Lectures on Anatomy &c. by Messrs. Blizard & Orange at the London Hospital. 1791.  1 Jany. 20th.. 1791. Mr. Blizard this day read over his introductory Lecture, in which he considered the ancient Method of practising Physic & Surgery as very vague & uncertain; The knowledge of the human frame, being but little understood, at that time, because scarcely any thing but Animals were dissected, whose various parts perform different functions, from the same parts in the human Subject, which should be attended to in practice, so as not to confound the one with the other. He next considered Anatomy, as the Groundwork of Physic, observing that the Healing Art is divided into 2 parts, Physic & Surgery, The former of which comprehends all internal Cures &c. The latter 2. all the manuel & operative part. &c That these 2 should be join'd together, & that tho they were different, it was difficult to detirmine the just bounds of each, for that the Physician & Surgeon often indiscriminately trespassed on each other; tho' he said this was to be excused, when the motives were good, & from a desire of prolonging the life of a Fellow Creature; tho' he regretted this was often otherwise the Case. He on account of the utility of this Science justly rank'd it before any other; He also esteemed it the most ancient of any, tho', says he, before, Luxury Dissipation were introduced among the primitive Inhabitants of this Globe, Deseases, were little known, wherefore little need of Remedies. ~ He said that when Man first began to Congregate & assemble together in Towns, Villages &c. they 3. then began to make distinctions of Men, such as Priests, Legislators, Warriors, Magistrates &c. & as these were generally very publick Characters, if they had performed their various functions during Life with applause &c. the Love the People bore them, shew'd itself after Death, by endeavouring to preserve their Remains by embalming the Body. The first publick Mention of which we have in the Old Testament concerning Jacob, who was embalmed by his own Physicians in Egypt: Surely, says he, this could not have been the 1st.. time of it's being employ'd &c. He then went in to remark that a Surgeon; was not one who understood the perfect management of a Knife, but one who understood the various parts of the Body, with all their Uses, & when an Operation was 4. absolutely necessary. ~ He next observed that We had made greater advances in Surgery within this Century or two, than for near 2 or 3000 Years before; Our knowledge of the Lacteals; Receptaculum Chyli; Thoracic Duct, & principally to Circulation of the blood, discovered by our illustrious Countryman Dr. Harvey, which Discovery would forever immortalize his Name. &c. He then finished his Lecture by stating how this Course would be conducted &c. _ Jany. 28th. Mr. Blizard this day explained some of the definitions given in his little Remembrance ~ The first Definition respects, Animal Matter, considered by him 5 him, as, "Vegetable Matter, modified by the moving powers; neither Acid nor Alkaline; possessing a principle of Vitality." & he then observes in the Words of Scripture "All flesh is Grass." Which he attempts to prove by saying, that Carnivorous Animals which prey on others, & are again preyd on themselves; it will be found (if you examine still higher), that some one Creature feeds upon the Grass & herbage, & ) that therefore these Carnivorous Animals do receive their Sustenance from the same, "vegetable matter modified &c. ~ His 2nd. Definition respects, Life, by him considered as, "The existence of the Vital principle in Animal Matter, either actively or latently, as relative to the moving powers." _ In Blood is the Life of Man." - - 6 This Vital Principle, he imagines a subtil, aerial, something, either active or latent &c. that is when the functions of the moving powers are imperceptible &c. 3rd. Definition _ Death _ "The Destruction or Deprivation of the Vital Principle." People &c. are not alway dead when supposed to be so, as in the Case of Drowning, the Vital principle in that Case being latent, not extinct. 4th: - Putrefaction - "The Natural Decomposition of Animal Matter after Death." When the Vital principle is entirely extinct, the Core which each particle of the various Components bears to it's like; occasions this Decomposition of parts; that they may thereby more readily combine &c. _ 7 5th. Constituents of dead Animal Matter. "Putrefaction, & Analysis by Fire, prove that Animal Matter is compounded of watery, earthy, saline, aerial, inflammable, & metallic, Matter; but affords no Information respecting these parts in their State of Union with the Vital principle" 6th.. Solids ~ "Animal Matter, whose earthy part, bears a relatively large proportion to the other Constituents." ~ 7th. Fluids ~ "Animal Matter whose wat'ry part bears a relatively ~ large proportion to the other Constituents" ~ _ 8th. Seats of the Fluids & Solids ~ "Vessels, Cavities, & Cells,"~ He obser- that he divided it into 3; more for the sake of perspicuity than any other Cause; for that Cavities & Cells, were in fact the same thing. 8 9th. Anatomy ~ "The Art of dividing & examining the parts of Animals, to ascertain their Structure, Situation & relative Connection; divided into Human & Comparative." 10th. Physiology. "The Science of the Functions of the Animal Organs" 11th. Pathology. "The Science of the Seats of Diseases, & the Nature of the Changes of the Structure & functions of the Animal Organs in Diseases." - 12th.. Surgery, "The Science & Art of salutarily actuating the moving powers, & manually obviating & removing obstacles in the treatment of Diseases assigned to it's Aid." - He then made a few Observations, respecting these several Heads & finished his 2nd. Lecture. - 9 Jany. 29th. Mr. Orange continued the explanation of the Definitions. 1st. Blood. "Proper Animal Matter, from various proportions of the Constituents of which, all the parts are formed & supported, & into which they are returned" ~ Nutrition may be considered as a Secretion, We are constantly receiving a supply from the Blood & are as constantly losing by Absorption; If it were not so, we should be constantly increasing in Bulk. It is the Blood which affords the Nutritive parts, & which is the Vehicle by which they are returned. ~ The Arteries deposit; & the Absorbents take away &c. The Cellular Substance is full of a fluid, which if seperated too fast, or if the Absorbents are weak 10. A Dropsy is the Consequence. 2nd. Spontaneous Separation of the Blood without Putrefaction. "Serum, Crassamentum & Coagulable Lymph, or Gluten ~ The various Constituents of Animal matter are destinguished by Putrefaction &c. _ 3rd. Gluten. "The proper Matrix for Vessels, &c. to which also they are properly formed; & indeed no part is properly form'd without it. Granulations on the Surface of Sores, is at first nothing but this Gluten, of a pale Colour, at length turning red & becoming Vascular, on which the Vessels elongate themselves; but if this Gluten is constantly removed, no Granulation will take place. 4th. Secretion. "A Separation & Determination" of Character of something from the blood." _ performed by the means of those bodies termed Glands; as the Salivary, for Saliva, Kidnies for Urine. &c. _ 5th. Secreted Matter. _ "Whatever is put out of the sanguiferous System of Vessels." as the various kinds of fat, Bile, &c. &c. 6th.. Nutrition. "The Secretion of the proper Constituents of a part." That Matter which is taken into the Stomach, forms the principle of Nutrition called Chyle &c. & whenever any part is removed, it must be renewed by the Constituents proper thereto. ~ 7th. Fibre. "An imaginary Line, consisting of points of Animal Matter." 12. It is an imaginary Line &c. But a bundle of them may be separated almost ad Infinitum. An Animal Line is; points, laying by each other, till their length exceeds their breadth &c. _ 8th. Elasticity. "The Sphere & power of Attraction of particles of Matter, after a Degree of Separation." Cohesive Attraction, is that which two bodies possess when at a certain distance from each other. &c. The Sphere of Attraction is that space allowed between the 2 ends &c of a body within which space is stretched, they would retract into their place, but beyond would break &c &c. _ 9th Membrane. "A Collection of fibres, whose Breadth, greatly exceeds it's 13. it's Thickness; of a pale Colour; elastic; has 2 Surfaces, one finely polished, the other Cellular." A Cloth may be compared to a membrane, &c. No Membrane in the body but what is Composed of fibres; They are very vascular, but are not supplied with the Crassamentum or Red part of the blood. The Tunica Conjunctiva of the Eye, in an Inflammation of that part, we see, receives red globules; they are elastic, as we see of the peritoneum in Ascites. Have 2 Surfaces, One finely polished; (this is alway next those parts contained within them &c.) & is the secreting Surface, has innumerable orifices, which if the secretion is too quick, causes Dropsy. 14 The other; is cellular, & is external, easily adhering to the surrounding parts. &c. 10th.. Cellular Substance. "Small portions of Membrane; connected so as to form communicating Cells." This we see, by passing a Blowpipe, into the Cellular Substance, & by blowing, the Wind will inflate all the Cells; It is by some, destinguished into Reticular & adipose but this is a wrong Idea. It is of great use; being an universal connecting Medium _ It connects, the fibres of Muscles, & smallest particle of bone; The Lungs, are chiefly formed of it, & it is elastic, giving us that Springiness, which we possess. 15. 11th. Valve. "A Duplicated membranous production, formed in Tubes & Cavities to assist in the determination of their Contents." A Vessel is Cylindrical Membrane. ~ A valve, is a Duplicature of this Membrane, it lays in the Direction of the fluid contain'd in the Vessel, urging it forward, & obstructing its Return ~ 12th.. Artery. "Muscular, membranous, strongly elastic, originates in one of the Ventricles of the Heart, terminates in secerning & Venal Extremities." _ These are elastic in every Direction. ~ When small ones are cut they retract, & are compressed by the Muscles in which they bury themselves; but those that are superficially placed, or on bone &c. 16 upon being cut, are followed by an Hœmorrhage. ~ The Heart as we shall hereafter consider is divided into 2 Sides, wh. are subdivided into Ventricle & Auricle. All the Veins of the Body empty themselves into the 2 Auricles, & the Blood is expelled from the Heart by the Ventricles. into those Tubes termed Arteries, which terminate either in Veins, open, or secerning Extremities, & Cavities, (this last is seldom the Case: ~ These open Extremities are discovered by Means of a very subtil red Injection, of Turpentine & Vermillion, &c. &c 17. Jany. 31st. Mr Blizard considered the Nature of Nerve, with it's Application & Uses. ~ Some Creatures have no Brain, & may therefore be considered as a Link in the great Chain of Nature between Animals, & Vegetables. There is somewhat answering to Sensation in them & we may even say in Vegetables. Without Brain we should be void of intellectual Sense &c. There are parts in us capable of Sensability, which have a Connection with the Brain, the Seat of the Mind. This Mass termed Brain, as we shall hereafter consider is lodged in the Skull. ~ We shall now define a Nerve. "Loosely fibrous of a soft whiteness, flexible; proceed from the Brain, Spinal Marrow, or a Ganglion, terminates in a Muscle or Organ of Sense." _ Loosely fibrous _ ~ It is not so close, but it. 18. it may divided. ~ Of a soft whiteness ~ It is of a milky appearance, & has not that shining blueish whiteness peculiar to a Tendon. It is very flexible. proceeds from the Brain, Spi. Mar: or Ganglion. Anatomically speaking, every Nerve is in a distinct form in the Brain ~ A Ganglion is a Collection of Nerves, highly organized, & connected by Cellular Substance. & they terminate either in Muscle, or Organ of Sense. All the Muscles we know, are nothing to those we are authorized to suppose we know nothing about. ~ ~ Nerves are the Means by wh. all Sensation is produced. Violence done to a Nerve, produces pain; & if an Impression be made on a Muscle, in which a Nerve is 19 produced, A Change will take place. Organs of Sense belong only to Animals with Brain. Where & whenever Muscles are applied, Nerves must be applied, Ergo, there is universal Sensation. We should here with Abruptness, draw the Line, & honestly confess that beyond this, we know nothing, & when we consider Muscle, how much we are in the Dark respecting Muscular Motion. Nerves however small they may be, may still be divided, ad infinitum. A Nerve may be considered as a Tree, Its roots in the Brain, & the Branches ramefying into all parts of the body. From this Idea, A person would say a Compression of the brain, would affect the Nerves, & vice versa. - 20. Organs of Sense are disposed to receive Impressions & propagate to the brain. Delight, Pleasure &c. are all subordinate to 3 great points, Support, Procreation & The Brain may be considered as a Medium between the Organs of Sense, & moving powers, to receive impressions from one, & to propagate Volition to the other. Every moving power is constructed to receive Impressions: & therefore in one general View, we may consider the whole Body as, an Organ of Sense. There are 2 Theories respecting the Nerves - The first is taken from the Idea of Vibration; it being imagined that a touch at one End of a Nerve will cause a Vibration to the Brain. The other is, that the Nerve is round & tubular, & fill'd, with 21. a subtil ætherial fluid, which if a part be touched it is altogether mov'd up towards the Brain. In respect to the first, There is no Nerve in the Body so tense as to propogate Sound; & even if there was, the Sound would be arested by the intervening Solids; & as to the latter, as this fluid has never been discovered, it seems very improbable. Nature of Impression. There is an inherent power in parts to change, according as they may be affected by the 3 great Causes mentioned. Each part is framed to perform various functions from each other from different Causes; The Eye from Light: The Nose from odorous particles &c. &c. & the Muscles from various Causes from which primarily they 22. were intended to receive them. But if these various Causes convey too strong an Impression, they will destroy the parts, they were intended to serve, & if too weak, will be inadaquate to the Task assigned them, Tho Custom will render both, proper. _ Feby. 1st. 1791. Mr. Orange considered the Structure & formation of bone. "A Collection of the 3 Species of Vessels, & Earthy Matter in Cellular Substance, constituting an inflexible body" Tho' this is termed inflexible, yet a bony fibre is, when separated, flexible. Bone is then a Secretion of Earth Matter in 23 an highly subtil State, floating in the Blood. We have before observ'd that the Gluten of the Blood seem'd the proper Matrix for Vessels to elongate themselves in &c. Tis a Collection of this Gluten which we perceive as the very first Rudiments of the future bone. (In a Compound fracture, the Stimulus throws out a great Quantity of this Gluten which becomes a Matrix for the Elongation of Vessels. If a Woman is pregnant & has a fracture, You will find, that it will not heal till after her Delivery, as the Gluten goes to the formation of the Infant, which would otherwise be determined to the fracture.) At length it becomes organised, & the earthy Matter begins to seperate from the Blood. ~ Every bone is 24. is fibrous, Connected throughout by Cellular Substance. Bones are Vascular, shewn clearly by Injections & feeding Animals with Madder, discovered by Mr. Belcherd. They are also Lamellated proved by destroying the soft parts by fire, or exposing to the Air ~ In long bones, the fibres shoot slanting from the middle to the Circumference; but in broad ones, from several middle central points, ~ Some have imagined that the bones (which when Young are in a Cartilaginous state) have been transmuted into bone, which is a wrong Idea; The Cartilage being reabsorbed, & earthy matter deposited. ~ Exfoliation is divided into 3 kinds; A spongy or powdry one; 2nd. Of Lamella or Plates: 3rd. of fibres; ~ There is 25 a 4th. Sort of Exfoliation, which takes place after Amputation. _ The Idea of Exfoliation seems to be, that Granulations taking place beneath the unsound part, it is pushed off; but the Truth is the Absorbents take away a portion all round & as it were the bad becomes insulated, Granulation then takes place, & the bad part sloughs off. - We must never remove a portion of bone, till Exfoliation takes place, but this done, You should assist Nature in throwing it off, who now considers it as foreign & extraneous. There must be a more than ordinary Exertion of the Heart & Vascular System for the formation of bone. Away to prove the Vascularity of bone, is by immersing it in any diluted Acid, which takes away the earthy part of the bone: ~ 26. It has been doubted whether bones [have sensitivity], They certainly have, tho' their great Quantity of earthy matter, prevents their Sensibility ~ The Granulations of bone are extremely sensible, which would not be, did not the Nerves in the bone elongate themselves. Cancelli ~ Are formed by the recession of the internal fibres of the bone from each other, which having no Resistance internally press that way; the Consequence is, the bone becomes thinner & thinner, at its extremities; so that a Disease of this part would soon penetrate the Cancelli, tho' in the middle of the bone, many plates may be thrown off without Danger. The Use is to support the Medulla, & they assist in expanding Articular Surfaces &c. &c. _ Heads, 27. of bones & all processes, are originally formed in a state of Epiphis, or Separation, having Cartilage interposed, which is by degrees absorbed. ~ Bones are subject to Inflammation. ~ _ Feby. 2nd.. Mr. Orange considered the Nature &c. of a Gland. ~ "A Congeries of the 3 Species of Vessels & Excretory Duct" The Secretions are performed by means of the open mouth'd Arteries. The remainder of the blood being return'd by the Veins; & in respect to the fluid separated, there are 2 opinions concerning it. ~ Malphigi, imagined that at the end of the Artery, there was a little Cupta or bag, & at the other end of the bag, a small excretory duct commenced, that a No. of these small ones open, into a large one, &c. _ _ Ruysh maintains that there was between the 2 Vessels 28. Vessels, no distinction, but that the one began where the other ended. ~ The Office then of Glands is to secrete from the blood, humours in various parts of the body; these humours being of various qualities & Uses; as, the salivary Glands to promote Digestion; of the Ears, to secrete a bitter acrid wax preventing the admission of Insects; &c. &c. But why the different Glands, secrete various humours, from the same Mass of blood we shall for ever perhaps remain ignorant. Glands are distinguished into Conglobate & Conglomerate; The former being round & supposed to have but one excretory Duct, as the kidney; the other composed of a number of smaller ones, having as many excretory ducts opening 20 into one larger, as, the Pancreas; But there is reason to beleive all Conglobate Glands are of a Conglomerate Nature, (this was shewn in a fœtal kidney) ~ The secreted fluid, however, receives vast Change from the Absorbents _ ~ Disease, Increased Circulation &c causing a distension of the vessels, gives admittance to red Globules of blood, (which in proper health &c. receive only the Gluten,) causing the increased Redness of the Urine &c. The Use of Glands may be rank'd under 2 heads General & particular, ~ General, in respect to their being a balance, between the Solids & fluids. We should have a Plethora if the Kidnies could not pass off the Urine separated, &c. _ An increased Secretion of the Glands 30. very often drives away a Cold, which is occasioned by the Stoppage of the pores of the Skin &c- The particular use of the Glands is the particular Separation each one makes as the Lungs & Skin seperate from the blood the most fluid & saline parts &c. - There is also a general Use, resulting from the particular ones, as it gives an opportunity to the parts to reabsorb; ~ In Jaundice, the Bile is reabsorbed in large Quantities, & the greater or less degrees of Complexion, are owing, to the Quantity of bile reabsorbed. &c &c. Glands have Nerves. They must feel their Influence, without which they cannot Act. ~ Medulla _ "Oleaginous Matter in the Cellular Substance sustained by the Cancelli of bone." Possesses 31. the principle of Phlogiston. ~ It is originally secreted in a much more fluid state; but after a time the more fluid parts are absorbed. _ It is considerably redder in Young bones than in Old Ones, the Vessels being larger, & admitting Red Globules into them. ~ Their Use is to answer occasional Absorption & prevent the frangibility of the bone. In people starved to Death, not only the adipose Matter, but even this Medulla is absorbed. ~ Cartilage. _ "Probably Gluten contained in arachnoid Cellular Substance, of a shining whiteness, not fibrous, next to bone in Solidity, ~ strongly elastic." _ It does not appear to be vascular, nor fibrous, & therefore thought to be Gluten, strongly elastic, which is it's great Use, in making. 32. making us perform our Motions. with facility. ~ The Old Man is stiff in his Motions; The Cartilage which surrounds the heads of the Bones, being reabsorbed & bony matter deposited, the least motion vibrates through his frame, & he complains that in walking his brain shakes, he being deprived of that Springing, which he formerly received from Cartilage. _ It keeps parts pervious, as the Nose Palpebræ, punctæ &c. _ & in its application to the heads of bones, it makes them globular being thickest in the Central part, & in Cavities about the edges, making them deeper &c _ 33. Feby. 3rd.. Mr. Orange this day considered Muscular Fibre, _ "Flexible, elastic, Contractile." 'Tis these alone which characterise Muscle; which is the only part of the body Contractile _ Redness is not the distinguishing mark of it, this depends on it's Vascularity & the size of its Vessels admitting the red Globules; There are many muscular fibres without any Redness, as the Iris of the Eye. ~ & there must be muscular fibres even in the fly, without which he would be incapable of Motion; We must admit that where there is Motion, their must be muscular fibres; but most probably, we shall ever remain in the dark respecting the Cause of that Motion. ~ The Definition of Muscle, 34. is, “A Congeries of Muscular fibres the effect of whose Contraction is generally the same.” A fibre we have before considered as divisible almost ad Infinitum into still smaller ones, therefore a Muscle is made up of bundles of bundles of these fibres, A fibre being only in Imagination ~ Its power of Contraction depends on the greater or less No. of fibres, of which it consists; Its sphere of Contraction on their length, tho' when No. & length combine, the Muscle is very powerful. All the Muscles are disposed to contract; if any one remains in that state too long, it is called Spasm; if it contracts quick & often 'tis termed Convulsion; Muscles are plentifully supplied with 35. Nerves, possess a Vis Inscita, not acting under the Influence of the ~ Nerves; & a Vis Nervia entirely dependant on the Will.~ Muscles are termed Voluntary, Involuntary, & those Composed of both. ~ The Muscles of the Arm Leg &c, are Voluntary, under the direction of the Will; The Heart is an Example of the 2nd. Diaphragm of the 3rd.. Muscles are never in a state of perfect Relaxation except in the dead person ~ Muscles, are termed Congeneres, which assist in the same Motion.~ Antagonistæ, such as are the Instruments of opposite Motion, as the Flexors & Extensors of the Arm &c. They are named from their figure &c &c, As the Deltoides, Biceps, Sterno Cleido Mastoideus. Sphincter Oris, Ani &c. _ 36 Tendon "Closely fibrous of a shining blueish whiteness, flexible, inelastic, proceeds from a Muscle." No other Substance but an unelastic one would do, to fix to a Muscle, which is Contractile. It was originally supposed to be compressed Muscular fibres, but it exists in the Fœtus in Utero before any Motion takes place, therefore I imagine it is not so. _ Muscles are Named penniform, single [Illustration], & double [Illustration]; but there is a still more powerful one, in which the Muscular fibres run all round the tendon [Illustration]. ~ Vessels are small in tendon only admitting the pale parts of the blood. ~ Their Nerves are small & few, consequently they have little sensation. _ Aponeurosis. "Expanded tendon." 37 The word Fascia is used syn. _ It is insensible like a tendon; Vessels are small, In a state of Inflammation, it becomes red by Vis a tergo, pushing forward the red Globules into Vessels not capable of receiving it ~ In Amputation of the Leg Thigh, Forearm &c - it is not unusual to have large flakes of it like brown paper come away; Stimulating digestives Are then useful, as the Circulation is languid, ~ Muscular fibres are loosely connected by Cellular Substance. & are dependant on a proper Quantity of Nervous Influence, & of blood, with a proper State of the Connecting Cellular Substance. _ 38 Feby. 4th. Mr. Orange this day, considered, The General Confirmation of Bones. ~ All Bones are divided into long & broad, having parts, called Processes, common to both; which are Risings above the level of the bone, These are named Coracoid, Mastoid, &c, &c, from their supposed resemblance to a Crowsbill, Nipple &c &c.- Tuberosities are processes not resembling any thing in Nature. A process rising almost perpendicular, is called a Spine, & if it's Edge be flat, it is the Crista of the Spine. A Spinous process terminates in a point ~ &c &c _ Coronoid processes also terminate in a point. A process standing out in a round ball, is called Caput, or head, which have a Cervix or Neck tho' in some scarce distinguishable. A Condyle is 39 a head flatned. ~ Bones have Cavities or Depressions, which if deep are termed Cotyloid, if shallow Glenoid, tho in a recent Subject the Cartilages, make them much deeper. Pitts, small roundish Channels sunk perpendicularly into the bone, ~ Furrows are long narrow Canals formed in the Surface, ending in Grooves. ~ Nitches, & Notches small Breaches in the bone; Sinnositics, broad superficial Depressions, without Brims: Fossæ large deep Cavities unequally surrounded by high brims; Sinuses, large Cavities within the Substance of the bone with small apertures. Foramina Canals pierceing through the Substance of the bone, when this goes any way in a bone, the middle part retains the Name of Canal &c - Epiphis. All processes & heads of Bones, are originally formed in 40. a state of Separation, by intervening Cartilage, which sometimes remains through Life; tho this is charactaristic of a weak frame, ricketty &c. & this is also the Case with most scrofulous people. ~ We shall now speak on Articulations _ which are 3 fold, 1st. Symphisis. The Union of 2 bones by intervention of a 3rd. body, & is divided into Syncondrosis, where a Cartilage intervenes, as the Ribs & Sternum; bodies of the Vertebræ, & Ossa Pubis._ Syndesmosis or Synneurosis; Ligaments intervening as, in all moveable Articulations. Syssareosis, ~ flesh intervening, as, a Muscle from one moveable bone to another 2nd. Synarthrosis. Immoveable Articulations, divided into Sutura, The mutual Indention of 2 bones, when 41. their fibres are flexible, as the bones of the Head, ~ - Gomphosis. One bone fix'd in another, as a Nail in a piece of Wood; thus the Teeth are placed in their Sockets ~ Schindylesis, or ploughing, When a thin Lamella of one bone is received into a long narrow furrow of another; as the Vomer with the processes Azygos of the Sphenoid bone. 3rd. Diathrosis. Allowing of large sphere of motion, divided into Enarthrosis, Arthrodia, & Ginglimus. The 1st. is like a ball & Socket, [when] as the Head of the Femur, & Acetabulum. The 2nd. is when a round head is received, in a superficial Cavity, as the Humerus & Scapula. The 3rd.. is subdivided into 3. viz. Trochoides when 1 bone turns on the other as a Wheel on it's Axis, thus the 1st & 2nd.. Vertebræ. ~ The next species, is if 42 a bone receives & is received by corresponding prominences & depressions, as the Humerus & Ulna, Femur & Tibia &c. _ The 3rd. species is, when one bone is articulated to another by more than one place as the Radius & Ulna &c &c _ The Cranium is formed of many peices, tho' the upper part, strictly so called in composed of 8 bones: 6 proper (The Os frontis, 2 Ossa Bregmitis, Os Occipitis, & 2 Ossa Temporum: Thes 6 have nothing to do in the formation of the face,) & 2 Common, both to the Head & face, viz Os Ethmoides & Os Spheroides. In the fœtal Cranium, the bones are separate, & therefore serve as so many points of Ossification, admitting also 43. of the growth of the brain, & at the time of birth, the bones lap over each other, & it is brought forth much easier than if the head was one solid piece ~ When Ossification goes on too quick, 'tis rank'd among the Causes of difficult Labour. The fœtal Cranium is more rotund than an Adult; The European Cranium also differs considerably from the African &c. ~ That part of any bone, on which a Muscle acts is rendered smooth by the Attrition; but where it acts from, the bone is drawn out into a process, as the Mastoid process is formed by the Action of the Sterno Cleido Mastoideus, there being little or none of this process in the Fœtus, who has not made use of that Muscle. _ 44. Sinciput is the Name given to the front of the Cranium; Occiput the back: The Temples are the Sides; Vextex the top: & Basis the bottom. _ The Cranium is composed of an external & internal table, which last from its natural polish is also termed Vitreous. Between these tables are Cancelli, called Diploe. _ Crania differ much in Thickness, as also does the Diploe in different Crania in Quantity; Thin ones sometimes having much, & sometimes, none at all & vice versa &c. _ Pitts _ Are accurately fill'd with brain, & as there is no evidence externally of there being a pitt or that it is a thin Skull; You should alway trefine, as if you were on a pitt or performing the Operation on a thin Skull. 45. Feby. 5th.. Mr. Orange considered 1st. The Os frontis, which occupies the fore & upper part of the Cranium, its figure resembles a Cockle Shell, externally Convex & vice versa; Its Coronal Edge joining with that of the parietal bones, forms the Coronal Suture. The Orbital ridges ends in the ex- & in-ternal angular processes. It has also the Orbital process, going horizontally backward, which forms part of the Orbit, & is inferiorly, internally concave, &c &c. Internally, we have the Spine of the Os frontis, from which arises the falx, dividing the 2 hemispheres of the brain ~ The Cavities & foramina of this bone, are; above the Orbital ridge, a nitch, wh. generally becomes a compleat foramen, called supra orbital foramen, 46 expressive of the passage of the 1st. branch of the 5th. pr. of nerves. More internally is a little notch expressive of the fastning of the trochlea through which the tendon of the trochlearis muscle passes. _ ~ Behind the external angular process is seated the Lachrymal Gland, the principal support of the fluid called tears. Between the 2 Orbital processes is the Ethmoidal fissure. ~ The foramen cæcum lies between the Crista Galls & the Spine of the Os frontis The frontal Sinus is occasioned by the Recession of the internal table from the external; & opens into the Nose. ~ The fibres of the internal table of the Skull 47. are sooner obliterated than those of the outer one, it being a lesser diameter &c _ When the sagittal Suture extends down the Os frontis we never have a Spine; & we may therefore, if a Suture extends down the Os frontis, trefine with safety; but this should not be very low down because of the frontal Sinus ~ The Spine is formed by the fibres of the internal table, (which as being the less Circle) sooner connecting themselves, & turn inwards. ~ A Man should be exceeding guarded in his prognosis concerning a Wound of the Orbital processes, on account of their termity, they forming a support to the anterior Lobes of the Brain &c _ We shall now take a View of the 48 Parietal bones. _ They are of a square figure, & are connected anteriorly to the Os frontis by the Coronal Suture; above to each other by the sagittal; & posteriorly to the Occipital bone by the lambdoidal; laterallay to the temporal bones by the squamose. &c. Its different Sides or edges being distinguished by saying the Coronal, sagittal, &c. _ & the Angles, into Anterior superior, &c &c _ This bone has externally a semicircular ridge, commencing at the external angular process of the Os frontis, & which is expressive of the fascia of the temporal muscle, formed in this manner. The pericranium is composed 49 of 2 Lamella: The first of which, entirely surrounds the Cranium, the other or upper one leaves the under at the attachment of the temporal muscle, which it covers & is itself attached to the Zygomatic process of the temporal bone. Internally along the sagittal suture lies the longitudinal sinus. ~ At it's anterior inferior angle is a groove expressive of the Spinous Artery, which is sometimes formed into a Canal; This place should be avoided in the Trefine; The principal branch of this Artery, runs parallel to the Coronal suture. Pitts are oft'nest found in this bone; The squamous edge appears thinnest, tho' it is made of the same thickness with the rest by the Os temporis. 50. The posterior inferior angle of this bone has part of the groove formed for the lodgment of the lateral sinus. Feby. 7th. Mr. Blizard considered the formation &c. of the Os temporis. wh. is divided into the pars squamosum, & mamillaris externally, & petrosum internally.- Pars squamosum, has an arch like appearance, & is very thin. ~ It is very unequal on the inside, occasioned by the Convolution of the brain. externally we have the Zygomatic process joining with one of the same Name, of the Os Malæ, & it forms a kind of Jujum, through which the temporal muscle passes, The Masseter muscle arises from this process ~ The appearance in recent & dry bones is very different. 51. Pars Mamillaris. _ supposed to resemble a Nipple; is formed into a projecting body, which is canullous, which is connected with the internal Ear which is very dependant on its goodness. Pars petrosum. ~ Has 2 Surfaces, & a ridge from which proceeds the tentorium. Its superior surface forms a support for the anterior lobes of the Cerebrum; the lateral part of the middle lobe of the Cerebellum being applied to its inferior Surface. _ Externally, going obliquely downwards & forwards is the Styloid process, which is an attachment for many muscles. ~ Between this, & the Zygomatic process, is the Vaginal process, & auditory; In this latter is a ridge [crossed out] expressive of the Attachment of the Membrana Tympani, which divides the external from the internal ear. _ 52. This Bone contains the Cavity in which the inferior maxillary bone is articulated ~ The 7th. pr. of Nerves enter the meatus internus in the petrous bone; & there divide into portio dera, (which goes out of the foramen stylo Mastoideum situated between the styloid & Mastoid processes & then becoming a cutaneous Nerve) & portio mollis, which is destined for the Organ of hearing. ~ Behind the vaginal process is the extremity of the foramen Carotideum, which goes up to the brain at a right angle, thus preventing the too quick projection of the blood. At the poster. infer. angle of the parital bones are the lateral sinuses, from wh. commence the internal 52. Jugular Veins, which come out at the foramen lacerum with the 8th. pr. of Nerves, & which is sometimes divided by a bony ridge from the Vein. _ Most of the processes are wanting in a fœtus. - Feby. 8th. Mr. Orange considered the Os Occipitis. ~ Somewhat triangular, bounded by the lambdoidal suture. & terminates in a process named basilary or cuneiform, which joins with one of the same name of the Sphenoid. The Medulla oblong. lies in the hollow of this process, and the basilary artery also lies on it. Externally posteriorly are 2 processes, named Condyles to which the 1st. Vertebræ is fix'd by it's superior oblique processes. ~ All except a small triangular portion of 54. this bone is covered by Muscles, which cannot therefore be trefined. The various Eminences &c. are expressive of the Attachment of several Muscles ~ Nearly opposite the external ridge, internally, is a tranverse one, which has a perpendicular one crossing it, forming 4 Hollows in the bone; the 2 upper of which are expressive of the position of the 2 posterior lobes of the Cerebrum. ~ The Falx is attached to the Cross ridge, & the Pentarium to the transverse. Between the Basilary process, & body of the bone is the foramen magnum, through which the Medulla oblongata, passes from the brain; & the Vertebral arteries to it. ~ Below the Condyles 55 are the 2 foramina Condyloidea, through which the 9th. pr. of Nerves pass to the tongue. ~ On the outside of these lie the Jugular fossæ, through which the internal Jugular Veins, & 8th. pr. of Nerves pass. ~ - Os Sphenoides ~ Is the most difficult of all the bones of the Cranium; It properly forms the basis Cranii, & is a wedge to the other bones, it is also one of the Common bones. Its Situation renders it impractible for Surgeons practise &c. It consists of, Body, & laterally Wings, & has been said to resemble a bat flying. ~ Of the Body ~ It has a superior & an inferior Surface; An anterior & posterior part. ~ It's superior surface is hollow, forming the Sella Turcica, anterior to which, is, 56 a smooth Surface expressive of the Conjunction of the optic Nerves. ~ It ends in the posterior clinoid processes. ~ Its inferior surface has only a solitary process, named Azygos, which receives the Vomer coming into the Nose. It's anterior part is cellular, joining with the Cells of the Ethmoid bone, which open into the Nose. ~ At its posterior part is the basilary process ~ The Alæ or Wings, end posteriorly in a point, termed the spinous processes, simply, to distinguish them from the transverse spinous processes, which join the broad part of the Alæ to the body, ending round, in the anterior 57 Clenoid processes, behind which the internal Carotid Arteries run, sometimes a compleat foramen is formed here. - The broad parts of the Alæ are formd into 3 Surfaces, anterior, external & internal, the 1st. forming part of the Orbit &c. Externally, we see the Pterygoid processes, dividing into ex- & in-ternal; the latter is form'd into a hook, over which the tendon of the Circumflexus palati plays, ~. The foramina optica, are rather anterior to the smooth surface mentioned. ~ Next are the foramina lacera, beneath the transverse spinous processes, thro' which the 3rd. 4th. 1st. branch of the 5th. & 6th. pr. of Nerves pass. _ Below these are the foramina rotunda, 58 through which the 2nd. branch of the 5th. pr. of Nerves pass, ~ & still lower are the foramina Ovalia, thro' which the 3rd. branch of the 5th pr. of Nerves pass. _ The foramina spinosa are still lower; these admit the spinous Artery. ~ There is another foramen through wh a considerable branch of the 2nd. branch of the 5th pr. of Nerves is reflected &c Feby 9th. Mr. Orange considered the Ethmoid bone. ~ This bone completely fills up the Ethmoidal fissure of the Os frontis; & forms the principal bony part of the Nose; It is very delicate & tender; ~ Has a superior perforated Surface termed the Crebriform Lamella 59 & an inferior cellular surface, hanging down into the Nose, ~ An Anterior projecting Surface, on wh. the Nasal bones rest; & a posterior surface joining with the Cells of the Sphenoid bone: It is divided into 2 parts by a thin bony plate termed the Nasal Lamella, the upper part of which is rounded, & named Crista Galli. The anterior Lobes of the Cerebrum rest on the Crebriform Lamella; so that a blow on the Nose, often drives the Nasal Lamella & Crista Galli into the brain; In such a Case we should introduce a pr. of forceps lined with Sponge &c. & seizing on the Nasal Lamella, draw it from it's Situation, which is all that can be done. 60. It is bounded on the Sides by the Os planum one of the bones of the Orbit; Next the Nasal Lamella are placed the superior Spongy bones. The tenuity of these bones &c. should make us cautious, in the introduction of Instruments into the Nose, or detaching a Polypus from thence. Superior Maxillary bone. _ Joins the Os frontis, Mali, &c &c &c. It is irregular; &c. It's Nasal process has a groove form'd in it, which by the junction of the Os Unguis, is form'd into a Canal call'd the ductus ad Nasum, above this, is the tendon of the Orbicularis palpebrarum. ~ Its anterior edge is formd for the reception of the Os Nasi. ~ Its upper part is named the orbitar process, going horizontally backwards, forming part of the floor of the Orbit & roof of the 61. Antrum ~ Its outside, receives the Cheek bone; termed it's malar process; & it's inferior edge termed it's Alvsolary process, has the Alveoli, or Sockets for the teeth form'd in it. _ These Alveoli are absorbed in Old Age, & occasions the Nose & Chin to meet. ~ Internally is the palatine process, doubly concave, forming part of the Roof of the Mouth & floor of the Nostrils; The remainder of the roof &c. being perfected by the Application of the palate bones. _ Just beneath the Orbit is the Infra Orbitar Foramen, thro' which the 2nd. branch of the 5 pr. of Nerves passes. _ ~ Os Mali. ~ Given the Rotundity to the face; ~ It's maxillary process joins the maxillary bone. ~ It has 5 processes, viz, superior, & inferior, obitar, Maxillary, & Zygomatic. & internal Orbitar. 