the tibia, leaving the middle uncovered, they increase
considerably the depth of the concavities for receiving the con-
dyles.   Their external circumference is thick, whereas, the in-
ternal is reduced by a gradual diminution of their thickness, to
a very thin edge.   The internal cartilage is but little more than
a semicircle, and is longer in its antero-posterior diameter than
in its transverse: on the other hand, the external is almost cir-
cular ;  an arrangement by which each  is suited to its respective
surface.   They adhere by their greater circumferences to the
fibrous matter surrounding the joint, particularly the lateral li-
gaments,  but not so  closely as to  prevent  their sliding back-
wards  and forwards in the flexions of  the leg.   The  tendon of
the popliteus adheres to  the external,  either directly  or by the
intervention of a small synovial sac.
  The internal semilunar cartilage is  attached by its fore ex-
tremity  to the anterior internal side of the roughness in front of
the ridge, called spinous process, on the top of the tibia, and by
the hind extremity to the posterior face of the base of the ridge,
just in ad vance of the posterior crucial  ligament.  The external
cartilage  is attached by its anterior end, also, to the roughness
                            26* 
306
SKELETON.
 in front of the ridge; but this attachment is considerably behind
 the corresponding one of the internal cartilage, and is somewhat
 blended with the anterior crucial ligament: the posterior end is
 fixed into the depression on the summit of the ridge or spinous
 process, and is there between the two crucial ligaments.  The
 anterior extremities of the two cartilages are united by a trans-
 verse ligamentous fasciculus a line in thickness, which is rather
 inconstant; but when found, is in front of the anterior crucial
 ligament.  These bodies, though presenting an appearance cor-
 responding with cartilages, on their surface, are, nevertheless,
 formed principally from concentric ligamentous fibres; the cha-
 racter of which is  very evident at their extremities, and when
 ihey are lacerated.

   The Synovial Membrane is thin,  loose, and delicate, and, as
 in other joints, is a perfect bag, covering the articular faces of
 the bones,  and  reflected from the one to the other.  As there is
 no  regular capsular ligament to the knee joint, the synovial
 membrane is very distinct on each side of the tendon of the pa-
 tella ; and comes in contact there with the fascia lata, or involu-
 crum, as it passes from the thigh to the leg.  The synovial mem-
 brane, after covering the articular faces of the tibia, is reflected
 from their  margin upon  the semilunar cartilages  so as to invest
 their inferior and superior surfaces; it then ascends to the con-
 dyles of the os femoris.  It  covers  the condyles, laterally, as
 well as on their articular faces, and leaves thereby half an inch
 or more of their circumference on each side of the  trochlea of
 tfie patella, included in the periphery  of  the joint.  The syno-
 vial membrane, anteriorly, being separated from  the tendon of
 ihe patella, by  the large mass of fat,  then covers the  posterior
 face of the patella, and, rising up still farther, lines the  posterior
 face of the tendons  of fhe extensor muscles for the  distance of
 three inches or thereabouts.   The superior end of this reflection
 is formed into a small pouch, communicating freely  with the
 general cavity, but  marked off from it by a partial and variable
 septum on  each side.  Some anatomists  consider the  pouch as
 a bursa, but it is so seldom  seen entirely distinct from  the joint,
 that it answers  "better  to describe it as  a part only of the  o-ene-
 ral reflection.   The synovial membrane, at the sides of the joint,
is in contact with the lateral ligaments,  Behind, it is  reflected 
           ARTICULATIONS OF THE LOWER EXTREMITIES.        307

on the anterior surface of the tendinous origins of the gastroc-
nemius, and envelops the tendon of the popliteus; it also invests
the crucial ligaments, but in such  a way as to leave them out
of its cavity.
  The mass of fat behind the tendon of the patella forms, just
below the latter, a ridge on each side, protruding into the arti-
culation, and having a fringed summit formed by a doubling of
the synovial membrane.   The external ridge is the Ligamentum
Alare Minus Externum, and the other the Ligamentum Alare
Majus Internum.  These ridges converge at their lower extre-
mities, and from their point of union proceeds a duplicature of
the synovial membrane, in front of the anterior crucial ligament;
the other end of the duplicature is  attached to the posterier ex-
tremity of the  groove, in the middle of the trochlea, for  the pa-
tella.   This duplicature is the Mucous Ligament, (Ligamentum
Mucosum.)

             Of the Peroneo-Tibial Articulation.

  The tibia and fibula  are held together by three places of
union, one above, another below; and,  thirdly, the ligament
which fills  up  the space between the bodies of the bones.

   1.  The Superior Articulation, formed by the upper extremity
of the fibula and the outer side of the head of the tibia, is entire-
ly disconnected with the cavity of the knee joint, and  has no-
thing in  common with its apparatus, except the external lateral
ligament, which has been described.   The  articular  faces are
small, and covered with cartilage; an anterior and a posterior
ligament, and  a synovial membrane, hold the bones together at
this point.
  The anterior ligament is attached by one end to fhe  front of
the head of the fibula, and proceeding upwards and inwards, is
inserted  by the other into the contiguous  part of the head of
the tibia, before the articular facet.  The fibres are separated
into fasciculi, leaving interstices between them for cellular sub-
stance.
  The posterior ligament is narrower than the anterior, but its
fibres are more compact; and, like the anterior, they observe a
transverse course, being attached by the one end to the head of
the fibula, and, by the other, to the  head of the tibia.  The pop- 
308
SKELETON.
 liteus muscle covers them.  This joint is also strengthened by
 other ligamentous fibres, and by the insertion of the tendon of
 the biceps.
   The synovial membrane is reflected over the  articular faces
 and the ligaments described, and has nothing of particular inte-
 rest in it.  Occasionally, the synovial membrane of the  knee
 joint runs into it.

   2. The Inferior Articulation, which  is formed between the
 lower extremities of the bones, is not incrusted by cartilage, ex-
 cept to the breadth of a line at its lower  part, bordering on the
 ankle joint.
   Its anterior ligament is  broad, and covers the face of the
 bones which are in apposition.  Attached by the one side to
 the front of the lower extremity of the fibula, its  fibres pass ob-
 liquely upwards and inwards, to be inserted into the correspond-
 ing part of the tibia.  Several interstices exist in it for the pas-
 sage of vessels,  and it is covered by the  peroneus tertius.   Its
 lower margin is in contact with the astragalus, and forms a por-
 tion of the ankle joint.
   The posterior ligament, in the arrangement and course of its
 fibres, corresponds with the anterior; being attached by one side
 to the posterior face of the fibula, and by the other to the cor-
 responding part of the tibia.  Like the other, its fibres are longer
 near the ankle joint than above.  Its lower margin is in contact
 with the  astragalus,  and is connected  with other ligaments
 coming from the fibula.
   In the space between the anterior  and the posterior ligament,
 where the bones touch, they are agglutinated by a short, strong,
 fibrous tissue, leaving intervals occupied by adipose matter.   It
contributes much to the solidity and  immobility of this articula-
tion.

  3. The Interosseous Ligament (Membrana Interossea,) is ana-
logous to that in the fore arm, by being a membrane stretched
between the two bones.   It arises from the  ridge on the outer
face of the tibia, and is attached to the corresponding ridge on
the inner face of the fibula.  It is broader above than  below,
being at the latter  point continuous  with  the  fibrous structure
which agglutinates the bones. Just below the head of the fibula 
           ARTICULATIONS OF THE LOWER EXTREMITIES.        309

is a large hole for transmitting the anterior tibial vessels, and
the origin of the tibialis posticus muscle.  It also presents, in its
descent, several smaller foramina for the passage of vessels.  Its
fibres are strong and unyielding, and run obliquely downwards
from the tibia to the  fibula.   It is covered in its whole length,
both before and behind,  by muscles, and serves as an origin  to
them and as  a means of attachment between the bones.


                      Of the Ankle Joint.

   The articular surfaces, here, being  covered by cartilage as
in other moveable joints, are formed  by the astragalus being
received into a deep cavity made by the  tibia and  the fibula.
The  capsular  ligament, properly speaking, does not exist ei-
ther on the front or the back of the joint, and is  represented,
there, by a few scattered,  loose fibres, on the  periphery of the
synovial membrane.   An internal and an external lateral liga-
ment, with the synovial membrane, constitute the whole appa-
ratus.

   The Internal Lateral Ligament, also called the Deltoid, (Lig.
Deltoideum) arises from the whole inferior margin of the mal-
leolus internus, and with particular strength from the depress-
ion which  exists in it: it then descends and is inserted into the
internal face of the astragalus, and into the lesser apophysis of
the os calcis, which lies just below it.  This ligament is broad,
thick, quadrilateral, and  composed  of fibres which descend
obliquely backwards.  The tendon of the tibialis posticus runs
in a trochlea which is formed on the internal face of this liga-
ment.

   The External Lateral Ligament (Lig. Triquelrum) consists in
three distinct fasciculi, of which  one is anterior, another pos-
terior, and the third in the middle.  The anterior arises from
the lower extremity of the  malleolus externus, and, running in-
wards and forwards,  is inserted into the outer face  of the as-
tragalus in front of the surface for the fibula.   The posterior
arises from the depression  in the extremity of the malleolus
externus, and, running inwards and backwards, is attached to
the point  of  the  astragalus, at the outside of the groove, for 
310                       SKELETON.

the tendon of the  flexor pollicis.  The middle arises from the
pointed termination of the malleolus externus, and, descending
beneath the tendons of the peronei muscles, is attached to the
external face of the os calcis, below the surface for the astra-
galus.  These fasciculi  are  composed of strong longitudinal
and  parallel  fibres.  The posterior is larger than either  of the
others, and occasionally detaches a part which is inserted into
the posterior margin of the articular face of the tibia.

   The Synovial Membrane is reflected, as usual, over the arti-
cular surfaces, and from one bone to the other.   It sends up a
short process of a line in length between the tibia and the fibula.
it  is  remarkably loose in front and behind, and has on its super- r
ficial face a considerable quantity of adipose matter, which can-
not be easily detached  from it.  It commonly contains an un-
usual quantity of synovia.


               Of the Articulations of the Foot.

   Of  the   Tarsal Articulations.— 1.  The Os Astragalus  is
united to the Os Calcis by a double articular surface, which has
been described.  The ligaments which hold them together are
as follow:—

   The Interosseous Ligament is placed between the two bones,
so as to occupy the large oblique fossa between the double ar-
ticular surface in each.   It is a collection  of very strong, short
fibres, with interstices for fatty matter, which, arising from the
whole length of the groove in the astragalus, descends to be in-
serted into corresponding points in the groove of the os calcis.
Where the fossa is narrow, as it is behind, the ligament is thin
and  flat, but it augments considerably in front, where there is
more room for it.

   The posterior Ligament arises from the posterior margin of
the astragalus, and, descending obliquely  inwards, is  inserted
into the adjacent portion of the os calcis.  Its fibres, are blend-
ed with those of the Deltoid  Ligament, and on their posterior
face  they form a  ligamentous trochlea for the tendon of the
flexor pollicis. 
ARTICULATIONS OF THE LOWER EXTREMITIES.        311
  This articulation is also strengthened by the insertion of the
lateral ligaments of the ankle joint into the os calcis.

  The Synovial Membrane forms a distinct cavity on the pos-
terior and larger articular face of the two bones, and is in con-
tact with the fatty matter in advance of the tendo-achillis.

  2. The  Articulation of the Astragalus with the  scaphoides is
formed by the convex head on the part of the former, and by
the concavity on the part of the latter.  It is covered, above, by
a thin, broad ligament, with parallel and oblique fibres, which,
arising from the superior and internal face of the astragalus, are
implanted into the upper face of the scaphoides, some  of its
fibres extending over to the cuneiform bones.  It is covered,
above, by the tendons of the extensor muscles of the toes and
of the tibialis anticus.

   On the  under surface of the foot, this articulation is support-
ed by two ligaments, called the Calcaneo Scaphoid, (Lig. Pla-
num,) from  their origin and insertion.  The interior one arises
from the internal margin  of the lesser apophysis of the os cal-
cis, and,  running  obliquely forwards and inwards, is inserted
into the under  and internal surface of the os scaphoides.   It is
a very thick, flattened fasciculus, on the under surface of which
is formed the  ligamentous trochleas, in which run the tendons
of the flexor pollicis  and flexor longus digitorum, and  which
surface is also in contact with  the tendon of the tibialis  posti-
cus.   By subtending the head of the astragalus, it contributes
largely to the  keeping of it in its place in the erect position.
 The External Calcaneo Scaphoid Ligament, placed at the outer-
 margin of the  last, arises from the  under  surface of the greater
 apophysis of the os calcis, and running obliquely inwards and
 forwards, is implanted into the under external surface  of the
 scaphoides.  It consists in two or more short, strong fasciculi.

    The Synovial Membrane of the articulation between  the as-
 tragalus and the scaphoides covers the articular faces of these
 bones, and  lines the ligaments above and  below.   A reflection
 of it, also,  lines the articulation between the os calcis and the 
312                     SKELETON.
  astragalus, in front of the rough fossa which is occupied by their
  interosseous ligament.

    3. The Calcaneo  Cuboid articulation,  formed by the two
  bones indicated  in the name, is maintained  by two ligaments,
  one above, the other below, and by a synovial membrane.

    The Superior  Calcaneo Cuboid Ligament arises from the up-
  per anterior surface of the os calcis, and  is inserted into the
  adjoining upper surface of the  cuboides.  It  is broad, thin, and
  quadrilateral, with short parallel fibres, and is in contact, above,
  with the peroneus tertius  tendon.

    The Inferior Calcaneo Cuboid Ligament, (Lig.  Planiare,)
 placed on the plantar surface of the  foot, is  remarkable for its
 size and extent.  It consists of two horizontal planes of fibres,
 of which the superficial is the longest.  The latter arises from
 the back under surface of  the os calcis,  and, advancing for-
 wards, its fibres are inserted into the summit of the ridge which
 traverses the cuboides obliquely; the greater part of them, how-
 ever, go beyond  this point, and, dividing into fasciculi, are in-
 serted into the base of the fourth and fifth metatarsal bones.
 The tendon of the peroneus longus is confined between  these
 fasciculi and the  under surface  of the cuboides.  The other
 plane of this ligament being more deeply seated, is also shorter.
 It arises from the front under surface  of the os calcis, where
 the tuberosity exists at this point, and, by advancing, is inserted
 entirely into the oblique ridge of the cuboides.

   The Synovial Membrane  being  reflected over  the  articular
 surfaces of the bones, and lining the ligaments, is uncovered at
 several places above, where interstices exist between the fibres
 of the superior ligament, and externally it is contiguous to the
 tendon of the peroneus longus.

  4. The Scaphoid and the Cuboid bones touch at the external
posterior angle of the cuneiforme  externum, and form, there
occasionally, a distinct articular surface, with a synovial mem-
brane.   Besides this mode of union, an interosseous ligament 
           ARTICULATIONS OF THE LOWER EXTREMITIES.        313

is introduced between them.  On the dorsum of the foot there
is a transverse ligament running from one bone to the other be-
neath the extensor  tendons;  and on the sole of the foot there
is an oblique ligament, which, arising from the under surface of
the scaphoides, is inserted into the anterior internal margin of
the cuboides.

  The articular surfaces of the Cuboides and Cuneiforme Ex-
ternum, which are in contact, besides a distinct synovial mem-
brane, are  secured by transverse and oblique ligamentous fibres
going.from the one bone to the other.

   5. The Articulation between  the scaphoides  and  the three
cuneiform  bones is  secured by a dorsal and a plantar ligament.
The dorsal, arising from the back of the scaphoides, is divided
into three fasciculi, that go, respectively, to  the back of each
cuneiform  bone;  of these, the internal is the strongest, and is
particularly well marked on the  internal face of the cuneiforme
internum.   The plantar ligaments are, also, three in number,
and, having a sort  of common  base from the under surface of
the  scaphoides, by being divided into three fasciculi, as the
above, are inserted into each cuneiform  bone.  They are not
so well marked as  the upper ones.

   The cuneiform bones are also connected together above and
 below, by  short transverse ligaments  going from one bone to
the other,  and holding their lateral surfaces in contact.  Those
below are  not so distinct as  the upper ones, and are  blended
 with the insertions  of the tibialis posticus.

   One synovial membrane covers the articular surfaces of the
 scaphoides and of the cuneiform bones which  are in contact;
 and it extends itself by digital processes between the  first and
 second,  and the second and third cuneiforms, so as to line also
 the articulations there.  The process between  the two latter is
 much shorter than  the process  between the other two, which
 extends itself into  the  tarso-metatarsal  articulations, after the
 same principle which is observable in the hand.
Vol. I.—27 
314
SKELETON.
             Of the Tarso-Metatarsal Articulations.

   The articular faces of the bones, here, having been sufficient-
 ly described, it is  to  be noted in addition, that besides being
 covered with cartilage, they have the apparatus of the movea-
 ble articulations generally, in ligaments which hold them toge-
 ther, and in synovial membranes.  The ligaments  are above
 and below.

   1.  The articulation of the first metatarsal bone with the cu-
 neiforme internum is one-third of *an inch in advance  of the
 next, and completely insulated by its synovial membrane: it is
 strongly secured by ligamentous fibres above,  internally and
 below, which give it almost a complete capsule.

   2.  The dorsal or upper ligaments of the remaining metatar-
 sal bones are arranged as follow. There are three for the se-
 cond metatarsal; one comes from the second cuneiform, one
 from the first, and another from the third:  the two  latter are
 oblique; and they all converge to be inserted into the base  of
 the bone to which  they belong.   One dorsal ligament passes
 from the third cuneiform to the base of the third metatarsal;
 it is  sometimes assisted by a  fasciculus from  the  cuboides.
 From the superior face of the cuboid bone a fasciculus is sent
 to the base of the third and fourth metatarsals.

   The plantar or under ligaments are arranged  on  the  same
 plan with the dorsal.  Not being quite so strong, they are re-
 enforced by the fibrous sheaths of the flexor tendons which lie
 upon them.

  The synovial membrane, which is reflected  over the articu-
lar surfaces between the second and third metatarsals and their
corresponding cuneiforms, is the elongation of the digital  pro-
cess sent from the scaphoid articulation  between the first and
second  cuneiforms.  This  process, besides extending to the
aforesaid tarso-metatarsal articulations, insinuates itself to the
articular surfaces on the sides  of the second metatarsal bone; 
           ARTICULATIONS OF THE LOWER EXTREMITIES.        315

but a  distinct synovial capsule is  sometimes formed between
the base of the third and fourth metatarsals.

   One synovial  membrane is reflected over the surfaces, be-
tween  the cuboides and the last two metatarsals, and. sends in
a  process between the latter.  In all  these cases the synovial
membranes line  the dorsal and plantar ligaments of their re-
spective articulations.

                Of the Metatarsal Articulations.

   The metatarsal bones, with the exception of the first, articu-
late with  each  other by the  contiguous faces of their roots;
which  has just been stated, along with  the manner of their get-
ting at these points, a lining of synovial membrane.   They are
farther fastened  to each other by short transverse ligamentous
fasciculi, which  pass from the base of one to  the base of the
adjoining.   These fasciculi exist both on the upper  and under
surface of the  bones, and are, therefore, denominated dorsal
and plantar metatarsal ligaments.  There is also a  description
of interosseous ligament between the bases of these bones, oc-
cupying the space intermediate to  the dorsal  and plantar liga-
ments  of each.
   The anterior  extremities of the  metatarsal bones are not in
contact; they are, however, fastened to each other  by a trans-
verse or Anterior Plantar ligament on their under surface, the
fibres  of which  are somewhat blended with the capsular liga-
ments  of the first joints  of the toes.

                 Of the  First Joint of the Toes.

   The surfaces  of the bones here being covered with cartilage,
are formed into an arthrodial articulation.   There  is a fibrous
capsule surrounding the articular faces, and enclosing the sy-
novial  membrane.  This capsule is considerably thickened be-
low, where the flexor tendons pass over it;  above,  it does not
exist, as the extensor tendon  is there lined  by the synovial
membrane:  on  each side it is also thickened, so as to form a
lateral ligament.  In the under part of the capsule of the great
toe, we find on each side the sesamoid bone.  These joints re- 
316
SKELETON.
semble so strongly the corresponding joints of the fingers, that
a farther description is unnecessary.

         Of the Second and Third Joints of the Toes.

  From the shape of the surfaces of the bones composing them,
these are simply ginglymous  articulations.   They  have  their
cartilaginous incrustations,  synovial membrane, and capsular
ligament.   The under part of the latter is much thickened, and
forms a trochlea for the flexor tendons;  on each side it is ar-
ranged into a lateral ligament, and above it is defective, as the
synovial membrane is in contact with the extensor  tendon.
These joints also resemble so  strongly the corresponding ones
of the fingers, that farther description is unnecessary. 
BOOK  II.
               Of the Integuments of the Body.

  The  integuments  of the body consist in the Cellular and
Adipose Substance, and in the Dermoid Covering.
                        PART  I.
               Cellular and Adipose Substance.

                     CHAPTER  I.

               OF THE CELLULAR SUBSTANCE.

   The  Cellular Substance  (Textus Cellulosus,  Mucosus) is an
elementary tissue, and is more generally diffused than any other
of the body, for it seems to be quite as indispensable to the lat-
ter as the corpus mucosum is  to vegetables.  It is found abun-
dantly beneath the skin; between muscles;  in the interstices of
muscles and of other parts; connecting membranes to one ano-
ther: surrounding organs;  entering  into  their  composition;
gluing them together;  in fine, under  every variety of circum-
stance and locality of which the  human  organization  admits.
Indispensable as it is to the texture of all other parts, we find
it, as may be expected, preceding them in  the development of
the fcetus; at which period it is in the condition of a fluid slight-
ly coagulated.
  When examined with a microscope, as  it winds around  a
muscle and introduces itself  between  the  fasciculi  of its fibres,
it will be seen that, however fine the latter may be,  yet this  body
                           27* 
318                    INTEGUMENTS.
is  interposed between them in thin laminas.   On separating
these fibres, the intervening laminae are resolved or drawn out
into  fine filaments, which, finally, break after'being stretched to
a certain extent.  The lamina  which surrounds the whole body
of the muscle, and constitutes  its sheath, on being put upon the
stretch, also tears after having been attenuated into still thinner
laminae and into fibres.
   If air  be blown into the  sheath of a muscle, this sheath is
distended into a multitude of cells of various forms  and sizes,
which have no determined shape, and do not upon expulsion
of the air return to the same shape upon a repetition of the in-
flation.  These cells communicate very freely; all limpid fluids
pass with the greatest ease from one to the other, so that from
any single point they may, by the force of injection, be distri-
buted  throughout the body; this is manifested in emphysema,
where from a small wound in the thorax, air becomes univer-
sally diffused.  Fluids of any kind, except they be  inspissated,
when deposited in these cells,  are subject  to the common laws
of gravity, and continue to descend successively from the high-
er to the lower cells, as in anasarca.  Blood traverses them
very readily in ecchymosis.
   Cellular tissue enjoys a good  deal of elasticity, for when
stretched it readily returns upon itself.   When  very thin, as
between the fibrillas of muscles, it is colourless or nearly so, and
of a gelatinous or glue-like consistence; but  when its laminas
are  thicker, it  is of an opaque  white,  and has  a strength
amounting almost to that of ligamentous matter.   When dried
it becomes crisp and of a dark brown;  but may be  restored to
its  colour and  condition by  soaking  in  water.   It is  only
very slightly affected by the  usual heat of the culinary pro-
cesses of roasting or boiling, as our dishes of meat daily prove;
but may be resolved into gelatine after a protracted ebullition.
Its putrefaction is slow, and cannot be accomplished, by mace-
ration, under several month?.
  The cellular substance is  pervaded by a  large  number of
blood vessels,  the majority of  which do not, in a natural state,
convey obviously red  blood;  but if any portion of it  be ex-
posed for a short time to the air,  or to any other unusual sti-
mulus, it quickly becomes suffused with red blood, circulating
through an infinitude of channels.  It cannot, however, be con- 
CELLULAR SUBSTANCE.
319
ceded, as  Ruysch supposes, that it is  formed exclusively of
blood vessels.  Some  anatomists, indeed, as  Haller  and Pro-
chaska, allow that though blood vessels ramify through it,  yet
they are not spent upon it, or do not form a part of its organi-
zation.   The distinction is rather to  subtle, to be readily  ad-
mitted,  and  seems, moreover, to be  refuted by the continued
exhalation and  absorption which is going on within.   It does
not appear  that nerves are  spent upon  the cellular substance,
though  they pass abundantly through  it to their respective
organs.
   It is probable that the granulations on which injured parts of
the body depend for their restoration, arise  from this  cellular
substance.   The late Professor Wistar attended a patient  for
compound fracture of the leg, with  a  large wound, which was
subsequently covered with luxuriant granulations.  The limb
was suddenly attacked with  an oedematous swelling, which  ex-
tended itself to the sore, and  caused  its granulations to  tumefy,
so that they  pitted upon pressure precisely like other parts.*

   The most generally received opinion of anatomists,t in  re-
gard to the arrangement of cellular tissue is, that it results from
the assemblage of a multitude of lamellae, and of fine soft fila-
ments, which, being variously interwoven, produce a series of
cells all communicating one  with another, but varying  in their
shape and size;  so that the  whole  cellular  substance  may be
considered to represent a single cavity subdivided into an infini-
tude of smaller ones.  To this it is objected,:}:  that when this
tissue is  accurately examined, it  appears rather as a homoge-
neous, viscid, and only partially solidified substance; particular-
ly in the inferior orders of animals,  and  in the embryo  state of
the more exalted, where it has still to  admit the deposite or for-
mation of the several  organs.  That the same is manifested at
any period of life; for neither with the  naked or assisted eye
does it assume any other appearance.  That its laminated and
fibrous condition, when such does appear, is  owing to its gluti-
nous or glue-like consistence, which causes it to assume a fac-

  * System of Anat. vol. i. p. 388, 2d edition.
  t Haller, Beclard, Bichat, Wm. Hunter, &c.
  t Bordeu, Recherches sur le Tissu Muqueux et  Celluleux.  Paris, 1790. J.
F, Meckel, Manuel D'Anat,  vol. i, p. 105, 
320
INTEGUMENTS.
titious arrangement upon being  drawn or inflated.  For ex-
ample, if one  separates two muscles  for a short distance, the
cellular substance between them becomes unequal and furrowed
without losing its cohesion; but  if they be farther separated,
filaments and cylindrical columns are produced.   If the trac-
tion be then suspended, and the muscles replaced, the filaments
shorten,  and are finally united into a consistent mass whose
parts all adhere together.*
   While such tractions are going on, it most frequently hap-
pens that air is insinuated into the  cellular substance, from which
comes the appearance of small cells and vesicles: upon the es-
cape of this air, the primitive state of cohesion is restored, and
upon a renewal of  the traction, cells  of a different shape, size,
and appearance arise.  Again, if air be so introduced, one may
push it in any direction, separate its globules, collect them again,
and into larger masses; vary their shape, and, in fine, by such
means mould the supposed cells into an infinity of forms.  From
these considerations, the inference is  plain, that when  cellular
substance is drawn it must yield itself into filaments; when in-
flated, as the air acts in every direction, its  supposed  lamellae
must be  separated and assume a cellular shape; and, by the ap-
plication of both forces at  once, it may be  caused to assume
both a cellular and a filamentous appearance.  Upon the whole,
Meckel  conceives  that  the term Mucous Tissue, adopted by
Bordeu, is much more exact than the one of Cellular  Tissue,
now most generally used.
   Notwithstanding  the perfect continuity of the mucous or cel-
lular substance throughout the body, anatomists for the ease of
description have divided it into External and Internal.
   The External  Cellular Substance (Textus Cellulosus Inter-
medins, seu laxus) has the general extent and shape of the body
and of its organs, so that if it were possible to extricate the lat-
ter from their envelope, it would present a  chamber  for the
lodgement of  each part.  But the walls of these  chambers
would not all be of  the same thickness, as the quantity of cel-
lular substance varies.   In the cranium and spinal cavity there
is  very little of it: on the surface of the head and in the orbits
more: about the trunk, both internally and externally, it is abun-
dant; in the extremities still more so, where it penetrates between
                    * J. F. Meckel, loc.Vit. 
CELLULAR SUBSTANCE.
321
the muscles.  In the arm pit, in the groin, and in the neck, all
parts where much  motion is enjoyed, it is unusually abundant.
The foramina of the cranium  and of the spine, establish the
points of connexion of the cellular substance of these parts with
others adjacent.  The cellular substance of the face is  conti-
nued into that of the neck; that of the latter is continued through
the upper opening of the thorax upon the viscera of this cavity;
and thence  through the openings  of the diaphragm, along the
great vessels and oesophagus upon the viscera of the abdomen
and pelvis.  The cellular substance of these cavities is  again
continuous with the deep-seated cellular substance of the limbs
at the arm pit and  at the groin.   The trunk of the  body being
enveloped by  one broad sheet of cellular  substance, it is con-
tinued superficially to the limbs.*
   With this general  sketch of the distribution  and  extent of
cellular substance, it is not surprising that in certain bad cases
of emphysema, the air shows  itself every where, even at  points
the most remote from the lungs,  and apparently the least ex-
posed to the accident, as the interstices of muscles, of glandular
organs, and so  on.   It will  also  now be understood how this
varied  distribution  of cellular substance and  its  proteiform
shape, have been the inexhaustible but delusive source of ana-
tomical discoveries and supposed   novelties, under the name of
fasciae,  sheaths  of  vessels, and so on; and will continue  to be
so, to such  as do not recollect that all these things are included
under the general character of this tissue; and that each mus-
cle, each viscus, each nerve, and each blood vessel, has its own
particular chamber under  this multiform arrangement,  which
chamber may be traced to or  from any other point, according
to fancy.   At the same time it should  be  noted that many of
the laminae have a  condensed form, which renders  a special
knowledge of them of the  greatest use  to the  surgeon, and
which is elsewhere succinctly pointed out, with the description
of their respective  organs.

  * For a detailed account of the inflections of the cellular substance, the stu-
dent may consult with advantage, Bordeu, loc. cit. These inflections are the fas-
ciae of modern Surgical Anatomy.
  Bichat, Anatomie Generale; Systeme Cellulare.  Paris, 1818.
  Andreas Bonn, de Conlinuationibus Membranarum, in Sandifort's Thesaurus
Dissertationum, Rotterdam, 1769.
  Haller, Element. Physiol, vol. i. 1757. 
322                     INTEGUMENTS.

   Anatomists who lived at a period much less illuminated than
the present on the subject of the elementary tissues of the body,
seem to have seized upon the idea of the universal inflection of
cellular substance over the surfaces, and  through the texture
of the several organs.  Mangetus,* without pretending to ori-
ginality, but  in alluding freely to the observations of others*
says, " Membrana  adiposa, est  expansio cellulosa, quas totum
corporis habitum, paucissimis, iisque minimis partibus exceptis,
circumambit; etin qua materia albicans unctuosa, sensuexpers,
ad partes  fovendas ac lubricandas colligilur.—Haec membrana
cellulosa seu  pinguedinosa, non tantum in exterioribus corporis
reperitur;  sed interius in intestinis, mesenterio, aliisque prope
omnibus partibus, non exceptis  etiam vasis sanguiferis, ut suo
loco videbimus, observatur."  And in describing the aponeuro-
tic covering  of  the body and of the  limbs, which in his day
was called Membrana  Musculosa, from some  false notions of
its nature, he adds, " Dicitur oriri a dorsi vertebris, quia scili-
cet earum spinis firmiter adhaeret, inibique multo  quam alibi
usquam robustior conspicitur.   Usus est, musculos universim
in sua"sede firmare, iisque  quasi thecam praestare, in  qua ut
supra innuimus laxius sibi cohaerente, lubrice moveri queant."
The cellular  investments of the muscles the same author calls
Membrana Musculi Propria, and he speaks of their  penetrating
between the fasciculi of muscles, and  most evidently those of
the glutaeus maximus and deltoides.

   The Internal Cellular Membrane (Textus  Cellularis Stipatus)
presents itself under different arrangements according to the
organ or part whose interstices  it penetrates.  As  it forms in
the muscles  an  envelope for each fasciculus and fibre, if the
latter  by  any art could be withdrawn, it would  represent a
congeries  of  fine parallel tubes.   In the case of glandular bo-
dies  the internal cellular membrane imitates the shape of their
lobe-s, lobules, and acini or small graniform masses, and may,
therefore,  be  compared to a sponge.   In the hollow viscera, as
the stomach and  bladder, it unites their successive laminae to
one another.  In the ligaments,  even where the fibrous struc-
ture  is perfectly evolved, the fibres are united by cellular tissue
* Theatrum Anatomicum, Geneva, 1716, vol. i. Ch. iii. 
CELLULAR SUESTANCE.
323
in their interstices.  This tissue is not  sufficiently abundant in
the bones, tendons, or cartilages, to be very distinct; but from
what is seen of it in the forming stage of the embryo, it is ne-
vertheless ascertained to be the base of  every part.   In glan-
dular textures it is frequently spoken of under the name of pa-
renchyma.

   Most of the membranous textures of  the body may by ma-
ceration be resolved into this mucous or cellular tissue, so that
we  hear anatomists, without  hesitation, asserting, that under
various degrees of consistence, it forms the  skin, the serous
membranes, the vessels, the ligaments, in short,  almost every
thing excepting the  bones, the  muscles, the  nervous system,
and the glands, and they only depart from  it in having their
globules deposited in its interstices.*  Meckel even adds to the
list the epidermis.

   The term mucous tissue  was substituted for that of  cellular,
by Bordeu,t owing to its glue-like  consistence, and to its re-
semblance to the corpus mucosum of vegetables.   Notwith-
standing  its propriety on these grounds, yet as the lining mem-
brane of all the hollow viscera has the same name, some con-
fusion may be produced unless one bears in  mind the distinc-
tion.   Bordeu  has expressed  the character of the  internal
cellular membrane very forcibly in saying, that in embryos all
their organs are species of buds, which vegetate in the cellular
tissue, like plants  do in the open air, or their roots in the ground,
and that  each one having an  apartment of its own, this apart-
ment is to  it a cellular atmosphere, which keeps in a perfect
relation with the  action of the organ.J

   In tracing many of the laminae of the  cellular substance, we
find, that as life advances, they assume a more fibrous charac-
ter than what they possessed  in infancy; this also occurs when

  * Beclard, Anat. Gen. p. 141.  Haller, loc. cit. p. 19; vol. i. p. 113.
  t Loc. cit.
  \ Loc. cit. p. 65.  Recherches Anatomiques sur les Glands, Paris, 1752. Also,
An Exposition of the  Physiol, and Pathol. Doctrines of Theoph. Bordeu, under-
stood to be  from 'the pen of a  learned friend, R. La Roche, M. D., in the North
American Med. and Surg. Journal. Philad. April, 1826. 
324
INTEGUMENTS.
they are pressed upon by tumours, or irritated from many other
causes.   This disposition of the cellular substance to assume a
ligamentous character, in  many of the attachments which are
formed between the two  tissues, frequently leaves  it doubtful
with which the membrane  under examination should be classed;
in some individuals  the  fibrous substance is predominant, and
in others the cellular.  This deposite of fibrous matter into cel-
lular substance, or rather  the change  of  the latter into it, may
be compared  to the partial or  even  perfect conversion of the
cartilages  of  the thorax into bone  by an increased deposite of
the  phosphate of lime.  It  perhaps will be better understood by
repeating that this cellular tissue is an elementary one, where-
as the ligamentous is composed of it and ligament.

   In addition to the uses of the cellular substance  in forming a
nidus for the  deposite of all  the molecules of the  body, and in
circumscribing each organ, so as to keep it distinct  from the
contiguous ones of a different character, its elasticity and yield-
ing  nature permit it, in the movements of the several parts upon
each other, to change its  position, and  upon  the cessation of
the  active cause, to re-establish itself.  Its extreme flexibility is
kept up by a  continued  exhalation of moisture from the  arte-
ries that ramify through  its  texture.  This cellular serosity,
when an animal  is  recently killed, and  its internal parts ex-
posed to a cold atmosphere, rises in the  form  of  vapour, and
has  a  particular  smell.   It is more abundant  in certain parts
than in others; and, as a general rule, where there is the least
adipose matter.  Indeed, these two substances seem to exist in
an inverse  ratio: in a person, for example,  who has died very
fat, the  parts are comparatively dry; whereas, in such as have
all the adipose matter wasted  by a lingering disease, there is a
humidity which quickly  disposes to putrefaction;  a fact  fre-
quently exemplified in our  dissecting-rooms.  The cellular se-
rosity is, consequently, more abundant in the scrotum, in  the
eyelids, and in the penis.   Bichat informs us, that he has satis-
fied  himself by experiments, of its augmentation during diges-
tion, during heavy perspirations, and  after sleep; which will
account for the swelling  of the eyelids, so commonly observed
in the morning, upon rising.
   This  serosity is  albuminous, as  proved by its being coagu- 
ADEPS.
325
lated by alcohol, and by the mineral acids.   It is removed by
the absorbents; assisted by the tonie contraction of the cellular
membrane, according  to M. Beclard.*  The latter author, in-
deed, goes on to say, that the cellular membrane is the essential
organ of absorption, by which the skin and the villosities of the
internal membrane of the hollow viscera perform this function.
That the substances introduced through it into the blood-ves-
sels, no doubt, in  doing so, undergo some kind of elaboration,
in the same way that  those do which are deposited in its inter-
stices for the growth, repair, and changes of the body.
                    CHAPTER  II.

                   OF THE FAT, (ADEPS.)

  Thk Adeps,  in subjects  not  much emaciated, is found be-
neath the skin;  between it and the fasciae; and in the layers of
common  cellular substance which are next to the muscles; as
on the face, the  neck, the trunk of the body, the buttocks, the
limbs, the palms of the hands, and the soles of the feet.  In the
adult, it is  also found between  the serous membranes and the
cavities which they line, as in the thorax and abdomen; it is
also  found  between the laminae of these membranes, as in the
omenta, mesentery, and so on.   It, likewise, exists between the
interstices of muscles; in the bones, and elsewhere;  so  that its
whole amount is estimated at about one-twentieth of the entire
weight of the body.   There are, however, certain portions of
the body, where its presence would have been very inconve-
nient: they, accordingly, are destitute of it;  to wit, the interior
of the cranium, of the ball of the eye, the nose, the ear, the in-
testinal canal, the eyelids, the scrotum, the penis, the labia in-
terna, and the substance of the glands.
  The adops is  of a yellowish colour, and of a  semifluid state
in the living body:  when after death it  has got a few degrees
below the standard of animal heat, it becomes somewhat solidi-

                     * Anat. Gen. p. 149.
  Vol. I.—28 
326
INTEGUMENTS.
fied, and then appears in small aggregated  masses of different
shapes and sizes.
  In chemical composition it differs from all other parts of the
body by the absence of nitrogen, and is formed of oxygen, hy-
drogen, and carbon, which render it, in  animals,  a very suita-
ble  article for candles and  lamps.   According  to  the analysis
of Chevreuil,* it consists of two kinds of matter, elain and stea-
rin ; the former of which remains fluid at the freezing point,
while, as mentioned, the 'Other becomes solid  by a very small
abatement of its living temperature.  The application of porous
paper enables one to separate them in a  small way.
  The adeps, though lodged in the cellular substance, is accom-
modated there under different circumstances from the cellular
serosity, and is  supposed to be in different cells.   This doctrine
was promulgated by Dr. Wm. Hunter,f and upon the following
grounds: That  certain parts of the cellular  membrane are des-
titute of it; that in persons who have died from, dropsy, the
portions of the cellular membrane which originally contained
fat,  have a more ligamentous condition than others; to wit, those
on the loins next to  the skin, more than the  stratum next to the
lumbar fascia;  that water or fluids  pass readily from  a higher
to a lower part of the cellular membrane, either when extrava-
sated naturally  or injected; that oil, when injected artificially,
subsides in  the same way, and has a doughy or cedematous fee],
yielding readily to  pressure  and pitting, whereas, fat never
shifts its position simply from gravitation.
  From these several causes, Dr. Hunter adopted the  opinion
that the fat of the cellular membrane is lodged in peculiar ve-
sicles, and not as the water of anasarca, in the reticular inter-
stices of parts.   This idea has been adopted by Beclard, who
says that the lobules of fat,  when examined with a microscope,
are  seen to be  composed of small grains or vesicles, from the
six  hundredth to the eighth hundreth part of an inch in diame-
ter, each one  having a  pedicle furnished  from the  adjacent
blood vessel.  That the parietes of the vesicles are so fine as to
escape observation, but that he considers them  as arranged in
the  same way with  the pulp of oranges, lemons, and such kind
of fruit.  These several reasons  are so plausible that I cannot
         * Annales de Chimie, vol. xciv.
         t  Medical Observations and Inquiries.  London, 1762. 
ADEPS.
327
but subscribe to their force and accuracy, notwithstanding the
objection raised from quarters of high authority.
   It is more abundant in the female than in the male, and in
both sexes it is removed as life declines.  In the infant the fat
is found at the surface of the body chiefly, little or none exist-
ing in the interstices of muscles, and in the cavities.
   Its uses are not fully understood.  At some points it serves
to diminish  pressure, as  on the hands and feet; at others it fills
up interstices;  it is also  a  bad conductor of caloric, and may,
therefore, serve in retaining animal heat.  But its most general
application  is to the purposes of nutrition, it being one of those
forms which nutritive matter assumes  previously to being per-
fectly assimilated.  This is very fully manifested in hibernating
animals, which being fat in the beginning of their torpid state,
return from it quite lean; and in insects which during their re-
pose in the chrysalis state, live upon their own fat while under-
going the metamorphosis into the perfect animal.*
* Beclard, Anat Gen. p. 17Q. 
PART If.
                 Of the Dermoid Covering.

  The Dermoid Covering, or tissue of the body, consists in the
Skin;—its Sebaceous organs;—the Nails;—and the Hair.
                     CHAPTER I.

                       OF THE SKIN.

   The Skin (Pellis, Cutis, h?i*.*)  is extended  over the  whole
 surface of the body, and thereby constitutes a complete invest-
 ment of it.   At the  orifices of the several canals which lead
 into the interior of the body, as the mouth, nose, vagina, anus,
 and urethra, it does not cease abruptly, but is  gradually con-
 verted  into  the mucous  membrane of the part, so that it is
 plainly  continuous with it.  At certain  places, on the middle
 line of the body, the  junction of the skin of the two sides is  in-
 dicated by a change  in its appearance, called Raphe; as on the
 upper lip; from the navel to the pubes;  on the scrotum, and in
 the perineum; in all of which places, in the development of the
 fcetus, the two sides of the  body are later in uniting than else-
 where.
  The colour of the  skin varies in different nations: it is black
 in the  negro; of a  copper colour in  the  American savage;
 bronzed, or tawny, in the Arabian; and white in the Europeans
 and their descendants.  It  is also subject  to various shades,
from the mixture of these races, and from the influence of cli- 
THE SKIN.
229
mate; its general tendency being to turn dark on parts exposed
to the influence of tropical heat and light.
   The external surface of the skin, or that which is free, has
on it a great multitude of wrinkles; some of them depend upon
the subjacent muscles, as on the forehead and  face; some are
caused by the flexions of the articulations, and are to be seen
at all of these places on the  limbs; in addition to which, where
there is much emaciation of  the  parts beneath, the skin not
having sufficient elasticity to accommodate itself to their state,
is thrown into other wrinkles, and sometimes into loose folds.
Finer wrinkles of another description are  also found  on the
skin, arranged in various angular and spiral  directions:  they
depend on an entirely different cause, which will be treated of
elsewhere.
   The skin abounds in  hairs, which vary in fineness  and  in
length according to the region over which they are distributed:
it, likewise, presents  many  small  pits, or  follicles, which are
the orifices of sebaceous glands.  A finer description of pores,
which are visible only to the assisted eye, are  supposed to  be
the orifices of exhalents and of absorbents, but  this is not quite
certain.
   The internal surface of the  skin is  connected to  the subja-
cent parts by  the cellular tissue, which permits a considerable
sliding of it backwards  and  forwards on  most parts  of the
body; on others, however, this  is restrained, as on the cranium,
the palms of the hands, and the soles of the feet, by ligamen-
tous fibres passing to it from  the fascial and bones below.  A
very interesting  attachment of this kind exists  on  the  fingers,
where a plane of ligamentous fibres is seen passing from each
side of  the lower end of the  first phalanx, downwards, to be
inserted into the skin, half an inch  or an inch off
   Since the first  observation of Malpighi, on the tongue of a
bullock, whereby he ascertained that its integuments consisted
in three layers, and the discovery of a similar arrangement on
other portions of the integuments by Ruysch,* anatomists have,
for the most part, admitted the skin to consist of three laminas,
the Cutis Vera, the Rete Mucosum, and the Cuticula.

                     * Thesaurus, Anat. IX.
                           28* 
330
INTEGUMENTS.
                SECT. I.--OF THE CUTIS VERA.

  The True Skin (cutis vera, derma, corion,) is the deepest, or
the layer  next to the cellular  substance.  Its thickness varies
according to age, sex, and the region of the body over which it
is stretched; on the trunk it is thicker behind than it is in front;
on the limbs, thicker on  their external than  on  their internal
faces or semi-circumferences.   On the mammae, the penis, scro-
tum, and external ear, its tenuity is remarkable.   When unin-
jected, it is perfectly white in people of all complexions, and in
the living state has a semi-transparency that permits  the blood
of the veins to be  seen  beneath it.

  The internal surface  of the true skin is so blended with the
cellular substance, that in the recent subject there is a difficul-
ty in  distinguishing where one terminates  and the other begins,
yet they may be separated by maceration so as to determine
this line ;  mortification of the cellular substance sometimes does
the same  thing; and in  the ham, cured by salting and smoking,
the true skin, after boiling, may be stripped off with but  little
difficulty.   In either of these cases  the internal surface of  the
latter is  seen to be studded with  small areolar depressions,
caused by the projection of granulated masses  of adeps;  the
margins of  those  alveoli are the principal points of adhesion
to  the subcutaneous cellular tissue, while their bottoms  are
pierced with small openings that lead through the skin.

   The external surface of the true  skin  is covered with very
fine papillae, or villi, (Papilla Tactus,) that are readily brought
within the observation of the  naked eye,  by  maceration, when
protracted long enough to permit the separation  of the  cuticle.
The projections on  the tongue  are  very similar to them,  and
the whole are designated as the papillary body.   These cuta-
neous papillae are particularly distinct at the bulbous ends of
the fil%ers and toe?, upon the palms and soles, on the lips, on
the glans penis, and the nipple; in other parts they are not so
evident, but still there can be  no doubt of their existence, from
analogy.  On the hands and  feet they are arranged  in double
rows or files, which occasion  the semicircular and spiral turns 
CUTIS VERA.
331
of small wrinkles or ridges at the ends of the fingers and toes;
and the transverse oblique, and curved  ones, on other parts of
the soles and palms.  The small, triangular, lozenge-shape, and
multangular elevations of the cutis vera,  seen elsewhere on its
external surface, are caused rather by its contraction than by
the papillae.
  These papillary projections resemble very much small conoi-
dal, cotton-like  filaments, standing up the twelfth of a line, or
thereabouts, from the surface of the skin: they are by no means
so long as the villi  generally of the intestines,  and,  like them,
consist in very delicate ramifications of nerves and blood ves-
sels, united by cellular tissue.  In places  where these  papillae
are less abundant, the cutis vera is not so vascular or sensitive.
They  readily receive a fine injection,  and,  if the  cuticle be
afterwards separated  by maceration, their vascularity is very
distinct.  Their nerves are destitute of neurileme.*

   The texture of the true skin is fibrous;  the fibres which com-
 pose it, by their irregular  intermixture, resolve it into a mass
 of net-work or areolae, the meshes of which  are  sufficiently
 large  in some parts to permit the introduction of the head of a
 small  pin.  The meshes, though they are  larger and more dis-
 tinct on the internal than on the external surface of  the true
 skin,  open,  however, upon the latter  surface; having passed
 through  the  skin  obliquely,  after the  manner of the ureters
 through  the  coats of the  bladder.  Those intervals between
 the fibres of the skin are  rendered very obvious after mace-
 ration of a  month  or two, or  after skin has been tanned.
 They serve to transmit hairs, blood vessels, nerves,  absorbents,
 and exhalent vessels also if such exist.   These interstices com-
 municate freely with the cellular substance, for in many cases
 of anasarca,  blisters,  when  made upon a  depending  part,
 empty the cellular membrane of water almost as quickly as
 scarifications;! but if the blisters inflame, they discharge incon-
 siderably,  owing to the porosities being shut  up by the tume-
 faction and fulness of the parts.  The  same is observable in
 scarifications.
   A fine injection, when forcibly driven into the extremities of
* Beclard, Anat. Gen.
t W. Hunter, loc. cit. 
332
INTEGUMENTS.
a foetus, will become extravasated between the cutis vera and
cuticle, and raise up the latter in  small  blisters, as I have fre-
quently experienced, though it cannot be caused to pass through
the cuticle.
  The precise nature of the tissue which composes the true skin
is not yet fully ascertained; it seems, however, to be a mixture
of cellular substance and ligamentous matter;  with  a striking
predominance of the latter  in most  parts of the body, though
its proportion varies considerably, being very abundant on the
thickest parts  of the skin,  while it  is scarcely discernible on
the thinnest.   The  following .analogies of dermoid  with liga-
mentous or desmoid tissue are observable.  It becomes yellow
and transparent on being  boiled, and  a continuation  of the
process dissolves it into gelatine.  It resists putrefaction for a
long time; is remarkably tenacious.  Contrary, however, to li-
gamentous matter, it is  extensible and elastic, though this pro-
perty may arise from the oblique intertexture of its fibres; as a
bandage from a piece of muslin, when torn longitudinally or
transversely, is inelastic, but if it be cut bias, it is then very
elastic.  The application of tannin increases its resistance, and
makes it one of the strongest animal substances known in hu-
man arts.
  The skin has a very strong power of contraction, which  is
manifested in an amputation, in  a long incised wound, or when
a.sensation of dullness  exists, as in  an ague or from the appli-
cation of  cold.  Owing to the diminution in size of its areolae,
its external surface then becomes wrinkled, rough, and studded
with projecting points, constituting the Cutis Anserina.
  The cutis vera is very vascular, and  abounds also in nerves
and absorbents.

