Some Anatomists say that there are three, some four,
others five Coats to the arteries, 1st the membranes, 2d. the
Cellular, 3. the Nervous or elastic, 4. the Muscular & 5th the
Cuticulan. But properly Speaking; they have no distinct Coats at 
all, unless about an Inch on little more of the Aorta & Pulmonary; wch
are Surrounded for that distance; by the [memb???]s Bag called the
Pericardium; but this Membrane Covering has its proper uses 
independent of the Arteries and cannot be said with any propriety
to belong to the Arteries what Authors mean by the difft. Coats
of ye. Arteries are only the many differt. Directions of the Fibres
of ye. Arteries; but these are so closely connected together, that they 
cannot be seperated without great Violence. However it may not be 
amiss to explain what they meant, more fully. Those who say there
are five Coats, call ye first or external plan of Fibres which run
in many differt. Directions. ye Membranous Coat; the next 
Plan which are more Circular they call the Cellular; the 3d. running
Spirally, the nervous or elastic; the 6th taking quite a Circul.
Course, is the muscular; and the 5th or internal Coat from at
Fineness & Smooth Appearance is called the Cuticular [Bu?]
whoever will take a Piece of the Aorta or any large artery & [ma?]
the Experimt. will find, by making an Incision transversly [thr?]
[?nto] Substance, it appears quite hard, firm & Compact; so [tha?]
these Fibres cannot be distinctly seen or demonstrated; [wher?]
take a piece of Intestine & divide it transversely & you'll [fin?]
plainly three distinct & separate Coats with a Body of [Cellul?]
Membrane between each of them; hence the Intestines may 
= pirly be said to have 3 Coats *___ The Internal Coat as
called, is the smallest of any in ye Body, [exce???]
neau transparent of ye. Eye; and this seems to b
contrived by [illegible] for the more easy & free
[??od].

day, serves to give it strength, the next the muscular will give it
[??action] and the 3d. the Cuticular is finely Polished for the easier Circulation
thro it -
It is customary for Anatomists to to say that those Parts wch.
have a power of Contracting, are composed of muscular Fibres and they 
speak of them [???ng] Similar to the muscular Fibres of the Muscles
themselves. but there is a very material Difference in the appearance
of what they call the muscular Coat of ye arteries, and the muscles 
of ye. Body; the one is red & inelastic, the other, white & Elastic. It
is the opinion of the last anatomists now that the Arteries have no
muscular Fibres at all -
The arteries have no Valves, as the Veins have, unless
it is immediately at their origin from the Heart; but we
can't say whether they belong to ye Heart or Arteries -
NB: Mr. Else thinks there may be a Transutation of Blood after Death from
these Vessels, but it proceeds chiefly from the Veins: he does not believe 
it does happen during the Life of ye Person -
The arteries are supposed by some to be dilated in their Diastole
and hence the Stroke we feel when feeling the Pulse, other [illegible]
this & say that they undergo no dilation at all _ whether
Diastole or Systole of the Arteries they are always filled with
Blood -
2

Before the act of making Preparations and the use of 
jections was understood, it was the general opinion of [anat?]
mists that the arteries were nourished by the Blood in its Passage
thro them; but Anatomists of ye. present Age are of a different
opinion, for they consider the arteries only as conductory Canals
for the Blood, and notwithstanding their white appearance, it 
can be demonstrably proved by Injections that they are Vascular,
tho their Vessels are So very minute as to escape the naked Eye, and
they are called the vasa vasorum and have Veins to return
their Blood as all other Vessels have; but the Veins are so fine
that they cannot be injected, but by a lucky Injection thro the 
arteries upon analogy however it is beyond a doubt they have vurry
The difft. Direction of the Course of the Fibres of Arteries,
is [are] supposed to strengthen them and to present their being ruptured
by accidental Causes, as Blows &c ... it is very probable
they may serve this purpose and by this means they can bear
resistance & act with greater Force against the circulating
Fluid, to propel it forwards -
Physiologists tell us, that the Circulation of
the Blood is quicker in the Capillaries than in the larger Vessel
and the observation we make in Amputation of the Fingers
Toes seems to confirm this opinion; for, it is remarked, that the
Blood runs from the Small arteries here in a continued Stream
on the contrary when a large artery is divided, the Blood flows
from it per Saltus, tho' it must be confessed with much greater 
Force -
When the arteries become very minute, they lose [th?]
pulsific Quality and then they no longer relax in the name of
Arteries, but are called Veins; but where this change is [illegible]

He is lead to think so from Seeing a Tumour once dissected from the
Throat, in which the Carotid was wounded, and tho the Patient
lost a great deal of Blood, which was thrown out with great
violence; yet he recovered

no Person can precisely determine -
An Anastomosis is a Communication of one Artery
with another, as the Coronary in the Stomach, ye Basilary in the
Head, the Radial & ulnar in the Palm of the Hand and many other 
These Anastomoses are of very great use & advantage in Aneurisms 
and after amputations, this is so obvious as to need no Explanation.
There have been Instances of the Crural & Brachial Arteries
having been divided and the Limbs have afterwards been preserv'd
by the Circulation's being carried on by means of these anastomoses*
- Mr. Else thinks that a division of ye carotid artery will not always prove mortal [??]
*. An Instances of ye Crural artery being divided without producing immediate
Death by the Hemorrhage, lately occurred in St. Thos. Hospl.
The artery was totally divided near the middle of the Thigh and
immediate assistance being procured and a Ligature made upon
the Vessel, the Hæmorrhage Stopped, and the man lived several
weeks; when headed of a putrid Fever after the Wound was almost
Cicatrized,: his Limb remained Swelled & œdematous for some
time, owing to the weak Circulation, but it was greatly subsided
before his Death _ Here it is evident the Circulation was carried 
on by the Anastomosing Branches which undoubtedly be
came more & more distended as the Circulation increased _
Mr. Else allowed us a remarkable Instance of this in a preparation
of ye Thigh of a Man, who had an obstruction of ye. Crural -
artery near the groin, and the Circulation was carried on by the
anastomosing Branches, which in time became nearly
as large as the Crural artery itself which was entirely [obstruc?]
& wasted away for some distance [cross out]
This case made a great noise at the Time; it was called the Floating
aneurism, and was This - a man was brought into St. Thomas's
Hospital with a Tumour on the inside of ye Thigh which has an evident 
Pulsatory

Pulsatory motion, on which account it was supposed to be an aneurism:
The Tumour disappeared, and the man went out of the Hospl.
well; but came again Sometime afterwards with a large swelling
under the Armpit which extended backwards under the Scapula.
Between the time of his going from the Hosp. & his coming again,
it was said that a Tumour like the first appeared in the
Ham of ye. Same [crossout] Limb, but likewise went away; However
this might be, the man, some time after he was taken in the
Second time died, being entirely worn out with excessive Pain,
occasioned by the Tumour's pressing upon a Large Plexus of 
Nerves lying in the arm Pit _ ~ Upon Dissection, The Tumour
in the axilla, as was expected, was found to be from an aneurism
of ye. axillary Artery: but what was the Cause of ye Tumour
in the Thigh, that it should first appear with a Pulsatory - 
Motion & continuing for some time, at least should entirely disappear?
To discover it, the Crural artery was Injected at
the Groin. as was likewise the Vein. Upon Dissection a Tumour 
was found situated immediately upon the Artery so as to compress
it in such a manner as entirely to obstruct the Circulation
a try totally obliterating the Passage from the whole length of ye
Tumour; and the Inject of the Artery had passed thro an anastomosing 
Branch which was sent off just above the 
Tumour & communicated again a little below it.
The Tumour we suppose to be originally an Indurated
Lymphatic Gland. -
They terminate with open mouth likewise on the Surface of the Skin
from where proceeds the Perspiration; and the Fluid which is found 
in the difft. Cavities in the Body are deposited there by there Lymphatic
arteries and may be considered as internal Perspiration -
[illegible]

Anatomists mention 3 Species or Orders of Arteries,
first, the Sanguiferous, which carry red Blood and all the largest
of any; Secondly, the Serous, which are smaller & carry Serum
on the Thinner Parts of ye. Blood, but the red Globules cannot
enter them; and the Third, the Lymphatics; these take up only
the thinnest of finest parts of ye. Blood, and are very fine pellucid
Tubes arriving from every part of ye Body, and will not permit
any of the Globules or Serous part of ye Blood to enter them*.
The arteries not only terminate in Veins, but in difft. manners
as we find, in the Pancreas & all the glands, ye. minute Ramifications
of ye artery terminate, some in the veins which bring 
back the Blood, others in small excretory Ducts, which joining
all together, form one Canal, which is called the excretory Duct of ye
Gland, thro wch. the Secreted Fluid Passes. In this manner the -
Urine is secreted in the Kidneys; ye Bile in ye Liver &c but this
will be better understood when we come to describe the Glands, their 
Secretion &c; when we shall likewise give a Description of the difft.
opinions for & against the existence of Follicles in Glands.
Arteries sometimes of the Extremities of old People
are found ossified: this is said by some to be owing to pressure,
but it is not true; as young people are sometimes affected in 
the same manner, tho rarely: others attribute it to a Disposition
in the Habit to ossification by a redundance of the earthy or chalky
Bony matter, and which is lodged between the internal & middle 
Coats of ye arteries †: however this is, it is evident, that if ye ossification 
is so great as to put an entire stop to ye Circulation in
those Parts, a Gangrene will follow as high up as the obstruction 
reaches -
*. Lymphatics are generally believed, tho some deny it, to terminate

with open Mouths in membranes lining Cavities, hence  [cross out]
proceeds the Watery Fluid found in ye Cavities of the Body, if not
from Transudation; and in every Cavity, there are absorbent
Vessels to take up the Fluid emptyed into it by the Lymphatics -
†. If we suppose Pressure to be the Cause of the ossification 
we should find hard labouring People scarsely was free from them;
besides, ossifications are found in the large arteries as well as in 
the small arteries of ye. Extremities. It seems as if the ossific
Matter was brought by the vasa vasorum, and being lodged 
between the Coats of the artery accumulates gradually _ May
not these ossifications frequently cause  aneurisms? -
Mr. Cæsar Hawkins says he never saw an aneurism, but he 
allways found upon examination, considerable stricture
in the vessels below it - There is in all probability a Disposition
in the Habit to form these ossifications and Gouty People whose
Blood abounds with a Cretaceous matter are more Subject to them
than others -

Lecture 3d. Oct. 3d. 1770 -
On Aneurisms.
In our last Lecture we just mentioned one Disease of the 
arteries. Ossifications; we shall now proceed to speak of other
Diseases, and first of the Aneurism. 
Aneurisms are of two Species, the true & false. The 
True aneurism is præternatural distension or Dilation of an 
Artery; the false is, when there is a wound made in the Artery
either by the bursting of ye true aneurism, or by a Lancet in Bleeding, 
[crossed out] or any sharp Instrumt. wounding it.
It has been said by Le Dran and others, that the 
artery as it becomes distended, grows thicker in proportion. Now
it is reasonable to suppose the contrary would happen, which is indeed
the Case; for upon a strict examination of ye Vessels they 
will allways found thinner in proportion to the Dilation; but 
when an aneurism has been of long standing, ye Blood adhering
to the sides of ye. Artery, becomes coagulated and gradually 
grows harder & thicker, & at the same time the Fluid Blood
Passes thro the middle of the Vessel: this Coagulum [cross out] daily
increases and growing thicker, the aneurism becomes harder
to the Feel, and loses its Pulsation; which is the true characteristic
of an aneurism and which perhaps was very evident
in the incipient State of ye. † Aneurism; it is this hard concreted
Coagulum firmly adhering to the Sides of ye Vessel,
which led Le Dran and those who adopted this opinion, into 
the Erron of supposing the artery to thicken as it become dilated.
This Coagulum may be [cross out] separated from the artery, and it
accounts for the Reason why a Puncture made into such an 
Aneurism is not followed by a profuse Hæmorrhage: besides:
if this was not the Case, the true aneurism would never burst,

10


or become the false or Spurious, which we know to be frequently the
Case. 
There is often a Disposition in the Habit to produce Aneurisms;
and I believe many People; who die without their Disorder being rightly understood,
have died in consequence of an Aneurism in Some part of the 
Body, when the Tumour cannot be perceived: we often find these People 
Subject to fainting Fits; which was the Case of a woman who was in St.
Thomas's Hospl.: She was Subject to frequent fainting Fits, which was
Said to be Hysterical, and she likewise complained of a Pain in the Loins
about the Region of ye Kidneys. The medces. prescribed for her, did not
alleviate her Complaints, tho' she was a little relieved in the Pain in
her Loins by Bleeding; she died after some time, and it was desired she
should be opened; when, a large Tumour was discovered near the left Kidney,
which upon examination was found to be an aneurism of the aorta wch.
after being much distended had burst, and an Extravasation of fluid Blood had been thrown
out from time to time, as was supposed, which might probably be the reason
of her frequent Faintings - Another Instance was of a Man who was
brought into the Hospl. as a Subject for Mr. Else to demonstrate the
viscera upon: in opening the Thorax of whom, a Tumour was discovered
lying on the Vertebræ, which proved to be an Aneurism of the aorta, which 
had been of so long standing, as to occasion a Caries of ye Vertebræ. 
what is most remarkable in these aneurisms, is, that the Patients
should live for such a length of time as they do, after the Bursting 
of the Aneurism which is situated so near the Heart in such large vessels
- This is owing to the pressure which the Viscera of these Cavities make 
against the Tumour - 
Authors say that a Spurious aneurism (unless made by 
an optional Cause) cannot happen without a previous Dilation of the
artery; that is, that an artery cannot be upturned without a previous 
Dilation: but that this is wrong is evident from a Case which happend
in this Hospital; when the aorta was found to be ruptured in two 
Places, just where the Carotids are sent off, without being in the least
Dilated: The preparation of this Mr. Else shewed us -

12


8
We now proceed to Speak of ye Veins -
These are elastic Tubes arising from the extremities of the Arteries and
terminating in the Auricles of ye Heart, the 2 Cavas in the right, &
the Pulmonary Veins, in the left auricle; serving by this means to bring 
back the Blood from all parts of ye. Body, carried there by the Arteries
to the Heart -
Authors disagree much about the Structure of ye Veins;
some say they have the same Coats with the Arteries, but are so thin that
they cannot be Separated. Others say that there is no muscular Coat to
them; whilst Haller says that muscular Fibres may be found in
the large Veins near the Heart; Palfin is of opinion that there is none, and
I am inclined to be of the Same opinion -
The veins generally take the same Course with the Arteries & accompany 
each other, at least all the larger Branches, as we see in the Cava
& aorta &c the Coronary Veins do not take the same Course as the 
arteries, & the Cutaneous Veins have no Arteries to attend them --
As the arteries have Vasa Vasorum for their nourishment, we
may likewise with equal propriety say that the Veins have a They
anastomose likewise in the Same manner as the arteries do.
The Circulation is said to be slower in the Veins than arteries; but
Haller has proved by Experiments upon Brutes, that it is not so.
It was formerly the opinion, and indeed is now with some, that
the mesenteric Veins had a power of absorption; but it is beyond a Doubt
that they only serve to carry back the Blood from the arteries no other 
veins do: there is nevertheless a power of absorption in 
some of ye. Sanguiferous Veins, as those of the Penis & Clitoris -
The Veins have fine, thin Membranes, of Semilunar. Form, on 
their internal Surface, which are so situated, as to suffer the Blood to 
pass freely on towards the Heart, but will prevent the Blood's Regurgitating
or returning back - These are called the Valves, and are
said to be formed by the continuations of the fine Cuticular Coat
of the Arteries. They are placed obliquely in such a manner as that
the

14


9
that the Column of Blood, in passing towards the Heart, shall
press them against the Sides of ye. Veins; but as soon as it attempts to
return Back, they rise up and, [:] as there are frequently two of them
situated opposite each other, the Edges of them are brought together &
form an entire Stoppage to the Blood's passing back; by which means
it is forced on continually in the right Course.
The large Veins are said to have no Valves, as those in the Cavities 
of the abdomen, & Thorax - The Valves are most numerous
in those places where the Blood has to move upwards against its own
Gravity; as in the Spermatics, & Veins of the Extremities, the lower especially -
Tho the Veins are elastic, yet they have no Systole &
Diastole, as the arteries have; but the Blood is propelled onwards
to the Heart, by the Pulsation of the arteries (in those Veins wch.
lie contiguous therewith) and by the action of the Muscles; hence
the reason why the Circulation is increased by exercise & strong
Muscular Motion -
Lately it has been asserted that the Large Veins
near the Heart have a Pulsatory motion like the arteries, aste
that this Motion in them was caused by their having 
a pulsatory power in themselves similar to that of
[cross out] ye circulation backwards;
the Arteries; but this is wrong, and tho the large Veins
near the Heart are observed to have a Dilatation &
Contraction, yet it is not that all the Veins in 
the Body or even these have a Pulsatory Motion
Similar to that of ye Arteries, but is caused by a
Regurgitation of Blood into them; This Regurgitation,
which obeys the Motion of Respiration is 
brought

16


10
brought about in this Manner - The Pulmonary Artery
receives Blood from the right Ventricle, this from the
right Auricle into which the Cavas empty themselves;
now, in Expiration the Lungs are [cross out] distended, at which time
we may imagine that the Blood has not so ready and easy a
Passage into Capillary Branches of ye. Pulmonary Arteries, 
hence a quantity of Blood will be detained, or
thrown back from the arteries, into the Ventricle, which
by this means becomes distended [cross out]
[cross out] and the Blood being emptied into
the Auricle and not finding at this Time a Passage into
the Ventricle is thrown back into the Veins which have no 
Valves to prevent it, and meeting with the other Column
of Blood coming toward the Heart creates a Dilatation
or Distension of ye Veins, as the Carotid, Subclavians
Vena Azygor &c. : but immediately as soon as Expiration
is performed the [???]istion in the Capillary Branches
of ye. Pulmonary arteries is removed by the Lungs become
[cross out] collapsed, the ventricle Contracts and empties itself as does
likewise that Auricles from whence the Blood is thrown into 
the Ventricle & the Veins from being before distended by 
the Regurgitation now contract to their natural Size;
hence these veins appear to have a Pulsation_ This
Regurgitation is likewise caused by the Contraction
of the Ventricle - The motion of the Brain is occasioned by
this

this Regurgitation of the Blood into the Sinuses which
occasions an obstruction & distinction in the veins of the
Pea Mater [cross out]
*. This Tumor was of a Considerable Size & had been of long standing 
when he came into the Hospital; it was situated near the Elbow
above the Joint and had no Pulsatory motion: but as aneurisms 
have no pulsatory motion when of long standing &
very large, no favourable conclusion could be drawn from that
Circumstance, and it was thought advisable to amputate
the arm, upon a presumption of its being an aneurism: what 
served to confirm them in the opinion of its being so, was that the man
said it had been punctured with a Lancet before he came into the 
House and nothing was discharged but a serous, Bloody Fluid.
After the amputation, Mr. Else dissected the Tumour & found 
it to be occasioned by a large vein being ruptured, and the Blood
Coagulating as it was extravasated, formed itself a Bag which 
kept continually thickening as the Blood concrated to its Sides,
as in the aneurism, till it was several Inches Thick, and in ye
middle of ye Tumour was found a Small quantity of fluid Blood,
so that the Tumour increased in proportion to the Extravasation.