62. Feby. 10th. Mr. Orange considered the Ossa Palati. ~ These may considered as parts of the Maxillary bone; they finish the Roof of the Mouth & floor of the Nostrils; doubly Concave; It has 3 processes, viz, palatine, pterygoid, & Orbitar, ~. It is very spongy & thin, often coming away in the Lues Venera, The Voice then becomes impaired, & there is a difficulty of swallowing. ~ Ossa Nasi. - These form the bony Arch of the Nose; but are not continued to it's Extremity, as it would be in danger of fracture. They are of different figures, wh. causes the various Shapes of Noses. Their upper part is bulbous & thick, connected with the Nasal process of the Os frontis 63. frontis. ~ Their middle rests on the Nasal Lamella of the Ethmoid bone, their Sides on the sup. Maxillary. ~ In a fracture of these bones, we should be exceeding guarded; & not, as is generally done, endeavour to depress the prominent part which is the natural State of it; but to elevate the depressed part, wh. has been beaten in; We must first ascertain the Condition of the Nasal Lamella with a probe, & if it is driven up into the Brain, draw it gently down with a pr of forceps, but if it is found, you should, with a Director or piec of Wood defended with Linen, elevate the depressed part ~ Vomer. ~ Its upper part, has a groove, in wh. the processes Azygos, of the Sphenoid bone, is received, 64. & this with the Nasal Lamella forms the Septum of the Nose; There is however a triangular Notch, which in the recent State is filld up with Cartilage, Inflammations of the bones of the Nose, should be removed by Fumigations &c &c. as soon as possible, as they soon exfoliate. _ Ossa Unguis. ~ Is composed externally of 2 smooth Concavities & a middle ridge; & is fix'd to the groove in the maxillary bone, thus compleating the ductus ad Nasum. This bone it is, which is perforated in the Operation of fistula lacrymalis, carrying the Instrument downwards & backwards.- 65. Inferior maxillary bone. - Consists of a body, & posteriorly the Rami, ending in the Coronoid & Condyloid processes _ Its inferior part is the basis, the middle is the Symphysis, which makes the difference of Chins, by projecting more or less. ~ The part where the Rami go off is termed its Angles - The Condyloid processes form a Sort of Enarthrosis Articulation, with the articular Cavity in the temporal bones. ~ To the Condyles are attached the temporal Muscles, & all the Rami are covered by the Masseter Muscles. ~ From the basis, rises a perpendicular process for the Reception of the teeth termed alveorlary ~. Internally at the Symphysis &c, are several protuberances, expressive of the attachment of various Muscles, as the Digastric &c &c & just below 66. the Coronoid process, the Buccinator Muscle is attached ~ On the inside the Rami are 2 holes, the entrances of a Canal, thro which the 3rd. branch of the 5th. pr of Nerves, & an Artery pass, to supply the teeth, coming out near the Symphysis of the Chin externally. Fractures of this bone often happen, & sometimes a troublesome Hemorrhage takes place, by the Contraction of the Artery into the bone, which cannot be got at without taking a piece of the bone away, ~ Sutures ~ formation. Bones are fibres, which in broad [long] bones, radiate from the Centre to Circumference, these at length approach & pass between each other; but they meet resistance as they approach, & 67. thus a Suture is formed. ~ These sometimes remain through Life, at other times they are obliterated.~ There are 5 principal Sutures, the Coronal, extending across the head; the Sagittal, placed longitudinally on the Skull & is sometimes continued down the Os frontis. The Lambdoidal, rather father back than the Vertex & going obliquely downward. & the 2 Squamous, a little above the ear. ~ ~ The best Method of tracing these, is; about an Inch from the external ang. pro. is the Coronal going obliquely upwards & backwards about the length of a common probe from the Nose. ~ The Sagittal terminates in a line carried round the Cranium from the external ang. process; & the lambdoidal terminates just above the Mastoid process 68. Feby. 11th. Mr. Orange, Considered the Spine, beginning at the condyles of the Occipital bone; Consists of true & false. The true comprehending 24 Vertebræ, the false, the sacrum & appendix Coxendicis. ~ The true are divided into, 7 Cervical, 12 dorsal, & 5 Lumbar, all of which agree in the general Character of having a body, (except the 1st. Cervical,) & processes; The bodies placed before, &c. 7 processes. 2 transverse, 4 oblique, & 1 Spinous, The specifick Character of each is different; viz. ~ The Cervical Vertebræ, are flatned at the fore part, on wh. the Oesophagus &c. rests; the dorsal, laterally, allowing room for the lungs &c &c. & the lumbar at their fore part, giving Room to the Viscera & The bodies are, greatly Cancellous 69. & their edges are covered by a thin plate of bone, & between each, is a thin plate of Cartilage & Ligaments. The 1st. Vertebra, called Atlas from its supporting the head, differs from all the others very materially, it has no body, but in its place a bony Arch, on the inside of which is [seated] a smooth Surface to receive the processes dentatus of the 2nd. Vertebra, round which it moves, It's superior oblique processes are articulated with with the Condyles. ~ The Cervical Vertebræ, may alway be known by a hole in the their transverse processes, forming a Canal for the transmission of the Vertebral Arteries. ~ The transverse process of the 1st. Vertebra, extend out much farther than the others 70. which occasions the Artery to make a Curve, before it enters the foramen magnum. ~ Its spinous is so small, as scarcely to deserve that Name. ~ The 2nd. Vertebra call'd dentata, from it's toothlike process, which arises from it's body & passes on the inside of the 1st. Verte: from it Ligaments to the Cranium which fasten it &c - This pro: is sometimes fractured in Children, which causes instant death, as the Spinal Marrow is compressed, having an Angle form'd by the Head falling forwards; & Apoplexy or Concussion of the brain is thought oftentimes to be the Cause. therefore in weak Children, something placed to keep the head erect, is not amiss. - 71. The Motion allowed of between the 1st. & 2nd. Vertebræ, is greater than between any other, The Medullary Canal, is always the largest in Vertebræ having the most motion. ~ The remaining Vertebræ if the Neck are pretty much the same, The spi: pro: of each being bifurcated. They grow larger as the descend, the 7th. being not unlike the 1st. dorsal &c. Dorsal Vertebræ ~ Are compressed laterally, have no holes in their trans: processes. ~ At their lateral part is a pit expressive of the Rib, & their transverse processes are pressed by the tubercle of the Rib, in respiration. ~ Their Spinous processes stand downwards & are very long. ~ The last dorsal Vertebræ, resemble the 1st. lumbar &c. 72. Lumbar Vertebræ, ~ Are largest of all the others; processes differ, &c &c. ~ by the application of Vertebræ we have lateral holes for the transmission of Nerves, & Vessels &c &c. _ The true Vertebræ may be considered, as a pyramid, its base, the last lumbar Vertebra. ~ The Os Sacrum or false Vertebræ, may also be considered as an inverted pyramid, its base joining the base of the true, &c - Costæ or Ribs. Of these there are 12 on a Side, 7 true, connected with the Sternum, & 5 false, connected with, the 7th: true one &c. There are the same No. in a Male as in a female ~ They all agree 73. in having a head, a prominent tuberosity, an Angle, & a superior & inferior Surface termed Costæ &c. The 1st. differs from the others; it is placed nearly horizontal & is immoveable, having Ligaments coming from the Clavicle; so that in Inspiration, the inferior Ribs, are brought toward this, by the intercostal Muscles, which turn them outward, & the Diaphragm descending, enlarges the Cavity of the Thorax. ~ Expiration, is the cessation of these Muscles _ Their heads are framed for articulation, with the dorsal Vertebræ; their inferior Costa has a groove in which the intercostal arteries run. ~ fractures generally happen beyond the angle of the Rib. &c. In the Operation of Empyema, we must keep close to the superior edge of an inferior Rib, on account of the Arteries &c. _ 74 Feby. 12th. Mr. Orange this day considered the Sternum ~ Said to consist of 3 peices of bone, though one is named the Xiphoid Cartilage; Altogether it is externally somewhat Convex, & a little Concave internally. ~ The 1st. portion is largest, & has laterally a Depression expressive of the attachment of the Clavicle. ~ The 1st. Rib is attached entirely to this; The 2nd. Rib is attached between the 1st. & 2nd. bone. ~ The 3 portions are often altogether ossified, so as to make but one bone. ~ The Sternum is very light & Spongy, apt to be affected with Caries, & it then crumbles away, ~ . _ 'Tis recommended to trefine this bone, when matter is form'd in the anterior Mediastinum.~ Fracture sometimes occurs, the only Remedy then is to lay the person [crossed out] on his back, raising him up with pillows &c &c. placed under him. _ 75 Upper Extremity, ~ Divided into, Shoulder, Upper Arm, Fore Arm. Carpus, Metacarpus & Fingers. _ Shoulder. ~ Consists of 2 bones, the Clavicle, & Scapula. ~ ~ Clavicle. ~ Gives that figure to the trunk which it possesses, by keeping the upper Extremities at a distance. ~ It is said to resemble an Italic ∫, placed horizontally, It has a body, & 2 Extremities, named Sternal & Scapular. _ The Sternal is larger & more rotund than the other, & has Ligaments, allowing of a Motion every way; ~ It acts as a fulcrum to the upper Extremity _ It's inferior part has a roughness expressive of a Ligament, going to the 1st. Rib. ~ Its Scapullar Extremity is flatted, having a Smooth ending Surface, expressive of its attachment with the Acromion of the Scapula & beneath is a Roughness, from wh. a Ligament goes to the Coracoid process. 76. It is almost entirely covered by Muscles, as the Deltoid, Pectoral Sterno Cleido Mastoideus &c &c &c. - About the middle is a hole through which the medullary Artery passes.~ Fractures of this bone often occur. ~ & the Weight of the upper Extremity will depress the part next it, & make the part affix'd to the Sternum, appear prominent, tho' it is natural, as the Sternum, is a fix'd part; Our Care is to elevate the depressed part, & keep the Shoulders back by a figure of 8 bandage. ~ ~ - Scapula. ~ Somewhat triangular, Externally Convex &c. _ term'd the dorsum, from which arises a Spine, which is somewhat hollow & flatted above, nam'd the Crista. to wh. several Muscles are attached. _ It is divided, into Superior & inferior 77. inferior Costæ, & basis, &c _ _ The Spine terminates in the Acromion, wh. has a Smooth internal edge for the reception of the Clavicle. The Head of the Scapula, is form'd into a Glenoid Cavity for the reception of the head of the Os Humeri; just above it is the Coracoid process, wh. is very important, having attached to it, 1 head of the Biceps; Coraco brachialis. &c. &c. _ Sometimes this is fractured, tho this mostly happens at the Cervix Scapula; ~ To determine if it be fracture or Dislocation, (the symtoms being the Same,) We must feel this process; by bending the Arm, & pressing into the hollow; if it yields, it is fracture &c _ _ _ You must press the head of the Humerus up by keeping the Arm in a Sling, covering the Elbow with it & keeping 78. down the Shoulder, with the reflexed Capsiline bandage. ~ The inferior Angle of the Scapula is made smooth by the Action of the latissimus Dorsi. ~ Matter is sometimes form'd behind this bone; & it is then recommended to trefine upon it. ~ &c - - - _ Feby. 14th. Mr. Orange considered the Os humeri. ~ Has a body, & upper & lower Extremities; Its head is fitted for connection with the Scapula, & is on one Side, in respect to its body The internal Condyle of its lower Extremity may serve as a guide to find it &c. _ The upper part of it body, has several Smooth Surfaces expressive of the attachment of Muscles, as is also the body itself. ~ The pectoral Muscle is attached 79. to an outer ridge, which is on the body, & the latissimus dorsi to an inner one. ~ The Coraco-brachialis, arises from the Coracoid process, & is attached to this bone; Somewhat flattened posteriorly, having a deep fossa, & also at it's internal part, into which the Olecranon, & Coronoid process of the Ulna play. It ends in it's ex- & in-ternal Condyles, the latter of which projects inwards considerably, & is often fractured without detriment to the joint. ~ The external Condyle is much rounded, & on it the Radius plays, it is much less than the internal one, which is alway fractured, in a Dislocation, of the fore Arm inwards, but a Dislocation may happen outwards, without fracture. ~ Extension of the fore Arm, is sufficient 80. to reduce it. Dislocations of the Humerus may take place downwards, backwards or forward but not upwards, without fracture of the processes of the Scapula ~ &c. &c. &c. _ _ _ Fore Arm. Consists of 2 bones, Radius & Ulna. ~ Radius. ~ Is rather Convex externally. &c. _ pretty regular. Its upper part hollow'd for Connection with the tubercle of the humerus, & laterally to the Semilunar Cavity of the Ulna. ~ It's Neck is surrounded by a ligament, fastening it to the Ulna. ~ Internally, below the neck, is a turbercle, to which is attached the tendon of the Biceps. _ below this it becomes broader ending in a kind of Ridge to which the interosseous ligament 81. ligament is attached, going to a similar ridge in the Ulna. ~ In the middle is a rough Surface, to wh. the pronator teres is attached from the internal Condyle of the Humerus, which Muscle, without Care is taken, will be divided in opening the Arm. ~ It ends in a Semilunar Notch in wh. the Ulna plays laterally, & its end has a Cavity for the reception of the Os, Scaphoides & lunare &c. _ The pronator quadratus arises from this. _ Ulna. ~ Is the longest of these bones, & the internal one; the Radius moves round this in pronation & Supination, it being fix'd. _ It has an articular Cavity bounded by the Olecranon & Coronoid process; The former has inferiorly, a triangular rough Surface, expressive of the 82. place on which we alway lean. _ When the Olecranon is fractured we must keep the Arm extended by a small Splint, from the Humerus to the fore Arm; & Inflammation, must by all means be avoided. ~ At a fortnights end or before, we must begin to move the Arm gently &c. _ ~ The Triceps Muscles is attached to this bone, at the Olecranon. & the Branchialis internus to the Coronoid process. ~ On its outside is a Semilunar Cavity in wh. the Radius plays: & a little lower is the Ridge to which the Ligament is fix'd surrounding the Radius, its outer Side has a Ridge to wh. the interosseus Ligament is attached, Its lower part is 83. round &c &c. _ _ _ It ends in the [Semilumar] Stiloid process ~ Both are sometimes fractured, A narrow Compress placed before & behind is Sufficient, over wh. a Splint may be placed. Carpus. _ Consists of 8 bones. divided into upper & lower phalanges, the Upper consists of the Os Scaphoides Lunare Cuneiforme, & pisciforme, the lower of, Os Trapezium, Trapezoides, magnum & cuneiforme. _ They are all of a Wedge like figure _ ~ Considerable motion between the 2 phalanges is allowed of. ~ All the bones communicate, one with the other, so that Disease of one, affects all: They also communicate, 84 with the Metacarpal bones. ~ wh. Should not be taken away at their Junction with the Carpus. ~ &c. _ Metacarpus. ~ Consists of 4 bones, the Thumb not having one. It may therefore be removed from the Carpus, without Detriment. _ Fingers. ~ 5 in No. each consisting of 3 bones. ~ The Thumb has the Strongest bones, as it counteracts, all the fingers; we should retain as much as possible of it in Amputation. &c. _ Feby. 15th.. Mr. Blizard, considered the bones of the pelvis: composed of the Sacrum Coccyx, & Ossa Innominata, wh, is divided into Ilium, Ischium & pubis. ~ The[ir] Situation of the pelvis is very inclined, ~ The upper part of The Ilium forms a Considerable part of the Abdominal parieties, ~ These 3 bones are compleated into a single one in Adults. _ The Ilium, is rounded above wh. part is termed its Crista, which ends, before in, Anterior sup: & inf: Spines; & behind in posterior Spine. _ Os pubis; where it joins its fellow has the term of Symphysis applied to it; it has a Ramus & an Angle &c &c. _ Ischium has a process term'd it's spine &c. which is turn'd more outwards in females than Males; Its inferior part, is rough, termed it's tuberosity. Its upper part forms the greatest share of the Acetabulum, At the bottom of wh. is the fossa for the Synovial gland &c &c. & it has a large Notch compleated in the recent subject, into a foramen, by Ligaments. 86. Sacrum; Consists of 5 bones in the fœtus, which in Adults, are form'd into one. _ It is a wedge like bone, & situated between the 2 Ilia behind. It has the Coccyx at its Extremity, divided into 2 or 3 bones, the 1st. of which has 2 processes standing up, from wh. Ligaments go to the Sacrum. - ~ The pubis is formed into an Arch by the junction of the 2, larger in Women than Men. ~ The Axis of the pelvis & Abdomen are different. ~ To the Crista of the Ilium, all the Abdominal Muscles are attached, &c. from its post: Spine Ligaments go to the Sacrum &c. &c. _ The Sartorius Muscle arises from the ant: sup: Spine; behind the 87. ant: inf: Spine, is a hollow, over wh. the psoas mag: & Iliacus internus pass; & a little lower, the place where the External Iliac Artery passes. ~ poupart, or Fallopius' Ligament goes from this bone to the Angle of the pubis, . &c &c _ Acetabulum. ~ Is form'd by the Junction of these 3 bones, & is the Socket, in wh. the head of the femur plays. _ &c. . Feby. 16th. Mr. Orange, considered the Os femoris; having a body & an upper & lower Extremity. Its upper part is form'd into a head laterally, having a contracted part, termed its Neck, to one side of which its body ends in the Trochanter major, & more internally downwards, is 88 the Trochanter minor. ~ Below the Trochanter major is rough line to wh the Gluteus medius, is attached; & at it's posterior part is the linea aspera. ~ Fractures of the Neck sometimes happen, ~ We may always tell the Situation of the head by its being anterior. & to one Side of the internal Condyle. ~ Its Head has a rough Surface at its Extremity to wh. the the Ligamentum teres is fix'd. ~ It terminates in the ex- & in-ternal Condyles, which a framed for a Ginglimoid & Enarthrosis Articulation. ~ It's anterior part is grooved receiving the patella. ~ Inflammation & fracture of the Condyles are very dangerous to the joint &c. Leg. _ Consists of the Tibia & fibula. Tibia. _ Somewhat triangular, having an external, internal & posterior Surface. ~ The internal, is, what we term, Shin, & 89. may be got at by a simply Inscision, wh. the others cannot be. Its anterior edge is termed its Spine. Externally below the head, is the Smooth Surface, to which the fibula is fix'd. ~ The Ligaments of the patella are fix'd to a protuberance it has at it's anterior part ~ Its inferior internal Surface, forms the Malleolus internus, which is somewhat rounded by the tendons of some Muscles; & is sometimes fractured. _ ~ Fibula. _ Is very slender. Its lower Extremity forms the Malleolus externus. fracture of its extremity may happen without Injury to the Joint ~ We are directed in Amputation to stand on the inside, as we shall fix our Saw on both bones at once. _ ~ Foot. Consists of Tarsus, Metatarsus & Toes. _ The Tarsus consists of 7 bones, viz, Astragalus, Os Calcis, &c. Naviculare, forming the 90. upper Phalanx. Os Cuboides, Cuneiforme externum, medium & internum, the lower phalanx. Astragalus, is the uppermost of these bones, and is articulated above to the Tibia & Fibula; below to the Os Calcis, & before to the Os Naviculare. Os Calcis, is the largest of these bones & to it the Tendo Achillis is fix'd. _ Metatarsus ~ Consists of 5 bones, larger in every respect than the Metacarpal bones; The great Toe has a metatarsal bone, The Ends of the Metatarsus are connected with the tarsus, & the same Observation, will be good, wh. was made respecting the Carpus. &c _ Toes ~ The great Toe has but 2 bones the others, each 3. &c &c. _ ~ Patella, ~ is of heart shape &c. _ & fractures of it longitudinally & transversely sometimes happen. _ & _ 91. No. of bones in the human body. Those proper to the head. Skull ~ & bones of the internal Ear. 16. Maxilla superior. 13. inferior. 1. 14. Teeth in both Jaws 16 32. Proper to the Trunk. _ Vertebræ. 24. Costæ. 24. Sternum. 1. 49. Ossa Innominata. 2. Sacrum. 1. ~3. Coccyx _ 3. _ ~3. Superior Extremities. Claviculæ. 2. Scapulæ 2. ~4. Ossa Humeri 2. Ulna 2. Radii. 2. ~6. Carpus of each hand 8. - 16. Metacarpus 4 ~8. Finger bones 15 _ 30. Inferior Extremities. _ Ossa Femoris, 2. Tibiæ. 2. - ~4. Fibulæ 2. Patellæ. 2. ~4. Tarsus of each foot 7 - 14. Metatarsus 5. _ 10. Toes - 14. 28. Total. 241  93. Of the Muscles. Feby. 18th.. Mr. Orange began the Consideration of the Various Muscles of the body; Commencing wh. those of the fore part of the Abdomen, which consist of 3 [pr.] layers may be reckoned as digastric. The 1st. is the externus obliquus. arising by fleshy digitations, from the inferior edges of the 8 inf: Ribs. meeting the digitations of the Serratus major anticus. _ It's fibres pass obliquely downwards being inserted into the Crista of the Ilium; It becomes tendinous at different distances, forming the Linea Semilunaris; & joins its fellow in the Linea alba. wh. is form'd by the tendinous fibres of the 3 layers, interlacing. 94 from the Xiphoid Cartilage to the pubis. _ ~ The tendinous fibres are bent downwards, from the ant: sup: Spine of the Ilium to the pubis, forming Poupart's Ligament; under wh. femoral hernia take place, & in wh. are seated the Rings, (through which the Spermatic Chord passes in Males, & the round Ligament of the Womb in females,) form'd by a separation of inferior fibres of wh. it is composed from the superior, wh. last go to the Symphysis pubis; the inferior to the angle; so that the Ring is triangular. _ therefore between the Angle & Symphysis a Truss should be applied in a hernia. _ 95. The peritoneum is never ruptured, but descends with the Intestines, forming the Hernial Sac. _ The Ring is prevented extending, by cross Ligaments &c. _ Those Hernia wh. pass through the Ring, as Bubonocele, &c &c. should be reduced in the direction of the ring, upwards, & outwards; but femoral hernia upwards & inwards, towards the Linea alba. _ Beneath this Muscle is seated the Internus obliquus: whose fibres run in a contrary direction to the last; It arises from the Crista of the Ilium &c. attached to the 7 inf: Ribs, Xiphoid Cartilage, & Linea alba.. from it's inferior fibres, the Cremaster Muscles, arises 96. wh. is lost in the Tunica Vaginalis Testis. &c. _ ~ Below this is the Transversalis, wh. arises tendinous from the transverse processes of the Vertebræ Lumborum, fleshy from the Crista of the Ilium, &c. &c. & is inserted into the 7 inf: Ribs, Xiphoid Cartilage & Linea alba. _ Recti. ~ Arise tendinous from the Ligament, connecting the Ossa pubis. & is inserted into the Cartilages of the 3 inf: true Ribs. _ It is intersected by tendon in different parts ~ & it is plac'd in a sheath form'd by the tendons of the Abdominal Muscles, that of the obliquus internus dividing into 2 parts wh. surround 97 this &c. _ These muscles are ~ bounded by the Linea semilunaris, & alba. _ The Umbilicus or Navel,, is seated about the middle of the Linea alba, at wh. Hernia sometimes take place, term'd Exomphalos &c. _ The Uses of these Abdominal Muscles, are 3 fold, viz, as Flexors, Respiratory & Expulsive powers: Flexors ~ When they act together they antagonise those placed behind. ~ &c. ~ They turn the body to one Side ~ The Ex. Oblique turns the body to the contrary Side; & the In: Oblique, to the same Side &c _ In Wounds of the Abdomen, these should be relaxed as much as possible. ~ & also in Contusions. _ 98. Respiratory powers. They counteract the intercostal muscles, pulling down the ribs & pressing the Contents of the Abdomen up against the Diaphragm; they lessen the Cavity of the Thorax, thus forcing the Air, out of the Lungs; they are Voluntary & involuntary, acting when asleep. Inflammation &c. of these causes difficulty of breathing &c. &c - Expulsive powers. - They expel the fœces, Urine, &c. & in females the fœtus. _ ~ In tapping, the mid space, between the ant: sup: Spine of the Ilium, &c. Umbilicus, is proper, wh. is just in the linea semilunaris. &c. _ Latissimus Colli. or platysma Myoides ~ Arises by slender fibres, from the Sternum, Acromion 99. Acromion, & pectoral & Deltoid Muscles, & is lost in the Muscles of the face, &c &c. _ The external Jugular Vein runs under this. &c _ Pectoralis ~ Arises from the Sternal extremity of the Clavicle, Sternum, & 5th. 6th. & 7th. Ribs, & is inserted into the upper, inner part, of the Humerus, it is a flexor & abductor of the Arm. ~ & in Climbing, it draws up the Trunk to the Extremities. _ ~ Upon this is seated the Mamma, or Breast, in the Amputation of wh. we should keep the Arm extended, thereby stretching the Muscle, &c. but the operation finished, we must place the Arm to the side, the Hand laying over the Thorax &c. _ 100. Feby. 19th.. Mr. Orange, considered the Muscles seated on the anterior part of the Neck, & first of the Sterno Cleido Mastoideus; wh. arises tendinous from the Sternum; & fleshy from the Clavicle, & is attached to the Mastoid process of the temporal bone. ~ When both these Muscles act together, they bend the Head, but when separate, turn it to the opposite Side; Wry neck, is the Disease of these Muscles, either an increased power of one; or a deminution &c. _ If it is from the first Cause, the division of the muscle, is necessary, performed with the probe-Rasor 101. probe-Rasor &c _ The Muscles of the fore part of the neck, are more useful as Physiologists, than Surgeons. ~ They are all subservient to the performance of Deglutition. ~ The pharinx is a large bag seated behind the Larynx, consisting of 5 Cartilages & Os Hyoides; Their Names are, Thyroid, Cricoid, 2 Aretinoid, & Epiglottis. The Os Hyoides, has a basis, & 2 Cornu, wh. are attached to the Thyroid Cartilage ~ Those Muscles, wh. draw up the Os Hyoides &c. are attached to the temporal bones, & under Jaw, going to the Os Hyoides. ~ The 1st. pair wh. we shall consider, are, 102. The Digastric Muscles _ Which arise on each Side, the Symphysis of the Chin, it has 2 fleshy bellies, the posterior of which arises from the Sulcus, at the bottom of the Mastoid process; it's anterior to the Os hyoides; wh it draws up, when the inf: max: bone is shut. ~ ~ - The Mylo Hyoideus lies beneath this. ~ A digastric muscle having a very extensive origin, from the Symphysis of the Chin to the Angle &c. _ it is inserted into the basis of the Os Hyoides. The Genio-hyoideus, lies beneath this, attached to the basis also. ~ The Stylo-Hyoideus, arises from 103. the Styloid process, & passes through the tendon of the digastric Muscle, it is fix'd to the Corner of the Os-hyoides. ~ These are Elevators of the Larynx & Os hyoides ~ ~ ~ The Depressors are, first, The Sterno-Hyoides, coming from the inside the Sternum, & going straight to the anterior part of the Os Hyoides; they are cut through in the Operation of Bronchotomy. ~ ~ ~ - The Sterno-Thyroidis, are beneath these, coming from the inside the Sternum, to the Thyroid Cartilage. _ ~ The Thyro Hyoidei. ~ from the Thyroid Carti; to the Os Hyoides. _ _ 104. Crico-Thyroideus. - arises from the Cricoid Cartilage, & is attached to the Thyroid, &c. _ _ Omo-Hyoideus ~ Arises from the (Clavicle), & is attached to the Os Hyoides. _ ~ Beneath these Muscles, is seated the Thyroid Gland, wh. is frequently enlarged, constituting a Derbysh. Neck. This produces difficulty of breathing, by pressing on the Aspera Arteria, & difficulty of swallowing, by preventing the action of these Muscles &c.. Serratus major anticus. ~ Arises from the basis of the Scapula; & is attached to the 8 superior Ribs; It draws the Scapula forwards &c. _ Serratus minor anticus. or pectoralis 105. pectoralis minor, arises from the 3rd. 4th. & 5th. Ribs. & goes to the Coracoid process. It brings the Scapula downwards & forwards, on the Ribs, & it draws them up, & may therefore be considered as accessory to Respiration. &c ' _ _ _ The Subclavius _ Arises from the Clavicle, & goes to the 1st. Rib, wh. it helps to fix, & may therefore be considered as a Ligament. &c. _ 106. Feby. 21st.. Mr.. Orange considered The Fronto-occipitalis, Muscle; It arises from the transverse Ridge of the Occiput, laterally to the mastoid process. & is tendinous over the Cranium &c. It is fleshy on the Os frontis & is inserted into the Orbicularis palpebrarum. wh. it draws up. The 1st. branch of 5th. pr. of Nerves, coming out at the Supra Orbitar foramen, supplies the frontal portion. ~ It is connected by short cellular Substance to the Hairy Scalp, & by long, to the pericranium; between both wh. Matter may be form'd the sooner discharged the better. ~ If the Nerve is in a State of paralysis, or cut, 107. &c. the Eyelid cannot support itself. _ &c. &c &c. _ Attolens, Retrahens Aurem. Anterior Auris &c &c. _ Temporal Muscle. Commences at the External any: process, the semicircular Ridge of the lateral part of the parietal bone &c &c & is inserted into the Coronoid process of the lower Jaw, wh. it pulls upwards & a little backwards &c. ~ It is surrounded by a facia formed by the Recession of the external layer of the pericranium from the internal. ~ Matter may be form'd below it, & is so deceptive, that it is often taken for fracture with depression- 108. Masseter. _ Arises from the Jugum, form'd by the temporal & Malar bones, & is inserted into the Ramus & Angle of the lower Jaw ~ It is composed of an ex- & in-ternal portion, the fibres of the former going backwards, of the latter, forwards ~ This pulls the Jaw upwards backwards & forwards. ~ ~ Muscles of the face. _ Eyelids. serve as Veils, against the light, dust &c. they sweep the tears over the Eye, & convey them away ~ They perform their function by means, of the Orbicularis palpebrarum - wh. surrounds the Orbit, & 109. is inserted into the Nasal process of the Sup: Max: bone. Its tendon is divided in the Operation of Fistula lacrymalis ~ ~ &c _ Elevators of the Lip ~ Levator Labii superioris proprius, Alæq: Nasi ~ Arises, from the sup: max: bone just above the infra orbitar foramen, & from its Nasal process; & is inserted into the Orbicularis Oris, & the Alæ Nasi; It raises the upper Lip & depresses the Nose. ~ ~ - Levator Anguli Oris. ~ Arises from the hollow of the sup: max: bone, & is inserted into the Angle of the Mouth, It draws the Corner of the Mouth upwards, as, in Smiling. ~ - 110. Zygomaticus, or, Distortor Anguli Oris. _ Arises from the Zygomatic process, & is inserted [inserted] into the Angle of the Mouth, wh. it draws up, in: "Grinning horribly a, ghastly Smile." ~ _ These Muscles elevate the upper Lip, &c Angles &c. It has 2 depressors. viz. ~ Depressor labii superioris proprius, Alæq: Nasi. _ wh. arises from the upper Jaw, & is inserted into the upper lip, & Ala Nasi. both wh. it draws downwards & backwards. Depressor Angulioris. _ Arises from the lower edge of the Maxilla inf: & is inserted into the Angle of the Mouth, wh. it pulls downwards. Buccinator. Arises from the Ramus of the inf: max: bone; & is inserted into the Angle of the Mouth, wh. it draws back & contracts. - 111. Elevator Menti. _ Arises on the outside the Alveolary processes of the inf: max: bone, & is inserted into the under lip & skin of the Chin. Orbicularis Oris. - Is form'd by the fibres of almost all the Muscles of the Mouth decussating each other, & surrounding the Mouth like a Sphincter. It shuts the Mouth & conteracts all the Muscles, wh. form it &c. _ Feby. 22nd.. Mr. Blizard considered the Diaphragm. ~ wh. forms a compleat Septum, between the Thorax & Abdomen; It is attached [& arises from] to the Xiphoid Cartilage, to [from] the Cartilage of the last true & all the false Ribs, & to the 3rd. 4th. & 5th. Lumbar Vertebræ, arising from a [crossed out] tendinous Centre, from wh. 112. the fibres diverge, The tendon is semilunar, & has a hole on its right side, through wh. the ascending Vena Cava passes. _ The fleshy part terminates in the Crura, &c _ the fibres of wh. decussate leaving a hole through wh. the Aorta passes, & above this is another hole which gives passage, to the Gula. This Muscle, is the principal Agent in Respiration &c. &. _ 113. Feby. 23rd. Mr. Orange considered the Trapezius, wh. with the Latissimus dorsi, almost cover the whole back. ~ It arises from, the protuberance in the Occiput, the 2 last Spinous processes of the Cervical Vertebræ, & all of those of the back. & is inserted into the posterior part of the Clavicle [crossed out], & the Spine of the Scapula. The direction of its fibres being 3 fold, will act accordingly. It's straight ones draw the Scapula directly backwards &c &c. It also draws the Head backwards, antagonizing the Sterno Cl. Mastoideus. _ The Ligamentum Nuchæ is the attachment it has with it's fellow at the Nape of the Neck. ~ As there are no muscular fibres here, Blisters, Setons, Issues, are to be applied &c. _ 114. Latissimus dorsi ~ Arises from the Spi: pro: of the Veterbræ of the loins, & Os Sacrum, & several of the dorsal, from the Extremities of the 3 or 4 inf: Ribs, & from the Crista & Spine of the Ilium, & is inserted into the inner edge of the groove in the Humerus. _ It pulls the Arm backwards & downwards, &c. _ Dislocations of this Muscle takes place sometimes, to reduce wh. the Arm, must be brought to the body, pressure, being made on the inf: ang: of the Scapula, when the Arm must be brought quickly upwards. ~ Rhomboideus. - situated between the 2 last muscles, & is distinguished into major & minor, the latter being superior &c. & taken together 115. arise from sev'ral of the Spinous processes of the Cervical & dorsal Vertebræ. & is attached to the basis of the Scapula, wh. they draw upwards & backwards. ~ ~ Serratus sup: posticus. - Arises from the spi: pro: of the last Cervical; & 2 upper dorsa Vertebræ, & is inserted into the Ribs, wh. it draws up, & is therefore an inspiratory pow'r. _ It is antagonized by the Serratus inf: posticus. wh. arises in Common with the tendon of the Latissimus dorsi, & is attached above to the Ribs. &c. _ Splenius Capitis. - Arises from the Lig: Nuchæ, & spi: pro: of 3 last Cervical Vertebræ & is inserted into the Occiput; pulls the head backwards. Splenius Colli. - Arises from the 3rd. & 4th.. cervical &c. of the back &c _ inserted into 5 sup: trans: -. 116. Complexus. Arises by digitations from the trans: proc: of the 4 inf: Cervical & 7 sup: dorsal Vertebræ. is attached to the Occiput, wh. it draws backward &c. _ Trachelo-Mastoideus. _ Arises from the trans: pro: of some of the lower Cervical, & upper dorsal Vertebræ & is inserted into the Mastoid process, assisting the Complexus &c _ Musculus Patientiæ. _ Arises from the sup: ang: of the Scapula & is inserted into the trans: pro: of 3 or 4. Cervical Vertebræ. It raises up the Scapula &c. _ ~ The principal flexors of the Thigh, lie in the Cavity of the Abdomen. Psoas. ~ Arises from the transverse pro: & bodies of the Lumbar Vertebræ 117. Vertebræ, & going over the brim of the Pelvis, is inserted into the Trochanter minor of the Femur. wh. it bends forwards. &c &c. _ There is sometimes a Psoas parvus. ~ &c _ inserted into the brim of the pelvis, arising from the 2 upper Lumbar Verterbræ, & assists the former in bending the Loins forwards &c. &c. _ Hiacus Internus. _ Arises from the trans: pro. of the last Lumbar Vertebræ &c. &c _ & joining the Psoas magnus, becomes tendinous, & is inserted into the Trochanter minor along with it. - 118. Feby. 24th. Mr Blizard, considered the Muscles of the Spine, which he said should all be taken together to understand their Uses. & Longissimus dorsi. _ Arises from the Sacrum, & post: Spine of the Ilium. &c. &c. inserted into the Vertebræ of the back & Ribs &c &c by small tendons. &c. _ It keeps the body erect. Sacro-Lumbalis. _ Arises, in common with the last: inserted into the Ribs, &c. & had the small Musculi ad Sacrolumbalem Accessorii attached to it. &c. From the upper part of this Muscle, the Cervicalis descendens, goes, to be attached to sev'ral trans: pro: of Cervical Vertebræ, wh. turns the head backwards & to one Side & _ ~ Semispinalis Colli & Dosi ~ Arise 119. from the trans: pro: of the Verterbræ of the back by tendons & inserted into the spi: pro: of Cervical Vertebræ, except 1st. & last. &c Multisidus Spina Arises from the Sacrum. Ilium. &c. &c. inserted into spi: pro: of Lum: dors: & cer: Vertebræ & Rectus major Capitis posticus, & minor. _ Obliquus superior, & inferior. ~ &c & Scaleni. ~ Arise from tran: pro: of Cervical Vertebræ, inserted into 1st. & 2nd Ribs. They bend the Neck, & elevate the Ribs. &c &c. _ Intercostales. ~ 2 layers, ex & in-ternal. _ External. Arise from the Spine &c, & & going downwards & forwards lose themselves at the Cartilages of the Ribs &c. _ The Internal commence at the Sternum & go downwards & backwards &c. stop before the arrive at the Spine. ~ These draw the Ribs upwards &c. Triangularis Sterni. Arises from the Sternum & internally Its fibres go upwards, & are fix'd in the Cartilages of 3rd. 4th. 5th. Ribs & wh. it depresses. & contracts the cavity of the thorax &c &c. - 120. Feby. 25th. Mr Orange began the Consideration of the muscles of superior Extremities &c. ~ Deltoides. _ Arises from the Clavicle, Acromion, & lower margin of the Spine of the Scapula, &c. & is inserted into the outer part of Os Humeri, near it's middle; It pulls the arm, outwards upwards, & backwards & forwards &c &c. _ Supraspinatus. ~ Arises from the base of the Scapula above the Spine, from, the Spine itself & sup: Costa &c. Is inserted into the protuberance on the head of the humerus &c. It raises the Arm up &c. _ Infraspinatus. arises from the base of the Scapula below the Spine, & is also inserted as above ~ It rotates the humerus outwards. &c. &c. _ Beneath it, from the hollow of the Scapula; arises the Teres minor. & is inserted, rather lower &c. than the 2 former. &c It rotates 121. the humerus outwards &c. _ ~ ~ The Subscapularis. ~ Arises from & fills up all the internal hollow of the Scapula. & is attached to one of the smooth Surfaces on the head of the humerus; It rotates the Humerus inwards &c. _ ~ The Teres major. _ Arises from the infer: angle of the Scapula. ~ Its tendon is attached with that of the Latiss: dorsi, is inserted along with it. ~ It rotates the humerus inwards, & is also a flexor &c. Coraco-brachialis. ~ Is an adductor &c. & arises in common from the Coracoid process, with the short head of the Biceps. & is inserted about the middle of the internal part of the Humerus &c &c. _ The Fore Arm, is capable of flexion, & Extension, &c &c. It has 2 flexors, viz. Biceps, & Brachialis internus. &c. &c. _ Biceps. Which in our Subject, happen'd to be a Triceps. ~ Arises, by its short 122. head from the Coracoid process. The Tendon of the long head, passes along the groove; through the Articulation from the upper edge of the glenoid Cavity; these uniting about the middle of the Arm, are inserted into the Tubercle on the upper end of the Radius &c. It is a flexor & Supinator of the fore-Arm & also an Adductor of the Humerus &c. _ From the bending of the Elbow, at the lateral internal part of the forearm &c. the tendon of this muscle sends off an aponeurosis, joining another sent off by the Triceps. wh. cover the Muscles &c. & afford attachment to some muscular fibres, under it the Arteries Deep seated Nerves pass &c. _ Triceps Extensor Cubiti - At the back of the Arm, arises, by 3 heads; from inf: Costa of the Scapula, by the long head &c, & from the humerus by the 2 others; these 123. join & their Tendon is fix'd to the Olecranon &c. - This is a powerful Extensor of the fore arm &c &c _ Branchialis internus. ~ Arises, from the Humerus &c, & is inserted into the Coronoid pro: of the Ulna ~ This flexes the Cubit. ~ Feby. 26th.. Mr Orange considered the Muscles of the Cubit &c. _ From the internal Condyle of the humerus, the pronator teres arises: & is inserted into the middle posterior part of the Radius &c. wh. it rolls inwards ~ Pronator quadratus, arises from the lower inner part of the Ulna, inserted into the lower anterior part of the [Ulna] Radius ~ wh. it rolls inwards &c. _ The hand has 2 Supinators_ Supinator Radii longres, Arises from the Humerus &c. inserted into the inferior extremity of the Radius. wh. it rolls outwards &c. _ ~ Supinator radii brevis ~ Arises from external Condyle 124 inserted into Tubercle &c. of the Radius, wh. it rolls outwards. ~ &c. _ Palmaris longus ~ Arises from internal Condyle, inserted into Lig: Carpi Annulare &c. &c. It bends the hand &c. _ Flexor Capi Ulnaris. _ Arises from internal Condyle of Humerus; inserted into Os pisiforme &c. bends the Arm. ~ Flexor Carpi Radialis. _ Arises from the internal Condyle &c. inserted into Os Trapezius &c. ~ It also bends the Arm. _ &c. Extensor Carpi radialis longior. _ Arises above the external Condyle &c. inserted into metacarpal bone of 1st. finger &c. Extensor Carpi radialis brevior. ~ Arises from external Condyle &c. inserted into metacarpal bone of middle finger. &c. _ Extensor Carpi Ulnaris. _ Arises from ext: Condyle [inserted] inserted into metacarpal bone of little finger &c. _ These 3. last. extend the Arm. &c. _ 125. The lateral motion of the Carpus perform'd by the flexors & Extensors of either Side, acting together. ~ ~ All the fingers have a Common Extensor &c. _ Extensor Digitonum Communis ~ Arises from external Condyle &c. & splits into 4 tendons, before it passes under the Lig: annulare: & is inserted into the bones of all the fingers. posteriorly. _ Indicator. _ Arises from the Ulna, & is inserted into 1st. bone, of fore finger. Flexor Sublimis ~ Arises from the Ulna. &c. _ inserted into 2nd. bone of each finger &c. Flexor profundus. _ Arises from Ulna &c. inserted into last bone of each finger &c. this passes through the last &c. _ Flexor longus pollicis, & brevis. _ the last arises from carpal Ligt: inserted into 1st. bone of the thumb &c. _ ~ The former from the Radius. goes to the 1st. bone &c.. _ For the sev'ral little muscles of the hand &c. see Innes [illegible] &c. _ 126. Feby. 28th.. Mr. Blizard considered the muscles of the Anus &c. &c. & gave some hints concerning the introduction of a Catheter, Sound &c. into the Bladder, & what the consequence of not depressing the handle of the gorget in Lithotomy would be &c. &c ~               Lectures on Anatomy &c. by Messrs. Blizard & Orange at the London Hospital. 