               SECT. II.--OF THE RETE MUCOSUM.

  The Mucous Net (Rele Mucosum,*) of Malpighi, is the second
layer of the  skin, and is that in which resides the colour of the
several races of men.   It covers every part of the surface of
the  cutis vera; its existence, however, is not so obvious beneath
the  nails and about the junction  of the skin with mucous mem-

  *  Caldani, Icon. Anat. PI. xci.  Albinus, Annot. Acad. Leyden, 175G.
Ruysch, Thes. Anat. ix. 
RETE MUC0SUM.
333
branes, as it is elsewhere;  though taking all things into consi-
deration, it is probable that it exists also at these several places*
but much finer.  It is so extremely thin, and of such a soft muci-
laginous consistence, that it is difficult to separate it as a distinct
lamina, either by maceration or by any other means; for it most
commonly peels off  by adhering to the cuticle, after the man-
ner of a pigment.  It,  however, by good management, may be
fairly raised as a  membrane, and separated for a certain dis-
tance from the other two coats  of the skin.
  Fine as this membrane is, it would seem, from  the observations
of Mr. Cruikshank* upon a negro dead from small-pox, and upon
an injection executed  in London, by  the late Dr. Baynham, of
Virginia,! and  from more  recent experiments in Paris, by M.
Gaultier,J that it consists in several  layers.  1. Upon  the in-
equalities or papillae  of the  cutis vera,  there is a  layer called, by
M. Gaultier, bloody  pimples, (Bourgeons Sanguins,) but which,
in the opinion  of  some other anatomists, are only the papillae
themselves of the cutis vera.  2. Then there is  a very thin and
transparent coat, called, from its  colour, Tunica  Albida Pro-
funda: it is especially visible in the negro; under the coloured
horns and scales of animals, and beneath the nails of white per-
sons.   3. Over  this  layer  is spread  another, (the Gemmula,)
which contains the colouring matter of the several  complexions
of the human family, and consists in a multitude of dark brown
points in the negro;  it is visible also  in those forms of disease
called ephelides (freckles,)  by the  French, where  the skin be-
comes spotted;  it  is not so distinct in the healthy state of the
white individual.  4. The last lamina of rete mucosum, is called,
by M. Gaultier,  Tunica Albida Superficialis, from its whiteness
and superficial  situation: in many animals it  is very distinct,
in the negro somewhat so,  but in the  white it is not to be seen
except  under  the  nails,  about the hair, and under accidental
horny excrescences.
  These observations of M. Gaultier  have been verified by M.
Dutrochet,§ in experiments upon the texture of the skin of ver-

  * Expts. on Perspiration.  London, 1795.
  t Wistar's Anat. vol. i.  p. 394.
  X Recherches sur lapeau, Paris, 1809; in Anat. De L'Homme, par J. Cloquet.
PI, CXVII.
  § Journal de Physique,  May, 1819.  Journal  Complementaire, vol. v, 
334                  INTEGUMENTS.

tebrated animals;  and are now generally acknowledged by the
French anatomists.  In negroes, in cutting through the skin of
the sole of the foot, from heel to toe perpendicularly to the fur-
rows, this arrangement is readily recognised;* and when it has
become indistinct, it may be improved by immersing the  skin
for three or four days in lime-water, or a solution of potash or
barytes, and afterwards keeping it the same length of time in a
solution  of corrosive  sublimate.   Blisters  also elucidate this
point on other parts of the body:  the fluids being locally at-
tracted there, infiltrate the rete mucosum, and separate in  part
its layers, so as to form a vesicle  frequently very thick, parti-
cularly in fat persons.
  The scrotum of the negro is also well suited to the exhibition
of the rete mucosum, as it is there very distinct, and  is univer-
sally much thicker and better marked in the negro than in any
other race.   From its extreme tenuity in the whites its existence
in them has by some persons been doubted, but erroneously, as
in them also its change of colour, from the influence of the  sun,
is readily demonstrated.  There are in fact few persons, perhaps
none, so white, but what a slight tinge of yellow exists in their
skins; which may be proved by contrasting them with any per-
fectly white  surface, as snow, bleached paper, or linen.   This
slight tinge of yellow is increased to an olive colour by the sun's
rays, and, in some instances by a spontaneous deposite; in other
cases, it is in certain spots removed, so as to leave a colour al-
most perfectly white, or that only of the cutis vera.t   When the
latter change occurs in the African, it occasions a hideous pie-
bald complexion, and the cuticle is readily elevated into blisters,
by the irritation of the solar rays.  Some persons have an entire
deficiency of this pigment on the skin, from birth; the same de-
ficiency occurs in the eyes, and hair; they are designated as al-
binos.   The  deficiency of the pigmentum nigrum in the  eye,
causes it to  look red, like that  of  the white rabbit;  and  also
makes it intolerant of a strong light, as that of noon-day.
  " In some very remarkable instances the skin becomes entire-
ly black.  We have read  to the  Society of Medicine of the Fa-

  * J. Cloquet, Anat. De L'Homme.  PI. cxvi. Fig. 6.
  j- A case of this kind is now in the Philadelphia Alms House, where the ab-
sorption of colour has occurred in spots on the hands of a dark-complexioned Eu-
ropean.  June 15,1826. 
RETE MUCOSUM.
335
culty, the history of a woman whose skin became black in the
period of a night, in consequence of a strong moral impression.
This woman had seen her daughter throw herself out of the win-
dow with her two little children; and we have since had occa-
sion to see, also, a woman, who having escaped capital punish-
ment, in the revolution, had experienced the same accident.  The
latter was at the  period of menstruation when she learned this
news.   The  menses were immediately suppressed, and  from
white, which she was, slje became black as a negress, which
colour continued even to her death.  We dissected with  care
the skin of these two women, and found the coloured portion to
be the rete mucosum.  We found it sufficiently easy to isolate
the epidermis and the dermis, which presented no abnormal co-
loration.  This black colour must be the result of a sanguineous
exhalation which operates upon the rete mucosum.
  " The violet tinge of the skin is, ordinarily, the result of em-
barrassed circulation.   The skin becomes blue in many very ad-
vanced diseases of the heart.  The name of Cyanosis, or blue
disease, has been given to this colour of the skin, which is falsely
attributed to an immediate  communication of the auricles by
means of the unobliterated foramen ovale.   This cause of the
cyanosis is much more rare than is commonly supposed."*
  The pigment of the rete mucosum  would seem, for the fore-
going reasons, to be continually undergoing a deposition and ab-
sorption.  When it has been lost by a  blister in  an African, it
is generally restored in a short time afterwards:  the same oc-
curs in their cicatrices, but requires a longer period. The ob-
servations of chemists tend to prove that it  is formed principal-
ly by carbon.  Its apparent use is to defend the  skin from the
rays of  the sun, in illustration of which several  ingenious ex-
periments have been executed by Sir Everard Home.f
  The  influence of the continued use of nitrate  of silver,  in
giving a lead colour to the  skin is well known.  Anatomists
generally have rejected the idea of the vascularity of the rete
mucosum, yet it would seem to have been  injected, on one oc-
casion at least by the late Dr. Baynham, in a leg which was

  *  Cours de Mddecine Clinique, par Leon Rostan.  Paris, 1830.
  f Philos. Transact. London, 1821. 
336
INTEGUMENTS.
 diseased from exostosis;* and there are now in the anatomical
 cabinet of the University, three preparations by myself of the
 fingers of an African, where the colouring matter of the injec-
 tion has been passed from the papillae of the cutis vera into the
 rete mucosum;  and there deposited in dots, indicating the for-
 mer position of the papillae.


             SECT. III.—OF THE CUTICLE (CUTICULA.)

   The Cuticle or Epidermis, is the most superficial layer of the
 skin, and takes its wrinkles from the closeness  of its applica-
 tion to the true skin.  It  is a thin, dry pellicle, which cannot
 be separated from the  cutis by dissection;  in  consequence  of
 which we have to resort to the alternate application  of hot and
 cold water;  to partial putrefaction;  or  in  the  living body to
 vesicatories.  The mode of adhesion between the cuticle and
 the true skin is not precisely understood:  the surfaces unques-
 tionably adhere, through the intervention of the rete  mucosum,
 with equal tenacity where there  are neither hairs nor sebaceous
 follicles to pin them together, as on the palms of the  hands and
 soles of the  feet; and when  by previous management this union
 is somewhat softened, they part very much after the manner
 of two sheets  of paper,  which had been recently  glued and
 were almost dry.   From  this it would  appear  that  the adhe-
 sion is universal, and not  defective at any points.
   In most parts  of the  body the cuticle presents itself ;is a sin-
gle homogeneal  layer, of a thickness uniformly about that of
the thinnest  Chinese blotting paper.  Upon the palms and soles
of persons generally, but especially of such  as are addicted to
heavy labour, and exposed  to a continued  mechanical  irrita-
tion of these parts, the cuticle becomes much thickened  and
laminated, apparently from  a successive deposite of it on the
skin, there.   It is transparent, by which the  colour of the parts
beneath is  readily discernible; in the African, however, it  is
extremely difficult, nay, impossible to clean it  wholly of the
colouring matter of the rete mucosum; it  seems  indeed as if it
were, according to the opinion of some, impregnated bv it.

  ♦ Meckel speaks familiarly of its being furnished with an innumerable quanti-
ty of capillary vessels. Vol. i. p. 470. 
CUTICLE.
337
  The structure of this body is entirely peculiar;  there  is no
evidence whatever of the existence of vessels in it: on the con-
trary, in inflammations, when the  skin becomes of the deepest
tinge of red, the epidermis never has its colour changed in the
smallest degree;  the impression made  on  it is only manifested
by its dropping off, while another layer is preparing to take its
place.
  Dr. W. Hunter^ though  he disbelieved in the  possibility of
injecting the cuticle, and  did not admit  the  evidence of the
preparations of his time having that reputation; yet thought the
communicating or perspiratory vessels might be exhibited in a
different manner, that is, by macerating for a short time a piece
of the sole of the foot: afterwards, in separating  the cuticle
from the cutis vera, as the  two membranes parted, these vessels
would be found in the angle  of separation passing from one to
the other like cob-web filaments.*
   There can be no doubt  of the  accuracy of this statement,
for it is  easily verified  by any one who will  take  the trouble
to perform the experiment;  yet it is more  than probable that
Dr.  Hunter was deceived in  the nature of these filaments, and
that as M. Beclard has suggested, they were merely the threads
formed out of the rete mucosum, which was rendered a viscous
fluid by the commencement of putrefaction; and, therefore,
when parted, would put on the  same  filamentous appearance,
that half dissolved glue does in  a similar situation.   Some of
the aforesaid filaments also are supposed  by Bichat and Chaus-
sier to be absorbents; but this opinion  of  course sinks  with the
objections brought against Dr. Hunter.
   Neither is there any evidence of the existence of nerves or
of the cellular membrane  in this  tissue;  for it  is in all states
entirely devoid of sensibility, and never puts forth granulations.
The excrescences which belong to it, as corns and indurations,
are, like it, laminated, owing to their thickness, and  have no
interior circulation; and though sometimes  painful, are so only
by their pressing upon the subjacent nerves of the skin.   It is
also destitute of filaments.
   The cuticle is penetrated by hairs, and by the orifices of'the
sebaceous follicles and glands; and according to Bichat, also,

          * Med. Obs. and Inquiries, vol. ii. p. 53, London, 1762,
   Vol.. I.—2V 
338
INTEGUMENTS.
 by the exhalents and absorbents, the  several orifices of which
 he says become distinct by holding it between the eye and a
 strong light.  As it, when raised by a blister, does  not allow
 the effused fluid to pass through  any  of  these pores, it is very
 reasonably supposed that  they are all oblique, and therefore
 exercise a valvular office on such an  occasion.   Or if, accord-
 ing to the supposition of Mr.  Cruikshank, the finest pores of the
 cutis vera are lined  by processes from the cuticle, the collapse
 of these processes on the separation of the cuticle will also  ac-
 count for the fact.   It seems to be well ascertained  at the pre-
 sent lime, that as the epidermis  is more  transparent at certain
 points than elsewhere, the  appearance has been mistaken  for
 porosities of exhalents and absorbents.  The cuticle, when  de-
 tached, will not allow a column of mercury to pass through it,
 except its weight be so great as to lacerate it: this  fact is  ra-
 ther against the doctrine of the pores  being  visible when exa-
 mined by permitting the light to shine through, and shows that
 even those for the hairs and the sebaceous follicles are stopped
 by some arrangement or other.   Upon the whole,  the opinion
 of organized pores in the cuticle for  exhalation or absorption,
 is not sustained  by  unobjectionable testimony, and  is scarcely
 admissible upon any principle.   At the same time it maybe re-
 marked, that the interstices which exist in it would seem  to be
 sufficient to account for many of the  phenomena of exhalation
 and  of absorption.
   The cuticle  has  but  little power of extension, and, conse-
 quently of contraction, and tears with the application of a very
 slight force.  It naturally contains so little moisture, that its
 bulk is only inconsiderably altered by drying.  It, like the hair
 or nails, resists putrefaction so much, that it has  been found in
 burial places after a lapse of fifty years.   When held in water,
 it swells, becomes white, wrinkles more, loses its  transparen-
 cy, and dulls the sensibility of the cutaneous papillae.  It can-
 not,  like the true skin, be readily reduced by boiling water into
gelatine, and consequently, is not affected by tanning: it, in-
deed, retards that process, when  left  on the proximate surface
of the cutis  vera.  When applied to  a fire,  it burns, like  the
hair  and  nails, wilh extreme  facility, owing to the presence of
a similar oil in it, and it gives out a very disagreeable odour.
  The little  extensibility of the cuticle causes it to be ruptured 
CUTICLE,
339
whenever tumours, as warts, &c, rise from the surface of the
cutis vera: it is supposed, however, not to be entirely deprived
of this quality, as it seems to stretch when raised into a blister,
though this may arise, in some measure, from the small wrinkles,
naturally existing in it, being drawn out.  It has not the slightest
sensibility, neither  is this quality evolved by any condition
whatever, as it  is in tendons,  ligaments, and  bones,  when
they become inflamed.

   There is, in all probability, a slow loss and reproduction of
the cuticle constantly going on.   The former  is manifested by
the large quantity of branny scales that are detached from its
surface, when one has abstained from bathing for a long time.
This is more remarkable on the palms and soles than elsewhere,
and the loss must, of course, be  continually supplied.   It, as is
well known, is rapidly regenerated when it has been lost sim-
ply by an abrasion or blistering, which has not interfered with
the organization of the rete mucosum.  In  some cases there is
an unusual  development of it: Bichat retained the skin of a
patient, dead at the Hotel Dieu, in whom the cuticle, at the pe-
riod of birth and  in subsequent life, was three  times the natural
thickness; and had always, with the exception of that of the
face,  been subject to a continual desquamation.
   As the epidermis has in itself no power of regeneration, ow-
ing to its deficient organization, the most plausible opinion in
regard to its source is, that it  is  produced by the inspissation
and drying either of the external layer of the rete mucosum or
of a secretion from it, which  renders it a sort of varnish, well
qualified to resist the agency of exterior objects, and to protect
the delicate organization of the proximate surface of the cutis
vera.  This opinion of its origin  seems to be proved by its par-
ticipating in the colour  of the rete mucosum, more or less, so
as to give it a sensible tinge, which cannot be washed from it.
   One of the most  striking properties of  the cuticle is  its re-
sistance  to evaporation from the surface of the body: in  a sub-
ject, any part of  the derm, when deprived of  it and exposed to
the air, dries up in the course  of a day or two, while the other
portions remain  soft and flexible for weeks, and, if it were not
for putrefaction  causing- the  cuticle to peel   off, would  some-
times remain so  for months.  Though it suppresses evapora- 
340
INTEGUMENTS.
tion, in a great measure, it does not do so entirely ; for, after
a subject has been kept some time, its fingers, toes,  nose,  and
ears get very dry and hard.
  During life the  process  of perspiration is continually going
on, either in a sensible or insensible manner; and according to
the experiments  of  Sanctorius,  more than one-half  of the
weight of our food is lost in  that way through  the skin and
lungs.   MM. Lavoisier and Seguin ascertained that the propor-
tionate exhalation from these organs was eleven of the former
to two of the latter.   When the perspiration is rapid, it assem-
bles on the  surface  of the body  in the form  of small drops,
having an acid, saltish taste,  and  a  peculiar odour.  In this
state, according to the analysis of Berzelius, it consists princi-
pally in water, holding in solution a hydrochlorate of soda and
of potash, some lactic acid, lactate of soda, and a little animal
matter.  The perspiration, besides its use as an excretion, is
a powerful  means, by its  evaporation, of enabling  the body
to resist a high  temperature.   It varies,  both  in quality and
quantity, according to age, sex, state of health, food, and habits
of life.
  The power of the cuticle to absorb or to transmit inwardly
articles through it, is not by any means so obvious as its exha-
lation: the facts, however,  upon the whole, seem to prove that
though this power is much  curtailed when compared with that
possessed by  mucous surfaces, yet it does exist to a certain ex-
tent.*
                     CHAPTER  II.

         OF THE SEBACEOUS ORGANS OF THE SKIN.

  The Sebaceous Organs consist in Follicles (Crypta Mucosa)
and Glands, (Glandula Sebacea.)   They furnish the oily exha-
lation,  which lubricates  the surface of the skin,  gives linen,
when worn a long time,  a greasy appearance, and cau'ses the
* Wistar's Anat. Vol. ii. p. 396, 3d edit. 
THE sebaceous organs.
341
 water in which we bathe to assemble  in drops, on the surface
 of  the body, rather than to wet it uniformly.  This humour
 produces a rancid disagreeable smell in negroes, and  such per-
 sons as do not resort to ablutions of the whole skin, from time
 to time.   It is  particularly abundant about the places provided
 with  hairs, as the scalp, the genital  organs,  the axillae, and
 seems to be intended to maintain the flexibility and smoothness
 of the skin and hair, and to  prevent the former from chapping.
 These qualities of it are  possessed, in a  considerable degree,
 by  the oily articles of the toilet, which are used for  the same
 purpose.   There can  be  no doubt of the  unctuous  quality of
 this secretion, as, when collected on a piece of clothing or on
 blotting-paper, it  burns with a  white flame.   Its quantity is
 readily augmented by certain kinds of clothing, which most
 persons must have observed shortly after putting  on a flannel
 shirt next to the skin.
  It is sufficiently  certain that the apparatus producing this oil
 is not visible to the naked eye in  most parts of the skin, so that
 there would seem to be a necessity of accounting for its ap-
 pearance there, in some other way besides  a distinct glandular
 apparatus.   Bichat considered it to arise from a set of  exha-
 lents differing  from those which secrete the matter of perspira-
 tion, a theory far more rational than that which attributes it to
 the percolation of the subcutaneous fatty matter.   M. Beclard,
 however, admits that sebaceous follicles  exist  over the whole
 surface of the skin, with  the  exception of  the  palms and
 soles; because the  skin is universally rendered unctuous by this
 discharge:  many follicles exist, which are only visible to the
 microscope; and because  morbid changes frequently render
 them evident, where their existence was not suspected before.
 In many places these follicles are sufficiently obvious  and very
 numerous,  as on the  nose, about the corners of the mouth, on
 the ear and behind it, and on the  face, generally, of some indi-
 viduals.  When the skin  has been injected, they are found  to
consist of  small pouches placed in its thickness, and having
their parietes abundantly furnished with blood vessels.
  The discharge from them sometimes becomes inspissated, and
does not readily pass through their orifices; in which case, con-
tinuing to  accumulate, it will, finally, form a  sensible tumour.
Most  frequently it  does not collect to such an exten',  but is
                            29* 
342
INTEGUMENTS.
indicated simply by a small black point, owing to the adhesion
of dirt to it: in this condition, when squeezed out, it assumes a
small vermicular shape.

  The Sebaceous Glands, properly speaking, are  about  the
size of a millet seed, of a light yellow colour, and are placed,
wherever they exist, immediately under the cutis vera.  They
are particularly numerous  under the skin of the mons veneris.
I have not observed them so distinctly elsewhere.
                     CHAPTER  III.

                       OF THE NAILS.

   The nails (Ungues)  supply the place of cuticle on the ex-
 tremities of the fingers and toes,  and may be  considered as a
 continuation of this  membrane, because  in maceration they
 come off along with it.  They correspond with the talons and
 hoofs of the lower orders of animals.
   Each nail  consists of  a root, of a body, and of a free ex-
 tremity, or that which  projects  and requires  paring.  The
 root is about one-fifth of the length of the nail; is thin, soft, and
 white, and  is received into a fold or fossa of the true skin,
 which is very distinct  when  the cuticle and nail are removed
 together by maceration.  The concave surface of the  nail
 adheres closely to the skin below, precisely as the cuticle does
 in any other part of the body, and therefore may be loosened
 by the same  processes,  as hot water and maceration.  The
 white part of the nail, at its root, is called the crescent, (lunula,)
 and  is said,  by Mosely,* never to exist in the fingers of Africans
 or of persons who have even a slight mixture of negro blood:
 the latter opinion I am disposed to consider incorrect.  This
 appearance, however, does  not depend  upon any peculiar or-
ganization of the nail itself at that part, but upon the cutis vera
below  it, which being more vascular elsewhere, causes  that
,-pot to look  white, the nail being semi-diaphanous and permit*
* Diseases of Warm Climates. 
THE NAILS.
343
ting a view of the circulation beneath.   This is also sufficiently
proved by the fact,  that when a nail is torn off, its lunula disap-
pears.   The  nail increases gradually in thickness from its root
to its free extremity.
  The nail is covered on the posterior face of its root by the
epidermis, which terminates there  in a thin, adherent, diapha-
nous band: behind  this band the root of the nail projects, and
is received into the groove of the  cutis vera.   The epidermis
also  adheres  to the  lateral margin of the nail, and in a curved
line  to  the concave side of its anterior end.  The under sur-
face of  the  nail is soft, pulpy, and has an  arrangement  of
superficial longitudinal grooves,  receiving the  papillae of the
corresponding surface  of  the cutis vera.  As the black  co-
lour of the negroes is sometimes seen beneath their nails, it is
probable, as  stated, that the  rete  mucosum exists there also;
but it is not so clearly ascertained, though the observations of
M. Gaultier, on the rete  mucosum of animals, tend  to  prove
it*
  As the nails  are entirely destitute  of  organization, having
neither vessels nor  nerves, they have no power  of growth  nor
of disease in themselves,  these qualities  being  derived exclu-
sively from the  cutis vera.  The materials of their formation
are, accordingly, secreted from the cutis  vera, in the bottom of
the groove, formed by the latter for the reception of their root.
As these materials adhere to the preceding  formation, and
become concrete,  by adding continually to its  length, they
shove it  forward, and thereby elongate it.  While this is going
on in the groove, the thickness of the nail is also somewhat in-
creased  by an excretion from the  skin contiguous to its con-
cave surface.  This  accounts for  the nail being thicker at its
free  extremity than at its root.
   Owing to a peculiarly morbid state of this proximate surface
of the true skin, it sometimes  happens, that the  contribution to
the nail  from it exceeds that from the groove; the consequence
of which is,  that the  whole nail grows upwards  like a horn, in-
stead of forwards.  An example of this  kind was lately exhi-
bited to me  by a  scientific friend, Dr.  Charles D. Meigs, of
this city, in  a female aged about ninety.  In  this case  one of
* See Rctc Mucosum. 
344
INTEGUMENTS.
the big toe nails had grown upwards, in a semi-spiral manner,
to the length of four and a quarter inches, when measured
along the outer edge of the spiral.  The corresponding nail
of the other side would have been  of  nearly the same length,
but it  had been broken.  The nails  of all  the other  toes
had assumed  a  similar  manner  of growth,  and measured
from one  and a half to  two inches.   In  the  case  of each
nail its  anterior extremity presented  the  primitive nail as
it had been before this extraordinary hypertrophy.
   The statement of the patient was, that the growth had com-
menced  about fifteen  years previously.  A tendency to this
horny growth from the skin, was also manifested in a tubercle,
three or four lines long, and with an ulcerated base, from the
back of  her nose; and also by scaly excrescences on the legs.
The patient having died  shortly afterwards, the  collection of
nails was politely presented to the Anatomical Museum, by Dr.
Meigs.
   In cases where the nail has been  lost by violence or disease,
the cutis vera secretes another; but it differs from the first, un-
less the  cutis vera has been restored to a perfectly healthy ac-
tion: from this cause, we see in individuals thick black  nails,
sometimes cleft longitudinally.
   The nails begin to appear about  the fifth month of fcetal life,
and are still imperfect at  birth.  When analyzed, they seem to
consist in  coagulated albumen, with  a small  quantity of the
phosphate of lime.
                    CHAPTER IV.

                      OF THE HAIRS.

  The Hairs  (Pili,  Crines) are  cylindrical  filaments, which
are found on most parts of the skin, excepting the palms  and
the  soles.   The finest of them are microscopical, and have not
a diameter exceeding the one-sixth hundredth of an inch. 
THE HAIRS.
345
   The hairs differ much in their size and appearance in the se-
 veral parts of the body.   Those on the head (capilli, caesaries,)
 grow to the greatest length of any, and are most numerous in
 proportion  to the space they occupy.  Those which  surround
 the mouth, and are  on the cheeks, (julus, mystax,  barba,) ex-
 ceed the others in size, and when allowed to grow,  are next in
 length, and more disposed to curl.   Those around  the  eyes
 (cilia and the supercilia,)  are not disposed to exceed an inch in
 length, and have a  long slender spindle shape.  Those  at the
 orifices of the nostrils and ears are of the  same habits  as the
 latter.   Those of the arm pit, (glandebalae,) and  about the or-
 gans of generation, (pubss,) are limited to the growth of a few
 inches.
   In  the male subject  there are  hairs of considerable length,
 also, on  the sternum, and  about the nipples, an  arrangement
 which seldom  occurs  in females.  In most individuals, hairs
 are found  over  the whole remaining surface of the body; but
 in females,  and  in many males, they are too fine to  be readily
 visible.  In some subjects, brought into our dissecting-rooms,
 the pilous system has been so developed as to form a shaggy
 coat over the whole body, and almost to conceal the skin.
   We are  informed, on the authority of Jameson's  Tour, of
 a  man, at Ava, covered from head to foot with hair.   That
 on the face and ears is shaggy, and about eight  inches long;
 on the breast and shoulders it  is from four to five.  He  is a
 native of the Shan country, and married a Burmese woman,
 by whom  he  has  two  daughters:  the  youngest is  covered
 with  hair  like her father, but the eldest resembles her  mo-
 ther.*
   In the  female  the hairs of the head are more abundant, and
reach a greater  length than they do in the male.  As a general
rule, the  colour  of the  hairs corresponds with that of  the eyes
and of the skin, and the darker they are, the coarser.   Accord-
ing to Withoff, a quarter of an  inch square of skin has upon it
147 black hairs, while the same extent has 162 hazel, or  182
white ones, in other individuals.
  Each hair consists in a bulb and in a stalk.  The  bulb is the
adherent extremity, and is whiter, softer, and generally larger
* Littell'a Museum, No. 69; p. 412. 
346
INTEGUMENTS.
than any other part; it is received into a follicle, compared ap-
propriately by Malpighi to the vase containing a flower or plant,
and which is deposited most commonly in the subcutaneous cel-
lular substance, but sometimes in the  skin itself.  This  follicle
is of an oblong ovoidal shape; its  open orifice  is  continuous
with the surface of the body, while its internal end is  closed,
and has some filaments passing from it to the adjacent cellular
substance.  It is  formed  of two membranes;  the  external is
white, strong, and  continuous with the derm or cutis vera; the
second being within the last, is more soft, delicate,  and  vascu-
lar, and seems  to be a continuation of the rete mucosum.  From
the bottom of the cavity of the follicle, a small conoidal  papilla
erects itself towards the orifice.   This papilla is vascular, and
from the  dissections of M. Beclard, on the human subject, and
of M. Rudolphi, on the  mustachios of seals, is  furnished with
nerves.   The mode of approach of its vessels is not  yet settled.
M. Gaultier says that the arteries pass from the surface  of the
skin into the orifice of the follicle, and then descend, in  a ser-
pentine manner, between its two membranes to the bottom.*
M. Beclard, on the contrary, considers them to pass through
the bottom of the follicle.  Each piliferous follicle is, moreover,
furnished, within its orifice, with many small sebaceous follicles
arranged round it.
   The bulb of the hair has in it  a conoidal cavity,  open at its
base, and receiving the  conoidal papilla of the follicle.j;  The
hair receives its nourishment  from the papilla.  The  hair is
moreover attached to the skin  by the cuticle; for the latter
having reached the orifice of the follicle is then reflected for
some distance  along the hair: this increases the strength of the
attachment of the hair to the skin.

   The stalk of a hair  has generally the loose extremity  smaller
than any other part, and  frequently split.   When examined with
a microscope the stalk appears to consist of two substances, one
within the other.   The exterior is a diaphanous sheath  almost
colourless, and, from having the properties  of  the  epidermis,
may be a continuation of it.   The interior consists of from five

          • J. Cloquet, Anat. de l'Homme, PI. CXVIII. fig. II.
          + Gaultier, see Cloquet, loc. cit. 
THE hairs.
347
to ten filaments, parallel with one another, and forming a tube
in the centre of the fasciculus.   The tube, as well as the inter-
stices between  the filaments, is filled with a fluid  called the
marrow of the hair.  This substance corresponds with one of
the  layers of the rete mucosum of the skin, and contains the co-
louring  matter.  The  probability is, that  the whole  hair is  a
continuation  of the rete mucosum, to which is joined the enve-
lope of the epidermis.   The canal in the centre of  the hair is
said to be unusually distinct in the hog's bristle; it is also well
seen in  thasupercilia: the follicle and bulb are best  studied in
the mustachios of the larger animals.  According to Mr. Heu-
singer,* the substance of the hair, when examined with a mi-
croscope of strong power,  exhibits an areolar appearance.
  Though the stalk of the  hair is destitute  of blood vessels and
of nerves, yet it is probable, from the sudden changes of colour
that sometimes occur in it from black to white, owing to terror
and grief, that there is a species of interstitial circulation going
on.   The emaciated and  peculiar appearance which sickness
gives to it, would also tend to support this opinion.   Strictly
speaking, the hairs are devoid of sensibility, yet, as the bulb is
planted over a sensitive papilla, they communicate certain sen-
sations  by being  removed or  touched.   Animals apply  their
mustachios particularly to this use  in  groping through dark
places, or when they are deprived of sight.  The hairs are emi-
nently hygroscopic, moisture lengthens,  and  dryness shortens
them; this property has caused them to  be applied to the con-
struction of hygrometers.
  In certain animals the hairs are erected by the contraction
of the subcutaneous muscle; the movement in the human sub-
ject corresponding with that, is the effect of great fright, and is
produced  by the contraction of the occipito fronta-lis muscle.
  In the development of hair, the part which first forms is the
follicle,  the young hair then pierces it at its summit, in the same
way that the tooth pierces  its capsule.   The death of the cap-
sule, or the drying up of its fluids, occasions the fall of the hair
and prevents its regeneration.   In old men who  are bald there
is no appearance of capsules; while in persons from  whom the
hair has fallen, owing to sickness, as the capsules still  remain,
* J. Cloquet, loc. cit. 
348
INTEGUMENTS.
 they soon put forth another crop of hair.  The rudiments of the
 hair are seen about the fifth month of foetal life.  The first crop
 is deciduous, and after covering the body of the fcetus like a fine
 down, till the eighth month of utero-gestation, it then falls off:
 sometimes, however, it is retained  either in whole or in part
 till after birth; this is particularly the case in regard to the hair
 of the head.  In this deciduous character we see another analo-
 gy between the hair and the teeth.
   When  the  hair  becomes  white  from  age, the conversion
 of colour begins at the loose extremity, another  proof of the
 interstitial  circulation, or change of particles in it.  The same
 fact is observable in animals who change colour  only  for the
 winter.  But the restoration of colour begins at the root.
   It is probable, in those  cases of plica  polonica attended with
 bleeding from the root of the hair when it is cut, that the vas-
 cular papilla has been so  much augmented  as to elevate itself
 above the level of the cuticle, and of course interferes with the
 sweep of the razor employed in shaving the head.  Ignorance
 in regard to the organization of the hair, and a slight inclination
 to the marvellous, would magnify this into every hair, in such
 a disease, being a sort of  branch-pipe from the general circu-
 lating  system,  and therefore  bleeding  upon  being wounded.
 Many of the victims to this disease accordingly prefer the loath-
 some matting of the hair with which it  is accompanied, to the
supposed risk of dying by hemorrhage. 
BOOK   III.
PART  I.
CHAPTER  I.
ON THE GENERAL ANATOMY OF THE MUSCLES.*
  The muscles (musculi) by their contraction produce the va-
rious flexions of the body, and are, therefore, the organs of mo-
tion.  They may be  known by their redness, softness, irrita-
bility, contractility, and by their being formed of long parallel
fibres.   The redness, however, does not always  attend them;
as this colour is very faint  in the  fcetus, and  does not exist at
all in animals that have not red blood.   They form a very con-
siderable share of the whole bulk  of the body.
  Though the  most perfect organs of motioa, and producing it
more efficiently and rapidly than any other apparatus, they are
not indispensable to it; for they are not observable in animals of
a very low grade, which apparently consist of a sort of cellular
or mucous substance.  In  the  next grade of animals, as the
worms, where there is a deficiency  both of bony and of carti-
laginous skeleton, the muscles are perceptible, and  produce lo-
comotion by their attachment to the skin or integuments; and,
finally, in animals which have  a skeleton, the muscles are  al-
most exclusively attached to its different points, and  by alter-
nately approximating them, effect locomotion.
  The muscles of the human body are referrible to two classes,
in consequence of their position and functions, though  they pre-

  * These organs were very  imperfectly known to the arcunts, e:c3pting Ga-
len, and had not generally  received names  till the time of Sylvius,  A. D. 1587.
The paramount authority of Albinus, in this department of anatomy, in his work
Historia Musculorum Hominis, Leydcn, 1734, has induced me to adopt it as the
standard of correct description and nomenclature, with but few exceptions.
  Vol.  I.—30 
350
MUSCLED.
sent a perfect similitude of structure every where.   The most
numerous class, as well as that in which they are of the greatest
magnitude, are the muscles of voluntary motion: they are placed
between the skeleton  and the integuments, and constitute  the
principal bulk of the extremities, and also afford a thick fleshy
covering to the trunk.  The second class is contained within
the large cavities of the skeleton, and forms  a portion of the
structure of the circulatory, of the digestive, and of the urinary
organs; and produces the principal internal  motions of the ani-
mal economy.
   Every muscle is  surrounded by an envelope of cellular sub-
stance, called its sheath,- (Membrana' Musculorum Communis,*}
which at different points of the body exhibits various degrees of
condensation.  In the muscles of voluntary;motion these sheaths
are formed by partitions, going from the aponeurotic expansions
just beneath the skin, to the periosteum, and are  the prolonga-
tions which  induced  Bichat to consider the  periosteum, as  the
centre of the desmoid systems These sheaths in some cases pre-
serve to a considerable extent the ligamentous appearance, but
 generally cellular substance predominates in them.  Upon their
 existence is founded the great variety of views and  descriptions
 which the later anatomists have taken of the  fasciae of  the hu-
 man body, some choosing to describe them in one way and some
 in another.   The sheaths of the second class of muscles are com-
 posed of a  much finer and looser coait of cellular substance than
 those of the first, and are commonly described as laminae or tu-
 nics to the organs  to which they respectively belong.  In every
 case, however, from the internal  face of these sheaths a great
 many partitions pass off, which penetrate the  body or thickness
 of the muscle, and  divide and subdivide it into  fasciculi, and into
 fibre's, even to their mast minute condition. These partitions be-
 come thinner the more they are multiplied.
   Many of the muscles are subdivided by fissures, into several
 large portions  called Fasciculi, or Lacerti.   These vary very
 much in size, and in  their distinctness from  each  other.   Some
are so  large and so widely separated as to appear  like  distinct
muscles; such, for example, are the biceps of the arm and of the
thio-h, the deltoid, the columnas carneae of the heart, and several
others.  But the greater part of the fasciculi are strictly  parallel
* Haller, Element. Physiol, torn. i. 
              GENERAL ANATOMY OF THE MUSCLES.            351

with each other, and merely separated by a thin lamina of cel-
lular substance.  The fasciculi are again subdivisible into 'fibres,
which from their smallness are not appreciable to the naked
eye, and even when examined with powerful microscopes seem
to admit of an endless division.   On this account some anato-
mists  have undertaken  to classify the fasciculi under the terras
of first, second, and third orders.   It is evident, however,  that
this arrangement is too  arbitrary to be needful, and that the
circumstance is sufficiently expressed by considering the fasci-
culi  as indefinitely divisable.   The  fibrous arrangement of
muscles is rendered still  more distinct by boiling them, or by
immersing them in alcohol.
   The structure of the muscular fibre has  been studied with
great attention by  microscopical  observers.  From such  ob-
servations, it  appears  that  their ultimate shape is prismatic,
pentagonal,  or  hexagonal.   According to  Prochaska, every
fibre extends the whole length  of the muscle, considering this
length as  represented by the tendinous beginning on  the  one
hand, and the tendinous  termination on  the other.  This  ar-
rangement holds even  in  regard to the longest muscles, as the
sartorius.
   The most approved accounts, of modern times, of  the  ulti-
mate structure of muscular  fibre, are those of Mr. Bauer; with
Sir Everard Home, and  of  MM. Prevost  and Dumas.  These
gentlemen concur in stating that the results  have been uniform
in all animals to whieh their observations have been extended.
That the  muscular fibre  is  a series of globules, resembling  the
globules of the blood deprived of colouring matter and adhering
in a line to each other.  That the medium of adhesion is invi-
sible from its  transparency and want of colour; but if the mus-
cle be macerated in water frequently changed, that this medium,
from its greater solubility and more ready putrefaction, may be
removed  so as to leave the globules detached from each other,
and still resembling the globules of the blood.  The fact of the
globular condition of  the muscular fibre was first pointed out
by Leuwenhoek and Hook;  it  is  also confirmed  by the testi-
 mony of Mr. Milne Edwards and M. Dutrochet.  The evidence
of their size is very unsettled ; it is stated at from one diameter
 to one-seventh of the diameter of a globule of blood, the latter 
352
MUSCLES.,
being estimated at the two-thousanth part, or less, of an inch,.
Such minute observations are necessarily very uncertain.
   In meat which is  prepared for the table by roasting  or boilr
ing, or in a muscle which is contracted, one frequently sees
the fibres undulated or crooked.   By Prochaska it is attributed
to the bridling of the fibre,, by the  contraction of its  cellular
substance, nerves, and blood vessels.  The cause, however, is
not well ascertained: the condition seems to be one of the pe-
culiarities of muscular fibre, which it manifests when in a state
of contraction only; for it disappears whenever the fibre is re-
laxed, either by spontaneous  movement, or by stretching it in
the  dead  body.  This undulation has probably contributed to
the  many inexact observations on the structure of muscles.
Thus, Haller thought they consisted  in a series of ovoid vesi-
cles, which  lengthened in a  state of relaxation, and became
more globular in  a  state of contraction.   It is unnecessary to
dwell on  mere errors of the eyes or of the imagination,  for the
fact seems, to be now well established, that,, though the  muscu-
lar  fibre, by contracting, loses its  straightness  and becomes
crooked, yet this is  effected without change in the form of the
ultimate globules of which it consists.
   By some it has been asserted that muscles are only the con-
tinuation  of  blood vessels.  To this  it is. replied,* that  though
insects have muscles, yet they have not blood vessels,  so that
the former cannot be a continuation of the latter.  Moreover,
a  successful injection, though, it may penetrate very finely be-
tween the fibres, so  as to, cause the muscle to swell considera-
bly, yet none of these vessels, can be traced into the ultimate
fibre.   The vital, phenomena and the organization of muscular
fibre,, are so very different from cellular substance, from  nerves,
and from  vessels, that it cannot be less than  a distinct slruc*
lure.
  Notwithstanding this limitation, which is  put  upon the dis-
tribution of the blood vessels, every  muscle is abundantly sup-
plied by them.   The arteries come from  the  adjacent large
trunks, and penetrate at different points of the periphery of the
muscle.   They first of all  pass between the larger fasciculi and
* JJeclard, Anat. Gen. 
              GENERAL ANATOMY OF THE MUSCLES.            353

 parallel with them;  they then divide  and follow the course of
 the smaller fasciculi; they divide and subdivide again after the
 same rule, till they become mere capillary tubes, from which
 the nutritive  matter is exhaled.  The  veins  accompany the
 arteries, and receive their blood; some of them creep along the
 surface of the muscle without having corresponding arteries.
 Bichat says that they are injected with great facility from their
 trunks, from which  he supposes that their  valves are less nu-
 merous than in other parts of the system.
   The colour of the muscular fibre seems to be, in  a measure,
 independent of the blood which circulates in it.  Some animals
 with red blood have white fibres, as frogs.   The colour of the
 muscular fibre is not altered in  animals that have been suffo-
 cated.  The muscular fibres of the intestines  and of the bladder,
 though abounding in blood vessels, are whiter than the muscles
 of voluntary motion.

   Lymphatics have been injected in the intervals between mus-
 cles and between their fasciculi.

   The Nerves of the  muscles are large  and abundant, as the
 nerves of the brain  and spinal  marrow are  chiefly  spent upon
 them.   They are generally proportioned  to the size of the mus-
 cle which they have to supply, but there is some variety in this
 respect.   They accompany the arteries, and are united to them
 by cellular substance.  Their ultimate terminations are traced
 with great difficulty, and there is ^consequently an uncertainty
 ;n this respect.   Before  they disappear  they  become soft by
 divesting themselves of their cellular envelope, and are supposed
 to bring thus their medullary substance  in  immediate contact
 with the muscular fibre.  The recent observations of MM. Pre-
 vost and Dumas, are thought to throw some light on this  sub-
ject, and have been received with a  very respectful attention.
They say, that by macerating in clean water, and in a dark
place, the muscle of a bullock, and then throwing a strong con-
centrated light upon  it, the  distinction of colour  between the
nerves and the muscular fibres becomes very apparent.  With
the aid of a microscope and a fine knife,  the nervous ramifica-
tions may be thus traced.   The  trunk of the nerve  enters the
muscle parallel with its fibres,  and soon  begins to give off, at
                           30* 
354
MUSCLES.
right angles, lateral filaments, which penetrate between the fas-
ciculi and  fibres of the muscles, and may be traced  to the top
of the undulations formed in the muscular fibres.  These lateral
filaments at some places are two in number, which pass at some
distance from  each other, but parallel, and terminate by an
interchange  of filaments ;■ at other places* the  terminating
branches are  spread  out  transversely  to  the muscular  fibre,
 and end by forming loops  with themselves.  According to this
 view, the nervous  filaments,  strictly speaking, have no termi-
 nation, but run again into the source from which they are de-
 rived.

   The chemical analysis of muscles shows them to be  com-
 posed of fibrine, albumen,  gelatine, extractive matter, the phos-
 phate of soda, ammonia,  and of lime, and of the carbonate of
 lime.   The  extractive matter of  the muscle may be removed
 by maceration in clean water, often changed.  If it be allowed
 to remain long, it assumes certain  appearances in its putre-
 faction peculiar to itself, but occasionally  it is converted into a
 substance resembling  spermaceti.   When a muscle is exposed
 to boiling  water,  the albumen is raised to the surface, like
 roam; the gelatine coagulates when the  muscle is cold; and the
 fibrine appears as a fibrous grayish substance, insoluble in hot
 water, closely resembling  the fibrine of the blood, and evolv-
 ing  large  quantities of nitrogen by the action  of nitric acid.
 When  a muscle is  exposed to the  fire alone, as in  roasting,
 the albumen is hardened;  the gelatine is  melted, and runs off,
 in part,  with the juices of the meat: the extractive matter  is-
 that which gives a dark colour to the  outside;  the fibrine  is
 cooked in the  juices of the moat, and- is  then  rendered very
 fender.  The muscular parts of animals are amongst the easiest
 of digestion.
   The  muscular  system  of  the  embryo is  first of all in a
gelatinous  state,  and  confounded  with   cellular  substance;
but  at  two  months from  conception, the fibres are distinct,
and at four they begin to contract  and to execute different mo-.
tions.
   The muscular system is  subject  to varieties of conformation.
 Robust, muscular individuals frequently have supernumerary
 muscles arjd supernumerary heads  to their  muscles, particularly 
MUSCULAR MOTION.
355
in the extremities.   In  monstrous foetuses it sometimes hap-
pens that the  muscular system  is either  wholly or partially
supplanted by  adipose matter and by infiltrated cellular sub-
stance.
                    CHAPTER II.

                  ON MUSCULAR MOTION.