Of the Diseases of ye Veins.
When we see a Vein preternaturally distended & knotty, as is 
frequently the Case in the Superficial Veins of the Legs of those
Persons who are Subject to the Cramp, we say that. it is varicose. 
But a Varix is as liable to happen in the deep Seated Veins as in 
the Superficial, and their forming a Tumour which, being seated [cross out]
contiguous to an artery, may have a Pulsatory motion and on that
account be taken for an aneurism; or if it has no Pulsatory motion 
at all, may be supposed from its appearance & Situation, to be an
aneurism. Tumours [cross out] from this Cause have frequently been mistaken 
for aneurism; several Instances of which, I have had an opportunity
of examining, where the Patients have either died, or amputation 
has been performed which I believe is is too hastily done in many of 
those Cases: one Instance of this, was in a man with a Tumour on
the arm *, anoyr. in a woman with a Tumour in the Leg, and anoyr. was
in a man who had Tumour in the Ham; all of which proved to be Veins
ruptured. The last of these indeed, was not supposed to be an aneurism
at first, but a common abcess; but upon being opened a large Hæmorrhage 
ensued, upon which amputation was thought to be necessary,
as it was than thought to be an aneurism; upon Dissection of
The Limb however, the Tumour was found to proceed from a rupture of
a Large vein - In all these Case, there would have been no necessity 
for Amputation, if the nature of them had been known: but the misfortune
is, that we know of no distinguishing Characteristic whereby
we may know the one from the other; for they both put on the same
appearance, seldom either of them producing any Discolouration on
the Integuments, and an aneurism often has no pulsatory motion 
but in its Infancy (occasioned by the coagulated Blood, as we before
observed, adhæring to the Sides of ye artery); so that it is impossible 
from these Circumstances to give his opinion positively upon them.
The best way to distinguish them & what is most depended on, is the Pulsation,
which, in incipient Aneurisms will be very evident. 
We have great Reason, if there were no Facts to prove it, to suspect 
that the Veins are oftener the Cause of these Tumours, than the arteries

20


12
from the Thinness of their Coats and their having valves which may
cause obstruction & in Time may Burst & form Tumours -

22


13
Lecture 4th.
On the Nerves -
The, Nerves are allowed by all anatomists to be the principal organs
of Sense & Motion, tho' at the same time they allow that the real Structure
of them is not known. 
By a Nerve, we mean a white, shining, inelastic 
Cord, first arising from the medullary Substance of the Brain,
and composed of many fine Fibrillæ which at their first Egress from
the Cranium seem loosely connected together, but afterwards become
more firmly & closely so as to form a white Cord.
The Nerves are generally divided into two Classes, those of the 
Encephalon, and those of the medulla spinalis; of the first, there are
reckoned 10 pair of the last, 30 pair; and these last are subdivided 
and take their names from the parts to which they are sent, as,
the Cervicles, Lumbricales. &c, the Ten pair which go out at the different
Foramina of ye Cranium, are sent principally to the Head,
Face, Eyes, Ears, Mouth, and some Twigs of ye 8th Pair, go to the
Stomach and difft. parts of ye Thorax & neck &c. and the 30 Pair
which proceed from the medulla Spinalis are bestowed upon all Parts 
of the Body besides.
The Nerves generally take the same Courses as the Arteries,
are surrounded by a Body of Cellular Membrane in their Passage
to all parts of ye Body and run between the Interstices of the Muscles,
which defends them from any rude Pressure externally, they differ in 
[cross out] their Colour some putting on a red appearance when some conjecture that they are difft. in Structure:
some we find are round, whilst others are flat, and some appear 
more fibrillous than others.
Authors differ in their opinions about the Structure of the 
Nerves; some allow only two Coats, others say they have three: those
who are of the last opinion, say, that the Brain has three Coats,
the Dura & Pia mater and the Tunica Arachnoides: it is however

24



14
however much doubled by some, whether the last Coat exists in all
Subjects; all anatomists are agreed in this, that it is but a partial 
Coat at most; not investing the whole Brain, as the Dura and Pia
mater do, but is to be found in a particular part near the Basis of 
the Brain; hence it is probably that the Nerves have only two Tunics:
the external is a continuation of the Dura mater, and the internal, 
a continuation of ye Pia matter surrounding & closely embracing
this medullary fibrous Substance of the Brain. These continuations
of the Dura & Pia Mater are called their processes -
These Coats give the Nerves a proper degree of strength, otherwise
the Nervous Fibrillæ would not be able to resist such Force as ye.
Nerves are sometimes exposed to, and they also support the Vessels
which are sent to them. Some Nerves are said to have no Coats or
Covering from the Dura & Pia Mater, as the 7th Pair; the Portis
Dura of which being covered by the Dura mater forms the Pes
Anserina, and the Portis mollis (from which we derive the faculty
of hearing) is distributed about different parts of ye Concha with
out any Coats at all.
The Nerves appear to the naked Eye to be composed of 
many Fibrillæ connected together by Cellular Membrane, which is
very apparent in the Cauda Equina, where these small tender Fibres
are very minute, as appears by maceration; when the Cellular membrane
is loosened from them, then these Fibrillæ are seperated. & set afloat,
from each other, as may be seen in water. an Expansion of the
Fibrillæ composing the optic nerve called the Retina appears very 
fine & beautifull in Water -- But take one of these small Fibrillæ, 
even the smallest you can get & [cross out] it will appear by a Microscope 
to be still composed of more & smaller Fibrillæ, so that it is
impossible to discover what an ultimate nervous Fibre is; Monroe
says, that from an Examination of ye minimum visible it is demonstrated,
that cash Fibre of the Retina or expanded optic nerve, [cross out]
[cross out] cannot exceed the size of the 32400th part of a hair;
and when we consider that every, even the most minute past of ye Body
is sensibile, and owes that sense to the Nerves, which it all were

*. We are not to suppose a Ganglion to be a Disease of the Nerves, as they are natural 
Appearances & are allways to be found in the same Places: and when Authors speak 
of Ganglions, we are to suppose they mean Tumors of the Tendons
[illustration]. Here we are speaking of ye first Class: the most specious Argument in favour of 
the opinion of Decussation of there, is, that a Blow shall be given on one Side of 
the Head & the Limbs of the opposite Side Shall become Paralytic, whilst the
other side shall remain unaffected: but those who have had an opportunity
of making the Observation, have observed, that altho' the Circumstance above
mentioned does some times happen, yet it oftener turns out otherwise. i.e.
That the Side of the Body on which the Blow was given shall be affected, whilst 
the other shall not.
26

15
were joined together would not make a Cord of an Inch Diameter,
is not to be wondered at.
The Nerves, particularly those of ye medulla Spinalis
unite in some places & form Knots, which are much larger than all the 
Nerves which composed them as they pass out of the medulla Spinalis Laterally.
this appearance is natural to the Nerves only, and is called a Ganglion*.
These Ganglions appear more red than the Nerves in other parts do, but
the Nerves going from these, are no ways different from the other Nerves,
tho the Coat of the Ganglions are thicker; which some will say is owing
to their having a muscular Coat, this however cannot be proved: The
red appearance in Ganglions of the Human Nerves is seldom observed unless
they are diseased, but it is always visible in Brutes, as, Horses &
other large Animals - The use of these Ganglions is variously
Described by difft. Authors; however it is not known: hence there is 
room for a variety of Conjectures by Speculative men, and till we
arrive at a greater knowledge of the Nerves, their use will not be
understood; some will tell us, that they are formed by Pressure; but
the Nerves which have these Ganglions are most of them so situated
as not to be liable to [the least] but very little Pressure, if any; and on 
the Contrary, those Nerves which are most liable to pressure as the
Cutaneous, are without these appearances. It is evident they were
designed for some particular purpose by nature, which we at present
are acquainted with -
The common opinion concerning the Rise of the Nerves, is
that they are sent off from that Side of ye. Encephalon [illustration], which is nearest
to the part of the Skull which they pass out at; tho there are some
who contract this, and say that the Nerves [cross out] or the pulpy fibrillous
Substance before it is sent out of the Cranium decussate or cross
over from the Side where they are formed, to the opposite Side, so that
those Nerves which are sent to the right side, are originally derived
from the left side of ye Encephalon. Cheselden mentions a Case which 

* This Doctrine may, tho' a very specious one, be overturned at once, by considering the
Origin & Distribution of the 5th. Pair of Nerves, which we know, from Dissections
& examination, is derived from the Cerebellum, but is distributed to many Parts
which have a voluntary Motion.
28

16
which seems to countenance this last opinion, and Monroe two Similar
Cases, where the Palsy and other Symptoms of an Injured Brain
appeared on ye Side opposite to where the Injury was received: but he
confesses that other Instances may be produced to overthrow this opinion
and confirm the other: It remains at present, a dispute among
Anatomists: however it is generally allowed by all, that not only ye,
Nerves of the first Class, as those of ye Sight, Small, Taste, Hearing
&c. but also those of the medulla Spinalis terminate in a pulpy
State, and this is evident that they are expanded on every part of the 
Cutis which gives it it's Exquisite Sensation with which it is endued;
and the nerves may be traced till they lose their Coats & terminate in
this Pulpy State -
Some are of opinion that there are two sorts of Nerves, one derived
from the Cerebrum & the other from the Cerebellum: those which come
from the Cerebrum, they say, are the Cause of [the] Voluntary Motion;
and those from the Cerebellum, are the Cause of Involuntary Motion,
as, that of ye Heart, Diaphragm, abdominal Muscles &c. the 2
last of which are endwed with both kinds of motion, partly voluntary 
& partly involuntary, which last is caused by the action of ye.
Lungs in Expiration & Inspiration: what induces them to be of this opinion,
is because Wounds of ye Cerebrum are not mortal, but have been
cured Sometimes even when a part of the Cerebrum has come away;
but those of the Cerebellum always do prove mortal & frequently produce
instantaneous Death: This can, however, be no proof at all of
their opinion, if we consider, that the same Nerve sends out 
Branches which are distributed upon Parts that are endwed with voluntary 
motion and also upon Parts which are endwed with involuntary
Motion *. It is proved beyond all doubt, that the Nerves are the organs,
of Sensation & motion: for, if the nerves are compressed on become
obstructed by any means, or are divided, the Limb, to which these
Nerves

*. a Compression or obstruction of ye Nervous Influx is sometimes 
caused by Tumours situated upon the Nerve; and when this 
is the Case the Limb below the Tumour will become paralytic
in the Same manner as when the Nerves are interrupted by 
external Injury, and if the Obstruction is total, the parts
to which the nerves so obstructed, were sent to, will Gangrene.
30

17
nerves were sent, will lose it's motion & sense of feeling, and become 
paralytic *: of this we are often Sensible in some measure, [by]
from the Pressure of the Cubital Nerve by leaning long upon it, when
a disagreeable Sensation is felt in the arm [and] below the Elbow for
some time after the Pressure is removed: the Same sometimes happens
in the Foot, when we say it is asleep: but here motion is not
entirely lost, no other Nerves are sent to the Limb besides this:
but in Such paralytic Cases as are attended with loss of all Sense
& motion, with wasting of ye Limb, then all the Nerves sent to 
that Limb are obstructed- hence an Injury done to any Part of 
the Medulla Spinalis immediately affects all the parts whose
Nerves take their origin before where the Injury was received; so
that if the medulla was much injured at the Lumbal Vertebræ, the
lower Extremities would become paralytic; if in the first Vertebræ of
the Neck, just where it commences ye. Spinal marrow, and the Injury
was great, immediate Death would ensue; and tho we cannot
account [for] satisfactorily for all the Phœnomina which turn
out from Injuries done to the Nerves in other Creature living nearly
[cross out] under same Circumstances as we do, yet we know ~
Such Causes produce such Effects generally in them as in Us - Tho'
we cant' account for Tortoises their Living a considerable time
after their Head are cut off, or a Frog's jumping about after
the Heart & contents of ye abdomens are taken out, or why a Worm
crawls about after being cut [unless] - into several Pieces; I say,
tho we cannot account for all these Causes, yet we must not 
consider them as objections to the Nerves being the Principal organs
of Sensation & Motion, for it is clear that they are; but in
what manner this Influence is communicated, or in what way
ye. Nerves act in producing these Effects authors are not agreed about
Some affirming that the Nervous Fibres are all solid Cords which 
act

*. A Fiddle String or any Cord will not vibrate, unless put upon the Stretch &
kept So; now, can one say, that the Nerves are in that Situation? Besides,
we know that when a Cord is tense, it will not vibrate if anything is in 
Contact with it; but the Nerves are surrounded & lie closely in Contact with
other parts of ye. Body: Therefore it is very improbable that the Nerves shou'd
act in this manner. It seems to be the most probable that they contain a
Fluid, which upon being touched, causes an Undulation which is immediately
communicated to the Brain: but even this is mere Conjecture & supposition,
and those Experimts. which have been made to prove that a Fluid does Circulate
thro them, are not be depended on; one of which & indeed the principal one,
is, that if you cut open the Thorax of a living Dog and catch hold of the 
Phrenic Nerve & compress it, the Diaphragm ceases immediately to act
remove your Hand, and that muscle will again act; gripe the Recursed,
Nerve with one Hand some distance above the Diaphram, it is unactive;
then with the other Hand, strip down the Nerve from the first Hand to
the Diaphragm, this muscle again contracts; after repeating this once or 
twice, it is said, the Liquor will be exhausted and you will not be able by
this means to create action it the Diaphragm. Now what are we to say,
when we are told, that whilst with one Hand we compress the Nerve if we
instead of Stripping the Nerves towards the diaphragm, carry our hand
quite the contrary way; i.e. strip the Nerve from the Diaphragm towards
the first Hand, and by this means produce the Same appearances &
Effects? This would seem to shew that the Action given to the Diaphragm in
The above Experiment, was owing to Irritation - [cross out] 
[illustration] That the Brain is the common Sensorium, may be easily conceived by the following
Case. A man was was trepanned & a large portion of the Os From his removed;
after the man got well, if a pressure was made on the Cicatrix for a little 
while, [the] a partial Blindness would insue; continue the Pressure a little
longer, total Blindness would be the Consequence & the man would fall 
fast asleep with a Snoring kind of noise -
+. These vessels have a beautiful spiral Course; as may be seen in the Spinal 
marrow when injected -
32

18
by elasticity or Vibration, in the Same manner as a Fiddle String*.
whilst others alledge that those Fibres are Small Pipes conveying
a Liquor by which all their effects are produced. However this may 
be, we know that the Brain is the primary seat of all Sense, and
that the Neves are the conveying Instrumts. of that Sense to the
common Sensorium, [cross out] the Brain [illustration]. These nerves we know likewise
are acted upon by impulse, as by the Touch, Sight &c. and all objects 
of Sense when applied to their proper Organ act by Impulse
thus, if we are in the Dark, we know by the Feel or Touch
what it is we do feel, whether wood, Iron &c. This is caused 
by the Impulse made upon the nerves & by them carried to the
Brain; and the Stronger the Blow [is] or Touch is, the greater [cross out]
will be the impulse given to the Nerves &c which will communicate
it to the Brain:- hence we may account for the Pain
proceeding from a Violent Blow, which sometimes tho given
at a Distance from the Head, has been known to bring on the 
same violent Symptoms as a Concussion of ye. Brain caused
by a Blow given immediately upon the Head.
The Nervous Fibrillæ are, as we have already observed,
connected together by Cellular membrane and coverd externally
by the [cross out]. Dura Mater & internally, that is under the Dura
Mater it has a second Covering the Pia Mater; and the they appear
white the naked Eye, yet they have a number of Vessels both
arteries, the whole Cord will appear coloured by the injected Fluid +,
and if the Injection is pushed forcibly into them, ye Cellular membrane
connecting the Fibrillæ will appear distended by it; and it is owing
perhaps to the vessels that enter the [cross out] centre of ye optic nerve &
the want of medullary Fibres here, where the optic nerve inters the
Eye that we cannot see the Parts of such Bodies whose Picture

34


19
whose Picture falls upon this Central part of the Retina,
The Brain is supposed to be a Gland, ye. external parts
of which are of an ashy Colour and is thought to be the principal 
seat of Secretion which is carried to the internal
white, pulpy mass called the medullary part, which is
supposed to be a Compages of Fibres, from which arise ye.
Nerves which are considered as the excretory Ducts on
Tubes to carry this Secreted Fluid called Animal Spirits
to all parts of ye Body: but it sh'll remains to be
discover'd, [cross out] in what manner the Sense is communicated to ye common Sensorium.
[cross out]: Anatomists have taken great Pains to
come at the Knowledge of this, but hitherto, their attempts
have proved unsuccessful, some asserting that there is
Fluid, which they call the Animal Spts., contained in the
nerves, whilst others insist upon it that the nerves act
by Vibration upon being touched, as a musical String. But 
the last seems to be improbable, if we consider how the Nerves
terminate, in a Pulpy State which renders then very unfit for
[cross out] Vibration: and as they appear inelastic, it is most
probable that they are Small pipes conveying the animal
Spirits to the difft. parts of ye. Body, tho they are so
minute as to escape the most diligent inquiries & Searches
hitherto made to discover them -

*. Some likewise dispute it's existence in the Brain as well as Bones: but 
from Analogy: we may Suppose that it does in Both: for, every Artery & vessel
in every other part of the Body, we know, is surrounded by it; why then, therefore, 
is it not reasonable to imagine that the Arteries & other vessels belonging
to the Brain & the Bones are likewise Surrounded by it. tho' it cannot
be proved, on account of ye Hardness of Bones & the soft Texture of the
Brain? Haller says, that he has seen the vitreous Humour of 
the Eye distended with air in an Emphysema, which seems to prove
its Existence there.
[illustration]. NB The Reticular membrane is very apparent in the Penis &
between the Coats of ye Intestines: and wherever the Skin lies loose
and is at times put into wrinkles or Folds, as in the Eye-lids,
in the Cranium, Back of ye Hand &c we know that it is reticular
in those Places. on the contrary, where the Skin is smooth & firm 
we know that it is the adipose kind which lies under it -
36

20
Lecture 5th. -
On ye cellular Membrane
The cellular Membrane is the universal connecting membrane, 
which lies immediately under the Cutis and dips down between & 
fills up all the Interstices of the Muscles; it fills up a very vacuity 
not only between the Muscles, but insinuates itself also between
the fleshy Fibres of ye Muscles & connects them together; it
envelopes all the Nerves, Arteries, Veins, Tendons, Ligaments &
all the different Viscera in the three Cavities. It has been doubted
whether this membrane exists in the Bones, it cannot be demonstrated
in them, but it is very probable it may exist there as well
as in every either part of the Body that is vascular, which the Bones
certainly are, but are so firm & rigid that this membrane cannot
be traced thro their Fibres*.
This Membrane has 3 difft. names given to it
which take their rise from the difft. appearance which it
puts on in dfft. parts of the Body: there are the Celluaris
Reticularis, and Adiposa. We have described it as existing
in every part of the Body [g] lying immediately under the Cutis;
and wherever it is found not much loaded with Fat as in the Back
of the Hand, it is called Cellular; when the Cells are small &
without Fat, so that the Cells are plainly Seen, it is called
Reticular [illustration]. and wherever it is loaded with Fat, as in the Nates
& other parts, it is with propriety called Adipose membrane
It is allways of the Adipose kind, in Health, where it fills up the
Interstices of the Large Muscles which are designed for much &
strong motion, as in the Thighs &s.: there is likewise a large Bed
of this adipose kind in the Orbits of the Eyes; hence it is, that
when People are become emaciated from long Illness, the Eyes
appear considerably sunk in the Head as it were; is which 
is not occasioned by any alteration or change in the Globe of 
the

*. Mr. Else said, that he could not determine positively whether it was vascular or 
not; that he had been at difft. Times of difft opinions, and [that] he owned that
he now was divided in his opinion, but rather believed it was not. -
38

21
the Eye but owing to the Absorption of this Fat which was lodged
at the Bottom of ye Orbits - It will also become thicker by Pressure,
as we see in the Soles of the Feet, and in Hands of hard working,
Men -
The external Appearance of this membrane in every 
Part of the Body, whether of the Cellular, adipose or Reticular
kind, is smooth & even, adhæring very firmly by it's Vessels ~
to the Cutis : its internal Surface is very irregular, as it is ~
designed to fill up all the Interstices of the Muscles, and likewise
insinuates itself thro the Bodies of the Muscles, which ~
must render it uneven : indeed, it can't be said properly, to have an internal Surface
It is disputed try some how this membrane is nourished;
but it is proved by Injections to be Vascular, tho it appears
perfectly white before it is Injected, as many other ~ 
Parts do. notwithstanding it is thus demonstrated to have Vessels,
yet some, and among these Haller, will tell us, that the 
Vessels which we see filled with Injections, are not Vessels proper
to this Membrane & sent to it for it's Nourishment, but
only pass thro it to the Cutis, in the same manner as vessels ~
pass thro the Pæriosteum to the Bones: but is it not highly
probable that these Vessels, in their Passage thro it to the the Cutis
should send off Branches which ramify upon it, as the Vessels
sent to the Bones, do upon the Periostæum, which is proved beyond
contradiction? Tho', the Vessel in this membrane are
not so numerous as in the Cutis: hence it cannot be said to be
so vascular; and the Vessels belonging to this membrane must 
be so very minute, as not to be visible till they are injected: in
like manner are the vessels of the Cornea Transparens of the
Eye, which appears very vascular when injected, but are so
minute as not to admit red Globules of Blood to pass into them,
unless when inflamed.

*. It is likewise yielding & elastic; the advantage arriving from which, is
evident where we find it covering Parts that are able to be distended,
as the Bladder, Intestines &c -
[Illustration]. It is a common, Artifice with Beggars to make a puncture into the 
Scrotum & distend it by blowing Air into its Cellular membrane; by 
this means seeming to be affected with a Disorder when nothing 
is the matter with them - The Butchers likewise often thrown air into 
the Cellular membrane of Calves, Sheep &c in order to make them appear
fatter - 
+. A Blow given on the lower part of ye. Abdomen & rupturing a Vessel, may
cause an Extravasation through the whole extent of the Penis & Scrotum
of which Mr. Else mentioned an Instance -
40

22.
We know that it is Cellular * that the Cells have ready &
frequent Communications with each other throughout the whole
Surface of the Body: This we have a convincing proof of. in the
Anasarca & Emphysema * This communication between the Cells, 
is more open in some parts than in others, i.e. in the reticular
more than in ye Cellular, & more in the Cellular than in the Adipose:
for Instance, if a Person receives a Blow upon the Eyelids or Scrotum +
or any other part where this membrane is thin & of the reticular
kind, if the Blow is so violent as to break down any of the Vessels,
the Blood soon insinuates itself from Cell to Cell, for a considerable
way about, as far as this membrane is of the reticular kind
where there is not any Fat to obstruct its Passage: so that it 
is not uncommon to see a person with extravasated Blood all around
the Eye, from receiving a Blow upon any part near the Eyelids: whereas,
was a Blow given upon the Cheek or any other Part where this 
membrane was loaded with Fat, notwithstanding it might be 
given with great Force, scarse any Blackness would appear, at
least but in a very small Compass, tho it might be attended with 
more Pain & Soreness than in the other Case:  the Reason is obvious,
the extravasated Blood is more confined by the Cells being loaded wth.
Fat 
This Membrane is the Seat of many Disorders: the Emphysema.
Anasarca, Abcesses &c - The Emphysema is a
Disorder peculiar to this membrane alone, and is caused by the
Air getting out of the Lungs into it and insinuating itself into it's
Cells, and unless a stop is put to it in the Beginning, will pass ~
from Cell to Cell throughout the whole Body, inflating it to an ~
enormous Size, till the Patient [cross out] dies. This Inflation in 
an Emphysema, is observed to be most considerable where the Cells
communicate most freely, as in the reticular Part which is least 
loaded with Fat, and where it is thinnest, hence it is usual, when 
the Emphysema has extended over the Head & Face, to see the

*. A Putrid state of the Juices of the Body; will produce an Universal Emphysema;
as in the Case mentioned by Doctr. Huxham, in which the Patient
was afflicted with an insituate Scurvey.