1791.  1 Jany. 20th.. 1791. Mr. Blizard this day read over his introductory Lecture, in which he considered the ancient Method of practising Physic & Surgery as very vague & uncertain; The knowledge of the human frame, being but little understood, at that time, because scarcely any thing but Animals were dissected, whose various parts perform different functions, from the same parts in the human Subject, which should be attended to in practice, so as not to confound the one with the other. He next considered Anatomy, as the Groundwork of Physic, observing that the Healing Art is divided into 2 parts, Physic & Surgery, The former of which comprehends all internal Cures &c. The latter 2. all the manuel & operative part. &c That these 2 should be join'd together, & that tho they were different, it was difficult to detirmine the just bounds of each, for that the Physician & Surgeon often indiscriminately trespassed on each other; tho' he said this was to be excused, when the motives were good, & from a desire of prolonging the life of a Fellow Creature; tho' he regretted this was often otherwise the Case. He on account of the utility of this Science justly rank'd it before any other; He also esteemed it the most ancient of any, tho', says he, before, Luxury Dissipation were introduced among the primitive Inhabitants of this Globe, Deseases, were little known, wherefore little need of Remedies. ~ He said that when Man first began to Congregate & assemble together in Towns, Villages &c. they 3. then began to make distinctions of Men, such as Priests, Legislators, Warriors, Magistrates &c. & as these were generally very publick Characters, if they had performed their various functions during Life with applause &c. the Love the People bore them, shew'd itself after Death, by endeavouring to preserve their Remains by embalming the Body. The first publick Mention of which we have in the Old Testament concerning Jacob, who was embalmed by his own Physicians in Egypt: Surely, says he, this could not have been the 1st.. time of it's being employ'd &c. He then went in to remark that a Surgeon; was not one who understood the perfect management of a Knife, but one who understood the various parts of the Body, with all their Uses, & when an Operation was 4. absolutely necessary. ~ He next observed that We had made greater advances in Surgery within this Century or two, than for near 2 or 3000 Years before; Our knowledge of the Lacteals; Receptaculum Chyli; Thoracic Duct, & principally to Circulation of the blood, discovered by our illustrious Countryman Dr. Harvey, which Discovery would forever immortalize his Name. &c. He then finished his Lecture by stating how this Course would be conducted &c. _ Jany. 28th. Mr. Blizard this day explained some of the definitions given in his little Remembrance ~ The first Definition respects, Animal Matter, considered by him 5 him, as, "Vegetable Matter, modified by the moving powers; neither Acid nor Alkaline; possessing a principle of Vitality." & he then observes in the Words of Scripture "All flesh is Grass." Which he attempts to prove by saying, that Carnivorous Animals which prey on others, & are again preyd on themselves; it will be found (if you examine still higher), that some one Creature feeds upon the Grass & herbage, & ) that therefore these Carnivorous Animals do receive their Sustenance from the same, "vegetable matter modified &c. ~ His 2nd. Definition respects, Life, by him considered as, "The existence of the Vital principle in Animal Matter, either actively or latently, as relative to the moving powers." _ In Blood is the Life of Man." - - 6 This Vital Principle, he imagines a subtil, aerial, something, either active or latent &c. that is when the functions of the moving powers are imperceptible &c. 3rd. Definition _ Death _ "The Destruction or Deprivation of the Vital Principle." People &c. are not alway dead when supposed to be so, as in the Case of Drowning, the Vital principle in that Case being latent, not extinct. 4th: - Putrefaction - "The Natural Decomposition of Animal Matter after Death." When the Vital principle is entirely extinct, the Core which each particle of the various Components bears to it's like; occasions this Decomposition of parts; that they may thereby more readily combine &c. _ 7 5th. Constituents of dead Animal Matter. "Putrefaction, & Analysis by Fire, prove that Animal Matter is compounded of watery, earthy, saline, aerial, inflammable, & metallic, Matter; but affords no Information respecting these parts in their State of Union with the Vital principle" 6th.. Solids ~ "Animal Matter, whose earthy part, bears a relatively large proportion to the other Constituents." ~ 7th. Fluids ~ "Animal Matter whose wat'ry part bears a relatively ~ large proportion to the other Constituents" ~ _ 8th. Seats of the Fluids & Solids ~ "Vessels, Cavities, & Cells,"~ He obser- that he divided it into 3; more for the sake of perspicuity than any other Cause; for that Cavities & Cells, were in fact the same thing. 8 9th. Anatomy ~ "The Art of dividing & examining the parts of Animals, to ascertain their Structure, Situation & relative Connection; divided into Human & Comparative." 10th. Physiology. "The Science of the Functions of the Animal Organs" 11th. Pathology. "The Science of the Seats of Diseases, & the Nature of the Changes of the Structure & functions of the Animal Organs in Diseases." - 12th.. Surgery, "The Science & Art of salutarily actuating the moving powers, & manually obviating & removing obstacles in the treatment of Diseases assigned to it's Aid." - He then made a few Observations, respecting these several Heads & finished his 2nd. Lecture. - 9 Jany. 29th. Mr. Orange continued the explanation of the Definitions. 1st. Blood. "Proper Animal Matter, from various proportions of the Constituents of which, all the parts are formed & supported, & into which they are returned" ~ Nutrition may be considered as a Secretion, We are constantly receiving a supply from the Blood & are as constantly losing by Absorption; If it were not so, we should be constantly increasing in Bulk. It is the Blood which affords the Nutritive parts, & which is the Vehicle by which they are returned. ~ The Arteries deposit; & the Absorbents take away &c. The Cellular Substance is full of a fluid, which if seperated too fast, or if the Absorbents are weak 10. A Dropsy is the Consequence. 2nd. Spontaneous Separation of the Blood without Putrefaction. "Serum, Crassamentum & Coagulable Lymph, or Gluten ~ The various Constituents of Animal matter are destinguished by Putrefaction &c. _ 3rd. Gluten. "The proper Matrix for Vessels, &c. to which also they are properly formed; & indeed no part is properly form'd without it. Granulations on the Surface of Sores, is at first nothing but this Gluten, of a pale Colour, at length turning red & becoming Vascular, on which the Vessels elongate themselves; but if this Gluten is constantly removed, no Granulation will take place. 4th. Secretion. "A Separation & Determination" of Character of something from the blood." _ performed by the means of those bodies termed Glands; as the Salivary, for Saliva, Kidnies for Urine. &c. _ 5th. Secreted Matter. _ "Whatever is put out of the sanguiferous System of Vessels." as the various kinds of fat, Bile, &c. &c. 6th.. Nutrition. "The Secretion of the proper Constituents of a part." That Matter which is taken into the Stomach, forms the principle of Nutrition called Chyle &c. & whenever any part is removed, it must be renewed by the Constituents proper thereto. ~ 7th. Fibre. "An imaginary Line, consisting of points of Animal Matter." 12. It is an imaginary Line &c. But a bundle of them may be separated almost ad Infinitum. An Animal Line is; points, laying by each other, till their length exceeds their breadth &c. _ 8th. Elasticity. "The Sphere & power of Attraction of particles of Matter, after a Degree of Separation." Cohesive Attraction, is that which two bodies possess when at a certain distance from each other. &c. The Sphere of Attraction is that space allowed between the 2 ends &c of a body within which space is stretched, they would retract into their place, but beyond would break &c &c. _ 9th Membrane. "A Collection of fibres, whose Breadth, greatly exceeds it's 13. it's Thickness; of a pale Colour; elastic; has 2 Surfaces, one finely polished, the other Cellular." A Cloth may be compared to a membrane, &c. No Membrane in the body but what is Composed of fibres; They are very vascular, but are not supplied with the Crassamentum or Red part of the blood. The Tunica Conjunctiva of the Eye, in an Inflammation of that part, we see, receives red globules; they are elastic, as we see of the peritoneum in Ascites. Have 2 Surfaces, One finely polished; (this is alway next those parts contained within them &c.) & is the secreting Surface, has innumerable orifices, which if the secretion is too quick, causes Dropsy. 14 The other; is cellular, & is external, easily adhering to the surrounding parts. &c. 10th.. Cellular Substance. "Small portions of Membrane; connected so as to form communicating Cells." This we see, by passing a Blowpipe, into the Cellular Substance, & by blowing, the Wind will inflate all the Cells; It is by some, destinguished into Reticular & adipose but this is a wrong Idea. It is of great use; being an universal connecting Medium _ It connects, the fibres of Muscles, & smallest particle of bone; The Lungs, are chiefly formed of it, & it is elastic, giving us that Springiness, which we possess. 15. 11th. Valve. "A Duplicated membranous production, formed in Tubes & Cavities to assist in the determination of their Contents." A Vessel is Cylindrical Membrane. ~ A valve, is a Duplicature of this Membrane, it lays in the Direction of the fluid contain'd in the Vessel, urging it forward, & obstructing its Return ~ 12th.. Artery. "Muscular, membranous, strongly elastic, originates in one of the Ventricles of the Heart, terminates in secerning & Venal Extremities." _ These are elastic in every Direction. ~ When small ones are cut they retract, & are compressed by the Muscles in which they bury themselves; but those that are superficially placed, or on bone &c. 16 upon being cut, are followed by an Hœmorrhage. ~ The Heart as we shall hereafter consider is divided into 2 Sides, wh. are subdivided into Ventricle & Auricle. All the Veins of the Body empty themselves into the 2 Auricles, & the Blood is expelled from the Heart by the Ventricles. into those Tubes termed Arteries, which terminate either in Veins, open, or secerning Extremities, & Cavities, (this last is seldom the Case: ~ These open Extremities are discovered by Means of a very subtil red Injection, of Turpentine & Vermillion, &c. &c 17. Jany. 31st. Mr Blizard considered the Nature of Nerve, with it's Application & Uses. ~ Some Creatures have no Brain, & may therefore be considered as a Link in the great Chain of Nature between Animals, & Vegetables. There is somewhat answering to Sensation in them & we may even say in Vegetables. Without Brain we should be void of intellectual Sense &c. There are parts in us capable of Sensability, which have a Connection with the Brain, the Seat of the Mind. This Mass termed Brain, as we shall hereafter consider is lodged in the Skull. ~ We shall now define a Nerve. "Loosely fibrous of a soft whiteness, flexible; proceed from the Brain, Spinal Marrow, or a Ganglion, terminates in a Muscle or Organ of Sense." _ Loosely fibrous _ ~ It is not so close, but it. 18. it may divided. ~ Of a soft whiteness ~ It is of a milky appearance, & has not that shining blueish whiteness peculiar to a Tendon. It is very flexible. proceeds from the Brain, Spi. Mar: or Ganglion. Anatomically speaking, every Nerve is in a distinct form in the Brain ~ A Ganglion is a Collection of Nerves, highly organized, & connected by Cellular Substance. & they terminate either in Muscle, or Organ of Sense. All the Muscles we know, are nothing to those we are authorized to suppose we know nothing about. ~ ~ Nerves are the Means by wh. all Sensation is produced. Violence done to a Nerve, produces pain; & if an Impression be made on a Muscle, in which a Nerve is 19 produced, A Change will take place. Organs of Sense belong only to Animals with Brain. Where & whenever Muscles are applied, Nerves must be applied, Ergo, there is universal Sensation. We should here with Abruptness, draw the Line, & honestly confess that beyond this, we know nothing, & when we consider Muscle, how much we are in the Dark respecting Muscular Motion. Nerves however small they may be, may still be divided, ad infinitum. A Nerve may be considered as a Tree, Its roots in the Brain, & the Branches ramefying into all parts of the body. From this Idea, A person would say a Compression of the brain, would affect the Nerves, & vice versa. - 20. Organs of Sense are disposed to receive Impressions & propagate to the brain. Delight, Pleasure &c. are all subordinate to 3 great points, Support, Procreation & The Brain may be considered as a Medium between the Organs of Sense, & moving powers, to receive impressions from one, & to propagate Volition to the other. Every moving power is constructed to receive Impressions: & therefore in one general View, we may consider the whole Body as, an Organ of Sense. There are 2 Theories respecting the Nerves - The first is taken from the Idea of Vibration; it being imagined that a touch at one End of a Nerve will cause a Vibration to the Brain. The other is, that the Nerve is round & tubular, & fill'd, with 21. a subtil ætherial fluid, which if a part be touched it is altogether mov'd up towards the Brain. In respect to the first, There is no Nerve in the Body so tense as to propogate Sound; & even if there was, the Sound would be arested by the intervening Solids; & as to the latter, as this fluid has never been discovered, it seems very improbable. Nature of Impression. There is an inherent power in parts to change, according as they may be affected by the 3 great Causes mentioned. Each part is framed to perform various functions from each other from different Causes; The Eye from Light: The Nose from odorous particles &c. &c. & the Muscles from various Causes from which primarily they 22. were intended to receive them. But if these various Causes convey too strong an Impression, they will destroy the parts, they were intended to serve, & if too weak, will be inadaquate to the Task assigned them, Tho Custom will render both, proper. _ Feby. 1st. 1791. Mr. Orange considered the Structure & formation of bone. "A Collection of the 3 Species of Vessels, & Earthy Matter in Cellular Substance, constituting an inflexible body" Tho' this is termed inflexible, yet a bony fibre is, when separated, flexible. Bone is then a Secretion of Earth Matter in 23 an highly subtil State, floating in the Blood. We have before observ'd that the Gluten of the Blood seem'd the proper Matrix for Vessels to elongate themselves in &c. Tis a Collection of this Gluten which we perceive as the very first Rudiments of the future bone. (In a Compound fracture, the Stimulus throws out a great Quantity of this Gluten which becomes a Matrix for the Elongation of Vessels. If a Woman is pregnant & has a fracture, You will find, that it will not heal till after her Delivery, as the Gluten goes to the formation of the Infant, which would otherwise be determined to the fracture.) At length it becomes organised, & the earthy Matter begins to seperate from the Blood. ~ Every bone is 24. is fibrous, Connected throughout by Cellular Substance. Bones are Vascular, shewn clearly by Injections & feeding Animals with Madder, discovered by Mr. Belcherd. They are also Lamellated proved by destroying the soft parts by fire, or exposing to the Air ~ In long bones, the fibres shoot slanting from the middle to the Circumference; but in broad ones, from several middle central points, ~ Some have imagined that the bones (which when Young are in a Cartilaginous state) have been transmuted into bone, which is a wrong Idea; The Cartilage being reabsorbed, & earthy matter deposited. ~ Exfoliation is divided into 3 kinds; A spongy or powdry one; 2nd. Of Lamella or Plates: 3rd. of fibres; ~ There is 25 a 4th. Sort of Exfoliation, which takes place after Amputation. _ The Idea of Exfoliation seems to be, that Granulations taking place beneath the unsound part, it is pushed off; but the Truth is the Absorbents take away a portion all round & as it were the bad becomes insulated, Granulation then takes place, & the bad part sloughs off. - We must never remove a portion of bone, till Exfoliation takes place, but this done, You should assist Nature in throwing it off, who now considers it as foreign & extraneous. There must be a more than ordinary Exertion of the Heart & Vascular System for the formation of bone. Away to prove the Vascularity of bone, is by immersing it in any diluted Acid, which takes away the earthy part of the bone: ~ 26. It has been doubted whether bones [have sensitivity], They certainly have, tho' their great Quantity of earthy matter, prevents their Sensibility ~ The Granulations of bone are extremely sensible, which would not be, did not the Nerves in the bone elongate themselves. Cancelli ~ Are formed by the recession of the internal fibres of the bone from each other, which having no Resistance internally press that way; the Consequence is, the bone becomes thinner & thinner, at its extremities; so that a Disease of this part would soon penetrate the Cancelli, tho' in the middle of the bone, many plates may be thrown off without Danger. The Use is to support the Medulla, & they assist in expanding Articular Surfaces &c. &c. _ Heads, 27. of bones & all processes, are originally formed in a state of Epiphis, or Separation, having Cartilage interposed, which is by degrees absorbed. ~ Bones are subject to Inflammation. ~ _ Feby. 2nd.. Mr. Orange considered the Nature &c. of a Gland. ~ "A Congeries of the 3 Species of Vessels & Excretory Duct" The Secretions are performed by means of the open mouth'd Arteries. The remainder of the blood being return'd by the Veins; & in respect to the fluid separated, there are 2 opinions concerning it. ~ Malphigi, imagined that at the end of the Artery, there was a little Cupta or bag, & at the other end of the bag, a small excretory duct commenced, that a No. of these small ones open, into a large one, &c. _ _ Ruysh maintains that there was between the 2 Vessels 28. Vessels, no distinction, but that the one began where the other ended. ~ The Office then of Glands is to secrete from the blood, humours in various parts of the body; these humours being of various qualities & Uses; as, the salivary Glands to promote Digestion; of the Ears, to secrete a bitter acrid wax preventing the admission of Insects; &c. &c. But why the different Glands, secrete various humours, from the same Mass of blood we shall for ever perhaps remain ignorant. Glands are distinguished into Conglobate & Conglomerate; The former being round & supposed to have but one excretory Duct, as the kidney; the other composed of a number of smaller ones, having as many excretory ducts opening 20 into one larger, as, the Pancreas; But there is reason to beleive all Conglobate Glands are of a Conglomerate Nature, (this was shewn in a fœtal kidney) ~ The secreted fluid, however, receives vast Change from the Absorbents _ ~ Disease, Increased Circulation &c causing a distension of the vessels, gives admittance to red Globules of blood, (which in proper health &c. receive only the Gluten,) causing the increased Redness of the Urine &c. The Use of Glands may be rank'd under 2 heads General & particular, ~ General, in respect to their being a balance, between the Solids & fluids. We should have a Plethora if the Kidnies could not pass off the Urine separated, &c. _ An increased Secretion of the Glands 30. very often drives away a Cold, which is occasioned by the Stoppage of the pores of the Skin &c- The particular use of the Glands is the particular Separation each one makes as the Lungs & Skin seperate from the blood the most fluid & saline parts &c. - There is also a general Use, resulting from the particular ones, as it gives an opportunity to the parts to reabsorb; ~ In Jaundice, the Bile is reabsorbed in large Quantities, & the greater or less degrees of Complexion, are owing, to the Quantity of bile reabsorbed. &c &c. Glands have Nerves. They must feel their Influence, without which they cannot Act. ~ Medulla _ "Oleaginous Matter in the Cellular Substance sustained by the Cancelli of bone." Possesses 31. the principle of Phlogiston. ~ It is originally secreted in a much more fluid state; but after a time the more fluid parts are absorbed. _ It is considerably redder in Young bones than in Old Ones, the Vessels being larger, & admitting Red Globules into them. ~ Their Use is to answer occasional Absorption & prevent the frangibility of the bone. In people starved to Death, not only the adipose Matter, but even this Medulla is absorbed. ~ Cartilage. _ "Probably Gluten contained in arachnoid Cellular Substance, of a shining whiteness, not fibrous, next to bone in Solidity, ~ strongly elastic." _ It does not appear to be vascular, nor fibrous, & therefore thought to be Gluten, strongly elastic, which is it's great Use, in making. 32. making us perform our Motions. with facility. ~ The Old Man is stiff in his Motions; The Cartilage which surrounds the heads of the Bones, being reabsorbed & bony matter deposited, the least motion vibrates through his frame, & he complains that in walking his brain shakes, he being deprived of that Springing, which he formerly received from Cartilage. _ It keeps parts pervious, as the Nose Palpebræ, punctæ &c. _ & in its application to the heads of bones, it makes them globular being thickest in the Central part, & in Cavities about the edges, making them deeper &c _ 33. Feby. 3rd.. Mr. Orange this day considered Muscular Fibre, _ "Flexible, elastic, Contractile." 'Tis these alone which characterise Muscle; which is the only part of the body Contractile _ Redness is not the distinguishing mark of it, this depends on it's Vascularity & the size of its Vessels admitting the red Globules; There are many muscular fibres without any Redness, as the Iris of the Eye. ~ & there must be muscular fibres even in the fly, without which he would be incapable of Motion; We must admit that where there is Motion, their must be muscular fibres; but most probably, we shall ever remain in the dark respecting the Cause of that Motion. ~ The Definition of Muscle, 34. is, “A Congeries of Muscular fibres the effect of whose Contraction is generally the same.” A fibre we have before considered as divisible almost ad Infinitum into still smaller ones, therefore a Muscle is made up of bundles of bundles of these fibres, A fibre being only in Imagination ~ Its power of Contraction depends on the greater or less No. of fibres, of which it consists; Its sphere of Contraction on their length, tho' when No. & length combine, the Muscle is very powerful. All the Muscles are disposed to contract; if any one remains in that state too long, it is called Spasm; if it contracts quick & often 'tis termed Convulsion; Muscles are plentifully supplied with 35. Nerves, possess a Vis Inscita, not acting under the Influence of the ~ Nerves; & a Vis Nervia entirely dependant on the Will.~ Muscles are termed Voluntary, Involuntary, & those Composed of both. ~ The Muscles of the Arm Leg &c, are Voluntary, under the direction of the Will; The Heart is an Example of the 2nd. Diaphragm of the 3rd.. Muscles are never in a state of perfect Relaxation except in the dead person ~ Muscles, are termed Congeneres, which assist in the same Motion.~ Antagonistæ, such as are the Instruments of opposite Motion, as the Flexors & Extensors of the Arm &c. They are named from their figure &c &c, As the Deltoides, Biceps, Sterno Cleido Mastoideus. Sphincter Oris, Ani &c. _ 36 Tendon "Closely fibrous of a shining blueish whiteness, flexible, inelastic, proceeds from a Muscle." No other Substance but an unelastic one would do, to fix to a Muscle, which is Contractile. It was originally supposed to be compressed Muscular fibres, but it exists in the Fœtus in Utero before any Motion takes place, therefore I imagine it is not so. _ Muscles are Named penniform, single [Illustration], & double [Illustration]; but there is a still more powerful one, in which the Muscular fibres run all round the tendon [Illustration]. ~ Vessels are small in tendon only admitting the pale parts of the blood. ~ Their Nerves are small & few, consequently they have little sensation. _ Aponeurosis. "Expanded tendon." 37 The word Fascia is used syn. _ It is insensible like a tendon; Vessels are small, In a state of Inflammation, it becomes red by Vis a tergo, pushing forward the red Globules into Vessels not capable of receiving it ~ In Amputation of the Leg Thigh, Forearm &c - it is not unusual to have large flakes of it like brown paper come away; Stimulating digestives Are then useful, as the Circulation is languid, ~ Muscular fibres are loosely connected by Cellular Substance. & are dependant on a proper Quantity of Nervous Influence, & of blood, with a proper State of the Connecting Cellular Substance. _ 38 Feby. 4th. Mr. Orange this day, considered, The General Confirmation of Bones. ~ All Bones are divided into long & broad, having parts, called Processes, common to both; which are Risings above the level of the bone, These are named Coracoid, Mastoid, &c, &c, from their supposed resemblance to a Crowsbill, Nipple &c &c.- Tuberosities are processes not resembling any thing in Nature. A process rising almost perpendicular, is called a Spine, & if it's Edge be flat, it is the Crista of the Spine. A Spinous process terminates in a point ~ &c &c _ Coronoid processes also terminate in a point. A process standing out in a round ball, is called Caput, or head, which have a Cervix or Neck tho' in some scarce distinguishable. A Condyle is 39 a head flatned. ~ Bones have Cavities or Depressions, which if deep are termed Cotyloid, if shallow Glenoid, tho in a recent Subject the Cartilages, make them much deeper. Pitts, small roundish Channels sunk perpendicularly into the bone, ~ Furrows are long narrow Canals formed in the Surface, ending in Grooves. ~ Nitches, & Notches small Breaches in the bone; Sinnositics, broad superficial Depressions, without Brims: Fossæ large deep Cavities unequally surrounded by high brims; Sinuses, large Cavities within the Substance of the bone with small apertures. Foramina Canals pierceing through the Substance of the bone, when this goes any way in a bone, the middle part retains the Name of Canal &c - Epiphis. All processes & heads of Bones, are originally formed in 40. a state of Separation, by intervening Cartilage, which sometimes remains through Life; tho this is charactaristic of a weak frame, ricketty &c. & this is also the Case with most scrofulous people. ~ We shall now speak on Articulations _ which are 3 fold, 1st. Symphisis. The Union of 2 bones by intervention of a 3rd. body, & is divided into Syncondrosis, where a Cartilage intervenes, as the Ribs & Sternum; bodies of the Vertebræ, & Ossa Pubis._ Syndesmosis or Synneurosis; Ligaments intervening as, in all moveable Articulations. Syssareosis, ~ flesh intervening, as, a Muscle from one moveable bone to another 2nd. Synarthrosis. Immoveable Articulations, divided into Sutura, The mutual Indention of 2 bones, when 41. their fibres are flexible, as the bones of the Head, ~ - Gomphosis. One bone fix'd in another, as a Nail in a piece of Wood; thus the Teeth are placed in their Sockets ~ Schindylesis, or ploughing, When a thin Lamella of one bone is received into a long narrow furrow of another; as the Vomer with the processes Azygos of the Sphenoid bone. 3rd. Diathrosis. Allowing of large sphere of motion, divided into Enarthrosis, Arthrodia, & Ginglimus. The 1st. is like a ball & Socket, [when] as the Head of the Femur, & Acetabulum. The 2nd. is when a round head is received, in a superficial Cavity, as the Humerus & Scapula. The 3rd.. is subdivided into 3. viz. Trochoides when 1 bone turns on the other as a Wheel on it's Axis, thus the 1st & 2nd.. Vertebræ. ~ The next species, is if 42 a bone receives & is received by corresponding prominences & depressions, as the Humerus & Ulna, Femur & Tibia &c. _ The 3rd. species is, when one bone is articulated to another by more than one place as the Radius & Ulna &c &c _ The Cranium is formed of many peices, tho' the upper part, strictly so called in composed of 8 bones: 6 proper (The Os frontis, 2 Ossa Bregmitis, Os Occipitis, & 2 Ossa Temporum: Thes 6 have nothing to do in the formation of the face,) & 2 Common, both to the Head & face, viz Os Ethmoides & Os Spheroides. In the fœtal Cranium, the bones are separate, & therefore serve as so many points of Ossification, admitting also 43. of the growth of the brain, & at the time of birth, the bones lap over each other, & it is brought forth much easier than if the head was one solid piece ~ When Ossification goes on too quick, 'tis rank'd among the Causes of difficult Labour. The fœtal Cranium is more rotund than an Adult; The European Cranium also differs considerably from the African &c. ~ That part of any bone, on which a Muscle acts is rendered smooth by the Attrition; but where it acts from, the bone is drawn out into a process, as the Mastoid process is formed by the Action of the Sterno Cleido Mastoideus, there being little or none of this process in the Fœtus, who has not made use of that Muscle. _ 44. Sinciput is the Name given to the front of the Cranium; Occiput the back: The Temples are the Sides; Vextex the top: & Basis the bottom. _ The Cranium is composed of an external & internal table, which last from its natural polish is also termed Vitreous. Between these tables are Cancelli, called Diploe. _ Crania differ much in Thickness, as also does the Diploe in different Crania in Quantity; Thin ones sometimes having much, & sometimes, none at all & vice versa &c. _ Pitts _ Are accurately fill'd with brain, & as there is no evidence externally of there being a pitt or that it is a thin Skull; You should alway trefine, as if you were on a pitt or performing the Operation on a thin Skull. 45. Feby. 5th.. Mr. Orange considered 1st. The Os frontis, which occupies the fore & upper part of the Cranium, its figure resembles a Cockle Shell, externally Convex & vice versa; Its Coronal Edge joining with that of the parietal bones, forms the Coronal Suture. The Orbital ridges ends in the ex- & in-ternal angular processes. It has also the Orbital process, going horizontally backward, which forms part of the Orbit, & is inferiorly, internally concave, &c &c. Internally, we have the Spine of the Os frontis, from which arises the falx, dividing the 2 hemispheres of the brain ~ The Cavities & foramina of this bone, are; above the Orbital ridge, a nitch, wh. generally becomes a compleat foramen, called supra orbital foramen, 46 expressive of the passage of the 1st. branch of the 5th. pr. of nerves. More internally is a little notch expressive of the fastning of the trochlea through which the tendon of the trochlearis muscle passes. _ ~ Behind the external angular process is seated the Lachrymal Gland, the principal support of the fluid called tears. Between the 2 Orbital processes is the Ethmoidal fissure. ~ The foramen cæcum lies between the Crista Galls & the Spine of the Os frontis The frontal Sinus is occasioned by the Recession of the internal table from the external; & opens into the Nose. ~ The fibres of the internal table of the Skull 47. are sooner obliterated than those of the outer one, it being a lesser diameter &c _ When the sagittal Suture extends down the Os frontis we never have a Spine; & we may therefore, if a Suture extends down the Os frontis, trefine with safety; but this should not be very low down because of the frontal Sinus ~ The Spine is formed by the fibres of the internal table, (which as being the less Circle) sooner connecting themselves, & turn inwards. ~ A Man should be exceeding guarded in his prognosis concerning a Wound of the Orbital processes, on account of their termity, they forming a support to the anterior Lobes of the Brain &c _ We shall now take a View of the 48 Parietal bones. _ They are of a square figure, & are connected anteriorly to the Os frontis by the Coronal Suture; above to each other by the sagittal; & posteriorly to the Occipital bone by the lambdoidal; laterallay to the temporal bones by the squamose. &c. Its different Sides or edges being distinguished by saying the Coronal, sagittal, &c. _ & the Angles, into Anterior superior, &c &c _ This bone has externally a semicircular ridge, commencing at the external angular process of the Os frontis, & which is expressive of the fascia of the temporal muscle, formed in this manner. The pericranium is composed 49 of 2 Lamella: The first of which, entirely surrounds the Cranium, the other or upper one leaves the under at the attachment of the temporal muscle, which it covers & is itself attached to the Zygomatic process of the temporal bone. Internally along the sagittal suture lies the longitudinal sinus. ~ At it's anterior inferior angle is a groove expressive of the Spinous Artery, which is sometimes formed into a Canal; This place should be avoided in the Trefine; The principal branch of this Artery, runs parallel to the Coronal suture. Pitts are oft'nest found in this bone; The squamous edge appears thinnest, tho' it is made of the same thickness with the rest by the Os temporis. 50. The posterior inferior angle of this bone has part of the groove formed for the lodgment of the lateral sinus. Feby. 7th. Mr. Blizard considered the formation &c. of the Os temporis. wh. is divided into the pars squamosum, & mamillaris externally, & petrosum internally.- Pars squamosum, has an arch like appearance, & is very thin. ~ It is very unequal on the inside, occasioned by the Convolution of the brain. externally we have the Zygomatic process joining with one of the same Name, of the Os Malæ, & it forms a kind of Jujum, through which the temporal muscle passes, The Masseter muscle arises from this process ~ The appearance in recent & dry bones is very different. 51. Pars Mamillaris. _ supposed to resemble a Nipple; is formed into a projecting body, which is canullous, which is connected with the internal Ear which is very dependant on its goodness. Pars petrosum. ~ Has 2 Surfaces, & a ridge from which proceeds the tentorium. Its superior surface forms a support for the anterior lobes of the Cerebrum; the lateral part of the middle lobe of the Cerebellum being applied to its inferior Surface. _ Externally, going obliquely downwards & forwards is the Styloid process, which is an attachment for many muscles. ~ Between this, & the Zygomatic process, is the Vaginal process, & auditory; In this latter is a ridge [crossed out] expressive of the Attachment of the Membrana Tympani, which divides the external from the internal ear. _ 52. This Bone contains the Cavity in which the inferior maxillary bone is articulated ~ The 7th. pr. of Nerves enter the meatus internus in the petrous bone; & there divide into portio dera, (which goes out of the foramen stylo Mastoideum situated between the styloid & Mastoid processes & then becoming a cutaneous Nerve) & portio mollis, which is destined for the Organ of hearing. ~ Behind the vaginal process is the extremity of the foramen Carotideum, which goes up to the brain at a right angle, thus preventing the too quick projection of the blood. At the poster. infer. angle of the parital bones are the lateral sinuses, from wh. commence the internal 52. Jugular Veins, which come out at the foramen lacerum with the 8th. pr. of Nerves, & which is sometimes divided by a bony ridge from the Vein. _ Most of the processes are wanting in a fœtus. - Feby. 8th. Mr. Orange considered the Os Occipitis. ~ Somewhat triangular, bounded by the lambdoidal suture. & terminates in a process named basilary or cuneiform, which joins with one of the same name of the Sphenoid. The Medulla oblong. lies in the hollow of this process, and the basilary artery also lies on it. Externally posteriorly are 2 processes, named Condyles to which the 1st. Vertebræ is fix'd by it's superior oblique processes. ~ All except a small triangular portion of 54. this bone is covered by Muscles, which cannot therefore be trefined. The various Eminences &c. are expressive of the Attachment of several Muscles ~ Nearly opposite the external ridge, internally, is a tranverse one, which has a perpendicular one crossing it, forming 4 Hollows in the bone; the 2 upper of which are expressive of the position of the 2 posterior lobes of the Cerebrum. ~ The Falx is attached to the Cross ridge, & the Pentarium to the transverse. Between the Basilary process, & body of the bone is the foramen magnum, through which the Medulla oblongata, passes from the brain; & the Vertebral arteries to it. ~ Below the Condyles 55 are the 2 foramina Condyloidea, through which the 9th. pr. of Nerves pass to the tongue. ~ On the outside of these lie the Jugular fossæ, through which the internal Jugular Veins, & 8th. pr. of Nerves pass. ~ - Os Sphenoides ~ Is the most difficult of all the bones of the Cranium; It properly forms the basis Cranii, & is a wedge to the other bones, it is also one of the Common bones. Its Situation renders it impractible for Surgeons practise &c. It consists of, Body, & laterally Wings, & has been said to resemble a bat flying. ~ Of the Body ~ It has a superior & an inferior Surface; An anterior & posterior part. ~ It's superior surface is hollow, forming the Sella Turcica, anterior to which, is, 56 a smooth Surface expressive of the Conjunction of the optic Nerves. ~ It ends in the posterior clinoid processes. ~ Its inferior surface has only a solitary process, named Azygos, which receives the Vomer coming into the Nose. It's anterior part is cellular, joining with the Cells of the Ethmoid bone, which open into the Nose. ~ At its posterior part is the basilary process ~ The Alæ or Wings, end posteriorly in a point, termed the spinous processes, simply, to distinguish them from the transverse spinous processes, which join the broad part of the Alæ to the body, ending round, in the anterior 57 Clenoid processes, behind which the internal Carotid Arteries run, sometimes a compleat foramen is formed here. - The broad parts of the Alæ are formd into 3 Surfaces, anterior, external & internal, the 1st. forming part of the Orbit &c. Externally, we see the Pterygoid processes, dividing into ex- & in-ternal; the latter is form'd into a hook, over which the tendon of the Circumflexus palati plays, ~. The foramina optica, are rather anterior to the smooth surface mentioned. ~ Next are the foramina lacera, beneath the transverse spinous processes, thro' which the 3rd. 4th. 1st. branch of the 5th. & 6th. pr. of Nerves pass. _ Below these are the foramina rotunda, 58 through which the 2nd. branch of the 5th. pr. of Nerves pass, ~ & still lower are the foramina Ovalia, thro' which the 3rd. branch of the 5th pr. of Nerves pass. _ The foramina spinosa are still lower; these admit the spinous Artery. ~ There is another foramen through wh a considerable branch of the 2nd. branch of the 5th pr. of Nerves is reflected &c Feby 9th. Mr. Orange considered the Ethmoid bone. ~ This bone completely fills up the Ethmoidal fissure of the Os frontis; & forms the principal bony part of the Nose; It is very delicate & tender; ~ Has a superior perforated Surface termed the Crebriform Lamella 59 & an inferior cellular surface, hanging down into the Nose, ~ An Anterior projecting Surface, on wh. the Nasal bones rest; & a posterior surface joining with the Cells of the Sphenoid bone: It is divided into 2 parts by a thin bony plate termed the Nasal Lamella, the upper part of which is rounded, & named Crista Galli. The anterior Lobes of the Cerebrum rest on the Crebriform Lamella; so that a blow on the Nose, often drives the Nasal Lamella & Crista Galli into the brain; In such a Case we should introduce a pr. of forceps lined with Sponge &c. & seizing on the Nasal Lamella, draw it from it's Situation, which is all that can be done. 60. It is bounded on the Sides by the Os planum one of the bones of the Orbit; Next the Nasal Lamella are placed the superior Spongy bones. The tenuity of these bones &c. should make us cautious, in the introduction of Instruments into the Nose, or detaching a Polypus from thence. Superior Maxillary bone. _ Joins the Os frontis, Mali, &c &c &c. It is irregular; &c. It's Nasal process has a groove form'd in it, which by the junction of the Os Unguis, is form'd into a Canal call'd the ductus ad Nasum, above this, is the tendon of the Orbicularis palpebrarum. ~ Its anterior edge is formd for the reception of the Os Nasi. ~ Its upper part is named the orbitar process, going horizontally backwards, forming part of the floor of the Orbit & roof of the 61. Antrum ~ Its outside, receives the Cheek bone; termed it's malar process; & it's inferior edge termed it's Alvsolary process, has the Alveoli, or Sockets for the teeth form'd in it. _ These Alveoli are absorbed in Old Age, & occasions the Nose & Chin to meet. ~ Internally is the palatine process, doubly concave, forming part of the Roof of the Mouth & floor of the Nostrils; The remainder of the roof &c. being perfected by the Application of the palate bones. _ Just beneath the Orbit is the Infra Orbitar Foramen, thro' which the 2nd. branch of the 5 pr. of Nerves passes. _ ~ Os Mali. ~ Given the Rotundity to the face; ~ It's maxillary process joins the maxillary bone. ~ It has 5 processes, viz, superior, & inferior, obitar, Maxillary, & Zygomatic. & internal Orbitar. 