  The muscles, after  death> are  soft, easy to tear, and have
but little elasticity; it is only during life that they manifest such
extraordinary strength, and  retain their  powers  of motion.
The general  phenomena  of the latter have  been happily ex-
pressed  by the word myotility, suggested- by  M. Chaussier.
These phenomena are, contraction, elongation, and, according
to Barthez, a power of remaining motionless  or fixed.
  In contracting,  the muscle  shortens, swells and  becomes
hard; presents wrinkles on its surface; and its fibres are some-
times thrown into a state of oscillation or vibration, from their
alternate relaxation and contraction.  It is owing to the vibra-
tory motion in the fibres of a muscle, during their contraction,
that a rustling is heard on the application of the stethoscope to
them.  The hollow, distant rumbling, when  the meatus exter-
nus is closed  by the finger, is owing  to  the  same vibration in
the  muscles of the finger employed.   This is readily proved by
the  following experiment: close the meatus with the end of the
handle of an awl or a fork, pressed against it by the finger,  and
it will be  found that the muscular vibrations  are continued
along the instrument: plant, afterwards, the point of the instru-
ment upon a soft, inelastic substance, so as  to make, in that
way, the closure of lhe meatus, and  the rumbling will instantly
cease.   The  roaring  noise of  sea-shells may be explained in
the  same way.  The colour  remains  the  same, which proves
that there is not an appreciable addition to the  quantity of its
circulating fluids.  The rapidity with which  this contraction
may lake  place, is manifested in speaking, in running, and in
playing  upon a stringed  instrument; and  its strength, by the
immense burdens that some individuals can. raise and bear.. 
356
MUSCLES.
   The power of elongation or relaxation seems to be an active
 state of the muscle, as well as its contraction.  This power of
 relaxation or of elongation is much inferior to that of contrac-
 tion; it seems to be only what is sufficient to restore the mus-
 cle to its proper length, so as to put it in  a  condition for  the
 renewal of its contractions.   The fixedness of muscles, which
 are contracted spasmodically, and their retaining this position
 even after death, until putrefaction begins to assail them, show
 that the  power  of elongation  does not depend  simply upon
 elasticity; for the latter quality being as much the attribute  of
 dead as of living matter, would be brought into play on death.
   The fixation of muscles is not  a  distinct power, but merely
 a qualification of contraction, by which the latter  may be  ar-
 rested  at any given point, and  retained there.
   As every  muscle augments in thickness during its contrac-
 tion, it has been a subject of inquiry to physiologists whether
 the whole mass  of  muscle was increased or diminished by its
 contraction.  Swammerdam, in order  to ascertain it, put an
 insulated solid muscle, not yet  dead, into a tube filled with wa-
 ter; by irritating the muscle,  and causing it  to contract, the
 water  descended;  but this result was not uniform.   When an
 arm is plunged into a tube properly formed and filled with wa-
 ter, if  the muscles be caused  to  contract, the fluid  descends;
 but the objection to the inference from this experiment is, that
 when all the muscles of the arm are caused  to contract vio-
 lently, the introduction  of arterial blood is much arrested, if
 not fully stopped; and the venous blood is at the same time ex-
 pelled : so that the change in the size  of the member may be
 accounted for in  that way.  The experiments of Erman on eels,
 fully immersed in a fluid, and submitted to  Galvanic  influence,
 are said to substantiate the theory of the muscles  diminishing
 in bulk by contracting.*

   The activity of a muscle, though closely depending upon the
afflux of blood to it, is not entirely so; for it is ascertained that
Galvanism will cause the muscles  of frogs  to  contract, when
the circulation is  arrested  by death, or  when the blood  is co-
agulated, or even when  it has  been drawn off.t  This pheno-
* Beclard; loc. cit.
i Prochaska de Came Musculari.  Vienne, 1778. 
MUSCULAR MOTION.
357
menon, however,  can only last  a comparatively short  time;
for a muscle soon dies, and runs into  a state of mortification,
after its vascular and nervous communications have been cut
off*   Physiologists  have entertained very different opinions on
the causes of the muscles contracting, or on muscular irritabi-
lity, as it is called.  Some have supposed it to be an attribute
of the muscle itself;* others, that it depended on the blood ves-
sels, which, by bringing a greater afflux of fluids into its inte-
rior, between its fasciculi  and fibres, obliged the  two latter to
take a more flexuous course; and others, on the nerves.f  Any
decision on this point is inconclusive,  because it is well known
that perfect  muscular action requires a  healthy state of the
muscle, and an uninterrupted nervous and sanguineous influence;
so that it  seems  to be  a result from the combination of three
systems, more than an attribute of one alone.J
   MM. Dumas and Prevost say, that in consequence of the final
nervous ramifications crossing the muscular fibres at right an-
gles to them, and parallel with one another, the Galvanic current
which passes through these ramifications, causes  the latter to
approach each other reciprocally; whereby the muscular fibres
to which the ramifications are fixed, are thrown into wrinkles.
It is clear, from this theory, that the muscular fibres themselves
are destitute of the power of contraction, and that they are only
the frame-work upon which  the  Galvanic batteries of  the ner-
vous system are displayed.
   There are no muscles which have not the power of contract-
ing some time after  apparent death, and this phenomenon  fre-
quently continues for an hour;§ it is uncommon for it to cease
with*the apparent extinction of life.   This irritability is of dif-
ferent durations in  the different muscles; it is first  lost in the
left ventricle of the heart; then  in the  large intestines;  after-
wards in the small, and in the stomach; and then in the blad-
der; then  in the right ventricle, the  iris, and in the voluntary
muscles, of which those of the trunk die first; those of the in-

  * Haller, Physiol.
  t Legallois sur le principe de la vie.
  X Meckel, Anat. Gen.; from Barzeliotti, Esame di alcuni moderne teorie inter*
no alia causa prossima della contrazione moscolare, 1796.
  § The recent visitation of cholera in Europe and in this country has given many
persons an opportunity of examining this singular fact. 
358
MUSCLES.
ferior extremities next, and those of the superior last.   The last
act of life is in the auricles, of which the right pulsates longest.
Different circumstances may produce some variety of this pro-
gress, in the loss of muscular irritability, but it will be found ge-
nerally  correct.*.  The experiments of Himlyf  demonstrate,
that laurel water, or that of bitter almonds, applied to the sto-
mach or brain, renders the heart insensible to the strongest sti-
mulants, while the  muscles of volition continue  to  move for
some hours afterwards.  The duration of irritability is, however,
much varied, according to the nature of the death, and the state
of health preceding.  Nysten asserts, that he has seen the right
auricle of a robust man pulsate nine hours after death.  In death
from chronic diseases, with much emaciation, the heart ceases
to beat shortly after intellectual  phenomena cease.   And  in
death from electricity; from a blow upon the stomach;  from the
inhalation  of carburetted hydrogen gas, and some other poison-
ous ones, muscular contraction ceases universally in a few mo-
ments,  and cannot be excited by any artificial means.
   The  irritability of the muscles is so modified that certain sti-
 mulants are peculiarly appropriate to  one and not to another.
 For example, light is the specific stimulant  to the iris; a me-
chanical application, to it  as in making artificial pupil, is borne
 frequently without its contracting.  The heart is very sensible
= to mechanical stimulants, and additionally so  when  they are
applied to its internal surface.
   Some of the  muscles are regularly under the influence of the
 will, others not at  all so, which has given rise to their division
into voluntary and involuntary.  These states, though kept per-
fectly distinct from each other  in health, are  sometimes blend-
ed in disease, the  voluntary muscles becoming involuntary in
their actions,  and the involuntary voluntary;  which, however,
is much more uncommon than the other.
   The  voluntary muscles  are generally such  as serve for loco-
motion and speech, and receive their nerves  directly from the
spinal marrow.   The involuntary muscles are such as are con-
cerned  in the functions of digestion, respiration, and circulation,
and which, in order to  continue  the life  of  the  animal, must

           * Meckel, Anat. Gen.
           f Commentatio de Morte, Goettingue, 1794. 
MUSCULAR MOTION.
359
never cease their actions for any long interval.  It is worthy of
remark, that apoplexy and other cerebral affections, paralyze,
most commonly, the voluntary muscles alone, while the others
retain their usual state and sensibilities.
  When irritability is  entirely gone from a  muscle, and it is
actually dead, the whole muscular system becomes  stiff, begin-
ning with the trunk, then the  inferior, and, lastly, the superior
extremities.  This stiffness seems to be independent of the ner-
vous system, as the destruction  of the spinal marrow, the cut-
ting of  nerves, and hemiplegia do  not arrest it.   It is thought,
by M. Beclard, to be analogous to  the contraction of the fibrine
of the blood;  and, like the latter, does not cease till putrefac-
tion begins.  The degree, as well  as the time, of its access is
variable under different circumstances.   In very aged persons;
in such as have  died from protracted disease attended with
great emaciation;  in  scorbutic and gangrenous diseases, the
stiffness comes on quickly, is very slight, and disappears in a
couple of hours.  But in muscular subjects who have died from
sudden  violence or from acute  diseases, the stiffness is some-
times postponed for twelve hours  or more, and may continue,
in the  winter, from  three or four days to  a week, or even
longer, depending upon the access of putrefaction.
   The sensibility of the muscles is  moderate.   When they have
been  much exercised, they only give out the sensation of fa-
tigue.  In amputations, the pain of cutting through  them is not
equal to that of the skin.  In inflammations they, as most other
parts, have their sensibility exalted to an exquisite  degree.
                    CHAPTER  III.

 OF THE MECHANICAL SHAPE AND  ARRANGEMENT OF THE
                   VOLUNTARY MUSCLES.
  Every muscle consists in  a belly and in two extremities, of
which the one that is the fixed point is the head or origin, and
the other  is the  tail  or insertion.   The  belly or body is the
fleshy part, the extremities are generally tendinous, either com-
pletely or partially. 
360
MUSCLES.
  Some of the muscles arise by a single head, and are inserted
into one point.   Some few arise by a  plurality of heads, but
have a single insertion, as the biceps flexor of the arm, and of
the thigh; others, again, have a single head, but a plural inser-
tion, as the flexors of the fingers and of the toes; others, again,
have multiplicate heads and multiplicate insertions, as the mus-
cles of the back*
   The most simple muscles  are such as have their fibres run-
ning in the direction  of the  length of  the  muscles, of which
there are many examples, as the sartorius, the biceps flexor
cubiti, the semi-tendinosus,  and others.  Others, again, have
their fibres running obliquely from a tendon or a  bony origin
on one side of the muscle, to  a  tendon  on the other, as the se-
mi-membranosus, the peronei, &c; these are called  musculi
semi-pennati.   Others have  a long tendon  in the  centre, to
which the fibres converge obliquely, forming an  angle with
each other; they are the penniform, (musculi pennati.)  Others,
again, are formed of a congeries of smaller muscles, the fibres
of which run in different directions and are intermixed with
tendinous matter, as  the deltoid  and the  subscapular.   As the
strength  of a  muscle depends upon the  number of its fibres,
those whose fibres go obliquely are stronger than if their fibres
had run longitudinally.
                    CHAPTER IV.

               OF THE TENDONS, (TENDINES.)
  The  tendinous extremities of muscles, present  themselves
under two general shapes: one  is funicular, or like cords, va-
rying in shape from cylindrical to paraboloid; the other is
spread  out into a  membrane, and resembles an aponeurosis.
They both adhere with great  tenacity to  the muscular fibres,
so as to have induced, erroneously, the opinion of absolute con-
tinuity: but maceration and boiling will separate them, and the
course of the fibres is different even to the naked eye; besides
the very obvious  difference in colour,  in consistence, and in
vital properties. 
THE TENDONS.
361
  The tendons are surrounded by a loose cellular membrane or
capsule, which  permits them  to glide  freely upon each other:
in some places this membrane is wanting, and is supplied by a
synovial membrane answering the same purposes.

  The tendons are readily recognised by their white and shining
appearance; they have no  elasticity  or  power  of  elongation
and contraction, and, therefore, like other ligamentous matter,
they are lacerated sooner than they can be  stretched.  They
are composed of desmoid tissue, the fibres of which are united
by  a  compact cellular substance  in small quantities.   The
fibres are longitudinal, and may be readily separated either by
maceration or by a  slight boiling.   When a  round tendon is
prepared in this way, it is easy to flatten it out into an aponeu-
rotic membrane: the  fibres are then made  very distinct, and
seem to adhere to each other by lateral  fibrillae.  In ordinary
health no red blood penetrates into the tendons, but if they be-
come inflamed, as their capillaries then enlarge, they admit the
red globules; at the  same time their sensibility, from being en-
tirely organic, or what is only sufficient for the internal actions
of  the  organ, is so much augmented  as  to  be very manifest.*
No nerves have been traced into them.   The tendons have the
character,  at large, of the  desmoid tissue, but  are  more gela-
tinous, or  completely soluble in boiling water, than the liga-
ments.   They have  a  great affinity for the phosphate of lime;
and, hence, we frequently find them  hardened and having small
pieces of bone in them, where they run over bony trochleae.

  * A knowledge of the disposition in tendons to augment their powers of circu-
lation on being inflamed, together with the late Dr. Physick's great success in
the  treatment of unnatural joints by a seton passed through the cavity of the
fracture, induced me in a late tour of service at the alms-house to try the effect
of a similar plan upon a ruptured tendo achillis; which, from the long period
since the accident happened, did not promise  a  cure on the ordinary principles
of treatment.  A seton of silk riband was accordingly introduced, and kept in
its place for six weeks and a half.  It produced considerable pain, tumefaction,
and inflammation, but was followed by a perfect reunion of the ruptured ends of
the  tendon.—Chapman's Med. and Phys. Journal, for July, 1826.   For a highly
interesting scries  of experiments on animals, undertaken at my suggestion, to
illustrate the same thing,  see An Essay for the  Degree of Doctor of Medicine,
by R. L. Fearn, Id. April 9, 1827.
   Vol. I.—31 
 
BOOK  III.
         PART II.

Special Anatomy of Muscles*
                        CHAPTER  I.

               MUSCLES OF THE HEAD AND NECK.

                  SECT. I.—MUSCLES OF THE FACE.

                        Occipito-Frontalis.

   The occipito-frontalis, a single muscle, consists of two symme-
trical parts, coming from the back of the head, and inserted into

  * I may here mention, once for all, in regard to the muscular system, that
though the very rigid mode of description adopted  by anatomists may lead the
inexperienced student to infer that  there are no departures from a common
standard, and that one invariable type for the muscles prevails in all human be-
ings; yet there will be  found  upon actual dissection occasional disagreements
with the best established descriptions, and which it is of some use to know.
Some of these departures are  common enough, others very rare; and they con-
sist either in a deficiency or a redundancy of muscles.  Wishing not to give false
ideas of their importance and frequency, and, indeed, fearful of doing so, they
are purposely introduced subordinately in notes: many of them have been ob-
served by me personally, others are recorded in  different medical writings, and
for the remainder I am indebted to the learned treatises on anatomy of T. Soem-
mering and J. F. Meckel.
  No part of the muscular system varies more in different subjects than the mus-
cles of the back; but, as it would be useless to enter fully on such trivial details,
they have been passed by, except in a few instances. 
364
MUSCLES.
the front of it.   It is superficial, being placed immediately below
the skin of the scalp, and has four bellies of muscular fibres, two
behind and two before, connected by a thin tendon, which covers
all the top of the head.  The tendon adheres by a short cellular
tissue, having no adeps, to the pericranium  below, and is at-
tached to the  common  integuments above.   The common in-
teguments  on  the  hairy scalp are formed by  skin and by a
closely adhering,  and, indeed,  almost inseparable  layer  of
granulated adeps, intermixed  with the capsules of the hairs.
  This muscle arises from the superior semicircular ridges of
the os occipitis by tendinous  and fleshy fibres, which form two
distinct bellies  (musculus occipitalis) about an inch and a half
long, one on each side of the  bone.  Its tendon»jvhen carefully
traced, will be found terminating a little in front of the coronal
suture, in the two  anterior fleshy bellies  (musculus'frontalis)
which cover the whole front part of the os frontis.  The internal
edges of these latter are in conjunction below.
  It is inserted, on each side, fleshy, into the superior margin
of the orbicularis oculi and of the corrugator*supercilii; and, by
its nasal slip, into each internal angular process of the os frontis,
and  into the root of the os nasi.
  It pulls the  skin  of the head  backwards and forwards, and
throws that of the  forehead into horizontal  wrinkles.  It  also
elevates the supercilia.*
                     Compressor Naris.

  The compressor naris arises by a pointed beginning from the
root of the ala nasi, and spreads like a fan over the lateral parts
of the nose below;  it is inserted  into its fellow of the opposite
side on the dorsum of the nose, and into the lower part of the
os nasi, where it is connected with the nasal slip of the occipito-
frontalis.
  This muscle consists of thin and pale fibres placed immediate-
ly under the skin.   If it act from  both extremities, by its curved
fibres being made straight, it will compress the nostril; but if it

  *  Varieties.  Its fleshy portion is said to have covered, in some instances, the
whole skull-cap. 
MUSCLES OF THE NECK.
365
act from its dorsal margin, assisted by the nasal slip of the occi-
pito-frontalis, it will dilate  the ala nasi, and has, therefore, been
called dilatans nasum by Columbus.


           Orbicularis, or Sphincter Palpebrarum.

  The orbicularis oculi  or palpebrarum is  a  broad  circular
muscle, lying immediately under  the skin of the eyelids, and
over the tarsi cartilages.   It is much connected  with essential
points in the anatomy of the eyelid.
  Its diameter exceeds that of the orbit, by  from four to eight
lines all around.   The fixed point of this muscle is principally
the ligamentum  palpebrale internum and the internal canthus
of the orbit;  for, in the greater part of its extent, besides, it  is
only loosely attached to the parts below.
  The orbicularis arises, by short tendinous fibres, from the up-
per end of the nasal process of the os maxillare superius, from
the internal angular process of the os frontis,  and  from the con-
tiguous part of the os unguis.  It also arises along the whole
superior margin of the internal palpebral ligament.
  The fibres from this origin compose the lamina of the upper
eyelid.   They may be traced, thence, around to the lower eye-
lid, and are found again terminating  at the internal canthus of
the orbit, where they are fixed into the anterior margin  of the
orbitar  process of the upper  maxillary  bone,  into the  corre-
sponding ridge of its nasal  process, and into the inferior margin
of the palpebral ligament.
  The temporal portion of this muscle is attached  to the tem-
poral fascia, so as to prevent it from being much  displaced.  It
is, therefore, obvious  that  the  effect of the contraction of the
upper and of the lower half of the muscle will be to bring the
eyelids together.   The fulcrum of motion is the internal or na-
sal side, as manifested by the radiated wrinkling of the skin at
that point.
  The  interior  portion of this  muscle, which is laid  upon the
tarsi cartilages, is called Ciliaris by Albinus: this distinction,
which is too arbitrary, is now abandoned.
31* 
366
MUSCLES.
                 The Corrugator Supercilii*

  This muscle is placed beneath the upper  margin of the or-
bicularis, at its internal extremity; by which, and by the adja-
cent portion of the occipito-frontalis, it is concealed.
  It arises from the internal angular process of the os frontis,
and going outwards  and a little upwards, its fibres are lost in
the inferior margin of the occipito-frontalis and in the superior
of the orbicularis.
  It draws the eyebrow and the skin of the forehead into ver-
tical wrinkles, and also draws them over the eye so as to over-
shadow it,


           The Levator Labii Superioris et Ala Nasi,

   Is fixed  just at the side of the nose.   It arises by a pointed
production from  the  nasal process of the superior  maxillary
bone at the internal canthus of the eye, and by a broad origin
from the anterior margin of  the orbitar process of  the same
bone.   Passing downwards, it is inserted into the side of the ala
nasi, and into the upper lip, being narrower below than above.
The part of this  musclewhich comes from  the orbitar process
is so distinct, that Albinus and the continental anatomists give
it the exclusive name of Levator Labii Superioris.
   It draws the upper lip and the ala nasi upwards.

   Just  beneath  this muscle there is sometimes  a fasciculus,
called the  Anomalus  Faciei of Albinus,  which is attached by
one end to the  upper jaw near the canine fossa, and by the
other to the upper lip.


                  The Levator Anguli Oris,

   Is a small muscle,  concealed very much by the last; it arises
from the anterior part of the-superior maxillary bone, between
the foramen infra-orbitarium and the first small grinder, and is
inserted into the corner of the mouth.
   It raises the angle  of the mouth. 
MUSCLES OF THE FACE.
367
                  The Zygomaticus Minor,

  Is a small muscle, arising from the fore part of the os mate;
it descends  obliquely, and is inserted into the upper lip  just
above the corner of the mouth.*


                     Zygomaticus Major,

  Is just  on the outside  of the  last, and  is much larger.   It
arises from  the malar bone, externally, at its posterior inferior
part, just  above the lower edge, where this bone contributes to
form the  zygoma.  It passes  obliquely downwards to be in-
serted into the corner of the mouth, and runs into the depressor
anguli oris.
  The last two muscles draw the corner of the mouth towards
the  cheek bone, or obliquely  upwards and  outwards, as in
smiling.

         The Depressor Labii Superioris et Ala Nasi,

  Is concealed by the orbicularis oris, and the levator labii su-
perioris et alae nasi.   To get a view of it, the upper lip must
be  inverted, and the lining membrane of the mouth removed
on  the side of the frsenum of the lip.  This muscle arises from
the  inferior part of the upper  maxilla in front of the alveolar
processes for the dens caninus and the incisores, and is inserted
into the side of the ala nasi, and into the contiguous part of the
upper lip.
  It depresses the upper lip and  the ala nasi*


                  The Depressor  Anguli Oris,

   Arises  broad and fleshy from  the base of the  lower  jaw on
the side of the chin; being somewhat triangular, its apex is in-
serted into the corner of the mouth.
  This muscle draws the corner of the mouth downwards.  It

  * Varieties.  Frequently it is  deficient; sometimes it is a fasciculus of the or-
bicularis oculi; sometimes it is double; sometimes it does not reach the corner
of the mouth. 
368
MUSCLES.
lies immediately under the skin, and blends above with the zy-
gomaticus major and with the levator anguli oris.

               The Depressor Labii lnferioris,

   Is in part beneath the last muscle, and, like it, arises broad
and fleshy from the basis of the lower jaw  on the side of the
chin; its fibres pass obliquely upwards and inwards, and are in-
serted into  the whole side of the lower lip.
   It draws the lip downwards.

   These last two muscles are much obscured  by being mixed
with  a quantity of  adipose matter; the skin, also, is closely
 blended with  them, and the roots of the beard  penetrate be-
 tween the intervals  of their fibres.*

            The Levator Menti, or Labii lnferioris,

   Being placed beneath the depressor labii inferioris, is demon-
 strated by turning downwards the lower lip and dissecting away
 its lining membrane on the side of the  fraenum; it will then be
 seen to arise in front of the alveolar processes of the external in-
 cisor and the canine tooth, and, passing obliquely downwards,
 to be inserted into the  lower lip.
   It  elevates  the lower lip.

                       The Buccinator,

   Arises from  the root of the coronoid  process of the  lower
maxilla; from  the back part of the upper maxilla near the pte-
rygoid process of the sphenoid bone, and from the  roots of the
alveolar processes of both the upper and the  lower maxillary
bone, as far forwards as the dentes  bicuspides.  It is  inserted
into the corner of the mouth, and into  the contiguous parts of
the upper and lower lips.
   It. draws  the corner of the mouth directly backwards.

  * Varieties.  Its exterior border is often formed  by the  Platysma Myodes. 
MUSCLES OF THE FACE.
369
                   Tlie Orbicularis Oris,

  Is a circular muscle just beneath the skin, much blended with
adipose matter externally, but more plain on the surface conti-
guous to the lining membrane of the mouth.  It constitutes  a
considerable part of the thickness of the lips,  and  surrounds
the mouth entirely.   It has no bony origin, but arises from the
fibres of the several muscles  which join each other at the cor-
ner of the  mouth, and therefore consists of two semicircular
planes, one for the upper and  the other for the lower lip.
  It is the antagonist to most of the other muscles of the mouth.
From its superior part a pyramidal slip goes to the tip of the
nose, being called, by Albinus, Nasalis Labii Superioris.


                         Masseter.

  The masseter  is  placed  between the skin and the ramus of
the lower jaw; it is of an oblong shape, and evidently consists
of two portions, an external  and an  internal, which  may be
readily recognised by the course of their fibres  as they decus-
sate.
  As a whole, it arises, tendinous and fleshy, from the malar
process of the  maxillare superius; from the inferior edge of the
malar bone, between the maxillary and the zygomatic sutures,
and from the zygomatic process of the temporal bone.   Of its
two portions, the internal is the smaller, and is  inserted tendi-
nous into the outer part of the root of the  coronoid process of
the lower jaw; while the external extends from the malar bone
to the angle of the  lower jaw, where  it is inserted tendinous
and fleshy.  A part of the internal portion may  be seen at the
zygomatic suture, behind the external, without the latter being
raised up.
  When both portions act  together, they close  the  jaws:  the
external, alone, also draws the jaw forwards;  and the internal,
alone, will also draw it backwards. 
370
MUSCLES.
                         Temporalis.

   The temporal muscle is placed on the side of the head, and
 occupies its middle inferior region.  It is covered  externally
 by the Fascia Temporalis, a thick, dense, tendinous membrane;
 which arises by the semicircular ridge on the side  of the cra-
 nium, and is inserted into the upper margin of the zygoma.
   The temporal muscle arises from the inner face  of this fas-
 cia;  from the whole  length of  the semicircular ridge on the
 side  of the os frontis and parietale; and  from the surface of the
 cranium between this ridge  and  the zygoma, including the part
 contributed by the frontal bone, the parietal, the squamous por-
 tion  of  the temporal, and the sphenoid.   This muscle ajso re-
 ceives an accession of fleshy fibres  from  the internal face of
 the zygoma.
   From this extensive origin the fibres  converge towards the
 zygoma, and passing beneath it, are inserted tendinous into the
 coronoid process of the lower jaw, so as to surround it on eve-
 ry side; some of these tendinous fibres go down in front almost
 to the last dens molaris.
   It  pulls the lower jaw directly upwards.


                    Pterygoideus Externus.

   The external pterygoid muscle, so called from its position,
 arises fleshy from the outer  side  of the external pterygoid pro-
 cess  of  the sphenoid bone, and from the adjoining surfaces of
 the same  bone by its  spinous and  temporal processes;  also,
 from  the tuber of the upper maxillary.
   It passes outwards and  backwards horizontally, and is in-
 serted into the inner side  of the  neck of the inferior maxilla,
 and into the  capsular ligament of the articulation.
   When the  muscles of the opposite sides act together, they
 draw  the lower jaw forwards, but if alternately, they give it a
grinding motion.*

  * Varieties. I have seen, in one case, this muscle continued into the inferior
margin of the temporal. 
MUSCLES OF THE NECK.
371
                   Pterygoideus Internus.

  The Internal Pterygoid muscle arises by tendinous and fleshy
jfibres from the internal pterygoid process of the sphenoid bone,
along the outer margin of the Eustachian tube, and from the
greater part of the pterygoid fossa.  Passing downwards  and
backwards, it is inserted tendinous and fleshy into the internal
face of the angle of the lower jaw.
  When the muscles  of  the opposite sides  act, they close the
jaw.

               SECT. II.--MUSCLES OF THE NECK.

              Of the  Fascia Superficialis Colli.

  Between the skin of the  neck and  its superficial muscles,
may be observed a layer of compact cellular substance, the
consistence of which is more strongly marked in some subjects
than in others.  It is the  continuation of the  same  membrane
which is spread  upon  the external abdominal muscles, and  is
called there the Fascia Superficialis Abdominis.  Passing from
the abdomen over  the thorax, it adheres to the clavicles  and
sternum, but not very  strongly; it then goes from them over the
neck  to the face, being slightly fastened to the base of the lower
jaw in advance of the masseter muscle.
  It is spread over the  submaxillary and parotid glands, is in
many subjects strongly marked there by its fibrous character;
and sends down  partitions between their lobules, as well as be-
tween the muscles and their fasciculi;  thereby forming sheaths
for the same.  By these  partitions it  communicates with the
fascia profunda colli.  Above, it is fixed to the mastoid process,
to the meatus auditorius  externus, and to the  zygoma.  Just
above the latter  it adheres to the fascia temporalis, and a  thin
layer of fat  intervenes between them.  This  fascia is more
strongly characterized about the parotid gland and  lower jaw
than elsewhere.  It is remarkably distinct  in the fcetus at full
time, the sheaths, which  it forms  for'  the muscles, being then
very  clear of adipose  matter, and semi-diaphanous. 
372                        MUSCLES.
                    The Plalysma Myodes,

   Or the Musculus Cutaneus, lies upon the fascia superficialis,
or rather is included between two lamina? of it, one above and
the other below, forming its  sheath, which is very thin, espe-
cially on the  side next to the skin.   This muscle covers, by its
breadth, a very considerable portion  of the side of the neck;
and extends,  obliquely, from the  thorax  to the face.
   It arises from the condensed cellular membrane on the upper
part of the pectoralis major muscle, and of the deltoid, just be-
low the  clavicle, nearly the whole length of this bone.  Its
fibres are much more  pale than those of other voluntary mus-
cles, are collected into  longitudinal  fasciculi,  constituting a
plane of scarcely a line in thickness, and terminate in the inte-
guments  of the lower  jaw and cheek.  It  is slightly attached
to the lower jaw, and not unfrequently runs into the muscles of
the lower part of the face.
   When  the whole muscle is  in  action,  it elevates the skin of
the neck.   The external jugular  vein is  seen running nearly in
the centre of it, in  the same direction  with the fibres  of this
muscle, and between it and the sterno-cleido mastoid.*


                 The Sterno-Cleido Mastoideus,

   Is beneath, arid decussates the  last muscle.   It forms always
a prominent  feature in the outline of  the neck,  in  passing
obliquely from the upper front part of  the thorax to the base of
the cranium.
   It arises tendinous and fleshy  from  the  edge  of the  upper
part of the sternum, and fleshy from the  sternal end of the cla-
vicle.   These origins are separated  by a considerable fissure;
but they soon unite.  It  is inserted  tendinous into the mastoid
process, and into the part of the superior  transverse ridge of
the cranium next to it.
  It draws the  chin towards the sternum.f
  * Varieties.  In some rare instances this rouscb has been found  thick and
round; and instead of going towards the face, inserted into the occiput.
  + Varieties.  Sometimes a  fasciculus, at its  posterior margin, is presented in
  tate entirely insulated.  Occasionally, its lower extremity has been observed 
MUSCLES OF THE NECK.                  373
                Of the Fascia Profunda Colli.

  When the origin of the sterno-cleido mastoideus is turned to
one side, the Fascia  Profunda of the neck is seen beneath  the
fascia superficialis, and somewhat separated from it by a lami-
na of cellular adipose matter.  This membrane arises from the
larynx,  forms a thin  capsule to the thyroid gland, and, being
closely  attached to its inferior  margin, descends by investing
the sterno-hyoid  and thyroid  muscles,  being well  seen  on
their anterior surfaces.  It is firmly fastened to the upper edge
of the sternum,  to the sternal end of the clavicles, and to  the
cartilages of the first ribs,  forming an elastic  and  resisting
membrane from the larynx  to the thorax.  By turning off  the
sterno-hyoid and thyroid muscles from their attachment to  the
sternum, the fascia profunda will be seen still more distinctly,
passing behind  them from the inferior margir; of the thyroid
gland, to the upper bone of the sternum: this lamina of it is in-
serted into the- sternum, twelve or fifteen lines  below the upper
edge.   It encloses or surrounds  the transverse vein and the ar-
teria innominata.  Beneath  the fascia profunda, are the tra-
chea, the roots  of the arteries of the head and upper extremi-
ties  and  the  trunks  of  their  veins.   There is  much  loose
cellular  and adipose matter placed at the lower part of  the
neck, beneath  this  fascia ; and between it and the trachea;
through  which the thyroid veins with  their ramifications pass.
This last circumstance must always render suppurations and
operations in the part highly dangerous, as the pus will form
fistula? under the sternum; moreover, the continual motion of the
part in respiration, prevents adhesions from forming, and, there-
fore, disposes to ulceration. An ingenious idea on the uses of this
fascia and of the sterno-hyoid and thyroid muscles as connect-
ed  with it, was suggested  by the  late Allen Burns: he con-
ceived that they were a defence to the  upper part of the thorax,
and sustained, in inspiration, the atmospheric pressure, which,
without them, would fall upon the trachea and produce difficul-

to reach as far as the rectus abdominis muscle, and even to the point of the third-
bone of the sternum.  The fissure between the sternal and clavicular portions in
mammifcrous animals, is, naturally, so much extended, as to  produce two dis-
tinct muscles.
   Vol. I.—32 
374
MUSCLES.
 ty of breathing, from the air not  passing through the larynx
 sufficiently rapidly to keep pace with the dilatation of the thorax.
 He illustrates the opinion by a case very much in point, of a gen-
 tleman who had lost this fascia and the muscles by suppuration,
 and who was afterwards incommoded by atmospheric pressure
 upon the trachea at this place.*  Mr.  Velpeau, on the contrary,
 asserts that cutting through it in opening  abscesses and in ope-
 rations has no such consequence.t
   The external borders  of the fascia profunda are continued
 into the sheaths of the  great vessels of the neck.  It and the
 fascia superficialis are also continuous with one another along
 the anterior edge of the sterno-cleido mastoideus.
   Within the inferior maxilla, at its angle, a ligamentous ex-
 pansion arises at  the pterygoideus externus  muscle, and  is
 spread out between the styloid process, and the ramus of the low-
 er jaw.  This membrane, described as the stylo-maxillary liga-
 ment, is joined at  its inferior edge by the fascia superficialis,
 just before the upper part of the sterno-mastoideus, and which in-
 creases its breadth downwards in the  neck, giving it somewhat
 the condition of a vertical septum of that region; at its lower edge
 it runs into the theca of the great vessels of the neck.  Through
 its lower  part penetrate  the stylo-hyoideus and  digastricus
 muscles, and the   upper part  separates  the parotid from the
 sub-maxillary gland.  It is felt like a cord extending  downwards
 and backwards below  the angle of  the maxillainferior.  It
 is connected  at its internal edge with  the compages of the
 nerves and vessels of the part, in such a  manner as to forbid
 description, but the practical anatomist will find no difficulty
 in discovering and understanding it.
   Below this septum, the round ligament, like  a nerve, passes
 from  the extremity of the styloid process to  the  appendix of
the os hyoides.
  The fascia  profunda colli is also well  marked in the fcetus,
 and not much blended with adipose matter.  It, like the fascia
superficialis,  is  only  the sheath the for muscles which it sur-

  * The late Dr. Lawrence informed me that the fascia profunda is well developed
in the neck of a  cat, and that having occasion to remove it in an experiment, the
respiration of the animal was conducted with great difficulty, amounting almost
tc suffocation.  This is a good confirmation of Mr. Burns's hypothesis.
  f Anat. Chir. Vol. i. p. 438, 2nd edit. 
                     MUSCLES OF THE NECK.                  <> ' °

rounds, and is called  fascia  from having some development  of
fibrous matter in its substance.

                     The Sterno-Hyoideus,

   Arises thin and fleshy on the interior of the thorax from the
approximated surfaces of the cartilage of the first rib, the cla-
vicle, and the first bone of the sternum; it passes upwards some-
what obliquely, and is inserted into the inferior edge of the base
of the os  hyoides.  Its lower end is covered by the sterno-mas-
toideus.
   It draws the os hyoides towards the sternum.*


                    The Sterne- Thyroideus,

   Is beneath  the last, and concealed, in a considerable degree,
by it.   It arises fleshy from the interior surface of the sternum,
about an inch below its upper margin, and from the cartilage  of
the first rib; diminishing somewhat in breadth, as it ascends, it
is inserted obliquely into the side of the thyroid cartilage.
   h draws this cartilage towards the sternum.t

                     The Thyro-Hyoideus.

   Arises  obliquely  from the side of the Thyroid Cartilage ex-
ternally, and is inserted into a part of the base, and into  nearly
all the cornu of the os hyoides.   It seems almost like a conti-
nuation of the Sterno-Thyroideus.
   Its use is to approximate the os hyoides and the thyroid car-
tilage,  in doing which it has the effect of planting the epiglottis
against the root of the tongue, and of drawing the cricoid and

  * Varieties. Sometimes it arises from the middle of the clavicle; it is double,
or is confounded below with the next muscle.
  t Varieties. Sometimes there are two of these muscles, one placed above  the
other;  sometimes it runs into the inferior constrictor of the pharynx; sometimes
it runs into the posterior margin of the thyro-hyoid muscle; sometimes the mus-
cle on one side is united to the other by transverse fibres.  1 have, in one  in-
stance, Jan. 1, 1839, seen a  slip at the  external margin of this muscle which
arising from the cartilage of the first rib, ascended in front of the great vessels'
and was inserted into their sheath on a level with the thyroid cartilage. 
376
MUSCLES.
 the arytenoid cartilages against it, so that the opening of the
 glottis is protected.*

                      The Omo-Hyoideus,

   Passes obliquely across the neck, from the superior edge of
 the scapula to the os hyoides.   It is a thin, narrow muscle, di-
 vided into  two bellies, one at each end, by an intermediate  ten-
 don; its inferior part is concealed by the trapezius muscle; its
 middle, where the tendon exists, crosses the great vessels of the
 neck, and  is covered by the sterno-cleido-mastoid muscle;  and
 its upper extremity is overlapped by the platysma myodes.
   It  arises from the scapula just behind the notch in its supe-
 rior costa, and curving somewhat downwards in its course, it is
 inserted into the lower edge of the base of the os hyoides, next
 to its cornu.
   It  draws the os hyoides downwards.f

                       The  Digastricus,
   Is  placed at the upper side of the neck, and passes from the
 back part  of the base of the head  to the chin.
   It  arises principally fleshy from the fossa of the temporal bone
 at the base of the mastoid process; its middle is converted  into
 a round tendon, which passes through the stylo-hyoideus mus-
 cle, and is fixed  by a ligamentous loop to the  cornu of the os
 hyoides.   After which another fleshy belly is formed, which is
 inserted into the inside of the base of the maxilla inferior, at
 the side of its symphysis.   It receives an accession  from  the
 base  of the os hyoides.
   Its use is to draw the os hyoides upwards when its extremi-
 ties are  fixed, and, as Mr. Hunter has pointed out, to throw the
 head backwards, and thereby to open the mouth when the lower
jaw is fixed upon a body of the  same height.J

  * Varieties. Its fibres sometimes run into those of the middle constrictor of
the pharynx; sometimes they arise from the cricoid cartilage; sometimes it is
continuous with the sterno-thyroideus.
  t Varieties. Sometimes it is double, so that besides the usual insertion, it has
one into the side of the tongue.
  X A common variety in this muscle consists in the mutual adhesion of the
two anterior bellies belonging to the opposite sides, showing thereby a marked
tendency to the quadruped arrangement. 
MUSCLES OF THE NECK.
377
                     The Stylo-Hyoideus,

  Is the more superficial of the three styloid muscles.  It arises
tendinous from the middle and inferior part of the styloid pro-
cess of the temporal bone; and being perforated, as mentioned,
by the tendon of the digastricus, is  inserted tendinous into the
cartilaginous juncture of the base and cornu of the os hyoides.
  It draws the os hyoides upwards and backwards.*


                     The Stylo-Glossus,

  Is within and above the other;  it arises from the upper in-
ternal part of the styloid process, tendinous and fleshy, and is
inserted into the side of the  root  of the tongue, forming a part
of its structure.!
  It draws the tongue backwards.^


                    The Stylo-Pharyngeus,

  Is more deeply situated than either of the other two muscles.
It arises from the inner side of the styloid process near its root,
and  runs into the side of the pharynx between the middle  and
upper constrictors, opposite the tonsil glands it afterwards de-
scends between the lining membrane of the pharynx and the
middle and lower constrictors, and is inserted into the posterior
margin of the thyroid cartilage.
  It draws the larynx and pharynx  upwards.


                     The Mylo-Hyoideus,

  Forms the floor of the  mouth and suspends the tongue;  it
arises at the root of the alveolar processes of the lower jaw,
from a  ridge extending from the  last dens molaris to the chin.
Its fibres converge towards  a white tendinous line placed be-

  * Varieties.  This muscle is frequently double.
  t See Tongue.
  X Varieties.  J. F. Meckel says, that on one occasion he found it double on
both sides.
                             32* 
378                       MUSCLES.

tween it and its fellow, and reaching from the base of the os
hyoides to the  chin.   This muscle is concealed by the anterior
belly of the  digastricus.  When it contracts, it draws the os
hyoides upwards and projects the tongue.*

                    The Genio-Hyoideus,

   Is concealed by the last; by turning over the anterior edge of
which, it is seen.   It arises tendinous from the tubercle on the
posterior side  of the  symphysis  of the lower jaw; and, in-
creasing somewhat in breadth, is inserted into the anterior part
of the base of  the os hyoides.
   It draws the os hyoides upwards and forwards.!

   (For the muscles of the tongue, see Mouth.)

   There are seven pairs of muscles, on the front and sides of
the cervical vertebras, which lie closely upon them.   They are
named from their situations and shapes.


                        1. Longus Colli.

   The Longus Colli is next to the middle line of  the  vertebra?.
It arises from  the sides of the bodies of the three superior ver-
tebras of the back, and from the anterior edges  of the  trans-
verse processes of the five lower cervical vertebras.   Its fibres
pass  somewhat obliquely upwards and  inwards, to be inserted
into the front  of the bodies of all the cervical vertebras.
   It  bends the neck forwards, and to one side.J

   * Varieties.  Sometimes  a part of it is inserted into the middle tendon of the
digastricus, or is joined with the sterno-hyoideus.
   t Varieties.  Sometimes  a distinct fasciculus  of this muscle is inserted  into
the greater part of the cornu of the os hyoides.   Sometimes  there is but one
muscle.  Rarely it is double on both sides.
   t. Varieties.  Sometimes  a fasciculus from the  first or second rib, or from the.
body of the sixth or seventh vertebra of the neck, joins it. 
MUSCLES OF THE NECK.
379
               2. Rectus Capitis Anticus Major,

  Is placed on the outside of the last.  It arises tendinous and
fleshy from the fronts of the transverse processes of the third,
fourth, fifth, and sixth cervical vertebras; forms a considerable
fleshy belly, and is inserted into the cuneiform process of the
os occipitis, just  before the condyle.  It bends the head for-
wards.*

               3. Rectus Capitis Anticus Minor.

  This is a very small muscle.  It arises fleshy from the front
of the first cervical vertebra near  its transverse process, and is
inserted  under the  rectus major before the root of the condy-
loid process of the occipital bone.
  It bends the head forwards.


                 4. Rectus Capitis Lateralis.

  This is also small, and  arises fleshy from  the  front of the
transverse  process of  the atlas.  It is inserted, tendinous and
fleshy, at  the outside  of the  condyle of the  occiput, into the
ridge leading from it to the mastoid process.
  It pulls the head a little to one side.t

                 5.  Scalenus Prior, or Anticus.

  The scalenus anticus arises by three distinct tendinous heads
from the transverse processes of the fourth, fifth, and sixth cer-
vical vertebrae, and is inserted tendinous and fleshy  into the
upper surface of the first rib, just  anteriorly to its middle.


                     6, Scalenus Medius.

   The scalenus medius arises by distinct tendons from the trans- '
verse processes of all the cervical vertebras, and is inserted ten-
  * Sometimes it also arises from the first and second vertebra.
  t Varieties.  Sometimes another muscle arises from the body of the first ver-
tebra ofthe neck. 
380
MUSCLES.
dinous and fleshy into the upper face of the first rib, in all the
space from its middle to its tubercle.


                     7.  Scalenus Posticus.

   The scalenus posticus  arises from the  transverse process
of the fifth and sixth cervical vertebrse, and is inserted into the
upper face of the second rib, just beyond its tubercle.
   The last three muscles are concealed  by the sterno-cleido
mastoideus and the anterior edge of the trapezius.  The scale-
nus posticus is best seen in dissecting the muscles of the spine,
and  resembles very much one  of the  class to which Albinus
gives the name of Levatores Costarum.
  All the Scaleni elevate the  ribs and bend the neck to one
side.   They are particularly interesting as  connected with the
course of the large blood vessels and nerves of the upper  ex-
tremity.*
                      CHAPTER   II.

                   MUSCLES OF THE TRUNK.

        SECT. I.--MUSCLES ON THE FRONT OF THE THORAX.

                     The Pectoralis Major,

   Is superficial, and  forms  the large  swelling cushion of flesh
under the skin of the breast.   It arises tendinous from the ante-
rior face of the first two bones of the sternum, their whole length,
fleshy from  the  cartilages of the fifth  and  sixth ribs, and by a
fleshy slip from the upper part of the tendon of the external ob-

  * Varieties.  Besides the three scaleni which are described, there are frequent-
ly supernumerary muscles or fasciculi. One of these, called the Scalenus Mini-
mus Albini, is between the first two, and occasionally appears as a fasciculus of
the scalenus anticus, separated from it by one or  more of the brachial nerves; it
is sometimes double.  Another fasciculus, called the Scalenus Lateralis, is be-
tween the scalenus medius and posticus; it comes from the posterior part of the
first rib, and is inserted into the transverse process of the fourth, fifth, and sixth
vertebra. 
MUSCLES OF THE THORAX.
381
lique muscle.   It  arises, also, fleshy from the  anterior two-
thirds of the clavicle.   The clavicular and sternal portions of
the origin are separated by an interval, giving the appearance
of two muscles.
   The fibres converge, and terminate by a broad, thin tendon^
which is inserted into  a roughness on the exterior edge  of the
bicipital  fossa of the os humeri, and into the fascia brachialis,
just at the internal edge of the deltoid muscle.   At this inser-
tion it adheres to the  tendon of the latissimus dorsi.  The un-
der edge of the muscle, near its insertion, is folded inwards and
upwards, which gives the rounded  thick margin to the  fore
part of the axilla.   That part  of the broad tendon belonging to
the clavicular  portion is inserted lower down than the sternal,
which produces a decussation of the fibres of the tendon.
   The pectoralis major draws the arm inwards  and forwards;
and also depresses it when it is raised.*


                      The Pectoralis Minor,

   Is brought  into view by raising  the last muscle.  It is com-
paratively small, and somewhat  triangular.  Arising by thin
tendinous digitations from the upper edges of the third,  fourth,
and fifth ribs, it soon becomes fleshy, and is inserted, by a short
flat tendon, into the inner facet of the coracoid  process  of the
scapula.   Its use is to draw the  scapula inwards and  down-
 wards.f

  * Varieties. Sometimes a single faseiculus arises from the eighth rib, which
ascends towards the os humeri, has a  tendon in its centre, and finally joins with
the tendon of the pectoralis minor;—sometimes this muscle attaches a small fas-
ciculus to the brachialis internus;—sometimes there is a small square  plane of
muscular fibres on its front surface, decussating the fibres  at right angles;—
sometimes a fasciculus almost cylindrical  proceeds from it towards the axilla,
and, being changed into a long tendon, is inserted into the internal tuberosity of
the os humeri. Supernumerary fasciculi are also found  going from one rib to
another, or towards the sternum; sometimes  its tendon  detaches a fasciculus,
which, crossing the insertion of the muscle, covers the bicipital groove of the os
humeri like a bridge, is blended with the tendon of the supra-spinatus, and in-
creases  the thickness of the capsular ligament of the shoulder joint.  In a mus-
cular male subject, black, it was entirely deficient, except the external clavicular
 half.  The pectoralis minor was wholly wanting in the same. Deer. 1837.
   t Varieties.  Sometimes  it sends a fleshy fasciculus to the tendinous origin
 of the coraco-brachialis. Sometimes, below it, there is a third pectoral muscle, 
382
MUSCLES.
                        The Subclavius,

   Is a small muscle, placed immediately under the clavicle.   It
arises from the cartilage of the first rib, and is inserted into the
inferior face of the clavicle, from near the sternum, to the  co-
noid  ligament, which  connects  the  coracoid  process and  the
clavicle together.   It draws the clavicle downwards.*


        The Serratus Magnus, or Serratus Major Anticus,

   Is a broad muscle, lying on the sides of the ribs, between them
and the scapula, and beginning at a line anterior to their middle.
It arises from  the nine upper ribs by fleshy digitations, the  su-
perior one of which seems  almost like a  distinct  muscle:  the
five lower are connected to the obliquus  externus abdominis,
the digitations of the two muscles inter-locking with each other.
The fibres converge, and are inserted into the base of the scapula
its whole length.   Its action is to draw the scapula forwards.!


                       The Intercostales,

   Fill up the spaces between the ribs.   There are  two in each
space, of which the external arises from the transverse process
of the vertebra, and from the  inferior acute edge of the rib,
from  its head almost to its cartilage, and is inserted into the  su-
perior rounded edge of the rib  below for the same  distance, its
fibres passing obliquely forwards and downwards.   The inter-
nal intercostal arises from the inferior edge of the rib, beginning
at the sternum, and extends backwards to the angle of the rib;
it  is inserted into the superior rounded  edge of the  rib, below,

which arises from the first and second ribs, and is inserted into the coracoid pro-
cess; whereby a striking analogy with birds is established.  Another variety has
also been observed iA the existence of a fasciculus, which comes  from the upper
rib, and which, covered by the little pectoral muscle, is inserted into the capsular
ligament of the scapulo-humeral articulation.
  * Varieties.  Sometimes two muscles exist; a bursa mucosa is formed between
its tendon and the cartilage of the first rib.
  t Varieties. Sometimes, it has ten or eleven origins; the upper origin is defi-
cient; the latter is so distinct that it may pass for a particular muscle; a wide
gap exists in the middle of the muscle, dividing it into two distinct parts. 
MUSCLES OF THE THORAX.
383
on its  inner side, its fibres passing obliquely  backwards and
downwards.  They draw the ribs together.


                   The Triangularis Sterni.

   Is on the posterior or cardiac face of the cartilages of the ribs,
and  arises from the whole length of the cartilago ensiformis at
its edge, and from the inferior half of the edge of the second
bone of the  sternum.  The fibres go obliquely upwards and
outwards, to be inserted into the cartilages of the third, fourth,
fifth, and  sixth ribs by fleshy and tendinous  digitations.  Its
use  is to  depress  the  ribs, and, consequently, to  diminish the
cavity of the thorax.
   This muscle is frequently defective or redundant in  the num-
ber of its heads, and is commonly more or less continuous with
the transversalis abdominis; but occasionally it is  so  much so,
that the two  seem to make but one muscle, and have, therefore,
been called Sterno-abdominalis, by Rosenmuller.
        SECT. II.--MUSCLES AND FASCIA OF THE ABDOMEN.