23.
Eye-lids inflated to such a Degree as to cause total Blindness.
The Emphysema is most frequently caused by fractured
Ribs, when they are forced inwards & the fractured Ends of ye Bone 
[cross out] have penetrated into the Substance of ye Lungs & wounded some
of the Air Tubes, from which, the air escaping, gets into this
Cellular Membrane & passing from one Cell to another may, if 
not prevented, insinuate itself throughout the whole Body.
An Emphysema may likewise happen in consequence of a wound
in the Trachea, which is produced in the following manner; the Air.
in it's Passage thro the Trachea, gets into the wound, which, either
from it's being [too] very Small, or if it has been large & the edges
brought together by the use of Sutures, will not afford a free Passage
to the air; by which means [some of] the air by degrees insinuates
itself into the Cellular Membrane, which had been divided 
by the Wounds & easily admits the air into it, and produces an
Emphysema - This membrane will likewise become
Emphysematous from putrefaction, as is the Case in drowned
Bodies, which after lying under water Several days, rise
up & float upon the Surface of it. This Circumstance depends
upon this membrane becoming Emphysematous or inflated wth.
Air, which is generated by Putrefaction, first beginning in this
loose & less vascular Membrane *.
The Symptoms of an Emphysema are very apparent;
viz, a white Swelling, without Pain, soon following the Fracture
of the Ribs; when pressed with the Hand, a crackling Noise is 
heard or more distinctly felt; it begins near the Fracture & Spreads
itself from them over the Thorax &c. and it's progress will be in
proportion to the Injury done to the Lungs & size of the Wound.
For the Cure of an Emphysema, and an account of the opinions
for and against Suffocation's being the Cause of the Patient's 
Death in Emphysemas, see Else's Surgery, Page 111 -

44



24
The next Disorder we shall mention, which has its Seat in this
Membrane, is, The Anasarca. In this Disease Water is contained
in the Cells of the Memba. Cellular. instead of air as in the 
Emphysema, and those parts where the membrane is Reticular &
Cellular, will in this Disease be most distended; we find in anasarcous
Patients, that the Legs allways swell first & are most distended
at night; this is owing to the water making it's way to the most 
dependent Parts as fast as it is extravasated, and we find, that in a
Morning, after having laid in an horizontal position the whole night,
the water will then be more generally diffused & the Legs become less, 
and the Eye - lids will sometimes be so distended as to cause a Blindness for
some time till the Patient has been up [cross out] some hours, when the
Swelling in these Parts will subside and the Legs from their dependent
Position will become again distended with Water: this shews us very
plainly what a ready Communication there is between the Cells -
I mean not to speak particularly of this Disease, but it is certain that
the Water here extravasted, is lodged or deposited in this membrane by
a Rupture of the Lymphatic Vessels, we frequently see it absorbed -
again by the Absorbent Vessels & Suddenly discharged out of ye Body by some 
of ye Ememetories: a weakness & Laxity of ye Absorbent Vessels may
likewise cause an anasarca -
As I do not give an acct. of any Surgical Operation, in treatg
of Operations, as indeed it does not deserve the name of an operation, in 
the Cure of an anasarca, I will now mention it; and in doing of which, 
I will just mention the ways which were formerly directed. It was a
common practice formerly, to make a large Incision 2 or 3 Inches long
in the lower Parts of the Legs, as being the most Dependant part of ye Body,
and it was thought that by making such large Incisions the water
would be more readily discharged, which perhaps it might; but whenever 
these large Incisions were made, a Gangrene of the Limb was
generally the Consequence, owing to the weak Languid Circulation in these
Parts; for this Reason these Incisions were omitted, and in their Stead,
a small crucial Incision was made in 2 or 3 places in the Legs; but

46



25
the best method and what I have found attended with as great Success as 
either of these Methods, and attended with Less danger of mortification, is
the making Simple Punctures with a Lancet in Several Places in the 
Small of the Leg; and these will be a Sufficient Drain for the water to.
I will however mention two Cautions to you in making them; the first is
that you sure to make your puncture deep enough; and the other, that
in making them you take Care to avoid wounding the Saphena or 
any other vein, as happened once to myself -
The Scrotum will become so distended sometimes as to endanger a Mortification,
and therefore it is advisable to make Punctures here, as well as
in the Legs -
Speaking of the Species of Dropsy, I shall take an opportunity of
mentioning a Species of Dropsy which is not taken notice of by writers;
this is an accumulation of Water between the Peritoneum & inner
Surface of the Abdominal Muscles - This Case happened to a woman
who died in this Hospital; upon opening of whom, the Viscera of the Thorax
& abdomen appeared to be perfectly Sound, but the Peritoneum was much 
thickened at least 1/4 of an Inch, and one of the Fallopian Tubes was 
stretched to 3 times its natural Length with the ovary carried to a 
great distance from its natural Situation -
We have been speaking of extravasations of wind & water 
in this membrane; let us now mention Extravastions of Blood: This
may be caused by wounds, Blows, and Strains, and whenever it happens, 
we must endeavour to get it absorbed in the most expeditious manner,
especially if Situated upon a Bone as it may destroy the
Periostœum & produce a Caries of ye Bone; This is done by Fomentations
with Spts. & vinegar, Pultices, Bleeding & procuring Evacuations by Stool,
The most effectual application in procuring absorption, I have found
to be the Lees of Wine, with which the Part is to be frequently fomented
and a Poultice made with it, may be afterwards applied.

*. Whilst I was speaking of abcesses I might mention a Circumstance
which now & then happens after openning large abcesses, and was
the Care of a man, a Patient of Mr. Smiths, who died a few days
ago. The observation relates to large collections of matter
under the fascial covering of muscular parts; unattended,
often, with any redness or inflammation of the Skin, in
which the care is best performed by passing a Seton
through the whole extent, rather than by an Incision.
I have seen several cases of this sort, in the Thighs where
the matter was lodged under the Fascia Lata of 
the Thigh. One of these happened in a young Lady
in London whom I attended, and cured by opening
with a Caustic in the most depending part, & the 
careful application of a Bandage. The other was
in a negro Girl of [an] belonging to an old plauter
in Virginia, which I cured by a Seton. 
B-
48

26
The Cellular membrane is the Seat of all Abcesses, Boils &c. and
Sometimes an abcess will form itself in this membrane between the Interstices
of ye Muscles, as in the Leg & Thigh, and the matter, not
having any Exit, will insinuate itself further about and cause those
Sinuous Ulcers common to those parts, and by its confinement will 
corrode & entirely destroy ye membrane, so that upon opening these
Abcessuss, ye. Muscles will appear quite naked & stripped of their
Cellular Covering. It may be asked, why the matter formed in this Cellular
membrane in small abcesses as Boils &c and indeed in all Abcess,
does not insinuate itself from one Cell to another as water does in
the Anasarca, or Blood when it is extravasated? The reason of this 
is obvious; On all these Abcesses, these first appear a Circumscrib'd
Tumour, attended with pain & Inflammation &c till the Matter is
perfectly formed, when the Pain abates, but the Inflammation still 
remains about the Edges of the Tumour, till the matter is discharg'd,
when the Inflammation commonly goes off in 2 or 3 days - we know that
the consequence of Inflammation is an adhesion or cohesion of Parts
in which it is situated & which were before disunited & Seperated; hence 
the Cells of this Membrane being united by this Inflammation, this 
Union prevents the matter from insinuating itself beyond the Limits
of the Inflammation*-
The Cellular Membrane is the Seat of the Adeps, and it is
the opinion of some, that the Oil is contained in the same Cells, which 
in an Anasarca, is filled with Water; but a celebrated anatomist is
of a Difft, opinion, and thinks, that there is a particular apparatus
of Vessels for the reception & retaining this adeps - We must suppose
there are a number of little Follicles or Bags situated with in this Membrane,
in which the oil is contained, but they cannot be demonstrated; and 
if this is the Case, we must likewise suppose, that they have Vessels
to carry Blood to them for their Supply & nourishment & to return
this Blood, with others which serve as absorbents; for it is beyond
a Doubt that in Diseases, absorption of this adeps does take place,
how can we else, account for a lusty Fat man to be reduced and emaciated

50


27
and emaciated by an acute Disease in 2 or 3 days time - The anasarca
destroys the Cells which contain the Adeps, and in chronical Diseases
we see People weakened & emaciated by an absorption of it -
The use of the adeps is to lubricate Parts which have Motion;
hence it's use is devious between those muscles which are subject to 
much Friction in their Actions; it likewise serves as a common
Integument over the whole Surface of the Body, service to fill up
the large Interstices made by some of the Muscles, [cross out]
[cross out] & by that means rendering the Surface of the Body Smooth & Beautiful -
It is the opinion of Some, that a particular use of this adipose membrane
is, that when a Person is deprived of all kinds of Food, nature
will be supplied with an absorption of the Adeps which serves as nourishment 
to the Body when taken into the Blood, for several days; and 
it seems to be as reasonable Supposition that the Body may be supplied
with nourishment not only by an absorption of this, but likewise
of every Fluid in the Body, [cross out]
The adeps or Fat is of difft. Consistence in People of difft. ages,
and it is also different in its structure & Consistence in Different parts
of ye Same Body; it is harder and firmer abt the Kidneys than
in any other part & is called Serum: it puts on a different appearance
likewise in the Dead and the Living Subjects -

52



53


54
[illustration]
Half Penniform Muscle.




[illustration]
Sphincter ani



56
1. Tendon
2. Fleshy fibres
Complex Penniform Muscle
[illustration]

[illustration]
Triceps



58

[illustration]
Digastricus or Biventer

60
[illustration]
Biceps

[illustration]
Radiated Muscle.
1. The Tendon
2. The fleshy or muscular fibres

62



Rectileneal Muscle.
[illustration]

64

28
Lecture 6th
On the Muscles -
The Muscles are those Parts of Animals which we call Flesh: they 
are a Bundle of red fleshy Fibres connected together by Cellular membrane:
the Muscles are the organs of motion and have a power of contraction. but
how this is effected we are entirely ignorant of: the muscles have two appearances,
the red, and the white; the red is what is called the fleshy 
Fibres, in which the power of Contraction is situated; the white is the Tendinous 
Fibres; these however are intimately blended together, and closely 
connected together by Cellular membrane: the fleshy Fibres are Loose, 
but the Tendinous are more compact & are inelastic, hence we know the
Power of Contraction is in the fleshy Fibres only, and for this Reason, the 
tendinous Fibres are looked upon to be passive organs only, which fleshy
Fibres are solely the active -
In describing a muscle, it is usual to divide it into 3 Parts,
the Head, the Belly & the Tail; by the Head we are to understand the 
origin of ye Muscle; its Belly or middle, is the fleshy part; and its
Tail is the End or Extremity of it, which is commonly tendinous: but there
are many exceptions to this Rule; therefore, the Terms Head & Tail are laid
aside & in their Places we have substitutes ye Terms, Origin & Insertion.
the Term Belly remaining. There are likewise objections to this Division, 
as it is often difficult to tell which is their origin or which their Insertion,
if we are to understand by it's origin what was meant by the Head of Muscle:
for Instance, the Biceps of the arm, and many other muscles whose
actions are different in different Positions of ye Body, sometimes acting
from their Origin (i.e. in that part nearest the Head) and in other
Positions acting from the Part which we term its Insertion. For this
Reason the French have with propriety laid aside this division & make 
use of the general name of Attachment to both: and tho' I took upon this
method of describing them to be the best yet Anatomists of this Country 
do not follow it -

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29
The Muscles of the Human Body, take their names from their
Figure, Situation, Actions attachments &c. as the muscles of the 
Tongue, called Hyoidsi, from their attachmt. to the os Hyoideus; the Sartorius
takes it's Name from its action; the Deltoid, from its supposed resemblance
to the Greek Letter △ - others take their names from the Direction 
of their Fibres, as the Recti of Transversales -
The attachments of the Muscles as well their origins as Insertions,
are various; some arise fleshy, other tendinous: and some are inserted
fleshy & arise tendinous; some are lost in the Cutis and have no distinct
origin or insertion, and these are called Cutaneous muscles, as the occipito
Frontalis &c.: some are inserted into Bones, others into Cartilages,
and the Periosteum; which last has the Slender muscles only, inserted
into them, the Strong ones, such whose actions are powerful are inserted
into the Substance of the Bones, and those which are inserted into Cartilages, 
serve to give Shape to the Parts, but some muscles have no particular 
attachmt. at all, as the Sphincters -
When a muscle arises from two different Parts, by two distinct
Heads, they are called Biceps: when arising by three Heads, they are
called Triceps: but sometimes the reverse of this happens in some 
muscles arising by one Hand, and soon after, dividing into 2 Tendons;
such are called Bicornis, and if they divide into 3 kinds, Tricornis:
we likewise see some muscles [arising] fleshy at their origin and
Insertion but Tendinous in the middle; these are called Biventers, on
Digastric Muscles.
Authors speak of three Species of Muscles. viz, the oblong,
Hollow, and ye Mixed = the oblong muscles are principally those of ye
Extremities, as the Sartorius, Biceps &c the Heart is a Hollow Muscle,
and the mixed, are those of ye Abdomen.
There are Several Species of Fibres in Muscles, as Rectilineal,
Penniform, half-penniform, radiated and the Complex penniform.
The Sartorius is the most perfect Rectilineal Muscle in the Body;
the Gastrocnemius the most perfect Penniform; Trapezius &
Temporal, the radiated &c - These different Directions of the 
Fibres

68


Fibres of the Muscles have all their different uses: for by this means
Some parts of a muscle may be put in action whilst another part of it
remains inactive. Tho this is contrary to the opinion of some Anatomists, 
yet it is certainly true, and we have an Instance of the truth
of it, in many muscles, particularly in the Orbicularis Palpebrarum
proprius; the upper part of which we generally see in motion, whilst
the lower part is inactive -
Muscles, when stripped of their Cellular Membrane, put on 
a red, fibrous or fasciculated appearance; but these Fibres are so
minute, like those of ye Nerves, that it is impossible to say what ultimate
Muscular Fibre is: for when these Fasculi become separated
from each other, either by boiling or maceration in water, the Smallest
Fibrillæ appears, when viewed thro a Glass, to be composed of Still more
smaller Fibres and so on ad Infinitum - It is disputed whether the 
muscular Fibres are hollow or not, and tho' this will admit of a 
Doubt, as we can't discover what an Ultimate Fibre is, yet it is most
probable they are hollow or porous like the Nerves, from the Effects
produced by an Interruption or obstruction of the Blood Vessels sent
to the muscles, which will produce a Paralysis of that muscle in
the Same manner as if an obstruction in either the Vascular 
or Nervous System will produce the same Effects upon the
Parts of ye Body which they are Distributed upon, it is reasonable
to imagine that they have both an equal share in producing
muscular motion; tho Haller is of opinion that the nerves are
the Primary Cause of muscular motion and the arteries the 
arteries the secondary or assistant Causes: but he made his Experiment
relative to this Point, upon Frogs & other animals, and
as their is a very great difference between the Human & Brute
Creation in their Analogy, no just Conclusion can be drawn from
Such Experiments: for Instance cut off the Hand & dissect
out the Heart and all the Viscera, and it will appear to have motion
& Life for Several Hours after; and the Same Experimts. have been
tried upon Frogs & other animals which are quite contrary to our Natures.

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31
Every Muscle hath it's Artery, Vein & Nerve sent to it, and some
have several arteries sent & ramified thro their Substance: the Muscles
have Lymphatics also: the Artery after entering the Substance of ye.
Muscle takes no Direct Courses thro it, but sends off Ramifications wch.
generally follow the Course of ye tendinous Fibres; and when a muscle
is minutely injected, it will appear one entire Congeries of Blood Vessels
so closely blended together, that it will be Similar to a Cake of wax, with 
which it is injected - The more Fibres a muscle is composed of, the 
stronger it will consequently be, and the longer the Fibres are, the 
greater will be the Action of ye Muscle, as all muscles have a power
of contracting themselves about one third of their Length, and all
Muscles act likewise according to the Course of their Fibres - It 
is observed that the Nerve sent to a muscle, enters in the same Course 
as the artery; but Willis is of opinion that it loses its Coats as soon 
as it enters the Muscle & the Pulpy Substance of it is distributed
thro the Muscle in every Part in the same manner as it is continued
over the Surface of ye Cutis -
Muscles by long Maceration in Water lose their red Colour
and become white; this shows, that the fleshy Fibres owe their red
Colour to the red Blood contained in their Vessels, and it is probable
from hence, that they are a Compages or Series of minute blood vessels
some muscles however are different in degree of Kidneys in difft. parts 
of the Same Body; Some are quite pale, whilst others put on a Livid or 
almost black appearance: it is remarkable that the Muscles of Executed
Bodies are more Livid & red, than those who die a natural Death;
owing to a greater quantity of Stagnated Blood in these Subjects, for wch.
Reason they are the properest Subjects for Dissecting the Muscles:
Some will say, that the muscles, even in a relaxed State, are always 
endeavouring to contract & shorten themselves: tho this may be the
Case in some small Degree, yet this opinion carried too far, has a dangerous
Tendency: for, it was the adopting this opinion too hastily, that 
mislead the Ancient & some of ye modern Surgeons to invent the 
Various Instrumts. for the Reduction of Dislocations; with which
they made a very forcible & violent Extension, at the Same time that the 
Muscle

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32
Muscles were put upon the Stretch by the Position of the Limb, in order
to counteract this supposed Resistance of ye Muscles & by overcoming it to reduce
the Dislocation; but every day's Experience now convinces us of the Cruelty of this 
Method and the inutility of others machines in Dislocations; from the Position
the Limb is ordered to be kept in when they are used it is reasonable to imagine
they increase the very Inconvenience which they are Designed to Obviate: for all
Muscles when they are extended or put on the Stretch, are, we know, in continual
Endeavours to contract, and the Limb is ordered to be kept extended
when the machines are used: where as, put the Muscles into a relaxed
State & the Dislocation is easily reduced with your Hands, which perhaps 
had foiled the operators who had used these machines. Hence we see
the Absolute necessity of being well acquainted with the attachments of
Muscles, not only to know what do suffer by the Dislocation, but 
also to understand the most favourable Position of ye. Limbs for Reductn.
What is called the Tendon of a Muscle, is only the white shining
tendinous Fibres which was seperated from each other, by the intervening
fleshy Fibres when in the Belly of the Muscle, but now closely connected
& united together so as to form a white shining inelastic Cord: and we 
have already observed that some muscles have this Tendinous appearance
both at their origin & Insertion; such Muscles have commonly very powerfull
Actions and are attached to Bones at both Extremities, and commonly 
near the great Joints; which mechanism is of Considerable Advantage,
because they be in much less compass, when thus united together
& take up much less space in their Insertions, than if their fleshy
Fibres had been continued to their attachment, in which Case the
Joints would have been considerably enlarged & renderd almost useless by 
their Flexion being considerably impeded - These Tendinous Fibres
when thus united; form a Strong Cord, equal in Strength to the muscle
itself; and being inelastic will not give way, when the Muscles act;
hence the Action of ye Muscle is more powerful -
The Tendons, tho they appear white to the naked Eye, are Vascular
as appears by Injections; the Vessels are very minute; we have another
proof, that Tendons are Vascular because when divided they will
unite; which is a proof beyond a Doubt, for, such parts as are

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33
not vascular, as the Cuticle, Hair, Nails &c. will not unite, when
divided - It was the Practice of ye ancients, & some of ye Surgeons to 
this day indeed, to make use of Sutures in divisions of the Tendons;
but the most emminent Surgeons have laid aside this method of
Treatment, and recommend the divided Ends of ye Tendon to be brought
and kept as nearly into Contact with each other as possible, by 
Placing the Limb in a proper Position; and they have the Satisfaction
to find this method attended with so much greater ease &
Success, that now, instead of confining the Patient to the Bed for
3 or 4 Months, as was the Custom when the Tendo Achillis was 
divided, they are only confined in a proper Position 2 or 3 weeks, when
they will generally be able to Set their Foot upon the Ground
& begin to walk -