62. Feby. 10th. Mr. Orange considered the Ossa Palati. ~ These may considered as parts of the Maxillary bone; they finish the Roof of the Mouth & floor of the Nostrils; doubly Concave; It has 3 processes, viz, palatine, pterygoid, & Orbitar, ~. It is very spongy & thin, often coming away in the Lues Venera, The Voice then becomes impaired, & there is a difficulty of swallowing. ~ Ossa Nasi. - These form the bony Arch of the Nose; but are not continued to it's Extremity, as it would be in danger of fracture. They are of different figures, wh. causes the various Shapes of Noses. Their upper part is bulbous & thick, connected with the Nasal process of the Os frontis 63. frontis. ~ Their middle rests on the Nasal Lamella of the Ethmoid bone, their Sides on the sup. Maxillary. ~ In a fracture of these bones, we should be exceeding guarded; & not, as is generally done, endeavour to depress the prominent part which is the natural State of it; but to elevate the depressed part, wh. has been beaten in; We must first ascertain the Condition of the Nasal Lamella with a probe, & if it is driven up into the Brain, draw it gently down with a pr of forceps, but if it is found, you should, with a Director or piec of Wood defended with Linen, elevate the depressed part ~ Vomer. ~ Its upper part, has a groove, in wh. the processes Azygos, of the Sphenoid bone, is received, 64. & this with the Nasal Lamella forms the Septum of the Nose; There is however a triangular Notch, which in the recent State is filld up with Cartilage, Inflammations of the bones of the Nose, should be removed by Fumigations &c &c. as soon as possible, as they soon exfoliate. _ Ossa Unguis. ~ Is composed externally of 2 smooth Concavities & a middle ridge; & is fix'd to the groove in the maxillary bone, thus compleating the ductus ad Nasum. This bone it is, which is perforated in the Operation of fistula lacrymalis, carrying the Instrument downwards & backwards.- 65. Inferior maxillary bone. - Consists of a body, & posteriorly the Rami, ending in the Coronoid & Condyloid processes _ Its inferior part is the basis, the middle is the Symphysis, which makes the difference of Chins, by projecting more or less. ~ The part where the Rami go off is termed its Angles - The Condyloid processes form a Sort of Enarthrosis Articulation, with the articular Cavity in the temporal bones. ~ To the Condyles are attached the temporal Muscles, & all the Rami are covered by the Masseter Muscles. ~ From the basis, rises a perpendicular process for the Reception of the teeth termed alveorlary ~. Internally at the Symphysis &c, are several protuberances, expressive of the attachment of various Muscles, as the Digastric &c &c & just below 66. the Coronoid process, the Buccinator Muscle is attached ~ On the inside the Rami are 2 holes, the entrances of a Canal, thro which the 3rd. branch of the 5th. pr of Nerves, & an Artery pass, to supply the teeth, coming out near the Symphysis of the Chin externally. Fractures of this bone often happen, & sometimes a troublesome Hemorrhage takes place, by the Contraction of the Artery into the bone, which cannot be got at without taking a piece of the bone away, ~ Sutures ~ formation. Bones are fibres, which in broad [long] bones, radiate from the Centre to Circumference, these at length approach & pass between each other; but they meet resistance as they approach, & 67. thus a Suture is formed. ~ These sometimes remain through Life, at other times they are obliterated.~ There are 5 principal Sutures, the Coronal, extending across the head; the Sagittal, placed longitudinally on the Skull & is sometimes continued down the Os frontis. The Lambdoidal, rather father back than the Vertex & going obliquely downward. & the 2 Squamous, a little above the ear. ~ ~ The best Method of tracing these, is; about an Inch from the external ang. pro. is the Coronal going obliquely upwards & backwards about the length of a common probe from the Nose. ~ The Sagittal terminates in a line carried round the Cranium from the external ang. process; & the lambdoidal terminates just above the Mastoid process 68. Feby. 11th. Mr. Orange, Considered the Spine, beginning at the condyles of the Occipital bone; Consists of true & false. The true comprehending 24 Vertebræ, the false, the sacrum & appendix Coxendicis. ~ The true are divided into, 7 Cervical, 12 dorsal, & 5 Lumbar, all of which agree in the general Character of having a body, (except the 1st. Cervical,) & processes; The bodies placed before, &c. 7 processes. 2 transverse, 4 oblique, & 1 Spinous, The specifick Character of each is different; viz. ~ The Cervical Vertebræ, are flatned at the fore part, on wh. the Oesophagus &c. rests; the dorsal, laterally, allowing room for the lungs &c &c. & the lumbar at their fore part, giving Room to the Viscera & The bodies are, greatly Cancellous 69. & their edges are covered by a thin plate of bone, & between each, is a thin plate of Cartilage & Ligaments. The 1st. Vertebra, called Atlas from its supporting the head, differs from all the others very materially, it has no body, but in its place a bony Arch, on the inside of which is [seated] a smooth Surface to receive the processes dentatus of the 2nd. Vertebra, round which it moves, It's superior oblique processes are articulated with with the Condyles. ~ The Cervical Vertebræ, may alway be known by a hole in the their transverse processes, forming a Canal for the transmission of the Vertebral Arteries. ~ The transverse process of the 1st. Vertebra, extend out much farther than the others 70. which occasions the Artery to make a Curve, before it enters the foramen magnum. ~ Its spinous is so small, as scarcely to deserve that Name. ~ The 2nd. Vertebra call'd dentata, from it's toothlike process, which arises from it's body & passes on the inside of the 1st. Verte: from it Ligaments to the Cranium which fasten it &c - This pro: is sometimes fractured in Children, which causes instant death, as the Spinal Marrow is compressed, having an Angle form'd by the Head falling forwards; & Apoplexy or Concussion of the brain is thought oftentimes to be the Cause. therefore in weak Children, something placed to keep the head erect, is not amiss. - 71. The Motion allowed of between the 1st. & 2nd. Vertebræ, is greater than between any other, The Medullary Canal, is always the largest in Vertebræ having the most motion. ~ The remaining Vertebræ if the Neck are pretty much the same, The spi: pro: of each being bifurcated. They grow larger as the descend, the 7th. being not unlike the 1st. dorsal &c. Dorsal Vertebræ ~ Are compressed laterally, have no holes in their trans: processes. ~ At their lateral part is a pit expressive of the Rib, & their transverse processes are pressed by the tubercle of the Rib, in respiration. ~ Their Spinous processes stand downwards & are very long. ~ The last dorsal Vertebræ, resemble the 1st. lumbar &c. 72. Lumbar Vertebræ, ~ Are largest of all the others; processes differ, &c &c. ~ by the application of Vertebræ we have lateral holes for the transmission of Nerves, & Vessels &c &c. _ The true Vertebræ may be considered, as a pyramid, its base, the last lumbar Vertebra. ~ The Os Sacrum or false Vertebræ, may also be considered as an inverted pyramid, its base joining the base of the true, &c - Costæ or Ribs. Of these there are 12 on a Side, 7 true, connected with the Sternum, & 5 false, connected with, the 7th: true one &c. There are the same No. in a Male as in a female ~ They all agree 73. in having a head, a prominent tuberosity, an Angle, & a superior & inferior Surface termed Costæ &c. The 1st. differs from the others; it is placed nearly horizontal & is immoveable, having Ligaments coming from the Clavicle; so that in Inspiration, the inferior Ribs, are brought toward this, by the intercostal Muscles, which turn them outward, & the Diaphragm descending, enlarges the Cavity of the Thorax. ~ Expiration, is the cessation of these Muscles _ Their heads are framed for articulation, with the dorsal Vertebræ; their inferior Costa has a groove in which the intercostal arteries run. ~ fractures generally happen beyond the angle of the Rib. &c. In the Operation of Empyema, we must keep close to the superior edge of an inferior Rib, on account of the Arteries &c. _ 74 Feby. 12th. Mr. Orange this day considered the Sternum ~ Said to consist of 3 peices of bone, though one is named the Xiphoid Cartilage; Altogether it is externally somewhat Convex, & a little Concave internally. ~ The 1st. portion is largest, & has laterally a Depression expressive of the attachment of the Clavicle. ~ The 1st. Rib is attached entirely to this; The 2nd. Rib is attached between the 1st. & 2nd. bone. ~ The 3 portions are often altogether ossified, so as to make but one bone. ~ The Sternum is very light & Spongy, apt to be affected with Caries, & it then crumbles away, ~ . _ 'Tis recommended to trefine this bone, when matter is form'd in the anterior Mediastinum.~ Fracture sometimes occurs, the only Remedy then is to lay the person [crossed out] on his back, raising him up with pillows &c &c. placed under him. _ 75 Upper Extremity, ~ Divided into, Shoulder, Upper Arm, Fore Arm. Carpus, Metacarpus & Fingers. _ Shoulder. ~ Consists of 2 bones, the Clavicle, & Scapula. ~ ~ Clavicle. ~ Gives that figure to the trunk which it possesses, by keeping the upper Extremities at a distance. ~ It is said to resemble an Italic ∫, placed horizontally, It has a body, & 2 Extremities, named Sternal & Scapular. _ The Sternal is larger & more rotund than the other, & has Ligaments, allowing of a Motion every way; ~ It acts as a fulcrum to the upper Extremity _ It's inferior part has a roughness expressive of a Ligament, going to the 1st. Rib. ~ Its Scapullar Extremity is flatted, having a Smooth ending Surface, expressive of its attachment with the Acromion of the Scapula & beneath is a Roughness, from wh. a Ligament goes to the Coracoid process. 76. It is almost entirely covered by Muscles, as the Deltoid, Pectoral Sterno Cleido Mastoideus &c &c &c. - About the middle is a hole through which the medullary Artery passes.~ Fractures of this bone often occur. ~ & the Weight of the upper Extremity will depress the part next it, & make the part affix'd to the Sternum, appear prominent, tho' it is natural, as the Sternum, is a fix'd part; Our Care is to elevate the depressed part, & keep the Shoulders back by a figure of 8 bandage. ~ ~ - Scapula. ~ Somewhat triangular, Externally Convex &c. _ term'd the dorsum, from which arises a Spine, which is somewhat hollow & flatted above, nam'd the Crista. to wh. several Muscles are attached. _ It is divided, into Superior & inferior 77. inferior Costæ, & basis, &c _ _ The Spine terminates in the Acromion, wh. has a Smooth internal edge for the reception of the Clavicle. The Head of the Scapula, is form'd into a Glenoid Cavity for the reception of the head of the Os Humeri; just above it is the Coracoid process, wh. is very important, having attached to it, 1 head of the Biceps; Coraco brachialis. &c. &c. _ Sometimes this is fractured, tho this mostly happens at the Cervix Scapula; ~ To determine if it be fracture or Dislocation, (the symtoms being the Same,) We must feel this process; by bending the Arm, & pressing into the hollow; if it yields, it is fracture &c _ _ _ You must press the head of the Humerus up by keeping the Arm in a Sling, covering the Elbow with it & keeping 78. down the Shoulder, with the reflexed Capsiline bandage. ~ The inferior Angle of the Scapula is made smooth by the Action of the latissimus Dorsi. ~ Matter is sometimes form'd behind this bone; & it is then recommended to trefine upon it. ~ &c - - - _ Feby. 14th. Mr. Orange considered the Os humeri. ~ Has a body, & upper & lower Extremities; Its head is fitted for connection with the Scapula, & is on one Side, in respect to its body The internal Condyle of its lower Extremity may serve as a guide to find it &c. _ The upper part of it body, has several Smooth Surfaces expressive of the attachment of Muscles, as is also the body itself. ~ The pectoral Muscle is attached 79. to an outer ridge, which is on the body, & the latissimus dorsi to an inner one. ~ The Coraco-brachialis, arises from the Coracoid process, & is attached to this bone; Somewhat flattened posteriorly, having a deep fossa, & also at it's internal part, into which the Olecranon, & Coronoid process of the Ulna play. It ends in it's ex- & in-ternal Condyles, the latter of which projects inwards considerably, & is often fractured without detriment to the joint. ~ The external Condyle is much rounded, & on it the Radius plays, it is much less than the internal one, which is alway fractured, in a Dislocation, of the fore Arm inwards, but a Dislocation may happen outwards, without fracture. ~ Extension of the fore Arm, is sufficient 80. to reduce it. Dislocations of the Humerus may take place downwards, backwards or forward but not upwards, without fracture of the processes of the Scapula ~ &c. &c. &c. _ _ _ Fore Arm. Consists of 2 bones, Radius & Ulna. ~ Radius. ~ Is rather Convex externally. &c. _ pretty regular. Its upper part hollow'd for Connection with the tubercle of the humerus, & laterally to the Semilunar Cavity of the Ulna. ~ It's Neck is surrounded by a ligament, fastening it to the Ulna. ~ Internally, below the neck, is a turbercle, to which is attached the tendon of the Biceps. _ below this it becomes broader ending in a kind of Ridge to which the interosseous ligament 81. ligament is attached, going to a similar ridge in the Ulna. ~ In the middle is a rough Surface, to wh. the pronator teres is attached from the internal Condyle of the Humerus, which Muscle, without Care is taken, will be divided in opening the Arm. ~ It ends in a Semilunar Notch in wh. the Ulna plays laterally, & its end has a Cavity for the reception of the Os, Scaphoides & lunare &c. _ The pronator quadratus arises from this. _ Ulna. ~ Is the longest of these bones, & the internal one; the Radius moves round this in pronation & Supination, it being fix'd. _ It has an articular Cavity bounded by the Olecranon & Coronoid process; The former has inferiorly, a triangular rough Surface, expressive of the 82. place on which we alway lean. _ When the Olecranon is fractured we must keep the Arm extended by a small Splint, from the Humerus to the fore Arm; & Inflammation, must by all means be avoided. ~ At a fortnights end or before, we must begin to move the Arm gently &c. _ ~ The Triceps Muscles is attached to this bone, at the Olecranon. & the Branchialis internus to the Coronoid process. ~ On its outside is a Semilunar Cavity in wh. the Radius plays: & a little lower is the Ridge to which the Ligament is fix'd surrounding the Radius, its outer Side has a Ridge to wh. the interosseus Ligament is attached, Its lower part is 83. round &c &c. _ _ _ It ends in the [Semilumar] Stiloid process ~ Both are sometimes fractured, A narrow Compress placed before & behind is Sufficient, over wh. a Splint may be placed. Carpus. _ Consists of 8 bones. divided into upper & lower phalanges, the Upper consists of the Os Scaphoides Lunare Cuneiforme, & pisciforme, the lower of, Os Trapezium, Trapezoides, magnum & cuneiforme. _ They are all of a Wedge like figure _ ~ Considerable motion between the 2 phalanges is allowed of. ~ All the bones communicate, one with the other, so that Disease of one, affects all: They also communicate, 84 with the Metacarpal bones. ~ wh. Should not be taken away at their Junction with the Carpus. ~ &c. _ Metacarpus. ~ Consists of 4 bones, the Thumb not having one. It may therefore be removed from the Carpus, without Detriment. _ Fingers. ~ 5 in No. each consisting of 3 bones. ~ The Thumb has the Strongest bones, as it counteracts, all the fingers; we should retain as much as possible of it in Amputation. &c. _ Feby. 15th.. Mr. Blizard, considered the bones of the pelvis: composed of the Sacrum Coccyx, & Ossa Innominata, wh, is divided into Ilium, Ischium & pubis. ~ The[ir] Situation of the pelvis is very inclined, ~ The upper part of The Ilium forms a Considerable part of the Abdominal parieties, ~ These 3 bones are compleated into a single one in Adults. _ The Ilium, is rounded above wh. part is termed its Crista, which ends, before in, Anterior sup: & inf: Spines; & behind in posterior Spine. _ Os pubis; where it joins its fellow has the term of Symphysis applied to it; it has a Ramus & an Angle &c &c. _ Ischium has a process term'd it's spine &c. which is turn'd more outwards in females than Males; Its inferior part, is rough, termed it's tuberosity. Its upper part forms the greatest share of the Acetabulum, At the bottom of wh. is the fossa for the Synovial gland &c &c. & it has a large Notch compleated in the recent subject, into a foramen, by Ligaments. 86. Sacrum; Consists of 5 bones in the fœtus, which in Adults, are form'd into one. _ It is a wedge like bone, & situated between the 2 Ilia behind. It has the Coccyx at its Extremity, divided into 2 or 3 bones, the 1st. of which has 2 processes standing up, from wh. Ligaments go to the Sacrum. - ~ The pubis is formed into an Arch by the junction of the 2, larger in Women than Men. ~ The Axis of the pelvis & Abdomen are different. ~ To the Crista of the Ilium, all the Abdominal Muscles are attached, &c. from its post: Spine Ligaments go to the Sacrum &c. &c. _ The Sartorius Muscle arises from the ant: sup: Spine; behind the 87. ant: inf: Spine, is a hollow, over wh. the psoas mag: & Iliacus internus pass; & a little lower, the place where the External Iliac Artery passes. ~ poupart, or Fallopius' Ligament goes from this bone to the Angle of the pubis, . &c &c _ Acetabulum. ~ Is form'd by the Junction of these 3 bones, & is the Socket, in wh. the head of the femur plays. _ &c. . Feby. 16th. Mr. Orange, considered the Os femoris; having a body & an upper & lower Extremity. Its upper part is form'd into a head laterally, having a contracted part, termed its Neck, to one side of which its body ends in the Trochanter major, & more internally downwards, is 88 the Trochanter minor. ~ Below the Trochanter major is rough line to wh the Gluteus medius, is attached; & at it's posterior part is the linea aspera. ~ Fractures of the Neck sometimes happen, ~ We may always tell the Situation of the head by its being anterior. & to one Side of the internal Condyle. ~ Its Head has a rough Surface at its Extremity to wh. the the Ligamentum teres is fix'd. ~ It terminates in the ex- & in-ternal Condyles, which a framed for a Ginglimoid & Enarthrosis Articulation. ~ It's anterior part is grooved receiving the patella. ~ Inflammation & fracture of the Condyles are very dangerous to the joint &c. Leg. _ Consists of the Tibia & fibula. Tibia. _ Somewhat triangular, having an external, internal & posterior Surface. ~ The internal, is, what we term, Shin, & 89. may be got at by a simply Inscision, wh. the others cannot be. Its anterior edge is termed its Spine. Externally below the head, is the Smooth Surface, to which the fibula is fix'd. ~ The Ligaments of the patella are fix'd to a protuberance it has at it's anterior part ~ Its inferior internal Surface, forms the Malleolus internus, which is somewhat rounded by the tendons of some Muscles; & is sometimes fractured. _ ~ Fibula. _ Is very slender. Its lower Extremity forms the Malleolus externus. fracture of its extremity may happen without Injury to the Joint ~ We are directed in Amputation to stand on the inside, as we shall fix our Saw on both bones at once. _ ~ Foot. Consists of Tarsus, Metatarsus & Toes. _ The Tarsus consists of 7 bones, viz, Astragalus, Os Calcis, &c. Naviculare, forming the 90. upper Phalanx. Os Cuboides, Cuneiforme externum, medium & internum, the lower phalanx. Astragalus, is the uppermost of these bones, and is articulated above to the Tibia & Fibula; below to the Os Calcis, & before to the Os Naviculare. Os Calcis, is the largest of these bones & to it the Tendo Achillis is fix'd. _ Metatarsus ~ Consists of 5 bones, larger in every respect than the Metacarpal bones; The great Toe has a metatarsal bone, The Ends of the Metatarsus are connected with the tarsus, & the same Observation, will be good, wh. was made respecting the Carpus. &c _ Toes ~ The great Toe has but 2 bones the others, each 3. &c &c. _ ~ Patella, ~ is of heart shape &c. _ & fractures of it longitudinally & transversely sometimes happen. _ & _ 91. No. of bones in the human body. Those proper to the head. Skull ~ & bones of the internal Ear. 16. Maxilla superior. 13. inferior. 1. 14. Teeth in both Jaws 16 32. Proper to the Trunk. _ Vertebræ. 24. Costæ. 24. Sternum. 1. 49. Ossa Innominata. 2. Sacrum. 1. ~3. Coccyx _ 3. _ ~3. Superior Extremities. Claviculæ. 2. Scapulæ 2. ~4. Ossa Humeri 2. Ulna 2. Radii. 2. ~6. Carpus of each hand 8. - 16. Metacarpus 4 ~8. Finger bones 15 _ 30. Inferior Extremities. _ Ossa Femoris, 2. Tibiæ. 2. - ~4. Fibulæ 2. Patellæ. 2. ~4. Tarsus of each foot 7 - 14. Metatarsus 5. _ 10. Toes - 14. 28. Total. 241  93. Of the Muscles. Feby. 18th.. Mr. Orange began the Consideration of the Various Muscles of the body; Commencing wh. those of the fore part of the Abdomen, which consist of 3 [pr.] layers may be reckoned as digastric. The 1st. is the externus obliquus. arising by fleshy digitations, from the inferior edges of the 8 inf: Ribs. meeting the digitations of the Serratus major anticus. _ It's fibres pass obliquely downwards being inserted into the Crista of the Ilium; It becomes tendinous at different distances, forming the Linea Semilunaris; & joins its fellow in the Linea alba. wh. is form'd by the tendinous fibres of the 3 layers, interlacing. 94 from the Xiphoid Cartilage to the pubis. _ ~ The tendinous fibres are bent downwards, from the ant: sup: Spine of the Ilium to the pubis, forming Poupart's Ligament; under wh. femoral hernia take place, & in wh. are seated the Rings, (through which the Spermatic Chord passes in Males, & the round Ligament of the Womb in females,) form'd by a separation of inferior fibres of wh. it is composed from the superior, wh. last go to the Symphysis pubis; the inferior to the angle; so that the Ring is triangular. _ therefore between the Angle & Symphysis a Truss should be applied in a hernia. _ 95. The peritoneum is never ruptured, but descends with the Intestines, forming the Hernial Sac. _ The Ring is prevented extending, by cross Ligaments &c. _ Those Hernia wh. pass through the Ring, as Bubonocele, &c &c. should be reduced in the direction of the ring, upwards, & outwards; but femoral hernia upwards & inwards, towards the Linea alba. _ Beneath this Muscle is seated the Internus obliquus: whose fibres run in a contrary direction to the last; It arises from the Crista of the Ilium &c. attached to the 7 inf: Ribs, Xiphoid Cartilage, & Linea alba.. from it's inferior fibres, the Cremaster Muscles, arises 96. wh. is lost in the Tunica Vaginalis Testis. &c. _ ~ Below this is the Transversalis, wh. arises tendinous from the transverse processes of the Vertebræ Lumborum, fleshy from the Crista of the Ilium, &c. &c. & is inserted into the 7 inf: Ribs, Xiphoid Cartilage & Linea alba. _ Recti. ~ Arise tendinous from the Ligament, connecting the Ossa pubis. & is inserted into the Cartilages of the 3 inf: true Ribs. _ It is intersected by tendon in different parts ~ & it is plac'd in a sheath form'd by the tendons of the Abdominal Muscles, that of the obliquus internus dividing into 2 parts wh. surround 97 this &c. _ These muscles are ~ bounded by the Linea semilunaris, & alba. _ The Umbilicus or Navel,, is seated about the middle of the Linea alba, at wh. Hernia sometimes take place, term'd Exomphalos &c. _ The Uses of these Abdominal Muscles, are 3 fold, viz, as Flexors, Respiratory & Expulsive powers: Flexors ~ When they act together they antagonise those placed behind. ~ &c. ~ They turn the body to one Side ~ The Ex. Oblique turns the body to the contrary Side; & the In: Oblique, to the same Side &c _ In Wounds of the Abdomen, these should be relaxed as much as possible. ~ & also in Contusions. _ 98. Respiratory powers. They counteract the intercostal muscles, pulling down the ribs & pressing the Contents of the Abdomen up against the Diaphragm; they lessen the Cavity of the Thorax, thus forcing the Air, out of the Lungs; they are Voluntary & involuntary, acting when asleep. Inflammation &c. of these causes difficulty of breathing &c. &c - Expulsive powers. - They expel the fœces, Urine, &c. & in females the fœtus. _ ~ In tapping, the mid space, between the ant: sup: Spine of the Ilium, &c. Umbilicus, is proper, wh. is just in the linea semilunaris. &c. _ Latissimus Colli. or platysma Myoides ~ Arises by slender fibres, from the Sternum, Acromion 99. Acromion, & pectoral & Deltoid Muscles, & is lost in the Muscles of the face, &c &c. _ The external Jugular Vein runs under this. &c _ Pectoralis ~ Arises from the Sternal extremity of the Clavicle, Sternum, & 5th. 6th. & 7th. Ribs, & is inserted into the upper, inner part, of the Humerus, it is a flexor & abductor of the Arm. ~ & in Climbing, it draws up the Trunk to the Extremities. _ ~ Upon this is seated the Mamma, or Breast, in the Amputation of wh. we should keep the Arm extended, thereby stretching the Muscle, &c. but the operation finished, we must place the Arm to the side, the Hand laying over the Thorax &c. _ 100. Feby. 19th.. Mr. Orange, considered the Muscles seated on the anterior part of the Neck, & first of the Sterno Cleido Mastoideus; wh. arises tendinous from the Sternum; & fleshy from the Clavicle, & is attached to the Mastoid process of the temporal bone. ~ When both these Muscles act together, they bend the Head, but when separate, turn it to the opposite Side; Wry neck, is the Disease of these Muscles, either an increased power of one; or a deminution &c. _ If it is from the first Cause, the division of the muscle, is necessary, performed with the probe-Rasor 101. probe-Rasor &c _ The Muscles of the fore part of the neck, are more useful as Physiologists, than Surgeons. ~ They are all subservient to the performance of Deglutition. ~ The pharinx is a large bag seated behind the Larynx, consisting of 5 Cartilages & Os Hyoides; Their Names are, Thyroid, Cricoid, 2 Aretinoid, & Epiglottis. The Os Hyoides, has a basis, & 2 Cornu, wh. are attached to the Thyroid Cartilage ~ Those Muscles, wh. draw up the Os Hyoides &c. are attached to the temporal bones, & under Jaw, going to the Os Hyoides. ~ The 1st. pair wh. we shall consider, are, 102. The Digastric Muscles _ Which arise on each Side, the Symphysis of the Chin, it has 2 fleshy bellies, the posterior of which arises from the Sulcus, at the bottom of the Mastoid process; it's anterior to the Os hyoides; wh it draws up, when the inf: max: bone is shut. ~ ~ - The Mylo Hyoideus lies beneath this. ~ A digastric muscle having a very extensive origin, from the Symphysis of the Chin to the Angle &c. _ it is inserted into the basis of the Os Hyoides. The Genio-hyoideus, lies beneath this, attached to the basis also. ~ The Stylo-Hyoideus, arises from 103. the Styloid process, & passes through the tendon of the digastric Muscle, it is fix'd to the Corner of the Os-hyoides. ~ These are Elevators of the Larynx & Os hyoides ~ ~ ~ The Depressors are, first, The Sterno-Hyoides, coming from the inside the Sternum, & going straight to the anterior part of the Os Hyoides; they are cut through in the Operation of Bronchotomy. ~ ~ ~ - The Sterno-Thyroidis, are beneath these, coming from the inside the Sternum, to the Thyroid Cartilage. _ ~ The Thyro Hyoidei. ~ from the Thyroid Carti; to the Os Hyoides. _ _ 104. Crico-Thyroideus. - arises from the Cricoid Cartilage, & is attached to the Thyroid, &c. _ _ Omo-Hyoideus ~ Arises from the (Clavicle), & is attached to the Os Hyoides. _ ~ Beneath these Muscles, is seated the Thyroid Gland, wh. is frequently enlarged, constituting a Derbysh. Neck. This produces difficulty of breathing, by pressing on the Aspera Arteria, & difficulty of swallowing, by preventing the action of these Muscles &c.. Serratus major anticus. ~ Arises from the basis of the Scapula; & is attached to the 8 superior Ribs; It draws the Scapula forwards &c. _ Serratus minor anticus. or pectoralis 105. pectoralis minor, arises from the 3rd. 4th. & 5th. Ribs. & goes to the Coracoid process. It brings the Scapula downwards & forwards, on the Ribs, & it draws them up, & may therefore be considered as accessory to Respiration. &c ' _ _ _ The Subclavius _ Arises from the Clavicle, & goes to the 1st. Rib, wh. it helps to fix, & may therefore be considered as a Ligament. &c. _ 106. Feby. 21st.. Mr.. Orange considered The Fronto-occipitalis, Muscle; It arises from the transverse Ridge of the Occiput, laterally to the mastoid process. & is tendinous over the Cranium &c. It is fleshy on the Os frontis & is inserted into the Orbicularis palpebrarum. wh. it draws up. The 1st. branch of 5th. pr. of Nerves, coming out at the Supra Orbitar foramen, supplies the frontal portion. ~ It is connected by short cellular Substance to the Hairy Scalp, & by long, to the pericranium; between both wh. Matter may be form'd the sooner discharged the better. ~ If the Nerve is in a State of paralysis, or cut, 107. &c. the Eyelid cannot support itself. _ &c. &c &c. _ Attolens, Retrahens Aurem. Anterior Auris &c &c. _ Temporal Muscle. Commences at the External any: process, the semicircular Ridge of the lateral part of the parietal bone &c &c & is inserted into the Coronoid process of the lower Jaw, wh. it pulls upwards & a little backwards &c. ~ It is surrounded by a facia formed by the Recession of the external layer of the pericranium from the internal. ~ Matter may be form'd below it, & is so deceptive, that it is often taken for fracture with depression- 108. Masseter. _ Arises from the Jugum, form'd by the temporal & Malar bones, & is inserted into the Ramus & Angle of the lower Jaw ~ It is composed of an ex- & in-ternal portion, the fibres of the former going backwards, of the latter, forwards ~ This pulls the Jaw upwards backwards & forwards. ~ ~ Muscles of the face. _ Eyelids. serve as Veils, against the light, dust &c. they sweep the tears over the Eye, & convey them away ~ They perform their function by means, of the Orbicularis palpebrarum - wh. surrounds the Orbit, & 109. is inserted into the Nasal process of the Sup: Max: bone. Its tendon is divided in the Operation of Fistula lacrymalis ~ ~ &c _ Elevators of the Lip ~ Levator Labii superioris proprius, Alæq: Nasi ~ Arises, from the sup: max: bone just above the infra orbitar foramen, & from its Nasal process; & is inserted into the Orbicularis Oris, & the Alæ Nasi; It raises the upper Lip & depresses the Nose. ~ ~ - Levator Anguli Oris. ~ Arises from the hollow of the sup: max: bone, & is inserted into the Angle of the Mouth, It draws the Corner of the Mouth upwards, as, in Smiling. ~ - 110. Zygomaticus, or, Distortor Anguli Oris. _ Arises from the Zygomatic process, & is inserted [inserted] into the Angle of the Mouth, wh. it draws up, in: "Grinning horribly a, ghastly Smile." ~ _ These Muscles elevate the upper Lip, &c Angles &c. It has 2 depressors. viz. ~ Depressor labii superioris proprius, Alæq: Nasi. _ wh. arises from the upper Jaw, & is inserted into the upper lip, & Ala Nasi. both wh. it draws downwards & backwards. Depressor Angulioris. _ Arises from the lower edge of the Maxilla inf: & is inserted into the Angle of the Mouth, wh. it pulls downwards. Buccinator. Arises from the Ramus of the inf: max: bone; & is inserted into the Angle of the Mouth, wh. it draws back & contracts. - 111. Elevator Menti. _ Arises on the outside the Alveolary processes of the inf: max: bone, & is inserted into the under lip & skin of the Chin. Orbicularis Oris. - Is form'd by the fibres of almost all the Muscles of the Mouth decussating each other, & surrounding the Mouth like a Sphincter. It shuts the Mouth & conteracts all the Muscles, wh. form it &c. _ Feby. 22nd.. Mr. Blizard considered the Diaphragm. ~ wh. forms a compleat Septum, between the Thorax & Abdomen; It is attached [& arises from] to the Xiphoid Cartilage, to [from] the Cartilage of the last true & all the false Ribs, & to the 3rd. 4th. & 5th. Lumbar Vertebræ, arising from a [crossed out] tendinous Centre, from wh. 112. the fibres diverge, The tendon is semilunar, & has a hole on its right side, through wh. the ascending Vena Cava passes. _ The fleshy part terminates in the Crura, &c _ the fibres of wh. decussate leaving a hole through wh. the Aorta passes, & above this is another hole which gives passage, to the Gula. This Muscle, is the principal Agent in Respiration &c. &. _ 113. Feby. 23rd. Mr. Orange considered the Trapezius, wh. with the Latissimus dorsi, almost cover the whole back. ~ It arises from, the protuberance in the Occiput, the 2 last Spinous processes of the Cervical Vertebræ, & all of those of the back. & is inserted into the posterior part of the Clavicle [crossed out], & the Spine of the Scapula. The direction of its fibres being 3 fold, will act accordingly. It's straight ones draw the Scapula directly backwards &c &c. It also draws the Head backwards, antagonizing the Sterno Cl. Mastoideus. _ The Ligamentum Nuchæ is the attachment it has with it's fellow at the Nape of the Neck. ~ As there are no muscular fibres here, Blisters, Setons, Issues, are to be applied &c. _ 114. Latissimus dorsi ~ Arises from the Spi: pro: of the Veterbræ of the loins, & Os Sacrum, & several of the dorsal, from the Extremities of the 3 or 4 inf: Ribs, & from the Crista & Spine of the Ilium, & is inserted into the inner edge of the groove in the Humerus. _ It pulls the Arm backwards & downwards, &c. _ Dislocations of this Muscle takes place sometimes, to reduce wh. the Arm, must be brought to the body, pressure, being made on the inf: ang: of the Scapula, when the Arm must be brought quickly upwards. ~ Rhomboideus. - situated between the 2 last muscles, & is distinguished into major & minor, the latter being superior &c. & taken together 115. arise from sev'ral of the Spinous processes of the Cervical & dorsal Vertebræ. & is attached to the basis of the Scapula, wh. they draw upwards & backwards. ~ ~ Serratus sup: posticus. - Arises from the spi: pro: of the last Cervical; & 2 upper dorsa Vertebræ, & is inserted into the Ribs, wh. it draws up, & is therefore an inspiratory pow'r. _ It is antagonized by the Serratus inf: posticus. wh. arises in Common with the tendon of the Latissimus dorsi, & is attached above to the Ribs. &c. _ Splenius Capitis. - Arises from the Lig: Nuchæ, & spi: pro: of 3 last Cervical Vertebræ & is inserted into the Occiput; pulls the head backwards. Splenius Colli. - Arises from the 3rd. & 4th.. cervical &c. of the back &c _ inserted into 5 sup: trans: -. 116. Complexus. Arises by digitations from the trans: proc: of the 4 inf: Cervical & 7 sup: dorsal Vertebræ. is attached to the Occiput, wh. it draws backward &c. _ Trachelo-Mastoideus. _ Arises from the trans: pro: of some of the lower Cervical, & upper dorsal Vertebræ & is inserted into the Mastoid process, assisting the Complexus &c _ Musculus Patientiæ. _ Arises from the sup: ang: of the Scapula & is inserted into the trans: pro: of 3 or 4. Cervical Vertebræ. It raises up the Scapula &c. _ ~ The principal flexors of the Thigh, lie in the Cavity of the Abdomen. Psoas. ~ Arises from the transverse pro: & bodies of the Lumbar Vertebræ 117. Vertebræ, & going over the brim of the Pelvis, is inserted into the Trochanter minor of the Femur. wh. it bends forwards. &c &c. _ There is sometimes a Psoas parvus. ~ &c _ inserted into the brim of the pelvis, arising from the 2 upper Lumbar Verterbræ, & assists the former in bending the Loins forwards &c. &c. _ Hiacus Internus. _ Arises from the trans: pro. of the last Lumbar Vertebræ &c. &c _ & joining the Psoas magnus, becomes tendinous, & is inserted into the Trochanter minor along with it. - 118. Feby. 24th. Mr Blizard, considered the Muscles of the Spine, which he said should all be taken together to understand their Uses. & Longissimus dorsi. _ Arises from the Sacrum, & post: Spine of the Ilium. &c. &c. inserted into the Vertebræ of the back & Ribs &c &c by small tendons. &c. _ It keeps the body erect. Sacro-Lumbalis. _ Arises, in common with the last: inserted into the Ribs, &c. & had the small Musculi ad Sacrolumbalem Accessorii attached to it. &c. From the upper part of this Muscle, the Cervicalis descendens, goes, to be attached to sev'ral trans: pro: of Cervical Vertebræ, wh. turns the head backwards & to one Side & _ ~ Semispinalis Colli & Dosi ~ Arise 119. from the trans: pro: of the Verterbræ of the back by tendons & inserted into the spi: pro: of Cervical Vertebræ, except 1st. & last. &c Multisidus Spina Arises from the Sacrum. Ilium. &c. &c. inserted into spi: pro: of Lum: dors: & cer: Vertebræ & Rectus major Capitis posticus, & minor. _ Obliquus superior, & inferior. ~ &c & Scaleni. ~ Arise from tran: pro: of Cervical Vertebræ, inserted into 1st. & 2nd Ribs. They bend the Neck, & elevate the Ribs. &c &c. _ Intercostales. ~ 2 layers, ex & in-ternal. _ External. Arise from the Spine &c, & & going downwards & forwards lose themselves at the Cartilages of the Ribs &c. _ The Internal commence at the Sternum & go downwards & backwards &c. stop before the arrive at the Spine. ~ These draw the Ribs upwards &c. Triangularis Sterni. Arises from the Sternum & internally Its fibres go upwards, & are fix'd in the Cartilages of 3rd. 4th. 5th. Ribs & wh. it depresses. & contracts the cavity of the thorax &c &c. - 120. Feby. 25th. Mr Orange began the Consideration of the muscles of superior Extremities &c. ~ Deltoides. _ Arises from the Clavicle, Acromion, & lower margin of the Spine of the Scapula, &c. & is inserted into the outer part of Os Humeri, near it's middle; It pulls the arm, outwards upwards, & backwards & forwards &c &c. _ Supraspinatus. ~ Arises from the base of the Scapula above the Spine, from, the Spine itself & sup: Costa &c. Is inserted into the protuberance on the head of the humerus &c. It raises the Arm up &c. _ Infraspinatus. arises from the base of the Scapula below the Spine, & is also inserted as above ~ It rotates the humerus outwards. &c. &c. _ Beneath it, from the hollow of the Scapula; arises the Teres minor. & is inserted, rather lower &c. than the 2 former. &c It rotates 121. the humerus outwards &c. _ ~ ~ The Subscapularis. ~ Arises from & fills up all the internal hollow of the Scapula. & is attached to one of the smooth Surfaces on the head of the humerus; It rotates the Humerus inwards &c. _ ~ The Teres major. _ Arises from the infer: angle of the Scapula. ~ Its tendon is attached with that of the Latiss: dorsi, is inserted along with it. ~ It rotates the humerus inwards, & is also a flexor &c. Coraco-brachialis. ~ Is an adductor &c. & arises in common from the Coracoid process, with the short head of the Biceps. & is inserted about the middle of the internal part of the Humerus &c &c. _ The Fore Arm, is capable of flexion, & Extension, &c &c. It has 2 flexors, viz. Biceps, & Brachialis internus. &c. &c. _ Biceps. Which in our Subject, happen'd to be a Triceps. ~ Arises, by its short 122. head from the Coracoid process. The Tendon of the long head, passes along the groove; through the Articulation from the upper edge of the glenoid Cavity; these uniting about the middle of the Arm, are inserted into the Tubercle on the upper end of the Radius &c. It is a flexor & Supinator of the fore-Arm & also an Adductor of the Humerus &c. _ From the bending of the Elbow, at the lateral internal part of the forearm &c. the tendon of this muscle sends off an aponeurosis, joining another sent off by the Triceps. wh. cover the Muscles &c. & afford attachment to some muscular fibres, under it the Arteries Deep seated Nerves pass &c. _ Triceps Extensor Cubiti - At the back of the Arm, arises, by 3 heads; from inf: Costa of the Scapula, by the long head &c, & from the humerus by the 2 others; these 123. join & their Tendon is fix'd to the Olecranon &c. - This is a powerful Extensor of the fore arm &c &c _ Branchialis internus. ~ Arises, from the Humerus &c, & is inserted into the Coronoid pro: of the Ulna ~ This flexes the Cubit. ~ Feby. 26th.. Mr Orange considered the Muscles of the Cubit &c. _ From the internal Condyle of the humerus, the pronator teres arises: & is inserted into the middle posterior part of the Radius &c. wh. it rolls inwards ~ Pronator quadratus, arises from the lower inner part of the Ulna, inserted into the lower anterior part of the [Ulna] Radius ~ wh. it rolls inwards &c. _ The hand has 2 Supinators_ Supinator Radii longres, Arises from the Humerus &c. inserted into the inferior extremity of the Radius. wh. it rolls outwards &c. _ ~ Supinator radii brevis ~ Arises from external Condyle 124 inserted into Tubercle &c. of the Radius, wh. it rolls outwards. ~ &c. _ Palmaris longus ~ Arises from internal Condyle, inserted into Lig: Carpi Annulare &c. &c. It bends the hand &c. _ Flexor Capi Ulnaris. _ Arises from internal Condyle of Humerus; inserted into Os pisiforme &c. bends the Arm. ~ Flexor Carpi Radialis. _ Arises from the internal Condyle &c. inserted into Os Trapezius &c. ~ It also bends the Arm. _ &c. Extensor Carpi radialis longior. _ Arises above the external Condyle &c. inserted into metacarpal bone of 1st. finger &c. Extensor Carpi radialis brevior. ~ Arises from external Condyle &c. inserted into metacarpal bone of middle finger. &c. _ Extensor Carpi Ulnaris. _ Arises from ext: Condyle [inserted] inserted into metacarpal bone of little finger &c. _ These 3. last. extend the Arm. &c. _ 125. The lateral motion of the Carpus perform'd by the flexors & Extensors of either Side, acting together. ~ ~ All the fingers have a Common Extensor &c. _ Extensor Digitonum Communis ~ Arises from external Condyle &c. & splits into 4 tendons, before it passes under the Lig: annulare: & is inserted into the bones of all the fingers. posteriorly. _ Indicator. _ Arises from the Ulna, & is inserted into 1st. bone, of fore finger. Flexor Sublimis ~ Arises from the Ulna. &c. _ inserted into 2nd. bone of each finger &c. Flexor profundus. _ Arises from Ulna &c. inserted into last bone of each finger &c. this passes through the last &c. _ Flexor longus pollicis, & brevis. _ the last arises from carpal Ligt: inserted into 1st. bone of the thumb &c. _ ~ The former from the Radius. goes to the 1st. bone &c.. _ For the sev'ral little muscles of the hand &c. see Innes [illegible] &c. _ 126. Feby. 28th.. Mr. Blizard considered the muscles of the Anus &c. &c. & gave some hints concerning the introduction of a Catheter, Sound &c. into the Bladder, & what the consequence of not depressing the handle of the gorget in Lithotomy would be &c. &c ~               Lectures on Anatomy &c. by Messrs. Blizard & Orange at the London Hospital. 