  Between the most superficial of the abdominal muscles, which
is the external oblique, and the skin, is found the Fascia Super-
ficialis Abdominis.   In lean subjects it is very distinct, but in
fat ones not so much so, from being blended  with adipose mat-
ter.  The laminas of it which are next  to the muscles* are kept,
in the latter case, rather more free  from fat than the more su-
perficial.   It consists of condensed cellular substance, with very
little fibrous  matter in it, and may  be  considered as taking its
origin on the front of the thigh,* and extending in front of the
abdominal muscles, as high up as the thorax: indeed, if we are
disposed to trace it to its whole extent, there is no difficulty in
following it over the front of the thorax; thence to the neck, as

  * This statement of origin is to  be viewed merely as an anatomical license for
descriptive purposes; the most natural line of origin is the whole  length of the
linea alba, and this same line might be considered as going along the front of
the sternum for the pectoral fascia, and along  the middle of the neck for its fascia
superficialis and profunda. 
384
MUSCLES.
 the fascia superficialis colli; and even to the face.  In ordinary
 cases its desmoid or aponeurotic character is very equivocal, but
 where the parts about the groin have been pressed upon  and
 thickened  by the irritation of hernial protrusion, it  is better
 marked.  On the thigh it is blended with fat;  and encloses be-
 tween its laminas the lymphatic glands of the groin, and the ex-
 ternal pudic vessels given off from the femoral artery, immedi-
 ately below Poupart's ligament.   On the tendon of the external
 oblique it is more condensed; branches of the femoral artery
 are also seen in it there.   One longer and larger than the others,
 the arteria ad cutem abdominis of Haller, winds over Poupart's
 ligament, and runs upwards somewhat in the line of the epigas-
 tric artery, to be distributed to the skin of the abdomen: the di-
 vision of it will produce sufficient hemorrhage to require atten-
 tion.   On the symphysis pubis and  about the external ring the
 laminae of the  fascia superficialis  are multiplied, and it  has
 more of the character  of common  adipose matter, as in most
 cases the adeps there is abundant.  From the  pubes it may be
 traced as a  condensed cellular membrane blended  with  the
 ligamentum suspensorium along the penis to its extremity; and,
 according to Mr. Colles, of Dublin, when matter is formed be-
 neath  it, it is apt to create fistulous sores on this organ.   A
 thin process of this membrane may be traced along the sper-
 matic chord, and identified with the tunica vaginalis communis.
 This fascia is more loosely connected to the parts beneath it,
 along the anterior margin of Poupart's ligament, than elsewhere,
 which disposes femoral  hernia to observe that course  in its in-
 crease.
  The fascia Superficialis, under the name of  Tunica Abdo-
 minalis, is well  developed  in animals with a large and project-
 ing belly, particularly in the large ruminantia and the solipedia.
 It has a yellowish tinge  in them, is very elastic and strong, and
 well calculated to support their viscera.*

  There are  five pairs of muscles called abdominal; to wit,  the
 External Oblique;  the Internal Oblique;  the Transverse;   the
 Straight;  and the Pyramidal.   The  first  three are  flat  and
 broad, and lie in layers  one upon the  other; the other two  are
long.
             Breschet, Thesis sur L'Hernie.  Paris, 1819. 
                  MUSCLES OF THE ABDOMEN.               385


                 1.  The Obliquus Externus,

  Arises from the eight inferior ribs by muscular and tendinous
digitations attached near their anterior extremities.   The first
head is  covered by a slip from the  pectoralis major, the  five
upper heads are interlocked with the origins  of the  serratus
major anticus, and the three inferior with those of the latissi-
mus dorsi.   The fibres pass obliquely downwards, and termi-
nate in  a broad thin tendon.  This tendon  extends  over the
whole front of the  abdomen, from the lower end of the second
bone of the sternum to the symphysis  of the pubes.
  This  muscle is inserted into the whole length  of  the linea
alba; into the anterior half or two-thirds of the crista of the ilium,
by muscular fibres posteriorly, and  tendinous anteriorly;  and,
from the anterior superior spinous process, the tendon extends
to the body and to the  symphysis of the pubes, forming thereby
the ligament of Poupart, or the Crural Arch.
  In the middle line of the body, the tendons of the three broad
muscles, on  both sides of the abdomen, unite to form the Linea
Alba, which extends from the sternum to the pubes.  From
two to three inches in the adult, on either side of the linea alba,
but more distant from it above than below, is another line, formed
by the same tendons,  which is the Linea Semilunaris.  The
navel,  which originally  was a hole  for  the passage of the
umbilical vessels, and, in the adult, is commonly depressed  into
a pit, appears in the  linea alba  as a protuberance  composed of
a condensed  cellular membrane.  Just at the navel there is  a
line crossing the linea  alba, and extending from one linea se-
milunaris to the other;  at the lower  end of the Cartilago-Ensi-
formis,  there is another;  and  half-way between this  and the
navel, a third: about half-way between the navel and the pubes
is a fourth, but it is generally imperfect.   These are the Lineas
Transversa, and they are formed by tendinous matter in the
substance of the recti muscles,  connecting them to their tendi-
nous sheath in front.
  The most interesting insertion of  the tendon of the external
oblique, is the portion  constituting Poupart's ligament, or the
Crural Arch.  The latter as it gets to the pubes from the ilium,
splits so as to leave  a  hole for the  passage of the Spermatic
  Vol. I.—33 
386
MUSCLES.
 Chord in the male, and of the Round Ligament of the Uterus in
 the female.   This opening is named the External  Abdominal
 Ring.  The tendon forming its upper boundary is inserted into
 the symphysis pubis, and into the pubes of the opposite side, by
 fibres which are interwoven  with and decussate those of its fel-
 low.  The tendon forming the lower margin of the ring is in-
 serted into the spine of the pubes, and into its crista for an inch.
 The portion inserted into the crista of the pubes is Gimbernat's
 ligament, which it will  be readily understood, means only a
 part of the Crural Arch.
   The Ring in  the  External  Oblique is rather triangular  than
 round; its base  is formed by the body of the pubes, and its point
 is at the place where the tendon splits.  The latter is kept from
 parting still farther by a  fasciculus of tendinous fibres, which
 runs across it.   The sides of this opening are called its Columns,
 and from their  situation, internal  and external, or  upper and
 lower Columns.   In the female it is oval and scarcely half an
 inch long.
   There are several small round holes in  the tendon  of  this
 muscle, which afford passage to nerves and to veins.  When,
 by the clearness of the dissection, the tendon has its characte-
 ristic gloss and  polish, they are very distinct.
   Use.  This muscle compresses the viscera of the abdomen
 and brings the pelvis and thorax towards each other.*


                    The  Obliquus Internus,

   Lies beneath  the last, and its fibres pass in a contrary direc-
tion to the fibres of the other.   It arises tendinous, by the fascia
lumborum, from the three inferior spinous processes of the loins
and from all those of the sacrum; tendinous and fleshy, from the
whole  length of the crista of the ilium; and fleshy, from  the
upper half of Poupart's ligament.   Though  the fibres of this

  * Varieties.  Sometimes a considerable part of its middle and anterior portion
is deficient, a vitiated conformation, to which it is subjected along with the other
abdominal muscles.  The inferior part of its tendon is incompletely developed
by the absence of tbe superficial fibres which retain together the  more deeply
seated, by which it is weakened  and caused to gape by one or more large oblong
fissures: this variety gives occasion to a form of inguinal hernia, differing mate-
rially from what is common. 
MUSCLES OF THE ABDOMEN.
387
muscle, in general, decussate the fibres of the external oblique,
all of them do not; for the lower are brought gradually to pur-
sue the same direction towards the symphysis of the pubes.
  Near the Linea Semilunaris, the muscular fibres cease, and
the tendon begins.
  It is inserted, by condensed fibrous cellular membrane, into
the cartilages of the seventh, eighth, and ninth ribs;  and by
flesh into the tenth, eleventh, and twelfth.  It is inserted also,
membranous, into the side of the ensiform cartilage, its whole
length; and into the linea alba, from the  sternum to the pubes.
  The tendon of this muscle  divides into two laminas, which
enclose the rectus  muscle, and thereby form a sheath  for it,
imperfect, however, at the lower posterior part near the pubes.
  Its use is the same as that of the External Oblique.*


              3. The  Transversalis Abdominis,

   Arises from the transverse processes of the last dorsal, of the
four upper lumbar vertebras,  and from the back  part  of the
crista of the ilium by the Fascia Lumborum.   It also  arises,
fleshy, from  the anterior two-thirds of the spine of the ilium,
and from the exterior half of Poupart's ligament; and tendinous
and fleshy alternately, from the inferior margin of the thorax,
formed by the cartilages of  the six  or  seven inferior ribs, at
their inner surfaces, where they are concerned in the origin of
the diaphragm.
   The fleshy part of this muscle occupies about  one-third of
its extent.  It is  inserted into  the side of the ensiform cartilage;
filling up the vacancy between it and the cartilages of the sixth
and seventh  ribs; and  into the linea alba, from the  extremity of
the sternum  to the pubes.  The Transversalis and the Internal
Oblique also form below a common tendon, which is inserted
for an inch into the  crista of the pubes, behind the insertion of
Gimbernat's Ligament;—into the spine of the pubes;—and into
that part of  the body of the pubes which forms the lower pos-
terior boundary  of  the externa] abdominal ring.   Just above
this insertion the common tendon alluded to splits  into two la-

  * Varieties.  It is  sometimes defective at its lower part, and on other occa-
sions redundant. 
388                       MUSCLES.

minas, terminating in the linea alba; one of which goes before
and the other behind the pyramidalis muscle, so that a sheath
is thus formed for it.
  Use; to compress the contents of the abdomen.*
                  4.  The Rectus Abdominis,

  Is seen beneath the tendons of the  other  muscles on  either
side of the linea alba.  Its origin is by a flat tendon of an inch
or more  in  breadth from the symphysis pubis  and the upper
posterior part of the body of the pubes.  The muscle increases
gradually in its ascent to the breadth of three or four inches.
The tendinous intersections, confining it to the tendinous sheath
in front, are fixed at the places mentioned as lineas transversae;
but, for the most part, they do not extend through the muscle.
When the origins of the Recti  are examined from behind, it
will be seen that the internal edge of one tendon, just above the
symphysis pubis, overlaps the corresponding part of the  other;
also, that a small pyramidal ligament finishes  more completely
the structure just above the symphysis pubis; this ligament is
called by M. G. Breschet, the Superior Pubic.
   The Rectus is inserted fleshy into the base  of the cartilago-
ensiformis, and into  the cartilages of the fifth, sixth, and  se-
venth ribs.
   It draws the  thorax towards the abdomen.t
                     5.  The Pyramidalis,

   Is at the lower front part of the rectus, and is about three
inches long.  It arises somewhat  thick, tendinous, and fleshy,
from the upper part of the pubes, from near its spine to the sym-
physis, between the rectus behind and the insertion  of the ex-

  * Varieties.  Sometimes transverse tendinous fibres creep across its belly, and
on other occasions a small transverse muscle is present, which decussates the
larger, and is inserted into the twelfth rib.
  t Varieties.  If there are eight sternal ribs, then this muscle has an additional
costal insertion.  It sometimes sends a fasciculus to the fourth rib; and I have
seen it ascending over the pectoralis major, to the root of the neck, as occurs in
mammiferous animals. 
MUSCLES OF THE AEDOMEN.
389
 ternal oblique before.  Being fixed in the sheath formed by the
 separation of the tendon of the transversalis muscle it tapers to
 a point above, and is inserted into the linea alba and internal
 edge of the rectus, for about the upper two-thirds of its  own
 length.
   It strengthens the lower part of the abdomen.*
   At the linea semilunaris the tendon of the internal oblique
 and of the transversalis unite intimately; and just  beyond this
 junction the two laminas are formed, which enclose the rectus
 muscle.  The anterior lamina is one half of the tendon of the
 internal oblique, which, after passing half an inch or an inch, is
 joined to the tendon of the external oblique, goes in front of the
 rectus muscle, and  covers it from origin to insertion.   The
 posterior lamina, made by the posterior  half of the tendon of
 the internal oblique, is united already at the lmea semilunaris to
 the tendon  of the transversalis: in this manner they pass behind
 the rectus muscle from the cartilago-ensiformis to  a  line  half-
 way between the umbilicus and the pubes.  From  this  line,
 downwards, all the tendons go in front of the rectus muscle.
   The obliquus externus  tendon  may be  dissected from the
 common  tendon of the others, without much difficulty, almost
 to the linea  alba.   The  term insertion, expresses, very imper-
 fectly, the manner  in which the tendons of these broad muscles
 all terminate in the  linea alba  from the thorax to the pelvis.
 It should rather be said, that they coalesce there by a general
 intertexture of their fibres.


                       The Cremaster,

   Is commonly attributed exclusively to the internal  oblique,
 as it is said to  be a detachment of fibres  from it;  but it is  also
 formed by fibres from the lower edge of the transversalis mus^
 cle.   The history of its formation is as follows: in the descent
 of the testicle, the latter has to pass beneath that edge of the
 transversalis and of the internal oblique which is extended from
 the outer  portion of Poupart's ligament, to the spine and crista

  * Varieties.  It is frequently defective, but sometimes two, three, or even four,,
are seen on a side. When defective, the rectus or  obliquus  internus is better.
developed than usual.
                            33* 
oqq                        MUSCLES.

of the pubes.   As the  testicle descends, it comes  in contact
with a fasciculus of these fibres, and takes it along.  This con-
stitutes the  Cremaster muscle, which, in adult life, and  in  a
strong muscular subject, is seen descending on the outside of
the spermatic chord, and  spreading over the anterior part of
the tunica  vaginalis in  arches with their  convexities  down-
wards, then rising on the inner side of the chord, to be inserted
into the spine of the pubes.*
  It draws up the testicle.


               Fascia  Transversalis Abdominis.

  The Fascia Transversalis is placed immediately behind the
transversus muscle, between it and the peritoneum.  An open-
ing in it,  which  permits the spermatic chord to pass, is called
the Internal Abdominal Ring, in order to distinguish it from the
opening in the tendon of the external oblique, called the Exter-
nal Ring.  The internal ring is rather nearer to the symphysis
pubis  than to the spine of the  ilium.  The space between the
internal ring and  the  external ring, is  about eighteen  lines in
the  adult, and  is very properly called  the Abdominal Canal,
from giving passage to the spermatic chord.  The anterior side
of  the canal is  formed by the 'tendon of the external oblique;
the inferior part, in the erect posture, is formed by Gimbernat's
ligament; the posterior side is  formed by the fascia transversa-
lis;  and  above, this canal  is overhung by the internal  oblique
and the transversalis muscles.  The spermatic chord, after pe-

  * Anat;.De L'Homme, par Jul. Cloquet.  This account, though easily verified
 in some subjects, and especially in such as are  muscular, does not appear to be
 applicable to all, or, in ether words, the arrangement in them is not quite so ob-
 vious.  It does not agree with Mr. John Hunter's observations on the descent of
 the testicle;  for he always found, while the latter was still in the loins, the cre-
 master running towards it.  Moreover, in the buffalo of America, a  testicle of
 which  Dr. R. Harlan, of this city, was obliging enough to furnish me with for
 dissection, I found that the cremaster, though remarkably robust and  strong,
 forms none of those nooses or arches with their convexities downwards, but ter-
 minates at the testicle in a tendinous and somewhat abrupt manner.  Taking all
 these points into consideration, it may be, that a part  of the cremaster is formed
 after the manner indicated by Mr. Hunter, and another part after that  mentioned
 by M. Cloquet; or, indeed,.cases may occur, presenting exclusively one  or the
 other. 
MUSCLES OF THE ABDOMEN.
391
netrating  the  fascia  transversalis, does not cross, directly at
right angles, the inferior edge of the internal oblique and trans-
versalis, but it slips under them  very obliquely; its inclination
being towards the pubes, so that it can be considered  as disen-
gaged from the inferior edge of these muscles, only about the
middle of the abdominal canal.
  The opening  in the  Fascia Transversalis, or the Internal
Ring, is not abrupt and well defined; but the fascia,  where it
transmits  the  spermatic chord, is reflected by a thin process,
and terminates insensibly in its cellular substance.   At the pos-
terior or ventral face  of the External Ring, the fascia  transver-
salis is not in contact with  the cord; but that part of the ten-
don of the internal oblique  and transversalis which is inserted
into the crista of the pubes, and forms a sheath for the pyrami-
dalis muscle, is placed between them, and secures this opening.
  The peritoneum covers the posterior face of the fascia trans-
versalis, and is thrown into  a duplicature or falciform process,
passing from near the middle of the crural arch towards  the
umbilicus.   This duplicature depends upon the round  ligament
of the bladder, which  was once the umbilical artery of the  foe-
tus.  It is broader near the pelvis than it is above, has its loose
edge turned towards  the cavity of the abdomen, and ascends
near the pubic margin of the Internal Ring.   The effect of its
existence  is to divide  the posterior  face of the inguinal  region
into two shallow  fossae; one next  to the  ilium, and the other
next to the pubes.   The one next to the ilium contains the be-
ginning of the internal abdominal ring,  which  is frequently
marked by a little pouch of peritoneum, going along  the sper-
matic chord for  a  few lines.  The fossa on the inner or pubic
side of the  falciform  process is just  behind the external ring,
but separated from it  by the fascia transversalis, along with the
tendon of the lower  part of the internal  oblique  and  of the
transversalis muscle,  where it is inserted into the  pubes, and
forms the sheath of the pyramidalis..  The two fossas indicate
the points where inguinal hernias  commence; the proper ingui-
nal protrusion begins  in the external fossa, and the ventro-in*
guinal  sometimes in the internal fossa..
  The view of the fascia transversalis from behind is extremely
satisfactory.  For a proper knowledge of this membrane, the
profession is indebted to the labours of Sir Astley Cooper; and 
392                       MUSCLES.
                                                     «
much of the zeal with which the  anatomy of hernia has been
investigated, in latter years, is attributable to him.  The fascia
transversalis is a thin tendinous  membrane, most generally; oc-
casionally it is merely condensed cellular membrane.   It arises
from the internal or abdominal edge of Poupart's ligament, and
from  the crista of the  pubes just behind  the  insertion of the
common tendon of the internal oblique and  transversalis mus-
cles, and is  extended upwards on the posterior face of the trans-
versalis muscle to the thorax.   At  its origin it is attached to the
inferior edge  of the transversalis and internal  oblique, particu-
larly  the part between  the internal  ring and the symphysis
pubis.   It is also  attached to the exterior margin of the rectus
abdominis where it is deprived behind of  its sheath.   The in-
ternal abdominal ring,  or opening in this  fascia,  marks it out
in some measure into two  portions, of which that on the iliac
side of the  ring is not so thick as the other, or  the one on the
pubic side; and  both portions  are much more tendinous near
the crural arch than they are higher up.
   Were it not for the important influence  of the fascia superfi-
cialis abdominis and  the fascia transversalis upon hernia, and
the consequent necessity of a minute knowledge of them, their
description  might be much curtailed in considering them in their
proper light, to wit;  as sheaths of the  abdominal  muscles; for
it is'now sufficiently apparent that the  first is contiguous to the
external oblique, and the  second to  the transverse muscle.
Upon the same  principle, fascias might be made of all the la-
minas of cellular substance  intermediate to the abdominal mus-
cles, but it  would be  useless.*

  * A very elaborate and exact account of the construction of the parts concerned
in  hernia has  lately been  presented by Alexander Thomson,  M. D., under the
title of Ouvrage complet sur L'Anatomie du JBas  Ventre. Paris, 1838. The cha-
racter of this work is not so much inventive as distinguished by great minute-
ness of research,  and a different distribution of the matter from what is commorii
together with a most copious supply of new terms in place of old ones.  Highly
creditable as it is to his industry, we can scarcely do less than protest against
the latter irregularity, and express our apprehensions that this objection, together
with the unusual approaches which he has opened to the structure as a substi-
tute for the settled ones, will restrict very much the reception of his work, and
render it less acceptable to both teacher and student.  The splitting  and inven-
tion of fasciae  was considered for some time as almost exclusively an Anglican
malady; it appears,  also,  to have propagated itself to Paris in an exasperated
form in this production of Mr. Thomson and in that of Mr. Velpeau, (Anatomic 
            MUSCLES OF THE PARIETES OF THE ABDOMEN.        393

  On removing the peritoneum from the iliacus internus mus-
cle,  the spermatic  vessels  are seen  to descend from the loins
to the internal ring, where they are joined by the vas deferens
coming  from the pelvis.   As  they engage under the edge of
the internal oblique muscle, after  penetrating the ring, the cre-
master muscle is detached to spread itself over them.  The
spermatic chord, thus constructed,passes through the abdominal
canal in  the  manner mentioned,  obliquely downwards and in-
wards;  and, emerging-from the external  ring, it descends ver-
tically,  lying rather upon  the outer column of the  ring  than
upon its base.
  On the posterior face of the fascia transversalis, between  it
and the peritoneum, is the  Epigastric Artery.   The  epigastric
arises from the external iliac as the latter is about to go under
the crural arch; it ascends inwardly along the internal margin
of the  internal abdominal  ring to  the  exterior margin of the
rectus  abdominis  muscle,  which  it reaches after a course of
two and a half or three inches.   The spermatic chord, in get-
ting  from  the abdomen  to  the  abdominal  canal,  therefore,
winds, in part, around the epigastric artery;  in the  first of its
course being at the iliac edge of the artery, and then in front
of  it.   Two  epigastric veins attend  the  artery,  one on each
of  its sides, and end by a  common trunk in the external  iliac
vein.

   The anatomical arrangement  of the parts concerned in in-
guinal  hernia in the female is the  same as  ia the male, except

Chirurgicale, 3d Edition, 1838,) both, unquestionably, works of  much  merit.
The practical anatomist may, however, ask, if all of the laminae described as such
be fasciae, what has become of the cellular substance which formerly entered so
largely into the composition of the human body?  Will he not rather find verbal
novelties than new existences? A sound anatomical verdict is yet to be given on
these points: our own opinion is, that anatomy is too staid a science for  mere
caprices in description and names, and that such innovations cannot possibly be-
come oecumenical.  The introduction of a new name in the place of an old one
is the highest act of medical authority, and is  so seldom sanctioned by general
suffrage, that an individual inclining to it may well pause, lest, in so doing, he
may seal up his own publications, by the use of terms too little known to be con-
venient or desirable. 
394
MUSCLES.
that the round ligament of the uterus supplies the place of the
spermatic chord, and there is no cremaster muscle.*


SECT. III.—MUSCLES OF THE UPPER AND POSTERIOR PARIETES OF THE
                         ABDOMEN.

  These  muscles are constituted by a single symmetrical one,
and by four pairs:  they can only be seen advantageously by
removing the abdominal viscera.


             1. The Diaphragm, (Diaphragma,)

  Is a complete, though moveable septum, placed between the
thoracic and abdominal cavities; it is  extremely concave be-
low and  convex above, the concavity being occupied by  seve-
ral of the abdominal viscera.  It is in  contact above with the
pericardium  and lungs, and below with the liver, spleen, and
stomach.
  It is connected with the inferior margin of the thorax on all
sides, and has for its centre a silvery tendon, resembling in its
outline the heart of a playing card.  This cordiform tendon
occupies a  considerable part of the extent of the diaphragm,
has its  apex next to the  sternum, and its notch towards the
spine; and the muscular part of the diaphragm is inserted all
around into its circumference. The cordiform tendon is nearly
horizontal  in the erect posture, its  elevation being on a line
with the lowest end of the  second bone  of the sternum.  On
each side of this tendon some of the muscular fibres rise so high
upwards before they join it, that they are  on a horizontal level
with the anterior end of the fourth rib.   The fasciculi of mus-
cular fibres are, for the  most part,  convergent  from  the cir-
cumference of the thorax, and are easily separated from one
another.
  In the diaphragm are three remarkable foramina.  The first
(the Foramen (Esophageum) is in the  back of the muscle, be-

  * For an account of both Inguinal and Femoral Hernia, the reader is referred
to Lessons in Practical Anatomy, 2d Edition. Philadelphia, 1836. 
           MUSCLES OF THE PARIETES OF THE ABDOMEN.        395

tween the spine and the notch of the cordiform tendon, a little
to the left of the middle line.   It gives passage to the oesophagus
and the par vagum nerves along with it, and is rather a fissure
or a long elliptical foramen made by the separation and reunion
of the muscular fibres; for, above and below, at each end of the
ellipsis, these fibres decussate one another in columns.  To the
right of this foramen, and a  little above its horizontal level, in
the back part of  the cordiform tendon, is a very large and pa-
tulous foramen for the ascending vena  cava, (Foramen Quad-
ratum.)   Its form is between an irregular quadrilateral figure
and  a circle; its edges are  composed of fasciculi  of tendon
rounded off, and  are not susceptible  of displacement, or of al-
teration in their relative position to each other; by which means
is obviated any impediment which might arise from a different
arrangement, to the course of the blood in the ascending cava.
Almost in  a vertical line  below, and  about three inches from
the foramen for  the oesophagus, is the third hole, in the dia-
phragm, which affords passage to the aorta, (Hiatus Aorticus.)
It is just in front  of the bodies of the  three upper lumbar verte-
bras, and is a much longer elliptical hole than the oesophageal;
its lowest extremity or pole is constituted by  the  tendinous
crura of the diaphragm, and  its upper by a decussation of mus-
cular fasciculi arising from them.  Through it,besides the aorta,
pass the Thoracic Duct, and the Great Splanchnic Nerve of
both sides.
   In the  horizontal  position of either the dead or  the living
body, the  right  side of the  diaphragm ascends higher in the
thorax  than the  left;  but the weight of the liver makes it, in
the vertical posture, descend lower than the other.
   Thus circumstanced, the detailed origin of the Diaphragm is
as follows: It arises fleshy from the internal face of the upper
edge of the Xiphoid Cartilage, from the internal face of the car-
tilages  of  the seventh true,  and  of  the succeeding  false ribs,
on each side; that is, from the cartilages of the eighth and ninth,
from the osseous  extremities of the tenth and eleventh, and from
both the osseous  and cartilaginous termination of the twelfth
rib.   As  the  line described includes  almost the whole of a
circle,  and the fibres all converge  to the  cordiform tendon,
they, of course, will pass in different  radiated directions, and
be of different lengths, which it is unnecessary to specify.  Be- 
396                       MUSCLES.
 tween the sternal and costal portion on each  side, there is a
 triangular fissure filled with fatty cellular tissue, which  some-
 times leaves an opening for hernia.  I have seen a case of the
 kind, in which the transverse parfof the colon was the subject
 of protrusion into the thorax.  It is probable that the great dis-
 placement of the abdominal viscera into the thorax, which some-
 times occurs, may have a congenital origin in this very fissure,
 and is subsequently, when  the parts are accommodated to their
 unnatural situation, thought to be a lusus naturae.  The portion
 described is called the Greater Muscle of the Diaphragm.
   Besides these origins, the  diaphragm has several from the
 vertebras of the loins, constituting its  crura;  there being four
 on each side of the foramen for the aorta.  The  first pair, en-
 tirely tendinous, comes from the front of the body of the third
 vertebra of the loins, and is prevented from being very distinct
 in its origin, in consequence of running into the ligament in front
 of the bodies of all the vertebrse or the Anterior Vertebral Li-
 gament as it is called.   The second pair of heads is on the out-
 side of the first, and arises, tendinous, from the intervertebral li-
 gament, between the second and third vertebras.   The third pair
 of heads arises tendinous from the upper part of the lateral face
 of the second lumbar vertebra.   And the fourth pair of  heads
 comes also  tendinous, from  the fore  part  of the root of the
 transverse process of the second lumbar vertebra.   These ten-
 dinous heads terminate in what is called  the Lesser Muscle of
 the Diaphragm, which is inserted into the notch of the cordi-
 form tendon.  It will  now be understood that the aorta passes
 between the two sides of the lesser muscle, and that the oeso-
 phagus has a hole in the upper part of its belly.*
  The origin of the  diaphragm is completed between its great-
 er and lesser muscle, by a tense ligament, the Ligamentum Ar-
 cuatum,  which passes from the root of the transverse  process
 of the first lumbar vertebra to the inferior part of the middle

  * This origin of the lesser muscle of the diaphragm is given by Albinus, but
it is difficult to make out fairly; for the most part it would be much more correct
to say that it arises tendinous, from the first, second, and third vertebra in front
and  the corresponding intervertebral matter.  The heads are generally much
smaller on one side, the left, than the other.  From which cause a large fascicu-
lus of muscle passes from the right to the left side in ascending, and  separates
the hole for the aorta, from that for the oesophagus. 
           MUSCLES OF THE PARIETES OF THE ABDOMEN.        397

of the twelfth rib; with the upper  edge of this  ligament the
diaphragm is connected; and with  the  lower, the psoas mag-
nus muscle^and the quadratus lumborum.   At the margin of
the other ribs, the diaphragm is connected with the transver-
salis abdominis.
  Use. In consequence of the muscular fibres of the diaphragm
passing in a curved direction  from the circumference  of the
thorax to  the cordiform tendon; and  of those fibres forming a
body concave below and convex above, their contraction at
the same moment enlarges the  cavity of the thorax, and has a
tendency  to diminish that of the abdomen, which latter  is pre-
vented by the yielding of the abdominal  muscles.  In easy res-
piration, its contractions and  relaxations produce alternately
the actions of inspiration and of expiration.  Its descent, also,
assists in the expulsion  of faecal and  other  matters  from the
abdomen.  By the experiments of Bourdon,* it appears  that it
only acts a secondary part in the latter,—that its functions are
limited to  inspiration and the associated actions; but that in
regard to its power of assisting in the expulsion of the contents
of  the abdomen, all  that it does is first  of all  to fill the lungs
with air, and then the closure of the glottis prevents the air from
being expelled from  the lungs.   Common observation in partu-
rition shows us, that the expulsive effort of the abdominal mus-
cles does  not take place when inspiration is going on, for the
former would prevent  the latter; but the moment that expira-
tion begins, it is arrested by the firm closure of the glottis, and
then the abdominal muscles contract advantageously.


                  The  Quadratus Lumborum,

   Is  an oblong muscle, arising from the crista of the ilium, at
the side-of the lumbar  vertebras, by a tendinous and fleshy ori-
gin of three inches in length.   It is inserted into the transverse
process of each  of  the lumbar vertebras and of the last of the
back by a short tendinous slip: it is also inserted into the low-
er edge of the last rib near its head, beneath the ligamentum
arcuatum.  .
   It bends the loins  to one side, and draws down the last rib.

       * Recherches sur la Respiration et la Circulation.  Paris, 1820.
   Vol. I.—34 
398
MUSCLES.
   It is covered behind by the tendinous origin of the transver-
 salis abdominis, which separates it from the sacro-lumbalis and
 from  the  longissimus dorsi.  It may also be  seen very well
 from behind, in the dissection of the back.*

                      The Psoas Parvus,

   Arises, fleshy, from the contiguous edge of the body of the
 last dorsal and of the first lumbar vertebra at their sides, and
 from the intervertebral  ligament.  It is  at the anterior and in-
 ternal edge of the psoas magnus; has a short belly, and a long
 tendon by which it  is inserted into  the linea  innominata, about
 half-way between the spine  of  the pubes  and the junction of
 this bone with the ilium.  The tendon, besides, is expanded into
 the fascia iliaca.
   Its use seems to be, to draw upwards the sheath  of the  fe-
 moral vessels, which is derived from the fascia iliaca, and, con-
 sequently, to draw upwards the  vessels  themselves; which pro-
 bably diminishes the liability to   injury  from their too great or
 sudden flexion.   This muscle is  sometimes wanting.


                      The Psoas Magnus.

   Arises,  fleshy, from the side  of  the body of the  last dorsal
 and of the four upper lumbar vertebras, and from the transverse
 processes of all the lumbar vertebras.  It forms an oblong fleshy
 cushion on the side of the lumbar vertebrae, and constituting the
 lateral boundary of the  inlet to  the pelvis, it passes out of the
 pelvis, under Poupart's ligament, about its middle.
   It is inserted tendinous, into the trochanter minor of the  os
 femoris, and fleshy  for an inch below it.
   It bends the body forwards, or draws the thigh upwards.f

  * Varieties. Sometimes a broad  tendon from it is inserted into the inferior
margin of the body of the eleventh vertebra of the back.  Sometimes a fascicu-
lus of it touches the margin of the eleventh rib, near its head, and above the in-
 tercostal vessels.
  ■j- Varieties.  Sometimes it  is joined by muscular fasciculi  from the first  se-
 cond, and even the third  bone of the sacrum. Sometimes, where it borders on
 the pelv'.s, there is a small fasciculus, which continues distinct almost to the tro.
 chanter minor, and then sends  its own tendon into the common tendon of the
iliacus internus and psoas magnus. 
MUSCLES OF THE PARIETES OF THE ABDOMEN.        399
                     The Iliacus Internus,

  Occupies the concavity of the ilium, being on the outside of
the psoas magnus.  It arises, fleshy, from the transverse pro-
cess of the lastiumbar vertebra; from the internal margin of the
crista of the ilium; from the whole concavity of the latter; from
its anterior edge at and above the anterior inferior spinous pro-
cess; and from that part of the  capsule of the hip joint near the
latter process.
  This muscle  terminates in the tendon of the psoas magnus,
just above its insertion into the trochanter minor.
  This and the psoas magnus,  from having a common tendon,
might with propriety be considered as only one muscle.  Their
action is the same.*

                     Of the Fascia  Iliaca.

  The Fascia Iliaca is a tendinous membrane, which lies on the
iliacus internus and psoas magnus muscles, and is continued
into the tendon of the Psoas Parvus.  Externally, it is connect-
ed  to the margin of the crista of the ilium; at the internal edge
of  the psoas magnus, it is connected with the  brim of the pel-
vis, and sinks into the cavity of the pelvis, being continuous
with the Aponeurosis Pelvica;  and below, it is inserted into the
edge of the crural arch, from the anterior superior spinous pro-
cess of the ilium almost to the  pubes, and is  there continuous
with the fascia transversalis abdominis.   The external iliac ves-
sels are upon this fascia,  between  it and  the  peritoneum; and
below them the fascia iliaca goes over that part of the  pubes
which gives origin to the  pectineus muscle, and is continuous
with the  pectineal fascia, or that which  covers the pectineus
muscle.  By introducing  the finger  or a knife handle into a
cut through the fascia iliaca, its attachment to the crural arch,
and its continuity with the fascia pectinea will be rendered very
obvious.

  • Varieties.  Sometimes an additional fasciculus arises below the inferior an-
terior spinous process, and descends along the external margin of this muscle.
This fasciculus varies somewhat in its size at different points, and is inserted into
the linea aspera below the trochanter minor. In very rare cases, the iliacus in-
ternus is kept totally distinct from the psoas magnus, from origin to insertion. 
400                      MUSCLES.

  The iliac vessels pass beneath the crural arch on the inner
margin of the psoas magnus muscle, the vein being nearest the
pubes and the artery at the outer side of the vein.  The fascia
iliaca being inserted into the crural arch as far as the vein, may
indeed be traced to the crista of the pubes; it is so connected
with the vessels that no opening for hernia exists between them,
or indeed in all the space from the internal margin of the vein
to the  spine of the ilium.  But at the inner side of the vein,
between  it and Gimbernat's ligament, an opening  appears,
called the Crural or Femoral Ring, and is the place where fe-
moral hernia commences.   This opening is generally occupied
by a lymphatic gland, and  a lamina of condensed but loosely
attached cellular substance, continuous with  the Aponeurosis
Pelvica.
    SECT. IV.-HMUSCLES ON THE POSTERIOR FACE OF THE TRUNK,

                The Trapezius or Cucullaris,

   Is a beautiful broad muscle, immediately under the skin, co-
vering the back parts of the neck and thorax, and extending
from the bottom of the latter to the top of the former.  Its an-
terior edge, above, is parallel with the posterior edge of the
sterno-cleido-mastoideus.   Its posterior  edge  is joined  with
that of its fellow, and below, it overlaps in part the latissimus
dorsi.

   It arises from the occipital protuberance, and from eight or
ten lines, sometimes more of the superior semicircular ridge of
the occiput, by a tendinous membrane.  It arises also from the
five superior spinous processes of the neck through the inter-
vention of the ligamentum nuchas, and tendinous directly from
the two lower spinous processes of the neck, and from all of
the back.
   It is inserted fleshy into  the  external third of the clavicle,
tendinous and fleshy into the inner edge of the  acromion pro-
cess, and into all the spine of the scapula.  Its fibres having a
very extended origin, must of course  converge  in getting to 
MUSCLES OF THE BACK.
401
these insertions; the upper fibres descend, the lower ascend,
and the middle are horizontal.*
  It draws the scapula towards the spine.

  In the cervical portion of these muscles, formed by the ori-
gins of both united, is an elliptical expanse of tendon, lying over
the ligamentum nuchae, and extended on each side.  The liga-
mentum nuchas itself, as mentioned  elsewhere,  is a vertical
septum  of ligamentous matter, extending from the central line
of the occipital bone, to the spinous processes of all the verte-
bras of  the neck.   At its  upper part, where the spinous pro-
cesses of the neck are short, this septum is very broad, and di-
vides completely the muscles of the two sides of the neck.


                    The Latissimus Dorsi,

  Is situated under the skin at the lower part of the  back, so
as to cover  the whole posterior portion of the latter.  It arises
by a thin tendinous membrane, from the seven inferior spinous
processes of the back; and by a thick tendinous membrane from
all those of the loins and sacrum.   Its origin also extends along
the outer inferior margin of the sacrum, and from the  posterior
third of the spine of the ilium.t  Besides which, the latissimus
dorsi has from the  sides of the three or four inferior false ribs,
as many fleshy heads which are  connected with the inferior
heads of the obliquus externus abdominis.
  From this extended origin the fibres converge, so as to form
the posterior fold of the axilla; and to terminate in a flat, thick
tendon,  of two inches in breadth, which  is inserted into the
posterior ridge of the bicipital groove of the os humeri.  The.
upper part of this muscle  passes over the inferior angle of the
scapula, and derives a fasciculus of fibres from it.  It is there
behind  the teres major, but as it advances  it winds around the
inferior edge of the latter  so as to get  before it.  Afterwards

  • Varieties.  It is sometimes short of the origin described, by from one to
four, of the lower spinous processes of the back.  Also the lower fasciculus  is
sometimes disjoined from the rest of the muscle, by a large triangular space.
  f This origin frequently is tendinous at the back part of the ilium, and fleshy
in front.
                            34* 
402                       MUSCLES.
the tendons of the two adhere closely, but have a bursa between
them at their termination.  That portion  of  the tendon of the
latissimus which is continuous with the lower edge of its fleshy
belly, by a half spiral turn in  the latter, becomes uppermost;
while  the  upper  portion is  by the same arrangement  made
lowest.  At the place of its insertion, it is commonly connected
to the pectoralis major.   The inferior margin of its tendon de-
taches a slip  to the brachial fascia, and  the superior margin
another to the  smaller tuberosity of the os humeri.
   It draws the os humeri downwards and backwards.*
   The thick tendinous membrane coming from the spinous pro-
cesses of the loins and back is the fascia lumborum, and is com-
mon to the latissimus the internal and external oblique muscles
of the  abdomen, and  several other muscles to be mentioned.


                The Serratus Inferior Posticus.

   The origin of this muscle is inseparably united to that of the
latissimus  dorsi by the fascia  lumborum,  and comes from the
two inferior spinous processes of the back, and fhe three superior
of the  loins.
   It is inserted by fleshy digitations into the  under edge  of the
four inferior ribs.
   It draws the ribs downwards, and is an antagonist to the dia-
phragm in some respects, but more particularly to the serratus
superior posticus.

   The removal of the  trapezius brings into view  several mus-
cles: the  most superficial of which are the rhomboid, which,
being  two together, look very much like one.

   * Varieties.  Sometimes from its anterior extremity a  fleshy or tendinous slip
is detached  in front of the coraco-brachialis, and is  inserted into the posterior
face of  the tendon of the pectoralis major. The brachial vessels and nerves are
liable to compression from this arrangement, which is said to be natural to birds
and moles.   Another variety is where a slip runs from this muscle, adheres to
the coraco-brachialis, and  is inserted tendinous into the  coracoid processof the.
scapula. 
MUSCLES OF THE BACK.                  403
                  The Rhomboideus Minor,

  Is above the other.  It is a narrow muscle which arises by
a thin tendon from the three inferior spinous processes of the
neck, and, passing obliquely  downwards, is inserted into the
base of the scapula, opposite the beginning of its spine.


                  The Rhomboideus Major,

  Arises, also, by a thin tendon from the last spinous process of
the neck, and from the four superior of the back, and is insert-
ed into all the base of the scapula below its spine.
  These muscles draw the scapula  upwards and backwards.


               The Serratus- Superior Posticus,

  Arises by a thin tendon from the three inferior spinous pro-
cesses of the neck, and the two superior of the back, and is in-
serted into the second, third,  fourth, and fifth  ribs, by tendi-
nous and fleshy slips, a little beyond their angles.
   This muscle draws the ribs upwards.

   Between the two serrati  is an  aponeurotic expansion de-
scribed by Rosenmuller, which connects them with each other,
and has induced some anatomists to consider them as but one
 muscle.   It is thin and diaphanous, but has the fibrous structure
 very apparent, and  running in a transverse direction from the
 spinous  processes to the angles of the ribs.  The superior mar-
 gin of the latissimus dorsi also runs into this fascia, so as  to
 render its own bounds somewhat undefined.   This fascia, along
 with the ribs and vertebras, forms that canal in which are con-
 tained the deep-seated  muscles of the back.


                     The Levator Scapula,.

    Is placed between the  posterior edge of the  sterno-cleido-
 mastoideus and  the anterior of the trapezius;  its lower end  is
 just above the rhomboideus  minor..  It arises by rounded ten- 
404
MUSCLES.
dons from the three, four, or five, superior transverse processes
of the  neck, between the scaleni muscles and the splenius colli.
  It is inserted, fleshy, into that part of the base of the scapula
above  the origin of its spine.  As its name  expresses, it draws
the scapula upwards.   A good view of this muscle may be ob-
tained in  the front dissection of the  neck.*


                         The Splenius,

  Has its inferior extremity beneath the serratus  superior pos-
ticus, but the principal  part of it is covered  by the  trapezius.
It arises from the spinous processes  of the five inferior cervical,
and of the four superior dorsal vertebras.
  It is inserted into the back of the mastoid process and  into a
small part of  the adjacent portion of the os occipitis, also into
the transverse processes of the two superior cervical vertebras.
It is customary to consider]- the part which  goes to the head as
Splenius Capitis, and the part below as Splenius Colli: the  lat-
ter, in  that case, is  said  to arise from the third and fourth dor-
sal  vertebras.   It draws the head and neck  backwards.

  Between the spinous processes of the vertebrse and the angles
of the  ribs, on either side, the  deep fossa is filled up entirely by
muscles.   Some  of them are large  and powerful, and the most
striking are the Sacro Lumbalis and the Longissimus Dorsi.


          The Sacro Lumbalis and Longissimus Dorsi,

  Have a common  origin from the back  of the pelvis and of the
lumbar vertebras, and extend to  the top of  the thorax.   They
arise, tendinous posteriorly, and fleshy, anteriorly, from the pos-
terior surface of the sacrum by its external  margin and spinous
processes: they arise, also, tendinous, from the spinous processes
and  fleshy, from  the ends of the transverse processes  of all the

  *  Varieties. Sometimes it arises from only two superior transverse processes;
occasionally its fasciculi are separated from the neck to the scapula; or, a long one
is detached towards the spine, thereby presenting a disposition similar to what
is met with in the dolphin.
  j-  Albinus, loc. cit. 
MUSCLES OF THE BACK.
405
vertebras of the loins;  and principally tendinous from the pos-
terior part of the spine of the ilium.  The external margin of the
belly is fleshy, and all the part  nearest to the spine is wholly
tendinous below; but, higher up  in the loins, it is so only on the
surface.  The tendon is very strong, and divided into fasciculi,
chiefly  near the spinous  processes of  the  lumbar vertebras.
From  the  under surface of this common belly, two heads, ten-
dinous  and fleshy, are inserted into  the inferior  edge of the
transverse process of each lumbar vertebra, the  smaller near its
root, and the larger near its  extremity.   On a level with the
lower  rib, and,  indeed, somewhat  below it, a fissure occurs in
the muscle which divides it into two parts.

   The  Longissimus Dorsi Is nearest the spine; it is inserted, by
small double tendons, proceeding from its internal surface, into
the ends of the transverse processes of all the vertebrae of the
back, except the first.   It also, from its  outer edge, sends long
slender tendons, by which it is inserted into the  under edges of
all the ribs beyond their tubercles, except the two inferior.
   The  Sacro-Lumbalis is inserted from its outer edge into  all
the ribs at their  angles, by long  and thin tendons, which are
successively longer, the higher they are inserted.
   By turning over this muscle towards the ribs, from the other,
one may see coming from the eight lower ribs, as many slips,
which run into the under surface  of  the sacro-lumbalis:  they
are the Musculi Accessorii ad Sacro-Lumbalem.
   These two muscles keep the spine erect, and  draw down the
ribs.*

                      The Spinalis Dorsi,

   Between the  ends of the  spinous processes and the edge of
the longissimus dorsi, is a muscle almost entirely tendinous, and
scarcely to be distinguished from the latter, both in consequence

   * Varieties.  The origin is uniform, but the  insertions vary in their number.
Sometimes, a fasciculus commences by a tendinous beginning from the fourth
rib, and is inserted into the transverse process of the sixth vertebra of the neck;
a fasciculus from the sacro-lumbalis joins the fascia extended between the two
serrati, or reaches to the splenius colli: the two muscles are sometimes joined
closely by an intermediate fasciculus. 
406                       MUSCLES.

of its close connexion with it, and of its insignificant size.  At
its lower part, it is absolutely a portion of the longissimus, and
can be separated from it only by a forced division.   It is a mere
string lying along the sides of the spinous processes, and is called,
from its origin and insertion, the Spinalis Dorsi.
  It arises tendinous from the spinous processes of the two supe-
rior lumbar, and of the three inferior dorsal vertebras, and is in-
serted, tendinous, into the spinous processes of the  nine superior
dorsal vertebras, except  the first.
  It tends to keep the spine erect.


                 The Cervicalis Descendens,

  Is a small muscle placed at the upper portion of the thorax,
between the insertions of the sacro lumbalis, and of the longis-
simus dorsi  into the upper  ribs; it looks, at  first, very much
like a continuation or appendix of the  first, running to the cer-
vical vertebrae.
  This muscle arises from the upper edges of the four superior
ribs by long tendons: it forms a small belly, which is inserted
by three distinct tendons into  the transverse processes of the
fourth, fifth, and sixth vertebras of the neck, between the leva-
tor scapulas and splenius colli.
  It draws the neck backwards.


                 The Transversalis Cervicis,

  Is on the inner side of the last, and in contact with it, being
about the  same size, and  having very much  the  same course
and appearance.  It is considered as an appendage to the lon-
gissimus dorsi.
  It arises from the transverse processes of  the five superior
dorsal  vertebrae by distinct tendons, and forms a narrow fleshy
belly, which is  inserted by distinct tendons, also, in the trans-
verse processes of the five middle cervical vertebras.
  It draws the head backwards. 
MUSCLES OF THE BACK.                 407
                  The Trachelo Mastoideus,

  Is at the inner side of the last muscle, in contact with it.
  It arises by distinct tendinous heads, from the  transverse
processes of the three superior vertebras of the back, and of the
five inferior of the neck; and is inserted, by a thin tendon, into
the posterior edge of the mastoid process.
  The dorsal origins are frequently deficient or irregular.
  It draws the head backwards.


                      The Complexus,

  A fine  large muscle, is situated at the inner face of the tra-
chelo mastoideus; and is  readily recognised  by showing itself
between the  bellies  of the two splenii  capitis, just below the
occiput.   A quantity of tendinous  matter exists in its middle,
which gives  it  the  complicated appearance from whence its
name is derived.
  It arises, by tendinous heads, from the seven superior dorsal,
and the four inferior cervical vertebras, by their transverse pro-
cesses;  also, by a fleshy slip from the  spinous process of the
first dorsal.   It is inserted into the inferior part of the os occi-
pitis, by the surface  between the upper and lower semicircular
ridges, on the outside of the vertical  ridge which exists in the
middle of the bone.
  It draws the head backwards.


                  The Semi-spinalis Cervicis,

  Is a muscle which passes  obliquely from  transverse to spi-
nous processes, and  is situated between the complexus and the
multifidus spinas;  the course  of its fibres renders it difficult to
be distinguished from the latter.
  It arises from the transverse processes of  the six upper ver-
tebrae of the back, by tendons which adhere to those of the ad-
jacent muscles; and passes up to the  neck, to be inserted into
the sides  of the spinous processes  of  the five  middle cervical
vertebras.
  It extends the neck obliquely backwards. 
408
MUSCLES.
I
                  The Semi-spinalis Dorsi,

   Is lower down on the spine, and with difficulty distinguished
from the multifidus: like the  last, it passes from transverse to
spinous processes.   It lies under the longissimus dorsi, between
it  and the multifidus.
   This muscle arises by tendons connected with those  of the
other muscles, from the transverse processes  of the seventh,
eighth, ninth, and tenth dorsal vertebrae;  and passes upwards
obliquely, to be inserted, tendinous, into the sides of the spinous
processes of the two lower cervical, and of the five upper dor-
sal vertebras.
   It draws the spine obliquely backwards.


                   The Multifidus Spina,

   Lies under the muscles as  yet mentioned, close to the bones
of the spine; in order to see  it well, they, therefore,  should all
be cut away.
   It has its commencement, tendinous  and fleshy, on the back
of the sacrum, being  connected to its  spinous processes and
posterior surface, also to the back part of the spine of the ilium.
It  there forms a belly, of sufficient magnitude to fill up much
of the cavity between the spinous processes of the sacrum and
the posterior part of the ilium.  It arises also from the roots of
the oblique and transverse processes of all the vertebras of the
loins, of the back, and of the  four inferior of the neck.
   The multifidus is inserted, tendinous and fleshy, into the roots
and sides of the spinous processes of all the vertebrae  of the
loins, of the back, and of the  five inferior of the neck.
   This  muscle consists of a great  number of small  bellies,
which are parallel to each other, and  each of  which arises
from a transverse or oblique process, and  goes to the  spinous
process  either of the first or second vertebra above it.
  It twists the spine backwards, and keeps it erect.

  Between the head and the first and second vertebras, and be-
tween the two latter, there are on either  side four small mus- 
MUSCLES OF THE BACK.
409
cles, intended for the motion of these parts upon each other.
They are brought into view by the removal of the complexus.


             The  Rectus Capitis Posticus Major,

  Arises, tendinous and fleshy, from the extremity of the spi-
nous process of the dentata, and  is inserted  into the inferior
transverse or semicircular ridge of the os occipitis, and into a
part of the continuous surface of bone below it.
  Its shape is pyramidal, the apex being below.   It turns the
head, and also draws it backwards.


              The  Rectus Capitis Posticus Minor,

  Is at the internal edge of the first.  It arises, tendinous, from
the tubercle on the back part of the first vertebra, and is in-
serted into the internal end of the inferior transverse or semi-
circular  ridge of the os occipitis, and into a part of the surface
between it and the foramen magnum.
  It is also  pyramidal, with  the  apex downwards.  It draws
the head backwards.


                The Obliquus Capitis Superior,

  Arises from the  transverse process of the first cervical  ver-
tebra, and is inserted into the outer end of the inferior semicir-
cular ridge of the  os occipitis, behind the posterior part of the
mastoid process, and beneath the splenius muscle.
  It draws the head backwards.


                The Obliquus Capitis Inferior,

  Arises from the  side of  the spinous process  of the  dentata,
and is inserted into the back part of  the transverse process of
the  first vertebra of the neck.
  It rotates the first vertebra on the second.
Vol. I.—35 
410
MUSCLES.
                     The Inter-spinales,

  Are small  short  muscles, placed between  the spinous pro-
cesses of contiguous vertebras.  In the neck  they are double,
in consequence of its spinous processes being bifurcated; in the
back they are almost entirely  tendinous; in the loins they are
single and well marked.
  They draw the spinous processes together,  and  keep  the
spine erect.

                   The Inter•■transversarii,

  Are also short  muscles, placed in a similar manner, between
the  transverse processes of the vertebras.   In  the neck  they
are double, in the back they are small, tendinous, and not well
marked; and in the loins they  are single and well seen.
  They draw the transverse  processes together, and will, of
course, bend the spine to one side.