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34
Lecture 7th. On the Glands
By a Gland is meant a Body of small Vessels performing Secretion,
and none are properly Glands but such as do perform this office; they 
take their Name from their supposed resemblance to an Acorn; they 
put on different appearances & have different Names given to them  
from ye Diff Fluids they Secrete and some take their Names from their
Situation, as the Mesenteric, Axillary, Ingiunal &c. The Secretion
of some Glands is Salutary, of others Excrementious -
Glands were first divided into two Species, by Sylvius; and
this Division has been universally followed by all anatomists since his
Time; this is, into Conglobate and Conglomerate: but Malpighi has
added another Class, to which he gives the Name of Follicular.
A Conglobate Gland is supposed to be Cellular internally, but its
external Surface has a smooth, regular, even appearance being
covered by a fine, thin, smooth Membrane.
The Conglomerate has a fleshy, irregular, Cluster-like appearance,
seeming to be composed of a number of Small Glandular 
Corpuscles, which are externally covered by a fine, thin Membrane 
which firmly adhæres to them, as the Pancreas, Parotid &c 
These Corpuscles which form the Body of the Gland, are connected
together by Cellular Membrane, and may be Seperated by maceration;
when, each of them seems to be composed in the same
manner as the Body of ye Gland, viz, of still smaller Corpuscles,
so that we cannot say what an ultimate Glandular Corpuscle is.
Some Anatomists object to this Division of ye Glands,
and for these Reasons; first, that the same Glands in difft.
animals, will be of a difft. Species, i.e. that in one animal a
Gland should be of ye Conglobate kind, whilst in anoy. Animal,
the Same Gland shall be of the Conglomerate Species; and again,
that the same Gland shall at difft. Periods, put on difft. Appearances;
that it shall at one time of Life be of ye Conglomerate kind,

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35
whilst at another time it appears to be of the Conglobate kind; an 
Instance of which is in the Kidneys. 
With regard to Follicles; the species as I before observ'd
was added by Malpighi, and are most numerous about the Ears
& where any unctious matter is to be Secreted, and they are likewise
very apparent on the Tongue -
By a Follicle is meant a little Bag which appears to 
have a narrow entrance but grows larger & larger as it proceeds 
to terminate either in the Excretory Duct, or on the Surface 
of any Part, as on the Tongue - The Tonsils are
a Cluster of those Follicles, tho' they appear to be distinct
Glands of the Conglomerate kind -
All Glands have an Artery, Vein & Excretory Duct
belonging to them; and Malpighi is of opinion, that in all
Glands, the Termination of the Arteries is partly in Veins &
partly in Follicles; i.e. that the Artery entering the Gland,
ramifies thro its Substance and some of its minute Branches
terminate in the minute Branches of ye. Vein, which, joining,
form the large Vein which brings back the superfluous.
Blood; whilst other Branches of ye Artery terminate in
the Follicles of ye Gland; which are supposed to be little 
Bags, situated between the Termination of the Artery & the
beginning of ye excretory Duct of the Follicle, and these
Ducts all uniting, as they Pass thro the Gland, form the 
common excretory Duct of, ye Gland - Ruysch however
positively Denies the Existence of Follicles in any Gland, 
and says that the vessels are continued into each other
without any intermediate Cavity - The arguments on 
each Side of ye controversy may be seen in a Series of Letters
between Booerhave & Ruysch-

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36
An Argument made use of in support of ye. Malpighian
Doctrine is, That they assert the Small Cysts of Pus 
found in diseased Glands to be Folliculi diseased: but it
is evident that they are nothing more than Hydatids, which 
may be found in many Places where no Secretion at all is 
performed, as, in the Ovaries &c. another objection to this is
that if these Cysts were Follicles, the matter contained in ym.
would in all probability partake of ye Taste of the Fluid to
be secreted by whatever Gland they were Situated in; but this 
is not the Case - many other arguments are brought in 
Support of this opinion, but they are of no Significancy:
and, tho' a very emminent anatomist of ye present age,
has taken a great deal of Pains to establish & Confirm it,
& some of his Preparations seem to shew their Existence,
yet it is the opinion of much the greater number of Anatomists
that Glands have not Follicles, and follow Ruych,
and I must own, that in all the Trials I have made, I 
never could discover anything like them -
Some of ye Fluids secerned, are used immediately,
as Saliva &c. others are deposited in Reservoirs
form whence they discharged on particular occasions, as the 
Bladder, Vesicula Seminales &c if in which after being contained 
sometime, they occasion a Stimulus on the 
Coats of the Reservoirs which excites an Excretion of 
them -
We know that such a Gland secretes such a 
Fluid from the Blood; but how is this Secretion carried 
on, is the Question? I must own, that after all the opinions,
hitherto formed about it are very unsatisfactory, and that
we are now as much in the Dark about it as ever. Anatomists

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37
Anatomists generally divide this operation into four
Stages, viz, the Blood is first assembled for the Secretion
of ye Fluid, Secretion is then performed, the 3d. is 
Depuration, & the 4th is Excretion -
Secretion is assisted by many Causes, and amongst them
Pressure contributes not a little; and accordingly we
find most of ye. Glands so situated as that they shall
be liable to Pressure in most actions of the Body; an
Instance of this is in the Salivary Glands, which discharge
a greater quantity of their Fluid at the time
we eat when it is most wanted; the same observation
may be made in the Pancreas & Liver, both of which
becomes compressed by the Stomach after a full meal
whereby a greater Quantity of ye Pancreatic Juice & Bile 
is forced into the Duodenum, which at this time is
most wanted in order to assist Digestion of ye Alimt.
& Perfection of ye Chyle &c - and so of other Glands; as
the Lachrymal Gland of ye. Eye, which secrete Tears as
they are wanted to moisten the Cornea, by the Pressure it
receives from the almost continual motion of the Eyelids;
and when any extraneous Body is lodged between the 
Eyelid & Tunica Conjunctiva of ye. Eye, we see what a 
continual discharge of Tears there is from the gland,
caused by its irritating & keeping the Parts in continual 
motion: the Gland is greatly affected by the 
Passions of ye Mind, Grief, which we all know

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38
to produce a discharge of Tears from this Gland.
From these observations it is easy to conceive that in action
People who use much exercise, glandular secretion
will be carried on & performed much more than in
Sedentary People - 
It is a dispute with some whether there are any 
Medcey which will particularly effect a particular
Gland, as Diuretics, the Kidneys &c but I think
there can be no doubt but there are, tho' I do not profess
to be a Judge; this much, however, evident from
every day's Experience, that mercury will Sometimes
affect one & Sometimes another Gland, sometimes causing
a spitting, which is indeed the most frequent, at other 
times creating a greater urinary Discharge, great perspiration 
&c - 
All Glands do not perform Secretion at first
Formation of them, but requires a Considerable Time to
acquire this Secretory Faculty, as the Testes, which 
do not perform Secretion till the age of Puberty; and
Some only have this power at the particular Seasons, as 
the Glands of ye Female Breasts, which only have
it at the Time women give Suck.
There are some Part of ye Body wch. are known
by the Name of Gland & yet it cannot be prov'd
or Demonstrated that they perform any Secretion; such
as the Thymus; the Glandulæ Renales are not known
to perform any secretion, yet they keep the name of Glands.

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39
Lecture 8th.
On the Structure of the Bones
The Bones are hard, Solid & compact Bodies, serving
for the Attachment of Muscles and to give shape & firmness 
to the Body.
They are divided into two Classes. ye flat. and the
Cylindrical; by the Flat Bones are meant all those which 
compose ye Cranium, the Bones of ye Pelvis, Scapula &c.
By the Cylindrical are meant the Bones of ye upper &
Lower Extremities &c -
All Flat Bones are composed of two Tables
or Plates, which are Solid & compact, and have an oily
Bloody Fluid lying in the middle between them, which
is called the Diploe or Meditullium - The Bones of ye
Cranium are commonly distinguished by their external
& Internal Tables -
The Cylindrical Bone are formed of a number of
Plates of Layers, very solid & Compact externally, but
internally they are Cavernous, loose & Cellular -
Bones are said to be fibrous, and that the 
Lamina or Plates are formed by the Fibres. How 
both it appear that they are fibrous2. If we look at a fresh Bone
it appears to have a fine Smooth Polished Surface externally, 
which is said to be caused by the Friction of the 
Muscles in their motion upon them, but is not so; 
because was this smoothness caused by this means, it

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40 
would be wanting in some Places, as on the Tibia, where
there are no Muscles, but we find this smooth appearance
here as well as in other Parts; but it appears by 
Maceration, that they are fibrous, and it is evidently demonstrated
by the Calcination of Bones; In the fœtal 
State, they appear very distinctly fibrous. In the flat Bones
the bony Fibres begin to shoot from the middle towards the
Circumference; but in the Cylindrical Bones Ossification
is first begun & perfected in the Middle, from whence the
bony Fibres shoot towards each Extremity of the Bone, & 
It is thought by some, that there are the same number of 
bony Fibres Continued to each Extremity of the Cylindrical 
Bones as there are in the middle of them; the middle
being more firm & Compact, Extremities more loose &
Spongy : but this is certainly not the Case; for [cross out]
[cross out] if you take a Bone and cut an Inch in the 
middle part of it and an Inch into the Extremity of 
the same Bone, and the middle will weigh the heaviest:
which seems to prove that there are more bony fibres in the 
middles than in the Extremities -
It is the general opinion of Anatomists, that these
Fibres shooting over each other, form the Lamina or
Plates in all Bones, as will Flat as Cylindrical. These
Lamina are Supposed to bear some [cross out] Analogy
in their Formation to melting Lead, throwing it upon a
Floor & letting it cool, then pour more melted Lead upon it
and let it cool, which will form anoyr. Layer; pour more Lead
upon the last & another Coat will be formed &c. This Laminous 
appearance is most Distinct & visible in the Bones of a

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41
of a Fœtus when prepared; and the Bones of a Turtle, evidently
shew the Fibres. The ossific Matter shoots differently 
in different Subjects, and the Bones of adults shew
these Laminæ in Exfoliation when they become diseased;
and an Exfoliation may be procured by the application of a
Caustic or any thing one the Bone, which destroys its Vessels,
which nourished the external Lamina, causing a Separation
of the external Lamina thus deprived of its Vessels, from the
Lamina situated beneath it, whose vessels are not affected
or acted upon by the caustic &c- These Lamina are 
said to be connected together by a Gluten or Jelly -
Internally, the Bones are more loose & Cellular; the Cells
are formed by bony partitions intersecting each other: they are
called, at the Extremities of the Bone, Cancelli, but towards
the middle they are called Reticular; these Cells have frequent
communications with each other, which may be seen by pouring
Quicksilver into them, and are supposed to be formed
by the internal Lamina shooting over in different Directions;
they are not found alike in any two Bones except in the Vertebræ
where they are larger -
All these Cells are lined by a thin membrane which 
encloses the marrow lodged within them: The Bones are
said to be strengthened by them, and that by this Formation they
are rendered lighter & fitted for action, than if they had been
quite Solid, which would have rendered them more liable to be
fractured - The Reticular are very tender & delicate & it
is dubious whether they exist in part of ye Bones - 
All the Bones are exceedingly Vascular, but the 
greater part of ye Vessel sent to them carry white Blood; and

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42
There are two orders of arteries which go to the Bones; one goes to 
the external Lamina, the other goes for the nourishment of 
the internal Parts, which last, are called Medullary arteries.
They have their Veins likewise, as we may judge from analogy,
but these cannot be so well demonstrated by Injections;
as the Arteries; there are a great number of Lymphatics also
in Bones, and there are several Foramina which serve for
the passage of ye. Vessels. indeed, Bones have not only Arteries
& Veins, but all the Vessels which other Compound Parts have,
except Glands. It is disputed whether they have nerves, as we
cannot trace them into the Bones with the arteries; but
from their Sensibility in a Diseased State we may judge that 
they have. Haller produces the Teeth to prove that they are
not Nervous, but as much of ye Teeth as are situated within
the Gums has every property &c's similar to the Bones of 
other parts, and [cross out] is acutely sensible when diseased; so
that it is no proof at all - It is my opinion that the Bones 
are not Sensible unless diseased; and I am induced to think
so, from observing that, People while the Cranium is 
sawing in applying the Trepan, seem insensible of any
Pain, nor, take a sharp Instrumt. of cut upon the Bone
& the Patient will not feel it, but take a rough Instrument,
such as a Rasp, & serape the Bone with it, and 
the patient will immediately complain of violent Pain;
which Pain is [not] occasioned by the Injury done to the 
adjacent Parts by the Parts by the Rasp. This Experimt. however is
not decisive; we only know that they are acutely sensible
when in a state of Disease - 
In the Bones are seen many transverse & longitudinal
Sinuses, the real use of which is not known; some

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43
Some say they are for the admission of Vessels, others for the 
Transmission of marrow -
Havers is of opinion that the use of the marrow
found in Bones, is for the nourishment of them and to 
prevent them from being too brittle & liable to be fractured
from very slight Causes. This marrow is observed to be 
more oily in the middle or Centre of Bones than towards
their Extremities where it is bloody: the use of the oily
part is to soften ye Bones which are harder & more
Compact in ye middle, and the more bloody part serves 
to prevent ye Spongy & soft parts of ye. Bones becoming 
too soft, which the oily part of ye marrow would have 
occasioned; for the same reason we find more bloody marrow
in Children than [crossed out] in those of adults & less of ye. oily.
The Marrow is secreted by the medullary arteries, wch.
generally enter the Cylindrical Bones obliquely, and it is 
contained in the Membrane wch. Lines the Bony Cells & 
Cancelli of ye Bones (in which the marrow is lodged) and 
is called sometimes membrana medullaries or Periosteum
internum; it cannot be inflated like the
Cellular membrane - 
The marrow of an Ox appears [appears] to 
be a series of little Globular Bdies, and the same in the
Human Species, only it is much Softer - There are two 
Species of this marrow, one called medulla and the 
other medulla mollis - 
The Secretion in Bones is thought to be of the
Vascular kind, as no Gland can be found in them -

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44
The Bones are liable to many Disease from their 
Vascular Structure; the Spina Ventosa is a Disease
beginning in the internal or cellular part of ye Bone
& extending from one Cell to anoyr. till it gets into the
Joints - Exfoliations are the most common Diseases,
of Bones, and it is thought that new bony Matter is
formed before an Exfoliation happens - Some Diseases
render the Bones too brittle, by destroying the oily marrow,
hence they become easily broken; a remarkable Instance
of this, happened lately in St. Thomas's Hospl.
a woman who was salivated for an inveterate Liver,
had all her Bones rendered quite Brittle, by the
Venereal Veins destroying the marrow, so that upon
the Slightest Cause, they broke; and one day,
attempting to raise her Head, it fell forwards upon
the Sternum, compressed the medulla Spinalis & 
She died immediately -

* Processes at the Extremity of a Bone which are of an
oval Figure are called Condyls, as at the lower extremity
of ye os Femoris Tibia &c-
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45
Lecture 9th.
Structure of the Bones continued -
There are several Bones belonging to the Human Body, which 
cannot properly come under ye Class either of the flat or the 
Cylindrical Bones; these are the Spherical, such as the 
Bones of the Tarsus & Carpus & the Patella. -
In several Bones of the Body, there are Eminences 
to be observed upon them, and to which we give the names
of Processes; these have different names given to them according 
to their Size, Form & use: where we meet with 
Bones which have a round Spherical Figure at either Extremity
of it, it is called the Head, as in the os Humeri,
Femoris &c; tho' we use the general Term, Head, to both
Extremities in Cylindrical Bones, as upper & lower *.
when we meet with Bones which are narrow & contracted
before it forms this Head, this narrow part is called 
its Cervix, as in the os Femoris - : and where we meet wth.
a process of an Oval Figure, to this we give the name of 
Condyl, when it is received into a Concavity [of] in another
Bone, as the Condyls of the os Femoris, which with the
Tibia &c form the Joint of the Knee; where we meet
with a process broad at its Basis & running into a sharp
[point or] Edge, to this we give the name of Spine, as
the Spine of the Scapula &c; where we have a deep
Cavity in Bone with a sharp Edge, to this Edge we
give the name Supercilium; and what we mean by a 
Process, is an entire continuation of the Substance of the

*The true use of the Epiphyses is to hasten ossification,
for by
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Substance of the Bone, as the Processes Acromion Scapula,
and by means of these Processes, Bones have their principal
degree of Motion; they give strength to the Bones & 
Serve to form Cavities & for the attachment of muscles
& the articulation of ye Joints; they also serve in many
Places for the Direction of Parts -
The flat Bones are divided into their Edges & Surfaces, 
the Cylindrical into their Bodies & Extremities or
Epiphyses - By an Epiphysis is meant an additional
Bone placed at the Extremities of ye Cylindrical Bones & their Use-
to check their growth, or they would be too luxuriant    
or perhaps irregular; these Epiphyses are very visible
in young Subjects, being united to a Bone by an intervening 
Cartilage which in adults becomes entirely
ossified & hard as Bone itself: there are some Bones
which have but one Epiphysis. at only one Extremity 
as the metatarsal Bones &c - the Term Apophysis is
often used for Processes at the Ends of Bones, and they 
are Synonymus Terms & as the great Trochanter of ye. Femur -
There are two Sorts of Cavities in Bones, one for the reception
of soft parts, as muscles &c, the other for Bones &c
The most remarkable for soft Parts are the Cranium &c
the Orbits for the Eyes - Those for hard Parts are divided into
Classes, as Fossa &c which are said to be formed partly 
by the action of Muscles, as they are observed to be deeper in hard laborious
men than in Women & other men of more tender

*. But what is very Singular is that no other Part but
Bone will be tinged red by the madder -
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47
and delicate Constitutions & who do not use much Exercise.
Where we meet with a Cavity at first narrow & & then growing 
Wider, it is called a Sinus; and where Holes pass thro ye.
Substance of ye Bones for the Admission of Vessels, such are
called Foramina; that thro wch. the medulla Spinalis passes
to the Spine is called Foramen magnum -
Bones are of different Colours in the Diff. Stages 
of Life; those of young Subjects are browner than those 
of Adults & put on a redish Colour which is owing to the 
greater Vascularity of the [same] young Bones, and we also observe
them of difft. Colours in different parts of ye same Bone; this 
is owing to there being a greater number of Vessels in some 
parts than in others -
Animals fed with Madder have their Bones tingd
with a red Colour: this was first observed by M. Belchier
when he was one day dining with a Calico Printer, who 
used great quantities of madder; and he observed that 
the Bones of some Hogs which had been fed upon madder
were all tingd with a red Colour: This has been 
frequently confirmed by Experiments. since made upon
other animals - The enamel part of ye. Teeth will 
not be tinged -
Madder will also tinge the fresh Callus of Bones
after they have been fractured, and the Canullous
part will be coloured by it also.*
Acids will dissolve Bones and render them quite
Flexible; and if you feed an animal with madder till 
the Bones become red, and then steep them in Vinegar, they 

+ which grow into Bone afterwards -
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48
lose their redness, which shews that the earthy cretaceous
matter alone is tinged. Madder will not Tinge
the Gluten of Bones or the Vessels of their Combination.
The Combination of Bones is performed differently,
Sometimes they are combined by the Bony Fibres shooting
into each other, as in the Sutures of the Cranium,
others are combined by Cartilages, Ligaments, muscles &c
These have motion, the others have not -
Articulation of Bones, is the conjunction of two
Bones to each other: Galen has divided articulation
into three Classes, and these are still continued; but
they are of no use - Diarthrosis, Synarthiosis, & Symphysis -
The assisting Parts or Appendages of bones 
are Cartilages, Ligaments, Glands & Vessels.
A Cartilage [cross out] is a smooth, elastic Substance
not so hard as Bone; and there are reckoned 3 Species,
the fœtal + those that give shape to Parts, as in the 
Ears, Larynx &c; those at the Extremities of
Bones which have motion - and these last we shall consider -
It is dubious whether Cartilages are 
Vascular; if they are, the Vessels are so minute as
not to be demonstrated; they are said to be insensible;
and are elastic in all parts of ye Body; hence an anatomists
account for a person's being taller in the morning
than in the Evening, by the Cartilages of the 
Spine giving way to pressure caused by the weight
of the upper parts of ye Body in an erect Posture,

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but again recovering their Elasticity by Rest.
The Extremities of all the Bones designed for 
motion are tipped with Cartilage; without which 
they would be liable from their continual Fiction, to 
be worn away, and by them, the bony Fibres are prevented 
from shooting or running into each other, as 
happens in an anchylosis, when the Cartilages become 
destroyed; they likewise, from their Elasticity,
prevent those Injuries which the Bones would be 
liable to, in Jumping &c.
Their Diseases are very few; the' on opening
Joints sometimes we find them destroyed -
Ligaments are strong, inelastic, insensible Ligamt.
parts, composed of a number of Fibres closely connected -
They are of various sorts; some bind down 
Tendons, & then are generally round; others surround
the Bones which form ye Joynts, & these are called
Capsular or Bursal - The Capsular Ligament is 
most perfect in large Joynts which have much motion;
it takes its name from its resemblance to
a purse or Bag, including the Extremities of ye
Bones so as to make a compleat Bag - The Bursal
Ligaments are said to be composed of two membranes, one 
is the Periostœum continued over it, & the other, the 
Internal Membrane is the Ligament itself [cross out] 

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which lines the external Surfaces of the Cartilages.
Besides these, there are other Ligamts; as the
Ligament. Teres or Suspensorium, the Cross round 
Ligmts. of ye Joynts &c -
When there is a total Dislocation of a Joint
the Capsular Ligament is generally torn by the Dislocated
Bone pushing thro it -
All the Ligaments are exceeding vascular;
they are none of them perfectly round, but rather
flat -
The Ligaments of the Joynts, serve
to limit them to a certain degree of motion and 
confines them properly in their Situations, & prevent
Luxations; they serve likewise as bags to 
the Synovia, which lubricates the Joints & renders
them fit for Action -
The Cross Ligamts. are only found in the Knee;
these Ligamts. become thickened sometimes in 
Fractures of the Legs where the Limb is kept motionless
& extended for any length of time, whereby a
Stiffness of ye. Joynt is brought about; but
frequent Flexions of the Joynt with Friction &c.
generally relieve it [aff] after some time -