1791.  1 Jany. 20th.. 1791. Mr. Blizard this day read over his introductory Lecture, in which he considered the ancient Method of practising Physic & Surgery as very vague & uncertain; The knowledge of the human frame, being but little understood, at that time, because scarcely any thing but Animals were dissected, whose various parts perform different functions, from the same parts in the human Subject, which should be attended to in practice, so as not to confound the one with the other. He next considered Anatomy, as the Groundwork of Physic, observing that the Healing Art is divided into 2 parts, Physic & Surgery, The former of which comprehends all internal Cures &c. The latter 2. all the manuel & operative part. &c That these 2 should be join'd together, & that tho they were different, it was difficult to detirmine the just bounds of each, for that the Physician & Surgeon often indiscriminately trespassed on each other; tho' he said this was to be excused, when the motives were good, & from a desire of prolonging the life of a Fellow Creature; tho' he regretted this was often otherwise the Case. He on account of the utility of this Science justly rank'd it before any other; He also esteemed it the most ancient of any, tho', says he, before, Luxury Dissipation were introduced among the primitive Inhabitants of this Globe, Deseases, were little known, wherefore little need of Remedies. ~ He said that when Man first began to Congregate & assemble together in Towns, Villages &c. they 3. then began to make distinctions of Men, such as Priests, Legislators, Warriors, Magistrates &c. & as these were generally very publick Characters, if they had performed their various functions during Life with applause &c. the Love the People bore them, shew'd itself after Death, by endeavouring to preserve their Remains by embalming the Body. The first publick Mention of which we have in the Old Testament concerning Jacob, who was embalmed by his own Physicians in Egypt: Surely, says he, this could not have been the 1st.. time of it's being employ'd &c. He then went in to remark that a Surgeon; was not one who understood the perfect management of a Knife, but one who understood the various parts of the Body, with all their Uses, & when an Operation was 4. absolutely necessary. ~ He next observed that We had made greater advances in Surgery within this Century or two, than for near 2 or 3000 Years before; Our knowledge of the Lacteals; Receptaculum Chyli; Thoracic Duct, & principally to Circulation of the blood, discovered by our illustrious Countryman Dr. Harvey, which Discovery would forever immortalize his Name. &c. He then finished his Lecture by stating how this Course would be conducted &c. _ Jany. 28th. Mr. Blizard this day explained some of the definitions given in his little Remembrance ~ The first Definition respects, Animal Matter, considered by him 5 him, as, "Vegetable Matter, modified by the moving powers; neither Acid nor Alkaline; possessing a principle of Vitality." & he then observes in the Words of Scripture "All flesh is Grass." Which he attempts to prove by saying, that Carnivorous Animals which prey on others, & are again preyd on themselves; it will be found (if you examine still higher), that some one Creature feeds upon the Grass & herbage, & ) that therefore these Carnivorous Animals do receive their Sustenance from the same, "vegetable matter modified &c. ~ His 2nd. Definition respects, Life, by him considered as, "The existence of the Vital principle in Animal Matter, either actively or latently, as relative to the moving powers." _ In Blood is the Life of Man." - - 6 This Vital Principle, he imagines a subtil, aerial, something, either active or latent &c. that is when the functions of the moving powers are imperceptible &c. 3rd. Definition _ Death _ "The Destruction or Deprivation of the Vital Principle." People &c. are not alway dead when supposed to be so, as in the Case of Drowning, the Vital principle in that Case being latent, not extinct. 4th: - Putrefaction - "The Natural Decomposition of Animal Matter after Death." When the Vital principle is entirely extinct, the Core which each particle of the various Components bears to it's like; occasions this Decomposition of parts; that they may thereby more readily combine &c. _ 7 5th. Constituents of dead Animal Matter. "Putrefaction, & Analysis by Fire, prove that Animal Matter is compounded of watery, earthy, saline, aerial, inflammable, & metallic, Matter; but affords no Information respecting these parts in their State of Union with the Vital principle" 6th.. Solids ~ "Animal Matter, whose earthy part, bears a relatively large proportion to the other Constituents." ~ 7th. Fluids ~ "Animal Matter whose wat'ry part bears a relatively ~ large proportion to the other Constituents" ~ _ 8th. Seats of the Fluids & Solids ~ "Vessels, Cavities, & Cells,"~ He obser- that he divided it into 3; more for the sake of perspicuity than any other Cause; for that Cavities & Cells, were in fact the same thing. 8 9th. Anatomy ~ "The Art of dividing & examining the parts of Animals, to ascertain their Structure, Situation & relative Connection; divided into Human & Comparative." 10th. Physiology. "The Science of the Functions of the Animal Organs" 11th. Pathology. "The Science of the Seats of Diseases, & the Nature of the Changes of the Structure & functions of the Animal Organs in Diseases." - 12th.. Surgery, "The Science & Art of salutarily actuating the moving powers, & manually obviating & removing obstacles in the treatment of Diseases assigned to it's Aid." - He then made a few Observations, respecting these several Heads & finished his 2nd. Lecture. - 9 Jany. 29th. Mr. Orange continued the explanation of the Definitions. 1st. Blood. "Proper Animal Matter, from various proportions of the Constituents of which, all the parts are formed & supported, & into which they are returned" ~ Nutrition may be considered as a Secretion, We are constantly receiving a supply from the Blood & are as constantly losing by Absorption; If it were not so, we should be constantly increasing in Bulk. It is the Blood which affords the Nutritive parts, & which is the Vehicle by which they are returned. ~ The Arteries deposit; & the Absorbents take away &c. The Cellular Substance is full of a fluid, which if seperated too fast, or if the Absorbents are weak 10. A Dropsy is the Consequence. 2nd. Spontaneous Separation of the Blood without Putrefaction. "Serum, Crassamentum & Coagulable Lymph, or Gluten ~ The various Constituents of Animal matter are destinguished by Putrefaction &c. _ 3rd. Gluten. "The proper Matrix for Vessels, &c. to which also they are properly formed; & indeed no part is properly form'd without it. Granulations on the Surface of Sores, is at first nothing but this Gluten, of a pale Colour, at length turning red & becoming Vascular, on which the Vessels elongate themselves; but if this Gluten is constantly removed, no Granulation will take place. 4th. Secretion. "A Separation & Determination" of Character of something from the blood." _ performed by the means of those bodies termed Glands; as the Salivary, for Saliva, Kidnies for Urine. &c. _ 5th. Secreted Matter. _ "Whatever is put out of the sanguiferous System of Vessels." as the various kinds of fat, Bile, &c. &c. 6th.. Nutrition. "The Secretion of the proper Constituents of a part." That Matter which is taken into the Stomach, forms the principle of Nutrition called Chyle &c. & whenever any part is removed, it must be renewed by the Constituents proper thereto. ~ 7th. Fibre. "An imaginary Line, consisting of points of Animal Matter." 12. It is an imaginary Line &c. But a bundle of them may be separated almost ad Infinitum. An Animal Line is; points, laying by each other, till their length exceeds their breadth &c. _ 8th. Elasticity. "The Sphere & power of Attraction of particles of Matter, after a Degree of Separation." Cohesive Attraction, is that which two bodies possess when at a certain distance from each other. &c. The Sphere of Attraction is that space allowed between the 2 ends &c of a body within which space is stretched, they would retract into their place, but beyond would break &c &c. _ 9th Membrane. "A Collection of fibres, whose Breadth, greatly exceeds it's 13. it's Thickness; of a pale Colour; elastic; has 2 Surfaces, one finely polished, the other Cellular." A Cloth may be compared to a membrane, &c. No Membrane in the body but what is Composed of fibres; They are very vascular, but are not supplied with the Crassamentum or Red part of the blood. The Tunica Conjunctiva of the Eye, in an Inflammation of that part, we see, receives red globules; they are elastic, as we see of the peritoneum in Ascites. Have 2 Surfaces, One finely polished; (this is alway next those parts contained within them &c.) & is the secreting Surface, has innumerable orifices, which if the secretion is too quick, causes Dropsy. 14 The other; is cellular, & is external, easily adhering to the surrounding parts. &c. 10th.. Cellular Substance. "Small portions of Membrane; connected so as to form communicating Cells." This we see, by passing a Blowpipe, into the Cellular Substance, & by blowing, the Wind will inflate all the Cells; It is by some, destinguished into Reticular & adipose but this is a wrong Idea. It is of great use; being an universal connecting Medium _ It connects, the fibres of Muscles, & smallest particle of bone; The Lungs, are chiefly formed of it, & it is elastic, giving us that Springiness, which we possess. 15. 11th. Valve. "A Duplicated membranous production, formed in Tubes & Cavities to assist in the determination of their Contents." A Vessel is Cylindrical Membrane. ~ A valve, is a Duplicature of this Membrane, it lays in the Direction of the fluid contain'd in the Vessel, urging it forward, & obstructing its Return ~ 12th.. Artery. "Muscular, membranous, strongly elastic, originates in one of the Ventricles of the Heart, terminates in secerning & Venal Extremities." _ These are elastic in every Direction. ~ When small ones are cut they retract, & are compressed by the Muscles in which they bury themselves; but those that are superficially placed, or on bone &c. 16 upon being cut, are followed by an Hœmorrhage. ~ The Heart as we shall hereafter consider is divided into 2 Sides, wh. are subdivided into Ventricle & Auricle. All the Veins of the Body empty themselves into the 2 Auricles, & the Blood is expelled from the Heart by the Ventricles. into those Tubes termed Arteries, which terminate either in Veins, open, or secerning Extremities, & Cavities, (this last is seldom the Case: ~ These open Extremities are discovered by Means of a very subtil red Injection, of Turpentine & Vermillion, &c. &c 17. Jany. 31st. Mr Blizard considered the Nature of Nerve, with it's Application & Uses. ~ Some Creatures have no Brain, & may therefore be considered as a Link in the great Chain of Nature between Animals, & Vegetables. There is somewhat answering to Sensation in them & we may even say in Vegetables. Without Brain we should be void of intellectual Sense &c. There are parts in us capable of Sensability, which have a Connection with the Brain, the Seat of the Mind. This Mass termed Brain, as we shall hereafter consider is lodged in the Skull. ~ We shall now define a Nerve. "Loosely fibrous of a soft whiteness, flexible; proceed from the Brain, Spinal Marrow, or a Ganglion, terminates in a Muscle or Organ of Sense." _ Loosely fibrous _ ~ It is not so close, but it. 18. it may divided. ~ Of a soft whiteness ~ It is of a milky appearance, & has not that shining blueish whiteness peculiar to a Tendon. It is very flexible. proceeds from the Brain, Spi. Mar: or Ganglion. Anatomically speaking, every Nerve is in a distinct form in the Brain ~ A Ganglion is a Collection of Nerves, highly organized, & connected by Cellular Substance. & they terminate either in Muscle, or Organ of Sense. All the Muscles we know, are nothing to those we are authorized to suppose we know nothing about. ~ ~ Nerves are the Means by wh. all Sensation is produced. Violence done to a Nerve, produces pain; & if an Impression be made on a Muscle, in which a Nerve is 19 produced, A Change will take place. Organs of Sense belong only to Animals with Brain. Where & whenever Muscles are applied, Nerves must be applied, Ergo, there is universal Sensation. We should here with Abruptness, draw the Line, & honestly confess that beyond this, we know nothing, & when we consider Muscle, how much we are in the Dark respecting Muscular Motion. Nerves however small they may be, may still be divided, ad infinitum. A Nerve may be considered as a Tree, Its roots in the Brain, & the Branches ramefying into all parts of the body. From this Idea, A person would say a Compression of the brain, would affect the Nerves, & vice versa. - 20. Organs of Sense are disposed to receive Impressions & propagate to the brain. Delight, Pleasure &c. are all subordinate to 3 great points, Support, Procreation & The Brain may be considered as a Medium between the Organs of Sense, & moving powers, to receive impressions from one, & to propagate Volition to the other. Every moving power is constructed to receive Impressions: & therefore in one general View, we may consider the whole Body as, an Organ of Sense. There are 2 Theories respecting the Nerves - The first is taken from the Idea of Vibration; it being imagined that a touch at one End of a Nerve will cause a Vibration to the Brain. The other is, that the Nerve is round & tubular, & fill'd, with 21. a subtil ætherial fluid, which if a part be touched it is altogether mov'd up towards the Brain. In respect to the first, There is no Nerve in the Body so tense as to propogate Sound; & even if there was, the Sound would be arested by the intervening Solids; & as to the latter, as this fluid has never been discovered, it seems very improbable. Nature of Impression. There is an inherent power in parts to change, according as they may be affected by the 3 great Causes mentioned. Each part is framed to perform various functions from each other from different Causes; The Eye from Light: The Nose from odorous particles &c. &c. & the Muscles from various Causes from which primarily they 22. were intended to receive them. But if these various Causes convey too strong an Impression, they will destroy the parts, they were intended to serve, & if too weak, will be inadaquate to the Task assigned them, Tho Custom will render both, proper. _ Feby. 1st. 1791. Mr. Orange considered the Structure & formation of bone. "A Collection of the 3 Species of Vessels, & Earthy Matter in Cellular Substance, constituting an inflexible body" Tho' this is termed inflexible, yet a bony fibre is, when separated, flexible. Bone is then a Secretion of Earth Matter in 23 an highly subtil State, floating in the Blood. We have before observ'd that the Gluten of the Blood seem'd the proper Matrix for Vessels to elongate themselves in &c. Tis a Collection of this Gluten which we perceive as the very first Rudiments of the future bone. (In a Compound fracture, the Stimulus throws out a great Quantity of this Gluten which becomes a Matrix for the Elongation of Vessels. If a Woman is pregnant & has a fracture, You will find, that it will not heal till after her Delivery, as the Gluten goes to the formation of the Infant, which would otherwise be determined to the fracture.) At length it becomes organised, & the earthy Matter begins to seperate from the Blood. ~ Every bone is 24. is fibrous, Connected throughout by Cellular Substance. Bones are Vascular, shewn clearly by Injections & feeding Animals with Madder, discovered by Mr. Belcherd. They are also Lamellated proved by destroying the soft parts by fire, or exposing to the Air ~ In long bones, the fibres shoot slanting from the middle to the Circumference; but in broad ones, from several middle central points, ~ Some have imagined that the bones (which when Young are in a Cartilaginous state) have been transmuted into bone, which is a wrong Idea; The Cartilage being reabsorbed, & earthy matter deposited. ~ Exfoliation is divided into 3 kinds; A spongy or powdry one; 2nd. Of Lamella or Plates: 3rd. of fibres; ~ There is 25 a 4th. Sort of Exfoliation, which takes place after Amputation. _ The Idea of Exfoliation seems to be, that Granulations taking place beneath the unsound part, it is pushed off; but the Truth is the Absorbents take away a portion all round & as it were the bad becomes insulated, Granulation then takes place, & the bad part sloughs off. - We must never remove a portion of bone, till Exfoliation takes place, but this done, You should assist Nature in throwing it off, who now considers it as foreign & extraneous. There must be a more than ordinary Exertion of the Heart & Vascular System for the formation of bone. Away to prove the Vascularity of bone, is by immersing it in any diluted Acid, which takes away the earthy part of the bone: ~ 26. It has been doubted whether bones [have sensitivity], They certainly have, tho' their great Quantity of earthy matter, prevents their Sensibility ~ The Granulations of bone are extremely sensible, which would not be, did not the Nerves in the bone elongate themselves. Cancelli ~ Are formed by the recession of the internal fibres of the bone from each other, which having no Resistance internally press that way; the Consequence is, the bone becomes thinner & thinner, at its extremities; so that a Disease of this part would soon penetrate the Cancelli, tho' in the middle of the bone, many plates may be thrown off without Danger. The Use is to support the Medulla, & they assist in expanding Articular Surfaces &c. &c. _ Heads, 27. of bones & all processes, are originally formed in a state of Epiphis, or Separation, having Cartilage interposed, which is by degrees absorbed. ~ Bones are subject to Inflammation. ~ _ Feby. 2nd.. Mr. Orange considered the Nature &c. of a Gland. ~ "A Congeries of the 3 Species of Vessels & Excretory Duct" The Secretions are performed by means of the open mouth'd Arteries. The remainder of the blood being return'd by the Veins; & in respect to the fluid separated, there are 2 opinions concerning it. ~ Malphigi, imagined that at the end of the Artery, there was a little Cupta or bag, & at the other end of the bag, a small excretory duct commenced, that a No. of these small ones open, into a large one, &c. _ _ Ruysh maintains that there was between the 2 Vessels 28. Vessels, no distinction, but that the one began where the other ended. ~ The Office then of Glands is to secrete from the blood, humours in various parts of the body; these humours being of various qualities & Uses; as, the salivary Glands to promote Digestion; of the Ears, to secrete a bitter acrid wax preventing the admission of Insects; &c. &c. But why the different Glands, secrete various humours, from the same Mass of blood we shall for ever perhaps remain ignorant. Glands are distinguished into Conglobate & Conglomerate; The former being round & supposed to have but one excretory Duct, as the kidney; the other composed of a number of smaller ones, having as many excretory ducts opening 20 into one larger, as, the Pancreas; But there is reason to beleive all Conglobate Glands are of a Conglomerate Nature, (this was shewn in a fœtal kidney) ~ The secreted fluid, however, receives vast Change from the Absorbents _ ~ Disease, Increased Circulation &c causing a distension of the vessels, gives admittance to red Globules of blood, (which in proper health &c. receive only the Gluten,) causing the increased Redness of the Urine &c. The Use of Glands may be rank'd under 2 heads General & particular, ~ General, in respect to their being a balance, between the Solids & fluids. We should have a Plethora if the Kidnies could not pass off the Urine separated, &c. _ An increased Secretion of the Glands 30. very often drives away a Cold, which is occasioned by the Stoppage of the pores of the Skin &c- The particular use of the Glands is the particular Separation each one makes as the Lungs & Skin seperate from the blood the most fluid & saline parts &c. - There is also a general Use, resulting from the particular ones, as it gives an opportunity to the parts to reabsorb; ~ In Jaundice, the Bile is reabsorbed in large Quantities, & the greater or less degrees of Complexion, are owing, to the Quantity of bile reabsorbed. &c &c. Glands have Nerves. They must feel their Influence, without which they cannot Act. ~ Medulla _ "Oleaginous Matter in the Cellular Substance sustained by the Cancelli of bone." Possesses 31. the principle of Phlogiston. ~ It is originally secreted in a much more fluid state; but after a time the more fluid parts are absorbed. _ It is considerably redder in Young bones than in Old Ones, the Vessels being larger, & admitting Red Globules into them. ~ Their Use is to answer occasional Absorption & prevent the frangibility of the bone. In people starved to Death, not only the adipose Matter, but even this Medulla is absorbed. ~ Cartilage. _ "Probably Gluten contained in arachnoid Cellular Substance, of a shining whiteness, not fibrous, next to bone in Solidity, ~ strongly elastic." _ It does not appear to be vascular, nor fibrous, & therefore thought to be Gluten, strongly elastic, which is it's great Use, in making. 32. making us perform our Motions. with facility. ~ The Old Man is stiff in his Motions; The Cartilage which surrounds the heads of the Bones, being reabsorbed & bony matter deposited, the least motion vibrates through his frame, & he complains that in walking his brain shakes, he being deprived of that Springing, which he formerly received from Cartilage. _ It keeps parts pervious, as the Nose Palpebræ, punctæ &c. _ & in its application to the heads of bones, it makes them globular being thickest in the Central part, & in Cavities about the edges, making them deeper &c _ 33. Feby. 3rd.. Mr. Orange this day considered Muscular Fibre, _ "Flexible, elastic, Contractile." 'Tis these alone which characterise Muscle; which is the only part of the body Contractile _ Redness is not the distinguishing mark of it, this depends on it's Vascularity & the size of its Vessels admitting the red Globules; There are many muscular fibres without any Redness, as the Iris of the Eye. ~ & there must be muscular fibres even in the fly, without which he would be incapable of Motion; We must admit that where there is Motion, their must be muscular fibres; but most probably, we shall ever remain in the dark respecting the Cause of that Motion. ~ The Definition of Muscle, 34. is, “A Congeries of Muscular fibres the effect of whose Contraction is generally the same.” A fibre we have before considered as divisible almost ad Infinitum into still smaller ones, therefore a Muscle is made up of bundles of bundles of these fibres, A fibre being only in Imagination ~ Its power of Contraction depends on the greater or less No. of fibres, of which it consists; Its sphere of Contraction on their length, tho' when No. & length combine, the Muscle is very powerful. All the Muscles are disposed to contract; if any one remains in that state too long, it is called Spasm; if it contracts quick & often 'tis termed Convulsion; Muscles are plentifully supplied with 35. Nerves, possess a Vis Inscita, not acting under the Influence of the ~ Nerves; & a Vis Nervia entirely dependant on the Will.~ Muscles are termed Voluntary, Involuntary, & those Composed of both. ~ The Muscles of the Arm Leg &c, are Voluntary, under the direction of the Will; The Heart is an Example of the 2nd. Diaphragm of the 3rd.. Muscles are never in a state of perfect Relaxation except in the dead person ~ Muscles, are termed Congeneres, which assist in the same Motion.~ Antagonistæ, such as are the Instruments of opposite Motion, as the Flexors & Extensors of the Arm &c. They are named from their figure &c &c, As the Deltoides, Biceps, Sterno Cleido Mastoideus. Sphincter Oris, Ani &c. _ 36 Tendon "Closely fibrous of a shining blueish whiteness, flexible, inelastic, proceeds from a Muscle." No other Substance but an unelastic one would do, to fix to a Muscle, which is Contractile. It was originally supposed to be compressed Muscular fibres, but it exists in the Fœtus in Utero before any Motion takes place, therefore I imagine it is not so. _ Muscles are Named penniform, single [Illustration], & double [Illustration]; but there is a still more powerful one, in which the Muscular fibres run all round the tendon [Illustration]. ~ Vessels are small in tendon only admitting the pale parts of the blood. ~ Their Nerves are small & few, consequently they have little sensation. _ Aponeurosis. "Expanded tendon." 37 The word Fascia is used syn. _ It is insensible like a tendon; Vessels are small, In a state of Inflammation, it becomes red by Vis a tergo, pushing forward the red Globules into Vessels not capable of receiving it ~ In Amputation of the Leg Thigh, Forearm &c - it is not unusual to have large flakes of it like brown paper come away; Stimulating digestives Are then useful, as the Circulation is languid, ~ Muscular fibres are loosely connected by Cellular Substance. & are dependant on a proper Quantity of Nervous Influence, & of blood, with a proper State of the Connecting Cellular Substance. _ 38 Feby. 4th. Mr. Orange this day, considered, The General Confirmation of Bones. ~ All Bones are divided into long & broad, having parts, called Processes, common to both; which are Risings above the level of the bone, These are named Coracoid, Mastoid, &c, &c, from their supposed resemblance to a Crowsbill, Nipple &c &c.- Tuberosities are processes not resembling any thing in Nature. A process rising almost perpendicular, is called a Spine, & if it's Edge be flat, it is the Crista of the Spine. A Spinous process terminates in a point ~ &c &c _ Coronoid processes also terminate in a point. A process standing out in a round ball, is called Caput, or head, which have a Cervix or Neck tho' in some scarce distinguishable. A Condyle is 39 a head flatned. ~ Bones have Cavities or Depressions, which if deep are termed Cotyloid, if shallow Glenoid, tho in a recent Subject the Cartilages, make them much deeper. Pitts, small roundish Channels sunk perpendicularly into the bone, ~ Furrows are long narrow Canals formed in the Surface, ending in Grooves. ~ Nitches, & Notches small Breaches in the bone; Sinnositics, broad superficial Depressions, without Brims: Fossæ large deep Cavities unequally surrounded by high brims; Sinuses, large Cavities within the Substance of the bone with small apertures. Foramina Canals pierceing through the Substance of the bone, when this goes any way in a bone, the middle part retains the Name of Canal &c - Epiphis. All processes & heads of Bones, are originally formed in 40. a state of Separation, by intervening Cartilage, which sometimes remains through Life; tho this is charactaristic of a weak frame, ricketty &c. & this is also the Case with most scrofulous people. ~ We shall now speak on Articulations _ which are 3 fold, 1st. Symphisis. The Union of 2 bones by intervention of a 3rd. body, & is divided into Syncondrosis, where a Cartilage intervenes, as the Ribs & Sternum; bodies of the Vertebræ, & Ossa Pubis._ Syndesmosis or Synneurosis; Ligaments intervening as, in all moveable Articulations. Syssareosis, ~ flesh intervening, as, a Muscle from one moveable bone to another 2nd. Synarthrosis. Immoveable Articulations, divided into Sutura, The mutual Indention of 2 bones, when 41. their fibres are flexible, as the bones of the Head, ~ - Gomphosis. One bone fix'd in another, as a Nail in a piece of Wood; thus the Teeth are placed in their Sockets ~ Schindylesis, or ploughing, When a thin Lamella of one bone is received into a long narrow furrow of another; as the Vomer with the processes Azygos of the Sphenoid bone. 3rd. Diathrosis. Allowing of large sphere of motion, divided into Enarthrosis, Arthrodia, & Ginglimus. The 1st. is like a ball & Socket, [when] as the Head of the Femur, & Acetabulum. The 2nd. is when a round head is received, in a superficial Cavity, as the Humerus & Scapula. The 3rd.. is subdivided into 3. viz. Trochoides when 1 bone turns on the other as a Wheel on it's Axis, thus the 1st & 2nd.. Vertebræ. ~ The next species, is if 42 a bone receives & is received by corresponding prominences & depressions, as the Humerus & Ulna, Femur & Tibia &c. _ The 3rd. species is, when one bone is articulated to another by more than one place as the Radius & Ulna &c &c _ The Cranium is formed of many peices, tho' the upper part, strictly so called in composed of 8 bones: 6 proper (The Os frontis, 2 Ossa Bregmitis, Os Occipitis, & 2 Ossa Temporum: Thes 6 have nothing to do in the formation of the face,) & 2 Common, both to the Head & face, viz Os Ethmoides & Os Spheroides. In the fœtal Cranium, the bones are separate, & therefore serve as so many points of Ossification, admitting also 43. of the growth of the brain, & at the time of birth, the bones lap over each other, & it is brought forth much easier than if the head was one solid piece ~ When Ossification goes on too quick, 'tis rank'd among the Causes of difficult Labour. The fœtal Cranium is more rotund than an Adult; The European Cranium also differs considerably from the African &c. ~ That part of any bone, on which a Muscle acts is rendered smooth by the Attrition; but where it acts from, the bone is drawn out into a process, as the Mastoid process is formed by the Action of the Sterno Cleido Mastoideus, there being little or none of this process in the Fœtus, who has not made use of that Muscle. _ 44. Sinciput is the Name given to the front of the Cranium; Occiput the back: The Temples are the Sides; Vextex the top: & Basis the bottom. _ The Cranium is composed of an external & internal table, which last from its natural polish is also termed Vitreous. Between these tables are Cancelli, called Diploe. _ Crania differ much in Thickness, as also does the Diploe in different Crania in Quantity; Thin ones sometimes having much, & sometimes, none at all & vice versa &c. _ Pitts _ Are accurately fill'd with brain, & as there is no evidence externally of there being a pitt or that it is a thin Skull; You should alway trefine, as if you were on a pitt or performing the Operation on a thin Skull. 45. Feby. 5th.. Mr. Orange considered 1st. The Os frontis, which occupies the fore & upper part of the Cranium, its figure resembles a Cockle Shell, externally Convex & vice versa; Its Coronal Edge joining with that of the parietal bones, forms the Coronal Suture. The Orbital ridges ends in the ex- & in-ternal angular processes. It has also the Orbital process, going horizontally backward, which forms part of the Orbit, & is inferiorly, internally concave, &c &c. Internally, we have the Spine of the Os frontis, from which arises the falx, dividing the 2 hemispheres of the brain ~ The Cavities & foramina of this bone, are; above the Orbital ridge, a nitch, wh. generally becomes a compleat foramen, called supra orbital foramen, 46 expressive of the passage of the 1st. branch of the 5th. pr. of nerves. More internally is a little notch expressive of the fastning of the trochlea through which the tendon of the trochlearis muscle passes. _ ~ Behind the external angular process is seated the Lachrymal Gland, the principal support of the fluid called tears. Between the 2 Orbital processes is the Ethmoidal fissure. ~ The foramen cæcum lies between the Crista Galls & the Spine of the Os frontis The frontal Sinus is occasioned by the Recession of the internal table from the external; & opens into the Nose. ~ The fibres of the internal table of the Skull 47. are sooner obliterated than those of the outer one, it being a lesser diameter &c _ When the sagittal Suture extends down the Os frontis we never have a Spine; & we may therefore, if a Suture extends down the Os frontis, trefine with safety; but this should not be very low down because of the frontal Sinus ~ The Spine is formed by the fibres of the internal table, (which as being the less Circle) sooner connecting themselves, & turn inwards. ~ A Man should be exceeding guarded in his prognosis concerning a Wound of the Orbital processes, on account of their termity, they forming a support to the anterior Lobes of the Brain &c _ We shall now take a View of the 48 Parietal bones. _ They are of a square figure, & are connected anteriorly to the Os frontis by the Coronal Suture; above to each other by the sagittal; & posteriorly to the Occipital bone by the lambdoidal; laterallay to the temporal bones by the squamose. &c. Its different Sides or edges being distinguished by saying the Coronal, sagittal, &c. _ & the Angles, into Anterior superior, &c &c _ This bone has externally a semicircular ridge, commencing at the external angular process of the Os frontis, & which is expressive of the fascia of the temporal muscle, formed in this manner. The pericranium is composed 49 of 2 Lamella: The first of which, entirely surrounds the Cranium, the other or upper one leaves the under at the attachment of the temporal muscle, which it covers & is itself attached to the Zygomatic process of the temporal bone. Internally along the sagittal suture lies the longitudinal sinus. ~ At it's anterior inferior angle is a groove expressive of the Spinous Artery, which is sometimes formed into a Canal; This place should be avoided in the Trefine; The principal branch of this Artery, runs parallel to the Coronal suture. Pitts are oft'nest found in this bone; The squamous edge appears thinnest, tho' it is made of the same thickness with the rest by the Os temporis. 50. The posterior inferior angle of this bone has part of the groove formed for the lodgment of the lateral sinus. Feby. 7th. Mr. Blizard considered the formation &c. of the Os temporis. wh. is divided into the pars squamosum, & mamillaris externally, & petrosum internally.- Pars squamosum, has an arch like appearance, & is very thin. ~ It is very unequal on the inside, occasioned by the Convolution of the brain. externally we have the Zygomatic process joining with one of the same Name, of the Os Malæ, & it forms a kind of Jujum, through which the temporal muscle passes, The Masseter muscle arises from this process ~ The appearance in recent & dry bones is very different. 51. Pars Mamillaris. _ supposed to resemble a Nipple; is formed into a projecting body, which is canullous, which is connected with the internal Ear which is very dependant on its goodness. Pars petrosum. ~ Has 2 Surfaces, & a ridge from which proceeds the tentorium. Its superior surface forms a support for the anterior lobes of the Cerebrum; the lateral part of the middle lobe of the Cerebellum being applied to its inferior Surface. _ Externally, going obliquely downwards & forwards is the Styloid process, which is an attachment for many muscles. ~ Between this, & the Zygomatic process, is the Vaginal process, & auditory; In this latter is a ridge [crossed out] expressive of the Attachment of the Membrana Tympani, which divides the external from the internal ear. _ 52. This Bone contains the Cavity in which the inferior maxillary bone is articulated ~ The 7th. pr. of Nerves enter the meatus internus in the petrous bone; & there divide into portio dera, (which goes out of the foramen stylo Mastoideum situated between the styloid & Mastoid processes & then becoming a cutaneous Nerve) & portio mollis, which is destined for the Organ of hearing. ~ Behind the vaginal process is the extremity of the foramen Carotideum, which goes up to the brain at a right angle, thus preventing the too quick projection of the blood. At the poster. infer. angle of the parital bones are the lateral sinuses, from wh. commence the internal 52. Jugular Veins, which come out at the foramen lacerum with the 8th. pr. of Nerves, & which is sometimes divided by a bony ridge from the Vein. _ Most of the processes are wanting in a fœtus. - Feby. 8th. Mr. Orange considered the Os Occipitis. ~ Somewhat triangular, bounded by the lambdoidal suture. & terminates in a process named basilary or cuneiform, which joins with one of the same name of the Sphenoid. The Medulla oblong. lies in the hollow of this process, and the basilary artery also lies on it. Externally posteriorly are 2 processes, named Condyles to which the 1st. Vertebræ is fix'd by it's superior oblique processes. ~ All except a small triangular portion of 54. this bone is covered by Muscles, which cannot therefore be trefined. The various Eminences &c. are expressive of the Attachment of several Muscles ~ Nearly opposite the external ridge, internally, is a tranverse one, which has a perpendicular one crossing it, forming 4 Hollows in the bone; the 2 upper of which are expressive of the position of the 2 posterior lobes of the Cerebrum. ~ The Falx is attached to the Cross ridge, & the Pentarium to the transverse. Between the Basilary process, & body of the bone is the foramen magnum, through which the Medulla oblongata, passes from the brain; & the Vertebral arteries to it. ~ Below the Condyles 55 are the 2 foramina Condyloidea, through which the 9th. pr. of Nerves pass to the tongue. ~ On the outside of these lie the Jugular fossæ, through which the internal Jugular Veins, & 8th. pr. of Nerves pass. ~ - Os Sphenoides ~ Is the most difficult of all the bones of the Cranium; It properly forms the basis Cranii, & is a wedge to the other bones, it is also one of the Common bones. Its Situation renders it impractible for Surgeons practise &c. It consists of, Body, & laterally Wings, & has been said to resemble a bat flying. ~ Of the Body ~ It has a superior & an inferior Surface; An anterior & posterior part. ~ It's superior surface is hollow, forming the Sella Turcica, anterior to which, is, 56 a smooth Surface expressive of the Conjunction of the optic Nerves. ~ It ends in the posterior clinoid processes. ~ Its inferior surface has only a solitary process, named Azygos, which receives the Vomer coming into the Nose. It's anterior part is cellular, joining with the Cells of the Ethmoid bone, which open into the Nose. ~ At its posterior part is the basilary process ~ The Alæ or Wings, end posteriorly in a point, termed the spinous processes, simply, to distinguish them from the transverse spinous processes, which join the broad part of the Alæ to the body, ending round, in the anterior 57 Clenoid processes, behind which the internal Carotid Arteries run, sometimes a compleat foramen is formed here. - The broad parts of the Alæ are formd into 3 Surfaces, anterior, external & internal, the 1st. forming part of the Orbit &c. Externally, we see the Pterygoid processes, dividing into ex- & in-ternal; the latter is form'd into a hook, over which the tendon of the Circumflexus palati plays, ~. The foramina optica, are rather anterior to the smooth surface mentioned. ~ Next are the foramina lacera, beneath the transverse spinous processes, thro' which the 3rd. 4th. 1st. branch of the 5th. & 6th. pr. of Nerves pass. _ Below these are the foramina rotunda, 58 through which the 2nd. branch of the 5th. pr. of Nerves pass, ~ & still lower are the foramina Ovalia, thro' which the 3rd. branch of the 5th pr. of Nerves pass. _ The foramina spinosa are still lower; these admit the spinous Artery. ~ There is another foramen through wh a considerable branch of the 2nd. branch of the 5th pr. of Nerves is reflected &c Feby 9th. Mr. Orange considered the Ethmoid bone. ~ This bone completely fills up the Ethmoidal fissure of the Os frontis; & forms the principal bony part of the Nose; It is very delicate & tender; ~ Has a superior perforated Surface termed the Crebriform Lamella 59 & an inferior cellular surface, hanging down into the Nose, ~ An Anterior projecting Surface, on wh. the Nasal bones rest; & a posterior surface joining with the Cells of the Sphenoid bone: It is divided into 2 parts by a thin bony plate termed the Nasal Lamella, the upper part of which is rounded, & named Crista Galli. The anterior Lobes of the Cerebrum rest on the Crebriform Lamella; so that a blow on the Nose, often drives the Nasal Lamella & Crista Galli into the brain; In such a Case we should introduce a pr. of forceps lined with Sponge &c. & seizing on the Nasal Lamella, draw it from it's Situation, which is all that can be done. 60. It is bounded on the Sides by the Os planum one of the bones of the Orbit; Next the Nasal Lamella are placed the superior Spongy bones. The tenuity of these bones &c. should make us cautious, in the introduction of Instruments into the Nose, or detaching a Polypus from thence. Superior Maxillary bone. _ Joins the Os frontis, Mali, &c &c &c. It is irregular; &c. It's Nasal process has a groove form'd in it, which by the junction of the Os Unguis, is form'd into a Canal call'd the ductus ad Nasum, above this, is the tendon of the Orbicularis palpebrarum. ~ Its anterior edge is formd for the reception of the Os Nasi. ~ Its upper part is named the orbitar process, going horizontally backwards, forming part of the floor of the Orbit & roof of the 61. Antrum ~ Its outside, receives the Cheek bone; termed it's malar process; & it's inferior edge termed it's Alvsolary process, has the Alveoli, or Sockets for the teeth form'd in it. _ These Alveoli are absorbed in Old Age, & occasions the Nose & Chin to meet. ~ Internally is the palatine process, doubly concave, forming part of the Roof of the Mouth & floor of the Nostrils; The remainder of the roof &c. being perfected by the Application of the palate bones. _ Just beneath the Orbit is the Infra Orbitar Foramen, thro' which the 2nd. branch of the 5 pr. of Nerves passes. _ ~ Os Mali. ~ Given the Rotundity to the face; ~ It's maxillary process joins the maxillary bone. ~ It has 5 processes, viz, superior, & inferior, obitar, Maxillary, & Zygomatic. & internal Orbitar. 