                  The Levatores Costarum,

  Are small muscles concealed by the sacro-lumbalis and lon-
gissimus dorsi, and pass from  the transverse process of the last
cervical and of the eleven superior dorsal vertebras, to the up-
per edges of the next ribs.  They are twelve on either side of
the spine, are tendinous in their origins and insertions, with in-
termediate muscular bellies.
  The upper ones are small and thin.  They increase in mag-
nitude as they descend.  From the inferior edge of nearly all
these muscles a fleshy slip is detached, which passes  over the
rib next below its origin, to the second  rib below, and  occa-
sionally to the third.  These slips are called Levatores Costa-
rum Longiores.   The others, which  descend from the trans-
verse process to  the rib next below, are called Levatores Cos-
tarum Breviores.
  These  muscles are parallel  in their obliquity, with the ex-
ternal intercostals, and are not very obviously separated  from
them.  They perform the same service, that of elevating the
ribs. 
FASCIA.
411
                   CHAPTER III.

 OF THE FASCIA AND  MUSCLES OF THE UPPER EXTREMITIES.

                      SECT. I.--FASCIA.

  The muscles of each upper extremity are invested by an apo-
neurotic membrane called the Fascia Brachialis, which extends
from the shoulder to the hand.  It begins at the base and spine
of the scapula, the margin of the acromion process, the acromial
extremity of the clavicle, and from the  cellular membrane  in
the arm-pit, and extends  itself over all the muscles of the dor-
sum of the scapula, and over  the deltoid muscle.  The tendons
of the latissimus dorsi  and pectoralis major, each send off from
their margins an expansion which is lost in it.  Below the spine
of the scapula it is strong and well marked, but on the deltoid
muscle, as wrell as on the  muscles of the arm, its desmoid cha-
racter is by no means so well developed, though it still retains the
appearance of a distinct membrane, and can be raised up as such
from the muscles.  On the fore arm its ligamentous appearance
is well preserved, and extends from the elbow to the wrist in-
clusively.  Its longitudinal  fibres  there are well secured by
transverse ones.
  Above the condyles of  the  os humeri, the. Fascia Brachialis
sends  down to the bone  a  strong tendinous partition to each
ridge, and which runs  the  length of the  latter from its upper
end to the condyle.  These processes separate  the muscles on
the back of the arm from such as are on the front of it,  and are
sometimes called the Ligamentum inter-musculare internum and
externum.  They afford origin to many muscular fibres.  A.t the
bend of the elbow, the fascia brachialis is joined by a fasciculus
of tendinous matter from  the ulnar margin of the  tendon of the
biceps flexor cubiti, and which, in  the contraction of the mus-
cle, will keep the fascia tense.
  At the lower extremity of the fore arm, the transverse fibres,
after diminishing sensibly, become more numerous, and by their 
 4|2                      FASCIA.

 attachments to the several ridges on the back of the radius and
 of the ulna, form  the Ligamentum Carpi Dorsale.  This  liga-
 ment is extended from the styloid or outer margin of the radius,
 transversely to  the styloid or inner margin of the ulna, to the
 pisiform bone, and to the  fifth metacarpal.   It consists, in some
 measure, of two portions: of which the superior is the smaller
 and thinner, has its fibres descending from the radius to the ulna,
 and is crossed, in  part, by the fibres  of the inferior or greater
 portion.  As this  ligament adheres, with great strength, to the
 ridges on the back of the  bones of the fore arm, six trochleas for
 the tendons of the  extensor muscles are thus formed.  The first,
 or that next to the styloid process of the radius, contains the
 tendons of the first two extensors of the thumb.  The  second is
 larger, and transmits the tendons of the two radial extensors of
 the carpus.  The third is small and oblique, for the tendon of
 the third extensor of the thumb.  The fourth is the largest, and
 is for the tendons of the extensor communis of the fingers.  The
 fifth is between the radius and the head of the ulna, and is for
 that tendon of  the extensor communis which goes to the  little
 finger.   The sixth is  on the back of the ulna, and is for the ten-
 don of the extensor carpi ulnaris.
   The  inferior margin of this dorsal ligament of the wrist  does
 not terminate abruptly, but resuming its fascia-like character,
 is continued over  the back of the wrist, and  over that of the
 hand to the fingers.   In this  progress  it  furnishes an  envelope
 to  the extensor tendons, and is very much blended with the ob-
 lique fasciculi, by  which they communicate with each other.

   The Fascia Brachialis affords origin, in part, to the muscles
 on the dorsum of the scapula below its spine; on  the  arm it is
 not so intimately connected with the  muscles, but on the fore
 arm they again begin to arise,  in part, from it.   In its whole
 course  partitions,  constituting the sheaths of the  muscles, and
 which consist, for the most part, of common cellular and adipose
 membrane, go from it down to the periosteum and interosseous
ligament.   It adheres very tightly to  the  ulna, from  the  ole-
 cranon to the styloid  process.  On  its cutaneous surface are
found all the superficial veins, nerves, and  lymphatics  of the
arm.  Bichat considers this membrane as the best example of 
UPPER EXTREMITIES.
413
the continuity of ligamentous with cellular tissue, and conse-
quently of the affinity of the two.

   The flexor tendons of the hand and fingers are held down,
by the Ligamentum Carpi Volare  or the Anterior Annular Li-
gament of the Wrist.  It is a very strong fasciculus of liga-
mentous fibres, which subtends the concavity of the carpal bones
in front, and converts it into the large oval foramen which con-
tains the tendons.   It is attached by one end at the  ulnar side
of the wrist, to the hook-like process of the unciforme, to the
cuneiforme, and to the pisiforme.   Its fibres go straightly across
the wrist to be attached by their other extremities to  the radial
end of the trapezium, and of the scaphoides; and may be readi-
ly distinguished from the fascia brachialis by their  uniformly
transverse  course; by their  superior whiteness; by their in-
creased thickness;  and by their great strength  and unyielding
nature.   Yet the superior margin  of this ligament is partially
continuous with the fascia brachialis, and  the inferior margin
with the aponeurosis palmaris.   Several of the little muscles of
the hand arise from its  front surface, while the posterior is in
contact with the flexor  tendons.
   The Aponeurosis Palmaris is placed just below the skin, and
covers the middle of the palm of the hand.   It is triangular,
and has its apex above,  where it arises from the inferior margin
of the volar or anterior  annular ligament of the wrist, and from
the tendon  of the palmaris longus; it spreads out in its descent,
and reaches the lower ends of the metacarpal bones, where it
is divided into four portions.  Each of these portions  bifurcates
and passes to the head  of its appropriate metacarpal bone, to
be fixed to  it just in advance of  the inferior palmar ligaments.
The vacuity of the bifurcation permits the flexor tendons to pass
on to the finger, and its branches are held together by transverse
and reticulated  fibres, the interstices of which  are filled with
fat.  The  lateral margins of this  aponeurosis  send off a thin
membrane, for the purpose of covering the muscles of the thumb
and of the little finger;  or, in other words, the thenar and the
hypothenar eminences in the palm of the hand.
 
414
MUSCLES.
          SECT- H'--OF THE MUSCLES OF THE SHOl LDER.

                         The Deltoides,

   Is a muscle which is extended over the top of the shoulder
joint, and forms there the subcutaneous cushion  of flesh which
protects and gives  rotundity to the articulation.  It arises from
the inferior edge of the whole  spine of the scapula, from the
circumference  of the acromion process, and from the exterior
third of the clavicle.  Its origin, for the most part, is tendinous
and fleshy mixed; but at its posterior part it is  entirely tendi-
nous.
   It is inserted, by a tendinous point, into the triangular rough
surface on the  outer side of the  os humeri near its middle.   Its
general  configuration is  triangular, and when  spread  out, its
upper margin is  much more extensive than one would suppose,
as it is  opposed to the  entire insertion of the  trapezius.   Its
fibres do not converge regularly to its insertion like the radii
of a circle, but the whole muscle is divided into several parts;
the interposition of inter-muscular tendons into which, affecting
the course of the fibres,  makes  several portions of the deltoid
look penniform, and others like smaller  deltoids introduced  into
the larger.
  The deltoid covers the insertion of the pectoralis major, latis-
simus dorsi, and  teres major, besides that of the other muscles
of the shoulder.   It also conceals the origin of the biceps flexor
cubiti and of the coraco-brachialis.  Its insertion  is between the
triceps extensor and the  biceps flexor, and  above the  origin of
the brachialis internus.*
  It raises the  os humeri.
  Between the superior edge of the deltoid, the  acromion pro-
cess, and the subjacent tendons on  the  top  of the articulation,
there is a large  Bursa Mucosa, which is sometimes partitioned
off into two.

  * Varieties.  Sometimes a fasciculus  arises, between the infraspinatus, and
the teres major, or from the inferior costa of the scapula, and joins itself to the
deltoids. 
MUSCLES OF THE SHOULDER.               415
                 The Supra-Spinatus Scapula,

  Arises, fleshy,  from the whole  fossa supra-spinata, which it
fills up, and  from its margins.   Forwards it  terminates in a
thick  robust  tendon closely connected with the  capsular liga-
ment of the joint, and which passes under the jugum formed by
the articulation of the acromion with the clavicle.
  It is inserted, tendinous, into the inner face  of the great tu-
berosity of the os humeri.
  It raises the arm, and turns it outwards.


                 The Infra-Spin at us Scapula,

  Arises, fleshy,  from  all that portfon of the dorsum scapulae
below its spine, from the  spine as far as the cervix, and from
the several margins of the fossa infra-spinata.   Its fibres pass
obliquely to  a middle  tendon, which  adheres closely to the
capsular ligament, and goes under  the projection of the acro-
mion.
  This tendon is  inserted  into the middle facet of the  greater
tuberosity of the os humeri.
  The infra-spinatus rolls  the os  humeri outwards and back-
wards.   There is a bursa between its tendon and the scapula.


                      The Teres Minor,

  Is situated at the inferior margin of the infra-spinatus, in the
fossa of the inferior costa scapulas, and looks very much like a
part of the infra-spinatus, to which  it occasionally adheres  so
closely as to be separated with difficulty.  It arises, fleshy, from
the whole of the fossa, and the margins of the inferior costa, in
the space from the cervix of the bone to within  an inch or  so
of its angle.
  It is inserted,  tendinous and fleshy, into the outer facet  of
the great tuberosity of the os humeri, just below the infra-spi-
natus.
  It draws the os humeri downwards and backwards,  and ro-
tates it outwards. 
416
MUSCLES.
                      The Teres Major,

   Is situated at the inferior edge of the teres minor.  It arises,
 fleshy, from the posterior surface of the angle of the scapula,
 and from a  small part of its inferior  costa;  the  interstice be-
 tween it and the teres minor is considerable.
   It is inserted, by a broad tendon, into  the  internal ridge of
 the  groove of the os humeri, along with the tendon of the la-
 tissimus dorsi.   Their tendons, at first, are closely united, but
 afterwards there is  an intermediate cavity lubricated with sy-
 novia. .The tendon of the latissimus dorsi is anterior, and the
 lower edge of the teres extends farther down  the arm than it.
   It rolls the humerus inwards, and draws it downwards and
 backwards.

                     The Subscapularis,

   Occupies  all  the  thoracic surface of the scapula, being be-
 tween it and the serratus major.  It arises, fleshy, from  the
 whole base, superior and inferior costa, and  costal surface of
 the scapula; it is divided into several columns, which look some-
 what like distinct muscles, but they all terminate in a thick ro-
 bust tendon that adheres to the inferior surface of the capsular
 ligament.
   This tendon is inserted into the lesser tuberosity of the  os hu-
 meri.
   The subscapularis rolls the bone inwards and draws it down-
 wards.   Between it and  the neck of the scapula,  there  is a
 bursa, which, as mentioned, communicates with the articula-
 tion.


           SECT. III.--OF THE MUSCLES OF THE ARM.

                  The Biceps Flexor Cubiti.

  This muscle  is just  beneath the fascia and integuments,
and forms the swell so obvious in the middle front  part of the 
MUSCLES OF THE ARM.
417
arm.   It  arises by two heads.  The first, called the long, is a
round tendon which comes from  the superior extremity of the
glenoid cavity of the scapula, passes through the shoulder joint
and through the groove of the os humeri;  the second head arises
tendinous from the extremity of the coracoid process of the sca-
pula, in company with the coraco-brachialis muscle.  The fleshy
bellies in which these tendons terminate,  unite with each other,
several inches below the shoulder joint, to form a common mus-
cle.  At first they are only connected  by loose  cellular  sub-
stance; but, about half-way down the arm, they are insepara-
bly united.
  The biceps terminates below in a flattened oval tendon, which
passes in front of the elbow joint, to be inserted into the poste-
rior rough part of the tubercle of the radius.   A bursa mucosa
is placed between the tendon and the front of the  tubercle, the
surface of  the latter being covered with  cartilage.  From  the
ulnar  side of this tendon proceeds the aponeurosis  running  into
that of  the fore arm.
  The  relative  position of the biceps is  as follows: Its long
head is first within the cavity of the capsular ligament, and then
between the tendons of the  latissimus dorsi and pectoralis  ma-
jor, where it is bound down by strong ligamentous  fibres.  The
tendon  below is superficial, and may be easily felt  by flexing
the fore-arm, but its insertion dips down  between the pronator
teres and supinator radii longus.
  This muscle flexes  the fore-arm.*
                   The Coraco-Brachialis,

  Is situated on the upper internal side of the arm, at the inner
edge of the short head of the biceps muscle, with which it  is
connected for  three or four  inches.   It arises  tendinous  and
fleshy from the middle facet  of the point of the coracoid pro-

  *  Varieties. Sometimes the division of the muscle is continued to the elbow;
sometimes there is a third head, coming either from the internal face of the  os
humeri, or from the brachialis internus; very rarely, the number of heads has
been multiplied to five, thereby making a close approximation to the arrangement
in birds.  This muscle is very liable to anomalies. 
418
MUSCLES.
cess of the scapula, in common with the short  head of the bi.
ceps muscle.
  It is  inserted, tendinous and  fleshy,  into the  internal side-of
the middle of the os humeri, by a  rough ridge, just below the
tendons of the latissimus dorsi and  teres major, and in front of
the brachialis externus or third  head of the triceps.  The lower
end of this muscle is attached to the inter-muscular ligament of
the internal side of the os humeri, which separates  the brachi-
alis internus from the third head of the triceps.
  This muscle draws the arm upwards and forwards.*


                    The Brachialis Internus,

  Is situated immediately beneath  the biceps, and is concealed
by it, excepting its outer edge.  It has a bifurcated fleshy ori-
gin from  the  middle front face of the  os  humeri  on each  side
of the insertion of the deltoid, and  its origin is continued fleshy
from this  point downwards, from  the whole front of the bone
to within a very small distance of its articular surface.
   It is inserted, by a strong short tendon, into the rough surface
at the root of the coronoid process of the ulna.  A bursa some-
times exists between the tendon of the brachialis internus, that
of the biceps, the supinator brevis, and the elbow joint.
   The brachialis flexes the fore arm, and, by passing in front of
the elbow joint,  strengthens the latter very much.  Its lower
part lies under the tendon of the  biceps, and between the pro-
nator teres and the supinator longus.f

  * Varieties.  This muscle being generally penetrated by the musculo-cuta-
neous nerve, the perforation thus made sometimes exists as a fissure, extending
the length of the lower half of the muscle; on other occasions the fissure is so
long as to divide the muscle completely into two.
  f Varieties.  Sometimes, at its external margin, there exists a smaller brachia-
lis internus muscle, which arises from about the same point of the humerus, and
is inserted into the same part of the cubitus.   Sometimes it detaches a fasciculus
which joins the biceps muscle.  Sometimes its posterior part is distinct from the
anterior. Sometimes a fasciculus of it runs along the supinator longus of the fore
arm. 
MUSCLES OF THE ARM.
419
          The Triceps Extensor Cubiti, or Brachii,

  Forms the whole of the fleshy mass on the back of the arm;
it therefore occupies the space between the integuments and the
bone.  It arises  by three  heads.  The first, called Longus,
comes, by a flattened tendon, between the teres major and  the
minor muscle, from a rough  ridge on the inferior edge  of the
cervix scapulas. The second, called the Brevis, arises by a sharp,
tendinous, and fleshy beginning, from a slight ridge on the outer
back part of the os humeri, just below its  head.  The third head.
called Brachialis Externus, arises, by an  acute fleshy beginnino-,
from the inner side of the os humeri near the insertion of  the
teres  major.   This muscle, both at  its  external and internal
edge, is separated from the muscles in front of the  arm  by the
external and internal inter-muscular ligaments, which arise near
the middle of  the os humeri, and run to the  condyles respec-
tively.  The whole back of the os humeri, as well as the pos-
terior surface of these inter-muscular septa, is occupied by the
origin of the triceps.  The  muscular fibres run in various direc-
tions, according to their respective heads and places of origin.
  At the inferior  end of the muscle is  found a broad tendon,
which covers  its  posterior  face.  This  tendon is inserted into
the base or back part of the olecranon, and  the ridge leading
down the ulna on  its radial side.   The  bellies of the triceps
unite above the middle of the os humeri, but the  interstices be-
tween them may be observed much  lower down.  There is  a
bursa between the  tendon  and the olecranon process;  besides
which, there is sometimes another on each side of the first.
  The triceps extends the fore arm.


                       The Anconeus,

  Is a small triangular muscle, just beneath the skin, at the outer
posterior part of  the elbow joint.  It  arises tendinous from the
posterior lower part of the external condyle of the os humeri,
adheres to the capsular ligament of the  joint, and is partly co-
vered by the tendon of the  triceps.
  It is inserted, fleshy and  thin, into  the ridge leading from the 
420
MUSCLES.
olecranon, on the outer part of the upper end  of the ulna, and
into the triangular depression found there; so as to fill it up.
  It extends the fore arm.

          SECT. IV.--OF THE MUSCLES OF THE FORE ARM.

  There are eight muscles on the front  of the fore  arm, some
of which are superficial, and others deep-seated.  They,  for the
most part, are  either directly or indirectly flexors of the fore
arm and hand, and in their origin adhere very much by the ten-
dinous partitions, called Inter-muscular Ligaments.


                1.  The Pronator Radii  Teres,

  Is just beneath the fascia of the fore arm, and forms the  ra-
dial side  of the muscles  of  the internal  condyle.   It  arises,
fleshy, from the anterior face  of  the internal condyle of  the os
humeri, and tendinous from the  coronoid process  of the ulna.
It passes very obliquely across the fore arm, at the internal edge
of the brachialis internus muscle, and is inserted, tendinous and
fleshy, into the external back  part of the radius, just below the
insertion  of the supinator radii  brevis,  occupying  about  two
inches of the middle of the bone.
  It rolls  the hand inwards.*


          2. The Flexor Manus  vel Carpi Radialis,

  Is placed at the ulnar side of the last  muscle, and is also su-
perficial.  It  arises, by a narrow tendon, from the lower front
part of the internal condyle of the humerus, fleshy from  the in-
ter-muscular ligaments, fascia, and from the upper part  of  the
ulna.  It forms a thick fleshy belly, terminating below in a ten-
don, which passes under the  anterior annular ligament  of  the
wrist, and runs through a groove  in the os trapezium.
  It is inserted, tendinous, into the base of the metacarpal bone
of the fore finger, in front.
* Varieties.  Sometimes it is double. 
MUSCLES OF THE PORE ARM.
421
   There is a' bursa between the lower extremity of its tendon
 and the trapezium; the tendon is there held down  by ligamen-
 tous fibres.
♦  It bends the hand,  and draws it towards the radius.


                  3.  The Palmaris Longus,

   Is at the ulnar side of the flexor carpi radialis, and is super-
 ficial.   It  is a small short muscle, terminating in  a long slen-
 der tendon, and arises by a small tendon from the internal con-
 dyle, and fleshy from the inter-muscular ligament on each of its
 sides.
   It is inserted, tendinous,  into the upper margin  of the liga-
 mentum carpi  annulare  anterius, near  the  root of the thumb;
 and a division  of its  tendon passes on  to the aponeurosis pal-
 maris.
   It bends the  hand, and makes tense the palmar aponeurosis.*

           4.  The Flexor Manus vel  Carpi Ulnaris,

   Occupies, among the superficial muscles, the ulnar side of the
 fore arm.  It arises, tendinous, from the internal condyle of the
 os  humeri, fleshy from the upper internal side of  the olecranon,
 and by a tendinous expansion, being a part of the fascia of  the
 fore arm, from the ridge at the internal side of the ulna to with-
 in three or four inches of the wrist.
   It  is inserted into the upper  side of the os pisiforme by a
 round tendon, which  arises  early at  the radial margin of  the
 muscle, and receives  the muscular fibres.   Sometimes the ten-
 don is continued over the os pisiforme, so  as to be likewise in-
 serted into the base of the metacarpal bone of the  little finger.
 There is a loose bursa at the junction  of the tendon  with  the
 pisiforme.
   It bends the hand,  and draws it towards the ulna.

  * Varieties. Sometimes it is deficient in both arms; sometimes the middle part
 only is fleshy; sometimes the belly goes almost to the wrist.
Vol. I.—36 
422
MUSCLES.
         5.  The Flexor Digitorum Sublimis Perforalus,

   Is concealed very much by the muscles just  enumerated, in
 consequence of being placed between them.  To  get  a good
 view of its origin, they all  should be cut away from the os hu-
 meri.   It arises, tendinous and fleshy, from the internal  con-
 dyle of the os humeri, tendinous from  the coronoid  process of
 the ulna, and fleshy from the  tubercle of the radius; the latter
 part of its origin being extended, tendinous  obliquely, for three
 or four inches from that line of the radius which is at the upper
 margin of the  supinator radii brevis.  With these origins the
 muscle spreads over the front of the fore arm at its upper part,
 from  the radial to the ulnar margin.
   Four distinct tendons pass from the lower end of the  muscle,
 which commence much above the wrist, pass  beneath its ante-
 rior ligament, and,  having reached the palm of the hand, diverge
 to the several fingers.  A tendon is appropriated to each finger,
 and passes in front of the metacarpal bone to the phalanges, be-
 ing inserted, after having split into two, into the  angles  formed
 by the junction of the cylindrical  and flat surface of the second
 phalanx near its middle.
   It bends the second phalanges on the first; its action may also
 be continued so as  to clench the hand and to bend it on the fore
 arm.*

        6.  The Flexor Digitorum Profundus P erf or an s,

  Is beneath the flexor sublimis and the  flexor ulnaris.  It arises,
fleshy, from the oblong concavity of the ulna, along the inner
side of the coronoid  and the olecranon  process, fleshy from
the lower  margin of the base of the coronoid process, from the
ulnar portion of the interosseous ligament, and from  the front of
the upper  two-thirds of the ulna.

  * Varieties.  The tendon to the little finger is sometimes  wanting,  in which
case the deficiency is supplied by the tendon of the flexor profundus.  Some-
times the section of this muscle which belongs to the  fore finger, is insulated
from the rest of it, by a long fissure, and, moreover, divided by a middle tendon
into two fkshy portions. 
                   MUSCLES OF THE FORE ARM.               423

  The tendons of this  muscle are different from those of the
other; they commence in front of it, like a tendinous membrane,
which  is gradually  divided into several  fasciculi, adhering to
each other by cellular membrane.   The fasciculated character
of the  tendons is still preserved when they go under the ante-
rior carpal ligament, and until they begin to disperse as distinct
tendons to each  of the fingers.
  Each tendon,  going in front of its metacarpal bone and of the
corresponding phalanges, gets through the slit in the flexor sub-
limis, and is inserted into the front part of the root of the third
phalanx of its respective finger.
  It bends the  last  phalanges of the fingers, and may, by in-
creased action, flex  the hand like the preceding muscle.*


                7.  The Flexor Longus Pollicis,

  Lies in front of the radius, but beneath  the flexor  sublimis.
It arises by an acute fleshy beginning, from the radius just be-
low its tubercle; also fleshy from  the middle  two-thirds of the
front of this bone, and from the radial portion of  the interosse-
ous ligament.   The body  of the muscle is joined by a small
fleshy  slip  having a tendinous origin from the internal condyle
of the  os humeri.
  A tendon is formed early  on the  ulnar margin of  this mus-
cle, and to which the fibres pass  obliquely.   The tendon  goes
under the annular ligament of the wrist, through the fossa formed
in the  short flexor muscle of  the thumb, and  between the sesa-
moid bones, to be inserted into  the base of  the second phalanx
of the  thumb.
   From the inferior end  of the fore arm to  the middle of the
first phalanx, the tendon is invested by its appropriate bursa.
   It bends the last joint of the thumb.

   The several Flexor tendons,  as they pass under the anterior
annular  ligament of the wrist,  are  surrounded by the superior
Bursa Mucosa.  x It begins  about an  inch and a half above the
  * Varieties.  Sometimes a distinct fasciculus comes from the internal condyle
to join it; sometimes a fasciculus comes from the flexor longus pollicis, and ter-
minating in a tendinous  expansion, is inserted into the tendon which the flexor
 profundus sends to  the fore finger. 
 424                      MUSCLES.

 radio-carpal articulation, and extends to the lower margin of the
 annular ligament.  It adheres by its  circumference to this liga-
 ment and to the capsule of the joint;  internally, it sends in a
 considerable number of processes, whereby each tendon is sur-
 rounded, and connected to the adjoining tendons; while at the
 same time no restraint  is put  upon the natural motions of the
 part.  In its texture this bursa resembles a dense and elastic
 cellular  membrane.
   In addition to this, the flexor tendons, as they pass from the
 root to the extremity of each finger,  are surrounded by a syno-
 vial bursa;  which by its secretion continually lubricates them,
 and permits them to play freely backwards and forwards, ac-
 cording  to  the flexions  and extensions of the fingers.  These
 mucous  or  synovial  sheaths,  begin a little distance above the
 first joint of the finger,  adhere there  to both flexor tendons, and
 extend to about the middle of the last  phalanx.  They give to
 the  tendons a very polished lubricated surface; are  reflected
 over the anterior flat faces of the phalanges, being  separated
 from them by a small quantity of adipose matter; they are also
 reflected over the anterior  faces of the capsular ligaments, and
 line of the vaginal ligaments.
   The Vaginal Ligaments of the fingers (Ligamenta Vaginalia)
 bind down  the  flexor tendons and  keep them applied to the
 fronts of the phalanges.   They are of the same extent from
 above downwards,  with the mucous sheaths just mentioned, and
 are  stretched between the  ulnar and the radial margins of the
 phalanges.   The fibres  of which they consist pass for the most
 part transversely, and are of a fibro-cartilaginous character.
 These fibres diminish in  number towards the end of each finger,
 and  are stronger on the fore finger than on any of the others.
 In front of the metacarpo-phalangial articulations, and the pha-
 langial articulations, the vaginal ligaments are much thinner
 than elsewhere, in order  to permit the free flexions of the fingers.
 The  structure, indeed, at these points,  is strongly marked  off
 by its diminished thickness; and though the course of the fibres
is the same from side to  side, yet some anatomists have thought
it worth  while to designate it, particularly under the name of
Annuli Juncturarum Ligamentosi.
  Within the vaginal ligaments  small tendinous frasna  arise
from the  first and second phalanges; they vary in number in 
MUSCLES OF THE FORE ARM.
425
different individuals, and run obliquely forwards, some  to  ter-
minate  in the flexor profundus tendons, and others in those of
the flexor  sublimis; they  are called Vincula  Accessoria,  and
are covered by a reflection of the^synovial sheath.


                 8.  The Pronator Quadratus,

  Is just above the carpal surfaces of the radius and ulna, and
between the  other  muscles and  the  bone.   In the adult it is
about two  inches wide, and its fibres run across the  fore arm.
It arises, fleshy and tendinous, from the ridge at the inner sur-
face of the ulna, near its lower extremity, and from the front
of the bone.
  It is inserted into the corresponding  front surface of the ra-
dius.
  It rotates the radius inwards.*

          Of the Muscles on the back of the Fore Arm.

  These muscles are ten in number.   They arise, for the most
part, from  the external condyle, and the ridge leading to it, and
are extensors either of the fore arm, or of the fingers and thumb.
Their origins are less blended with each other than those of the
flexor muscles; nevertheless, between several of them there are
inter-muscular ligaments which connect them.  They are su-
perficial and deep-seated.

               1.  The Supinator Radii Longus,

   Is situated along the radial edge of the fore arm, immediate-
ly beneath the integuments.   It  arises, fleshy and  tendinous,
from the higher  part of the ridge leading to the external con-
dyle;  commencing just below the insertion of the deltoid mus-
cle, and being here placed between the brachialis internus and
the  outer  head of the  triceps.   It forms a  thick fleshy belly,
constituting  the  external  margin of the arm, about the  elbow

  * Varieties.  This muscle in some very rare cases does not exist. Sometimes
it consists in two layers whose fibres cross each other.  In a case noticed in the
Pennsylvania Hospital by Dr. J. R. Barton, it consisted in t.vo triangular pieces,
the bases of which were reversed.
                             36* 
426
MUSCLES.
joint;  and terminates about the middle of the radius in a flat
tendon.
   It*is inserted, by the tendon, into a  small, rough ridge, on
the outer side of the radius just above its styloid process.
   It rolls the radius outwards.


           2,  The Extensor Carpi Radialis Longior,

   Is situated beneath the former muscle.  It arises, tendinous
and fleshy, from the space of the external ridge of the os hu-
meri, between the  supinator longus and the external condyle.
It forms a short, fleshy belly, which terminates in a flat tendon
above the middle of the radius.
   It  is  inserted, by this tendon, into the posterior part of the
root of the metacarpal bone of the fore finger, near the thumb.
   The tendon of this muscle is surrounded by a synovial sheath,
at the place where it passes the lower end of the radius, under
the  posterior carpal ligament.   Another  bursa  exists, also, at
its insertion; which, on one occasion, I found so much enlarged
in a young woman, as to require its extirpation: the operation
was fully successful.
   It extends the hand.*


           3.  The Extensor Carpi Radialis Brevier,

   Is beneath the  last, but projects somewhat  beyond it.  It
arises, tendinous, from the posterior and lower part  of the ex-
ternal condyle,  and from the external lateral ligament of the
elbow joint.   It forms a  thick, fleshy belly, placed along the
radius, and terminates in a flat  tendon about the middle of that
bone.
   Its tendon, becoming  rounded, is  inserted into the posterior
part of the base of the metacarpal bone of the second finger,
and  has  a bursa beneath its insertion, and another at the wrist.
   It extends  the hand.f

  * Varieties. Sometimes a small fascieulus is detached from its posterior mar.
gin, and has a tendinous insertion into the third metacarpal bone.
  t Varieties. Sometimes this muscle is so blended with the preceding, aa to be
in common with it. 
MUSCLES OF THE FORE ARM.
427
               4.  The Extensor Carpi Ulnaris,

  Is superficial, and placed principally parallel with the ulna.
It arises, tendinous, from the external condyle, fleshy from the
inter-muscular ligament, and inside  of the  fascia.  Crossing
very obliquely the upper part of the radius and the ulna, it also
arises fleshy from the back part of the  latter bone. Its fibres
terminate obliquely in a tendon which goes through the groove
of the ulna, and is there furnished with a bursa.
  It is inserted, by its tendon, into the ulnar side of the base of
the metacarpal bone of the little finger.
  It extends the hand.*


           5.  The Extensor Digitorum Communis,

  Is superficial, being placed between the extensor  ulnaris and
the extensor radialis brevior.   It arises, tendinous, from the ex-
ternal condyle, and fleshy from  the inter-muscular ligament of
the contiguous muscles.  As it approaches the wrist it sends off
four tendons, which pass together through a common groove on
the back of the radius.  On the  back of the hand these tendons
diverge, and near the roots of  the fingers send cross  slips to
each other.
  Each tendon goes to its  respective finger, and covers the
whole posterior part of it,  being spread  out into a membrane
which adheres to the phalanges from the root of the first to the
root of  the last.   The precise mode of the insertion of these
tendons is as follows: on the back of the first phalanx, the la-
teral margins of these tendons are joined by the tendons of the
lumbricales and interossei;  and  the tendinous membrane, thus
formed, simply adheres by condensed cellular membrane to the
whole back of the first phalanx; the middle part of this tendon
then passes on to be inserted near the articular margin of the
base of  the second phalanx;  and the two  lateral parts of the
tendinous membrane, after  keeping separate for some distance,

 * Varieties. Sometimes its tendon is joined, by a small fascieulus, to the ex-
tensor tendon of the little finger. 
428
MUSCLES.
unite, and are jointly inserted into the back of the base of the
third phalanx.
  The section of this muscle appropriated to the little finger
has a distinct appearance, and frequently its tendon goes through
a separate fossa in the radius, from which causes it has obtained
the name of Auricularis.  A bursa invests these tendons at the
wrist as they pass through  their groove, and is  single above;
but, in following the course of the tendons, like them it divides
and follows each tendon  respectively to  the base  of the  first
phalanx.
  This muscle extends all  the joints of the fingers, being the
antagonist of the flexors.*


                 6.  The Supinator Radii Brevis,

  Can only be well seen  by detaching the origin of the afore-
said muscles;  it will then be found in contact with the radius,
making a close investment of its head and upper third.   It arises,
tendinous, from the external condyle of the  os  humeri, tendi-
nous and fleshy from the ridge on the posterior radial  edge  of
the ulna which descends from its coronoid process.
   Its fibres surround, obliquely, the upper external  part of the
radius, and  are  inserted  into  its tubercle, and into its oblique
rough ridge, corresponding with the upper margin of the  pro-
nator teres.   At the interstice between the radius and ulna, near
the  anterior edge of this muscle,  a  fleshy slip is occasionally
seen which passes from the radial side of the coronoid process
to the ulnar edge of the radius.
  This muscle rotates the radius outwards.f


         7.  The Extensor Ossis Metacarpi Pollicis Manus,

  Arises, fleshy, from the posterior part  of the  ulna  immedi-
ately below the anconeus, from the interosseous  ligament,  and

  * Varieties.  It sometimes sends a double tendon to the little finger, in which
case the auricularis is more distinct than usual, and the tendon next to the ulna
runs through a distinct trochlea in the posterior carpal ligament.
  t Varieties.  Sometimes the superior part is separated from the inferior; some.
times the muscle is double. 
MUSCLES OF THE FORE ARM.
429
from the back part of the radius just below the insertion of the
supinator brevis.   It  terminates  in a rounded tendon  which
passes over the tendons of the radial extensors, and through a
groove on the styloid  side of the lower eiffl of the radius.   The
tendon is there invested by a bursa.
   It is inserted, by its tendon, into the base of the metacarpal
bone of the  thumb, and into the external side of the trapezium.
   It extends the metacarpal bone of the thumb.*


             8.  The Extensor Minor Pollicis Manus,

   Is at the  ulnar side of the  last muscle.  It  arises, tendinous,
from the back of the ulna below its* middle, and fleshy from the
interosseous ligament.   It adheres to the radius, and terminates
in a tendon which passes through the groove in the styloid side
of the  radius, along with the last named muscle.
   It is inserted into the first phalanx of the thumb, by its ten-
don, which  is extended to  the root of the second phalanx.
   It extends the first phalanx.f

             9.  The Extensor Major Pollicis Manus,

   Arises, by a small tendinous, and an extensive fleshy origin,
from the back of the ulna above  its middle, and from the inte-
rosseous ligament, also from the back of the radius; it terminates
near the wrist, in a tendon which  passes through the groove on
the back of the radius near the ulna.  The belly of this muscle
conceals,  very  much, the other extensors of the thumb.
   It is inserted, by its tendon, into the oblong  transverse tu-
bercle, on the  back of the base  of the second phalanx of the
thumb.  Its tendon is  furnished with one synovial sheath, at the
inferior extremity of the radius, which extends to the carpus, and
another which  is  smaller, and is placed upon the  carpus and
upon the base of the first metacarpal bone.
   It extends the second  phalanx.J
  * Varieties.   This muscle is sometimes double, and has several other modifi- -
cations which it is unnecessary to state.
  f Varieties.   This muscle is sometimes only an appendage of the preceding.
Occasionally, its tendon is confounded with that of the succeeding muscle.
  t Varieties.   Sometimes this muscle is completely double. 
430
MUSCLES.
  The tendons of the last two muscles are much connected with
each other, and are spread in the form of a membrane on the
back of the thumb, after the manner of the extensor tendons of
the fingers.

                       10.  The Indicator,

  Is a small muscle on the back of the ulna, concealed by the
extensor communis and extensor  ulnaris.  It arises, tendinous
and fleshy, from the back of the ulna, commencing near its mid-
dle, and from the contiguous part of the interosseous ligament.
It terminates  in a tendon  which  goes through the same fossa
with the extensor  communis; it afterwards is  joined  about the
head of the first phalanx to the tendon of the common extensor
belonging  to the fore finger.
  With the tendon of the extensor communis, it is inserted along
the back of the fore finger as far as the base of the third phalanx.
   It extends the fore finger.*


            SECT. V.--OF THE MUSCLES OF THE HAND.

                     The Palmaris Brevis,

  Is just  below the skin,  at the  inner side of the palm of the
hand.   It  consists of separate  fasciculi unequally divided,  and
arises from the anterior ligament of the wrist, and from the ul-
nar side of the palmar aponeurosis.
  It is inserted into the skin and fat at the inner margin of the
hand, and covers the muscles of the little finger.
  It contracts the skin of the hand.

  * Varieties.  This muscle is subject to many modifications; sometimes it is di-
gastric; sometimes it is double, and the second head goes to the middle finger. In
the latter case, anatomists have recognised a disposition similar to that of the short
extensors of the toes, and also an arrangement corresponding with what occurs in
some species of the ape.  As a general rule, it is admitted that the most of those
varieties in the muscular system, commonly called anomalies, are only indications
on the part of nature of the alliance between the structure of man, and that of the
lower orders of animals.  In this point of view, they are both instructive and
amusing, and are well deserving of attention. 
MUSCLES OF THE HAND.
431
  Beneath the Aponeurosis Palmaris are placed the long flexor
tendons, and many of the small muscles of the hand.


                      The Lumbricales,

  Are conspicuous; they are four in  number, of the  size and
shape of earth worms.  They arise, tendinous and fleshy, from
the radial sides of the tendons of the flexor profundus, beneath
the ligamentum  carpi annulare anterius, and a little beyond its
inferior edge..
  They terminate in little flat tendons, which run along the outer
or radial edge of the fingers, and  are inserted respectively  into
the tendinous expansion of the extensor communis on the back
of the first phalanx of each finger, about its middle.
  They bend the first phalanges.*

  Four muscles constitute the ball of the thumb.


               1. The Abductor Pollicis Manus,

  Arises,  tendinous and fleshy, from the anterior surface of the
ligamentum carpi annulare, and from the projecting ends of the
trapezium and scaphoides.
  It is inserted,  tendinous, into the outer side of the base of the
first phalanx of the  thumb, and into the  tendinous membrane
derived from the extensors on its back part.
  It draws the  thumb from  the fore  fingers.   This muscle is
next to the skin.

                  2. The Opponens Pollicis,

  Is beneath the abductor, and without its removal can scarcely
be seen.   It  arises, tendinous and  fleshy,  from  the projecting
point of the os trapezium, and from the adjacent part of the an-
nular ligament.

  * Varieties.  Sometimes one is deficient; sometimes one or more is double, in
which case the supernumerary goes to the ulnar edge of the adjoining finger. 
432
MUSCLES.
  It is inserted, tendinous and fleshy, into the radial edge of
the metacarpal bone of the thumb, from its base to its head.
  It draws the metacarpal bone inwards.


            3. The Flexor Brevis Pollicis Manus,

  Is beneath the abductor pollicis, and at the side of the oppo-
nens pollicis.  A groove  is formed  in it by the  tendon of the
flexor longus pollicis, which divides  it into two heads.
  The first head arises, fleshy, from  the points of the trapezium,
trapezoides, and from the contiguous part of the internal sur-
face of the annular ligament, and is inserted into the  outer sesa-
moid bone;  the sesamoid bone, like a patella, being connected
to the first phalanx of the thumb by  a tendon.
  The second or internal head arises, fleshy, from the magnum
and unciforme, near their metacarpal surfaces,  and from the
base of the metacarpal bone of the middle finger.   It is inserted
into the inner sesamoid bone, which, like the external, is con-
nected, by ligament, to the first phalanx.
  The short flexor,  as its name implies, bends the first phalanx
of the thumb.

              4.  The Adductor Pollicis Manus,

  Lies in the palm of the hand, beneath  the lumbricales and
the tendons of the flexor sublimis  and profundus.   It arises,
fleshy, from the ulnar edge of the metacarpal bone of the mid-
ble  finger, between its base and head, and it is inserted, tendi-
nous, into the  inner part  of the base of the first phalanx of the
thumb, just above the sesamoid bone.
  It pulls the thumb towards the fingers.

                The Abductor Indicis Manus,

  Is on the  radial edge  of the hand, between the metacarpal
bones of the  fore finger and thumb, and is just beneath the skin.
It arises tendinous from the trapezium, and fleshy from the ul-
nar edge of the metacarpal bone of the thumb, between its base
and head. 
MUSCLES OF THE HAND.
433
  Being placed  along the side of the metacarpal bone of the
fore finger, it is inserted, by a short tendon, into the radial side
of the first phalanx.
  It draws the fore finger from the others.

  There are three muscles constituting the ball of the ulnar side
of the hand, or of the little finger.


           1.  The Abductor Minimi Digiti Manus,

   Is the most  superficial.  It arises, fleshy, from the protube-
rance on the internal side of the os pisiforme, and from the con-
tiguous part of the annular ligament.
   It is  inserted, tendinous, into the ulnar side of the  first pha-
lanx of the little finger, and into the tendinous membrane which
covers its back part.
   It draws the little finger from  the rest.

         2. The Flexor Parvus Minimi Digiti Manus,

   Is beneath the abductor.   It arises, fleshy, from the unciform
process of the  os  unciforme, and  from the contiguous part of
the annular ligament.
   It is inserted, tendinous, into the ulnar side of the base of the
first phalanx of the  little finger, being  united  with the tendon
of the  abductor, and with  the tendinous membrane  expanded
over the back of the finger.
   It bends the little finger.*

           3. The Adductor Metacarpi Minimi Digiti,

   Is placed beneath the abductor and flexor, next to the meta-
carpal bone.  It arises, fleshy, from the unciform process of the
os unciforme; and  from the contiguous part of the annular liga-
ment of the wrist.
   It is  inserted, tendinous and fleshy, into the fore part of the
metacarpal bone of the little finger, from its base to its head.

  * Varieties.  Sometimes it is wanting, in which case the preceding is more
developed than usual.
   Vol. I.—37 
434
MUSCLES.
  It brings the metacarpal bone of the little finger towards the
wrist, and thereby deepens the hollow of the hand.

  The Interosseous Muscles fill up the interstices  of the  meta-
carpal bones; they are seven in number, four on the palm, and
three on the back of the hand.   The back ones arise by double
heads from the contiguous sides of two  metacarpal bones;  the
palmar ones have a single head, which comes only from the meta-
carpal bone of the finger which the  interosseous  muscle is in-
tended to serve.   As a general description, they all may be said
to arise, fleshy and tendinous, from the base and sides of the me-
tacarpal bones, and to be inserted, tendinous, into the  sides of
the first phalanges, and into the tendinous membrane on the back
of the fingers, derived from the tendons of the extensor commu-
nis.  The first four must  be looked  for on the palm, the three
others  on the back of the hand.

                    1.  The Prior Indicis,

   Is along the radial side of the first digital metacarpal bone7
and arises from  the base and side of the same.
   It is inserted, tendinous, into  the radial side of  the first pha-
lanx of the fore finger.
   It draws the fore finger towards the thumb.

                   2. The Posterior Indicis,

  Is at the ulnar side of the  first digital metacarpal bone.   It
arises from the base and ulnar side of the same bone, and is in-
serted, tendinous, into the  ulnar side of the first phalanx of the
fore finger.
  It draws the fore finger  .towards the others.

                   3. The Prior Annularis,

  Is at the radial side of  the metacarpal bone of the third or
ring finger.   It arises from the base and radial side of the said
bone. 
MUSCLES OF THE HAND.
435
  It is inserted, tendinous, into the  radial side of the  first pha-
lanx of the ring finger.
  It draws that finger towards the  thumb.


             4. The Interosseus Digiti Auricularis,

  Is at the radial  side of the metacarpal  bone  of the little fin-
ger, and arises from the radial side and base of said bone.
  It is inserted, tendinous,  into the  radial  side of the  first pha-
lanx of the same  finger.
  It draws the little finger towards the other.

  By  removing the tendons  of the  extensor  communis from
the back of the  hand, we see the three posterior or  double-
headed interosseous muscles.

                     5.  The Prior Medii,

  Is between the metacarpal  bone  of the fore and of the mid-
dle finger.  It arises  from the opposed roots and sides of these
bones.
  It is inserted, tendinous,  into the  radial side  of  the first pha-
lanx of the middle finger.
  It draws the middle finger towards the thumb.


                   6.  The Posterior Medii,

  Is between the metacarpal bone of the  middle and of the
ring finger.   It arises from the opposite sides and roots  of these
bones.
  It is inserted, tendinous, into the ulnar side  of the first pha-
lanx of the middle finger.
  It draws the middle finger towards the little.

                  7.  The Posterior Annularis,

  Is between the metacarpal bones of the ring and little finger.
It arises  from the opposed sides and roots of these metacarpal
bones. 
436                       FASCIA.

  It is inserted, tendinous, into the ulnar side of the first pha-
lanx of the ring finger.
  It draws the ring towards the little finger.
                    CHAPTER  IV.

OF THE FASCLE AND MUSCLES OF THE LOWER EXTREMITIES.

                  SECT. I.-—OF THE FASCIA.

  The muscles of the  lower extremity, from the pelvis to the
foot  inclusively, are invested by a  strong  aponeurotic mem-
brane, placed immediately beneath the skin or common integu-
ments.  Its external face  is  in  contact  with  the superficial
nerves and blood vessels, and the internal face with the muscles.
Though it is absolutely continuous from  one end to the other,
it will be  useful, for study, to divide it into three parts; the one
covering  the thigh, the second covering the ]eg,  and the third
covering the foot;, as  each of them presents certain points of
arrangement, which  could not be very conveniently introduced
into  a general description.

   1. The  aponeurosis of the thigh (Fascia Lata Femoris) begins
posteriorly, from  the upper  part of  the gluteus magnus mus-
cle, by a very gradual  conversion of the cellular  membrane of
the part into desmoid  substance; it  also begins in the way of
cellular substance from  the  margin of the sacrum and os coc-
cygis.  The character here  is seldom clearly aponeurotic till it
gets  on a level with the tendon of the gluteus magnus, from
which emanate a great many of its fibres.  Externally, it arises
from the whole length of the crista of the ilium, is there striking-
ly aponeurotic, and is  closely adherent to the  gluteus medius
muscle, many of whose fibres arise from it.  It also arises from
the body and rami of the pubes, and from the tuber and ramus
of the ischium.  Its attachment at the latter is not very strong, 
FASCIA OF THIGH.
437
neither, is its character so well marked.   It is  there, in some
measure, continuous with  the perineal fascia.   In  front, it ad-
heres very closely to  the inferior margin  of the tendon of the
external  oblique muscle, so as to be almost continuous with it,
from the anterior superior spinous process of the  ilium to the
pubes.
   From  these several connexions at the pelvis, the fascia femo«
ris descends in enveloping the  muscles  of the  thigh, and then
forms other strong attachments  about the knee,  to the condyles
of the os femoris and to the head of the tibia.   In front, it ad-
heres very closely to, and  is almost blended  into the common
tendon of the extensor muscles; it adheres, also, to the inferior
margins  of the two  vasti, and  is one and the same with the '
membranous expansion (Involucrum) going from  them to the
head of  the tibia, and answering the purpose of capsular liga-
ment to  the articulation of the knee, on each  side of the patella,
as far back as  the lateral ligaments.  Behind, it covers up  the
fat in the ham, and is continued into the fascia of  the leg.
   The fascia femoris, almost every where, consists in a fibrous
texture, which is sufficiently evident, but the fibres pass in very
various directions.   At many places, particularly  on  the inter-
nal  side  of the thigh, there are oblique fibres spread  upon a la-
mina which is not fibrous.  On the outside of the thigh, the fas-
cia  consists principally in longitudinal fibres, held together by
transverse ones;  and when its interior surface  is  examined,
many oblique fibres are also found  there.  It  is very thick and
strong externally, thinner behind; and  still weaker  internally,
where cellular substance seems to predominate  in  its composi-
tion.  It is pierced at several points with  small round holes for
the  passing of blood  vessels and of the cutaneous nerves.
   From  the interior surface  of the Fascia Femoris, partitions
pass off, which separate  the muscles of the thigh from each
other, and form sheaths for them.  Some of these processes are
merely cellular substance; others have a more  distinct desmoid
character.  Externally, as it passes from the gluteus medius to
 the groin, it separates into two laminas,  which receive between
them the tensor vaginas femoris. and then reunite.   The sarto-
 rius muscle, in almost its whole length, is also enclosed between
two laminas.   At the origin of this muscle,  the posterior lami-
na passes on to the iliacus internus, and  psoas magnus muscles,
                             37* 
438
FASCIA.
and then to the pectineus, to become the  pectineal fascia, in all
of which distance it is continuous with  the  iliac fascia of the
pelvis; but the anterior lamina of the fascia at this place has its
upper margin continuous  with Poupart's ligament; and this la-
mina terminates in a point or angle, which  is  turned inward to
the crista of the pubes, and ends by an insertion into it immedi-
ately exterior  to Gimbernat's ligament,  and in  the same line
with it.  This point,  from the part which  it  acts in femoral her-
nia, has been studied with particular attention, and goes under
the name of Hey's,  or the Femoral Ligament.