+ Dura mater, Ligaments, Tendons &c . which is reasonable,
as they seem to have a resemblance to each other in their 
Structure. It is said by some to be exceedingly sensible;
which they attempt to prove by observing the extreme pain
ensuing after Striking the Skin against a hard Body; but 
this may be & probably is owing to the Injury done to the Cutis; another
Circumstance which they mention in Support of this 
opinion is that in amputation, the Patient is said
to Complain of very acute [cross out] pain when this membrane is
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51
The Bones of the whole Body are covered by 
a thick, Strong, inelastic membrane, called the 
Periostœum in every part but where it covers the 
Cranium, when it takes the name of Pericranium.
It is disputed whether the Periostœum is sensible 
or not: we know it is Vascular, by Injection;
but less so than the Bones themselves, some of 
whose Vessels, as they pass thro this membrane to
the Bones, ramify upon it for its nourishment.
it is strongly attached to every Part of ye [Bones] external 
Surfaces of Bones by means of these Vessels;
and when this membrane is destroyed, an Exfoliation
of the external Lamina of ye. Bone ensues *.
It is thicker in the middle of ye. Cylindrical Bones, than 
at their Extremities, where it is sometimes very thin as
also on the Processes of Bones; It [does] is not continued
over the Cartilages which tip the Ends of Bones, but
Passes on over the Joints, surrounding them entirely
& forming the external Layer of the Capsular Ligamts.
In many parts of its external Surface it is rough
& irregular, in other smooth & even; the Irregularities
are owing to the Insertions of Tendons of Muscles into 
it, and the Smoothness is generally found where the 
Bellies of muscles are found lying upon it
It is disputed whether it is nervous or not, but it 
seems to be of the same sensibility with the Dura +
[illustration] not always -

is divided in order to make way for the Jaw; but
this may be owing to the Slip of a nerve, or a muscle
being divided, or after the Jaw is applied hanging in
the Teeth of the Jaw -
One use, which those who say it is exceedingly 
Sensible, attribute to it is, that it is placed upon
the Bones to warn us when any Danger approaches
or Injury is done to the Bone, which they look upon
to be insensible: but this is certainly all imagination
without any foundation. many other advantages 
are said to be derived from this membrane, but 
its principal use seems to be from its making a 
Smooth Bed for the Bellies of Muscles, by which 
they are prevented from receiving any Injury from the 
Hardness of the Bones, which they lie in contact with,
during their action - 
It is liable to Inflammation, which sometimes causes
only a thickening of it, at other times it will Slough away:
as it is an inelastic membrane, whenever we suspect
matter or any other Fluid contained underneath it, we 
should not lose any time in evacuating it, as it may 
by Confinement render the Bone Carious. Vid Eles'
Surgery, page - on nodes -
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52
Lecture 10th on the Synovial Glands.
The Synovia is supposed to be secreted by small fatty
Bodies situated in the Joynts, which from their resemblance
have been called Glands: they have sometimes been called
Glandulæ Mucosa & sometimes mucilaginous Glands.
Their Situation, Size & Shape is various according to 
the difft. Sizes of ye. Joints. The largest is in the Knee;
and they are all so situated that, every time the Joynts
are moved, they undergo a degree of Pressure, by which the
Synovia is discharged from them, service to lubricate the 
Ends of the Bones for the easier motion of the Joynt &c.
we find all the secretory organs very vascular; these are
exceedingly so. The Fat of these Glands is sold for neat foot oil.
The Synovia is a very Slippery, mucilaginous
Fluid; abounding in great quantities in some of the Large
Joynts designed for much motion, as the Knee &c. In
performing operations at the Joynts where these Glands
are [seperated] Situated, the operation will sometimes be 
rendered very troublesome by the discharge of the Synovia - 
With respect to the quantity these Glands will seperate
we find that very small Glands are capable of Secreting 
a large quantity of their Fluid at particular times,
as the Salivary Glands, and these Bodies, whether
they are secretory organs or not, when wounded will discharge
a great quantity of Synovia; as we see in wounds wch.
penetrate the Capsular Ligamt. into the Joynt which will
be followed by a considerable discharge of their Glary Matter;
and these Wounds are always attended with Danger, the 
Inflammatory Symptoms running high with Pain, Fever &c.

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and very often the Synovia will insinuate itself into the Cellular 
membrane of the Parts adjacent, forming Abcesses &c.
which destroy the Patient. These glands are not found in ye. Shoulder.
We find these bodies described by almost all
Anatomists, as Secretory organs, tho I believe it will be
difficult to demonstrate that they are Glands. The most
favourable argumt. for their being Glands, is their vascular
Structure; and another Circumstance, which seems to 
shew that they are different from the Adeps in other parts
of the Body & not Cellular, is, that in Dropsies of the Joynts
upon opening the Joynts, these Glands [???ly] be found to contain
no Water - There is some room to doubt whether they do secrete 
the Synovia or not, as they are not to be found the Shoulder,
which is as much or more used than my Joint in the Body, and
a great quantity of Synovia is allways found in it; from this 
Circumstance, some have imagined that the Synovia is deposited
it the Joynts by the Vessels terminating on the inner
Surface of the Capsular Ligaments, in which likewise are
Placid absorbent Vessels to reconvey any Superfluous quantity.
If then, these fatty appearances are not secretory organs, their
use must be to fill up the Cavities in the Joints where they are
Situated as the adeps does in other parts ye. Body.
That we have absorbent Vessels in the Joynts, is evidently prov'd
in Dropsies of Joynts - This Disease [may] is a Tumour of 
the Joynt ended with Pain, and having no Discolouration
of ye. Integument, a Fluctuation very percievable: this is the
first stage of the Disease, but when it is of long standing,
it may be attended with bad Consequences. It may arise from 

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54
from an Extravasation of the Synovia or a too Viscid State of it, &
likewise from a Relaxation of the Absorbent Vessels, which 
I believe is most commonly the Cause, as we generally find them
exist in relaxed Habits -
In the Cure we are to aim at procuring an Absorption, which 
when the Disease is fresh, may generally be performed by
Friction with the Flesh Brush, tight Bandages, & drastic 
Purgatives given now & then. Sometimes they will go off of 
themselves upon the patient's using an increased Exercise
& changing Climates.
It is doubted by some whether this disease does even 
exist, but it certainly does.
There is a Disease which sometimes may be mistaken
for this; which is an Extravasation of a Fluid 
under the Patilla on the outside of the Capsular Ligamet.:
and is said to be a Collection in the Sacculi Mucosi. But
they may be distinguished from each other by the [cross out] Fluctuation
in this, being more evident, and the Tumour extends
high up the Thigh, than in the Dropsy of the Joynt.
It is said, that Synovia will not only grow viscid,
but likewise become [cross out] as hard as Bone itself. Hence
the old opinion, in Luxation of Long Standing, that the Socket
which formerly contained the Head of the Luxated Bone, was
filled up by the Synovia which had grown hard & consequently 
prevent the reduction of the Luxation; but this
is erroneous, as likewise is the opinion of the Stiffness of Joynts,
[in] after being a long time kept without Flexion, being occasioned 
by the same means; for there never was found the least

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55
least appearance of concreted Synovia in any of the 
Joynts upon Dissection - The Cause of the Stiffness of
Joynts, which very frequently happens after Fractures, 
is owing to the thickening of the Ligaments of the Joint,
and unless remedied in Time by hot & Vapor Baths, 
Friction &c may produce an incurable Anchylosis
Of Osteology & Ossification.
It may be expected that I should give some account of
the different Changes or Degrees of ossification from ye.
Embrio to the Adult, but it would be taking up too much 
of our Time to little Purpose & prone but of little Satisfaction:
those who are curious, may if they chuse it, see
an account of the difft. Stages of Ossification, in
The Progress of ossification is various in difft.
Subjects; we see it compleated much quicken in some 
than in others, as in Ricketty Children, in whom it 
proceeds slowly - It appears in flat Bones to begin
with a number of fine Threads shooting divers
ways; and in the Cylindrical a Small Ring is first
formed about the middle of the Limb, from when [illegible] bony
Fibres are afterwards sent off towards the Extremities.
The first Stage of Ossification, the Bony Matter is said 
to be [like] of ye. Consistence of Jelly, the next Cartilage
and at last it becomes hard.

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56
There are various opinion with respect to the Manner 
by which Bone acquire their hardness - Some Say it is 
acquired by Pressure, from the Pulsation of the Arteries first,
afterwards by the Pressure made upon the bony matter by the 
Bellies of the muscles; thus likewise they account for the 
Soft Parts becoming hard & ossified in old People as we 
see in some Parts of Arteries sometimes. But many 
objections occur in opposition to this Doctrine - If the
Ossification is first begun by the Pressure of the Artery, 
this would be Surrounded first by Bone, which is not the 
Case; again, if the muscles advanced ossification, the 
Bony Fibres would take the same Course with the Fibres
of ye muscles, which is the case indeed with some of ye.
large Cylindrical Bones, but not in the flat; and those
Bones which would be most subject to pressure wou'd
become ossified & hard first, which does not turn out;
the Bones of the Ear receive no Pressure at all, and they 
are generally compleat in a Fœtus of 4 Months. In Short
it is not in the least probable that it is by this means
ossification takes place -
The most probable & reasonable opinion is that of 
Doct. Nesbit; which is, that the Bony matter is lodgd
between two membranes in some parts, as is the Cranium,
& in others, in the middle of Cartilage; that there exists
in the Blood a bony Cretaceous matter, which is deposited
by Vessels continually bringing it to its proper

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57
place. This seems to be the Case in the Ossification of the 
Patella, which when injected whilst in its Cartilaginous
State, appear to have several white bony Spots, to each
of which a Vessel is dispatched & seems to be spent entirely
in it - according to this Doctrine, the ossification of Soft
Parts is most likely caused by a redundancy of this
Bony matter in the Habit, and that this is the Case
in Gouty Habits, in which we see Chalk Stones, as they 
are Called, lodged upon the Joints -
Doct. Nesbit denies that Cartilage is chang'd
into Bone; but says, that the Bony matter is often
lodged in the Centre of Cartilage, as in the Patella,
Epiphysis &c. In an Epiphysis, we often see the
first appearance of the Bone which afterwards forms
the Epiphysis, in a little round Ball lodged in the Centre
of a quantity of cartilage; and this Cartilage is supposed
to change by degrees into Bone; but Dr. Nesbit
proves that the little round Bone lodgd in the Cartilagens.
Substance has no Connection (as would be the Case was
it as was formerly Supposed that the Cartilage changd
into Bone) at all with it; for by maceration in Water 
they will entirely Seperate & the little Bone will fall
out of its Lodging in the Cartilage if there is a Section
made thro the Cartilage. What then becomes of the
Cartilage? The Bone, as it enlarged, causes the 
Cartilage to grow thinner & thinner by degrees and

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at last entirely disappears -
The opinion of a French Anatomist is very 
improbable & may be totally overthrown, tho adopted by
some very good anatomists, among who is Palfin. The 
opinion is that the Bone is formed from the Periostœum;
this one observation of ossification begun in the 
middle of the Epiphysis, i.e. surrounded entirely by
Cartilage, will prove the above to be erroneous -
Of Callus -
By Callus is meant the new Bone which unites
the broken ends of Bones together after a Fracture: it 
is more Solid & compact than Bone, but nevertheless 
is cellular internally.
It is formed by the bony matter issuing from the
divided ends of the Bone; and Haller says that its progress
towards ossification is the same as of the Bone
itself, i.e. that it is first a Jelly, then, cartilaginous 
and at last becomes hard as bone itself. The 
uniting of the Callus is supposed to be performed in
the same manner as the Ciccatrization of Soft Parts
which are united by Vessels; [cross out] 
[cross out] as they both prove to be vascular
by Injection; indeed all new Animal Substances
are vascular, except the Cuticle: Haller says that
the Callus is more Vascular than Bone, which he 
proved by an Experimt. made on a Pidgeon - Tho' 
it 

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59.
it is said, that the Callus is formed from the Vessels
of the divided Extremities of ye Bone, yet it is my opinion
that Callus may be supplied from Vessels coming
from other Parts; and I am induced to be of this opinion
from a Case related by Mr. Gooch -
Callus is covered by Periostœum, at least by 
a membrane Similar to it -
It sometimes happen that Callus
will not be formed, as in the Scurvy which will
even dissolve Callus, if we may believe what is related
on this Subject in Anson's Voyage round the world;
Sometimes the Patient's Restlessness will prevent
the Formation of it. In 2 or 3 Cases where Callus
woud not easily form, I have seen amputation
performed; but I would never be to hasty in this +
It will not form, often, during Pregnancy, especially 
in large Bones; in small ones, I believe it
may. This matter is not well understood & the Causes
of it have never been clearly pointed out -
NB. From this Lecture to the 30th Mr. Else
is on osteology & the muscles; on which Subjects,
read Munroe & Douglas ---

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60
Practical Observations
which occur in Speaking of the Bones: and
first of the Cranium chiefly respecting the application 
of the Trepan
The first taken notice of is the Os Frontis. This 
Bone is divided into its Surfaces, Edges, Processes, Foramen
&c - On the upper Edge of each Orbit in the Processes called 
the Superciliary, is situated a small blind Hole or notch
thro which nerves and an artery pass to be spent on the Forehead;
These Vessels are sometimes divided by Cuts on the Forehead;
when it happens that the artery is divided at a distance from
the Foramen, the Hemorrhage may be easily Stopped by Bandages,
compresses &c but if it shou'd happen near the Foramen, 
the Artery may retract & it would be troublesome to 
Stop the Hemorrhage, as Pressure in this Case cannot have
any Effect & we can not come at the mouth of the Vessel to 
apply Styptics; we are to endeavour to stop the Bleeding by plugging
up the Foramen with Lint, and if that should not be effectual, 
the only way remaining, is to make a Ligature on the 
Vessel in the upper part of the [S]upper Eyelid -
In the Substance of this Bone just above the Nose and on each 
Side of it are situated two, 3, 4 & sometimes 5 Sinuses, divided by a bony
Septum, but all of them having a Communication with the Cavity of
the nose & lined wth. [cross out] membrane: These Sinuses, together
with a Spine situated on the internal Surface of this Bone in its Sehneider's
Middle, render the application of ye Trepan very dangerous & indeed
impracticable; in any other part of this Bone, the Trepan
may be applied with Safety; even over the Longitudinal Sinus, wch. runs
along the middle of this Bone; this however is to be avoided if possible 
& not to be done unless absolutely necessary, as in all operations
we are to avoid as much risque of Danger as we can - It is

In tracing a fracture of the left parietal bone in a
young man I was oblig'd to to cut through & to remove a
considerable portion of this Muscle. The patient got well
and appears to have sustained no inconvenience from it,
except a little uneasiness in chewing at first. I made
four perforations with the Trephine; the last near the 
anterior + inferior angle, of the parietal bone.
The hæmorrhage from the temporal artery, which was 
divided, and some of its branches, was easily
stopt by the needle + Ligature -
Essex County Apl. 10th. 1793 -

61
It is worth our while to remember that these Sinuses are rarely if
ever found in young Children, & not often in Women - 
We are not to mind what Authors tell us respecting the Application
of ye Trepan on the Sides of this Bone, on accot. of the Attachment 
of the Crotophite or Temporal Muscle to that part of it, wch.
must be divided & which they say, will not easily heal, occasioning
locked Jaws &c. Some of you have had an opportunity of Seeing the
Uselessness of this observation & Caution in a Boy whom I lately
Trepanned, where a large portion of this Muscle was removed,
& the Boy is now near well, having had no ill Symptom from it
but on the Contrary has been remarkably well ever Since the Operation
Of the Ossa Parietalia.
These Bones allow a large Scope for the application of the 
Trepan, there not being any part of it, but what upon emergencies,
it may be applied; but it is seldom that we are
under a necessity of applying the Trepan upon the Suture wch.
Connects these two Bones which is the most dangerous part to 
apply the Trepan on, on account of the Longitudinal Sinus
running immediately under it: it may, & has been done, however, 
both by Mr. Warner & Mr. Pott, without injuring the 
Sinus: The Trepan woud be dangerous on the lower part of
anterior [crossed out] inferior Angle of this Bone, where the artery of the
Dura Mater runs between the two Tables for a Small Distance;
but this is seated so low down toward the Basis of the
Skull that the Trepan could not be easily applied on it. 
There are in some Skulls, sometimes one & sometimes 2 small Holes,
near the edge of the Sagittal Suture a Small distance from the 
Posterior Superior Angle of this Bone, which serve for the transmission 
of vessels: a Hæmorrhage is sometimes troblesome from these.

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62
arteries, if divided, at or near their exit thro these Holes -
Of the os Occipitis -
It is Seldom we are obliged to apply the Trepan on this
Bone: it has been done however, the upper part of it &
rather to one side; as applied from a Skull Mr. Else shew'd us.
Mr. Else himself lately had occasion to apply it
on this bone; which he did just below the Lambdoidal
Suture between it & the [cross out] right lateral [illegible]
The patient lived Several weeks & then died.

134 

63

136

64



138



65



140



66



142



67
Of the Ligaments, Cartilages &c ~
The Ligaments are divided into Classes; viz, the
Bursal or Capsular, which Surround the Joints:
the Round, which serve to connect the Bones of
ye. Joints, as in the Femur & Acetabulum of ye. os
Innominat.; the Crucial, which are nothing more
than two of ye. Round ones crossing each other,
as in the Knee; and the flat, which Serve for
the attachmt. of Muscles, connecting two longitudinally Bones,
binding down Tendons &c-: those which connect 
two Bones in a longitudinal Direction
as the Tibia to the Fibula, are called Interossec.
They are composed of strong membranous Bodies
of Fibres closely united, and are Similar to the 
Tendons, being all of them inelastic in their Nature,
at least they will stretch or give way but very little.
Some Serve to connect Soft Parts, others hard; 
of the first, are the Ligaments of ye. Uterus &c.; &
the last are those which connect Bones, and 
of these I shall chiefly speak, confining myself to 
those

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68
those only which are the most remarkable -
of ye Ligaments of ye Spine -
Winston describes Ligaments running longitudinally 
upon the Spine externally, but they are 
very inconsiderable: on the inside of ye. Spine there
is a ligamentous Substance which Serves as a 
Sheath to the Bodies of ye Vertebræ: and each 
Spinal Process is connected to the other by a 
Small flat Ligament - There is a Strong Ligamentous
Substance which connects the Basis
of the Cranium to the Processus Dentatus of ye.
Cervical Vertebra, which Serves to preserve the 
Process. dentat. in its proper Situation, and 
to prevent the Head from falling forwards &c.
it is situated on the internal Surface of the 
Vertebræ of ye Neck & runs longitudinally over
their Bodies -
Between the root of each Spinal Process &
each oblique Process is placed a yellow Ligamentous
Substance which in Flexions of ye Spine
gives way & again recovers itself when the Spine
is erect: it has not the Shining appearance of ye white 
inelastic

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69
white inelastic Ligaments -
Between each of ye Vertebra of ye Spine is situated
a Ligamentous Substance, called Intervertebral Subste.
which on the outside resembles Cartilage, being harder
& more compact than in the middle where it is soft
& pulpy - It is thickest on its internal Edge & 
gradually grows thinner towards the external Edge.
It exists much plainer in young Subjects than in 
Old: in the latter it often becomes more firm
& hard and its attachmt. to the Vertebræ Stronger
by which means it prevents the free & easy Flexion
of ye. Spine, brings on an anchylosis between some
of ye. Vertebræ which causes an incurable Stooping &c.
Of ye. Ligaments of ye. Upper Extremities.
The Ligaments of ye. Clavicle have nothing in 
them remarkable. This Bone is connected at 
each Extremity by a short Capsular Ligament,
which admits of some little degree of motion: the 
Extremities of it being tipt with Cartilage - The Luxation
of this Bone at the Articulation with the Sternum
is not very common tho' it does sometimes
happen; for which, vid Else Surgery -
Between the Acromion & Coracoid Processes is placed
a

148



70
a Strong forked Ligament which connects these two 
immoveable Parts -
The Superior Extremity of ye Humerus is connected
to the Scapula by a Capsular Ligament which is 
longer than that of ye Femur at it's articulation
with the os Innominat. tho a smaller Joint, in order
that the motion of this Joint might be the greater:
it is a very perfect Instance of ye. Capsular Ligament, 
and this Joint has no round Ligament as
the Joint of the Femur & or Innominatum, but is
~ preserved in it's place, i.e. the Head of ye. Humeny
is presevered in its acetabulum by this Ligamt. &
muscles Surrounding it. This Ligament is connected
to the Brim of ye. acetabulum, from which it is reflected
on & lines the internal Surface of ye. acetabulum;
it is connected to the Cervix of ye. Humeny at the articulation
with the Epiphysis & is reflected over the 
Cartilage which cover the Head of ye Bone - within
the Capsular Ligament of this Joint lies the Tendon
of the Biceps muscle running to be inserted into 
the upper part of ye acetabulum Scapula, and Serves
in some measure the Purpose of a round Ligament to 
this Joint by preventing [fr???] Luxations. As Tendons
are inelastic this Tendon is sometimes torn in 
Dislocations