62. Feby. 10th. Mr. Orange considered the Ossa Palati. ~ These may considered as parts of the Maxillary bone; they finish the Roof of the Mouth & floor of the Nostrils; doubly Concave; It has 3 processes, viz, palatine, pterygoid, & Orbitar, ~. It is very spongy & thin, often coming away in the Lues Venera, The Voice then becomes impaired, & there is a difficulty of swallowing. ~ Ossa Nasi. - These form the bony Arch of the Nose; but are not continued to it's Extremity, as it would be in danger of fracture. They are of different figures, wh. causes the various Shapes of Noses. Their upper part is bulbous & thick, connected with the Nasal process of the Os frontis 63. frontis. ~ Their middle rests on the Nasal Lamella of the Ethmoid bone, their Sides on the sup. Maxillary. ~ In a fracture of these bones, we should be exceeding guarded; & not, as is generally done, endeavour to depress the prominent part which is the natural State of it; but to elevate the depressed part, wh. has been beaten in; We must first ascertain the Condition of the Nasal Lamella with a probe, & if it is driven up into the Brain, draw it gently down with a pr of forceps, but if it is found, you should, with a Director or piec of Wood defended with Linen, elevate the depressed part ~ Vomer. ~ Its upper part, has a groove, in wh. the processes Azygos, of the Sphenoid bone, is received, 64. & this with the Nasal Lamella forms the Septum of the Nose; There is however a triangular Notch, which in the recent State is filld up with Cartilage, Inflammations of the bones of the Nose, should be removed by Fumigations &c &c. as soon as possible, as they soon exfoliate. _ Ossa Unguis. ~ Is composed externally of 2 smooth Concavities & a middle ridge; & is fix'd to the groove in the maxillary bone, thus compleating the ductus ad Nasum. This bone it is, which is perforated in the Operation of fistula lacrymalis, carrying the Instrument downwards & backwards.- 65. Inferior maxillary bone. - Consists of a body, & posteriorly the Rami, ending in the Coronoid & Condyloid processes _ Its inferior part is the basis, the middle is the Symphysis, which makes the difference of Chins, by projecting more or less. ~ The part where the Rami go off is termed its Angles - The Condyloid processes form a Sort of Enarthrosis Articulation, with the articular Cavity in the temporal bones. ~ To the Condyles are attached the temporal Muscles, & all the Rami are covered by the Masseter Muscles. ~ From the basis, rises a perpendicular process for the Reception of the teeth termed alveorlary ~. Internally at the Symphysis &c, are several protuberances, expressive of the attachment of various Muscles, as the Digastric &c &c & just below 66. the Coronoid process, the Buccinator Muscle is attached ~ On the inside the Rami are 2 holes, the entrances of a Canal, thro which the 3rd. branch of the 5th. pr of Nerves, & an Artery pass, to supply the teeth, coming out near the Symphysis of the Chin externally. Fractures of this bone often happen, & sometimes a troublesome Hemorrhage takes place, by the Contraction of the Artery into the bone, which cannot be got at without taking a piece of the bone away, ~ Sutures ~ formation. Bones are fibres, which in broad [long] bones, radiate from the Centre to Circumference, these at length approach & pass between each other; but they meet resistance as they approach, & 67. thus a Suture is formed. ~ These sometimes remain through Life, at other times they are obliterated.~ There are 5 principal Sutures, the Coronal, extending across the head; the Sagittal, placed longitudinally on the Skull & is sometimes continued down the Os frontis. The Lambdoidal, rather father back than the Vertex & going obliquely downward. & the 2 Squamous, a little above the ear. ~ ~ The best Method of tracing these, is; about an Inch from the external ang. pro. is the Coronal going obliquely upwards & backwards about the length of a common probe from the Nose. ~ The Sagittal terminates in a line carried round the Cranium from the external ang. process; & the lambdoidal terminates just above the Mastoid process 68. Feby. 11th. Mr. Orange, Considered the Spine, beginning at the condyles of the Occipital bone; Consists of true & false. The true comprehending 24 Vertebræ, the false, the sacrum & appendix Coxendicis. ~ The true are divided into, 7 Cervical, 12 dorsal, & 5 Lumbar, all of which agree in the general Character of having a body, (except the 1st. Cervical,) & processes; The bodies placed before, &c. 7 processes. 2 transverse, 4 oblique, & 1 Spinous, The specifick Character of each is different; viz. ~ The Cervical Vertebræ, are flatned at the fore part, on wh. the Oesophagus &c. rests; the dorsal, laterally, allowing room for the lungs &c &c. & the lumbar at their fore part, giving Room to the Viscera & The bodies are, greatly Cancellous 69. & their edges are covered by a thin plate of bone, & between each, is a thin plate of Cartilage & Ligaments. The 1st. Vertebra, called Atlas from its supporting the head, differs from all the others very materially, it has no body, but in its place a bony Arch, on the inside of which is [seated] a smooth Surface to receive the processes dentatus of the 2nd. Vertebra, round which it moves, It's superior oblique processes are articulated with with the Condyles. ~ The Cervical Vertebræ, may alway be known by a hole in the their transverse processes, forming a Canal for the transmission of the Vertebral Arteries. ~ The transverse process of the 1st. Vertebra, extend out much farther than the others 70. which occasions the Artery to make a Curve, before it enters the foramen magnum. ~ Its spinous is so small, as scarcely to deserve that Name. ~ The 2nd. Vertebra call'd dentata, from it's toothlike process, which arises from it's body & passes on the inside of the 1st. Verte: from it Ligaments to the Cranium which fasten it &c - This pro: is sometimes fractured in Children, which causes instant death, as the Spinal Marrow is compressed, having an Angle form'd by the Head falling forwards; & Apoplexy or Concussion of the brain is thought oftentimes to be the Cause. therefore in weak Children, something placed to keep the head erect, is not amiss. - 71. The Motion allowed of between the 1st. & 2nd. Vertebræ, is greater than between any other, The Medullary Canal, is always the largest in Vertebræ having the most motion. ~ The remaining Vertebræ if the Neck are pretty much the same, The spi: pro: of each being bifurcated. They grow larger as the descend, the 7th. being not unlike the 1st. dorsal &c. Dorsal Vertebræ ~ Are compressed laterally, have no holes in their trans: processes. ~ At their lateral part is a pit expressive of the Rib, & their transverse processes are pressed by the tubercle of the Rib, in respiration. ~ Their Spinous processes stand downwards & are very long. ~ The last dorsal Vertebræ, resemble the 1st. lumbar &c. 72. Lumbar Vertebræ, ~ Are largest of all the others; processes differ, &c &c. ~ by the application of Vertebræ we have lateral holes for the transmission of Nerves, & Vessels &c &c. _ The true Vertebræ may be considered, as a pyramid, its base, the last lumbar Vertebra. ~ The Os Sacrum or false Vertebræ, may also be considered as an inverted pyramid, its base joining the base of the true, &c - Costæ or Ribs. Of these there are 12 on a Side, 7 true, connected with the Sternum, & 5 false, connected with, the 7th: true one &c. There are the same No. in a Male as in a female ~ They all agree 73. in having a head, a prominent tuberosity, an Angle, & a superior & inferior Surface termed Costæ &c. The 1st. differs from the others; it is placed nearly horizontal & is immoveable, having Ligaments coming from the Clavicle; so that in Inspiration, the inferior Ribs, are brought toward this, by the intercostal Muscles, which turn them outward, & the Diaphragm descending, enlarges the Cavity of the Thorax. ~ Expiration, is the cessation of these Muscles _ Their heads are framed for articulation, with the dorsal Vertebræ; their inferior Costa has a groove in which the intercostal arteries run. ~ fractures generally happen beyond the angle of the Rib. &c. In the Operation of Empyema, we must keep close to the superior edge of an inferior Rib, on account of the Arteries &c. _ 74 Feby. 12th. Mr. Orange this day considered the Sternum ~ Said to consist of 3 peices of bone, though one is named the Xiphoid Cartilage; Altogether it is externally somewhat Convex, & a little Concave internally. ~ The 1st. portion is largest, & has laterally a Depression expressive of the attachment of the Clavicle. ~ The 1st. Rib is attached entirely to this; The 2nd. Rib is attached between the 1st. & 2nd. bone. ~ The 3 portions are often altogether ossified, so as to make but one bone. ~ The Sternum is very light & Spongy, apt to be affected with Caries, & it then crumbles away, ~ . _ 'Tis recommended to trefine this bone, when matter is form'd in the anterior Mediastinum.~ Fracture sometimes occurs, the only Remedy then is to lay the person [crossed out] on his back, raising him up with pillows &c &c. placed under him. _ 75 Upper Extremity, ~ Divided into, Shoulder, Upper Arm, Fore Arm. Carpus, Metacarpus & Fingers. _ Shoulder. ~ Consists of 2 bones, the Clavicle, & Scapula. ~ ~ Clavicle. ~ Gives that figure to the trunk which it possesses, by keeping the upper Extremities at a distance. ~ It is said to resemble an Italic ∫, placed horizontally, It has a body, & 2 Extremities, named Sternal & Scapular. _ The Sternal is larger & more rotund than the other, & has Ligaments, allowing of a Motion every way; ~ It acts as a fulcrum to the upper Extremity _ It's inferior part has a roughness expressive of a Ligament, going to the 1st. Rib. ~ Its Scapullar Extremity is flatted, having a Smooth ending Surface, expressive of its attachment with the Acromion of the Scapula & beneath is a Roughness, from wh. a Ligament goes to the Coracoid process. 76. It is almost entirely covered by Muscles, as the Deltoid, Pectoral Sterno Cleido Mastoideus &c &c &c. - About the middle is a hole through which the medullary Artery passes.~ Fractures of this bone often occur. ~ & the Weight of the upper Extremity will depress the part next it, & make the part affix'd to the Sternum, appear prominent, tho' it is natural, as the Sternum, is a fix'd part; Our Care is to elevate the depressed part, & keep the Shoulders back by a figure of 8 bandage. ~ ~ - Scapula. ~ Somewhat triangular, Externally Convex &c. _ term'd the dorsum, from which arises a Spine, which is somewhat hollow & flatted above, nam'd the Crista. to wh. several Muscles are attached. _ It is divided, into Superior & inferior 77. inferior Costæ, & basis, &c _ _ The Spine terminates in the Acromion, wh. has a Smooth internal edge for the reception of the Clavicle. The Head of the Scapula, is form'd into a Glenoid Cavity for the reception of the head of the Os Humeri; just above it is the Coracoid process, wh. is very important, having attached to it, 1 head of the Biceps; Coraco brachialis. &c. &c. _ Sometimes this is fractured, tho this mostly happens at the Cervix Scapula; ~ To determine if it be fracture or Dislocation, (the symtoms being the Same,) We must feel this process; by bending the Arm, & pressing into the hollow; if it yields, it is fracture &c _ _ _ You must press the head of the Humerus up by keeping the Arm in a Sling, covering the Elbow with it & keeping 78. down the Shoulder, with the reflexed Capsiline bandage. ~ The inferior Angle of the Scapula is made smooth by the Action of the latissimus Dorsi. ~ Matter is sometimes form'd behind this bone; & it is then recommended to trefine upon it. ~ &c - - - _ Feby. 14th. Mr. Orange considered the Os humeri. ~ Has a body, & upper & lower Extremities; Its head is fitted for connection with the Scapula, & is on one Side, in respect to its body The internal Condyle of its lower Extremity may serve as a guide to find it &c. _ The upper part of it body, has several Smooth Surfaces expressive of the attachment of Muscles, as is also the body itself. ~ The pectoral Muscle is attached 79. to an outer ridge, which is on the body, & the latissimus dorsi to an inner one. ~ The Coraco-brachialis, arises from the Coracoid process, & is attached to this bone; Somewhat flattened posteriorly, having a deep fossa, & also at it's internal part, into which the Olecranon, & Coronoid process of the Ulna play. It ends in it's ex- & in-ternal Condyles, the latter of which projects inwards considerably, & is often fractured without detriment to the joint. ~ The external Condyle is much rounded, & on it the Radius plays, it is much less than the internal one, which is alway fractured, in a Dislocation, of the fore Arm inwards, but a Dislocation may happen outwards, without fracture. ~ Extension of the fore Arm, is sufficient 80. to reduce it. Dislocations of the Humerus may take place downwards, backwards or forward but not upwards, without fracture of the processes of the Scapula ~ &c. &c. &c. _ _ _ Fore Arm. Consists of 2 bones, Radius & Ulna. ~ Radius. ~ Is rather Convex externally. &c. _ pretty regular. Its upper part hollow'd for Connection with the tubercle of the humerus, & laterally to the Semilunar Cavity of the Ulna. ~ It's Neck is surrounded by a ligament, fastening it to the Ulna. ~ Internally, below the neck, is a turbercle, to which is attached the tendon of the Biceps. _ below this it becomes broader ending in a kind of Ridge to which the interosseous ligament 81. ligament is attached, going to a similar ridge in the Ulna. ~ In the middle is a rough Surface, to wh. the pronator teres is attached from the internal Condyle of the Humerus, which Muscle, without Care is taken, will be divided in opening the Arm. ~ It ends in a Semilunar Notch in wh. the Ulna plays laterally, & its end has a Cavity for the reception of the Os, Scaphoides & lunare &c. _ The pronator quadratus arises from this. _ Ulna. ~ Is the longest of these bones, & the internal one; the Radius moves round this in pronation & Supination, it being fix'd. _ It has an articular Cavity bounded by the Olecranon & Coronoid process; The former has inferiorly, a triangular rough Surface, expressive of the 82. place on which we alway lean. _ When the Olecranon is fractured we must keep the Arm extended by a small Splint, from the Humerus to the fore Arm; & Inflammation, must by all means be avoided. ~ At a fortnights end or before, we must begin to move the Arm gently &c. _ ~ The Triceps Muscles is attached to this bone, at the Olecranon. & the Branchialis internus to the Coronoid process. ~ On its outside is a Semilunar Cavity in wh. the Radius plays: & a little lower is the Ridge to which the Ligament is fix'd surrounding the Radius, its outer Side has a Ridge to wh. the interosseus Ligament is attached, Its lower part is 83. round &c &c. _ _ _ It ends in the [Semilumar] Stiloid process ~ Both are sometimes fractured, A narrow Compress placed before & behind is Sufficient, over wh. a Splint may be placed. Carpus. _ Consists of 8 bones. divided into upper & lower phalanges, the Upper consists of the Os Scaphoides Lunare Cuneiforme, & pisciforme, the lower of, Os Trapezium, Trapezoides, magnum & cuneiforme. _ They are all of a Wedge like figure _ ~ Considerable motion between the 2 phalanges is allowed of. ~ All the bones communicate, one with the other, so that Disease of one, affects all: They also communicate, 84 with the Metacarpal bones. ~ wh. Should not be taken away at their Junction with the Carpus. ~ &c. _ Metacarpus. ~ Consists of 4 bones, the Thumb not having one. It may therefore be removed from the Carpus, without Detriment. _ Fingers. ~ 5 in No. each consisting of 3 bones. ~ The Thumb has the Strongest bones, as it counteracts, all the fingers; we should retain as much as possible of it in Amputation. &c. _ Feby. 15th.. Mr. Blizard, considered the bones of the pelvis: composed of the Sacrum Coccyx, & Ossa Innominata, wh, is divided into Ilium, Ischium & pubis. ~ The[ir] Situation of the pelvis is very inclined, ~ The upper part of The Ilium forms a Considerable part of the Abdominal parieties, ~ These 3 bones are compleated into a single one in Adults. _ The Ilium, is rounded above wh. part is termed its Crista, which ends, before in, Anterior sup: & inf: Spines; & behind in posterior Spine. _ Os pubis; where it joins its fellow has the term of Symphysis applied to it; it has a Ramus & an Angle &c &c. _ Ischium has a process term'd it's spine &c. which is turn'd more outwards in females than Males; Its inferior part, is rough, termed it's tuberosity. Its upper part forms the greatest share of the Acetabulum, At the bottom of wh. is the fossa for the Synovial gland &c &c. & it has a large Notch compleated in the recent subject, into a foramen, by Ligaments. 86. Sacrum; Consists of 5 bones in the fœtus, which in Adults, are form'd into one. _ It is a wedge like bone, & situated between the 2 Ilia behind. It has the Coccyx at its Extremity, divided into 2 or 3 bones, the 1st. of which has 2 processes standing up, from wh. Ligaments go to the Sacrum. - ~ The pubis is formed into an Arch by the junction of the 2, larger in Women than Men. ~ The Axis of the pelvis & Abdomen are different. ~ To the Crista of the Ilium, all the Abdominal Muscles are attached, &c. from its post: Spine Ligaments go to the Sacrum &c. &c. _ The Sartorius Muscle arises from the ant: sup: Spine; behind the 87. ant: inf: Spine, is a hollow, over wh. the psoas mag: & Iliacus internus pass; & a little lower, the place where the External Iliac Artery passes. ~ poupart, or Fallopius' Ligament goes from this bone to the Angle of the pubis, . &c &c _ Acetabulum. ~ Is form'd by the Junction of these 3 bones, & is the Socket, in wh. the head of the femur plays. _ &c. . Feby. 16th. Mr. Orange, considered the Os femoris; having a body & an upper & lower Extremity. Its upper part is form'd into a head laterally, having a contracted part, termed its Neck, to one side of which its body ends in the Trochanter major, & more internally downwards, is 88 the Trochanter minor. ~ Below the Trochanter major is rough line to wh the Gluteus medius, is attached; & at it's posterior part is the linea aspera. ~ Fractures of the Neck sometimes happen, ~ We may always tell the Situation of the head by its being anterior. & to one Side of the internal Condyle. ~ Its Head has a rough Surface at its Extremity to wh. the the Ligamentum teres is fix'd. ~ It terminates in the ex- & in-ternal Condyles, which a framed for a Ginglimoid & Enarthrosis Articulation. ~ It's anterior part is grooved receiving the patella. ~ Inflammation & fracture of the Condyles are very dangerous to the joint &c. Leg. _ Consists of the Tibia & fibula. Tibia. _ Somewhat triangular, having an external, internal & posterior Surface. ~ The internal, is, what we term, Shin, & 89. may be got at by a simply Inscision, wh. the others cannot be. Its anterior edge is termed its Spine. Externally below the head, is the Smooth Surface, to which the fibula is fix'd. ~ The Ligaments of the patella are fix'd to a protuberance it has at it's anterior part ~ Its inferior internal Surface, forms the Malleolus internus, which is somewhat rounded by the tendons of some Muscles; & is sometimes fractured. _ ~ Fibula. _ Is very slender. Its lower Extremity forms the Malleolus externus. fracture of its extremity may happen without Injury to the Joint ~ We are directed in Amputation to stand on the inside, as we shall fix our Saw on both bones at once. _ ~ Foot. Consists of Tarsus, Metatarsus & Toes. _ The Tarsus consists of 7 bones, viz, Astragalus, Os Calcis, &c. Naviculare, forming the 90. upper Phalanx. Os Cuboides, Cuneiforme externum, medium & internum, the lower phalanx. Astragalus, is the uppermost of these bones, and is articulated above to the Tibia & Fibula; below to the Os Calcis, & before to the Os Naviculare. Os Calcis, is the largest of these bones & to it the Tendo Achillis is fix'd. _ Metatarsus ~ Consists of 5 bones, larger in every respect than the Metacarpal bones; The great Toe has a metatarsal bone, The Ends of the Metatarsus are connected with the tarsus, & the same Observation, will be good, wh. was made respecting the Carpus. &c _ Toes ~ The great Toe has but 2 bones the others, each 3. &c &c. _ ~ Patella, ~ is of heart shape &c. _ & fractures of it longitudinally & transversely sometimes happen. _ & _ 91. No. of bones in the human body. Those proper to the head. Skull ~ & bones of the internal Ear. 16. Maxilla superior. 13. inferior. 1. 14. Teeth in both Jaws 16 32. Proper to the Trunk. _ Vertebræ. 24. Costæ. 24. Sternum. 1. 49. Ossa Innominata. 2. Sacrum. 1. ~3. Coccyx _ 3. _ ~3. Superior Extremities. Claviculæ. 2. Scapulæ 2. ~4. Ossa Humeri 2. Ulna 2. Radii. 2. ~6. Carpus of each hand 8. - 16. Metacarpus 4 ~8. Finger bones 15 _ 30. Inferior Extremities. _ Ossa Femoris, 2. Tibiæ. 2. - ~4. Fibulæ 2. Patellæ. 2. ~4. Tarsus of each foot 7 - 14. Metatarsus 5. _ 10. Toes - 14. 28. Total. 241  93. Of the Muscles. Feby. 18th.. Mr. Orange began the Consideration of the Various Muscles of the body; Commencing wh. those of the fore part of the Abdomen, which consist of 3 [pr.] layers may be reckoned as digastric. The 1st. is the externus obliquus. arising by fleshy digitations, from the inferior edges of the 8 inf: Ribs. meeting the digitations of the Serratus major anticus. _ It's fibres pass obliquely downwards being inserted into the Crista of the Ilium; It becomes tendinous at different distances, forming the Linea Semilunaris; & joins its fellow in the Linea alba. wh. is form'd by the tendinous fibres of the 3 layers, interlacing. 94 from the Xiphoid Cartilage to the pubis. _ ~ The tendinous fibres are bent downwards, from the ant: sup: Spine of the Ilium to the pubis, forming Poupart's Ligament; under wh. femoral hernia take place, & in wh. are seated the Rings, (through which the Spermatic Chord passes in Males, & the round Ligament of the Womb in females,) form'd by a separation of inferior fibres of wh. it is composed from the superior, wh. last go to the Symphysis pubis; the inferior to the angle; so that the Ring is triangular. _ therefore between the Angle & Symphysis a Truss should be applied in a hernia. _ 95. The peritoneum is never ruptured, but descends with the Intestines, forming the Hernial Sac. _ The Ring is prevented extending, by cross Ligaments &c. _ Those Hernia wh. pass through the Ring, as Bubonocele, &c &c. should be reduced in the direction of the ring, upwards, & outwards; but femoral hernia upwards & inwards, towards the Linea alba. _ Beneath this Muscle is seated the Internus obliquus: whose fibres run in a contrary direction to the last; It arises from the Crista of the Ilium &c. attached to the 7 inf: Ribs, Xiphoid Cartilage, & Linea alba.. from it's inferior fibres, the Cremaster Muscles, arises 96. wh. is lost in the Tunica Vaginalis Testis. &c. _ ~ Below this is the Transversalis, wh. arises tendinous from the transverse processes of the Vertebræ Lumborum, fleshy from the Crista of the Ilium, &c. &c. & is inserted into the 7 inf: Ribs, Xiphoid Cartilage & Linea alba. _ Recti. ~ Arise tendinous from the Ligament, connecting the Ossa pubis. & is inserted into the Cartilages of the 3 inf: true Ribs. _ It is intersected by tendon in different parts ~ & it is plac'd in a sheath form'd by the tendons of the Abdominal Muscles, that of the obliquus internus dividing into 2 parts wh. surround 97 this &c. _ These muscles are ~ bounded by the Linea semilunaris, & alba. _ The Umbilicus or Navel,, is seated about the middle of the Linea alba, at wh. Hernia sometimes take place, term'd Exomphalos &c. _ The Uses of these Abdominal Muscles, are 3 fold, viz, as Flexors, Respiratory & Expulsive powers: Flexors ~ When they act together they antagonise those placed behind. ~ &c. ~ They turn the body to one Side ~ The Ex. Oblique turns the body to the contrary Side; & the In: Oblique, to the same Side &c _ In Wounds of the Abdomen, these should be relaxed as much as possible. ~ & also in Contusions. _ 98. Respiratory powers. They counteract the intercostal muscles, pulling down the ribs & pressing the Contents of the Abdomen up against the Diaphragm; they lessen the Cavity of the Thorax, thus forcing the Air, out of the Lungs; they are Voluntary & involuntary, acting when asleep. Inflammation &c. of these causes difficulty of breathing &c. &c - Expulsive powers. - They expel the fœces, Urine, &c. & in females the fœtus. _ ~ In tapping, the mid space, between the ant: sup: Spine of the Ilium, &c. Umbilicus, is proper, wh. is just in the linea semilunaris. &c. _ Latissimus Colli. or platysma Myoides ~ Arises by slender fibres, from the Sternum, Acromion 99. Acromion, & pectoral & Deltoid Muscles, & is lost in the Muscles of the face, &c &c. _ The external Jugular Vein runs under this. &c _ Pectoralis ~ Arises from the Sternal extremity of the Clavicle, Sternum, & 5th. 6th. & 7th. Ribs, & is inserted into the upper, inner part, of the Humerus, it is a flexor & abductor of the Arm. ~ & in Climbing, it draws up the Trunk to the Extremities. _ ~ Upon this is seated the Mamma, or Breast, in the Amputation of wh. we should keep the Arm extended, thereby stretching the Muscle, &c. but the operation finished, we must place the Arm to the side, the Hand laying over the Thorax &c. _ 100. Feby. 19th.. Mr. Orange, considered the Muscles seated on the anterior part of the Neck, & first of the Sterno Cleido Mastoideus; wh. arises tendinous from the Sternum; & fleshy from the Clavicle, & is attached to the Mastoid process of the temporal bone. ~ When both these Muscles act together, they bend the Head, but when separate, turn it to the opposite Side; Wry neck, is the Disease of these Muscles, either an increased power of one; or a deminution &c. _ If it is from the first Cause, the division of the muscle, is necessary, performed with the probe-Rasor 101. probe-Rasor &c _ The Muscles of the fore part of the neck, are more useful as Physiologists, than Surgeons. ~ They are all subservient to the performance of Deglutition. ~ The pharinx is a large bag seated behind the Larynx, consisting of 5 Cartilages & Os Hyoides; Their Names are, Thyroid, Cricoid, 2 Aretinoid, & Epiglottis. The Os Hyoides, has a basis, & 2 Cornu, wh. are attached to the Thyroid Cartilage ~ Those Muscles, wh. draw up the Os Hyoides &c. are attached to the temporal bones, & under Jaw, going to the Os Hyoides. ~ The 1st. pair wh. we shall consider, are, 102. The Digastric Muscles _ Which arise on each Side, the Symphysis of the Chin, it has 2 fleshy bellies, the posterior of which arises from the Sulcus, at the bottom of the Mastoid process; it's anterior to the Os hyoides; wh it draws up, when the inf: max: bone is shut. ~ ~ - The Mylo Hyoideus lies beneath this. ~ A digastric muscle having a very extensive origin, from the Symphysis of the Chin to the Angle &c. _ it is inserted into the basis of the Os Hyoides. The Genio-hyoideus, lies beneath this, attached to the basis also. ~ The Stylo-Hyoideus, arises from 103. the Styloid process, & passes through the tendon of the digastric Muscle, it is fix'd to the Corner of the Os-hyoides. ~ These are Elevators of the Larynx & Os hyoides ~ ~ ~ The Depressors are, first, The Sterno-Hyoides, coming from the inside the Sternum, & going straight to the anterior part of the Os Hyoides; they are cut through in the Operation of Bronchotomy. ~ ~ ~ - The Sterno-Thyroidis, are beneath these, coming from the inside the Sternum, to the Thyroid Cartilage. _ ~ The Thyro Hyoidei. ~ from the Thyroid Carti; to the Os Hyoides. _ _ 104. Crico-Thyroideus. - arises from the Cricoid Cartilage, & is attached to the Thyroid, &c. _ _ Omo-Hyoideus ~ Arises from the (Clavicle), & is attached to the Os Hyoides. _ ~ Beneath these Muscles, is seated the Thyroid Gland, wh. is frequently enlarged, constituting a Derbysh. Neck. This produces difficulty of breathing, by pressing on the Aspera Arteria, & difficulty of swallowing, by preventing the action of these Muscles &c.. Serratus major anticus. ~ Arises from the basis of the Scapula; & is attached to the 8 superior Ribs; It draws the Scapula forwards &c. _ Serratus minor anticus. or pectoralis 105. pectoralis minor, arises from the 3rd. 4th. & 5th. Ribs. & goes to the Coracoid process. It brings the Scapula downwards & forwards, on the Ribs, & it draws them up, & may therefore be considered as accessory to Respiration. &c ' _ _ _ The Subclavius _ Arises from the Clavicle, & goes to the 1st. Rib, wh. it helps to fix, & may therefore be considered as a Ligament. &c. _ 106. Feby. 21st.. Mr.. Orange considered The Fronto-occipitalis, Muscle; It arises from the transverse Ridge of the Occiput, laterally to the mastoid process. & is tendinous over the Cranium &c. It is fleshy on the Os frontis & is inserted into the Orbicularis palpebrarum. wh. it draws up. The 1st. branch of 5th. pr. of Nerves, coming out at the Supra Orbitar foramen, supplies the frontal portion. ~ It is connected by short cellular Substance to the Hairy Scalp, & by long, to the pericranium; between both wh. Matter may be form'd the sooner discharged the better. ~ If the Nerve is in a State of paralysis, or cut, 107. &c. the Eyelid cannot support itself. _ &c. &c &c. _ Attolens, Retrahens Aurem. Anterior Auris &c &c. _ Temporal Muscle. Commences at the External any: process, the semicircular Ridge of the lateral part of the parietal bone &c &c & is inserted into the Coronoid process of the lower Jaw, wh. it pulls upwards & a little backwards &c. ~ It is surrounded by a facia formed by the Recession of the external layer of the pericranium from the internal. ~ Matter may be form'd below it, & is so deceptive, that it is often taken for fracture with depression- 108. Masseter. _ Arises from the Jugum, form'd by the temporal & Malar bones, & is inserted into the Ramus & Angle of the lower Jaw ~ It is composed of an ex- & in-ternal portion, the fibres of the former going backwards, of the latter, forwards ~ This pulls the Jaw upwards backwards & forwards. ~ ~ Muscles of the face. _ Eyelids. serve as Veils, against the light, dust &c. they sweep the tears over the Eye, & convey them away ~ They perform their function by means, of the Orbicularis palpebrarum - wh. surrounds the Orbit, & 109. is inserted into the Nasal process of the Sup: Max: bone. Its tendon is divided in the Operation of Fistula lacrymalis ~ ~ &c _ Elevators of the Lip ~ Levator Labii superioris proprius, Alæq: Nasi ~ Arises, from the sup: max: bone just above the infra orbitar foramen, & from its Nasal process; & is inserted into the Orbicularis Oris, & the Alæ Nasi; It raises the upper Lip & depresses the Nose. ~ ~ - Levator Anguli Oris. ~ Arises from the hollow of the sup: max: bone, & is inserted into the Angle of the Mouth, It draws the Corner of the Mouth upwards, as, in Smiling. ~ - 110. Zygomaticus, or, Distortor Anguli Oris. _ Arises from the Zygomatic process, & is inserted [inserted] into the Angle of the Mouth, wh. it draws up, in: "Grinning horribly a, ghastly Smile." ~ _ These Muscles elevate the upper Lip, &c Angles &c. It has 2 depressors. viz. ~ Depressor labii superioris proprius, Alæq: Nasi. _ wh. arises from the upper Jaw, & is inserted into the upper lip, & Ala Nasi. both wh. it draws downwards & backwards. Depressor Angulioris. _ Arises from the lower edge of the Maxilla inf: & is inserted into the Angle of the Mouth, wh. it pulls downwards. Buccinator. Arises from the Ramus of the inf: max: bone; & is inserted into the Angle of the Mouth, wh. it draws back & contracts. - 111. Elevator Menti. _ Arises on the outside the Alveolary processes of the inf: max: bone, & is inserted into the under lip & skin of the Chin. Orbicularis Oris. - Is form'd by the fibres of almost all the Muscles of the Mouth decussating each other, & surrounding the Mouth like a Sphincter. It shuts the Mouth & conteracts all the Muscles, wh. form it &c. _ Feby. 22nd.. Mr. Blizard considered the Diaphragm. ~ wh. forms a compleat Septum, between the Thorax & Abdomen; It is attached [& arises from] to the Xiphoid Cartilage, to [from] the Cartilage of the last true & all the false Ribs, & to the 3rd. 4th. & 5th. Lumbar Vertebræ, arising from a [crossed out] tendinous Centre, from wh. 112. the fibres diverge, The tendon is semilunar, & has a hole on its right side, through wh. the ascending Vena Cava passes. _ The fleshy part terminates in the Crura, &c _ the fibres of wh. decussate leaving a hole through wh. the Aorta passes, & above this is another hole which gives passage, to the Gula. This Muscle, is the principal Agent in Respiration &c. &. _ 113. Feby. 23rd. Mr. Orange considered the Trapezius, wh. with the Latissimus dorsi, almost cover the whole back. ~ It arises from, the protuberance in the Occiput, the 2 last Spinous processes of the Cervical Vertebræ, & all of those of the back. & is inserted into the posterior part of the Clavicle [crossed out], & the Spine of the Scapula. The direction of its fibres being 3 fold, will act accordingly. It's straight ones draw the Scapula directly backwards &c &c. It also draws the Head backwards, antagonizing the Sterno Cl. Mastoideus. _ The Ligamentum Nuchæ is the attachment it has with it's fellow at the Nape of the Neck. ~ As there are no muscular fibres here, Blisters, Setons, Issues, are to be applied &c. _ 114. Latissimus dorsi ~ Arises from the Spi: pro: of the Veterbræ of the loins, & Os Sacrum, & several of the dorsal, from the Extremities of the 3 or 4 inf: Ribs, & from the Crista & Spine of the Ilium, & is inserted into the inner edge of the groove in the Humerus. _ It pulls the Arm backwards & downwards, &c. _ Dislocations of this Muscle takes place sometimes, to reduce wh. the Arm, must be brought to the body, pressure, being made on the inf: ang: of the Scapula, when the Arm must be brought quickly upwards. ~ Rhomboideus. - situated between the 2 last muscles, & is distinguished into major & minor, the latter being superior &c. & taken together 115. arise from sev'ral of the Spinous processes of the Cervical & dorsal Vertebræ. & is attached to the basis of the Scapula, wh. they draw upwards & backwards. ~ ~ Serratus sup: posticus. - Arises from the spi: pro: of the last Cervical; & 2 upper dorsa Vertebræ, & is inserted into the Ribs, wh. it draws up, & is therefore an inspiratory pow'r. _ It is antagonized by the Serratus inf: posticus. wh. arises in Common with the tendon of the Latissimus dorsi, & is attached above to the Ribs. &c. _ Splenius Capitis. - Arises from the Lig: Nuchæ, & spi: pro: of 3 last Cervical Vertebræ & is inserted into the Occiput; pulls the head backwards. Splenius Colli. - Arises from the 3rd. & 4th.. cervical &c. of the back &c _ inserted into 5 sup: trans: -. 116. Complexus. Arises by digitations from the trans: proc: of the 4 inf: Cervical & 7 sup: dorsal Vertebræ. is attached to the Occiput, wh. it draws backward &c. _ Trachelo-Mastoideus. _ Arises from the trans: pro: of some of the lower Cervical, & upper dorsal Vertebræ & is inserted into the Mastoid process, assisting the Complexus &c _ Musculus Patientiæ. _ Arises from the sup: ang: of the Scapula & is inserted into the trans: pro: of 3 or 4. Cervical Vertebræ. It raises up the Scapula &c. _ ~ The principal flexors of the Thigh, lie in the Cavity of the Abdomen. Psoas. ~ Arises from the transverse pro: & bodies of the Lumbar Vertebræ 117. Vertebræ, & going over the brim of the Pelvis, is inserted into the Trochanter minor of the Femur. wh. it bends forwards. &c &c. _ There is sometimes a Psoas parvus. ~ &c _ inserted into the brim of the pelvis, arising from the 2 upper Lumbar Verterbræ, & assists the former in bending the Loins forwards &c. &c. _ Hiacus Internus. _ Arises from the trans: pro. of the last Lumbar Vertebræ &c. &c _ & joining the Psoas magnus, becomes tendinous, & is inserted into the Trochanter minor along with it. - 118. Feby. 24th. Mr Blizard, considered the Muscles of the Spine, which he said should all be taken together to understand their Uses. & Longissimus dorsi. _ Arises from the Sacrum, & post: Spine of the Ilium. &c. &c. inserted into the Vertebræ of the back & Ribs &c &c by small tendons. &c. _ It keeps the body erect. Sacro-Lumbalis. _ Arises, in common with the last: inserted into the Ribs, &c. & had the small Musculi ad Sacrolumbalem Accessorii attached to it. &c. From the upper part of this Muscle, the Cervicalis descendens, goes, to be attached to sev'ral trans: pro: of Cervical Vertebræ, wh. turns the head backwards & to one Side & _ ~ Semispinalis Colli & Dosi ~ Arise 119. from the trans: pro: of the Verterbræ of the back by tendons & inserted into the spi: pro: of Cervical Vertebræ, except 1st. & last. &c Multisidus Spina Arises from the Sacrum. Ilium. &c. &c. inserted into spi: pro: of Lum: dors: & cer: Vertebræ & Rectus major Capitis posticus, & minor. _ Obliquus superior, & inferior. ~ &c & Scaleni. ~ Arise from tran: pro: of Cervical Vertebræ, inserted into 1st. & 2nd Ribs. They bend the Neck, & elevate the Ribs. &c &c. _ Intercostales. ~ 2 layers, ex & in-ternal. _ External. Arise from the Spine &c, & & going downwards & forwards lose themselves at the Cartilages of the Ribs &c. _ The Internal commence at the Sternum & go downwards & backwards &c. stop before the arrive at the Spine. ~ These draw the Ribs upwards &c. Triangularis Sterni. Arises from the Sternum & internally Its fibres go upwards, & are fix'd in the Cartilages of 3rd. 4th. 5th. Ribs & wh. it depresses. & contracts the cavity of the thorax &c &c. - 120. Feby. 25th. Mr Orange began the Consideration of the muscles of superior Extremities &c. ~ Deltoides. _ Arises from the Clavicle, Acromion, & lower margin of the Spine of the Scapula, &c. & is inserted into the outer part of Os Humeri, near it's middle; It pulls the arm, outwards upwards, & backwards & forwards &c &c. _ Supraspinatus. ~ Arises from the base of the Scapula above the Spine, from, the Spine itself & sup: Costa &c. Is inserted into the protuberance on the head of the humerus &c. It raises the Arm up &c. _ Infraspinatus. arises from the base of the Scapula below the Spine, & is also inserted as above ~ It rotates the humerus outwards. &c. &c. _ Beneath it, from the hollow of the Scapula; arises the Teres minor. & is inserted, rather lower &c. than the 2 former. &c It rotates 121. the humerus outwards &c. _ ~ ~ The Subscapularis. ~ Arises from & fills up all the internal hollow of the Scapula. & is attached to one of the smooth Surfaces on the head of the humerus; It rotates the Humerus inwards &c. _ ~ The Teres major. _ Arises from the infer: angle of the Scapula. ~ Its tendon is attached with that of the Latiss: dorsi, is inserted along with it. ~ It rotates the humerus inwards, & is also a flexor &c. Coraco-brachialis. ~ Is an adductor &c. & arises in common from the Coracoid process, with the short head of the Biceps. & is inserted about the middle of the internal part of the Humerus &c &c. _ The Fore Arm, is capable of flexion, & Extension, &c &c. It has 2 flexors, viz. Biceps, & Brachialis internus. &c. &c. _ Biceps. Which in our Subject, happen'd to be a Triceps. ~ Arises, by its short 122. head from the Coracoid process. The Tendon of the long head, passes along the groove; through the Articulation from the upper edge of the glenoid Cavity; these uniting about the middle of the Arm, are inserted into the Tubercle on the upper end of the Radius &c. It is a flexor & Supinator of the fore-Arm & also an Adductor of the Humerus &c. _ From the bending of the Elbow, at the lateral internal part of the forearm &c. the tendon of this muscle sends off an aponeurosis, joining another sent off by the Triceps. wh. cover the Muscles &c. & afford attachment to some muscular fibres, under it the Arteries Deep seated Nerves pass &c. _ Triceps Extensor Cubiti - At the back of the Arm, arises, by 3 heads; from inf: Costa of the Scapula, by the long head &c, & from the humerus by the 2 others; these 123. join & their Tendon is fix'd to the Olecranon &c. - This is a powerful Extensor of the fore arm &c &c _ Branchialis internus. ~ Arises, from the Humerus &c, & is inserted into the Coronoid pro: of the Ulna ~ This flexes the Cubit. ~ Feby. 26th.. Mr Orange considered the Muscles of the Cubit &c. _ From the internal Condyle of the humerus, the pronator teres arises: & is inserted into the middle posterior part of the Radius &c. wh. it rolls inwards ~ Pronator quadratus, arises from the lower inner part of the Ulna, inserted into the lower anterior part of the [Ulna] Radius ~ wh. it rolls inwards &c. _ The hand has 2 Supinators_ Supinator Radii longres, Arises from the Humerus &c. inserted into the inferior extremity of the Radius. wh. it rolls outwards &c. _ ~ Supinator radii brevis ~ Arises from external Condyle 124 inserted into Tubercle &c. of the Radius, wh. it rolls outwards. ~ &c. _ Palmaris longus ~ Arises from internal Condyle, inserted into Lig: Carpi Annulare &c. &c. It bends the hand &c. _ Flexor Capi Ulnaris. _ Arises from internal Condyle of Humerus; inserted into Os pisiforme &c. bends the Arm. ~ Flexor Carpi Radialis. _ Arises from the internal Condyle &c. inserted into Os Trapezius &c. ~ It also bends the Arm. _ &c. Extensor Carpi radialis longior. _ Arises above the external Condyle &c. inserted into metacarpal bone of 1st. finger &c. Extensor Carpi radialis brevior. ~ Arises from external Condyle &c. inserted into metacarpal bone of middle finger. &c. _ Extensor Carpi Ulnaris. _ Arises from ext: Condyle [inserted] inserted into metacarpal bone of little finger &c. _ These 3. last. extend the Arm. &c. _ 125. The lateral motion of the Carpus perform'd by the flexors & Extensors of either Side, acting together. ~ ~ All the fingers have a Common Extensor &c. _ Extensor Digitonum Communis ~ Arises from external Condyle &c. & splits into 4 tendons, before it passes under the Lig: annulare: & is inserted into the bones of all the fingers. posteriorly. _ Indicator. _ Arises from the Ulna, & is inserted into 1st. bone, of fore finger. Flexor Sublimis ~ Arises from the Ulna. &c. _ inserted into 2nd. bone of each finger &c. Flexor profundus. _ Arises from Ulna &c. inserted into last bone of each finger &c. this passes through the last &c. _ Flexor longus pollicis, & brevis. _ the last arises from carpal Ligt: inserted into 1st. bone of the thumb &c. _ ~ The former from the Radius. goes to the 1st. bone &c.. _ For the sev'ral little muscles of the hand &c. see Innes [illegible] &c. _ 126. Feby. 28th.. Mr. Blizard considered the muscles of the Anus &c. &c. & gave some hints concerning the introduction of a Catheter, Sound &c. into the Bladder, & what the consequence of not depressing the handle of the gorget in Lithotomy would be &c. &c ~               Lectures on Anatomy &c. by Messrs. Blizard & Orange at the London Hospital. 