  The Pectineal fascia is placed behind the femoral vessels, but
tlie sartorial fascia is before them.*   The latter  terminates on
its pubic side, in a crescentic or lunated  edge of one and a half
or two inches in length,  the  concavity of which is towards the
penis-t   Hey's ligament is the superior extremity of the  cres-
cent; the inferior end can scarcely be considered  to have a de-
finite boundary, but  is continuous with the adjacent part of the
pectineal fascia.   The place of continuity is covered by the sa-
phena vein, which being  between the  skin and the fascia lata,
dips there into the femoral vein which is under the  crescentic
edge.  The femoral vessels reposing in their sheaths, are then
placed between these laminae of the fascia femoris.  The  vein
is only partially covered by  the lunated edge, while the artery,
which  is on the iliac side of the vein, is completely concealed.
By keeping the leg extended, and turning  the toes of the subject
inwards  or outwards, it will be seen that the crescentic  edge
and the tendon of the  external oblique exercise a mutual ten-
sion.   Beneath. Poupart's ligament, at  the inner margin of the
femoral vein, is the hole called the Femoral Ring, through which
the bowel escapes in femoral hernia.   This hole is constricted
by turning the  toes outwards, and related by turning them in-
wards; it becomes very much relaxed, if, at the same time, the

  *  By sartorial fascia, is. merely meant the portion of the fascia lata femoris con-
tiguous to the sartorius muscle; and, by pectineal fascia, the part covering the
pectineus muscle.
  f  The crescentic edge  is not always well defined, for in many cases it is blend-
ed insensibly with the sheath of the vessels, so that a denned exhibition of it k
Either the resuU of artificial separation, or dissection,  than a, natural condition,. 
FASCIA OF LEG.
439
thigh be drawn upwards.  Valuable indications for the mode of
replacing a prolapsed bowel are thus obtained.
  In addition to this arrangement,  which is  all-important  in
hernia, the fascia femoris has  the following.   On the front  of
the thigh it simply covers the  extensor muscles, the partitions
between  which  are  cellular substance.  On the inner  side it
dips down to the periosteum between the adductor muscles, but
is still cellular.  Behind, it covers the ham-string muscles, and
sends down to the linea aspera a thick fibrous partition be-
tween the  vastus externus and the biceps flexor.
  The superior margin of the gluteus magnus is inserted into
this fascia, which from its connexion with  the gluteus medius
and tensor vaginas femoris, causes all these muscles to exercise
a mutual  influence, as well as to keep tense the fascia  itself.
On the internal  semi-circumference of the thigh  it adheres
somewhat closely to the muscles; but  on the external, where
the fascia is opposed to the tendinous facing of the vastus ex-
ternus muscle, it is connected by a  long, loose, and scattered
cellular substance, which scarcely presents an obstacle to the
introduction of the finger or any blunt instrument between the
two.

   2. The Fascia Cruralis, or that of  the Leg, though absolutely
continuous with that of the  thigh, may be described as arising
externally, from the head of the fibula and from a prolongation
of the biceps flexor cruris; internally from prolongations of the
tendons of the sartorius, the gracilis, and the semi-tendinosus.
It, in descending, covers all the superficial muscles of the leg,
does not go over  the tibia, but  adheres to its spine and to  its
internal angle.  It unites below to the  annular ligament of the
ankle, to the ligamentous sheath of the peroneal muscles, and
to that on  the inner ankle.
   The fascia  cruralis, in the superior half of the leg, assists in
giving origin  to its muscles in front and externally, but is rather
loosely attached to them below.  On the back of the leg it is
also rather loosely connected  to the  gastrocnemii.  It sends in
one aponeurotic partition between the  common extensor of the
toes and the long peroneus, and  another between the latter and
the soleus, both of which are inserted  into the fibula.  It also
is  insinuated between the soleus  and the flexor muscles next to 
440
FASCIA.
 the bones.   This prolongation is strong and fibrous, penetrates
 between these flexor muscles, dips down to the tibia and fibula,
 and is lost insensibly just below the fascia of the popliteus mus-
 cle.  The popliteal fascia may also be considered one of the
 emanations from the fascia cruralis.
   The fascia cruralis is not so strong as the femoral, yet it has
 the same compact desmoid  texture, and is  formed from fibres
 crossing in various directions.   It is thicker in front than be-
 hind, and is made tense by its connexion with the internal and
 external hamstring muscles.

       Of the Ligamentum Annulare of the Ankle Joint.

   The muscles on the front of  the leg have their tendons con-
 fined at  the ankle by this ligament, which may be very properly
 associated with  the description of the crural fascia, owing to
 the closeness of their connexion. - It consists in a fasciculus of
 ligamentous fibres running across the front of the ankle joint.
 It  is attached by one extremity to the  superior face of the
 greater  apophysis of the os calcis, just before the malleolus ex-
 ternus;  is there very strikingly  fibrous or ligamentous,  and has
 its small fasciculi separated by  fatty matter.   It is then direct-
 ed inwards, and divides into two laminas, one of which  goes
 above the tendons, and the other below them.   These  laminas,
 by adhering to their  respective  sides of the  tendons, form a
 loose gutter for each of them to play  in;  the gutters, however,
 for the tibialis anticus and extensor pollicis  are not so perfect
 behind as the others, and are also more loose.  The ligament
 is then fixed by one division  to the anterior margin of the mal-
 leolus internus, and by another,  which is wrapped over the in-
 ternal face  of the foot, into the  scaphoides  and the  internal
 margin of the fascia plantaris.  As the upper margin of this lig-
 ament is continuous  with  the fascia  cruralis, so the  inferior
 runs into the fascia on the back  of the foot, called aponeurosis
 dorsalis  pedis.

  Of the  Fascia of the Foot.—The fascia cruralis, being strongly
attached  to the posterior and  lower margins of the internal an-
kle, its fibres radiate  thence to the lower part of the tendo-
achillis, to the inner side of the os calcis, and to the internal mar- 
FASCIA OF FOOT.                    441
gin of the fascia plantaris.  This is the Ligamentum Laciniatum
(or plaited  ligament) of writers,  and  conceals  the tendons
which pass  to the sole of the foot, along the sinuosity of the os
calcis.

   The Aponeurosis Dorsalis is continued from the annular liga-
ment, over the upper surface of the foot, to the roots of the toes.
It is thin, but its fibrous texture is apparent.  It is spread over
the extensor tendons of the toes and the extensor brevis muscle,
and is slightly attached along the internal and the external mar-
gin of the foot.

   The Aponeurosis Plantaris is on the sole of the foot, between
its common integuments and the muscles.  It is  attached be-
hind to the  tuberosities of the  os calcis, and is quickly divided
into three portions, which are kept  distinct by well marked de-
pressions between them.   The internal portion  lies upon the
muscles at the inner side of the foot,  the external portion upon
the muscles at the outer side, and the middle covers longitudi-
nally the  central parts of the sole.  The first two portions are
thin, reticulated, and extended to the roots of the outer and in-
ner metatarsal bones, and along the margins of the foot, where
they join  the fascia dorsalis.   The  middle  portion increases in
breadth as  it advances, and at the anterior extremity of the
metatarsus  is divided  into five slips, one for each metatarsal
bone.   Each of these slips is subdivided into two, which pene-
trate  upwards, and fix themselves to their  respective side of
the head of the  corresponding metatarsal bone.   In the inter-
val left by this  bifurcation, pass the  flexor  tendons, the  lum-
bricales, the vessels and the nerves, to the toe.

   The plantar aponeurosis, or  fascia, affords behind, origin to
the superficial muscles of the sole of the foot.  It also sends in
partitions between them.   Its thickness is considerable behind,
but continually diminishes as it  advances forwards.   Its fibrous
texture is very  well marked, and is much  more compact near
the heel, where it looks like ligament; the  fibres run principal-
ly longitudinally.  From its inferior surface many strong fila-
ments pass to the skin on the sole of the foot, and contain with-
in their interstices a granulated adeps. 
442
MUSCLES.
              SECT. II.—MUSCLES OF THE THIGH.

           The  Tensor  Fascia vel Vagina Femoris,

  Is situated superficially on the anterior outer part of the hip.
It arises, tendinous, from the anterior superior spinous process
of the ilium; passes downwards and somewhat backwards be-
tween two laminas  of the fascia femoris, increasing in breadth
as it descends;  and is  inserted fleshy into the fascia  femoris,
somewhat below the level of the trochanter major.
  It rotates the  foot inwards, and makes the fascia tense.


                        The Sartorius,

  Is placed superficially on the internal  side  of the thigh.   It
arises by  a short tendon from the anterior superior spinous pro-
cess of the ilium, and passes in a spiral course to the inner side
of the thigh and to the  back of the internal condyle.  It then
winds behind the head of the tibia, and advances forwards so as
to be inserted into  the internal side  of the lower part of its tu-
bercle by a broad tendon.  Its fibres run the whole  length  of
the muscle.
  Its tendon is continued by a flat  slip from its lower margin
into the fascia cruralis, by which attachment the muscle is held
in its spiral course.  It crosses the rectus femoris and vastus in-
ternus above, the triceps adductor at the middle of the thigh,
and at the lower part of the latter, just above the knee, it  is be-
tween the tendon of the adductor magnus and that of the gra-
cilis.
   It bends the leg  and  draws it obliquely inwards.*


                    The Rectus Femoris,

  Is in front of the thigh bone and just beneath the fascia femo-
ris, with the exception  of its origin, which is covered by the

  * Varieties. Sometimes a  small fasciculus is detached from its inferior part;
sometimes its fibres are interrupted by a middle tendon which adheres closely to
the fascia femoris.   Meckel reports it as deficient in one case that he met with.
In the African I have occasionally seen it unusually broad. 
MUSCLES OF THE THIGH.
443
sartorius.  It is a complete penniform muscle, fleshy in front,
for the most part, but faced behind with tendon.  It arises from
the anterior inferior spinous process of the ilium by a round
tendon, which  is joined  by another tendon, coming  from  the
superior margin of the acetabulum.
   It is inserted into the superior surface of the patella by a
strong tendon, and intermediately by the ligamentum patellas
into  the tubercle of the tibia.
   Its extends the leg.


                   The  Vastus Externus,

   Is a very large muscle on the outside of the thigh;  it arises,
tendinous and fleshy, from the upper part of the os femoris^ im-
mediately below the trochanter major.  Its  origin commences
in front, and passes obliquely around the bone to the  linea as-
pera.  It continues afterwards to arise from the whole length of
the linea aspera, and from the upper half of  the  line running
from it to the  external condyle.
   Its fibres pass inwards and downwards, and are inserted, by
a flat tendon,  into the external edge of the tendon of the rectus,
and also into the external upper part of the patella.  This mus-
cle has a broad tendinous surface exteriorly and above; at its
lower part it has a tendinous facing on the side  next to  the bone.
   It also extends the leg.


                     The Vastus Internus,

   Covers the whole  inside  of the os  femoris.   It arises, by a
pointed fleshy origin, in front of  the os femoris, just on a level
with the trochanter minor, tendinous and fleshy from the whole
length of the internal edge of the  linea aspera, and from the line
leading from it to the internal condyle.
   Its fibres descend obliquely, and are inserted by a flat tendon
into the internal edge of the  tendon of the rectus, and into the
upper internal edge of the patella.
   It also extends the leg. 
444                      MUSCLES.
                       The Cruraus,

  Is almost completely overlapped and concealed by the two
vasti, and is immediately behind the rectus femoris.   The edge
of the vastus externus, above, is very distinguishable from it, as
it overlaps  it, and is rounded off, besides being somewhat sepa-
rated by vessels.  But the origin of the  vastus internus is  not
so distinguishable, as the fibres of the two muscles run into each
other; it is, therefore, necessary, most frequently, to cut through
some of their fibres on the internal face of the os femoris, on a
level with the trochanter minor.  The crurasus will be seen to
arise, fleshy, from all  the fore part of the bone, and from all its
outside as far as the linea aspera.  Between the internal edge
of this muscle and the linea aspera, the interior face of the os
femoris  is free or unoccupied, the breadth of an inch along the
whole shaft of the bone, which is very readily seen by turning
off the vastus internus.
  The crurasus is inserted into the posterior face  of the tendon
of the rectus below, and into the upper surface of the patella.
  It also extends the leg.

  The Ligamentum Patellas is the common chord by which the
action of the last four named muscles  is communicated to the
tibia. It is a flattened thick tendon, an inch and a half wide,
arising from the inferior edge of the patella, and inserted into
the  tubercle of the tibia.  Between its insertion and the head
of the tibia, is a bursa.   Besides this, a fascia  or  tendinous ex-
pansion, (lnvolucrum,) an appurtenance of the fascia femoris, as
mentioned  before, comes from the inferior ends  of  these mus-
cles, extends itself over the  whole of the anterior and lateral
parts of the knee joint, and is inserted into the  head of the tibia
and of the fibula.  Through this it happens  that, even when
the patella  or its tendon  is fractured, some motion or extension
may be  communicated to the leg from the thigh.
  In consequence of the common insertion of these  four mus-
cles, some anatomists  describe them as but one, under the name
of Quadriceps Femoris.*
* Soemmering de Corp. Hum. Fab. 
MUSCLES OF THE THIGH.                 445
   A bursa exists between the lower part  of their tendon  and
 the fascia femoris, higher up than the patella; occasionally, one
 is found still lower down, on the patella.*


                         The Gracilis,

   Is a beautiful muscle at  the inner margin of the thigh,  and
 lies immediately under the fascia; it extends from the pelvis to
 the leg.
   It arises,  by a broad thin tendon, from  the front  of the os
 pubis, just at the lower part of its symphysis, and from its  de- ,
 scending ramus; the muscle tapers to a point below, and, a lit-
 tle above the knee, terminates in a round tendon, which passes
 behind the" internal condyle of the  os  femoris and the head of
 the tibia.  It then makes a curve  forwards and downwards at
 the internal  side of the latter, and  is inserted at the lateral and
 inferior part of its tubercle.
   The tendon at the knee  is beneath the tendon  of the sarto-
 rius.  This  muscle is a flexor of the leg.


                 The Pectinalis. or Pectineus,

   Is a short, fleshy muscle, at the inner edge of the psoas mag-
 nus.  It arises, fleshy, from the  concavity  on the upper face of
 the pubes, between the linea innominata, and the  ridge above
 the obturator foramen, and is inserted, tendinous, into the linea
 aspera, immediately below the trochanter minor.
   It draws the thigh inwards and forwards.f


                          Adductors,

   1.  The Adductor Longus comes, by a rounded, short  tendon,
 from the upper front part  of the pubes  near its symphysis; it
 forms a triangular  belly which increases in breadth in its dc-

  ♦Some unimportant varieties have been observed in these extensor muscles.
   Varieties.  Sometimes this muscle is split into two by a fissure, in which
 case the lower portion is the smaller, and has its tendon below connected or
joined to the tendon of the other, and its  other extremity attached to the upper
internal margin  of the thyroid foramen.
  Vol. I.—38 
446
MUSCLES.
scent, and is inserted into the middle third of the linea aspera
at its inner edge.
   As the subject lies on its back, this muscle is uppermost; its
origin is between that of the pectinalis, and of the gracilis; its
upper edge is in contact with the lower edge of the pectinalis.*

   2.  The Adductor Brevis is the smallest of the three; it is  situ-
ated beneath the adductor longus and pectinalis, and on the  out-
side of the gracilis.   It  arises, by a rounded tendon, from the
middle front part of  the pubes, between  its symphysis and the
foramen thyroideum, just below the origin of the first adductor.
   It is  inserted into the upper third of the inner edge of the li-
nea aspera, between the  trochanter minor and  the  upper edge
of  the adductor longus, by a flat thin tendon.f

   3.  The Adductor Magnus is below the other two, and is by
far the largest.   It  arises, fleshy, from the lower part of the
body of the pubes and  from its descending ramus, also from the
ascending ramus  of the ischium as far as its tuberosity, occupy-
ing the whole bony  surface between  the foramen thyroideum
below,  and the margin of the bone.
   It is  inserted, fleshy, into the whole  length of the linea aspe-
ra, and on its internal margin a  tendon is gradually generated
which  passes downwards  to be  inserted into the upper part of
the internal condyle  of the os femoris, and, by a thin edge or
expansion, into the line leading from the linea  aspera to the in-
ternal condyle.
   The  adductor magnus  separates the muscles on the anterior
from  such as are  on  the posterior part of the thigh;  and its in-
sertion  is closely connected with  the origin  of  the vastus inter-
nus, the two surfaces adhering by a short and compact cellular
membrane.J
  The three adductors  contribute to the same end, that of draw-

  * Varieties.  Occasionally this muscle is divided into two by a fissure, which
is of various lengths.  Sometimes it is continued much lower down than usual by
means of a small tendon united  to that of the adductor magnus.
  ■j- Varieties.  It is also occasionally split, more or less fully, into  two muscles
by a fissure, which, according to Meckel, establishes a remarkable analogy with
apes.
  *  Varieties.  It also is occasionally divided into two portions, as in apes. 
MUSCLES OF THE THIGH.                447
ing the thigh inwards.  From  their common action and very
close connexion at their insertions, they are sometimes described
as one, under the  name  of Triceps Adductor, and with great
propriety.  The pectineus muscle is also associated with  them
so closely in  its course and character, that, as Meckel has sug-
gested, it ought to be considered as a fourth head to the triceps.


                    The Glutaus Magnus,

   Arises, fleshy, from the posterior third of the crista of the
ilium,  from the side of the sacrum below it, from the side of the
os coccygis,  and from the posterior surface of the large sacro-
sciatic ligament.   The fibres of this muscle  are collected into
large  fasciculi, with  deep interstices between them;  and the
lower  edge of  it is folded over the sciatic  ligament.
   Its fibres  pass obliquely forwards and downwards,  and ter-
minate in a thick,  broad tendon, the upper part  of which  goes
on the outside of the trochanter major,  and is very strongly
inserted into  the fascia femoris;  while the  lower part is inserted
into the upper  third of the linea  aspera, going down as far as
the origin of the short head of the  biceps flexor cruris.
   This muscle is placed immediately under the  skin, the fasci-
culi being separated to some depth by processes from the fascia
femoris.  It covers nearly all the other muscles on the back part
of the  pelvis, laps over its  inferior margin laterally, and conceals
the origins of the  ham-string muscles.
   There is a very large bursa  placed between the tendon of this
muscle and the external face  of the trochanter major; another
of almost equal magnitude, between it, the  superior extremity
of the vastus externus, and the inferior end of the tensor fascias
femoris; and there are two smaller ones between the same ten-
don and the  os femoris, which are placed lower and more pos-
teriorly.
   The glutasus magnus draws the thigh backwards, and assists
in keeping the trunk  erect. 
448
MUSCLES.
                    The Glutaus Medius,

  Arises from  the whole length of the crista of the ilium, ex-
cept its posterior third; from that part of the dorsum of the bone
which is between its crista and the semicircular ridge, extend-
ing from  the anterior superior  spinous process to the sciatic
notch; from the lunated edge of the os ilium, between the an-
terior superior  and the anterior inferior spinous process;  and
from that part of the inner face of the fascia femoris which co-
vers it.
  The anterior superior part of this muscle is not covered by
the glutasus magnus, but lies before it.   Its fibres converge, and
are inserted, by a broad thick tendon, into the upper surface of
the trochanter major, and  into the upper anterior part of the
shaft of the bone just in front of the trochanter.
  It draws the thigh backwards and outwards.
  A bursa is interposed between the extremity of its tendon and
the tendinous insertions of the small rotator muscles.

                   The Glutaus Minimus,

  x\rises from that  part of the dorsum of the ilium between the
semicircular ridge just spoken of, and the  margin of the capsu-
lar ligament of the hip joint.   It is entirely concealed by the
glutasus medius.
   Its fibres converge and terminate in a round tendon, which is
inserted into the anterior superior part of the trochanter major,
just within the  anterior insertion of the glutasus medius.
   It abducts the thigh, and can  also rotate the limb inwards.
  A bursa of small size  exists between its tendon  and the tro-
chanter major.

  There are several small muscles about the hip joint, the most
of which can be seen by the removal of the glutasus magnus.

                      The Pyriformis,

   Arises, fleshy and tendinous, within the pelvis, from the an-
terior face of the second, third, and fourth bones of the sacrum. 
MUSCLES OF THE THIGH.
449
It forms a  conical belly, which passes out of the pelvis at the
upper part of the sacro-sciatic foramen, receiving a slip of fibres
from the posterior inferior spinous process of the ilium.
  It js inserted, by a round tendon, into the upper middle part
of the trochanter major within the insertion of the glutasus me-
dius.
  It rotates the limb outwards.   Between its tendon and the su-
perior geminus a small bursa exists.*


                        The Gemini,

  Are  two small muscles, closely connected with each  other,
which are  situated  lower down on  the pelvis than the pyrifor-
mis.  The upper one arises from  the posterior part of the root
of the spinous process of the ischium ; the lower  from  the upper
back part of the tuberosity of the ischium.
  Being parallel to  each other, and connected  by their conti-
guous edges, they are inserted  together into  the posterior part*
of the thigh bone at the root of the trochanter major, where the
deep pit is.
   They also rotate  the limb outwards.f

                   The Obturator Internus,

   Is  principally situated  within  the cavity  of  the  pelvis.   It
arises, fleshy, from all the margin of the  foramen thyroideum,
except  where the obturator  vessels go out; from  the posterior
face of the ligamentous membrane stretched across it; also from
the upper part of the plane of the ischium just below the linea
innominata;  its fibres converge, and forming a tendon, pass out
of the pelvis over the trochlea of the ischium, between the sa-
cro-sciatic ligaments.
   The  tendon  is placed between the gemini  muscles, which
form a  sheath for it; and it  is inserted into the pit on the back
of the os femoris, at tho root of the trochanter major.

  * Varieties.  It is sometimes split by the sciatic nerve, and when  the latter di-
vides very high up, by one of its portions only.
  \ Varieties.  The upper one, occasionally, does not exist,  whereby a striking
resemblance with apes is established.  Sometimes both are wanting.
                             38* 
450                       MUSCLES.

  Between the tendon of this muscle and the gemini is a long
bursa; a second is found where the muscle plays over the is-
chium.
  It rotates the limb outwards.

                  The Quadratus Femoris,

  Is lower down than the  other muscles.   It arises, tendinous
and fleshy, on the  outer side  of  the ischium, from  the ridge
which constitutes the exterior boundary of the tuberosity.   Its
fibres are transverse, and  are inserted, fleshy, into the  rough
ridge of the os femoris, on its back part, which goes from one
trochanter to  the other.
  It rotates the limb outwards.  A bursa exists between it and
the trochanter minor.*


                   The Obturator Externus,

   Is concealed, in front, by the pectineus and triceps adductor,
and, behind, by the quadratus femoris:  to get a  satisfactory
view of it, therefore, these muscles should be detached from the
bone.   It arises from the whole anterior circumference  of the
foramen thyroideum, excepting the place where the obturator
vessels come  out, and from the anterior face of the ligamentous
membrane stretched across it.
   The fibres  of this muscle converge, pass beneath the  capsu-
lar ligament of the hip joint adhering to it, and terminate suc-
cessively in a round  tendon, which is inserted into the inferior
part of the cavity on the posterior surface of the os femoris, at
the root of the trochanter  major.   The course of the tendon of
this muscle is marked on the neck of the thigh bone by a  su-
perficial fossa.
   It rotates the thigh outwards.

  * Varieties.  Occasionally, this muscle is absent; more rarely it is divided into
a great number of fasciculi, amounting in one instance to thirty. 
MUSCLES OF THE THIGH.
451
                 The Biceps Flexor Cruris,

  Constitutes the outer hamstring, and  is situated on the pos-
terior outer part of the thigh; it  arises by two heads.  The
first, called the long head, has an  origin, in common with the
semi-tendinosus, from the upper back part  of  the tuberosity of
the ischium, by a short tendon, which, in its descent, is changed
into a  thick fleshy belly.   The other, called  the short  head,
arises, by  an acute fleshy  beginning, from the linea aspera just
below the insertion of the glutasus magnus, and this origin  is
continued  along the lower part  of the linea aspera  and from
the ridge leading to the external condyle.
  A thick tendon  is  gradually formed on  the  outside of the
muscle, which, descending along the external face of the ex-
ternal condyle, is inserted  into the superior  face of the head of
the fibula at its point.  A  bursa  is  found between this tendon
and the external lateral ligament of the knee.
  This  muscle flexes the leg  on  the thigh.*


                      The Semitendinosus,

  Is on the inside of the thigh, between the  biceps and gracilis;
it is superficial, being immediately under the fascia, and arises,
in common with the biceps, from the back part of the tuberosi-
ty of the ischium;  it  also  adheres, for three or four  inches, to
the inner  edge of the tendon of  this the long  head of the
biceps.
  About four inches above the  knee it terminates  in a long
round tendon, which  passes  behind the internal  condyle and
the head of the tibia, and  is  reflected  forwards to be inserted
into the side of the tibia, just below its tubercle and  very near
it,  being  lower down than the insertion of the tendon  of the
gracilis.   Its insertion is much connected with that of the gra-

  * Varieties. Sometimes the short head does not exist, thereby  affording an
analogy with animals.   Sometimes there is a third head, but more delicate, which
comes either from the tuber of the ischium or from the long head, and descend-
ing along the back of tho leg, runs into the tendo-achillis, corresponding there-
by with the arrangement of mammiferous animals. 
452
MUSCLES.
cilis, and is  generally divided into two slips, one above  the
other.
  Between its origin, that  of the long head of the biceps, and
the semimembranosus, there is a bursa: one or more are like-
wise found between its tendon below, that of  the sartorius, of
the gracilis, and the internal lateral ligament of the knee.
  It flexes the leg on the thigh.*


                    The Semimembranosus,

  Is at the inner side of the thigh; its upper part is concealed
by the semitendinosus and the origin  of  the long head  of  the
biceps, and below it projects between these two muscles.  It is
in contact with the posterior surface of the adductor  magnus.
  It arises, by a thick round tendon, from the exterior upper
part of the tuberosity of  the ischium, which  tendon soon  be-
comes flattened, and sends  off the muscular  fibres  obliquely
from its  exterior edge to a corresponding tendon below.  The
latter passes behind the internal  condyle and  the head  of  the
tibia, and despatches a thin aponeurotic  membrane under  the
inner head of the gastrocnemius, to cover the  posterior part of
the capsule of the knee joint, and to be fastened to the external
condyle.
   It is inserted, by a  round  tendon, into  the  inner  and back
part of  the head of the tibia, just below the joint.   The unfa-
vourable insertion of this  muscle is compensated for by  the
multitude of its  fibres, which gives  it  a  great  increase  of
strength.
  A bursa exists between its tendon above and the quadratus;
another  exists between its  tendinous  termination,  the internal
head of the gastrocnemius, and the capsule of  the knee.
  It flexes the leg on the thigh.


               SECT. III.--MUSCLES OF THE LEG.

  These  muscles  are  situated anteriorly, posteriorly, and ex-
ternally.
  * Varieties. Sometimes it  is  divided into three sections by two transverse
tendinous lines. 
MUSCLES OF THE LEG.
453
                    The Tibialis Anticus,

  Is situated superficially under  the fascia of the leg, at the
outside of the spine of the tibia, and in front of the interosseous
ligament.   It arises, fleshy, from the head of the tibia, from its
outer surface,  spine, and  from  the interosseous  ligament to
within three or four inches of the ankle.   It also arises, by its
front surface, from the internal face of the  fascia of the leg.
  A rounded long tendon is formed in front below, into which
the fleshy fibres  run obliquely, and which, passing through a
distinct noose of the annular ligament in front of the malleolus
internus, crosses  the  astragalus and os  naviculare, and is in-
serted on the inner side of the sole of the foot into the anterior
part of the base of the cuneiforme internum, and into  the adja-
cent part of the metatarsal bone of the great toe.
  A bursa surrounds the tendon  where it  passes  beneath the
annular ligament; another also exists at its lower part.
  This  muscle corresponds with the radial extensors of the
arm.
  It bends the foot, and presents the sole obliquely inwards.


           The Extensor Longus Digitorum Pedis,

  Is also "superficially placed just under the  fascia of the leg
and in front of the fibula, being in contact  above with the tibi-
alis anticus, and below with  the  extensor proprius pollicis.   It
arises, tendinous and  fleshy, from the outer part of the head of
the tibia; from the head of the  fibula, and  almost the  whole
length of its anterior angle;  also from  the upper part of the
interosseous ligament and the internal face of the fascia of the
leg-
  Its fibres go obliquely downwards and forwards to the ten-
don which begins  not far from its upper end, and  descends
along its anterior margin.  About the middle of the leg the ten-
don splits into four, which are  confined by the annular liga-
ment of the ankle, and then diverging, each is inserted into the
base of its respective toe, the big excepted, and expanded over
its  back part as far as the last phalanx.
   When these four tendons  first reach the  roots of the toes, 
454
MUSCLES.
they expand over the back of the articulation there, and  send
downwards triangular  processes which  are  attached to the
base of the first phalanx, and to the tendinous terminations of
the interosseous muscles.   On the back of the  first joint the
tendon adheres closely to its synovial membrane, and is some-
what cartilaginous.   At the second joint  the tendon splits par-
tially into  two, which pass somewhat  laterally, and then re-
unite.  The tendon  then adheres again closely to the synovial
membrane  of  the third articulation, and finally terminates in
the base of the third phalanx.
   This muscle extends the toes, but flexes the foot.
   A long bursa is  found enveloping  the tendons where they
 pass beneath the annular ligament of the ankle.
    It extends all the joints of the small  toes, and flexes the foot.


                     The Peroneus Tertius,

    Is rather a  portion of the extensor longus, is  found  at its
  lower outer part, and cannot be naturally separated from it.  It
  arises from the anterior angle of the fibula, between its middle
  and lower end.
    It is inserted, by a flattened tendon, into the base of the me-
  tatarsal bone of the little toe, and assists in bending the foot.


             The Extensor Proprius Pollicis Pedis,

    Is between the lower part of the tibialis anticus, and of the ex-
  tensor longus.   It arises from  the  fibula between its  anterior
  and internal angles, by a tendinous and fleshy  origin, which
  commences about four inches below the head of the fibula, and
 continues  almost  to  its  inferior  extremity.  A few fibres also
 come from the interosseous  ligament, and from  the lower part
 of the tibia.
    The muscle being half penniform, the fibres run obliquely to
 a tendon at its fore part, which  passes through a particular gut-
 ter of the annular ligament, and over the astragalus and sca-
 phoides and upper internal parts of the foot, to  be inserted into
 the base  of the  first and second phalanx of the great toe.  A 
MUSCLES OF THE LEG.
455
bursa invests  this tendon where it passes beneath the annular
ligament.
  It extends, as its name implies, the great toe.*
  On the outside of the  leg, between the fibula and fascia, are
the two Peronei muscles.


              The Peroneous Longus, seu Primus,

  Arises,  tendinous and fleshy, from the fore and outside of
the head of the fibula, from the space on its outer side above,
between the external and anterior angles; also, from its external
angle to within a short distance of the ankle.
   A flattened thick tendon, to which the fibres pass obliquely,
constitutes the outer face of the muscle.   This tendon is lodged
in the groove at the posterior part of the malleolus  externus,
being confined to it by a thick ligamentous noose, and  furnished
there with a bursa; it  then traverses the outer side of the os cal-
cis, where its  passage  is marked by a superficial sulcus; it then
runs through  the groove of the os cuboides, where  there is ano-
ther bursa.  Lying deep in the sole of the foot, covered by the
calcaneo-cuboid ligament, and next to the tarsal bones, it is in-
serted into the base of the internal  cuneiform bone, and into the
adjacent part  of the metatarsal bone of the great toe.
   It extends the foot  and inclines  the  sole obliquely outwards.
It corresponds with the flexor carpi ulnaris of the fore arm.
   As the  tendon experiences much friction at the ankle, on the
os  calcis,  and where it winds around the os cuboides, it is not
unusual to  find in  it small  sesamoid bones there,  especially at
the latter place.


             The Peroneus Brevis, seu Secundus,

   Is concealed in a great degree by the peroneus longus, being
situated between the latter and the extensor longus digitorum.
It  arises, tendinous and fleshy, from the outer  surface of the
fibula, commencing about one-third  of  the length of the  bone
from its head, and continuing almost to the ankle.

  Varieties.  A partial effort is sometimes manifested to divide  it into two mus-
cles. 
456
MUSCLES.
   A tendinous facing exists externally also in this  muscle, to
 which its  fibres proceed obliquely.  This  tendon is continued
 through the fossa at the back part of the malleolus externus, be-
 ng covered by the tendon of the peroneus longus, and confined
 by the same ligamentous noose; passing through the superficial
 fossa at the outer side of the os calcis, it is  inserted into the ex-
 ternal part of the base of the metatarsal bone of the little toe.
   It  extends the foot, and  presents the sole  obliquely down-
 wards.  It corresponds with the flexor  carpi ulnaris.*


                        Triceps Sura.

   The muscular mass on the  back of the  leg, constituting its
 calf,  is formed by the two following muscles, which, with much
 reason, may be considered as composing only one. Anatomists,
 who  view them in this latter light, describe  them  under the
 name of Triceps Suras, of which the Gastrocnemius portion has
 two heads, and the Soleus, or Gastrocnemius internus, but one.

   1.  The Gastrocnemius  is  the most superficial muscle on the
 back of the leg, and conceals  the other, in consequence of its
 breadth.   It comes from the condyles of the os femoris by two
 heads.  One head arises, tendinous, from the up-per back part of
 the internal condyle, and fleshy from the ridge leading to the
 linea aspera: the other head arises, by  a broad tendon in the
 same way, from the external condyle and  the ridge above it.
 A triangular vacancy is left between the heads of the  muscle
 for the passage of the popliteal vessels;  the heads then join to-
 gether, but in such a way that the appearance of two bellies is
 distinctly preserved, of which the internal is the largest.   The
 muscular fibres pass from a  broad tendinous facing on the back
 to a corresponding one on the front surface  of the muscle, from
 the latter of which comes the tendo-achillis.

  2. The Soleus is beneath the Gastrocnemius, and arises, fleshy,
from the posterior part of the head of the fibula, and from the
external angle of that bone,  for two-thirds  of its length  down,
behind the  peroneus longus.  It also arises, fleshy, from the ob-

               * Varieties. It is sometimes double. 
MUSCLES OF THE LEG.
457
lique ridge on the posterior surface of the tibia, just at the lower
edge of the popliteus muscle, and from the internal angle of the
tibia for four or five inches.  The two origins are separated for
the passage of the posterior tibial vessels.
  The body of this muscle has a great intermixture of tendinous
matter in it, and from its lower extremity proceeds another
origin of the tendo-achillis.   About three or four inches above
the heel, this tendon joins the anterior face of the tendon of the
gastrocnemius, and by the union of the  two the  tendo-achillis
is completed, and then inserted into the posterior surface of the
os calcis near its tuberosities.   The tendon becomes more round
as it descends.
  These muscles extend the foot, and are all-important in walk-
ing.  A bursa is between their tendon and the os calcis.

                      The Plantaris,

  Is a singular little muscle,  concealed  by the  gastrocnemius,
and has a short fleshy belly and a long tendon.  It arises, fleshy,
from the ridge of the os  femoris, just above the external con-
dyle, passes across the capsular ligament of the joint, and  ad-
heres to it in its  course;  the  belly terminates somewhat below
the head of the tibia, in a long, delicate tendon, which descends
between the inner part of the soleus and  the gastrocnemius.
  At the place where the tendons of these unite, the tendon of
the plantaris emerges  from between them, and, running at  the
inner edge of the tendo-achillis, is inserted into the inside of the
os calcis, just before the  insertion of the  latter.
  It extends the foot.   This muscle is sometimes wanting.   It
contributes so little to the motions of the foot, and, in other  re-
spects, is of such doubtful use, that its proper destination is un-
certain.  In some mammiferous animals it is large and impor-
tant;  perhaps, therefore,.in the human subject, it is one of the
links connecting us with animals, of which there are many evi-
dences in the muscular system.


                      The Popliteus,

  Is a triangular muscle on the back of the knee joint. It arises,
by a thick round  tendon, from a deep depression on the exte-
  Vol. I.—39 
.ro                       MUSCLES.

rior face of the external condyle, passes through the capsular
ligament, being connected with the external  semi-lunar carti-
lage ; and then forms a fleshy belly which passes obliquely in-
wards and downwards.
  It is inserted, fleshy, into the oblique ridge on the back of the
tibia, just below its head, and into the triangular depression
above it.   A bursa exists between its origin  and the capsular
ligament; its tendon is in contact  with the synovial membrane
of the joint.
   It bends the leg, and rotates it inwards, when bent.


      The Flexor Longus Digitorum Pedis  Perforans,

   Is behind the tibia, and at the inner edge of the  tibialis pos-
ticus.   It arises, by an acute, tendinous and  fleshy beginning,
from the back of the tibia, a little below the popliteus muscle;
its origin being continued along the internal angle  of the tibia
almost  to  the  ankle joint.  It arises, also, by tendinous and
fleshy fibres, from the outer edge of the tibia, just above its con-
nexion  with the fibula  at the  ankle: the latter origin is, how-
ever, frequently deficient,  and between this double  order of
fibres the tibialis posticus passes.
   The  fibres go obliquely into a  tendon at the posterior  edge
of the  muscle, which  runs in the groove  behind  the internal
malleolus, and  is confined there by a strong ligamentous sheath,
beino- placed behind, and within  the tendon of the tibialis pos-
ticus.  The tendon  then gets  to the sole of the foot along the
 sinuosity of the os calcis, and being joined by a  considerable
 tendon, detached from the  flexor longus pollicis, it divides into
 four branches  which are appropriated to the  four smaller toes.
   These tendons are inserted into  the base of the last phalanges
 of the  lesser toes, are very near the tarsal bones, and, from per-
 forating the tendons of the flexor brevis, correspond with the
 flexor perforans of the hand.  A  bursa exists where the tendon
 passes  along the tibia and the os calcis; and  another is found in
 the sole of the foot, enveloping this tendon and that of the flexor
 longus pollicis.
   A fifth tendon is  sometimes observed, which  splits and goes 
MUSCLES OF THE LEG.
459
to the second bone of the small toe:  this occurs when  the lat-
ter is not supplied from the flexor brevis.
   This muscle flexes the small toes, and extends the foot.


              The Flexor Longus Pollicis Pedis,

   Is a stout muscle formed of oblique fibres, and situated on the
back part of the fibula, at the outer side of the tibialis posticus.
It arises, by an acute, tendinous and fleshy beginning, from the
posterior flat surface of the  fibula, commencing about  three
inches from its head, and continuing almost to the ankle.
   The tendon of this muscle is large and round; it forms gra-
dually, and constitutes a facing to the posterior edge of the mus-
cle.   It passes through a superficial fossa of the tibia, at the
back of  the ankle near its middle, and from  thence  through a
notch in the back edge of the astragalus, to the sole of the foot;
at the  latter plaee it crosses the  tendon  of the flexor longus  di-
gitorum, and gives off to it the branch just mentioned, which
goes, principally, to  the  second toe.   This tendon  is  deeper
seated in the foot than the other.
   The tendon of the flexor longus pollicis is inserted into the
last phalanx of the great  toe.
   It bends the great toe, and  from its connexion with the others
will bend them also.  A bursa invests its tendon in the canal
of the astragalus, and along the os calcis; another, as stated, is
common to it and the last muscle; and  a third invests  the ten-
don along the metatarsal bone, and the first phalanx of the great
toe.*

                   The Tibialis Posticus,

   Is placed between,  and concealed by the last two muscles.   It
arises by a narrow fleshy beginning, from the front of the tibia,
at the  under surface of the process which joins it to  the fibula,
and then gets to the back of the leg through the  hole in  the up-
per part  of the  interosseous ligament.  It continues its origin
from the whole of the interosseous ligament, and from the sur-

  * The variations in this muscle consist, principally, in the  manner  of distri-
buting its tendon to that of the small toes, and frequently this connexion is defi-
cient. 
460
MUSCLES.
faces of the tibia and fibula bordering on this ligament, except-
ing one-third of the lower part of the fibula, and rather more of
the lower part of the tibia.
  The  fleshy fibres  run obliquely  to  a middle  tendon which
passes in the groove  at the back of the malleolus internus, and
is confined there by a fibro-cartilaginous noose, and invested by
a bursa.  It is inserted into the posterior internal part of the os
naviculare or scaphoides, at its tuberosity;  and also  divides in
such a way as to be  inserted into the internal and external cu-
neiform bones, into the os cuboides, and os calcis.
  It extends the foot, and  presents  the  sole obliquely inwards.
It corresponds with the flexor radialis of the hand.


            SECT. IV.--OF THE MUSCLES OF THE FOOT.

           The  Extensor Brevis Digitorum Pedis,,

  Is a muscle situated on the superior surface of the foot.   It is
placed beneath  the tendons of the extensor longus, and arises,
tendinous and fleshy, from the fore upper part of  the greater
apophysis of the os calcis, being  intermixed with the origin  of
the annular ligament  of the ankle.   It forms a short, fleshy bel-
ly, which is partially  divided into four parts;. from these parts
proceed  as many tendons, which crossing very obliquely the
tendons of the extensor longus, are inserted into  the  great toe,
and  the  three  next toes, by joining with the tendons  of the ex-
tensor longus, which  are spread over their backs.   The tendon
going to the great toe  has  its principal insertion into the first
phalanx.
  It extends the toes.*

  When the Aponeurosis Plantaris is removed from the sole  of
the  foot, we see three muscles; the middle one having been co-
vered  by the large  central portion of the aponeurosis, is the
Flexor Brevis Digitorum Pedis;  the outer, is the Abductor Mi-
nimi Digiti Pedis; and the inner, the Abductor Pollicis Pedis.

 * Varieties.  The internal part, or belly, is sometimes distinct from the adjoin-
ing.  In some very rare cases all the bellies are insulated, as in birds.   Sometimes
it sends a tendon to the little toe. 
MUSCLES OF THE FOOT.
461
             The Flexor Brevis Digitorum Pedis,

   Arises, fleshy, from the large tuberosity of the os calcis, by a
 narrow beginning; also from the upper surface of the aponeu-
 rosis plantaris, and the tendinous septa between it and the con-
 tiguous muscles.
   It forms a fleshy belly, going nearly as far forwards  as the
 middle of the metatarsal bones; there it divides into four tendons,
 which go to the four smaller toes.  These are perforated by the
 tendons of the flexor longus, and are inserted  into the sides of
 the second phalanges.  The tendon for the little toe is often de-
 ficient.
   It bends the second joint of the toes.

   By detaching this muscle from its origin, and turning it down.
 we bring into view the tendon of the Flexor Longus Digitorum
 Pedis; and the attachment of the latter to the tendinous slip from
 the Flexor Longus Pollicis,—to the Massa Carnea Jacobi Sylvii,
 or Flexor Accessorius,—and to the Lumbricales Muscles.


                   The Flexor Accessorius,

   Is at the outside of the tendon of the flexor longus.  It arises.
 fleshy, from  the inside of the sinuosity of the os calcis, and, by
 a thin  tendon, from the outside of the same bone before its tu-
 berosities.
   It is inserted, fleshy, into the outside of the tendon of the flexor
 longus, just at its division into four tendons.  Like a second hand
 to a rope, it assists in flexing the toes.
   »
                  The Lumbricales Pedis,

   Are  four small tapering muscles, which arise from the tendon
of the  flexor longus, just after its division, or while it is  in  the
act of dividing.   One of them is appropriated to each lesser toe.
and is inserted  into the inside of its  first phalanx, and into the
tendinous  expansion that is sent off from the  extensor muscles to
cover its dorsum.
   They increase the flexion of the toes, and draw them inwards.
                            39* 
462
MUSCLES.
                 The Abductor Pollicis Pedis,

   Arises, tendinous and fleshy, from the internal anterior part of
 the large tuberosity of the os calcis;  from a ligament being  a
 part of the aponeurosis of the sole of the foot extended from this
 tuberosity to the sheath of the tendon of the tibialis posticus;
 from the internal side of the naviculare, and from the cuneiforme
 internum.
   It forms the internal margin of the sole of the foot, and is in-
 serted, tendinous, into the internal sesamoid bone, and into the
 base of the first phalanx of the great toe.
   It draws the great toe from the rest.


               The Flexor Brevis Pollicis Pedis,

   Is situated immediately at the exterior edge of the abductor
 pollicis.   It consists of two bellies, which are parallel with each
 other, and separated by the tendon of the flexor  longus pollicis;
 one is inseparably connected with  the tendon of the abductor
 pollicis,  and the other with the adductor pollicis pedis.
   It arises, in common with the calcaneo-cuboid ligament, ten-
 dinous, from the under part of the os calcis, just  behind its con-
 nexion with the os cuboides, and from the under part of the ex-
 ternal cuneiform bone.
   The internal belly is inserted, tendinous, into  the internal se-
 samoid bone, along with the tendon of the abductor pollicis, and
 the external belly is inserted, tendinous, into the external sesa-
 moid bone, along  with the tendon of the  adductor pollicis.
 Each insertion is continued to the  base of the  first phalanx of
 the great toe.
   It flexes the great toe..


                 The Adductor Pollicis Pedis,

   Is situated at the outside of the flexor brevis, and is extended
obliquely across  the metatarsal bones.  It arises, tendinous, at
the external part of the foot, from the calcaneo-cuboid ligament,
and from  the roots  of  the second, third, and fourth metatarsal
bonest. 
MUSCLES OF THE FOOT.
463
  It is  inserted, tendinous, into the external sesamoid  bone,
which insertion is  continued to the first phalanx of the  great
toe, and is closely united to the tendon of the external head of
the flexor brevis pollicis,
  It draws the great toe towards the others.


             The Abductor Minimi Digiti Pedis,

  Forms the external margin of the sole of the foot, and  is im-
mediately beneath  the  aponeurosis plantaris.  It arises,  tendi-
nous and fleshy, from the outer tuberosity of  the os calcis, and
also from the exterior part of the base of the metatarsal bone of
the little toe.
  It is inserted, by a rounded tendon, into the exterior part of
the base of the first phalanx of the little toe.
  It draws the little toe from the  other toes.


            The Flexor Brevis Mi?iimi Digiti Pedis,

  Is just within the tendon of the abductor  minimi digiti.   It
arises from  the calcaneo-cuboid  ligament  as extended from
the tuberosity of the cuboid bone  to the heads of the two outer
metatarsal bones;  also from the root of the outer or fifth meta-
tarsal bone.
  It is  inserted, by a tendon, into the lower part of the  first pha-
lanx of the little toe, at its base, and into the  head of the meta-
tarsal bone of the same tpe..
  It bends the little toe.

                   The Transversalis Pedisj

  Is placed  beneath  the tendons  of. the flexor  muscles.*  It is
small, and lies  across the anterior extremities of the metatarsal
bones.  It arises, tendinous, from the capsular ligament of the
first joint of the little toe; it also arises from the capsular liga-
ment of the  first joint of the next toe.
   It is  inserted into the exterior face of the common tendon of,
•- The sole is presumed, to be upwards. 
t64
MUSCLES.
  the adductor and the flexor brevis pollicis, at the external sesa-
  moid bone.
    It approximates the heads of the metatarsal bones.

    The Interosseous Muscles are seven in number, four of which
  may be seen on the upper surface of the foot.   There are two
  to the first smaller toe, two to the second, two to the  third, and
  one to the fourth, or  little toe.  The  muscles seen on  the upper
  side of the foot are  double-headed, that is, they arise from the
  contiguous surfaces of the metatarsal bones.


   The Interosseus Primus, Digiti Primi Pedis, or the Abductor
                        Indicis Pedis,

   Is seen superiorly.  It is placed between the metatarsal bone
 of the great toe, and the first small toe, and arises, fleshy, by a
 double head, from the opposed surfaces of their roots and bodies.
   It is inserted, tendinous, into the inside of the root of the first
 joint of the first small toe, and pulls it inwards.


 The Interosseus Secundus, Digiti Primi, or the Adductor Indicis
                           Pedis,

   Is also external or above.  It is situated between the meta-
 tarsal bones of the first and second small toes, arising from the
 opposed surfaces of their roots and bodies by a double, fleshy,
 and tendinous head.
   It is inserted into the outside of the first phalanx of the same
 toe, by a tendon.
   It draws this toe outwards.

   The Interosseus Secundus, Digiti Secundi, or the Adductor
                        Medii Digiti,

   Is seen at the upper part of the foot, between the second and
third metatarsal bones of the lesser toes, arising from the oppo-
site surfaces of their roots and bodies.
   It is inserted, tendinous, into the outside of the base of the
first phalanx of the second small toe.
  It draws this toe outwards. 
MUSCLES OF THE FOOT.
465
 The Interosseus Secundus, Digiti Tertii, or the Adductor Tertii
                           Digiti,

  Is seen on the upper surface of the foot, occupying the inter-
val of the metatarsal bones of the third and fourth small toes,
and arises, by a double head, from the opposite surfaces of their
roots and bodies.
  It is inserted, tendinous, into the outside of the  root  of  the
first phalanx of the third small toe.
  It draws this toe outwards.


 The Interosseus Primus, Digiti Secundi Pedis, or the Abductor
                        Medii Digiti,

  Is at the bottom of the foot, and arises from the  inside of the
metatarsal bone of the second  smaller toe.
  It is inserted into the inside of the first phalanx of the second
toe.
  It draws this toe inwards.