150



71
Dislocations, and when it is, the Joint remains weak
for a great length of Time and the Patient is not able
to lift his arm up to his Head, notwithstanding the
Luxation was well & immediately reduced - And
Sometimes this Tendon is Dislodged from its sulcus
in the Bone; which is attended with Violent pain
and an Inability to move the Limb as in a Luxation;
It may be easily replaced with the Hands after relaxing
the Muscle -
There are no Synovial Glands, as they are called, in this
Joint -
The Capsular Ligament of this Joint is often lacerated - always 
in dislocation by the Head of the Humerus pushing
thro' it; vid. a Case published in the Lond. Md. Obsns. 
by Mr Thompson: and it is often lacerated by the
violent Force used in Reduction of ye. dislocated 
Bone -
These Capsular Ligaments are said to 
be composed of two Lamina one external, the other
internal; but the external Coat is nothing but a
Continuation of ye Periostœum - It is observed
that the Capsular Ligament where they have the 
most motion are the thinnest, and in Such Joynts
as

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72
is have but little motion they are thickest: and they 
are likewise of difft. Thickness in different Parts of ye. 
Same Joynt, as in the Elbow; whose Capsular Ligament
is thinnest anteriorly and posteriorly; and thickest
laterally, where on accot. of this Thickening there has been
described 2 other Ligamts. called the Bracheo-radial
& Bracheo-Cubital; but they are nothing more than 
these thickenings of ye. Capsular Ligament - The Coronary 
Ligament of this Joint is a Plan of Fibres
continued from the Capsular Ligament and taking 
a Circular Course round the Head of ye. Radius
serving to give it Circular Motion -
In this Joint there are 3 fatty Substances called
Synovial Glands; one of them is very large & situated 
in the Cavity in the Extremity of ye Humerus which 
receives the olecranon of ye. Ulna -
The Radius & Ulna are connected to each other
by an Interosseus Ligament, in which as in [the]
other Interosseus Ligamts. there are Perforations thro
which Arteries & Veins Pass - It is this Ligament
we shoud carefully divide in amputations of ye.
arm below the Cubit before we apply the Saw, as it
will be apt to clogg the Teeth of ye. Jaw and prevent,
its

154



73
it's working freely -
The Radius & Ulna are connected to ye. Carpal Bones
at the wrist by a Capsular Ligament similar to those
of ye other Joints -
At the Anterior & posterior Part of the Carpus [are] is
placed a Ligament running transversely & serving to
bind down the Tendons of ye Flexor & Extensor Muscles
of the Hand -
The Ligament Transversale vel annulare Carpi is 
that situated at the anterior part of ye Carpus, and 
is a very strong Ligament serving not only to bind 
down the Flexor Tendons of ye. Hand but likewise
for the attachment of some of ye. muscles of the 
Hand, and to prevent the Bones of the Carpus from 
receding from each other, being in general attached
to the 5th & 8th Bone of ye Carpus -
There are several Synovial Glands in the
Joint of ye. wrist. -
Ganglions are white hard Tumours commonly 
without pain and Situated generally upon
the Tendons: they are formed by an Inspissation
of ye Viscid Gluey matter which besmears the
Tendon in all parts; they are encysted Tumours &
have

156



74 
have their Cyst formed by the Cellular membrane Surrounding
the Tendons - 
The Treatments of incipient Ganglions is by Pressure
to prevent the further accumulation of the matter, by 
mercurl. Plaisters &c - They have been cured in their 
Infany by sudden Blows upon them and wearing 
a continual Pressure with a Piece of Lead; for by 
these methods the Fluid contained in the Cyst is [cross out] 
forced out and is afterwards absorbed - Small Ganglions
may be opened by Incision without much Risque
but large ones when opened are generally attended with
violent Symptoms - The method which I look upon 
to be the best in opening Ganglions is this - The principal 
Cause of ye. violent Symptoms Supervening an
opening made into these Tumours is the Exposure of 
ye. Tendons to the external Air; therefore in order to
Obviate this, the Integuments covering the Ganglion
Shoud be drawn aside and kept Stretched till an
Incision is made into the Cyst of ye Ganglion and the 
Fluid contained pressed out; after which the skin is
suffered to recede into its natural Situation, by which
means, the wound in the Skin being at a distance from 
that made into the Cyst of ye. Tumour, all Communication
between them is shut off & the air is prevented from 
having any access to the Tendons; a Piece of Sticking 
Plaster

158


75
Plaister is to be applied over the Wound with a Piece of 
Lead secured upon it in order to make a moderately tight
Pressure upon the Part to prevent a further accumulation 
of Fluid; and what is left in the Cyst, as 
it cannot all be pressed out, will be absorbed. -
This method has succeeded Several Times without
any violent Symptoms, and is preferable to any other
method - If ye Ganglion shoud be large & this method
shoud fail, a Seton may be passed thro' it, wch.
will cure it without exposing the Tendons - Mr. Baker
thought that as the Caustic Cured in the Hydrocele, it
might probably answer in these Tumours; but
in the Hydrocele the Scrotum contracts itself as the
Sloughs of ye. Tunica Vaginalis comes away, and by 
that means prevents the access of Air to the Testes;
in the Case of the Ganglions it is different, for here when 
the Slough occasioned by the Caustic comes away,
the Integuments not having that contractile Power
as in the Scrotum, the Tendons become exposed to the 
Air which dries them & brings on the violent Inflammation 
&c. for which Reason tho' Mr. Baker succeeded in 
one Case yet I think the Practice is not to be recommended -
Mr. Sharpe when Surgeon to Guy's Hospl.
attempted the Cure of Ganglions when large by removing
a

160



76
an oval piece of the Integuments & dissecting out the
Cyst; but by this method the Tendons & ligaments were
laid bare and the Patients not only generally lost
their Limbs but narrowly escaped with their Lives.
As these Ganglions are caused by an Inspissation
of ye. Glary viscid matter which every where lubricates
the Tendons, we oftener find Ganglions situated upon
the Flexors & Extensors of ye. Hand; for being very
numerous, more confined & closer together under
& near to these Transverse Ligaments that bind
them down, a greater quantity of this Fluid is necessary 
and is allways found here; and being Situated
So near the Joynt are more dangerous; for if the Fluid
is suffered to remain in the Cyst till it bursts of itself
it has commonly become acrid & destroyed the Joynt &
insinuating itself among the Tendons, unless immediate
resource is had to amputation, the Patient generally
loses his Life from the violence of ye Subseqt.
Symptoms; and if they are opened by Caustic or Incision 
as formerly, the consequence is the Same; therefore
the Method I have laid down, I look upon is the
most promising to obviate this mischief - The 
Ganglion

- N.B. Mr. Sharpe imagines there is not so much danger as is
said to be in the Division of the Ligamt. transvers. Carpi. &
that the Objections to its being done so not of much Consequence; 
and therefore when Surgeon to Guy's Hospl. he divided
it once in a man who had a large Ganglion under it: but
tho' he succeeded in it, yet the Symptoms of Inflammatn.
run so high that the Patient narrowly escaped losing
not only his arm but his Life - Mr. Warner likewise
has done it more than once - But for my own part I
cannot approve of it -
162 

77
Ganglion most to be dreaded is that situated under the
Carpal Ligament as we cannot come at it for the Cure 
without wounding this Ligament; and when they grow
to any Size, by putting the Ligamt. upon the Stretch & compressing
the Tendons [Many] it creates great pain & prevents
the Flexion of the Tendons - ~ N.B.
There are other transverse Ligaments placed at the
Extremities of ye Metacarpal Bones towards the Fingers
under which the Flexors of ye. Fingers pass; and there 
are likewise at every Joynt of ye. Fingers Strong ligamentous
or tendinous Fascia to keep down the Tendons, under
which matter often forms and causes what is called
a Whitlow - In these Cases the matter cannot point
easily outwards in the Fingers or Palm of ye. Hand
and therefore we often See that the matter insinuates
itself backwards pointing upon the Back of the 
Hand, and sometimes above the Carpal Ligament 
on the inside of ye. wrist, in which last Case the 
Bones of ye. Carpus &c. are often, indeed generally, 
Carious & Amputation is often necessary : this may
be prevented by timely making an Incision down to
the Bone, and dividing by that means the Tendinous
Fascia which being inelastic will not give way to the 
Matter

164



78
matter for it to point externally until much mischief 
has been done: if at any time we shoud Inspect 
matter to be confined in any of these Plans & 
Shoud proceed with the Incision and find no matter
the Injury will not be great; but if the contrary shoud
turn out much Mischief will be prevented - This
Rule holds good in every part of ye. Body wherever
we suspect Matter to be formed under the Tendinous
Fascia, as of ye Temporal Muscle &c -
Of the Ligaments of ye. lower Extremity & Pelvis -
There are a great many Ligaments belonging to the 
Pelvis, the principle ones are the Sacro-Sciatic & Obturators -
The Sacro-Sciatic Ligaments run from the 
Sacrum to the Acute & obtuse processes of ye Ischium
The Obturator fills up the great Foramen Ischii thro wch.
the Obturator Vessels pass into the Thigh -
The Capsular Ligament of ye Os Femoris at it's 
Articulation with the os Innominatum is similar to that
at the Humerus, but within it there is anoyr. Ligamt.
called called Ligamt. Teres, which is fixed into the
Bottom of the Acetabulum and in the middle of ye.
Head of ye. os Femoris: this Ligament prevents a Luxation
upwards & outwards, & in this Species of Luxation
this Ligamt. I believe is always ruptured: it has 
sometimes

166



79
sometimes been found ossified in old People, in which
Case it may occasion an Inability to move the Joynt -
The Capsular Ligament serves to resist a Luxation in 
some degree in every Direction - At the Bottom of the 
acetabulum is a large Synovial Gland: which sometimes 
increases so much as to throw the Hand of ye.
Bone of ye. Socket -
At the Knee there is a Strong broad Ligament which 
goes off from the Patella to be inserted into the Tibia 
connecting these two Bones together - a Rupture of 
this Ligament Sometimes happens which may easily
distinguished and the Treatment consists in keeping
the Patient in Bed with his Knee Strait makg;
use of Bandages, splints &c. till it is united -
The Capsular Ligament of this Joint is very Short,
is thinner anteriorly & posteriorly than laterally: the 
2 lateral Ligaments are only parts of the Capsular 
as they cannot be Seperated - Within the Joint
there are two round Ligaments which cross each 
other and for that reason are called Crucial Ligamts.
The largest Synovial Gland in the Body is situated
in this Joynt -
The Capsular Ligamt. of the Knee contains & encloses
the Water in a Dropsy of this Joynt which Mr. Baker
has attempted to cure with Caustic, but he was 
disappointed




80
disappointed; and the best method of treating them is 
with moderately tight Bandage and drastic Purges
given at proper intervals - 
On the upper part of the Tibia are placed two Semilunar
Cartilages upon which the two Condyls of 
the Femor rest -
The Tibia & Fibula are connected by an Interosseous
Ligament; which we are carefully to divide in amputations
of ye. Leg before the Saw is applied.
The Joints of ankle & Foot are Surrounded by 
Capsular Ligamts. as in the wrist & Hand & besides
a number of other Ligaments which will not admit
of a Seperate Description; they are all much Stronger
in the Foot than the Hand as they support the 
weight of ye. whole Body - 
All the Bones of ye. Tarsus have a small degree
of Motion upon each other - It often happens that 
matter will be formed among these Bones, & from a
Presumption that all the Bones are Carious, Surgeons
all ways recommend Amputation of ye. Leg: but if
we could be certain that only one or two of the Bones
were affected, the Limb may be saved by extracting 
the Carious Bones, which I once Saw done by an
eminent Surgeon of this Hospl. & the Patient did well
with ye. Inconvenience only of a little Stiffness in ye. Foot. -




81
Of the Viscera-
The Viscera are the Contents of ye three great Cavities 
of ye Body, that of ye Cranium, Thorax & abdomen;
of which the smallest is the Cranium, and that of
ye. Abdomen by much the largest - We shall first 
examine the Contents or Viscera of ye. Cranium, which 
are called by ye. general Term of Encephalon -
After removing the Cranium the first that present itself
to our View is the Dura Mater which Surrounds the 
Brain in every part; under it we have the Pia 
Mater which lies in immediate contact with the Substance
of ye. Brain - The Brain is divided into three
Parts, viz the Cerebrum, the Cerebellum & Medulla 
Oblongata; the Cerebrum is much the largest of the 
three & the medulla the smallest. The 
Cerebrum is Situated anteriorly. Superiorly & posteriorly;
the Cerebellum posteriorly & inferiorly; and under it
the medulla oblongata is placed, immediately before
the great Foramen, and passing thro it to the 
Spine is called medulla Spinalis, carrying along wth.
it as it passes the Dura & pia Mater as its Coats
or Coverings - The Cerebrum is divided into two Portions 
called its Hemispheres by a Longitudinal process of 
the




82
the Dura Mater called the Falx, and each of these
Hemispheres are divided into 3 Lobes, the anterior,
middle & Posterior; the last of which lies immediately 
over the Cerebellum, which is divided into 2 Lobes - 
I shall first examine the Coats or Membranes of
the Brain & afterwards Speak of its Structure -
The Brain has two proper membranes or Coverings
called the Dura & Pia mater; and some say that
it has a third which they call Tunica Arachnoids,
but if this is allowed to be a Membrane of ye. Brain
it is only a partial one & perhaps does not exist in
all Subjects; in any Subject it can only be found in 
a Small proportion lying between the Dura & Pia Mater
at the Posterior part ye. Brain towards its Basis
The Dura Mater is the external Coat, and is a
strong, thick, inelastic membrane of a white Glittering
appearance in a Sound State: the external Surface
appears to the Eye Smooth & even, but when put 
into water there appear many Small Filaments
attached to it & floating in the Water, which are 
nothing but its Vessels and not processes of it as is said by
some - It adheres to the Cranium internally by its
Blood-Vessels, and this adhesion is most strong at
the




83
the Suture, which is occasioned by the Bones of the Cranium
when they first meet & unite to form the Sutures taking in
a part of this Membrane between their Indentations; this
adhesion however at the Sutures is much Stronger in Infants
& young Children than in Adults: it likewise adheres very
strongly at the Basis and different Foramina of ye. Skull
at which it meets with the external Covering of the Cranium 
the Pericranium and adhering to it causes this adhesion -
The internal Surface is smooth & polished and is seperated
from the Pia mater by a small qty: of pellucid Fluid
like that of ye Pericardium; but there is a Slight Adhesion 
of these two membranes in places where the Veins of the 
Pia mater pass the Dura mater into the Sinuses; This 
Fluid is deposited by Vessels as no Glands can be found 
there ~ The Dura mater is said to be composed of two 
Lamina, and that the Sinuses of the Cranium were formed
by the external, and the internal processes of this Membrane
were continuations of ye internal Lamina; but
this is not the Case as it cannot be seperated but by
Violence -
The Dura Mater has external & Internal Processes;
the most remarkable of ye external is at the great 
Foramen, and where the nerves go out they are every where
Surround by this membrane - The internal Processes are 
4; the Longitudinal or falciform, 2 Transverse, and anoyr.
Small




84
small one which divides the two Lobes of the Cerebellum.
The falciform begins at the Crita Galli of ye os Ethmoides
& passing along ye middle of the OS. Frontis, & under the Sagittall
Suture, till it getes a little beyond the Lambdoidal Suture where
it divides into the two Transverse, The falciform divided the Cerebrum
into the two Hemispheres, and the Transverse divides the Cerebrum from
the Cerebellum, preventing the first from pressing too much upon the 
latter; and the fourth Divides the Cerebellum into its two equal
Lobes - These Processes are sometimes Ossified which is said to have been the
Case of One in His Royal Highness the Late Duke of Cumberland.
The Structure of these processes is very singular, for if you carefully
take off the Dura Mater, they will appear as firm & strechd out, as
in a dried State, but thrust the Point of a Lancet or even a Pin thro
any part of them, & the whole will immediately Sink down and
Collapse.
The Sinuses are caverns receiving Blood from all the
Vessels of ye. Brain & it's Membranes, and are in reality nothing
but Veins, but they are rather thinner than the 
Veins in other Parts of ye. Body: they are of a Triangular
Shape, and their Situation, which we ought to be well
acquainted with, is every where behind the internal Processes
of ye Dura Mater; so that if we understand the 
Course of ye. one we may of ye. other. The 4 Principal ones 
are, the Longitudinal, 2 Lateral, and the Torcular: some
describe 13 or 14, but none are of any Consequence except the
4 Just mentioned, the Course of which is of much Consequence
to




85
to be understood -
The Longitudinal begins at the Crifta Galli where it is small
& runs along behind the falciform Process increasing in Size
in it's Progress towards the Lambdoidal Suture where it divides 
into 2 Lateral which run behind the Transverse Processes
of ye Dura Mater & go to terminate in the Jugular Veins -
The Torcular Herophili is situated between the Cerebrum & Cerebellum
on the upper part of ye latter in the middle between its two Lobes,
and receives the Blood from the Plexus Choroides - The Course of ye.
Circulation in these Sinuses is from before backwards: they 
are said to receive Blood from arteries terminating in them, but
the finest Injection will not pass into them by the arteries, where
as any Course Injection will pass into them by the Jugular Veins,
for they have no Valves, and they may be distended by throwing
air into one of ye Veins which plainly shews their Communication; 
the Pulsation which is observed in them & caused the
Conjecture that arteries terminated in them, is occasioned by ye
motion of ye Brain, which the Pulsation of ye Sinuses obeys.
on the internal Surface of the Sinuses are a no. of Small white
Cords, called Cords Willisii, which runs from one Side to the other
and Strengthen & prevent a too great Distension of them - Polypus
concretions are allmost allways found in the Sinuses -
It has been laid down as a Rule not to apply the Trepan
upon the Sutures of ye Cranium for fear of wounding these Sinuses, as no
application whatever can be made use of to restrain the Hæmorrhage;
but many Instances have been given by some late
Surgeons of their having been wounded & the Patients did well:
Mr.




86
Mr. Warmer lately met with a Case where the fractured 
Bone was depressed upon the Sagittal Suture; he removed the
fractured Bone and the Sinus was found to be wounded, but
there was no profuse Hæmorrhage and the Patient did well
Mr. Pott has twice applied the Trepan and extracted Bones
that ware forced thro these Sinuses with Success, but it was
on the fore part of ye. Head where the Sinus is but Small -
Some have lately punctured the Sinuses purposely, in preference
to bleeding in the arm, when they have been laid 
bare in Fracture of the Cranium without being wounded; 
but this I woud not recommend, nor the application of ye. 
Trepan upon the Sutures unless there was an absolute necessity
for ye. Relief of ye. Patient and when this is the Case I
woud not hesitate about doing it if it was on the forepart
of ye. Head where the Sinus is small; but on the back
part where they are large, in all probability the Hæmorrhage
woud be fatal if they were to be wounded-
The Dura mater is inelastic; hence it will not give
way to matter when it is formed under it, in which case
it is necessary to puncture it to discharge the Matter before
it can affect the Brain, but this Puncture is by
no means to be made wantonly & upon a slight suspicion;
as the exposure of ye. Dura Mater is attended with bad
Consequences; besides, even a Simple exposure of it
alone in Trepanning sometimes is attended with violent
Inflammatory 




87
inflammatory Symptoms, and there woud be much greater Danger
in puncturing it - It was a long time Supposed that the Dura
Mater had Motion in itself, hence it was thought to be muscular;
but when it was proved that it had no muscular 
Fibres, it was then Said that the Pulsation was caused by
the arteries upon it's Surface; but it has no motion at all 
of itself, and when a portion of ye. Skull is removed from
it, the motion which is observed in the Dura Mater it that
Placed is caused by ye Motion of ye. Brain - It has 2 
arteries and the Impressions they make upon the internal
Surface of ye. Cranium shew how exactly the Cranium
is filled up in every part by the Encephalon -
The Pia Mater is a very fine thin membrane every
where closely adhering to and covering the Brain; the external
Surface is smooth & Even, with its' Blood vessels appearing
very visibly on it on account of its' Fineness - It has
external & internal Processes; the external are Similar to
those of ye Dura Mater always accompanying each other
and as they pass out at the great Foramen they adhere together;
the internal processes insinuate themselves between all the
Convolutions of the Brain forming a No of Septa, Plecæ &c.
in the Cerebrum & Cerebellum -
We know but little or nothing of ye Structure of the
Brain; it is supposed to be a Gland by some - It is externally




88
externally of a brown Cineritious Colour, internally white; the
brown part is called the Cortical; & the White the medullary
Part, which is much less vascular than the cortical.
The cortical part is looked upon to be the Secretary part
and the medullary parts are supposed to receive the Secreted
Fluid called the animal Spirits which is conveyed 
from thence to every part of the Body by the Nerves wch.
are looked to be the excretory Ducts -
All Animals are Supposed to have a greater or less degree
of Sagacity in proportion to the Size of their Brains but
I believe there is little in it; the Human Brain is the
largest of all animals, and weighs about 4 Pounds in
an Adult -
Of the Structure of ye. Brain with the
Method of Dissecting it -
The Cranium being Sawed thro all round near its' 
Basis just above the Orbits of ye. Eyes & upper extremities 
of the Ears and taken away, the Dura Mater is then to 
be carefully raised from the Pia Mater with the falciform
Process, and the two Hemispheres covered with 
the Pia Mater is laid bare -
Seperate the 2 Hemispheres a little asunder with
the Fingers, and we get a View of a little white Appearance
called the Corpus Callosum. 
a