1791.  1 Jany. 20th.. 1791. Mr. Blizard this day read over his introductory Lecture, in which he considered the ancient Method of practising Physic & Surgery as very vague & uncertain; The knowledge of the human frame, being but little understood, at that time, because scarcely any thing but Animals were dissected, whose various parts perform different functions, from the same parts in the human Subject, which should be attended to in practice, so as not to confound the one with the other. He next considered Anatomy, as the Groundwork of Physic, observing that the Healing Art is divided into 2 parts, Physic & Surgery, The former of which comprehends all internal Cures &c. The latter 2. all the manuel & operative part. &c That these 2 should be join'd together, & that tho they were different, it was difficult to detirmine the just bounds of each, for that the Physician & Surgeon often indiscriminately trespassed on each other; tho' he said this was to be excused, when the motives were good, & from a desire of prolonging the life of a Fellow Creature; tho' he regretted this was often otherwise the Case. He on account of the utility of this Science justly rank'd it before any other; He also esteemed it the most ancient of any, tho', says he, before, Luxury Dissipation were introduced among the primitive Inhabitants of this Globe, Deseases, were little known, wherefore little need of Remedies. ~ He said that when Man first began to Congregate & assemble together in Towns, Villages &c. they 3. then began to make distinctions of Men, such as Priests, Legislators, Warriors, Magistrates &c. & as these were generally very publick Characters, if they had performed their various functions during Life with applause &c. the Love the People bore them, shew'd itself after Death, by endeavouring to preserve their Remains by embalming the Body. The first publick Mention of which we have in the Old Testament concerning Jacob, who was embalmed by his own Physicians in Egypt: Surely, says he, this could not have been the 1st.. time of it's being employ'd &c. He then went in to remark that a Surgeon; was not one who understood the perfect management of a Knife, but one who understood the various parts of the Body, with all their Uses, & when an Operation was 4. absolutely necessary. ~ He next observed that We had made greater advances in Surgery within this Century or two, than for near 2 or 3000 Years before; Our knowledge of the Lacteals; Receptaculum Chyli; Thoracic Duct, & principally to Circulation of the blood, discovered by our illustrious Countryman Dr. Harvey, which Discovery would forever immortalize his Name. &c. He then finished his Lecture by stating how this Course would be conducted &c. _ Jany. 28th. Mr. Blizard this day explained some of the definitions given in his little Remembrance ~ The first Definition respects, Animal Matter, considered by him 5 him, as, "Vegetable Matter, modified by the moving powers; neither Acid nor Alkaline; possessing a principle of Vitality." & he then observes in the Words of Scripture "All flesh is Grass." Which he attempts to prove by saying, that Carnivorous Animals which prey on others, & are again preyd on themselves; it will be found (if you examine still higher), that some one Creature feeds upon the Grass & herbage, & ) that therefore these Carnivorous Animals do receive their Sustenance from the same, "vegetable matter modified &c. ~ His 2nd. Definition respects, Life, by him considered as, "The existence of the Vital principle in Animal Matter, either actively or latently, as relative to the moving powers." _ In Blood is the Life of Man." - - 6 This Vital Principle, he imagines a subtil, aerial, something, either active or latent &c. that is when the functions of the moving powers are imperceptible &c. 3rd. Definition _ Death _ "The Destruction or Deprivation of the Vital Principle." People &c. are not alway dead when supposed to be so, as in the Case of Drowning, the Vital principle in that Case being latent, not extinct. 4th: - Putrefaction - "The Natural Decomposition of Animal Matter after Death." When the Vital principle is entirely extinct, the Core which each particle of the various Components bears to it's like; occasions this Decomposition of parts; that they may thereby more readily combine &c. _ 7 5th. Constituents of dead Animal Matter. "Putrefaction, & Analysis by Fire, prove that Animal Matter is compounded of watery, earthy, saline, aerial, inflammable, & metallic, Matter; but affords no Information respecting these parts in their State of Union with the Vital principle" 6th.. Solids ~ "Animal Matter, whose earthy part, bears a relatively large proportion to the other Constituents." ~ 7th. Fluids ~ "Animal Matter whose wat'ry part bears a relatively ~ large proportion to the other Constituents" ~ _ 8th. Seats of the Fluids & Solids ~ "Vessels, Cavities, & Cells,"~ He obser- that he divided it into 3; more for the sake of perspicuity than any other Cause; for that Cavities & Cells, were in fact the same thing. 8 9th. Anatomy ~ "The Art of dividing & examining the parts of Animals, to ascertain their Structure, Situation & relative Connection; divided into Human & Comparative." 10th. Physiology. "The Science of the Functions of the Animal Organs" 11th. Pathology. "The Science of the Seats of Diseases, & the Nature of the Changes of the Structure & functions of the Animal Organs in Diseases." - 12th.. Surgery, "The Science & Art of salutarily actuating the moving powers, & manually obviating & removing obstacles in the treatment of Diseases assigned to it's Aid." - He then made a few Observations, respecting these several Heads & finished his 2nd. Lecture. - 9 Jany. 29th. Mr. Orange continued the explanation of the Definitions. 1st. Blood. "Proper Animal Matter, from various proportions of the Constituents of which, all the parts are formed & supported, & into which they are returned" ~ Nutrition may be considered as a Secretion, We are constantly receiving a supply from the Blood & are as constantly losing by Absorption; If it were not so, we should be constantly increasing in Bulk. It is the Blood which affords the Nutritive parts, & which is the Vehicle by which they are returned. ~ The Arteries deposit; & the Absorbents take away &c. The Cellular Substance is full of a fluid, which if seperated too fast, or if the Absorbents are weak 10. A Dropsy is the Consequence. 2nd. Spontaneous Separation of the Blood without Putrefaction. "Serum, Crassamentum & Coagulable Lymph, or Gluten ~ The various Constituents of Animal matter are destinguished by Putrefaction &c. _ 3rd. Gluten. "The proper Matrix for Vessels, &c. to which also they are properly formed; & indeed no part is properly form'd without it. Granulations on the Surface of Sores, is at first nothing but this Gluten, of a pale Colour, at length turning red & becoming Vascular, on which the Vessels elongate themselves; but if this Gluten is constantly removed, no Granulation will take place. 4th. Secretion. "A Separation & Determination" of Character of something from the blood." _ performed by the means of those bodies termed Glands; as the Salivary, for Saliva, Kidnies for Urine. &c. _ 5th. Secreted Matter. _ "Whatever is put out of the sanguiferous System of Vessels." as the various kinds of fat, Bile, &c. &c. 6th.. Nutrition. "The Secretion of the proper Constituents of a part." That Matter which is taken into the Stomach, forms the principle of Nutrition called Chyle &c. & whenever any part is removed, it must be renewed by the Constituents proper thereto. ~ 7th. Fibre. "An imaginary Line, consisting of points of Animal Matter." 12. It is an imaginary Line &c. But a bundle of them may be separated almost ad Infinitum. An Animal Line is; points, laying by each other, till their length exceeds their breadth &c. _ 8th. Elasticity. "The Sphere & power of Attraction of particles of Matter, after a Degree of Separation." Cohesive Attraction, is that which two bodies possess when at a certain distance from each other. &c. The Sphere of Attraction is that space allowed between the 2 ends &c of a body within which space is stretched, they would retract into their place, but beyond would break &c &c. _ 9th Membrane. "A Collection of fibres, whose Breadth, greatly exceeds it's 13. it's Thickness; of a pale Colour; elastic; has 2 Surfaces, one finely polished, the other Cellular." A Cloth may be compared to a membrane, &c. No Membrane in the body but what is Composed of fibres; They are very vascular, but are not supplied with the Crassamentum or Red part of the blood. The Tunica Conjunctiva of the Eye, in an Inflammation of that part, we see, receives red globules; they are elastic, as we see of the peritoneum in Ascites. Have 2 Surfaces, One finely polished; (this is alway next those parts contained within them &c.) & is the secreting Surface, has innumerable orifices, which if the secretion is too quick, causes Dropsy. 14 The other; is cellular, & is external, easily adhering to the surrounding parts. &c. 10th.. Cellular Substance. "Small portions of Membrane; connected so as to form communicating Cells." This we see, by passing a Blowpipe, into the Cellular Substance, & by blowing, the Wind will inflate all the Cells; It is by some, destinguished into Reticular & adipose but this is a wrong Idea. It is of great use; being an universal connecting Medium _ It connects, the fibres of Muscles, & smallest particle of bone; The Lungs, are chiefly formed of it, & it is elastic, giving us that Springiness, which we possess. 15. 11th. Valve. "A Duplicated membranous production, formed in Tubes & Cavities to assist in the determination of their Contents." A Vessel is Cylindrical Membrane. ~ A valve, is a Duplicature of this Membrane, it lays in the Direction of the fluid contain'd in the Vessel, urging it forward, & obstructing its Return ~ 12th.. Artery. "Muscular, membranous, strongly elastic, originates in one of the Ventricles of the Heart, terminates in secerning & Venal Extremities." _ These are elastic in every Direction. ~ When small ones are cut they retract, & are compressed by the Muscles in which they bury themselves; but those that are superficially placed, or on bone &c. 16 upon being cut, are followed by an Hœmorrhage. ~ The Heart as we shall hereafter consider is divided into 2 Sides, wh. are subdivided into Ventricle & Auricle. All the Veins of the Body empty themselves into the 2 Auricles, & the Blood is expelled from the Heart by the Ventricles. into those Tubes termed Arteries, which terminate either in Veins, open, or secerning Extremities, & Cavities, (this last is seldom the Case: ~ These open Extremities are discovered by Means of a very subtil red Injection, of Turpentine & Vermillion, &c. &c 17. Jany. 31st. Mr Blizard considered the Nature of Nerve, with it's Application & Uses. ~ Some Creatures have no Brain, & may therefore be considered as a Link in the great Chain of Nature between Animals, & Vegetables. There is somewhat answering to Sensation in them & we may even say in Vegetables. Without Brain we should be void of intellectual Sense &c. There are parts in us capable of Sensability, which have a Connection with the Brain, the Seat of the Mind. This Mass termed Brain, as we shall hereafter consider is lodged in the Skull. ~ We shall now define a Nerve. "Loosely fibrous of a soft whiteness, flexible; proceed from the Brain, Spinal Marrow, or a Ganglion, terminates in a Muscle or Organ of Sense." _ Loosely fibrous _ ~ It is not so close, but it. 18. it may divided. ~ Of a soft whiteness ~ It is of a milky appearance, & has not that shining blueish whiteness peculiar to a Tendon. It is very flexible. proceeds from the Brain, Spi. Mar: or Ganglion. Anatomically speaking, every Nerve is in a distinct form in the Brain ~ A Ganglion is a Collection of Nerves, highly organized, & connected by Cellular Substance. & they terminate either in Muscle, or Organ of Sense. All the Muscles we know, are nothing to those we are authorized to suppose we know nothing about. ~ ~ Nerves are the Means by wh. all Sensation is produced. Violence done to a Nerve, produces pain; & if an Impression be made on a Muscle, in which a Nerve is 19 produced, A Change will take place. Organs of Sense belong only to Animals with Brain. Where & whenever Muscles are applied, Nerves must be applied, Ergo, there is universal Sensation. We should here with Abruptness, draw the Line, & honestly confess that beyond this, we know nothing, & when we consider Muscle, how much we are in the Dark respecting Muscular Motion. Nerves however small they may be, may still be divided, ad infinitum. A Nerve may be considered as a Tree, Its roots in the Brain, & the Branches ramefying into all parts of the body. From this Idea, A person would say a Compression of the brain, would affect the Nerves, & vice versa. - 20. Organs of Sense are disposed to receive Impressions & propagate to the brain. Delight, Pleasure &c. are all subordinate to 3 great points, Support, Procreation & The Brain may be considered as a Medium between the Organs of Sense, & moving powers, to receive impressions from one, & to propagate Volition to the other. Every moving power is constructed to receive Impressions: & therefore in one general View, we may consider the whole Body as, an Organ of Sense. There are 2 Theories respecting the Nerves - The first is taken from the Idea of Vibration; it being imagined that a touch at one End of a Nerve will cause a Vibration to the Brain. The other is, that the Nerve is round & tubular, & fill'd, with 21. a subtil ætherial fluid, which if a part be touched it is altogether mov'd up towards the Brain. In respect to the first, There is no Nerve in the Body so tense as to propogate Sound; & even if there was, the Sound would be arested by the intervening Solids; & as to the latter, as this fluid has never been discovered, it seems very improbable. Nature of Impression. There is an inherent power in parts to change, according as they may be affected by the 3 great Causes mentioned. Each part is framed to perform various functions from each other from different Causes; The Eye from Light: The Nose from odorous particles &c. &c. & the Muscles from various Causes from which primarily they 22. were intended to receive them. But if these various Causes convey too strong an Impression, they will destroy the parts, they were intended to serve, & if too weak, will be inadaquate to the Task assigned them, Tho Custom will render both, proper. _ Feby. 1st. 1791. Mr. Orange considered the Structure & formation of bone. "A Collection of the 3 Species of Vessels, & Earthy Matter in Cellular Substance, constituting an inflexible body" Tho' this is termed inflexible, yet a bony fibre is, when separated, flexible. Bone is then a Secretion of Earth Matter in 23 an highly subtil State, floating in the Blood. We have before observ'd that the Gluten of the Blood seem'd the proper Matrix for Vessels to elongate themselves in &c. Tis a Collection of this Gluten which we perceive as the very first Rudiments of the future bone. (In a Compound fracture, the Stimulus throws out a great Quantity of this Gluten which becomes a Matrix for the Elongation of Vessels. If a Woman is pregnant & has a fracture, You will find, that it will not heal till after her Delivery, as the Gluten goes to the formation of the Infant, which would otherwise be determined to the fracture.) At length it becomes organised, & the earthy Matter begins to seperate from the Blood. ~ Every bone is 24. is fibrous, Connected throughout by Cellular Substance. Bones are Vascular, shewn clearly by Injections & feeding Animals with Madder, discovered by Mr. Belcherd. They are also Lamellated proved by destroying the soft parts by fire, or exposing to the Air ~ In long bones, the fibres shoot slanting from the middle to the Circumference; but in broad ones, from several middle central points, ~ Some have imagined that the bones (which when Young are in a Cartilaginous state) have been transmuted into bone, which is a wrong Idea; The Cartilage being reabsorbed, & earthy matter deposited. ~ Exfoliation is divided into 3 kinds; A spongy or powdry one; 2nd. Of Lamella or Plates: 3rd. of fibres; ~ There is 25 a 4th. Sort of Exfoliation, which takes place after Amputation. _ The Idea of Exfoliation seems to be, that Granulations taking place beneath the unsound part, it is pushed off; but the Truth is the Absorbents take away a portion all round & as it were the bad becomes insulated, Granulation then takes place, & the bad part sloughs off. - We must never remove a portion of bone, till Exfoliation takes place, but this done, You should assist Nature in throwing it off, who now considers it as foreign & extraneous. There must be a more than ordinary Exertion of the Heart & Vascular System for the formation of bone. Away to prove the Vascularity of bone, is by immersing it in any diluted Acid, which takes away the earthy part of the bone: ~ 26. It has been doubted whether bones [have sensitivity], They certainly have, tho' their great Quantity of earthy matter, prevents their Sensibility ~ The Granulations of bone are extremely sensible, which would not be, did not the Nerves in the bone elongate themselves. Cancelli ~ Are formed by the recession of the internal fibres of the bone from each other, which having no Resistance internally press that way; the Consequence is, the bone becomes thinner & thinner, at its extremities; so that a Disease of this part would soon penetrate the Cancelli, tho' in the middle of the bone, many plates may be thrown off without Danger. The Use is to support the Medulla, & they assist in expanding Articular Surfaces &c. &c. _ Heads, 27. of bones & all processes, are originally formed in a state of Epiphis, or Separation, having Cartilage interposed, which is by degrees absorbed. ~ Bones are subject to Inflammation. ~ _ Feby. 2nd.. Mr. Orange considered the Nature &c. of a Gland. ~ "A Congeries of the 3 Species of Vessels & Excretory Duct" The Secretions are performed by means of the open mouth'd Arteries. The remainder of the blood being return'd by the Veins; & in respect to the fluid separated, there are 2 opinions concerning it. ~ Malphigi, imagined that at the end of the Artery, there was a little Cupta or bag, & at the other end of the bag, a small excretory duct commenced, that a No. of these small ones open, into a large one, &c. _ _ Ruysh maintains that there was between the 2 Vessels 28. Vessels, no distinction, but that the one began where the other ended. ~ The Office then of Glands is to secrete from the blood, humours in various parts of the body; these humours being of various qualities & Uses; as, the salivary Glands to promote Digestion; of the Ears, to secrete a bitter acrid wax preventing the admission of Insects; &c. &c. But why the different Glands, secrete various humours, from the same Mass of blood we shall for ever perhaps remain ignorant. Glands are distinguished into Conglobate & Conglomerate; The former being round & supposed to have but one excretory Duct, as the kidney; the other composed of a number of smaller ones, having as many excretory ducts opening 20 into one larger, as, the Pancreas; But there is reason to beleive all Conglobate Glands are of a Conglomerate Nature, (this was shewn in a fœtal kidney) ~ The secreted fluid, however, receives vast Change from the Absorbents _ ~ Disease, Increased Circulation &c causing a distension of the vessels, gives admittance to red Globules of blood, (which in proper health &c. receive only the Gluten,) causing the increased Redness of the Urine &c. The Use of Glands may be rank'd under 2 heads General & particular, ~ General, in respect to their being a balance, between the Solids & fluids. We should have a Plethora if the Kidnies could not pass off the Urine separated, &c. _ An increased Secretion of the Glands 30. very often drives away a Cold, which is occasioned by the Stoppage of the pores of the Skin &c- The particular use of the Glands is the particular Separation each one makes as the Lungs & Skin seperate from the blood the most fluid & saline parts &c. - There is also a general Use, resulting from the particular ones, as it gives an opportunity to the parts to reabsorb; ~ In Jaundice, the Bile is reabsorbed in large Quantities, & the greater or less degrees of Complexion, are owing, to the Quantity of bile reabsorbed. &c &c. Glands have Nerves. They must feel their Influence, without which they cannot Act. ~ Medulla _ "Oleaginous Matter in the Cellular Substance sustained by the Cancelli of bone." Possesses 31. the principle of Phlogiston. ~ It is originally secreted in a much more fluid state; but after a time the more fluid parts are absorbed. _ It is considerably redder in Young bones than in Old Ones, the Vessels being larger, & admitting Red Globules into them. ~ Their Use is to answer occasional Absorption & prevent the frangibility of the bone. In people starved to Death, not only the adipose Matter, but even this Medulla is absorbed. ~ Cartilage. _ "Probably Gluten contained in arachnoid Cellular Substance, of a shining whiteness, not fibrous, next to bone in Solidity, ~ strongly elastic." _ It does not appear to be vascular, nor fibrous, & therefore thought to be Gluten, strongly elastic, which is it's great Use, in making. 32. making us perform our Motions. with facility. ~ The Old Man is stiff in his Motions; The Cartilage which surrounds the heads of the Bones, being reabsorbed & bony matter deposited, the least motion vibrates through his frame, & he complains that in walking his brain shakes, he being deprived of that Springing, which he formerly received from Cartilage. _ It keeps parts pervious, as the Nose Palpebræ, punctæ &c. _ & in its application to the heads of bones, it makes them globular being thickest in the Central part, & in Cavities about the edges, making them deeper &c _ 33. Feby. 3rd.. Mr. Orange this day considered Muscular Fibre, _ "Flexible, elastic, Contractile." 'Tis these alone which characterise Muscle; which is the only part of the body Contractile _ Redness is not the distinguishing mark of it, this depends on it's Vascularity & the size of its Vessels admitting the red Globules; There are many muscular fibres without any Redness, as the Iris of the Eye. ~ & there must be muscular fibres even in the fly, without which he would be incapable of Motion; We must admit that where there is Motion, their must be muscular fibres; but most probably, we shall ever remain in the dark respecting the Cause of that Motion. ~ The Definition of Muscle, 34. is, “A Congeries of Muscular fibres the effect of whose Contraction is generally the same.” A fibre we have before considered as divisible almost ad Infinitum into still smaller ones, therefore a Muscle is made up of bundles of bundles of these fibres, A fibre being only in Imagination ~ Its power of Contraction depends on the greater or less No. of fibres, of which it consists; Its sphere of Contraction on their length, tho' when No. & length combine, the Muscle is very powerful. All the Muscles are disposed to contract; if any one remains in that state too long, it is called Spasm; if it contracts quick & often 'tis termed Convulsion; Muscles are plentifully supplied with 35. Nerves, possess a Vis Inscita, not acting under the Influence of the ~ Nerves; & a Vis Nervia entirely dependant on the Will.~ Muscles are termed Voluntary, Involuntary, & those Composed of both. ~ The Muscles of the Arm Leg &c, are Voluntary, under the direction of the Will; The Heart is an Example of the 2nd. Diaphragm of the 3rd.. Muscles are never in a state of perfect Relaxation except in the dead person ~ Muscles, are termed Congeneres, which assist in the same Motion.~ Antagonistæ, such as are the Instruments of opposite Motion, as the Flexors & Extensors of the Arm &c. They are named from their figure &c &c, As the Deltoides, Biceps, Sterno Cleido Mastoideus. Sphincter Oris, Ani &c. _ 36 Tendon "Closely fibrous of a shining blueish whiteness, flexible, inelastic, proceeds from a Muscle." No other Substance but an unelastic one would do, to fix to a Muscle, which is Contractile. It was originally supposed to be compressed Muscular fibres, but it exists in the Fœtus in Utero before any Motion takes place, therefore I imagine it is not so. _ Muscles are Named penniform, single [Illustration], & double [Illustration]; but there is a still more powerful one, in which the Muscular fibres run all round the tendon [Illustration]. ~ Vessels are small in tendon only admitting the pale parts of the blood. ~ Their Nerves are small & few, consequently they have little sensation. _ Aponeurosis. "Expanded tendon." 37 The word Fascia is used syn. _ It is insensible like a tendon; Vessels are small, In a state of Inflammation, it becomes red by Vis a tergo, pushing forward the red Globules into Vessels not capable of receiving it ~ In Amputation of the Leg Thigh, Forearm &c - it is not unusual to have large flakes of it like brown paper come away; Stimulating digestives Are then useful, as the Circulation is languid, ~ Muscular fibres are loosely connected by Cellular Substance. & are dependant on a proper Quantity of Nervous Influence, & of blood, with a proper State of the Connecting Cellular Substance. _ 38 Feby. 4th. Mr. Orange this day, considered, The General Confirmation of Bones. ~ All Bones are divided into long & broad, having parts, called Processes, common to both; which are Risings above the level of the bone, These are named Coracoid, Mastoid, &c, &c, from their supposed resemblance to a Crowsbill, Nipple &c &c.- Tuberosities are processes not resembling any thing in Nature. A process rising almost perpendicular, is called a Spine, & if it's Edge be flat, it is the Crista of the Spine. A Spinous process terminates in a point ~ &c &c _ Coronoid processes also terminate in a point. A process standing out in a round ball, is called Caput, or head, which have a Cervix or Neck tho' in some scarce distinguishable. A Condyle is 39 a head flatned. ~ Bones have Cavities or Depressions, which if deep are termed Cotyloid, if shallow Glenoid, tho in a recent Subject the Cartilages, make them much deeper. Pitts, small roundish Channels sunk perpendicularly into the bone, ~ Furrows are long narrow Canals formed in the Surface, ending in Grooves. ~ Nitches, & Notches small Breaches in the bone; Sinnositics, broad superficial Depressions, without Brims: Fossæ large deep Cavities unequally surrounded by high brims; Sinuses, large Cavities within the Substance of the bone with small apertures. Foramina Canals pierceing through the Substance of the bone, when this goes any way in a bone, the middle part retains the Name of Canal &c - Epiphis. All processes & heads of Bones, are originally formed in 40. a state of Separation, by intervening Cartilage, which sometimes remains through Life; tho this is charactaristic of a weak frame, ricketty &c. & this is also the Case with most scrofulous people. ~ We shall now speak on Articulations _ which are 3 fold, 1st. Symphisis. The Union of 2 bones by intervention of a 3rd. body, & is divided into Syncondrosis, where a Cartilage intervenes, as the Ribs & Sternum; bodies of the Vertebræ, & Ossa Pubis._ Syndesmosis or Synneurosis; Ligaments intervening as, in all moveable Articulations. Syssareosis, ~ flesh intervening, as, a Muscle from one moveable bone to another 2nd. Synarthrosis. Immoveable Articulations, divided into Sutura, The mutual Indention of 2 bones, when 41. their fibres are flexible, as the bones of the Head, ~ - Gomphosis. One bone fix'd in another, as a Nail in a piece of Wood; thus the Teeth are placed in their Sockets ~ Schindylesis, or ploughing, When a thin Lamella of one bone is received into a long narrow furrow of another; as the Vomer with the processes Azygos of the Sphenoid bone. 3rd. Diathrosis. Allowing of large sphere of motion, divided into Enarthrosis, Arthrodia, & Ginglimus. The 1st. is like a ball & Socket, [when] as the Head of the Femur, & Acetabulum. The 2nd. is when a round head is received, in a superficial Cavity, as the Humerus & Scapula. The 3rd.. is subdivided into 3. viz. Trochoides when 1 bone turns on the other as a Wheel on it's Axis, thus the 1st & 2nd.. Vertebræ. ~ The next species, is if 42 a bone receives & is received by corresponding prominences & depressions, as the Humerus & Ulna, Femur & Tibia &c. _ The 3rd. species is, when one bone is articulated to another by more than one place as the Radius & Ulna &c &c _ The Cranium is formed of many peices, tho' the upper part, strictly so called in composed of 8 bones: 6 proper (The Os frontis, 2 Ossa Bregmitis, Os Occipitis, & 2 Ossa Temporum: Thes 6 have nothing to do in the formation of the face,) & 2 Common, both to the Head & face, viz Os Ethmoides & Os Spheroides. In the fœtal Cranium, the bones are separate, & therefore serve as so many points of Ossification, admitting also 43. of the growth of the brain, & at the time of birth, the bones lap over each other, & it is brought forth much easier than if the head was one solid piece ~ When Ossification goes on too quick, 'tis rank'd among the Causes of difficult Labour. The fœtal Cranium is more rotund than an Adult; The European Cranium also differs considerably from the African &c. ~ That part of any bone, on which a Muscle acts is rendered smooth by the Attrition; but where it acts from, the bone is drawn out into a process, as the Mastoid process is formed by the Action of the Sterno Cleido Mastoideus, there being little or none of this process in the Fœtus, who has not made use of that Muscle. _ 44. Sinciput is the Name given to the front of the Cranium; Occiput the back: The Temples are the Sides; Vextex the top: & Basis the bottom. _ The Cranium is composed of an external & internal table, which last from its natural polish is also termed Vitreous. Between these tables are Cancelli, called Diploe. _ Crania differ much in Thickness, as also does the Diploe in different Crania in Quantity; Thin ones sometimes having much, & sometimes, none at all & vice versa &c. _ Pitts _ Are accurately fill'd with brain, & as there is no evidence externally of there being a pitt or that it is a thin Skull; You should alway trefine, as if you were on a pitt or performing the Operation on a thin Skull. 45. Feby. 5th.. Mr. Orange considered 1st. The Os frontis, which occupies the fore & upper part of the Cranium, its figure resembles a Cockle Shell, externally Convex & vice versa; Its Coronal Edge joining with that of the parietal bones, forms the Coronal Suture. The Orbital ridges ends in the ex- & in-ternal angular processes. It has also the Orbital process, going horizontally backward, which forms part of the Orbit, & is inferiorly, internally concave, &c &c. Internally, we have the Spine of the Os frontis, from which arises the falx, dividing the 2 hemispheres of the brain ~ The Cavities & foramina of this bone, are; above the Orbital ridge, a nitch, wh. generally becomes a compleat foramen, called supra orbital foramen, 46 expressive of the passage of the 1st. branch of the 5th. pr. of nerves. More internally is a little notch expressive of the fastning of the trochlea through which the tendon of the trochlearis muscle passes. _ ~ Behind the external angular process is seated the Lachrymal Gland, the principal support of the fluid called tears. Between the 2 Orbital processes is the Ethmoidal fissure. ~ The foramen cæcum lies between the Crista Galls & the Spine of the Os frontis The frontal Sinus is occasioned by the Recession of the internal table from the external; & opens into the Nose. ~ The fibres of the internal table of the Skull 47. are sooner obliterated than those of the outer one, it being a lesser diameter &c _ When the sagittal Suture extends down the Os frontis we never have a Spine; & we may therefore, if a Suture extends down the Os frontis, trefine with safety; but this should not be very low down because of the frontal Sinus ~ The Spine is formed by the fibres of the internal table, (which as being the less Circle) sooner connecting themselves, & turn inwards. ~ A Man should be exceeding guarded in his prognosis concerning a Wound of the Orbital processes, on account of their termity, they forming a support to the anterior Lobes of the Brain &c _ We shall now take a View of the 48 Parietal bones. _ They are of a square figure, & are connected anteriorly to the Os frontis by the Coronal Suture; above to each other by the sagittal; & posteriorly to the Occipital bone by the lambdoidal; laterallay to the temporal bones by the squamose. &c. Its different Sides or edges being distinguished by saying the Coronal, sagittal, &c. _ & the Angles, into Anterior superior, &c &c _ This bone has externally a semicircular ridge, commencing at the external angular process of the Os frontis, & which is expressive of the fascia of the temporal muscle, formed in this manner. The pericranium is composed 49 of 2 Lamella: The first of which, entirely surrounds the Cranium, the other or upper one leaves the under at the attachment of the temporal muscle, which it covers & is itself attached to the Zygomatic process of the temporal bone. Internally along the sagittal suture lies the longitudinal sinus. ~ At it's anterior inferior angle is a groove expressive of the Spinous Artery, which is sometimes formed into a Canal; This place should be avoided in the Trefine; The principal branch of this Artery, runs parallel to the Coronal suture. Pitts are oft'nest found in this bone; The squamous edge appears thinnest, tho' it is made of the same thickness with the rest by the Os temporis. 50. The posterior inferior angle of this bone has part of the groove formed for the lodgment of the lateral sinus. Feby. 7th. Mr. Blizard considered the formation &c. of the Os temporis. wh. is divided into the pars squamosum, & mamillaris externally, & petrosum internally.- Pars squamosum, has an arch like appearance, & is very thin. ~ It is very unequal on the inside, occasioned by the Convolution of the brain. externally we have the Zygomatic process joining with one of the same Name, of the Os Malæ, & it forms a kind of Jujum, through which the temporal muscle passes, The Masseter muscle arises from this process ~ The appearance in recent & dry bones is very different. 51. Pars Mamillaris. _ supposed to resemble a Nipple; is formed into a projecting body, which is canullous, which is connected with the internal Ear which is very dependant on its goodness. Pars petrosum. ~ Has 2 Surfaces, & a ridge from which proceeds the tentorium. Its superior surface forms a support for the anterior lobes of the Cerebrum; the lateral part of the middle lobe of the Cerebellum being applied to its inferior Surface. _ Externally, going obliquely downwards & forwards is the Styloid process, which is an attachment for many muscles. ~ Between this, & the Zygomatic process, is the Vaginal process, & auditory; In this latter is a ridge [crossed out] expressive of the Attachment of the Membrana Tympani, which divides the external from the internal ear. _ 52. This Bone contains the Cavity in which the inferior maxillary bone is articulated ~ The 7th. pr. of Nerves enter the meatus internus in the petrous bone; & there divide into portio dera, (which goes out of the foramen stylo Mastoideum situated between the styloid & Mastoid processes & then becoming a cutaneous Nerve) & portio mollis, which is destined for the Organ of hearing. ~ Behind the vaginal process is the extremity of the foramen Carotideum, which goes up to the brain at a right angle, thus preventing the too quick projection of the blood. At the poster. infer. angle of the parital bones are the lateral sinuses, from wh. commence the internal 52. Jugular Veins, which come out at the foramen lacerum with the 8th. pr. of Nerves, & which is sometimes divided by a bony ridge from the Vein. _ Most of the processes are wanting in a fœtus. - Feby. 8th. Mr. Orange considered the Os Occipitis. ~ Somewhat triangular, bounded by the lambdoidal suture. & terminates in a process named basilary or cuneiform, which joins with one of the same name of the Sphenoid. The Medulla oblong. lies in the hollow of this process, and the basilary artery also lies on it. Externally posteriorly are 2 processes, named Condyles to which the 1st. Vertebræ is fix'd by it's superior oblique processes. ~ All except a small triangular portion of 54. this bone is covered by Muscles, which cannot therefore be trefined. The various Eminences &c. are expressive of the Attachment of several Muscles ~ Nearly opposite the external ridge, internally, is a tranverse one, which has a perpendicular one crossing it, forming 4 Hollows in the bone; the 2 upper of which are expressive of the position of the 2 posterior lobes of the Cerebrum. ~ The Falx is attached to the Cross ridge, & the Pentarium to the transverse. Between the Basilary process, & body of the bone is the foramen magnum, through which the Medulla oblongata, passes from the brain; & the Vertebral arteries to it. ~ Below the Condyles 55 are the 2 foramina Condyloidea, through which the 9th. pr. of Nerves pass to the tongue. ~ On the outside of these lie the Jugular fossæ, through which the internal Jugular Veins, & 8th. pr. of Nerves pass. ~ - Os Sphenoides ~ Is the most difficult of all the bones of the Cranium; It properly forms the basis Cranii, & is a wedge to the other bones, it is also one of the Common bones. Its Situation renders it impractible for Surgeons practise &c. It consists of, Body, & laterally Wings, & has been said to resemble a bat flying. ~ Of the Body ~ It has a superior & an inferior Surface; An anterior & posterior part. ~ It's superior surface is hollow, forming the Sella Turcica, anterior to which, is, 56 a smooth Surface expressive of the Conjunction of the optic Nerves. ~ It ends in the posterior clinoid processes. ~ Its inferior surface has only a solitary process, named Azygos, which receives the Vomer coming into the Nose. It's anterior part is cellular, joining with the Cells of the Ethmoid bone, which open into the Nose. ~ At its posterior part is the basilary process ~ The Alæ or Wings, end posteriorly in a point, termed the spinous processes, simply, to distinguish them from the transverse spinous processes, which join the broad part of the Alæ to the body, ending round, in the anterior 57 Clenoid processes, behind which the internal Carotid Arteries run, sometimes a compleat foramen is formed here. - The broad parts of the Alæ are formd into 3 Surfaces, anterior, external & internal, the 1st. forming part of the Orbit &c. Externally, we see the Pterygoid processes, dividing into ex- & in-ternal; the latter is form'd into a hook, over which the tendon of the Circumflexus palati plays, ~. The foramina optica, are rather anterior to the smooth surface mentioned. ~ Next are the foramina lacera, beneath the transverse spinous processes, thro' which the 3rd. 4th. 1st. branch of the 5th. & 6th. pr. of Nerves pass. _ Below these are the foramina rotunda, 58 through which the 2nd. branch of the 5th. pr. of Nerves pass, ~ & still lower are the foramina Ovalia, thro' which the 3rd. branch of the 5th pr. of Nerves pass. _ The foramina spinosa are still lower; these admit the spinous Artery. ~ There is another foramen through wh a considerable branch of the 2nd. branch of the 5th pr. of Nerves is reflected &c Feby 9th. Mr. Orange considered the Ethmoid bone. ~ This bone completely fills up the Ethmoidal fissure of the Os frontis; & forms the principal bony part of the Nose; It is very delicate & tender; ~ Has a superior perforated Surface termed the Crebriform Lamella 59 & an inferior cellular surface, hanging down into the Nose, ~ An Anterior projecting Surface, on wh. the Nasal bones rest; & a posterior surface joining with the Cells of the Sphenoid bone: It is divided into 2 parts by a thin bony plate termed the Nasal Lamella, the upper part of which is rounded, & named Crista Galli. The anterior Lobes of the Cerebrum rest on the Crebriform Lamella; so that a blow on the Nose, often drives the Nasal Lamella & Crista Galli into the brain; In such a Case we should introduce a pr. of forceps lined with Sponge &c. & seizing on the Nasal Lamella, draw it from it's Situation, which is all that can be done. 60. It is bounded on the Sides by the Os planum one of the bones of the Orbit; Next the Nasal Lamella are placed the superior Spongy bones. The tenuity of these bones &c. should make us cautious, in the introduction of Instruments into the Nose, or detaching a Polypus from thence. Superior Maxillary bone. _ Joins the Os frontis, Mali, &c &c &c. It is irregular; &c. It's Nasal process has a groove form'd in it, which by the junction of the Os Unguis, is form'd into a Canal call'd the ductus ad Nasum, above this, is the tendon of the Orbicularis palpebrarum. ~ Its anterior edge is formd for the reception of the Os Nasi. ~ Its upper part is named the orbitar process, going horizontally backwards, forming part of the floor of the Orbit & roof of the 61. Antrum ~ Its outside, receives the Cheek bone; termed it's malar process; & it's inferior edge termed it's Alvsolary process, has the Alveoli, or Sockets for the teeth form'd in it. _ These Alveoli are absorbed in Old Age, & occasions the Nose & Chin to meet. ~ Internally is the palatine process, doubly concave, forming part of the Roof of the Mouth & floor of the Nostrils; The remainder of the roof &c. being perfected by the Application of the palate bones. _ Just beneath the Orbit is the Infra Orbitar Foramen, thro' which the 2nd. branch of the 5 pr. of Nerves passes. _ ~ Os Mali. ~ Given the Rotundity to the face; ~ It's maxillary process joins the maxillary bone. ~ It has 5 processes, viz, superior, & inferior, obitar, Maxillary, & Zygomatic. & internal Orbitar. 