  The Interosseus Primus, Digiti Tertii, or the Abductor Tertii
                           Digiti,

  Is in the sole of the foot.   It arises from the inside of the me-
tatarsal bone of the third smaller toe, beginning near its root,
and is inserted, tendinous, into the inside of the base of the first
phalanx of the same toe.
  It draws this toe inwards.

         The Interosseus seu Adductor, Digiti Minimi,

  Is on the under surface of the  foot.   It arises from the inside
of the base and body of the metatarsal bone of the fourth small,
or the little toe, and is inserted, tendinous, into the inside of the
first phalanx of the little toe.
  It draws this toe inwards. 
 
BOOK  IV.
                OF THE ORGANS OF DIGESTION.

  The organs of digestion consist in an uninterrupted canal ex-
tending from the lips to the anus;  and of numerous glandular
bodies placed all  along its track, for  pouring  their secretions
into it.

  This canal, called Alimentary, (Ductus Cibarius,) is in three
principal portions: the superior, the middle, and the inferior or
terminating.  The superior portion is composed of the mouth,
the pharynx, and the oesophagus.   The middle, of the stomach
and small intestine.  And the inferior, of the large intestine.

  The glandular  organs are the salivary glands, the pancreas,
the liver, the spleen, and an  extremely  numerous set of mu-
ciparous glands, extending from one end to the other of the
canal.
  The organs of digestion may be divided, according to their
physical functions, into those of mastication and deglutition, and
into those of assimilation. 
 
BOOK  IV.
                        PART  I.

            Organs of Mastication and Deglutition.

                     CHAPTER  I.

                     OF THE MOUTH.

   The Mouth (Cavum Oris) occupies the space in the inferior
part of the face, between the upper and the lower jaw/  It is
separated from the nose by the palatine processes of the supe-
rior maxillary and palate bones, and by the soft palate, which
is continued backwards from them.   It extends from the lips,
in front, to the soft palate and pharynx behind, and  its floor is
formed by the mylo-hyoid muscles.
   The anterior and lateral periphery of the mouth is constituted
by the muscles of the lips and  cheeks, covered externally by
common skin, and internally by the lining  membrane  of the
mouth.  The cavity  of the latter is  divided  into two portions,
by the projection of the teeth and of the alveolar processes of
the upper  and under jaws; these two portions, when the teeth
are complete, are separated  from each other while the mouth
is closed.  The anterior portion, which is sometimes  called the
vestibule of the mouth,  varies its  size  very considerably in
mastication, and has its parietes extremely moveable.   The ca-
paciousness of the posterior admits also of much change, by the
motions of the tongue and by the depression  of the lower jaw.
   The whole cavity of the mouth is lined by a membrane, con-
tinued over the lips from the skin, and, in many respects, strong-
ly resembling the texture of the latter; it  is, however, much
  Vol. I.—40 
470              v   ORGANS OF DIGESTION.
finer; is furnished every where with an epidermis;  is very vas-
cular, and has beneath it a great number of muciparous glands.
Its texture undergoes some changes, according to  its  position,
upon the lips and cheeks, upon the gums and  palate, and upon
the tongue;  all of which will be explained in due season.
   This  lining membrane of the mouth, for the most part thin
and  very flexible, forms, at several points, folds or duplicatures.
Four of them are situated on the middle line  of  the body, and
are called frenula: one goes from the posterior face of the upper
lip to the middle palate suture in front of the central  alveolar
processes of the upper jaw; a second goes from the posterior
face of the lower lip to the front of the symphysis of the lower
jaw; a third goes from the under part of the tongue to the pos-
terior face of the symphysis of the lower jaw, (franulum lin-
gua ;) and the fourth goes from the front of the epiglottis carti-
lage to the  middle of the  root of the tongue.  Besides these,
there are some other duplications, which  will be mentioned in
their proper order.

   The lips (Labia) are always somewhat thicker at their loose
margins than elsewhere;  the skin which covers  them  there, is
remarkable  for its vascularity, and changes its texture insensi-
bly,  as it is continued from the face to the lining membrane of
the mouth.
   The upper lip is longer and thicker than the lower, is some-
what pointed in  the centre, and has on its front surface a ver-
tical depression, (philtrum,) beginning at the septum of the nose
and  going downwards to the centre of the lip.   This depression
is the remains of a fissure which always exists between the two
halves of the lip, in the  early foetal or forming stage.  The
junction of the extremities of the lips constitutes the corners of
the mouth (anguli oris.)
   The lips are composed of muscular fibres, much blended with
adipose matter.  The muscles which concur to form them are
the orbicularis oris and the buccinators ; besides which, the up-
per lip is furnished on each side with the  two levators, with the
depressor, and the zygomatici;  while the lower lip has its two
depressors and a levator.   See muscles of the face. 
OF THE TEETH.
471
                    CHAPTER  II.

                      OF THE TEETH.

  The Teeth (Denies) are by far  the "hardest portions of the
human fabric; and though they bear in their composition and
appearance a strong analogy with  bone, yet they differ from it
in their more limited  duration, their  mode  of  development,
their partial nudity, their nutrition, and in the manner by which
they are united to the body.
  The greater part of the length  of each  tooth  is implanted
into the alveolar  process  of  the jaw, and the part so fixed is
technically called the root;  immediately beyond this  a  small
portion of the tooth is embraced by the gum; this is the  neck;
and the free, or projecting part of the  tooth  covered with a
shining porcelain like layer called the enamel, is its body.
                         SECTION I.

  The whole number of teeth in the adult is thirty-two, sixteen
in each jaw, and, when healthy, they are all fixed with so much
firmness by the gomphosis articulation, that the  very slight de-
gree of motion, which, by force, they may be caused  to exe-
cute, is scarcely perceptible.  The differences existing in their
shape,  have  caused  anatomists to classify them accordingly;
on each side of the middle line of each jaw there are two Inci-
sors, one  Cuspated,  two Bicuspated, and three Molar  teeth.
There  are also some peculiarities, as they belong to the upper
or to the lower jaw; but they correspond exactly with their
fellows on the opposite side of the same jaw.

  The  Incisors  (Denies Incisivi) are  next to  the middle line,
and are named  from  their being brought to a straight cutting
edge, like a chisel, by being bevelled from behind.   They are
somewhat convex on their anterior faces, but behind they are 
472                 ORGANS OF DIGESTION.

very concave: owing to their thinness for some distance from
the cutting edge, they are apt to be broken.  In early life their
cutting  edge is  slightly  serrated.  They have each but one
root, which is conoidal, terminates by a sharp point, and is not
unfrequently impressed longitudinally on each side by a super-
ficial furrow.
  The central incisors of the upper jaw are broader and longer
than the outer ones ;  the anterior face of the latter is more con-
vex, and their cutting edge more rounded.  The incisors of the
lower jaw are much narrower than those of the upper, and
have their roots flattened on the sides; they do not differ essen-
tially among themselves, except that the external ones are some-
what wider than the  internal.
  The enamel of the incisors is continued farther  down, and is
thicker  on their anterior and  posterior  surfaces than laterally;
it is also thicker on the front than on the back part.*

  The Cuspated Teeth (Denies Cuspidati, Canini,) are next to
the incisors, one on each side.  Their body is conoidal, and is
brought to a  sharp point at its summit;  the principal obliquity
in effecting the latter, being on  the side of the interior of the
mouth.  They are more  convex  externally, than the incisors,
but not  so concave internally, they  are  also thicker and  more
cylindroid.  They have each but one root, which is conoidal,
and which, as also the body,  is longer  than the corresponding
portion  of any of the other teeth.   They stand nearly perpen-
dicularly,  and are  more  covered on their sides with  enamel
than the incisors.
  The cuspated teeth of the upper jaw  have longer roots than
those of the lower, and are called, in common language, eye-
teeth : those of the lower jaw sometimes are called stomach-
teeth.

  The Bicuspated Teeth (Denies Bicuspidati,) two in  number
on each side, are  situated  behind the  cuspate; they are also
called small molar.  They are almost precisely alike, with the
exception  that the  first is smaller than the other, and resembles
rather more the  type of the  cuspidatus than the second  does.
* Natural History of the Human Teeth, by J. Hunter, London, 1778. 
                        OF THE TEETH.                    473

 Their body is very nearly cylindrical, being flattened, however,
 on the faces next to adjoining teeth.  The masticating surface
 of the body is formed into two points, whence the name;  one
 external, and the other internal:  the former is the longest and
 thickest, and, consequently,  the most  conspicuous.   The ena-
 mel forms an almost circular  crown, covering the projecting
 parts of these teeth.  The root of each one is single, but has a
 deep and well marked  fossa on  each  side running its whole
 length, and presenting the  semblance of an effort at duplicity;
 it is also conoidal, and sometimes  in the upper jaw bifurcated
 at its end.
   The bicuspate teeth of the upper and of the lower jaw re-
 semble each other so strongly that the difference between them
 is not striking;  it is, however, determined  by those of the up-
 per jaw being rather more voluminous and ovoidal in their bo-
 dies, and  having rather longer and larger roots.

   The Molar Teeth, (Denies Molares,) three in number, on each
 side, succeed the bicuspated.  They are well characterized by
 their greater size.  Their  bodies  are  almost cuboidal, with
 rounded  angles,  and are protected with a circular crown of
 enamel;  their grinding surface  has five points, three externally,
 and two  internally:  the rule, however, is not uniform, as they
 frequently have  only four, and sometimes in the upper jaw only
 three points.
   The first molar is the largest of  any, and  very generally  has
 five points, in  the upper jaw it has three roots, two of which
 are outward, and the other inward; but in the lower jaw it  has
 only two roots, one  before the other.
   The second molar of each jaw, with the exception of its being
 smaller than the first, presents  no  essential  difference  from it,
 either in  regard  to  its body or roots.  The  fifth point is some-
 times not so well developed.
   The third molar  resembles the other  two in its  body, but is
 smaller than either of them.   Most frequently its roots, instead
 of diverging from each other and  standing out distinctly, are
 imperfectly developed, and  fused together.   Some slight sepa-
 ration al their extremities, and the  longitudinal depressions  on
 their sides, mark the effort to form three roots for  the tooth of
the upper jaw, and two for the lower, according to the general
                            40* 
474
ORGANS OF DIGESTION.
rule.  Owing to this tooth growing  at the posterior extremity
of the alveolar processes, in a place where, from the preceding
development of the other teeth, it is much cramped for room,
it is not only imperfectly evolved in  most cases, but it  often
takes a very irregular direction; its grinding surface sometimes
looking forwards and sometimes backwards.

  The Alveolar Processes in each jaw form a semi-elliptical
row of sockets, for the insertion  of  the roots of the teeth into
them.  These processes and the  teeth, as Mr. Hunter has very
property explained, have such a mutual dependence upon each
other, that the destruction of the one is inevitably followed by
that of the other: "If we had no teeth, it is likely we should
not only have no sockets, but not even these processes in which
the sockets are formed."* The semi-elliptical arrangement ob-
served by the teeth is such, that when the mouth is closed, the
exterior circumference of the row above projects beyond those
below; this is more obviously the case in front; but it also pre-
vails at  the  sides,  and  depends primarily  upon the greater
breadth of the incisors  of the upper jaw.  The grinding sur-
face of the under row, as a whole, is slightly concave from be-
fore backwards, while the opposed surface of the upper row
has a corresponding  convexity.  Each row, viewed collective-
ly, forms a single edge, in front; but  after having passed the
cuspidati, it becomes thicker, forms a  double edge, and is con-
tinued backwards in  that state.
  SECT II.—OF THE TEXTURE AND ORGANIZATION OF THE TEETH.

  The teeth consist in two kinds of substance, one ,of which is
ivory or bone-like,, and the other enamel.

  The Enamel forms the periphery of the body of a tooth, and
is distinguished  by its whiteness, its brittleness, its semi-trans-
parency, and a hardness so considerable that it soon takes down
the edge of the best tempered saw or file, so  that it is very dif->
* Loc. cit. p. 7. 
TEXTURE AND ORGANIZATION OF THE TEETH.        475
ficulf. to penetrate it.   It forms a crust upon the body scarcely
half a line in thickness, is  more abundant upon the grinding
surface, and is reduced to a thin edge where it terminates at the
neck.  When broken, it is seen to be fibrous, and the fibres are
so placed as to pass in a direction from the surface towards the
centre of the tooth : by which all  the friction to which the fibres
are exposed is applied against their extremities: an arrange-
ment on the principle of the articular cartilages, and, like them,
precisely suited to resist  their being rubbed down in mastica-
tion, and also to  prevent their splitting.
   Enamel consists principally  in a phosphate of lime, with a
very small proportion of gelatine.  When immersed in a weak
acid, its form is retained, but the slightest disturbance afterwards
causes it to crumble down  into a white pulp.  When  animals
are fed upon madder, the colour of the  enamel is not affected;*
though it  may be changed by dyes applied externally, as ex-
hibited by the inhabitants  of the Pelew  Islands,  who, by the
use of plants  turn it black, and  by persons who chew tobacco,
in whom it becomes yellow.  It  is entirely devoid of blood ves-
sels.  When  exposed to  heat it becomes very brittle, cracks
off from the  enclosed bony part of the  body, and presents  a
singed appearance, from the small quantity of gelatine in it.
   The enamel is  not so thick on the deciduous as on  the per-
 manent  teeth; it is thicker on the cuspidati than on the incisors,
 and on the first molar- than on the second and third.  It is very
 readily dissolved in strong nitric or muriatic acid.

   The Osseous portion of the tooth is by much the most abun-
 dant, as it forms the root, the neck, and the body also, with the
 exception of the crust of enamel  upon  it.   In its texture  it
 strongly resembles the petrous  bone, and is  even  harder than
 it, but has no cellular arrangement within.  It consists in a se-
 ries of longitudinal laminae, one within  the other, and when de-
 composed presents about seventy parts of the phosphate of lime
 and other calcareous combinations, with  about twenty of  gela-
 tine and ten of water, f

   * J. Hunter, loc. cit.  I have also verified the same opinion by the same expe-
 riment.
   f Pepys. 
476  *              ORGANS OF DIGESTION.
  The bony part of a tooth has very nearly the same form with
the entire body; hence, upon the grinding surface, we  have the
same modifications.of shape as when the enamel is left on.   The
application of a heated iron to  it, turns it to a deep black from
the abundance of animal matter in it, which is one way to mark
out decidedly the distinction betwen it and enamel.   The ani-
mal substance, when separated from the calcareous by muriatic
acid, is more compact than the corresponding substance of bone,
but, like it, is soft and flexible.
  The bony part  is  not vascular;  Mr. Hunter, after  repeated
trials in old and young subjects upon this point, never succeed-
ed in  making an injection of it; neither  could he  trace vessels
from  the pulp to  a growing  tooth.  In growing  animals,  fed
upon  madder, he found that the portion which was formed pre-
viously to the commencement of this diet, retained its  primitive
colour, while the part formed during the administration  of  the
diet was affected by it and turned red: again, if the animal were
permitted to live some weeks after  the madder was  suspended,
to the preceding condition was superadded a new layer  of white.
In this experiment, a conclusive difference from common bone
is established; for besides, in all cases, the  facility of  injecting
the latter with size, it is susceptible of being dyed  throughout
by the administration of madder; though the formed  parts do
not take the latter  so readily as the forming.  These experi-
ments, which are confirmed by my own observations, prove sa-
tisfactory the  total  absence of blood vessels  in the texture of
the teeth; and that  the colouring matter, when  fixed  in them,
does not  depend upon a circulation, but upon its being deposited
as the tooth grows, and left there permanently.  The teeth  are
consequently not subjected to  a mutation of particles, and to
being continually remodelled as the bones  are; but when once
formed, they remain in the same state, without change.

  Every tooth has within its  body a cavity, which varies in
form and size according to the class to which the tooth belongs:
this cavity  is continued as a conoidal canal, through the whole
length of each root, and  terminates, by a small opening,  at its
point.  The cavity  is smooth  on its internal surface, and is
filled  with  a soft pulpy matter which has  no adhesion  to  the 
            TEXTURE AND ORGANIZATION OF THE TEETH.        477

sides of the tooth, but receives, through the opening in the root,
an artery, a vein,  and a nerve.   The  surface of the pulp is
moistened  by a slight  exhalation, and its principal bulk seems
to be formed by the nerve, on which the vessels ramify;  the
latter in youth are much more abundant  than in old age.*   The
base of each projection on the grinding surface of a tooth is hol-
lowed out for receiving a process from the pulp.   The latter is
supposed, by M. Serres, to be  a  ganglion; it must, however,
be a point of much difficulty to fix this character  upon it, as the
fine cellular substance which holds its constituents together may
be readily mistaken for soft nervous fibres.
  The arteries of the teeth  of the upper jaw are derived from
the alveolar and the infra-orbitar, and the nerves from the  se-
cond branch of the fifth pair.   The arteries of the teeth of the
lower jaw come from a single branch  of the internal maxillary,
and the nerves from the third branch of the fifth pair.   The in-
ferior maxillary, or dental artery,  and nerve, go through  the
canal in the centre of  the spongy structure of the lower jaw,
and send  off branches successively to the  roots of the teeth.
The residue of the  artery and  nerve issues through the ante-
rior mental foramen.
  The teeth have been, till lately, very generally ranged among
the bones belonging to the skeleton; the continental anatomistsf
are, however, now more disposed to view them as the produc-
tion of the dermoid tissue,  like  the nails and the hair; and  to
withdraw them from the class of bones for the following rea-
sons.   The rudiments  of the bones are always in  a cartilagi-
nous state, and they are gradually changed from  that condition
to the perfect bone; the teeth are  never so, for  the secretion
which forms them is from the beginning deposited in the state
in which it ever afterwards remains.  The bones are all fur-
nished with a periosteum; the teeth are not, but have the sur-
faces of their bodies exposed  to the air.  The general soften-
ing of the skeleton which occurs in  some cases of rickets, never
is manifested in the teeth.J   The texture of the bones is pene-
trated in every direction with blood vessels, but  only the cen-

  * Serres, Essai sur l'Anat.  et Physiol, des Dents, Paris, 1817.
  t J. F. Meckel, Hipp. Cloquet, Breschet, Serres, &c.
  X There is, however, a species of brittleness of the teeth, in which their strength
becomes about that of pipe clay. 
478
ORGANS OF DIGESTION.
tral pulp of the teeth  is furnished with the  latter.   The teeth
are composed of two kinds of calcarious matter, one ivory-like,
the other enamel;  the bones, on the contrary, have but one.*
To this we may add,  that the teeth  have no power of intersti-
tial growth like the bones.  It is also  said by naturalists, that
in mammiferous animals, the teeth present insensible transitions
from their  most perfect state to  a lamellated condition resem-
bling horns and nails.t  Some  animals, as the shark, have the
teeth only adhering to the gum and not fixed in sockets, others
have them in the  stomach: both of which circumstances serve
to illustrate still farther the independence of the teeth upon the
osseous system; and that their being fixed in sockets belonging
to the latter, is merely a collateral and not  an essential ar-
rangement.


                         SECTION III.

   The Gums (Gingiva) are a continuation of the lining mem-
brane  of the mouth over the alveolar processes, but  its texture
there is much changed; as it becomes more fibrous and vascu-
lar, and loses much of its sensibility and capability of being ex-
tended.  As the gums cover both the lingual and the buccal cir-
cumference of the alveolar processes,  they adhere very closely
to the periosteum, and send  in partitions through the interstices
between the teeth.   They also adhere  tightly to the neck of
each tooth, so that when  the latter is drawn, the gum, unless
previously detached,  is apt to be lacerated;  this adhesion is by
a sort of  rounded or partially doubled edge, that admits of a
slight  degree of motion, and which, from its thickness, if it be
removed by ulceration or by pressure, causes the tooth to ap-
pear  to  project unnaturally from its socket.  The teeth, from
being  united  to  the  jaw by the gum, and  by the periosteum
being continued over  the cavity of  the socket;  have preserved
to them that degree  of yielding motion which prevents them,
on their unexpected  and forcible  application to hard bodies,
from being fractured, and also saves their sockets.J

                  * Serres, loc. cit.
                  t Traducteurs de J. F. Meckel.
                  $ J. Hunter, loc. cit. 
FORMATION OF THE TEETH.               479
         SECT. IV.--OF THE FORMATION OF THE TEETH.

  The teeth, before they become visible, are  formed in the in-
terior of the  maxillary bones.  Their rudiments consist in a
vascular pulpy substance, having somewhat  the shape of  the
future tooth, and surrounded by two membranes or sacs.
  The external sac is soft, fibrous, and spongy, and, according
to Mr. Hunter, is destitute of vessels.   It lines the interior of
the  socket, thereby forming its periosteum;* adheres closely by
its deepest end to the dental nerves and blood vessels, and by
its superficial one to the cartilaginous thickening which exists
on the margins of the gums of infants.  Fox, Blake, and Meckel,
consider this sac vascular, which I think more probable, from
its being a continuation of the periosteum, or acting as  such.
Mr. Hunter might, therefore, mean that it  was comparatively
destitute of vessels, and not totally.   It is more spongy, loose,
and soft, than the internal sac, and owing to its adhesion to the
gum may, by pulling at the  latter, be readily drawn out entire
with all its contents.  The internal sac is extremely vascular,
and when successfully  injected appears red all over; it is very
thin and transparent, and was considered by Bichat as a serous
membrane.   It  adheres to  the external sac where the  latter
corresponds with the gum;  but is elsewhere detached from it
with the exception of its base, where it is united by the medium
of  the  vessels that penetrate to the pulp, apd in doing so it ob-
tains its extreme  vascularity from these vessels.   Between it
and the pulp there is a mucilaginous fluid like the synovia of
the joints;!  which causes the  internal sac to protrude like a
hernia, if a small puncture be made through the parietes  of the
external one. ■ The internal sac forms an envelope to the ves-
sels and nerves  of  the pulp, and  being reflected along them,
terminates by adhering to the  base  of the  pulp.   When the
tooth protrudes  through the  gum, the capsule thus formed by
the  two sacs is perforated at its  apex; and wastes  away, like
the  gum, till  the  body of the  tooth is sufficiently advanced.
The two capsules which are then to be considered as the peri-
osteum of the socket and of the root  of the tooth, adhere close-
* Serres, loc. cit.
t Hunter, loc. cit 
480
ORGANS OF DIGESTION.
 ly to the neck of the latter and to its root.   These sacs, or fol-
 licles, as they are sometimes called, are visible in the tenth
 week of uterine  existence.

    The Pulp, or  germ  of the tooth (Pulpas Dentis) is  a very
 vascular body, and adheres  to  the socket only at its bottom,
 where the vessels enter; it becomes sufficiently distinct about
 the fourth month of foetal existence, and rises up then from the
 base of the internal membrane of the sac  like  a small simple
 tubercle.  In developing itself it acquires  the precise form pe-
 culiar to each tooth, and is actually the mould  for it: it is sur-
 rounded by  a very fine vascular web, which is detached from
 it with much difficulty.

    The ossification of  a tooth first  commences on that surface
 of the pulp  next to the gum, by one or more points according
 to the number of projections, which the future tooth is to have
 on its grinding surface.  The osseous deposite in its very early
 stage is thin, soft, and elastic, but  soon acquires a hard con-
 sistence.  The incisors begin to ossify by three  points, the cus-
 pidatus by one, the bicuspis by two, and the molaris by three,
 four or five.  The several points of ossification  continue to in-
 crease till their bases come into contact;  they then coalesce,
 and afterwards the tooth grows as an entire body.  The tritu-
 rating surface of the tooth being first formed after this manner,
 a deposite of bone  then takes place along its edges, till  the
 body of the  tooth, with the cavity in the centre, is  completely
 built up.  In this progress, it gradually surrounds the pulp, till
 the whole of the latter, excepting its  base, is covered with
 bone.

   The adhesion of the  pulp to the new-formed  bone is such as
 to require some slight force to separate them; but this may be
 done without rupturing either the one or the other; their sur-
 faces which  were in  contact  are perfectly smooth, neither is
there any evidence of a  vascular  communication between
them.*   The line of the strongest adhesion is along the latest
* Hunter, Serres, Meckel, loc. cit. 
FORMATION OF THE TEETH.
481
formed edge of the tooth, and that results from the exact appo-
sition of  the pulp and it.
  The crown  or body of  the  tooth  being finally finished, its
base is somewhat contracted, and thus forms the neck of the
tooth.   In the subsequent process of the ossification of the roots,
the number of the latter is predetermined and always indicated
by the number of distinct vessels and nerves which go  to the
pulp; there are, therefore, three roots to the upper molares, two
to the  lower, one to the incisors, and so on.   When the root is
fully formed, its  extremity is tapered off to a conoidal point;
and the canal  or hollow in it containing the pulp  is diminished
to a proportionate size, so that  being  also conoidal, its external
end appears as a very  small opening  not large enough to admit
a bristle.
  From the preceding  account,'it is clear that the bony part of
the tooth is-formed by  an exudation from the external surface
of the pulp; consequently, that the external lamina of the crown
is the  first one deposited, and is originally of the  size which it
ever afterwards  retains; and that the pulp continues this secre-
tion of bony matter, from the circumference to the centre;  until
the tooth, (body, neck, and root,) is  completely formed.   The
pulp, during this process, diminishes continually in size, but
elongates itself at the same time towards the bottom of the sock-
et; or, in the words of  Mr. Hunter, " is lengthened into a fang."
   As the fang  grows in length, the resistance being at its  end,
causes the  tooth to rise  through the gum; the socket, in the
mean time, has grasped the neck, or beginning fang, and, being
modelled upon the  root, arises  with it.*  Mr. Hunter's experi-
ments on animals, interruptedly fed on  madder, prove, conclu-
sively, that the bony  part of a tooth is.  formed of lamella?, one
placed within another ; that the outer lamella being first formed,
is consequently, the shortest, and  that the internal ones lengthen
successively.

  * The present doctrine about the dermoid origin of the teeth, seems to have pre-
sented itself forcibly  to  the original and sagacious mind of Mr. Hunter;  for he
says, "JBoth in the body and  in the fang of a growing tooth, the extreme edge of
the ossification is  bo thin, transparent,  and flexible, that it would  appear to be
horny rather than bony, very much like the mouth or edge of the shell of  a snail
when it is growing: and, indeed, it would seem to grow much in the same man-
ner, and the ossified part of a tooth would seem to have much the same connexion
with the pulp as a snail has with its shell."—Nat. Hist, of Human Teeth, p, 91),
  Vol. I.—41 
482                 ORGANS OF DIGESTION.
   In the formation of a molar tooth, when the body is finished,
ossifications shoot from its brim, and proceed  to the centre,
where, by their union, they form  the commencement of two,
three, or even more  roots.  Mr. Hunter says, that also  a dis-
tinct ossification is frequently found upon the centre of the base
of the pulp; and two or more processes according to the num-
ber of roots to  be formed, proceed to join it from the circum-
ference  of the tooth;  and in this way the fangs of the multiform
teeth begin.
  The secretion of enamel begins shortly after the external la-
minas of the bony matter commence being deposited.   This
secretion, which has its mould always previously formed of the
bony part, comes from a pulpy substance adhering to the  inter-
nal face of the internal capsule.  The pulpy substance is placed
on the part of  the capsule nearest  to trie gum, and faces the
pulp which secretes  the bone; whatever eminences the one
pulp has, the other has the  same, but reversed, so that  they
exactly fit upon  each other.   This  pulp is best seen in the fcetus
of seven or eight months, and is not very vascular; it is  much
thinner than the other, and decreases in size as the development
of the teeth advances.  That which belongs to the incisor teeth
is in contact with their concave interior surface, but  in the mo-
lar it is  opposed to their biting surface.*
  " In the graminivorous animals, such as the horse, cow, &c,
whose teeth have  the enamel intermixed with  the bony part,
and whose teeth, when forming, have as many interstices  as
there are continuations of  the enamel, we find processes from
the pulp passing down into those interstices as far as the pulp
which the tooth is formed from, and  there coming into contact
with it.
  " The enamel appears  to be  secreted from the pulp above
described, and  perhaps from the  capsula which encloses the
body of  the tooth.  That it is from the pulp and capsula, seems
evident  in the horse, ass,  ox, sheep, &c; therefore  we have
little reason to  doubt of it in the  human  species.  It is a cal-
careous  earth, probably dissolved in the juices of our body, and
thrown  out from these parts, which act here  as a gland.   After
it is secreted, the earth is attracted  by the bony part of the tooth,
which is already formed; and upon that surface it crystallizes.
                          * Hunter. 
FORMATION OF THE TEETH."
483
  " The operation is similar to the formation of the shell of the
egg, the stone in the kidneys  and bladder, and the gall stone.
This accounts for the  striated crystallized  appearance which
the enamel has when broken, and also for the direction of these
striae.
  "The enamel  is thicker at the points and bases than at the
neck of the teeth, which  may be easily accounted for from  its
manner of formation; for if we suppose it to be always secreting
and laid equally over the whole surface, as the tooth grows, the  v
first formed will be the thickest; and the  neck  of the tooth,
which is  the last formed part enclosed  in  this capsula, must
have  the  thinnest coat; and  the  fang  where  the periosteum
adheres, and leaves no vacant  space, will  have  none of the
enamel.
  "At its first formation  it is not very hard, for, by exposing
a very  young tooth to the air, the  enamel  cracks  and looks
rough; but by the time that the  teeth cut  the gum, the enamel
seems to be as hard as ever it is afterwards  ; so that the air seems
to have' no effect in hardening it."
  The preceding passages have been extracted  literally from
Mr. J. Hunter's  Natural History of the Human Teeth, not only
on  account of their graphical value, but to fix  upon him the
merit of having  first considered the human teeth as a secretion ;
an opinion the originality  of which is falsely attributed to  the
Baron Cuvier, by M. Serres.*
  In infants, for several months after birth,  the biting margins
of the gums upon each jaw are faced by a cartilaginous rising
of some lines in  elevation, and divided  by slight fissures.  Its
usual appellation is that of Dental  Cartilage (Cartilago-Den-
tails;) it performs the function of teeth, in retaining the nipple,
and in mastication, and is analogous  to the horny beak of birds,
and of some reptiles; it only disappears upon the protrusion of
the teeth.   In  the upper jaw it is  about three lines wide, and
in the lower about two.  If it be removed by  thin slices, suc-
cessively  made,  till  the margins  of the  alveoli  appear, one
arrives  by that  means  at the ends  of  the   dental follicles  or
sacs; from which it appears that there is  no intermediate  sub-
stance.
* Anat. et Phys. des Dents, p. 63. 
484             -    ORGANS OF DIGESTION.

   In  the  preceding cartilage  are found many  small  glands,
grouped  about in different parts of it.   They were  discovered
within a few years past by M. Serres,* of Paris; are about the
size of a millet seed, contain a whitish fluid, and when examined
by the aid of  a microscope  do not appear to have any distinct
opening or duct, in consequence of which they must be punctured
in order to expel their contents.  The largest of them are on the
internal side of the gum near the molar teeth.
   According to their discoverer, these glands serve to lubricate
the dental cartilages of the infant, but after the protrusion of the
teeth  they secrete  the substance commonly called Tartar, and
heretofore falsely attributed to the saliva. Their secretion being
of a fatty nature, keeps up the high and brilliant polish which the
teeth  have till middle age; it being afterwards altered, the teeth
then become more dull and yellow.  Salivation produces an ex-
cessive secretion and deposite of tartar from these glands.  J. F.
Meckel states, that he has never been able to discover them till
towards the period of dentition, from which he is rather induced
to consider them as a morbid production  depending upon irri-
tation, and probably not differing from little abscesses.


                    SECT. V.--DENTITION.

   Infants have a set of teeth called Deciduous, from  their being
lost after a certain period of time.   Their whole number is twen-
ty, ten in each jaw, consisting on either side of two incisors; one
cuspidatus; and two molares, having a shape corresponding with
that of the large grinders in the adult.  Several of these teeth
fall out about the_seventh year, and all of them have disappeared
about the fourteenth.  The time of their first  protrusion through
the gums is variable, but  may, as  a general rule, be stated at
from  the  sixth to  the  eighth month after birth.   They appear
commonly in pairs.  The pairs of the lower jaw have prece-
dence in their protrusion; and are  immediately followed,  suc-
cessively,  by their  congeners in the upper.   The order of  pro-
trusion is as follows:—
  The two central incisors, from the sixth to the eighth  month;
  The two lateral incisors, from the seventh to the tenth month ;
* Loc. cit. 
                         DENTITION.                      485

   The first molar tooth, on each side, from the twelfth to th e
 fourteenth month;
   The cuspated, from the fifteenth to the twentieth month;
   The second molar, on each side, from the twentieth  to the
 thirtieth month.*

   The Deciduous teeth, by a process which will be presently ex -
 plained, drop from the gums and are succeeded by the perma-
 nent teeth.  The first permanent molar, about six or seven years
 of age, by emerging behind the second infant molar, leads the
 way to the second epoch of dentition which occurs in the fol-
 lowing order:—
   The central infant incisors fallout about the sixth or seventh
 year, and are  immediately followed  by the central perma-
 nent incisors;
   In a few months  afterwards, sometimes at the same period,
 the lateral infant incisors tumble out, and are succeeded by the
 lateral permanent incisors;
   About the ninth year the  first molar  teeth fall out. and  are
 succeeded by the first bicuspated;
   From the ninth to the eleventh year, the second molars  fall
 out, to be succeeded by the second bicuspated;
   From the eleventh to the twelfth, the  infant cuspated are fol-
 lowed by  the adult cuspated ;
   About  the end of the twelfth year,  the second  permanent
 molars protrude  behind the first permanent;
   And, finally, from the sixteenth to the twenty-fifth year, the
 third permanent  molars or the Dentes  Sapientias, make their
 appearance.
  In the jaw of a fcetus of three or four months after conception,
 the beginning of the alveolar processes may be observed, in the
 condition of a longitudinal groove, deeper and more narrow in
 front, more shallow  and wider  behind; and in the bottom of the
 groove are small transverse  ridges, dividing it into superficial
 depressions.   From this simple condition, ridges begin to shoot
out from the opposite sides of the canal near its brim ; and form,
by their junction, arches across it; more matter  being added to
these arches, they make, in their progress, a sort of cell for each

                       * Series, loc. cit.
                           41* 
486
ORGANS OF DIGESTION.
tooth, open on its alveolar surface.   This opening is nearer the
internal circumference of the alveolar processes, so that the teeth
are almost covered, and probably for the reason advanced by
Mr. Hunter, that the gums may be firmly supported before the
teeth come through.

   The rudiments of the teeth which are earliest in their appear-
ance maybe found in a fcetus of two or two and a half months;
and at the expiration of three months, it is said that all the germs
of both sets of teeth exist in a manner to be distinguished.* The
germs of  this period are lodged in membranous folds belonging
to the gum, to which t4ie germs of the  first dentition are imme-
diately attached, while those of the second are suspended by
pedicles of a line or two  in length, which circumstance alone
permits them to be distinguished.   At four months all the germs
are contiguous to each other, with the exception of the incisors ;
shortly afterwards they begin to be separated by the rudiments
of the alveolar processes ; and  about the fifth month  ossification
is perceptible in the infant incisors, and goes on in the other teeth
very much in the order of their appearance.
   The germs of the  deciduous teeth are placed in  an arc of a
circle, the cuspidati being thrown forwards out of the line  of the
others  and somewhat lower; in consequence of which, the first
molar border closely upon the  incisors   The germs of the per-
manent teeth are brought into view by removing the internal
face of the jaw, and are at the posterior upper side of the first
germs ;  being, therefore, nearer to the edges of the alveolar pro-
cesses.
   At birth, ossification has taken place in all  the infant  teeth,
though their roots are not yet completed.  The rudiments  of the
permanent teeth, though  seen  at  an early period of fcetal ex-
istence, do not begin to ossify till after birth.  Thus, the first
adult incisor and molar begin to ossify about the fifth or sixth
month of life, the second incisor and.cuspidatus about the ninth
month, the first bicuspis about  the fifth year, the second bicuspis
and second molar about the sixth or seventh, and the third mo-
lar about the twelfth  year.t
  The  teeth which  have no predecessors are in consequence
of their adhesion to the gum brought out in their regular places;
       * Series, p. 3.                           t  Hunter. 
DENTITION.
487
but, in the case of such permanent teeth as take the position oc-
cupied by the deciduous, there is, before the teeth protrude, a
pedicle, (Gubernaculum Dentis,) which passes from the alveolar
end of the sac of the permanent tooth to the sac of the decidu-
ous tooth; and  even when the latter is  fully  formed and pro-
truded, the same pedicle may be traced to that part of the gum
surrounding the neck of the deciduous tooth.*  At birth, the
rudiments of fifty-two  teeth may be found in the  two jaws;
and, as a general rule at that period, the rudiments of the per-
manent are more superficial than those of the deciduous; but
their position is subsequently changed, so that  the first descend
while the  latter ascend.t

   As the permanent teeth are preparing to protrude, the alveo-
lar cavities, in which they are  contained, form orifices on the
internal surface of the jaw near the edges of the deciduous al-
veolar processes, and which are  called the Alveolo-dental Ca-
nals, (Itinera Dentium.)   Those for the incisor and canine teeth,
are just behind their corresponding deciduous teeth, and those for
the bicuspated near and somewhat behind  the infant molares.
At this period, a bony septum separates almost completely the
two orders of alveolar cavities from each other,  and  there-
by prevents their mutual interference.
   The permanent teeth being thus formed in  new and distinct
sockets, and being kept off from  the deciduous, it is clear that
the latter cannot be pushed out of their .alveoli, as is sometimes
supposed, by the growth of the former; and if it did take  place,
it would produce the great inconvenience of causing them to rise
up into the mouth, beyond the level of the other teeth.  On the
contrary, the deciduous teeth are made loose by  the removal of
their roots, which progresses till nothing but the neck is left, and
then the slightest force  applied dislodges them from their posi-
tion on the  gum.  This decay  of the root is not even affected,
according to Mr. Hunter, by the pressure of the rising tooth, for
the new alveoli rise with the new teeth, and the old ones  decay
along with  their decaying fangs; and when the first  set falls
out, the succeeding teeth are enclosed by a complete bony sock-
et; from which  it is evident that the  change is not produced by
   * J. Cloquet, Anat. Pi. XXII. fig. 16, 17.  Serres, loc. cit. p. 109.
   ■j- Serres. 
488
ORGANS OF DIGESTION.
 mechanical pressure, but is a particular process in the animal
 economy.* In farther proof, however, Mr. Hunter has seen two
 or three jaws where the second deciduous grinders were shed-
 ding by the decay of their roots, without there being under-
 neath any tooth to press upon them; and in another jaw he ob-
 served the same circumstance in both  grinders.  In a female
 patient, in whom the last temporary molar was loose, and was
 pulled  out  in consequence,  it was  not succeeded by another
 tooth.  One of these patients at the time was aged twenty, and
 the other thirty; from which it would appear, that though the
 wasting of the fang of a deciduous tooth does not depend upon
 the'pressure of the permanent one, yet the  latter determines,
 in some measure, its expulsion, as, without some such influence,
 the  period of shedding would not have  been so late*
   From these observations  of Mr. Hunter, it would appear,
 that the pressure of the permanent tooth is not indispensable to
 the  removal of the deciduous one in all cases; yet  I think it
 will be most frequently found  that much of the decay of the
 root of the deciduous tooth is  owing to its being absorbed by
 the pressure of the body of the permanent  one.  The  alveoli
 of the latter, judging from my own observations, are seldom
 so perfect towards  the period of their protrusion as  to form a
 complete separation of the two orders of teeth, and even when
 the alveoli are perfect, they are made to press upon the root of
 the deciduous tooth by the evolution of the body of the perma-
 nent.
  Besides the deciduous teeth being loosened, as stated by Mr.
 Hunter, by the absorption  of their alveolar cavities while the
 fangs are dissappearing, the  following  process occurs.   The
 permanent teeth  protrude  within  the circle of the deciduous,
 the  arch of the latter is weakened, and its several pieces are in
 that way detached by a force acting from within  outwards:
 this influence being much assisted by the obliteration of the al-
 veolar cavities proceeding principally at  their  outer circumfe-
 rence.   The latter,  however,  is not so obviously the case with
 the molar as with the incisive and canine teeth.
  The deciduous teeth, even  before they are loosened by the
absorption of their fangs and of their alveolar processes, are
much more easily extracted in proportion than the adult teeth,
                       *  Hunter, loc. 
                    ATTACHMENT OF TEETH.                 489

from  the  texture of their  periosteum being  much softer  and
more  yielding.


  A question of some interest has recently arisen  in regard to
the precise apparatus of attachment of the fangs of both sets of
teeth to their alveolar cavities.  The principal cause of attach-
ment is attributed to a distinct ligament or fasciculus for each
tooth, having for its  position  the side of the tooth the most  dis-
tant from  the front line of the symphysis of the jaws.  The liga-
ment  thus situated is said to arise from the edge of the alveo-
lus between the teeth, and  proceeding forwards in the  case of
the molars, and inwards in the case of the incisors: to be inserted
into the neck of the tooth not quite the sixteenth part of an inch
from  the  enamel.  The ligamentous character is considered as
very  distinct,  the fibres being white and shining like  tendon.
The exclusive cutting of it is also said to  facilitate very much
the extraction of a tooth.*
   My own observations, made upon the parts softened in mu-
riatic acid,  and in the recent state, have not led me to  see  the
ligamentum dentis in so distinct a light or to witness the extreme
facility of extraction after it alone is cut.   It is, however, pro-
bable that the  insinuation  of an  instrument between the tooth
and alveolus will generally, to the extent of the incision, dimi-
nish the force of resistance in pulling the tooth out.  The ac-
tual adhesion  of the tooth to  the alveolus appears to me to
arise  from the  original  capsules of the teeth  being  converted
into a  single  layer  of  periosteum,  one surface of which  ad-
heres to the alveolus, and  the other to  the fang of the tooth.
The adhesion I have found  particularly strong at  the margin
of the alveolus, and  converging circularly from  it to the neck of
the tooth, somewhat in the  manner of a  coronary ligament.
Another subject of  remark is, that the filaments of periosteum
are not laid down laterally to the teeth, but one end of the fila-
ment  adheres  to the  alveolus, and the other to the  tooth,  like
the filaments of the  interosseous  ligament at the lower junction
of the tibia  and fibula.  In  this way a cap of such fibres is found
over the whole fang of  the tooth: one of the best  means of de-

  * See Description of the Ligamentum Dentis, by Paul B. Goddard, M. D. in
Am. Journ. of Med. Sciences, vol. xxiii. Phil. 1839, 
490
ORGANS OF DIGESTION.
 monstrating it, is, to chip off the alveolus in front of a cuspate
 tooth of the lower jaw, then seize the body of the tooth with a
 pair of strong  pliers, and make it rotate on its axis, the fibres
 will thus be seen to start up and to show the attachment of their
 two ends, one to the alveolus  and the other to the tooth.  The
 jaw of a  strong  muscular subject is especially recommended.
 This arrangement of the course of the fibres is very well exhi-
 bited in the cow and horse.

   In the lower jaw of the adult, there is but one arterial trunk,
 which supplies the teeth; but,  in the fcetus, and till  the  age of
 six or seven years, there are two arteries,* and as many canals
 for containing them.   The lowest  of these arteries belongs,
 exclusively, to the deciduous teeth; it is distinctly visible in the
 foetus, augments  till  the  third or fourth  year,  afterwards  it
 shrinks, and is obliterated about the sixth or seventh year.   In
 some  rare cases  its canal remains open for a longer time, as
 M. Serres has met with it in a woman of thirty.  Being a branch
 from the inferior maxillary, it  enters the bone  at a foramen
 somewhat lower down than the posterior maxillary; and what
 remains of it after the teeth are supplied comes out at another
 aperture,  a little  below  the anterior maxillary foramen, and
 there anastomoses with the  other dental artery.
   M. Serres  supposes that  this  artery, discovered  by himself,
 and obviously serving in the evolution of the deciduous  teeth,
 by being obliterated before they fall out, destroys their vitality,
 and, therefore, they become absolutely foreign bodies, the ex-
 pulsion of which is required by nature on common principles.

          SECT. VI.--OF IRREGULARITIES IN DENTITION.

   The process in certain individuals is premature; Louis XIV
 was born  with two teeth; many instances of the  same  sort o
 precosity are recorded by Haller, and other medical writers, in
 some of which even ten teeth were found protruded at birth.
   On other occasions, the process is retarded in a manner equal-
 ly striking, and varying from the tenth month to the sixth  or
 seventh year.   This unusual tardiness is sometimes manifested
in particular teeth; thus, I  know a young gentleman in whom
                     * Serres, loc. cit. p. 17. 
IRREGULARITIES IN DENTITION.
491
one of the permanent incisors of the upper jaw did not come
down before the fourteenth year.  Borelli reports a woman in
her sixtieth year who never had teeth; a magistrate of Frede-
rickstadt lived to an advanced age, and never had either canine
or incisor teeth; he was however furnished with molares.
  The teeth are sometimes supernumerary;  it  is not very un-
common to see this manifested by a single canine or incisor,
and more frequently in the upper jaw than in the lower.   Occa-
sionally, there are several supernumerary teeth.
   Cases are recorded in which several teeth have been fused or
joined together.  Bernard Gengha reports, that in a pile of bones
belonging to the Hospital S. Fsprit, at  Rome, he found  a cra-
nium in which there were only three teeth;  in  the two upper
maxilla? one occupied the space of all the incisors and the two
cuspidati, and each of the others the space of all the molares of
its respective side.*   According to the historians Plutarch and
Valerius Maximus; Pyrrhus, king of Epirus, and Prusias, king
of Bithynia, had a single dental piece in each jaw, which stood
in the* place of the usual allowance of sixteen teeth.   These
cases are scarcely credible, for the reason, that for  them to
have occurred, the middle palate suture, which is slow inform-
ing, and divides the germs of the two sides from each other,
could not have existed during the foetal state, at any time sub-
sequent to the third month; or what is more compatible with
this account, at no time whatever.  It is more probable, there-
fore, that notwithstanding the royal opportunities of cleanliness
possessed by these persons, their teeth were neglected, and per-
mitted  to incrust themselves with a dense, thick coat of tartar,
which gave them the appearance of a single piece: a circum-
stance  which occurred to Sabatier, in  a girl of fifteen or six-
teen, and to Fournier in an individual of the same age and sex.t
Another objection  is, that as the common law of the  germs is
to develop themselves, and to  ossify at different epochs, in these
two cases they were all not only proceeding at the same rale, but
also joining one another so  as to form but a common sac, con-
founding, thereby, all the known phenomena of dentition.
   In most persons  there are but two sets of teeth; it  has hap-
pened, however, in several instances, for people about the age of
seventy to have one or more new teeth belonging to a third set:

    * Sabatier, Anat. tome 1, p. 78.    f Diet, des Sc. Med. 
492
ORGANS OF DIGESTION.
thev are commonly incisors.  J. Hunter saw an example of the
kind.*   The Countess of Desmond, who  lived to her hundred
and fortieth year, had, at this period, according to Bacon, a
third set of teeth.t  Mentzelius narrates a  similar casej in the
following words: having accompanied the Elector of Branden-
burg on a visit to Cleves, in 1666, there  arrived, at the  same
time, a man aged one hundred and twenty, who exhibited him-
self for money, and whom I saw at  the court of the Elector.
His strength of voice manifested that of his breast, and he having
run over the gamut, was heard at more than a  hundred paces
off.  Having then opened his mouth, he showed us two rows of
pearly teeth, and on the subject of their beauty related ' that be-
ing at the Hague two years before, on the same errand which
brought him to Cleves, there arrived an Englishman aged one
hundred and twenty^  that he visited the latter, and addressed
him in the following terms: * We are nearly of the same age,
for I am only two years younger than you, and I have had the
greatest desire to see one older than  myself, for I have felt no
inconvenience till lately; but during the three days that I have
been here, I have had severe headach and dreadful pains in the
jaws, which convince me that I am  about  to die.'   ' You are
mistaken, my dear friend,'said he to me: 'on the contrary,
you are becoming younger, for you  are about  to teethe again
like an infant.'  ' Oh !' answered I,' I pray to God not to punish
me by prolonging my days.' ' I left him then and went to bed,
and  immediately  after felt the most  excruciating pains in the
jaws, which were followed by the protrusion of the teeth that
you now see.'"
   The circumstance of a third dentition, has given rise to a ques-
tion among physiologists, whether the germs are primarily super-
numerary 1 or whether the gums have within themselves organs
capable of forming and of producing new teeth?
   When such teeth come out in a straggling manner, thev hurt
the opposite jaw, and require to be extracted.
   In old persons who have lost all their teeth,  there is a carti-
laginous hardening of the gum, as in infancy, whereby they still
retain some power of mastication.
   When the body of the tooth has been worn away, nature pre-
vents the exposure of its cavity by the deposite  of new matter,
    * I.oc. cit. p. 85.                 t Hist. vit. et mort. Col. 536.
    t Serres, loc. cit. p. 40. 
MUSCLES OF THE TONGUE.
493
which  may be  known by its darker colour, and by its transpa-
rency.
  The  muscles of mastication being the Temporalis, the Mas-
seter, the Pterygoideus  Internus, and the Pterygoideus Exter-
nus, their description may be seen elsewhere.
                    CHAPTER  III.

                     OF THE TONGUE.