89
A very large Portion of the Cerebrum, almost the whole of it,
is carefully to be removed with a very Sharpe Knife, when 
we see the cortical Part every where external & the medullary
Part internal & putting on an oval appearance, hence
called the Centrum Ovale; we have now a better and plain
View of the Corpus callosum, thro the middle of which runs
a longitudinal Eminence called the Raphe'; on each side
of this Raphe' are situated the lateral Ventricles -
The next thing to be done is to open the Ventricles by making
an Incision on each Side the Raphe thro the Corpus callos.
and carefully removing a part of ye. medulla about it on 
each Side; we have then a view of these canals running
from the Anterior part of the Brain & passing beyond the
Middle Lobes to the Posterior one they take a winding
turn downwards & forwards & terminate in the third
Ventricle -
In these Cavities there is all ways a small quantity
of watery Fluid; and when this Fluid is accumulated 
in too large a Quantity, the Disease is 
called a Hydrocephalus, for which we ought never 
to open the Tumour in order to discharge the water
for the Patient generally dies in a Short time after the
Operation -
Immediately under the Raphe, is a white medullary




90
medullary Substance appearing when the Raphe is
gently drawn upwards, called the Septum Lucidum.
We now make a Longitudinal Incision along the
middle of ye. Raphe & thro the Septum Lucidum and
carefully throw aside the part on each Side, when 
we get a view of ye. Fornix, which is a white medullary
Body following the Course of ye Ventricles beginning
anteriorly in one Body and running a little way posteriorly
they divide into 2 Crura called
Crura Fornicis, on each Side of which is seen a 
portion of ye. red vascular Substance called the
Plexus Choroides, and at the anterior Part of 
the Fornix are Situated 4 Eminences, two small
ones which are most anterior & called Corpora Striata
and two larger & more Posterior called the Thalami
nervorum opticorum -
Cut thro the Body of the Fornix and turn one part
forwards & the other backwards, and we then get a more
perfect view of ye Plexus Choroides and the Thalami
Nervor. Opts; on each Side the Plexus choroides and
between the Thalami are one or two large Veins
called Vena magna Galeni which come from the 
Plexus choroides and limiting form a large veins
which 




91
which terminates and empties its Blood into the 4th
Ventricle of ye. Brain called the Torcular Herophili
The Plexus choroides serves as a kind of Pia mater
to the Ventricles whose Course it follows every where
and is nothing but a fine membrane composed of 
Blood Vessels, all of which empty their Blood into 
the Torcular Herophili -
Remove the Lupus Choroidis & we then have a
more perfect view of ye: Thalami between which is situated
the 3d. Ventricle which we may see by Seperating
the two Thalami a little: here we have also two 
small Foramina, one anterior leading from the Thalami
to the Infundibulum and called the Vulva or 
Iter ad Infundibul.; the other posteriorly going into 
the aqueduct & called Anus; these 2 Foramina
communicate with each other between the Thalami
The Iter ad Infundil. [cross out] Leads immediately down to the 
Glandula Pituitaria, and when a Probe is thrust
down thro it the end of the Probe rests immediately
upon the Gland which is situated upon the Sella
Turcica - The Infundibulum is that Part where
the Ventricles all terminate in the middle Lobes
of ye. Brain - Between the Thalami posteriorly we 
have




92
have situated small red Body called the Glandula
Pinealis which is covered by a Pia mater & is attached 
to the Thalami - This was supposed by Descartes to
be the Seat of the Soul because the Cerebrum & Cerebellum
met here first - Behind the Infundibul.
lies the 4th Ventricle which communicates with 
the 3d. by the Aqueduct of Fallopius, and has a
process called Calamus Scriptorius; but this cannot
be shewn till the Brain is taken out of the Cranium,
and we must therefore now proceed to the Cerebellum:
to get a view of which, we must carry off all the 
Posterior Lobe of ye. Cerebrum carefully, and when 
this is done we have a view of it covered by, the 
Dura mater and divided by the 4th. Process of ye. 
Dura mater into 2 Lobes; we likewise See the
Plexus choroides going to terminate in the Torcular
Herophili. On removing the transverse processes
of the Cerebellum it then appears covered with the
Pia Mater - on making a horizontal Section
thro its Substance we find the external, the Cortical 
Part, & the Internal the Medullary; but the Medullary
part puts on a different form from that of
the Cerebrum, ramyfying like the Branches of a 
Tree`




93
Tree & hence called Arbor Vitæ -
We now return to the Brain & shew 4 Eminences
Situated behind the Thalami and immediately
under the Penial Gland called Tubercul:
Quadrugimin. or Nates & Testes -
Underneath these Tubercles runs the Aqueduct
of Fallopices leading from the 3rd. to the 4th. Ventricle - 
The 4th. Ventricle is shewn by removing a
Portion of the Cerebellum Situated on the Back
part of ye Medulla oblongata, and by introducing
a Blow-pipe between the 2 Thalami
into the 3d. Ventricle & blowing air into it we
blow up the 4th by ye Air running thro the 
Aqueduct. Fallopii into it - Thus then we 
see the Communication between the 4 Ventricles;
the 2 Lateral terminating in the 
3d. & the 3d. with the 4th. as above -
The Brain is now to be taken out of ye. Portion
of ye. Skull that contains it; in doing of which we
are to shew the different Pair of nerves that belong
to the Head - of these there are 10 Pair; all of which




94
which at their first origin appear very loosely connected
together by the Pia mater only and after
Piercing thro' the Dura Mater they are closely surrounded
by that Membrane and appear to be 
white Shining Cords - The 1st. Pair we have a 
Sight of after raising the anterior Lobes of the
Cerebrum a little out of ye. Basis of ye. Cranium
are the Olfactory which are very small and pass
out near the Crista Galli - The 2d. Pair are
the Optic, which are very large and arise Single
at first from the Thalami nervor. optic.
but unite at the Sella Turcica and again soon 
Divide, and pass out thro the Foramina in the Os
Sphenoides & go one to each Eye - Behind these 
we see the 2 Carotids going into the Brain; the Gland.
Pituitaria and the Infundibulum - We come
next to the 3d. Pair which arise from the anterior
Part of ye. Tuberculum Annulare and are distributed
about the Globe & Muscles of ye Eyes - Behind these
are the 4th. pair which are the smallest of any, 
arise nearly in the same place as the 3d. and are 
distributed about the Eyes - The 5th. are a 
large




95 
large Pair which arise from the Tuberculum
annulare laterally and are distributed upon the 
Forehead &c. - Behind the 5th. are a smaller
Pair the 6th. which arise from the Corpora
Pyramidatia and are distributed about the 
Face chiefly - The 7th. are the auditory, which 
are Small and are distributed in two Branches
each about the Ears; one Branch is the Portis
Mollis which is supposed to receive no Covering
from the Dura Mater and is distributed about
the internal Parts of ye. Ear; and the other Brch
the Portis dura is spent upon the external Prts.
& part adjacent - Next to these we have the 
8th. which arise from the 2 Eminences called 
Olivaria and joining the Nerve called Accessor.
Willesii and are distributed about the Neck,
Some Muscles of ye. arm, Larynx, Face &c -
The 9th. go out just at the Verge of ye. great Foramen
and are distributed upon the Tongue &
Muscles of ye. Os Hyoides &c. - The 10th. we cannot
now Seow as they pass out between the 1st. & 2 
Vertebræ




96
Vertebræ of ye. Neck upon the muscles of which 
and other Parts adjacent -
An (Obstruction in any [crossed out] of these Nerves will
cause a Paralysis or loss of motion or Sensation 
in whatever parts they are Sent to, unless they 
receive Branches from other Nerves, and if they 
do, the Action of such Parts will nevertheless be
much impaired from this obstruction of ye. Principal 
Nerve - Thus an obstruction in the first
Pair may occasion a Loss of ye. Sense of Smelling:
in the optic, Loss of Sight, which is called a Gutt
Serena when the Eye does not alter its appearce.
at all but yet has no Sights; in the 7th. Pair
an obstruction produces an Incurable Deafness
The Brain is now taken out, and the 
Basis turned upward; this appears very 
irregular, having 4 Eminences; the 2 anterr.
which are the posterior Lobes of ye. Cerebrum are called Olivaria;
and the 2 posterior are the inferior part
of ye. 2 Lobes of ye. Cerebellum and are called the
Corpora Pyramidatia: in the middle between these
4




97
4 Eminences is situated another Eminence called
Tuberculum Annulare from which the Medulla 
Oblongata is continued thro the great Foramen - 
In some Brains the Tunica arachnoides may be 
now Shewn on the posterior part of ye. Medulla Oblongt.
between the Dura & Pia Mater -
Upon the Medulla Oblongata are observed several
Eminences, and on the Posterior part of it is seen 
the Process of ye. 4th. Ventricle called the Calamus
Scriptorius.  




98
Of the Thoracic Viscera.
The Thorax is bonded anteriorly partly by Bone & 
partly by Cartilage, posteriorly and laterally by Bones, Ligaments, 
Muscles &c - Its Contents are, the Aorta & 
Oesophogus, which run behind the Pleura, the Lungs,
and the Heart with the Pericardium which are contained 
within the Pleura. The Cavity of the Thorax is lined 
internally by the Pleura which is a reflected membrane
giving a Coat to the Lungs &c.: it's external Surface is
rough & uneven, owing to the Cellular Membrane adhering
to it; its internal Surface is smooth & even and is lubricated
by a watery Fluid called Liquor Pleura: it differs 
from the Peritonm. in one Respect, forming only 
one Bag for the Abdominal Viscera, whereas the Pleura
forms two, one for each Lobe of the Lungs. These two 
Bags come nearly in Contact anteriorly in the Middle 
between each Lobe of ye. Lungs under the middle of 
the Sternum; their two Sides here are only Separated by a 
Small quantity of Cellular Membrane and this Duplicature
of ye. Pleura is called Mediastinum, which is attached 
to the middle of the first & Second Bone of the Sternum, but
when it gets to the 3d. or last Bone it turns a little to the 
left; hence ye right side is larger than the left - but 
this is various in different Subjects - The quantity of Cellular
Membe.




99
Membrane between this Duplicature is but small, tho' we
find some authors describing it as keeping the 2 Folds or
Sides of ye. Bags at a considerable Distance from each other;
this is occasioned by lifting up the Sternum to shew this 
Part, but if we replace that Bone in its proper place it is
evident that the Sides of ye. Mediastinum is nearly in
Contact, but when the Sternum is raised they Seperate 
wider - at the Anterior & Superior Part of ye Mediastinum
is placed the Thymus Gland - The Sides of these two Bags
approach each other behind at the Spine in the same 
manner as they do anteriorly, which some have distinguish'd
by the name of medinstin. poster., but it is only a Continuation
of ye. Duplicature - The Pleura is reflected over
the Lungs from the Place where the Pulmonary Vessels enter,
and gives an external covering to them: we sometimes meet 
with adhesions of ye. Pleura which lines the Cavity & that
which covers the Lungs, which are unattended with any
bad Symptoms during Life -
We are told by Surgeons that Abcesses form sometimes
between the two Lamina of the Mediastinum; to remedy 
which, they advise making a Perforation thro the
Sternum with a Trephine to evacuate the matter. The 
Symptoms attending these Abcesses are Pain and
Difficulty of Breathing, Syncope &c., and Sometimes 
there is an external Tumour attended with a Pulsatory 
Motion




100
Motion, and hence is mistaken for an aneurism of the 
Aorta. A Case of this Kind lately happened in Guy's Hospl.,
in which, the Surgeons observing the Pulsation which the 
Tumour had, expected when it burst that the man woud
immediately die; but to their Surprize it burst and discharged
in large Quantity of Pus and the Patient did well.
Here if the Case had been suspected, the application of the
Trepan in Time woud have been of Service: and there is 
not the Danger of Applying this Instrument upon the Sternum
in these Cases as some imagine; for tho' the mediastinum
in a sound state is nearly in Contact, yet when 
Matter is collected in great Quantities between the Duplicature 
of it, they are Seperated by it so far that there
will be no danger of opening either the right or left side
of the Cavity of ye. Thorax, which we shoud be very careful
to avoid allways; for if the Pleura is wounded on both
Side of ye. Mediastinum, ye. air rushing into both
Cavities woud occasion a Suffocation - if only one Side
however of ye. Cavity is opened, the Air getting into it, wou'd
not produce Suffocation, as the other Lobe of the Lungs woud
not be interrupted in performing its office by this accidt. 
The Mediastinum Serves to keep one Lobe of the Lungs
from pressing upon the other whenever we lie down upon
Side, and also to cut off all Communication between them,
that




101
that one may act without Interruption when the other is 
diseased: and we have frequent Instances of Patients
who have lived Consumptive for Several months, when one
of the Lobes have been found after Death entirely destroy'd:
Such however have allways a Difficulty of Breathing &c.
In Empyemas the Lungs are often eroded, and sometimes 
one Lobe entirely destroyed, yet the Patient lives some
Time after it - A Man not long since at Guy's Hospl.
had the operation for the Empyema performed & Several
Quarts discharged and the whole Lobe on one Side in
a ulcerated State, yet he lived Several months after
it; and on Dissection after Death, only a Schirrus Knot
was found in that Side of ye. Cavity and no Air Tubes or 
Vessels were observed to be sent to it - There are some
who deny this Doctrine however -
The Thymus has a vascular appearance in Adults
and is small; in ye. Fœtus and young Subjects it is 
large and appears a perfect Gland: it often extends
under the Sternum and into the neck above the Clavicles.
no excretory Duct has yet been found belonging to it, tho'
it is said that it secretes a Fluid which is deposited in 
the thoracic Duct for the Nourishment of ye. Fœtus; but 
how it can get there is not clear - as it is so small in 
adults



102
adults to what it is in the Fœtus it may perhaps serve
Some Particular Purpose to the Fœtus which is no longer
necessary after Birth and therefore it gradually decreases
as age advances, and in some there is hardly any vestage 
of it left - I have seen it very large in a Criminal
who I dissected at Surgeons Hall -
The Liquor Pleura serves to moisten the internal Surface
of ye Pleura and external Surface of the Lungs, preventing
adhœsions of them &c.-; some say it is deposited by Glands, 
and others by Vessels, which last is certainly the Case, as
no Glands can be demonstrated here, when this Fluid is 
accumulated in too large Quantities it is called a 
Dropsy of the Breast; if it is in too small quantity it
may be the Cause of Adhœsions - 
The Thyroid Gland is situated upon the upper part
of the Trachea rather below the Thyroid Cartilage more
upon the Cricoid, but it is connected to the Thyroid Cartilage
from whence it hangs down upon the Cricoid. It is called 
a Gland tho no excretory Duct can be found, nor do we know
that any Secretion is carried on by it, and it's use is equally
unknown - It is the seat of the Bronchocele which is 
an Enlargement of this Substance - It has 4 considerable 
Blood vessels to it, hence we might conjecture it
might



103
must serve some particular use which we are unacquainted 
with at present - In the adult there is observed
a considerable Depression or Fissure in the middle 
of this Gland -
On the Anterior part of the Neck we See the Larynx 
projecting forwards, from which is continued the Trachea
or Air Tube, which is in part muscular & in part Cartilaginous -
Behind the Trachea lies the Oesophogus
or Alimentary Canal, which is a muscular Bag;
from this Situation of the Oesophogus it is evident
it can hardly ever be injured in any attempts of 
People who cut their Throats, or without dividing the 
external Carotids &c -
The Pericardium is a membranous Bag containing
the Heart within it, and hence its Name - Some
anatomists describe it as having 3 Coats, others 4; but
properly it is composed of two only, the membranous &
Tendinous: the Membranous is only a Continuation
of the Pleura over it; the 2d. Coat ye. tendinous adhæres
to the Diaphragm, and hence it obeys its Motion: therefore
for we are told that in very deep Inspirations this
Tunic is compressed by the Diaphragm against the right
auricle & Ventricles and by that means puts a stop to the
Circulation



104
Circulation for a Second or two; this will be found to
be true; for if we make a deep Inspiration and hold
our Breath for some time after as long as we can, 
and at the same time keep a Finger upon the Pulse
at the wrist we may observe the Pulsation to flagg or
totally Stop for a short time - the 3d. Coat as described 
by some is the internal surface of ye last which is 
reflected over the great Vessels going from the Heart
from the Place where the Pericardium adhæres to them, 
and over the external Surface of the Heart - within 
the Pericardium is lodged a Liquor which Lubricates
the external Surface of the Heart & prevents its adhering
to the Pericardium. The quantity of this 
Fluid is different in difft. Subjects; in some near
a pint has been found & the Parts not at all
diseased, in others very little - some say, the longer 
it is before the Body is dissected after Death the greater 
will the quantity be, and vice versa - But this is 
only conjecture as I have found the reverse turn out:
it is sometimes of a reddish Colour, which is owing to 
a Transudation of Blood from some of ye. Small Vessels
of ye. Heart after Death & mixing with it gives
it this Colour - It is deposited by Vessels -



105
Of the Lungs -
The Organs of Respiration are divided into Active
& passive: the Lungs are the Passive & the Diaphragm
Intercostal Muscles &c. are the Active.
The Lungs are divided by the Mediastinum into 2
Lobes, the right & left: the Figure of them have 
been compared by some to the Hoofs of a Cow's Foot;
they are convex Superiorly, posteriorly & laterally, and
concave inferiorly -
In a deep Inspiration the Heart with its Pericardium
is almost entirely covered by the Lungs, but in
Expiration they recede from each other & leave the anterior
part of the Pericardium bare - whether in Expiration 
or Inspiration the Lungs with the Heart 
& their membranes entirely fill up the Cavity of the 
Thorax & the Lungs are allways in Contact with
the inner Surface of ye. Pleura; hence it is scarcely
possible for the Lungs to remain unhurt in wounds
penetrating the Cavity, and wounds of them are easily
discovered by the Discharge of frothy Blood both from 
the Wound. and Mouth; and if the wound is deep it 
will be attended with violent Symptoms of Inflammation
&c. which generally prove fatal; tho' Slight
wound of the Lungs have done well -




106
The outer Surface of the Lungs in Infants appears to
be of a granulated Substance like a conglomerate
Gland, but in adults this appearance does not exist;
they are of a redder Colour in ye. Fœtus than in adults
in whom they put on a greyish appearance - 
The Lungs have 2 Coats; the external is a Continuation
of the Pleura reflected over their external 
Surface and is connected to the 2d. by a Body of Cellular
Membrane in the Fœtus, but in Adults it is very 
difficult to Separate the one from the other. The 2d.
Coat adheres firmly to the vascular substance and 
sends off Continuations which are insinuated thro
the Substance of the Lungs &c Covering the air Cells.
The Lungs are composed of Blood Vessels & Air
Vessels - The Air Vessels are Derived originally from 
the air Tube the Trachea, which ramifies thro their 
Substance and forms an infinite number of Cells
which communicate one with the other - This Tube 
Arises in one Trunk & takes different names in 
different Parts before it gets to the Lungs; its 
upper part is called the Larynx which is covered by 
the Glottis to prevent any Alimt. getting into it in 
Deglutition




106
Deglutition; then running down on the Forepart of the 
Neck it is called Trachea till it gets into the Cavity of 
the Thorax, where it divides into 2 Branches, one going
to the right, the other to the left Lobe of the Lungs; at
it's Bifurcation it is called Bronchia which name
it retains thro the whole Substance of the Lungs. The 
Trachea is covered externally only by the common Integuments;
it is round anteriorly & flattened Posteriorly
where it lies in Contact with the Osophogus, and
is in part Cartilaginous, in part muscular, membranous
& Glandular: Anteriorly it is composed of
a Number of Cartilaginous Rings which are connected
together by an intervening Ligamentous Substance
which is yielding & elastic and gives way in Expiration 
& Inspiration to the Shortening & lengthening of 
the Trachea, posteriorly it is musuclar & membranous 
and is flattened to make room for the Passage of the 
Aliment thro the Oesophogus which it woud have impeded
had it been round as it is anteriorly, and bedsides
if that has been the Case it might have also obstructed 
Respiration in the Passage of ye Aliment thro the Oesophogus -
Hence its advantages in being partly Cartilaginous 
and partly muscular & membraneous - On
the




107
the posterior flat part there are a no. of Small Eminences 
which are called Glands and are most numerous
where the Trachea divides into Bronchia; they secrete
a Mucus to lubricate & keep moist the internal 
Surface of the Trachea which is lined by a fine thin
Vascular Membrane which is enbued in every part
with the most exquisite Sense, as we often find, if only
a drop of water in Drinking pass over the Glottis into
the Trachea, so that it seems to be adapted for the 
Reception of Air alone: it is supposed to derive this 
Sensibility from a no. nervous Fibrillæ spent upon it
From the continual Passage of the air thro this Tube
the membrane which lines it's internal Surface woud
soon grow dry if it was not for the Mucus which 
these glands Secrete; this Mucus sometimes becomes
hardened & inspissated by Heat in Colds, Cough &c. &
is the Cause of great uneasiness till it is spit up - This
frequently happens in a morning when we have fallen
asleep with our months open we awake & find a
disagreeable uneasy Sensation in the Throat from the 
Dryness of the Parts & thickening of the Mucus, which 
as soon as the Mucus is coughed up goes off -
Wounds of the Trachea if properly managed are not 
dangerous