62. Feby. 10th. Mr. Orange considered the Ossa Palati. ~ These may considered as parts of the Maxillary bone; they finish the Roof of the Mouth & floor of the Nostrils; doubly Concave; It has 3 processes, viz, palatine, pterygoid, & Orbitar, ~. It is very spongy & thin, often coming away in the Lues Venera, The Voice then becomes impaired, & there is a difficulty of swallowing. ~ Ossa Nasi. - These form the bony Arch of the Nose; but are not continued to it's Extremity, as it would be in danger of fracture. They are of different figures, wh. causes the various Shapes of Noses. Their upper part is bulbous & thick, connected with the Nasal process of the Os frontis 63. frontis. ~ Their middle rests on the Nasal Lamella of the Ethmoid bone, their Sides on the sup. Maxillary. ~ In a fracture of these bones, we should be exceeding guarded; & not, as is generally done, endeavour to depress the prominent part which is the natural State of it; but to elevate the depressed part, wh. has been beaten in; We must first ascertain the Condition of the Nasal Lamella with a probe, & if it is driven up into the Brain, draw it gently down with a pr of forceps, but if it is found, you should, with a Director or piec of Wood defended with Linen, elevate the depressed part ~ Vomer. ~ Its upper part, has a groove, in wh. the processes Azygos, of the Sphenoid bone, is received, 64. & this with the Nasal Lamella forms the Septum of the Nose; There is however a triangular Notch, which in the recent State is filld up with Cartilage, Inflammations of the bones of the Nose, should be removed by Fumigations &c &c. as soon as possible, as they soon exfoliate. _ Ossa Unguis. ~ Is composed externally of 2 smooth Concavities & a middle ridge; & is fix'd to the groove in the maxillary bone, thus compleating the ductus ad Nasum. This bone it is, which is perforated in the Operation of fistula lacrymalis, carrying the Instrument downwards & backwards.- 65. Inferior maxillary bone. - Consists of a body, & posteriorly the Rami, ending in the Coronoid & Condyloid processes _ Its inferior part is the basis, the middle is the Symphysis, which makes the difference of Chins, by projecting more or less. ~ The part where the Rami go off is termed its Angles - The Condyloid processes form a Sort of Enarthrosis Articulation, with the articular Cavity in the temporal bones. ~ To the Condyles are attached the temporal Muscles, & all the Rami are covered by the Masseter Muscles. ~ From the basis, rises a perpendicular process for the Reception of the teeth termed alveorlary ~. Internally at the Symphysis &c, are several protuberances, expressive of the attachment of various Muscles, as the Digastric &c &c & just below 66. the Coronoid process, the Buccinator Muscle is attached ~ On the inside the Rami are 2 holes, the entrances of a Canal, thro which the 3rd. branch of the 5th. pr of Nerves, & an Artery pass, to supply the teeth, coming out near the Symphysis of the Chin externally. Fractures of this bone often happen, & sometimes a troublesome Hemorrhage takes place, by the Contraction of the Artery into the bone, which cannot be got at without taking a piece of the bone away, ~ Sutures ~ formation. Bones are fibres, which in broad [long] bones, radiate from the Centre to Circumference, these at length approach & pass between each other; but they meet resistance as they approach, & 67. thus a Suture is formed. ~ These sometimes remain through Life, at other times they are obliterated.~ There are 5 principal Sutures, the Coronal, extending across the head; the Sagittal, placed longitudinally on the Skull & is sometimes continued down the Os frontis. The Lambdoidal, rather father back than the Vertex & going obliquely downward. & the 2 Squamous, a little above the ear. ~ ~ The best Method of tracing these, is; about an Inch from the external ang. pro. is the Coronal going obliquely upwards & backwards about the length of a common probe from the Nose. ~ The Sagittal terminates in a line carried round the Cranium from the external ang. process; & the lambdoidal terminates just above the Mastoid process 68. Feby. 11th. Mr. Orange, Considered the Spine, beginning at the condyles of the Occipital bone; Consists of true & false. The true comprehending 24 Vertebræ, the false, the sacrum & appendix Coxendicis. ~ The true are divided into, 7 Cervical, 12 dorsal, & 5 Lumbar, all of which agree in the general Character of having a body, (except the 1st. Cervical,) & processes; The bodies placed before, &c. 7 processes. 2 transverse, 4 oblique, & 1 Spinous, The specifick Character of each is different; viz. ~ The Cervical Vertebræ, are flatned at the fore part, on wh. the Oesophagus &c. rests; the dorsal, laterally, allowing room for the lungs &c &c. & the lumbar at their fore part, giving Room to the Viscera & The bodies are, greatly Cancellous 69. & their edges are covered by a thin plate of bone, & between each, is a thin plate of Cartilage & Ligaments. The 1st. Vertebra, called Atlas from its supporting the head, differs from all the others very materially, it has no body, but in its place a bony Arch, on the inside of which is [seated] a smooth Surface to receive the processes dentatus of the 2nd. Vertebra, round which it moves, It's superior oblique processes are articulated with with the Condyles. ~ The Cervical Vertebræ, may alway be known by a hole in the their transverse processes, forming a Canal for the transmission of the Vertebral Arteries. ~ The transverse process of the 1st. Vertebra, extend out much farther than the others 70. which occasions the Artery to make a Curve, before it enters the foramen magnum. ~ Its spinous is so small, as scarcely to deserve that Name. ~ The 2nd. Vertebra call'd dentata, from it's toothlike process, which arises from it's body & passes on the inside of the 1st. Verte: from it Ligaments to the Cranium which fasten it &c - This pro: is sometimes fractured in Children, which causes instant death, as the Spinal Marrow is compressed, having an Angle form'd by the Head falling forwards; & Apoplexy or Concussion of the brain is thought oftentimes to be the Cause. therefore in weak Children, something placed to keep the head erect, is not amiss. - 71. The Motion allowed of between the 1st. & 2nd. Vertebræ, is greater than between any other, The Medullary Canal, is always the largest in Vertebræ having the most motion. ~ The remaining Vertebræ if the Neck are pretty much the same, The spi: pro: of each being bifurcated. They grow larger as the descend, the 7th. being not unlike the 1st. dorsal &c. Dorsal Vertebræ ~ Are compressed laterally, have no holes in their trans: processes. ~ At their lateral part is a pit expressive of the Rib, & their transverse processes are pressed by the tubercle of the Rib, in respiration. ~ Their Spinous processes stand downwards & are very long. ~ The last dorsal Vertebræ, resemble the 1st. lumbar &c. 72. Lumbar Vertebræ, ~ Are largest of all the others; processes differ, &c &c. ~ by the application of Vertebræ we have lateral holes for the transmission of Nerves, & Vessels &c &c. _ The true Vertebræ may be considered, as a pyramid, its base, the last lumbar Vertebra. ~ The Os Sacrum or false Vertebræ, may also be considered as an inverted pyramid, its base joining the base of the true, &c - Costæ or Ribs. Of these there are 12 on a Side, 7 true, connected with the Sternum, & 5 false, connected with, the 7th: true one &c. There are the same No. in a Male as in a female ~ They all agree 73. in having a head, a prominent tuberosity, an Angle, & a superior & inferior Surface termed Costæ &c. The 1st. differs from the others; it is placed nearly horizontal & is immoveable, having Ligaments coming from the Clavicle; so that in Inspiration, the inferior Ribs, are brought toward this, by the intercostal Muscles, which turn them outward, & the Diaphragm descending, enlarges the Cavity of the Thorax. ~ Expiration, is the cessation of these Muscles _ Their heads are framed for articulation, with the dorsal Vertebræ; their inferior Costa has a groove in which the intercostal arteries run. ~ fractures generally happen beyond the angle of the Rib. &c. In the Operation of Empyema, we must keep close to the superior edge of an inferior Rib, on account of the Arteries &c. _ 74 Feby. 12th. Mr. Orange this day considered the Sternum ~ Said to consist of 3 peices of bone, though one is named the Xiphoid Cartilage; Altogether it is externally somewhat Convex, & a little Concave internally. ~ The 1st. portion is largest, & has laterally a Depression expressive of the attachment of the Clavicle. ~ The 1st. Rib is attached entirely to this; The 2nd. Rib is attached between the 1st. & 2nd. bone. ~ The 3 portions are often altogether ossified, so as to make but one bone. ~ The Sternum is very light & Spongy, apt to be affected with Caries, & it then crumbles away, ~ . _ 'Tis recommended to trefine this bone, when matter is form'd in the anterior Mediastinum.~ Fracture sometimes occurs, the only Remedy then is to lay the person [crossed out] on his back, raising him up with pillows &c &c. placed under him. _ 75 Upper Extremity, ~ Divided into, Shoulder, Upper Arm, Fore Arm. Carpus, Metacarpus & Fingers. _ Shoulder. ~ Consists of 2 bones, the Clavicle, & Scapula. ~ ~ Clavicle. ~ Gives that figure to the trunk which it possesses, by keeping the upper Extremities at a distance. ~ It is said to resemble an Italic ∫, placed horizontally, It has a body, & 2 Extremities, named Sternal & Scapular. _ The Sternal is larger & more rotund than the other, & has Ligaments, allowing of a Motion every way; ~ It acts as a fulcrum to the upper Extremity _ It's inferior part has a roughness expressive of a Ligament, going to the 1st. Rib. ~ Its Scapullar Extremity is flatted, having a Smooth ending Surface, expressive of its attachment with the Acromion of the Scapula & beneath is a Roughness, from wh. a Ligament goes to the Coracoid process. 76. It is almost entirely covered by Muscles, as the Deltoid, Pectoral Sterno Cleido Mastoideus &c &c &c. - About the middle is a hole through which the medullary Artery passes.~ Fractures of this bone often occur. ~ & the Weight of the upper Extremity will depress the part next it, & make the part affix'd to the Sternum, appear prominent, tho' it is natural, as the Sternum, is a fix'd part; Our Care is to elevate the depressed part, & keep the Shoulders back by a figure of 8 bandage. ~ ~ - Scapula. ~ Somewhat triangular, Externally Convex &c. _ term'd the dorsum, from which arises a Spine, which is somewhat hollow & flatted above, nam'd the Crista. to wh. several Muscles are attached. _ It is divided, into Superior & inferior 77. inferior Costæ, & basis, &c _ _ The Spine terminates in the Acromion, wh. has a Smooth internal edge for the reception of the Clavicle. The Head of the Scapula, is form'd into a Glenoid Cavity for the reception of the head of the Os Humeri; just above it is the Coracoid process, wh. is very important, having attached to it, 1 head of the Biceps; Coraco brachialis. &c. &c. _ Sometimes this is fractured, tho this mostly happens at the Cervix Scapula; ~ To determine if it be fracture or Dislocation, (the symtoms being the Same,) We must feel this process; by bending the Arm, & pressing into the hollow; if it yields, it is fracture &c _ _ _ You must press the head of the Humerus up by keeping the Arm in a Sling, covering the Elbow with it & keeping 78. down the Shoulder, with the reflexed Capsiline bandage. ~ The inferior Angle of the Scapula is made smooth by the Action of the latissimus Dorsi. ~ Matter is sometimes form'd behind this bone; & it is then recommended to trefine upon it. ~ &c - - - _ Feby. 14th. Mr. Orange considered the Os humeri. ~ Has a body, & upper & lower Extremities; Its head is fitted for connection with the Scapula, & is on one Side, in respect to its body The internal Condyle of its lower Extremity may serve as a guide to find it &c. _ The upper part of it body, has several Smooth Surfaces expressive of the attachment of Muscles, as is also the body itself. ~ The pectoral Muscle is attached 79. to an outer ridge, which is on the body, & the latissimus dorsi to an inner one. ~ The Coraco-brachialis, arises from the Coracoid process, & is attached to this bone; Somewhat flattened posteriorly, having a deep fossa, & also at it's internal part, into which the Olecranon, & Coronoid process of the Ulna play. It ends in it's ex- & in-ternal Condyles, the latter of which projects inwards considerably, & is often fractured without detriment to the joint. ~ The external Condyle is much rounded, & on it the Radius plays, it is much less than the internal one, which is alway fractured, in a Dislocation, of the fore Arm inwards, but a Dislocation may happen outwards, without fracture. ~ Extension of the fore Arm, is sufficient 80. to reduce it. Dislocations of the Humerus may take place downwards, backwards or forward but not upwards, without fracture of the processes of the Scapula ~ &c. &c. &c. _ _ _ Fore Arm. Consists of 2 bones, Radius & Ulna. ~ Radius. ~ Is rather Convex externally. &c. _ pretty regular. Its upper part hollow'd for Connection with the tubercle of the humerus, & laterally to the Semilunar Cavity of the Ulna. ~ It's Neck is surrounded by a ligament, fastening it to the Ulna. ~ Internally, below the neck, is a turbercle, to which is attached the tendon of the Biceps. _ below this it becomes broader ending in a kind of Ridge to which the interosseous ligament 81. ligament is attached, going to a similar ridge in the Ulna. ~ In the middle is a rough Surface, to wh. the pronator teres is attached from the internal Condyle of the Humerus, which Muscle, without Care is taken, will be divided in opening the Arm. ~ It ends in a Semilunar Notch in wh. the Ulna plays laterally, & its end has a Cavity for the reception of the Os, Scaphoides & lunare &c. _ The pronator quadratus arises from this. _ Ulna. ~ Is the longest of these bones, & the internal one; the Radius moves round this in pronation & Supination, it being fix'd. _ It has an articular Cavity bounded by the Olecranon & Coronoid process; The former has inferiorly, a triangular rough Surface, expressive of the 82. place on which we alway lean. _ When the Olecranon is fractured we must keep the Arm extended by a small Splint, from the Humerus to the fore Arm; & Inflammation, must by all means be avoided. ~ At a fortnights end or before, we must begin to move the Arm gently &c. _ ~ The Triceps Muscles is attached to this bone, at the Olecranon. & the Branchialis internus to the Coronoid process. ~ On its outside is a Semilunar Cavity in wh. the Radius plays: & a little lower is the Ridge to which the Ligament is fix'd surrounding the Radius, its outer Side has a Ridge to wh. the interosseus Ligament is attached, Its lower part is 83. round &c &c. _ _ _ It ends in the [Semilumar] Stiloid process ~ Both are sometimes fractured, A narrow Compress placed before & behind is Sufficient, over wh. a Splint may be placed. Carpus. _ Consists of 8 bones. divided into upper & lower phalanges, the Upper consists of the Os Scaphoides Lunare Cuneiforme, & pisciforme, the lower of, Os Trapezium, Trapezoides, magnum & cuneiforme. _ They are all of a Wedge like figure _ ~ Considerable motion between the 2 phalanges is allowed of. ~ All the bones communicate, one with the other, so that Disease of one, affects all: They also communicate, 84 with the Metacarpal bones. ~ wh. Should not be taken away at their Junction with the Carpus. ~ &c. _ Metacarpus. ~ Consists of 4 bones, the Thumb not having one. It may therefore be removed from the Carpus, without Detriment. _ Fingers. ~ 5 in No. each consisting of 3 bones. ~ The Thumb has the Strongest bones, as it counteracts, all the fingers; we should retain as much as possible of it in Amputation. &c. _ Feby. 15th.. Mr. Blizard, considered the bones of the pelvis: composed of the Sacrum Coccyx, & Ossa Innominata, wh, is divided into Ilium, Ischium & pubis. ~ The[ir] Situation of the pelvis is very inclined, ~ The upper part of The Ilium forms a Considerable part of the Abdominal parieties, ~ These 3 bones are compleated into a single one in Adults. _ The Ilium, is rounded above wh. part is termed its Crista, which ends, before in, Anterior sup: & inf: Spines; & behind in posterior Spine. _ Os pubis; where it joins its fellow has the term of Symphysis applied to it; it has a Ramus & an Angle &c &c. _ Ischium has a process term'd it's spine &c. which is turn'd more outwards in females than Males; Its inferior part, is rough, termed it's tuberosity. Its upper part forms the greatest share of the Acetabulum, At the bottom of wh. is the fossa for the Synovial gland &c &c. & it has a large Notch compleated in the recent subject, into a foramen, by Ligaments. 86. Sacrum; Consists of 5 bones in the fœtus, which in Adults, are form'd into one. _ It is a wedge like bone, & situated between the 2 Ilia behind. It has the Coccyx at its Extremity, divided into 2 or 3 bones, the 1st. of which has 2 processes standing up, from wh. Ligaments go to the Sacrum. - ~ The pubis is formed into an Arch by the junction of the 2, larger in Women than Men. ~ The Axis of the pelvis & Abdomen are different. ~ To the Crista of the Ilium, all the Abdominal Muscles are attached, &c. from its post: Spine Ligaments go to the Sacrum &c. &c. _ The Sartorius Muscle arises from the ant: sup: Spine; behind the 87. ant: inf: Spine, is a hollow, over wh. the psoas mag: & Iliacus internus pass; & a little lower, the place where the External Iliac Artery passes. ~ poupart, or Fallopius' Ligament goes from this bone to the Angle of the pubis, . &c &c _ Acetabulum. ~ Is form'd by the Junction of these 3 bones, & is the Socket, in wh. the head of the femur plays. _ &c. . Feby. 16th. Mr. Orange, considered the Os femoris; having a body & an upper & lower Extremity. Its upper part is form'd into a head laterally, having a contracted part, termed its Neck, to one side of which its body ends in the Trochanter major, & more internally downwards, is 88 the Trochanter minor. ~ Below the Trochanter major is rough line to wh the Gluteus medius, is attached; & at it's posterior part is the linea aspera. ~ Fractures of the Neck sometimes happen, ~ We may always tell the Situation of the head by its being anterior. & to one Side of the internal Condyle. ~ Its Head has a rough Surface at its Extremity to wh. the the Ligamentum teres is fix'd. ~ It terminates in the ex- & in-ternal Condyles, which a framed for a Ginglimoid & Enarthrosis Articulation. ~ It's anterior part is grooved receiving the patella. ~ Inflammation & fracture of the Condyles are very dangerous to the joint &c. Leg. _ Consists of the Tibia & fibula. Tibia. _ Somewhat triangular, having an external, internal & posterior Surface. ~ The internal, is, what we term, Shin, & 89. may be got at by a simply Inscision, wh. the others cannot be. Its anterior edge is termed its Spine. Externally below the head, is the Smooth Surface, to which the fibula is fix'd. ~ The Ligaments of the patella are fix'd to a protuberance it has at it's anterior part ~ Its inferior internal Surface, forms the Malleolus internus, which is somewhat rounded by the tendons of some Muscles; & is sometimes fractured. _ ~ Fibula. _ Is very slender. Its lower Extremity forms the Malleolus externus. fracture of its extremity may happen without Injury to the Joint ~ We are directed in Amputation to stand on the inside, as we shall fix our Saw on both bones at once. _ ~ Foot. Consists of Tarsus, Metatarsus & Toes. _ The Tarsus consists of 7 bones, viz, Astragalus, Os Calcis, &c. Naviculare, forming the 90. upper Phalanx. Os Cuboides, Cuneiforme externum, medium & internum, the lower phalanx. Astragalus, is the uppermost of these bones, and is articulated above to the Tibia & Fibula; below to the Os Calcis, & before to the Os Naviculare. Os Calcis, is the largest of these bones & to it the Tendo Achillis is fix'd. _ Metatarsus ~ Consists of 5 bones, larger in every respect than the Metacarpal bones; The great Toe has a metatarsal bone, The Ends of the Metatarsus are connected with the tarsus, & the same Observation, will be good, wh. was made respecting the Carpus. &c _ Toes ~ The great Toe has but 2 bones the others, each 3. &c &c. _ ~ Patella, ~ is of heart shape &c. _ & fractures of it longitudinally & transversely sometimes happen. _ & _ 91. No. of bones in the human body. Those proper to the head. Skull ~ & bones of the internal Ear. 16. Maxilla superior. 13. inferior. 1. 14. Teeth in both Jaws 16 32. Proper to the Trunk. _ Vertebræ. 24. Costæ. 24. Sternum. 1. 49. Ossa Innominata. 2. Sacrum. 1. ~3. Coccyx _ 3. _ ~3. Superior Extremities. Claviculæ. 2. Scapulæ 2. ~4. Ossa Humeri 2. Ulna 2. Radii. 2. ~6. Carpus of each hand 8. - 16. Metacarpus 4 ~8. Finger bones 15 _ 30. Inferior Extremities. _ Ossa Femoris, 2. Tibiæ. 2. - ~4. Fibulæ 2. Patellæ. 2. ~4. Tarsus of each foot 7 - 14. Metatarsus 5. _ 10. Toes - 14. 28. Total. 241  93. Of the Muscles. Feby. 18th.. Mr. Orange began the Consideration of the Various Muscles of the body; Commencing wh. those of the fore part of the Abdomen, which consist of 3 [pr.] layers may be reckoned as digastric. The 1st. is the externus obliquus. arising by fleshy digitations, from the inferior edges of the 8 inf: Ribs. meeting the digitations of the Serratus major anticus. _ It's fibres pass obliquely downwards being inserted into the Crista of the Ilium; It becomes tendinous at different distances, forming the Linea Semilunaris; & joins its fellow in the Linea alba. wh. is form'd by the tendinous fibres of the 3 layers, interlacing. 94 from the Xiphoid Cartilage to the pubis. _ ~ The tendinous fibres are bent downwards, from the ant: sup: Spine of the Ilium to the pubis, forming Poupart's Ligament; under wh. femoral hernia take place, & in wh. are seated the Rings, (through which the Spermatic Chord passes in Males, & the round Ligament of the Womb in females,) form'd by a separation of inferior fibres of wh. it is composed from the superior, wh. last go to the Symphysis pubis; the inferior to the angle; so that the Ring is triangular. _ therefore between the Angle & Symphysis a Truss should be applied in a hernia. _ 95. The peritoneum is never ruptured, but descends with the Intestines, forming the Hernial Sac. _ The Ring is prevented extending, by cross Ligaments &c. _ Those Hernia wh. pass through the Ring, as Bubonocele, &c &c. should be reduced in the direction of the ring, upwards, & outwards; but femoral hernia upwards & inwards, towards the Linea alba. _ Beneath this Muscle is seated the Internus obliquus: whose fibres run in a contrary direction to the last; It arises from the Crista of the Ilium &c. attached to the 7 inf: Ribs, Xiphoid Cartilage, & Linea alba.. from it's inferior fibres, the Cremaster Muscles, arises 96. wh. is lost in the Tunica Vaginalis Testis. &c. _ ~ Below this is the Transversalis, wh. arises tendinous from the transverse processes of the Vertebræ Lumborum, fleshy from the Crista of the Ilium, &c. &c. & is inserted into the 7 inf: Ribs, Xiphoid Cartilage & Linea alba. _ Recti. ~ Arise tendinous from the Ligament, connecting the Ossa pubis. & is inserted into the Cartilages of the 3 inf: true Ribs. _ It is intersected by tendon in different parts ~ & it is plac'd in a sheath form'd by the tendons of the Abdominal Muscles, that of the obliquus internus dividing into 2 parts wh. surround 97 this &c. _ These muscles are ~ bounded by the Linea semilunaris, & alba. _ The Umbilicus or Navel,, is seated about the middle of the Linea alba, at wh. Hernia sometimes take place, term'd Exomphalos &c. _ The Uses of these Abdominal Muscles, are 3 fold, viz, as Flexors, Respiratory & Expulsive powers: Flexors ~ When they act together they antagonise those placed behind. ~ &c. ~ They turn the body to one Side ~ The Ex. Oblique turns the body to the contrary Side; & the In: Oblique, to the same Side &c _ In Wounds of the Abdomen, these should be relaxed as much as possible. ~ & also in Contusions. _ 98. Respiratory powers. They counteract the intercostal muscles, pulling down the ribs & pressing the Contents of the Abdomen up against the Diaphragm; they lessen the Cavity of the Thorax, thus forcing the Air, out of the Lungs; they are Voluntary & involuntary, acting when asleep. Inflammation &c. of these causes difficulty of breathing &c. &c - Expulsive powers. - They expel the fœces, Urine, &c. & in females the fœtus. _ ~ In tapping, the mid space, between the ant: sup: Spine of the Ilium, &c. Umbilicus, is proper, wh. is just in the linea semilunaris. &c. _ Latissimus Colli. or platysma Myoides ~ Arises by slender fibres, from the Sternum, Acromion 99. Acromion, & pectoral & Deltoid Muscles, & is lost in the Muscles of the face, &c &c. _ The external Jugular Vein runs under this. &c _ Pectoralis ~ Arises from the Sternal extremity of the Clavicle, Sternum, & 5th. 6th. & 7th. Ribs, & is inserted into the upper, inner part, of the Humerus, it is a flexor & abductor of the Arm. ~ & in Climbing, it draws up the Trunk to the Extremities. _ ~ Upon this is seated the Mamma, or Breast, in the Amputation of wh. we should keep the Arm extended, thereby stretching the Muscle, &c. but the operation finished, we must place the Arm to the side, the Hand laying over the Thorax &c. _ 100. Feby. 19th.. Mr. Orange, considered the Muscles seated on the anterior part of the Neck, & first of the Sterno Cleido Mastoideus; wh. arises tendinous from the Sternum; & fleshy from the Clavicle, & is attached to the Mastoid process of the temporal bone. ~ When both these Muscles act together, they bend the Head, but when separate, turn it to the opposite Side; Wry neck, is the Disease of these Muscles, either an increased power of one; or a deminution &c. _ If it is from the first Cause, the division of the muscle, is necessary, performed with the probe-Rasor 101. probe-Rasor &c _ The Muscles of the fore part of the neck, are more useful as Physiologists, than Surgeons. ~ They are all subservient to the performance of Deglutition. ~ The pharinx is a large bag seated behind the Larynx, consisting of 5 Cartilages & Os Hyoides; Their Names are, Thyroid, Cricoid, 2 Aretinoid, & Epiglottis. The Os Hyoides, has a basis, & 2 Cornu, wh. are attached to the Thyroid Cartilage ~ Those Muscles, wh. draw up the Os Hyoides &c. are attached to the temporal bones, & under Jaw, going to the Os Hyoides. ~ The 1st. pair wh. we shall consider, are, 102. The Digastric Muscles _ Which arise on each Side, the Symphysis of the Chin, it has 2 fleshy bellies, the posterior of which arises from the Sulcus, at the bottom of the Mastoid process; it's anterior to the Os hyoides; wh it draws up, when the inf: max: bone is shut. ~ ~ - The Mylo Hyoideus lies beneath this. ~ A digastric muscle having a very extensive origin, from the Symphysis of the Chin to the Angle &c. _ it is inserted into the basis of the Os Hyoides. The Genio-hyoideus, lies beneath this, attached to the basis also. ~ The Stylo-Hyoideus, arises from 103. the Styloid process, & passes through the tendon of the digastric Muscle, it is fix'd to the Corner of the Os-hyoides. ~ These are Elevators of the Larynx & Os hyoides ~ ~ ~ The Depressors are, first, The Sterno-Hyoides, coming from the inside the Sternum, & going straight to the anterior part of the Os Hyoides; they are cut through in the Operation of Bronchotomy. ~ ~ ~ - The Sterno-Thyroidis, are beneath these, coming from the inside the Sternum, to the Thyroid Cartilage. _ ~ The Thyro Hyoidei. ~ from the Thyroid Carti; to the Os Hyoides. _ _ 104. Crico-Thyroideus. - arises from the Cricoid Cartilage, & is attached to the Thyroid, &c. _ _ Omo-Hyoideus ~ Arises from the (Clavicle), & is attached to the Os Hyoides. _ ~ Beneath these Muscles, is seated the Thyroid Gland, wh. is frequently enlarged, constituting a Derbysh. Neck. This produces difficulty of breathing, by pressing on the Aspera Arteria, & difficulty of swallowing, by preventing the action of these Muscles &c.. Serratus major anticus. ~ Arises from the basis of the Scapula; & is attached to the 8 superior Ribs; It draws the Scapula forwards &c. _ Serratus minor anticus. or pectoralis 105. pectoralis minor, arises from the 3rd. 4th. & 5th. Ribs. & goes to the Coracoid process. It brings the Scapula downwards & forwards, on the Ribs, & it draws them up, & may therefore be considered as accessory to Respiration. &c ' _ _ _ The Subclavius _ Arises from the Clavicle, & goes to the 1st. Rib, wh. it helps to fix, & may therefore be considered as a Ligament. &c. _ 106. Feby. 21st.. Mr.. Orange considered The Fronto-occipitalis, Muscle; It arises from the transverse Ridge of the Occiput, laterally to the mastoid process. & is tendinous over the Cranium &c. It is fleshy on the Os frontis & is inserted into the Orbicularis palpebrarum. wh. it draws up. The 1st. branch of 5th. pr. of Nerves, coming out at the Supra Orbitar foramen, supplies the frontal portion. ~ It is connected by short cellular Substance to the Hairy Scalp, & by long, to the pericranium; between both wh. Matter may be form'd the sooner discharged the better. ~ If the Nerve is in a State of paralysis, or cut, 107. &c. the Eyelid cannot support itself. _ &c. &c &c. _ Attolens, Retrahens Aurem. Anterior Auris &c &c. _ Temporal Muscle. Commences at the External any: process, the semicircular Ridge of the lateral part of the parietal bone &c &c & is inserted into the Coronoid process of the lower Jaw, wh. it pulls upwards & a little backwards &c. ~ It is surrounded by a facia formed by the Recession of the external layer of the pericranium from the internal. ~ Matter may be form'd below it, & is so deceptive, that it is often taken for fracture with depression- 108. Masseter. _ Arises from the Jugum, form'd by the temporal & Malar bones, & is inserted into the Ramus & Angle of the lower Jaw ~ It is composed of an ex- & in-ternal portion, the fibres of the former going backwards, of the latter, forwards ~ This pulls the Jaw upwards backwards & forwards. ~ ~ Muscles of the face. _ Eyelids. serve as Veils, against the light, dust &c. they sweep the tears over the Eye, & convey them away ~ They perform their function by means, of the Orbicularis palpebrarum - wh. surrounds the Orbit, & 109. is inserted into the Nasal process of the Sup: Max: bone. Its tendon is divided in the Operation of Fistula lacrymalis ~ ~ &c _ Elevators of the Lip ~ Levator Labii superioris proprius, Alæq: Nasi ~ Arises, from the sup: max: bone just above the infra orbitar foramen, & from its Nasal process; & is inserted into the Orbicularis Oris, & the Alæ Nasi; It raises the upper Lip & depresses the Nose. ~ ~ - Levator Anguli Oris. ~ Arises from the hollow of the sup: max: bone, & is inserted into the Angle of the Mouth, It draws the Corner of the Mouth upwards, as, in Smiling. ~ - 110. Zygomaticus, or, Distortor Anguli Oris. _ Arises from the Zygomatic process, & is inserted [inserted] into the Angle of the Mouth, wh. it draws up, in: "Grinning horribly a, ghastly Smile." ~ _ These Muscles elevate the upper Lip, &c Angles &c. It has 2 depressors. viz. ~ Depressor labii superioris proprius, Alæq: Nasi. _ wh. arises from the upper Jaw, & is inserted into the upper lip, & Ala Nasi. both wh. it draws downwards & backwards. Depressor Angulioris. _ Arises from the lower edge of the Maxilla inf: & is inserted into the Angle of the Mouth, wh. it pulls downwards. Buccinator. Arises from the Ramus of the inf: max: bone; & is inserted into the Angle of the Mouth, wh. it draws back & contracts. - 111. Elevator Menti. _ Arises on the outside the Alveolary processes of the inf: max: bone, & is inserted into the under lip & skin of the Chin. Orbicularis Oris. - Is form'd by the fibres of almost all the Muscles of the Mouth decussating each other, & surrounding the Mouth like a Sphincter. It shuts the Mouth & conteracts all the Muscles, wh. form it &c. _ Feby. 22nd.. Mr. Blizard considered the Diaphragm. ~ wh. forms a compleat Septum, between the Thorax & Abdomen; It is attached [& arises from] to the Xiphoid Cartilage, to [from] the Cartilage of the last true & all the false Ribs, & to the 3rd. 4th. & 5th. Lumbar Vertebræ, arising from a [crossed out] tendinous Centre, from wh. 112. the fibres diverge, The tendon is semilunar, & has a hole on its right side, through wh. the ascending Vena Cava passes. _ The fleshy part terminates in the Crura, &c _ the fibres of wh. decussate leaving a hole through wh. the Aorta passes, & above this is another hole which gives passage, to the Gula. This Muscle, is the principal Agent in Respiration &c. &. _ 113. Feby. 23rd. Mr. Orange considered the Trapezius, wh. with the Latissimus dorsi, almost cover the whole back. ~ It arises from, the protuberance in the Occiput, the 2 last Spinous processes of the Cervical Vertebræ, & all of those of the back. & is inserted into the posterior part of the Clavicle [crossed out], & the Spine of the Scapula. The direction of its fibres being 3 fold, will act accordingly. It's straight ones draw the Scapula directly backwards &c &c. It also draws the Head backwards, antagonizing the Sterno Cl. Mastoideus. _ The Ligamentum Nuchæ is the attachment it has with it's fellow at the Nape of the Neck. ~ As there are no muscular fibres here, Blisters, Setons, Issues, are to be applied &c. _ 114. Latissimus dorsi ~ Arises from the Spi: pro: of the Veterbræ of the loins, & Os Sacrum, & several of the dorsal, from the Extremities of the 3 or 4 inf: Ribs, & from the Crista & Spine of the Ilium, & is inserted into the inner edge of the groove in the Humerus. _ It pulls the Arm backwards & downwards, &c. _ Dislocations of this Muscle takes place sometimes, to reduce wh. the Arm, must be brought to the body, pressure, being made on the inf: ang: of the Scapula, when the Arm must be brought quickly upwards. ~ Rhomboideus. - situated between the 2 last muscles, & is distinguished into major & minor, the latter being superior &c. & taken together 115. arise from sev'ral of the Spinous processes of the Cervical & dorsal Vertebræ. & is attached to the basis of the Scapula, wh. they draw upwards & backwards. ~ ~ Serratus sup: posticus. - Arises from the spi: pro: of the last Cervical; & 2 upper dorsa Vertebræ, & is inserted into the Ribs, wh. it draws up, & is therefore an inspiratory pow'r. _ It is antagonized by the Serratus inf: posticus. wh. arises in Common with the tendon of the Latissimus dorsi, & is attached above to the Ribs. &c. _ Splenius Capitis. - Arises from the Lig: Nuchæ, & spi: pro: of 3 last Cervical Vertebræ & is inserted into the Occiput; pulls the head backwards. Splenius Colli. - Arises from the 3rd. & 4th.. cervical &c. of the back &c _ inserted into 5 sup: trans: -. 116. Complexus. Arises by digitations from the trans: proc: of the 4 inf: Cervical & 7 sup: dorsal Vertebræ. is attached to the Occiput, wh. it draws backward &c. _ Trachelo-Mastoideus. _ Arises from the trans: pro: of some of the lower Cervical, & upper dorsal Vertebræ & is inserted into the Mastoid process, assisting the Complexus &c _ Musculus Patientiæ. _ Arises from the sup: ang: of the Scapula & is inserted into the trans: pro: of 3 or 4. Cervical Vertebræ. It raises up the Scapula &c. _ ~ The principal flexors of the Thigh, lie in the Cavity of the Abdomen. Psoas. ~ Arises from the transverse pro: & bodies of the Lumbar Vertebræ 117. Vertebræ, & going over the brim of the Pelvis, is inserted into the Trochanter minor of the Femur. wh. it bends forwards. &c &c. _ There is sometimes a Psoas parvus. ~ &c _ inserted into the brim of the pelvis, arising from the 2 upper Lumbar Verterbræ, & assists the former in bending the Loins forwards &c. &c. _ Hiacus Internus. _ Arises from the trans: pro. of the last Lumbar Vertebræ &c. &c _ & joining the Psoas magnus, becomes tendinous, & is inserted into the Trochanter minor along with it. - 118. Feby. 24th. Mr Blizard, considered the Muscles of the Spine, which he said should all be taken together to understand their Uses. & Longissimus dorsi. _ Arises from the Sacrum, & post: Spine of the Ilium. &c. &c. inserted into the Vertebræ of the back & Ribs &c &c by small tendons. &c. _ It keeps the body erect. Sacro-Lumbalis. _ Arises, in common with the last: inserted into the Ribs, &c. & had the small Musculi ad Sacrolumbalem Accessorii attached to it. &c. From the upper part of this Muscle, the Cervicalis descendens, goes, to be attached to sev'ral trans: pro: of Cervical Vertebræ, wh. turns the head backwards & to one Side & _ ~ Semispinalis Colli & Dosi ~ Arise 119. from the trans: pro: of the Verterbræ of the back by tendons & inserted into the spi: pro: of Cervical Vertebræ, except 1st. & last. &c Multisidus Spina Arises from the Sacrum. Ilium. &c. &c. inserted into spi: pro: of Lum: dors: & cer: Vertebræ & Rectus major Capitis posticus, & minor. _ Obliquus superior, & inferior. ~ &c & Scaleni. ~ Arise from tran: pro: of Cervical Vertebræ, inserted into 1st. & 2nd Ribs. They bend the Neck, & elevate the Ribs. &c &c. _ Intercostales. ~ 2 layers, ex & in-ternal. _ External. Arise from the Spine &c, & & going downwards & forwards lose themselves at the Cartilages of the Ribs &c. _ The Internal commence at the Sternum & go downwards & backwards &c. stop before the arrive at the Spine. ~ These draw the Ribs upwards &c. Triangularis Sterni. Arises from the Sternum & internally Its fibres go upwards, & are fix'd in the Cartilages of 3rd. 4th. 5th. Ribs & wh. it depresses. & contracts the cavity of the thorax &c &c. - 120. Feby. 25th. Mr Orange began the Consideration of the muscles of superior Extremities &c. ~ Deltoides. _ Arises from the Clavicle, Acromion, & lower margin of the Spine of the Scapula, &c. & is inserted into the outer part of Os Humeri, near it's middle; It pulls the arm, outwards upwards, & backwards & forwards &c &c. _ Supraspinatus. ~ Arises from the base of the Scapula above the Spine, from, the Spine itself & sup: Costa &c. Is inserted into the protuberance on the head of the humerus &c. It raises the Arm up &c. _ Infraspinatus. arises from the base of the Scapula below the Spine, & is also inserted as above ~ It rotates the humerus outwards. &c. &c. _ Beneath it, from the hollow of the Scapula; arises the Teres minor. & is inserted, rather lower &c. than the 2 former. &c It rotates 121. the humerus outwards &c. _ ~ ~ The Subscapularis. ~ Arises from & fills up all the internal hollow of the Scapula. & is attached to one of the smooth Surfaces on the head of the humerus; It rotates the Humerus inwards &c. _ ~ The Teres major. _ Arises from the infer: angle of the Scapula. ~ Its tendon is attached with that of the Latiss: dorsi, is inserted along with it. ~ It rotates the humerus inwards, & is also a flexor &c. Coraco-brachialis. ~ Is an adductor &c. & arises in common from the Coracoid process, with the short head of the Biceps. & is inserted about the middle of the internal part of the Humerus &c &c. _ The Fore Arm, is capable of flexion, & Extension, &c &c. It has 2 flexors, viz. Biceps, & Brachialis internus. &c. &c. _ Biceps. Which in our Subject, happen'd to be a Triceps. ~ Arises, by its short 122. head from the Coracoid process. The Tendon of the long head, passes along the groove; through the Articulation from the upper edge of the glenoid Cavity; these uniting about the middle of the Arm, are inserted into the Tubercle on the upper end of the Radius &c. It is a flexor & Supinator of the fore-Arm & also an Adductor of the Humerus &c. _ From the bending of the Elbow, at the lateral internal part of the forearm &c. the tendon of this muscle sends off an aponeurosis, joining another sent off by the Triceps. wh. cover the Muscles &c. & afford attachment to some muscular fibres, under it the Arteries Deep seated Nerves pass &c. _ Triceps Extensor Cubiti - At the back of the Arm, arises, by 3 heads; from inf: Costa of the Scapula, by the long head &c, & from the humerus by the 2 others; these 123. join & their Tendon is fix'd to the Olecranon &c. - This is a powerful Extensor of the fore arm &c &c _ Branchialis internus. ~ Arises, from the Humerus &c, & is inserted into the Coronoid pro: of the Ulna ~ This flexes the Cubit. ~ Feby. 26th.. Mr Orange considered the Muscles of the Cubit &c. _ From the internal Condyle of the humerus, the pronator teres arises: & is inserted into the middle posterior part of the Radius &c. wh. it rolls inwards ~ Pronator quadratus, arises from the lower inner part of the Ulna, inserted into the lower anterior part of the [Ulna] Radius ~ wh. it rolls inwards &c. _ The hand has 2 Supinators_ Supinator Radii longres, Arises from the Humerus &c. inserted into the inferior extremity of the Radius. wh. it rolls outwards &c. _ ~ Supinator radii brevis ~ Arises from external Condyle 124 inserted into Tubercle &c. of the Radius, wh. it rolls outwards. ~ &c. _ Palmaris longus ~ Arises from internal Condyle, inserted into Lig: Carpi Annulare &c. &c. It bends the hand &c. _ Flexor Capi Ulnaris. _ Arises from internal Condyle of Humerus; inserted into Os pisiforme &c. bends the Arm. ~ Flexor Carpi Radialis. _ Arises from the internal Condyle &c. inserted into Os Trapezius &c. ~ It also bends the Arm. _ &c. Extensor Carpi radialis longior. _ Arises above the external Condyle &c. inserted into metacarpal bone of 1st. finger &c. Extensor Carpi radialis brevior. ~ Arises from external Condyle &c. inserted into metacarpal bone of middle finger. &c. _ Extensor Carpi Ulnaris. _ Arises from ext: Condyle [inserted] inserted into metacarpal bone of little finger &c. _ These 3. last. extend the Arm. &c. _ 125. The lateral motion of the Carpus perform'd by the flexors & Extensors of either Side, acting together. ~ ~ All the fingers have a Common Extensor &c. _ Extensor Digitonum Communis ~ Arises from external Condyle &c. & splits into 4 tendons, before it passes under the Lig: annulare: & is inserted into the bones of all the fingers. posteriorly. _ Indicator. _ Arises from the Ulna, & is inserted into 1st. bone, of fore finger. Flexor Sublimis ~ Arises from the Ulna. &c. _ inserted into 2nd. bone of each finger &c. Flexor profundus. _ Arises from Ulna &c. inserted into last bone of each finger &c. this passes through the last &c. _ Flexor longus pollicis, & brevis. _ the last arises from carpal Ligt: inserted into 1st. bone of the thumb &c. _ ~ The former from the Radius. goes to the 1st. bone &c.. _ For the sev'ral little muscles of the hand &c. see Innes [illegible] &c. _ 126. Feby. 28th.. Mr. Blizard considered the muscles of the Anus &c. &c. & gave some hints concerning the introduction of a Catheter, Sound &c. into the Bladder, & what the consequence of not depressing the handle of the gorget in Lithotomy would be &c. &c ~