  The Tongue (Lingua) is the principal organ of taste, and is
also concerned in mastication and in speech.  It is an oblong,
flattened, symmetrical, muscular body,  which extends from the
os hyoides posteriorly to the incisor teeth anteriorly, and, being
placed at the bottom of the mouth, fills  up the space within the
two sides of the body of the lower jaw. The exact extent of room
which it occupies, varies according to its being in a state of re-
pose or of activity.
   The posterior extremity of the tongue is  called  its  base  or
root, and arises muscular from the body and the cornua of the
os hyoides; it is there considerably thinner than elsewhere, it also
has a fibro-muscular origin from the centre of the epiglottis car-
tilage: sometimes  a cartilage is found in the middle of the base,
and which forms a sort of ball and socket joint with the os hy-
oides.   Its anterior extremity is called  the tip or point, is loose,
and has a rounded thin termination.  Between  the  point and
the base is the body.  The superior surface of the tongue is flat,
is divided  by a middle longitudinal fissure of inconsiderable
depth into two equal parts, and is covered by the  lining mem-
brane of the mouth, under a particular modification of structure.
The inferior  surface of the tongue,  with the  exception  of  its
middle part, is also free, and covered  by the common mucous
membrane of the mouth; but the latter is there very thin, and the
veins may be readily seen shining through it.

              SECT. I.—MUSCLES OF THE TONGUE.

  The muscles which compose the principal part of the bulk of
the tongue, are, the Stylo-glossus, the  Hyo-glossus, the Genio-
   Vol. L—42 
*494
ORGANS OF DIGESTION.
hyo-glossus, and the Lingualis.   As these, besides belonging to
the general muscular system, also form so important a part of
this organ, with a view of collecting  the account of its  struc-
ture, their description will be repeated.

  1. The Stylo-glossus arises  from the styloid process of the
temporal bone,  and soon reaches the side of the base of the
tongue.  Some  of its  fibres  extend to the tip and confound
themselves along with those  of the superficial lingual muscle,
above  and below the margin of  the tongue: while  others form a
broad transverse fasciculus, which is  united to the correspond-
ing portion of the other  side in the region of the greater pa-
pilla?.*

  2. The Hy^o-glossus arises from the side of the base of the os
hyoides, from its cornu; and from its appendix, in a slight degree.
It  is placed within  the stylo-glossus,  and extends forwards to
the tip of the tongue.  Some of its fibres go as far as the mid-
dle line of the tongue; others  rise almost perpendicularly up-
wards to its base; while the remainder are confounded, along
the margin of the tongue, with  the superficial lingual muscle.

  3. The Genio-hyo-glossus arises from the tubercle on the
posterior face  of the symphysis of the lower jaw, and imme-
diately after its origin spreads  itself after the manner of a fan.
Its inferior fibres are inserted into the base of the os hyoides,
while the remainder, by their  diverging, are inserted into the
whole length  of the tongue  from its base to its point.   This
muscle is in contact, side by side, with its fellow, and there is
a sort  of fissure with a small  quantity of adipose matter be-
tween them.

  As the fibres of this muscle go from below upwards, they pe-
netrate to the  upper surface of  the tongue;  and, consequently,
traverse the transverse lingual  muscles and  the superficial lin-
gual.

   4. The Lingualis is a small narrow fasciculus of fibres, which
arises indistinctly about the root of the tongue, in the yellow
* See Cloquet's Anat. pi. CXX. 
                MUCOUS COVERING OF THE TONGUE.           495

cellular tissue there, and advances to the tip between the hyo-   ,
glossus  and the genio-hyo-glossus.

  5. The Superficial Lingual Muscle (Superficialis Lingua-) is
a broad, thin layer, covering the upper surface of the tongue,
below the mucous membrane;  it begins  behind, on a line with
the greater papilla?, and advances forwards to the tip.  Its more
internal fibres converge and end at the middle line, but the ex-
ternal ones terminate above and below, near the margin  of the
tongue.

  6. The Transverse Lingual Muscles (Transversales Lingua,)
consist in small scattered fasciculi, which are placed below the
last, and in the thickness of the tongue, which they traverse at
right angles.   One end of them, on each side, ceases at the mid-
dle line of the tongue, where there is a small seam,  and the
other end terminates in the covering membrane of the tongue,
at the  lateral margin of this organ.  These fibres are  to be
found in the whole length of the tongue, and gradually become
more curved at its base.

  7. The Vertical Lingual Muscles (Verticales Lingua) extend
from the upper to the under investing membrane of the tongue.
They consist in small scattered fasciculi, like the preceding,
and cross them at  right angles in traversing the thickness of
the tongue.*  Many of these fibres appear to me to proceed
from the genio-hyo-glossus.

          SECT. II.—MUCOUS COVERING OF THE TONGUE.

  The mucous membrane of the mouth, where it forms the frse-
num linguae,  is over the  anterior margin of genio-hyo-glossi
muscles; the same  membrane, in  going from the base of the
tongue  to the epiglottis, and forming another frasnum, has, on
each side of it, a depression or pouch in  which articles of food
sometimes lodge.  Beneath the last frasnum is a  ligamentous
tissue which  runs  to the base of the  tongue from the front of
the  epiglottis, and serves  to keep the latter erect:  some mus-

  *  The preceding views of the minute muscular structure of the tongue have
lately been advanced by M. Gerdy, of Paris,  See J. Cloquet, Anat. de L'Homme,
pi. CXIX. CXX.  J. F. Meckel, loc. cit.  Note des  Traducteurs, vol. iii. p. 313. 
496
ORGANS OF DIGESTION.
 cular fibres are occasionally seen  in this tissue in the human
 subject:  in  the  black bear of North America,  and in some
 other animals, it consists in a pair of strong muscles.  The
 pouch, on each side, is bordered, externally, by a more super-
 ficial doubling of the  mucous membrane, which  passes, from
 the base  of the tongue to the side.of the epiglottis.*
   The lingual portion  of the lining membrane of the mouth, on
 the upper surface of the tongue, is somewhat cartilaginous, and
 into it is  inserted many of the subjacent muscular fibres.   At
 the base  of the tongue this cartilaginous condition is deficient,
 and its place is supplied by a yellow cellular tissue which  ad-
 heres to the os hyoides, to the epiglottis, and to many muscular
 fibres below, and has in it numerous mucous follicles.
   As observed, the  mucous  membrane, on the under surface of
 the tongue, offers no peculiarity of organization: but, on  the up-
 per surface, it is remarkable for the unusual size and develop-
 ment of its papillae, for having its epidermis easilydetached, and
 also for having the muscular structure beneath fixed to  it with
 extreme closeness.
   The anterior two-thirds of the upper surface of the  tongue
 are entirely covered by these papillae.   They are so thickly
 set  as to,touch one  another; and, as  they present some pecu-
 liarities of form, they are divided into Papillee Maximae or Ca-
 pitatae, Mediae, Villosae, and  Filiformes.
   The Papillae Maximae constitute the posterior border of the pa-
 pillary surface of the tongue, and  are about nine in number,
 though they are frequently fewer, and sometimes more.  They
 are  disposed in two oblique  rows, which, by converging back-
 wards, meet and generally form something like the letter V.; the
 fifth papilla being the angle of the figure.  Each of these  bodies
 resembles a cone standing upon its summit, and is surrounded by
 a circular fossa which permits it to  project but inconsiderably
 above the general level of the tongue.  Sometimes two or more
 are in the same fossa.   The Papillae Mediae, or Fungiformes, are
 more numerous than the last, and  next to  them in size; they
 are enlarged at their loose  end into a sort  of  rounded head,
 whence their name; they are irregularly scattered over the

  * This doubling also exhibits, occasionally, a small muscle inserted into its base,
and arising  from the upper  constrictor of the pharynx, and which  has the
effect of widening the pouch. 
               MUCOUS COVERING OF THE TONGUE.             497

tongue.  Those which are next in size and still more abundant,
are the Papillae Villosae.   The Papillae Filiformes fill up the in-
tervals of the others, are the smallest, and are found, principally,
near the middle of the tongue and at its front extremity.
   Most commonly the central papilla maxima  has  the largest
fossa of any of that class, and which is designated by the term
foramen coecum.   A little behind this foramen there is frequent-
ly another, called the same  by some  anatomists, but not fur-
nished with a papilla, into which some mucous follicles discharge
their contents:  from time to time it has been fallaciously consi-
dered as receiving the excretory duct of the thyroid, or of some
of the salivary  glands.
   The papillae  of the tongue, though  they vary in  their shape
and size, have very much the same  structure in regard to the
abundance of blood vessels and nerves which enter  into their
composition.   When uninjected, and viewed with the naked eye,
their surface appears smooth, but when  made turgid by injection,
they are covered with little asperities or  filaments, which seem to
be formed principally of blood vessels, having a very tortuous and
superficial course; forming loops, or doublings, in projecting on
the surface of  the  papilla, and anastomosing freely with each
other.*   Besides  vessels, there is a soft whitish substance, sup-
posed to be nervous, entering into the  composition of each  fila-
ment.   The larger papillae on the back part of  the tongue are
supplied by the glosso-pharyngeal  nerve, and the papillae on its
front part by the  trigeminus or fifth pair.
   The surface  of the tongue between  the papillae maxima? and
the os hyoides is  destitute of papillae, and is covered only by the
common mucous membrane of the mouth, having beneath it many
muciparous glands, which in different individuals produce promi-
nences more or less elevated,  and are of a lenticular shape with
a diameter of a line or two.   Their orifices are very visible, and
easily receive a large bristle.
  The Epidermis, which is found upon all other parts of the lining
membrane of the  mouth, is also continued over the whole upper
surface of the tongue, and consequently invests each papilla; it
is called there Peri-glottis. Jt is soft and  humid, may be detached,
by maceration,  and is frequently detached in fevers.   On its up-

              * Soemmering', Anat. J, Cloquet. pi. cxix.
                            42* 
498
ORGANS OF DIGESTION.
per surface, it, when detached, will have many elevations; while
on the lower there will be corresponding excavations, which to
superficial  observation give it the  appearance of being cribri-
form.

  The tongue is supplied with arteries, principally from the lin-
gual branch of the carotid, and with nerves from the hypo-glos-
sal,  the fifth pair, and  the  glossopharyngeal.   The former is
supposed to be exclusively appropriated to its muscular move-
ments, and the two latter to its sensations.  Its faculty of taste
seems to be most active at the tip: on the sides, and near the
middle, behind, it is inconsiderable.   The soft palate seems also
to participate in the function of taste.
                    CHAPTER IV.

                      OF THE PALATE.

  The Palate (Palatum) is composed at its anterior part of the
palatine processes of the superior maxillary and palatine bones,
covered above by the pituitary membrane, and below by the
lining membrane of the mouth.  This portion of it is  the  hard
palate, and separates the  mouth from the nose.   Behind it is  a
membranous portion called the soft palate, which separates par-
tially the mouth from the upper part of the pharynx.
  That part of the lining membrane of the mouth which covers
the hard palate, has a hard cartilaginous feel, and is not so vas-
cular or sensible as other parts.  It has a ridge in its centre just
beneath the middle palate suture, and from each side of it there
are transverse ridges extending to  the alveolar processes.  This
arrangement is more evident at its anterior part, and in middle-
aged persons; in the old it is faint, and frequently does not exist
when the alveoli are gone.   Beneath this membrane, particular-
ly at its posterior part, the muciparous glands are very abundant
and closely set against each other, so as to form a perfect layer,
extending itself upon the front of the soft palate, and making one
half of its thickness.

   The Soft Palate (Velum Pendulum Palati) has on oblong shape, 
MUSCLES OF THE PALATE.
499
and being continued from the posterior margin of the hard pa-
late, it is stretched across the back of the mouth from one side to
the other, and obliquely downwards and backwards.  Its inferior
margin, which is free, offers in its centre  a projection of half an
inch or three quarters in  length, which is the Uvula.   From each
side of the latter there proceed two crescentic doublings of the
lining membrane of the mouth, called the lateral half arches of
the palate.
   The Anterior Half Arch is  more distinct than the other, and
arising at the side of the uvula by one  end, terminates by the
other in the side of the base of the tongue on a line with the
papillae maximae.
   The Posterior Half Arch arises from the side of the uvula near
 the last, and diverging from it backwards, and outwards, has the
 other end lost gradually in the lining membrane of the pharynx
 near its middle.  In the depression between these duplications,
on either side, is the Tonsil Gland.   The space bounded in front
 and behind by these lateral half arches  is the Fauces, and the
 anterior opening into it, is the Isthmus of the Fauces.
    When the mucous membrane of the soft palate is removed, its
 muscles are exposed, and are as follow:—

    1. The Constrictor Isthmi  Faucium  is a  small fasciculus of
 fibres, on each side, within the duplicature of the anterior lateral
 half arch.  It arises from the middle of the soft palate near the
 base of the uvula, and is inserted into the side of the tongue near
 its root in a line with the papillae  maximae.
    It tends to  close the opening between the mouth and  the pha-
 rynx.

    2. The Palato-Pharyngeus is also a small fasciculus, within
 the duplicature forming the posterior lateral half arch.   It arises
 from the middle of the soft palate near the base of the uvula,
 and is inserted into the pharynx at  the space between  the mid-
 dle and lower constrictors, behind the stylo-pharyngeus, and into
 the superior posterior margin of the thyroid cartilage. It spreads
 itself out considerably, so as to cover, along with the stylo-pha-
 ryngeus, almost the whole lateral portion of  the pharynx to its
 lower part.
    It draws the soft palate downwards. 
500                 ORGANS OF DIGESTION.
  3. The Circumflexus, or Tensor Palati, is behind the pterygoid
process of the sphenoid bone.   It arises from the spinous process
of the latter behind the foramen ovale, and from the contiguous
part of the Eustachian tube; it then passes downwards in con-
tact with the pterygoideus interims muscle, and terminates in a
broad tendon below, which winds around the hook of the inter-
ml  pterygoid process, and is inserted into the  soft palate near
its middle, and into  the  posterior  lunated edge of the palate
bone.
  It spreads out or extends the palate.

  4. The Levator Palati is on the inner side of the last.  It
arises from the point of the petrous bone, and from the contigu-
ous part  of the Eustachian tube, and passes  downwards to be
inserted into  the soft palate.  This muscle, in the dissection of
the  pharynx may be seen between its external edge, and the pte-
rygoideus internus  muscle.
  It draws the soft palate upwards.

  5. The Azygos Uvulae is in the centre of the soft  palate and
of the uvula.  It arises from the posterior pointed termination of
the  middle  palate suture, and goes down into the uvula.
  It draws the  uvula upwards,  and diminishes the  vertical
breadth of the soft  palate.
  When  the mucous membrane is removed, the upper constric-
tor of the pharynx appears between the anterior and the poste-
rior  half arches.
                    CHAPTER V.

              OF THE GLANDS OF THE  MOUTH.

  These glands consist in such  as are muciparous,  and in
such as are salivary.

                SECT. I.--MUCIPAROUS GLANDS.

  These glands  (Glandula Mucipara)  are whitish, somewhat
oval and flattened, and are from  the fraction of a line to two 
SALIVARY GLANDS.
501
lines in diameter: they are found in great abundance beneath the
lining membrane of the mouth at several places, to wit: on the
lips, (Gland. Labiates;)  on the cheeks, (Gland. Buccales;) and
also, as mentioned, at the posterior part of the upper surface of
the tongue, (Glatid. Mucip. Lingua)  The layer of them, (Gland.
Palatince,) which is found at the posterior part of the hard palate,
is also continued  over the anterior and the posterior surface of
the soft palate, especially the anterior  surface.
   The Tonsils, (Tonsilia, Amygdala,) situated, as observed, one on
each side, between the half arches of the palate, are six or eight
lines long, four or five wide, and about three  thick.  They are
rather a collection of large  mucous follicles, than a congeries of
glandular bodies, in consequence of  which their surface is very
much reticulated.  Owing to  their being placed upon the upper
constrictor  of  the pharynx, their  mobility is very striking and
considerable.
   A great many small pores are observed on the internal sur-
face of the mouth, which are the orifices of the ducts  of the
muciparous glands.

                  SECT. II.--SALIVARY GLANDS.

   On either side of the neck, bordering upon the mouth, there
are three glandular bodies for the secretion of saliva; they are
the parotid, the submaxillary, and the  sublingual.   The fluid se-
creted from them is of great service in digestion, and  is blended
with the food  in mastication, and in  swallowing.   According to
Berzelius, it has  a considerable affinity to oxygen; and consists
in a white mucous substance,  holding, in a state of solution, the
saline  articles usually found in the serum of the blood.

   The Parotid Gland (Glandula Parotis,) is  the largest of the
three,  and, like the others, is of a  light pink colour.  Owing to
he space into which it is crowded,it  is  o  a very irregular figure.
It fills up the cavity on the side of the  head between the mastoid
process and the ramus of the lower jaw, extending beyond the
edge of the  latter so as to cover the posterior  margin of the mas-
seter muscle.   It is somewhat pointed at its  fore part.  Its ver-
tical length reaches from the zygoma  above, to the angle of the
jaw below; sometimes, indeed, a  little lower down.   In  thick- 
502
ORGANS OF DIGESTION.
ness it extends  from the integuments externally, to  the  styloid
process, the styloid muscles, and  the tendon of the digastricus,
internally, being there only separated from the internal carotid
artery by these parts.   It is traversed from behind forwards by
the portio-dura nerve, and from  below upwards along its inter-
nal margin by the external carotid artery and the temporal vein.
  This gland has no appropriate capsule, but being covered, on
its external face, by the continuation of the fascia superficialis
of the neck, prolongations are sent from the fascia which pene-
trate  it in every direction, and keep its lobules together.
  Its  duct  (Ductus Stenonianus) departs  from its anterior edge
a few lines below the zygoma, and traverses the outer face  of
the masseter muscle, in  a  line,  according to the observations
of Dr. Physick, drawn from the lobe  of  the ear to the end of
the nose.   It is about the size of a crow quill, is hard and ten-
dinous, with thick parietes.   It lies close to the masseter mus-
cle, and at the anterior edge of  the latter  penetrates a  pad of
fat commonly found there  on the side of the  cheek; it then
perforates  the posterior end  of  the buccinator,  so  as to have
its oral orifice opposite the  second large molar tooth of the up-
per jaw.  On opening  the  mouth wide during a state  of fast-
ing, a jet of  saliva will sometimes indicate the position of this
,■...: c„~
   A small gland (Gland. Accessoria Parotidis) is sometimes found
between this duct and  the zygoma, it varies in form  and size,
and has a distinct excretory canal discharging itself into the
parotid duct.

   The Submaxillary gland (Glandula Submaxillaris) is not more
than  a third or one half the size of the last, and has a more re-
gular form in being somewhat  ovoidal.  It is accommodated
in the depression on the side of the neck formed by the body
of the  lower jaw externally,  by  the  mylo-hyoideus  muscle
above, and by the tendon of the digastric below.  The platys-
ma myodes  intervenes between  it and  the skin.   It almost
touches the parotid gland behind, being separated from it only
by a process sent in from the fascia superficialis, and continu-
 ous with the ligament, going from the styloid  process  to the
 ramus of the lower jaw. As it extends to  the posterior margin
 of the mylo-hyoideus  muscle,  it there touches the sublingual 
SALIVARY GLANDS.
503
gland.   The facial artery either passes through it  or  is very
much connected with it.
  Its colour and appearance  are the  same with the parotid;
but its lobules  are more easily separated, as they are held to-
gether only by weak cellular substance, which forms a sort of
capsule to them.  Its duct, (Ductus  Whartonianus,) which is
single, comes  from the  assembling and junction of branches
from the  several lobes.   It is much thinner, more extensible,
and larger in proportion than the parotid duct; and being di-
rected backwards, winds over the posterior edge of the mylo-
hyoid muscle, in order to get to the cavity of the  mouth.   It
then passes along the internal face of the sublingual gland, be-
low the tongue, and terminates by a small projecting orifice on
the anterior margin of the fraenum linguae.
   A continuation of the substance of this gland, of a few lines
in thickness, described by Bartholin, is found  at the posterior
end of  the sublingual gland, and has its  excretory duct some-
times opening at the side of the duct of Wharton, and, on other
occasions, into one of the ducts which issue  from the  sublin-
gual gland.   When  this common duct exists, it is called the
canal of Bartholin, (Ductus Bartholinianus,) who first discovered
 it in the lion,  in 1684.

   The Sublingual Gland (Glandula Sublingualis) is an oblong
 body, covered by the lining membrane of the mouth, but visible
 when the tongue is  turned up.   It is placed above the mylo-
 hyoid muscle, along  the under surface of the  tongue, and  is
 readily distinguished  by its ridged unequal surface, projecting
 into the mouth.   It is not so large as the submaxillary gland.
    Its lobules are smaller than those of the  preceding gland, and
 are also whiter and harder.  Instead of having but one  excreto-
 ry duct, if has several; sometimes fifteen or twenty of them are
 discernible: on other occasions, several of them are collected
 into one or two principal trunks,  (Ductus  Riviniani,) and open
 either directly into  the mouth, or into  the duct of Wharton.
 These  several  openings are  found along the  bottom of the
 mouth, on either side below the tongue.   Several small saliva-
 ry granulations or glands border on the sublingual.
    The position of the  salivary glands  is such, that  they are
 much moved and pressed upon  by the  neighbouring  parts in 
504
ORGANS OF DIGESTION.
mastication, independently of the emission of their  fluid being
provoked by hunger.   Owing to the similitude of their struc-
ture, and to their not being regularly supplied like other glands
with capsules, their limits are occasionally so inexactly traced,
that they continue into each other by adjacent points, and form
thus an uninterrupted chain.*
  They all are of the conglomerate kind, or, in other words, con-
sist in a congeries of smaller glands or lobes and lobules. They
are well furnished with arteries; which are branches, from the
external carotid, and go in several trunks instead of in a lead-
ing one.   The parotid is commonly supplied by trunks  coming
directly from the external^carotid, the submaxillary is supplied
from the facial artery, and the sublingual  gland from the lin-
gual artery.  Their nerves come from the fifth pair, and from
the portio dura.
  The retrograde injection of their excretory ducts shows how
the latter are formed by the assembling  of branches from the
different lobules.  These ducts consist of two coats, a  fibrous
one externally, and  a  mucous one internally.
                    CHAPTER  VI.

            OF THE PHARYNX AND CESOPHAGUS.

                 SECT. 1.—OF THE THARYNX.

  The  Pharynx  (Pharynx)  is  a large  membranous cavity,
placed between the cervical vertebrae and the posterior part of
the nose and mouth.   It extends from the base of the cranium
to the lower part  of the cricoid cartilage, or to the_ lower part
of the  fifth cervical vertebra.  It is in contact, behind, with
the vertebrae  and the  muscles lying upon them, being simply
attached there by loose cellular  substance; above, it adheres
to the cuneiform process of the os occipitis, and to the point of
the  petrous portion of the temporal bones; in front, to the pos-
terior part of the  upper and of the lower maxilla near the ter-
* Bichat, Anat. Descrip. vol. v. p. 24. 
THE PHARYNX.
505
mination of their alveolar processes, tothe cornua  of the  os
hyoides, the side  of the thyroid and of the cricoid cartilage;
and below it is continued into the oesophagus.   In consequence
of these several attachments the  pharynx is kept open, or, in
other words, its sides are  prevented from collapsing, and  it is
drawn up  and down in the motions of the tongue and of the
larynx.
  The Pharynx consists in three coats: an external one, formed
by three muscles, on each side,  one above the other, and called
constrictors; an intermediate cellular coat; and an internal mu-
cous one.

  1. The Musculus Constrictor  Pharyngis Inferior, arises from
the' side of the cricoid, and from the whole length of the side  of
the thyroid cartilage.  From these points its fibres diverge  to
the middle vertical line on the back of the pharynx, where they
join  with  their congeners of the  opposite side.   The lower
fibres are nearly if not completely horizontal, and  those above
increase successively in their  obliquity upwards, so  that the
upper ones are extremely oblique,  and reach, at their termina-
tion, to within twelve or fourteen lines of the upper part of the
pharynx.

  2. The Constrictor Pharyngis Medius,  arises from the cornu
and appendix of the os hyoides, and from the ligament connect-
ing the  posterior end of the latter with the upper cornu of the
thyroid cartilage.   Its inferior margin is overlapped by the su-
perior margin of  the last; its fibres there are  also  horizontal,
and, indeed, somewhat convex downwards; while the superior
fibres become successively more oblique  in ascending.  It  is
inserted by the middle line behind, into its fellow of  the oppo-
site side, and by its point above into the cuneiform process  of
the os occipitis, just in advance of the recti majores muscles.

  P. The Constrictor Pharyngis  Superior, arises from the ptery-
goid processes of  the sphenoid  bone, at  their lower  end;  and
below them from the back part  of the upper and under jaws be-
hind the last molar teeth, it is  also connected at its anterior
margin with the  buccinator  muscle, and with  the  root of the
tongue between the anterior and the  posterior half arches  of
  Vol. I.—43 
506
ORGANS OF DIGESTION.
the palate, being blended there with the transverse fasciculus of
the stylo-glossus muscle.   It  has its lower edge overlapped by
the constrictor medius; and its fibres are more horizontal, ge-
nerally, than those of the preceding muscles.  It is inserted
into its fellow by a middle  line, the upper end of which adheres
to the  cuneiform  process  of the  os occipitis.   The  superior
margin of this muscle between the pterygoid process of the
sphenoid, and the  cuneiform process  of the occipital makes  a
crescentic line, the concavity of which is upwards.

  The constrictor muscles of the pharynx, by their successive
contraction, convey the  food from the mouth into the  oeso-
phagus.

  The Stylo-Pharyngeus,  which is mentioned among the  mus-
cles of the  neck,  forms an interesting portion of the structure
of the pharynx, and may be considered on a footing with the
longitudinal fibres of the oesophagus and of the intestines; being
intended to shorten the pharynx by arising from, or having  a
fixed point at the styloid process  above,  and by being joined
into the pharynx below.   Its fibres being first of all on the out-
side of the  upper constrictor, are readily traced between the
lining membrane and the two lower constrictors to the poste-
rior margin of the thyroid cartilage; into which, after spread-
ing out considerably, they are finally inserted.

  The intermediate membrane  of the pharynx  is merely con-
densed cellular tissue, which joins the muscular to the mucous
coat.

  The internal or mucous membrane of the pharynx, which
lines the last, is spread uniformly over it; the only irregularity
of  its surface being made by the presence of mucous follicles
and glands,  which are more abundant above between the pos-
terior margins of the two stylo-pharyngei than below.   It is
covered by a very delicate epidermis, and is supplied with two
arteries on  each side, the superior and inferior pharyngeal, the
first of which comes  from the internal maxillary, and the se-
cond from the external carotid.  It exhibits a number of  small
veins,  which run into  the  internal  jugular or some of  its
branches. 
03S0PHAGUS.
507
  The shape of the cavity of the pharynx is oblong and cylin-
drical, being somewhat larger at its superior end;  at the latter
place, where it is attached to the petrous bone, it presents  a
deep corner, which gives it a square appearance there, and has
a collection  of muciparous follicles somewhat  like  the tonsil
gland.  Anteriorly, and above, it is continuous with the Eusta-
chian tubes, and with the posterior nares; just below this,  with
the fauces and mouth, and  below the  root  of  the  tongue  with
the cavity of the glottis or larynx.   At its lower extremity,
where it terminates in the oesophagus, it is so  contracted as to
suit the size of the latter cavity.


                SECT. II.--OF THE CESOPHAGUS.

   The oesophagus is the tube just in front of the spine and be-
hind the trachea, which conducts  food from the pharynx into
the stomach.   When inflated it is of a cylindrical  shape, about
ten or twelve lines in diameter: it is nine  or ten  inches  long,
and gradually increases in its size from above downwards: in
its state of repose  it is flattened from before backwards.  Its
descent is  not entirely vertical, but  at  the lower part of the
neck it inclines somewhat  to the left of the  middle line, and is,
therefore, rather to the left side of the trachea  than behind it.
 It passes down the thorax  in the posterior  mediastinum, being
 bounded on its left side by the aorta, and on the right by the
 vena azygos.  It keeps during the early part of its course in
this cavity, in front of the middle line of the  spine; but lower
 down it inclines again slightly to the left side, in  front of the
 aorta, in order to reach the oesophageal orifice of the diaphragm,
 through which it penetrates into the abdomen.  In all this pas-
 sage the oesophagus is united to adjacent parts  by a loose cel-
 lular tissue.
   The oesophagus is  composed of three coats:  the  muscular;
 the cellular or nervous; and the mucous.

   The muscular coat is the external, and very strong.  It con-
 sists in two well marked laminae of muscular fibres.   The most
 exterior is the thickest, and goes, longitudinally, from one end
 to the  other  of the tube;  commencing,  according  to  J.  F.
 Meckel, by three fasciculi above; one of  which  arises,  tendi- 
508
ORGANS OF DIGESTION.
nously, from the posterior face of the cricoid cartilage, and the
other two, one on each  side, from the inferior constrictor of
the pharynx.  These fasciculi descend for an inch or two be-
fore they spread out into  a  uniform membrane.  The internal
muscular lamina consists in  circular fibres, which may be con-
sidered as a  continuation of the lower margin of the inferior
constrictor of the pharynx, and are either horizontal or slightly
spiral; they are rather deficient on the fore part of the oeso-
phagus for an inch  at its  superior extremity.  Individually,
their length is short of the circumference of the oesophagus.

   The cellular coat is next  in  order, and serves to unite  the
muscular and the  mucous together.   It  adheres much more
closely to the latter than it does  to the former, has no adipose
matter in it, but is found to be abundantly furnished, more par-
ticularly towards its upper end, with small muciparous glands;
it  also serves  to transmit the blood vessels through the struc-
ture of the oesophagus.

   The mucous coat of the oesophagus is the most internal; in
the  undistended state it  always  presents many longitudinal
folds, going from one end to the other, but sometimes  blending
with each other, owing to the contraction of the circular mus-
cular fibres.   When suspended in water its fine villous ap-
pearance is very perceptible, as  well as the  mucous lacunae or
glands which  open upon its internal surface.  As it is a conti-
nuation of the mucous membrane of the  pharynx, it  has the
same general appearance, but is  rather whiter.   Its internal
surface is also covered by a  delicate  epidermis, which ceases
at the  cardiac orifice of  the  stomach, and  may be raised in
shreds by maceration and  by boiling; in some  pathological
conditions this epidermis  becomes very  distinct  by acquiring
more thickness and solidity, than what belong  to  its healthy
state.

   The arteries of the oesophagus are derived from the inferior
thyroidal, from the  thoracic aorta, and from the  gastric.   Its
nerves come principally  from the pneumogastric.
END OF VOL. I. 
INDEX  TO  VOL.  I.
			Page
Abdominal Fascia, -	-	-	383
Abdomen, Muscles of, -			383
Abductor Pollicis Pedis,	-	-	462
Abductor Min. Digit. Pedis,			463
Abductor Pollicis Manus,	-	.	431
Abductor Indicis,			432
Abductor Min. Digit.,	-	-	433
Adductor Pollicis Pedis,			462
Adductor Metacarpi Min. Digiti,	-	-	433
Adductores Femoris,			445
Adductor Pollicis Manus,	-	-	432
Alimentary Canal,			467
Alveolar Processes,	-	-	474
Americans, -	-	-	177
Annuli Junct. Ligamentosi,	-	-	424
Anconeus, -		-	419
Ankle Joint, - - -	-	-	309
Ankle, Ligament of,	-		440
Aponeurosis Plantaris,	-	-	441
Aponeurosis Palmaris, -			413
Arm, Muscles of,		-	420
Articulations, -	-	-	251
Articular Cartilages,	-	-	255
Articulation of Wrist,			291
Articulation, Sterno-Clavicular,	-	-	283
Astragalus, -			225
Auricularis,	-	-	428
.	-	50
Composition of,	-	56
Carpal,	-	193
Growth of,		71
Individual,	-	77
Texture of, -		52
Vascularity of,	-	61
sFlexor Cubiti,		416
Vol. I.—44 
510                         INDEX.

                                                           Page
                                                           451
Biceps Flexor Cruris, -                                .286
Bicorn Ligament, -      -                                  g2Q
Bordeu,        -                                       -418
                                                           423
                                                           368
Brachialis Internus,
Bursa of Fingers,
Buccinator,  -
                                                            74
Callus, -                                              -     112
Cartilages of Ribs,  -       -                                  gg
Carpus,       -       -                                _     174
Caucasian Race,    -                                        051
Cartilages,    -                                            253
Cartilages, Accidental,     -                                 223
Calcis,  -                                                   oil
Calcaneo-Scaphoid Ligament,                                 »

                                                           312
                                                            80
                                                           317
                                                           323
Carpal Articulation,
Calcaneo-Cuboid Ligament
Cervical Vertebrae,
Cellular Substance, -
Cellular Atmosphere,   -       -                             ^*
Cervicalis Descendens,     -
Clavicle,      -                                             go
Coccyx,          -                                        274
Coccygeal Ligament,   -       -
Compressor Naris, -       -
Complexus,    -      -                                    2gg
Conoid Ligament,  -       -                                 2g6
Coracoid Ligament,    -                                    g66
Corrugator Supercilii,
Coraco-Brachialis,
Costo-Clavicular Ligament,
                                                           417
                                                           284
                                                           299
Cotyloid Ligament,     -                                    122
Cranium,   -                                               jgg
Cranium, Internal Face of,     -                              ggg
Cremaster,         -                               _        444
Crurseus,  -                                           _     3q4
Crucial Ligaments,         -                                 22g
Cuboides,      -                                      _     227
Cuneiform Bones,          -                                 ggg
Cutis Vera,     -       -                               _     gg2
Cutis Anserina,     -                                        ggg
Cuticula,       -       *                               _     gg5
Cyanosis,  -
Development of Skeleton,      -       -                       °'
Dermoid Covering,         -       -                          (j
Depressor Labii Sup., -                                     »"'
Depressor Anguli Oris,    ....            do/
Depressor Labii lnferioris,      - 
INDEX.
511
                                                            Page
Deltoides,          -       -       -       -       -       -     414
Dental Cartilage,       ....       -        483
Dental Glands,     ------     484
Dentition,      ------        484
Dentition, Irregularities of  -      -       -       -       -     490
Diaphysis,     ------         52
Diploe,     -       -        -       -       -       -       -     156
Digastricus,    -       -       -       -       -       -        376
Diaphragm,        ------     394
Digestion, Organs of,   -       -       -       -       -       467
Dorsal Vertebrae,           -----      84
Dutrochet,     ------        333

Elbow Joint,       ------     288
Elain,  -------        326
Enamel,    ------            474
Epiphyses,    -----                 52
Epidermis,  -------     336
Ethmoides,    -       -       -       -       -       "         135
External Cellular Tissue,   -----     320
Extensor Carp. Rad. Long.,    -                               426
         Brev. Digit.  Pedis,       -       -       -      -     460
         Carpi Ulnaris,       ...       -        427
         Carp. Rad. Brev.,        -       -       -       -    426
         Digit. Com.,  -----         428
         Long. Digit Pedis,      ....    453
         Metacarpi Pollicis,   -       -       -       -         428
         Pollicis Minor, et Major,  -       -       -       -    429
         Prop. Poll. Pedis,     -                              454
Facial Angle,      -       -       -      -       -      -     172
Face,.......138, 169
Fat,       -                     -      -       -      -     325
Fascia Superficialis Colli,      -       -       -       -         371
Fascia Superficialis Abdominis,     ...      -     383
Fascia Profunda Colli,  -----         373
Fascia Transversalis,       ....      -     390
Fascia Iliaca,   ------         339
Fasciae of Lower Extrem.,  -----     436
Fasciae of Upper Extrem.,     -       -       -       -         411
Fascia Lata,       ------     436
Fasciae of Foot,        -----         446
Fascia Cruralis,    ------     439
Femoral Bone,  ------         213
Fibro-Cartilage,    ------     256
Fibula,         ------         220
Finger Joints,      ------     298
Fingers,       ------         199
Flexor Carpi Radialis,      -       -      -       -      -     420
Flexor Carpi Ulnaris,  -----         421 
512
INDEX.
                                                           Page
Flexor Digitorum Subl.,   -----    422
Flexor Digit. Profund., -----        422
Flexor Brev. Poll. Manus, -   ,    -       -       -      -    432
Flexor Parv. Min. Digit.,      -_      -      -       -        433
Flexor Long. Digiti Pedis, -----    458
Flexor Long. Poll. Pedis,      ...       -        459
Flexor Brev. Digit. Pedis,         ....    461
Flexor Brev. Poll. Pedis,      -                             462
Flexor Min. Digit. Pedis,  -----    463
Flexor Accessorius,            -      -      -       -        461
Flexor Pollicis Longus,    ....      -    423
Foot, Motions of,                                           244
Foot, Bones of,    -      -       -       -       -      -    223
Foot, Muscles  of,                                           460
Foot, Articulations of,      -       -       -       -      -310
Fontanels,      ------        179
Fore Arm,  Motions of,            -       -       -      -    207
Fore Arm,  Muscles of, -      -      -      -       -        420
Fore Arm,-Articulations of,        -       -       -      -    291
Frenulae of Mouth,     -----        470
Frontal Bone,      -       -       -       -              -    124
Gagliardi on Bones,    -----         58
Gaultier,           ...              -       -     333
Gastrocnemius, ------        456
Genio-Hyoideus,   -      -      -       -       -            378
Gemini,        ------        449
Glenoid Ligament, ------     288
Glutaeus Magnus,      -----        447
Glutaeus Minimus, ------     448
Glutaeus Medius,       -----        448
Gracilis,          ------     445
Gums,  -------        478
Hairs,  -      -       -
Half Arches, of Palate,
Hand, Muscles of,
Hand, Motions of,  -
Hand, Bones of,
Head, Development of Foetal,
Head, External Surface of,
Head,
Hey's Ligament,
Hip Joint,
Hunter,-
Humeral Bone,
Hyoides,
344
499
430
210
193
177
161
121
438
299
337
187
181 
INDEX.
513
                                                            Page
Ilium,.......97
Iliacus Internus,       -----        399
Ilio Lumbar Ligament,     -       -.      -      -       -     275
Innominata,    ------         97
Intervertebral Substance,         .. -       -      -       -     266
Inferior Extremities,   -       -       -       -       -        213
Inf. Extremities in Standing,       ...        -    235
Inf. Extremities in Locomotion,        ...   241, 246
Inf. Palmar Ligaments,     .....    297
Inter-Clavicular Ligament,-    ....        283
Integuments,        _..---    317
Internal Cellular Tissue,       ...       -        322
Intercostal Muscles,        ....        -    382
Inter-Trans versarii,    -       -       -       -       -        410
Infra-Spinatus,      -       -       -       - ■      -       -    415
Indicator,      -       -       -  .     -       "               430
Interosseal Lig. of Fore Arm,       ....    290
Interosseous Ligament of Leg,  -       -       -       -        308
Interosseous Muscles of Hand,     .       -       -       -    434
Interosseous Muscles of Foot,  -       -       -               464
Inter-Spinales,      -       -       -       -       "            410
Itinera Dentium,       -----       487
Ischium,   ------             100

Joints,  -------        260


Knee Joint, -------    302


Latissimus Dorsi,          -       -       -       -        -     401
Lateral Lig. of Knee,   -----        304
Lacerti, of Muscles,        -----     350
Leg, Motions of,                                             243
Levator Anguli  Oris,       ....        -     366
Levator Labii Sup.,    -----        366
Levator Labii lnferioris,            ...        -     368
Leg, Muscles of,                                             452
Levator Scapulae,   ------     403
Levatores Costarum,   -----        410
Ligamentous Tissue,       -----     257
Ligaments, Yellow,    .....       269
Ligament. Alare,    ------    307
Ligament. Mucosum,   -       -       -       -       -        307
Lig. Carpi Volare,         -       -       -       *        -413
Lig. Carpi Dorsale,    -      -       -       -       -       412
Ligamenta Vaginalis,       .....    424
Lips,.......470
Little  Toe, Muscles of,                                       463
Longus Colli,   ------        378
Longissimus Dorsi,        ...      -            405
                               44* 
514
INDEX.
Lower Jaw, Articulations of,    -       -      -       -        263
Lower Extremities, Joints of,                                 299
Lumbar Vertebrae,     -----          85
Lumbricales Pedis,        -      -       -       -      -    461
Lumbricales,   -      -       -       -      -       -        431
Malar Bones,   -       -       -      -      -       -         144
Maxillare Inferius,  -      -       -       -       -      -146
Maxillare Superius,     -       -      -      -       -         138
Masseter,  -------     369
Medulla,       ------          65
Metacarpal Joints,  ------     295
Metacarpus,    -       -       -      -      -       -         197
Metatarsus,         -      -       -       -       -      -     229
Metatarsal Joints,       -       -      -      -       -         315
Membrana Musculorum,    -----     350
Middle Straight Ligament,      ....         273
Moderator Ligament,       .....     272
Mongolian Race,        -       -      -      -       -         174
Mouth,     .......     469
Mouth, Glands of,     -----        -         500
Muciparous Glands,        -                                   500
Multifidus Spinae,       -----         408
Muscles, General Anatomy of,      -       -       -      -     349
Muscles of the Back,   -----         400
Muscular Fibre,     -       -       -       -       -      -351
Muscular Motion,      -----         355
Mylo-Hyoideus,    ------     377


Nasal Bones,   ------         142
Nails,      -------     342
Negroes,    __-       -       -      -      -       ••         174
Nose,      -       -       -       -       -       -      -     165
Obliquus Ext. Abdominis,     ....        385
Obliquus Int. Abdominis,  -----    386
Obliquus Capitis,      -                                      409
Obturator Ligament,       -       -       -       -       -    277
Obturator Externus,           ...               450
Obturator Internus,  -       -              -                   449
Occipito Vertebral Articulation,        ...        270
Occiput,         -       -       -       -       -            127
Occipito-Frontalis,     -----       363
Omo-Hyoideus,  ------    376
Opponens Pollicis,     -      -       -       -      -        431
Orbits,    -      -       -       -       -       -       -    167
Orbicularis Oris,       -                                      369
Orbicularis Palpebrarum,  -       -       -       -            365
Orbicular Ligament,    .....        289 
INDEX.	515
	Page
Ossification,	. . 68
Osteogeny, ....	67
Osseous Part of Teeth,	475
(Esophagus, . - . .	507
Ossa Longa, Lata, Crassa, .	51
Palmaris Longus,	421
Palate, Soft, ....	498
Palmaris Brevis,	430
Palate, Muscles of,	499
Palate Bones,	140
Papillae of Tongue,	496
Papillae Tactus,	230
Parotid Gland, ....	501
Parietal Bone,	126
Patella, ....	220
Patella, Ligaments of,	303
Pectoralis Major,	380
Pectoralis Minor,	381
Pectinalis, . .	445"
Pectineal Fascia,	438
Pelvis, Ligaments of, .	274
Pelvis, ....	102
Development of, .	105
Mechanism of,	106
Male and Female,	103
Pelvic Vertebrae,	86
Periosteum Externum, .	63
Periosteum Internum,	65
Perichondrium, ....	254
Periglottis, ....	496
Peroneo-Tibial Articulations,	307
Peroneus Brevis,	455
Peroneus Longus,	455
Peroneus Tertius,	454
Pharynx, Muscles of, .	505
Pharynx, ....	504
Phalanges of Hand,	199
Phalangial Articulations,	298
Platysma Myodes Muscle,	372
Plica Polonica,	348
Plantaris, ....	457
Posterior Ligaments of Knee,	303
Popliteus, . .	457
Pronator Quadratus	425
Pronator Radii Teres, .	420
Psoas Magnus,	398
Psoas Parvus, . . . •	398
Pterygoideus Internus,	371
 
 516                         INDEX.

                                                           Page
 Pterygoideus Externus,        ...       -        370
 Pubic Ligament,    ------    278
 Pulp of Tooth, ------        480
 Pubes,     ------            99
 Pyriformis,    ------        448
 Pyramidalis,       ------    388

 Quadratus Femoris,    -----        450
 Quadratus Lumborum,      -----    397

 Radio-Carpal Articulation,      ...       -        292
 Radio-Ulnar Articulation,   -       -       -       -      -    291
 Radius,-       ------        191
 Rectus Abdominis,  ------    388
 Rectus Capitis,        -----        379
 Rectus Capitis Posticus,    -----    409
 Rectus Femoris,  -    -      -       -      -       -,        442
 Rete Mucosum,    -       -       -       -       -      -    332
 Rhomboideus Major,   -      -       -      -       -        403
 Rhomboideus Minor,       -       -       -       -      -    403
 Ribs,.......107
 Ribs, Articulation of,       ....      -    278
 Round Ligament,       -                                    300

 Sacrum,    -      -       -    .   -       -       -      -      86
 Sacro-Iliac Ligament,   -----        276
 Sacro-Spinous Ligament,   -       -       -       -       -     275
 Sacro-Lumbalis,        -----        404
 Sacciform Ligament,       -       -       -       -       -     310
 Salivary Glands,       -      -       -      -       -        501
 Sartorius,   -------     442
 Scalenus Anticus,      ....      -       #379
 Scalenus Medius,   ------     379
 Scalenus Posticus,     -----        380
 Scaphoides,        -       -       -       -       -       -226
 Scapula,       -      -       -       -       -      -        183
 Scarpa on Bones,   ------      60
 Scapulo-Humeral Joint,        ....        287
 Sciatic Ligament,   -      -      -       -       -       -     276
 Sesamoid Bones,      -----   201, 233
Semi-Lunar Cartilages,      -----     305
Semilunare,    -      -       -       -              -        194
Sebaceous Organs, ------     340
Serosity,      ------        324
Semi-spinalis Cervicis,     -                                 407
Semi-spinalis Dorsi,    -----        408
Semi-membranosus,        -----     452
Semi-tendinosus,      -       -       -       -      -        451
Sella Turcica,      ......     159 
INDEX.
517
Temporal Bone,
Thorax,
                                                           Page
Serratus Magnus,      .....        382
Serratus Inferior Posticus,  -----     402
Serratus Superior Posticus,    ...      -        403
Shoulder,  -      -       -       -       -      -       -     182
Shoulder, Articulations of,                                    283
Shape of Muscles,         -                                  259
Shoulder, Motions of,  -      -       -       -      -        204
Shoulder, Muscles of,      -       -       -      -       -     414
Skin,    -       -       -       -       -      -      -      328
Skeleton, Anatomy of,  -                                      49
Soleus,      -------     456
Sphenoides,     ------          133
Spinalis Dorsi,  ------        405
Spine,      -------      78
Spine, Uses of, -      -      -       -       -       -        190
Spine, Ligaments of,       ....       -     2bo
Splenius,......404
Spongiosum Inferius,      ....       -     145
Stearin, -------        326
Stenos Duct,        -      -       -      -      -       "     ? 7
Sternum,      -      -      -       -       -   .  "        ***
Sterno-Cleido Mastoideus,  -----     372
Sterno-Hyoideus,      ....      -        375
Sterno-Thyroideus,       -----      375
Stylo-Glossus,      ------     377
Stylo-Pharyngeus,     -----        377
Stylo-Maxillary Ligament,  -       -       -       -       -     264
Subscapularis,   -      -      -       -        -       -        41o
Subclavius,  -            -       -       -       -       -    . 382
Sublingual Gland,     -                                     503
Submaxillary Gland,      -  -            -       -       -     502
Supinator Rad. Long., -----        425
Supinator Rad. Brev.,      ....       -     428
Supra Spinatus,       -       -       -       -      -        415
Sutures, Formation of,     -       -       -       »       -     154
Sutures, Uses of,                                            15?
Sutures,    -        -      -       -       -       -       -     149
Symphysis Pubis,     -                                     2^7
Synovial Capsules,        ...       -       -     261
130
107
Articulations of,             -                          27^
Development of,         -       -      -               JJ^
Triquetra,
*_,V , V-.wj^---~    ,                                       lift
Mechanism of,                                        *-y:
                                                     lOy 
518
INDEX.
	Page
Tarsus, -	223
Tarso-Metatarsal Articulation, -	314
Teeth, -----	471
Formation of, -	479
Temporalis, ....	370
Tendons, -	360
Teres Major, -	416
Teres Minor, - - - -	415
Tensor Vaginae, -	442
Thumb, Articulations of,	298
Thyreo-Hyoideus Muscle, -	375
Thigh, Motions of, -	241
Muscles of, -	442
Tibia, -----	. 217
Tibialis Posticus, - - - -	459
Tibialis Anticus,	453
Toes, Bones of, -	232
Joints of, -	315
Tongue, ....	493
Mucous Covering of,	495
Muscles of, -	493
Trachelo Mastoideus,	407
Transversalis Abdominis,	387
Transversalis Cervicis, -	406
Transversalis Pedis,	463
Transverse Ligament, -	272
Trapezoid Lig., ....	285
Trapezium, . . . -	194
Trapezius, ...	401
Triceps Extensor Cubiti,	419
Triceps Surae,	456
Triangularis Sterni,	383
Triangular Lig.,	286
Trunk, ....	78
Muscles of, ...	'* - 400
Ulna,      -       -      -      -      -       -            189
Unguis,        -       -       -       -      -      -        143
Upper Extremities,        -      -      -       -       -    182
                 Articulations of,     -      -      -        283
                 Development of,       ...     201
                 Mechanism of,       -       -       -       202
                 Muscles of,     -      -       -       -    411
Vastus Externus,       ....       -        443
Vastus Internus,    ------    443
Vertebrse,      ------         78
        Development of,  -      -       -       -       -     89
        Motions of,  -       -       -       -       - •        93 
INDEX.
519
Vertebral Ligaments,
Vincula Accessoria,
Vomer,
Page
 266
 425
 146
Wrist, Articulations of, -
291
Zygomaticus Minor,
Zygomaticus Major,
367
367
H~KK}y 
■/ H06 
 
NLM032045769