108
dangerous. I woud by no means recommend the wound
of ye. Trachea to be sewed up, but the Head shoud be
brought forwards. & kept in that position which will
bring the disunited parts into Contact and if they are
not disturbed will soon heal if at the Same time the 
wound is dressed quite Superficially: if the wound in 
the Integuments is very large a Stitch or two may 
be made in that to hasten the reunion of the Lips of 
the wound - When the Trachea is wounded & the 
wound in the Integumts. is at the same time very
small as may happen from the Stabs with a Sharp
pointed Knife or Sword, an Emphysema may follow
which is occasioned by the air coming from the Lungs
in Expiration not having a free Exit thro the external
wound, insinuating itself into the Cellular Membrane
in the Same manner as we See Ecchymoses follow
Bleeding when the orifice is made too small when the
Blood gets into the Cellular Membrane are & cause that
Lividness from its not having a free Exit from the 
Vein; whereas had the wound been large enough in 
the one or the orifice in the other neither an Emphysema
or Ecchymosis woud have followed, when 
the air or Blood had a free Exit: In this Emphysema 
there will be no necessity to dilate the wound
of ye. Integuments, but it may treated as an Emphysema

* Would it not be advisable to take the bark & other
antiseptics internally? -



109
Emphysema arising from an Injury done to the Lungs
by making punctures into the Cellular Membe. in difft.
Parts & using Compresses &c - I once saw a Child who 
from a violent fit of Coughing in the Hooping Cough
ruptured the Trachea which was followed by an Emphysema
in the Neck -
Dr. Huxham relates the Case of a Patient who had 
a general Emphysema without any previous accident 
happening to injure the Lungs or air - Tube, but 
this man had an unusual Scurvy which had vitiated
the Fluids and rendered them acrimonious as to erode
the Cellular membrane of the Lungs and the other
Parts of the Body, and the air escaping from the Lungs
got into the Cellular membrane the nearest situated
to them & by degrees became general - In mortifications
we frequently see the Gangrened Parts
become Emphysematous which is caused by the
Putrefaction generating air in those Parts; when 
it shews itself above the Gangrened Part it denotes
the Mortification is increasing - In all these Cases
I would recommend as tight a Bandage after the 
Confined air was pressed out as the Patient coud
bear with Compresses dipt in Spts. to prevent 
the farther putrefaction & compress the memb. Cellr*
The




110
The Bronchia after they enter the Lungs ramify 
thro their Substance & terminate in air Bladders with oval or spherical
Points all over the Surface of the Lungs which are very
evident & appear exceedingly numerous when filled with 
Quicksilver; according to the general opinion at present
these Cells have free Lateral Communications
with each other - Upon the Branches of the Bronchia
and around the large Blood-Vessels of the Lungs
are situated little Bodies of a reddish Colour in ye. 
Fœtus but bluish Colour in Adults which are most 
Numerous about the Bronchia just before they enter
the Lungs and are called Bronchial Glands - Winslow 
thinks they are mucus Glands, but they appear
to be rather Lymphatic as no excretory Ducts can 
be discovered belonging to them - Some are of opinion
that the darkish Colourd Mucus we sometimes 
Spit up of a morning is secreted by these Glands
but it is only Conjecture - We hear of People who 
have lived several years after they were supposed
to have expectorated part of their Lungs and even the
Pulmonary Artery with it, but common Sense will 
tell us that it is absurd to believe Such a Report
and that it is nothing but this Mucus Inspissated
and




111
and brought away in Knots of Various Sizes & Colours-
The Blood Vessels of the Lungs are two Arteries 
one to each Lobe, & according to Some 2 Veins coming 
from each Lobe - The Pulmonary artery is rather
thinner in proportion than the aorta & other Arteries; 
and the Veins are Less Capacious than the Arteries
which is contrary to the general Rule of Nature
in other Parts of the Body: the Reason of this is 
said to be that by the Smallness of the Veins the 
Blood is not so easily thrown out of the Arteries
into the Veins and by that means it is kept longer
in the Lungs for them to have more time to produce
that Change upon the Blood which it is said to undergo
in them - But besides these Vessels, the Lungs
have a Small artery & vein called the Bronchial or
Ruyschian which runs along the Trachea & Bronchia
& their Branches conveying Blood purely for 
their Nourishment and for the Secretion of ye.
Mucus in the Trachea -
All the Vessels, both air & Blood Vessels enter 
the Lungs at one Place and this is called the Root
of the Lungs when they are connected & surrounded by 
a Body of Cellular Membrane which is continued 
thro 




112 
thro the whole Substance of the Lungs - The Cells of this 
membrane here are not distended to any considerable
Degree in Emphysemas & anasarca as in other parts
of ye. Body, without producing Suffocation - It has 
been asserted that the Cellular Membrane which 
surrounded the Vessels of ye. Lungs was much distended
in the Disease which lately raged among the horned
Cattle -
It has been a dispute among many whether any air 
was contained in the Cavity of the Thorax between the 
inner Surface of the Pleura & external one of the 
Lungs; but it is absurd to imagine that there is -
The Lungs after they have inflated with air
will float in Water, but in the Fœtal State before
Birth when no air has ever entered them, they will 
Sink like a piece of Liver, Spleen &c. because they 
are compact & in a Collapsed State like them, but 
as soon as the Child is born, the Lungs become distended
by the Childs Breathing & the Air Cells which
were before collapsed become now filled with air which 
it is a hard matter to press out afterwards so as to 
prevent there being a Sufficient quantity still left
to cause them to Swim when put into Water -
From this observation it customary upon Trials of 
Women




113 
Women who have been suspected of murdering their
Children to have recourse this Experiment of throwing
the Lungs into water as the best Criterion to Judge
whether the Child was born dead or alive and Surgeons
are sometimes called in to give their opinion; if the 
Lungs swim in the water, it is concluded that the 
Person is guilty, if they Sink on the other hand it 
is concluded that the Child was born dead & the 
accused Person is acquitted - But like all other 
general Rules it is liable to exceptions and is by 
no means an infallible one; for the Child may have 
been dead so long before the Lungs are examined that
they shall have become putrid, in which Case the 
air which is generated [by] in them by putrefaction
will be Sufficient to cause them to Swim in water
tho' the Child never breathed; and another Circumstance
is that Children are often delivered, who 
shall just breath and immediately die, but as the 
Lungs have been inflated by that means it is sufficient
to cause the Lungs to Swim - For these 
Reason when a Surgeon is called upon for his opinion 
in such a Case he shoud weigh well every Circumstce. 
relative to the appearance not only of the Lungs
but of every other part of the Body as the Life & 
Reputation 




114
Reputation of ye. Parent is at Stake, and for 
this Reason he ought to be very tender in delivering
his Sentiments upon it and not condemn the unfortunate  
& perhaps innocent Mother, but offer these 
Circumstances to the Consideration of the Court; for tho'
the Swimming of the Lung when they are in a sound
State may be a proof of Guilt, yet it is not Sufficient 
without some other corroborating proofs to
convict a person - Indeed this Experiment in not 
conclusive on either side of the Question; for the Lungs 
may happen to sink in water & yet the Child be born 
alive: but we ought to be on the most favourable 
Side of the Question for our own peace of mind &
therefore when this shoud turn out, shoud certainly
judge according to the recd. opinion, that the [Lungs]
Child was Still-born, rather than appear too
Severe & pressing for the mothers Conviction - For 
Instance, the Child is born alive, but from some 
Cause or other an Inflammation comes on the
Lungs immediately after Birth, which will cause 
such an adhesion of the air cells and other Parts
of ye Lungs as to kill the Child in a few minutes:
in this Cause they will appear as if they never had
been inflated and if put into Water will sink:
and




115
and it is said that a Child may be born alive &
breathe a few minutes and Suddenly dying, the 
Lungs will appear collapsed as if no one air had ever 
been in the air Cells and will sink in Water; & 
this may happen without any Inflammation [cross out] =
preceding- Here are two objections, in which the 
Child was born alive & yet the Lungs Sink in
Water - It is necessary we shoud be well acquainted
with all these Circumstances, tho we woud not
willingly mention them in a Court of Judicatl.
unless we were first called upon to answer the 
Question whether it was possible to happen or not -
The use of these organs we are perfectly unacquainted
with further than that they are the grand
organs of Respiration. But it is supposed that
the Blood is sent thro them to undergo some change
that it may be rendered more perfect & nutritious,
but in what matter it is affected or whether it
does undergo any change at all is not known. It 
is supposed to be cooled as it passes thro the Lungs 
by being fanned by the Air in Respiration; for the 
Circulation thro the Pulmonary Arteries is very rapid
it has been calculated that the whole mass of Blood 
passes




116
passes thro the Lungs 43 times in an Hour -
many Hypothesis have been started to prove that
the Air enters thro the Vessels & mixes with the 
Blood; or that the air Vessels communicate
with the Blood Vessels; but it cannot be proved 
that they do communicate, by the most Subtle
Injections -
Of the Heart
the Heart is one of the most curious and important 
organs in the whole Body and is in continual Action
from the first to the last Moment of a Man's Life,
receiving & distributing Blood to all parts of the
Body - It is a hollow Muscle and is the only 
Muscle in the Body that is covered by a Membranous
Coat - its Situation is obliquely across the Spine
with its Basis or broad Extremity turned towards
the right and it's apex a small Extremity to the
left Side - It is divided into it's Basis, Body, Apex
Surfaces & Edge; the Basis or Broad Extremity is 
formed by the Auricles & upper part of the Ventricles;
it's Body is formed by the Ventricles which running
to a blunt Point form it's apex; its Edge are 
turned




117
turned to the right & left side of the Thorax; and the
Surfaces are the Posterior which is flattend & the
Anterior which is convex, its Figure somewhat 
resembling a half of a Cone made by a Longitudinl.
Section - Its external Surface is covered by a fine
Smooth Coat which is a reflection of the inner membrane
of the Pericardium over it -
It is composed of 4 Hollow Bags or Cavities, which 
are the 2 Auricles & 2 Ventricles:- the Auricles have 
a free Communication with the Ventricles, the right
Auricle with the right Ventricle, & the left Auricle
with the left Ventricle: the Ventricles are much the 
Strongest of these Cavities, and round their upper
Part runs a Notch or Depression which divides
them from the Auricles & in which lie the Coronary 
Vessels. All the Veins in the Body terminate in the
2 Auricles and the arteries are continued from the
Ventricles: the 2 Venæ Cavæ empty their Blood into 
the right Auricle and the Pulmonary Veins bring
their Blood into the left; the Pulmonary artery
goes off from the right Ventricle and the Aorta from the
left -
The right Auricle is much larger than the left,
as




118
as it receives the Blood from all Parts of the Body 
except the Lungs, and the left only receives the
Blood from the Lungs : it terminates in a blind
Point which was formerly called the Auricle &
the Body of ye auricle called the Sinus of the Vena
Cava; but the first is now only called its appendix
& the other the Auricle - The 2 Cavas enter into 
this Bag each of them obliquely by which means
the 2 Columns of Blood are more readily drove on 
towards the Heart - The Auricle is covered externally
by the Reflection of the Pericardium which covers the 
Heart, and appears externally smooth & even, but
internally it is rough and irregularly fascicular
having a number of little Bundles of fleshy Fibres
which are very strong; and between these Fasciculi
the Auricle is membranous only -
Just at the entrance of the inferior Cava into the Auricle
is situated a small Semilunar Valve called
Valvula Eustachii, which is more distinct in the 
Fœtus than the Adult, and is supposed to be to 
direct the Blood into the Foramen Ovale -
Between the Entrance of the 2 Cavas there is an 
Eminence called Tuberculum loneri which is 
more




119
more considerable in Brutes than in the Human
Heart: it is said to divert the 2 Streams of Blood
in the Cavas entering and meeting each other fully
& to turn it more into the Body of ye. Auricle; but
it is too inconsiderable in the human Heart to answr. 
any great purpose - 
In the Fœtal Heart there is a hole or Perforation
in the Septum which divided the 2 Auricles
from each other; by which means a Communication
is formed between the 2 Auricles, so that the
Blood passes in the fœtus in Utero from one auricle
into the other without going thro the right 
Ventricle & into the Lungs - this perforation is called
Foramen ovale, which closes up after Birth when 
the Circulation is carried on as in the adult; and 
leaves a Dent or Depression of an oval Figure;
in some adults it remain previous - In the Fœtus
there is also a Communication between the Aorta &
Pulmonary Artery by a Canal running from the
one to the other called Ductus Arteriosus, thro which 
a small quantity of Blood passes into & Circulates thro
the Lungs & is returned by pulmonary Veins - Thus 
the Circulation in the Fœtus is carried on in this 
manner




120
manner; the Blood is brought by the Cavas into the
right auricle, from the right auricle it is carried 
into the left thro the Foramen ovale, from the left
auricle it is thrown into the left Ventricle, from
whence it is thrown into the Aorta and by that distributed 
to all parts of the Body; but a small quantity 
as before observed passes from the Aorta thro the Ductus
anterior. into the Lungs & circulates thro them &c.
The Ductus anterior. as well as the Foramen ovale
closes up after Birth as there is then no further 
Occasion for them; but sometimes they both remain 
pervious in adults; and when it is the Case, it is 
said that the Circulation may be carried on with out the 
assistance of Respiration, and the Person will live
some time without Breathing as in the Fœtus, by 
the Circulation being performed in the same manner,
as in the fœtal State -
Just at the Entrance of the inferior Cava into the auricle
between it & the ventricle is situated in the mouth of 
the Coronary Vein which has a small Semilunar Valve
at its entrance into the auricle to prevent the Regurgitation 
of Blood into it -
The use of the right auricle is to receive the Blood
of the 2 Cavas & to force it onwards into the Right 
Ventricle



121
Ventricle: when the Blood is emptied into the auricles
it occasions a Stimulus and the auricles contracting 
throws the Blood into the ventricle; but there is also
at the same time a Regurgitation of Blood into the
2 Cavas which causes them to become distended till
the ventricle becomes empty to receive more Blood
from the auricle, when the veins again recede [cross out]
[the ventricle] by this means a Pulsatory motion is observed 
in these Veins. vid, Lecte. on the structure of the 
veins p ---8.
The right Ventricle is externally smooth & even unless
loaded with Fat: internally it has a no. of fleshy
fasciculated Fibres called Cardiæ Columnæ running 
from one Side of ye. Ventricle to the other; and besides
these, there is an order of tendinous Fibres running 
across the ventricles called Cordæ tendinæ. The Cardiæ
columnæ by contracting propell the Blood forwards into 
the arteries; and the Cordæ tendineæ being inelastic
strengthen the ventricle & prevent the too great Dilatation 
or Distension of it: and some of them seem to Serve 
as Tendons to the Cardiæ Columnæ-
The Ventricles have two orifices, the one called it's
auricular & the other the Ventricular orifice, at 
each of which are placed Valves; those at the auricular
orifice 



122
Orifice are called Tricuspides, tho they are not properly
3 distinct Valves but only a fine membrane hanging
loosely down from which are going off several Cordæ
tendineæ which at the Time the ventricle contracts
to them the Blood thro' the expelling orifice into the 
artery, draws the Side of these values nearly together
and prevents the return of the Blood into the 
Auricle, but when the auricle contracts & throw the
Blood into the Ventricle they are pressed down by 
the Column of Blood against the Sides of the Ventricle, 
so that they are no impediment to the Bloods,
passage from the auricle into the Ventricle, tho'
they prevent it's regurgitating back into the auricle -
At the upper part of ye. ventricle is the 
arterial orifice from whence goes off the Pulmonary
Artery; at this Place we have 3 distinct
valves situated just at the beginning of the artery 
and from their Semilunar Form are called
Valvulæ Semilunares - They are so situated that
when the Blood is thrown out of the Ventricle into 
the artery they will be pressed down close to the Sides
of the artery & suffer the Blood to pass freely on, but
when it attempts to return back, they are forced
up



123
up & project across the Cavity so as entirely to stop 
up the Passage & by that means prevents the return 
of the Blood into the Ventricle at the time the 
artery contracts to propell the Blood forwards -
The left auricle is smaller than the right 
as has been before mentioned. Into this the Pulmonary
Veins empty their Blood, whose entrance
differs in almost every Subject; they often enter by
two different Branches from each Lobe of the Lungs
on each Side of the Auricle, but this is not always 
the Case - This auricle has the same appearce. 
externally as the right and has the same fasciculated
appearance internally, but they are not
so strong as in the other; it is thicker than the 
right: there are no valves in the Pulmonary veins
and there Seems no necessity for any, tho some assert
there are - The left Auricle is in every other respect 
Similar to the right except in the appendix which 
terminates in a sharp point -
The Ventricle is thick, strong & muscular 
rather stronger than the right: in it are observed
the Carnæ Columnæ and Cordæ Tendineæ the same 
as



124 
as in the right which have the same use, and it 
has the auriculum & arterial or Ventricular
orifice - In the left auricle are observed often 
bloody Concretions called Polypi lying loose in it -
The Remains of ye Foramen Ovale is to be seen in
this side of ye. Septum as in the right -
Between the auricle & Ventricle is placed the 
same kind of membrane forms the valvulæ
Tricuspides in the right Ventricle, but here it is
divided into two Portions only and from its resemblance
to a mitre are called Valvulæ mitrates.
Their use is similar to that of the Tricuspedes.
The Valvulæ Semilunares of the Aorta are Similar
in their Situation, Shape & use to those of the 
Pulmonary Artery - It is observed that not only 
here but in the Pulmonary artery, in the middle 
of these Valves, there are little emminus or additional 
Valves which Serve to fill up the Passage of
the Arteries entirely, when the Blood attempts to 
regurgitate from the arteries, which it is easy to 
conceive the Valvulæ Semilunares alone cou'd not
do (as they are only Semilunar) with their convex
Sides only in contact which is the Case when they 
rise




125
rise up & project within the Cavity of the Artery
at which time they form a small cavity or hole 
in the middle which is filled up by these little
Eminences or additional Valves, which are called
Corpora Sesamoidea - 
The Structure of these Tricuspin Valves is entirely 
Membranous and are said to be formed by a continuation 
& projection of ye. internal Coat of the Arteries 
It is observed that the right auricle is stronger 
& larger than the left, but the right Ventricle is
not so strong as the left, because it sends ye.
Blood into the Lungs only, which being near does
not require so great force to propel the Blood into
them as [cross out] is necessary to propel the Blood to 
all parts of the Body which the [right] left Ventricle does;
and for the same Reason the Aorta is stronger than 
the Pulmonary Artery - 
The vessels of the Heart are arteries, veins
Nerves & Lymphatics - The arteries & Veins are
called the Coronary Vessels: the arteries are the first
Branches the aorta gives off, one running to the left
& the other to the right side of the Heart, called the 
right & left Coronary: they are sent to the Heart entirely
for




126
for it's Nourishment; they run in the notch which 
divides the Auricles from the Ventricles and distribute
Branches all over the Surface of the Heart which 
have freqt. anastomes with each other, and two considerable
Branches meeting at the anterior part
and uniting forms what is called the Median
Coronary artery - The mouths of these arteries sometimes 
open into the Ventricle & when they do, the
Blood is thrown into them by the Contraction of the 
Ventricle; but they more commonly arise from the 
Aorta just beyond the Valv. Semilunar. and 
when this is the Case it is evident they must 
be filled with Blood when the Artery Contracts
to throw the Blood onwards, for the Valves are
pressed down over their mouth, by the Column
of Blood coming from the Ventricle into the
Aorta and by that means prevents their being 
filled by the Contraction of the Ventricle: but
as soon the Aorta contracts, the Valves are raised
up & leave the Mouths of ye. Arteries open, so
that the Blood then passes into them -
There are a great number of ye. Lymphatics running
over the Surface of the Heart, which are 
Supposed




127
Supposed by some anatomists to empty their
Lymph within the Pericardium - However this
is, there is allways a qty. more or less of their 
Fluid deposited here, in order to lubricate & 
keep the Parts moist, that the motion of the
Heart may be free & easy and to defend it from
Injuries [from] it woud otherwise be liable to
from Friction - The Veins of the Heart are commonly 
described as two and called right & left
Coronary, but there is properly no right; the
largest Branch of the Veins is placed within the
Notch on the left side of the Heart & may properly
be called the left Coronary Vein - The
Branches are distributed in various Directions
over its Surface & frequently anastomose -
The Nerves Sent to the Heart are very minute
& numerous which makes it the most irritable
organ in the Body - On the inner Surface of the 
Auricles & Ventricles there are said to be a number
of Foramina which some say are Arteries & Veins;
but I believe this opinion is false - Some object
to the Heart's being muscular because they cannot 
unravel its' Texture, but the reason why they cannot
do




128
do that, is that the Fibres run in a great many
different Directions: but whoever will boil the
Heart of an Animal & make a transverse Section
of it may see the muscular Fibres very 
distinctly running in so many various Directions
that they cannot be Seperated by the nicest &
most careful Dissection -
It was long disputed whether the two Auricles
acted together at the same time, and whether
the Ventricles did the Same; or whether they acted
alternately: but since the immortal Harvey's
Time it is generally allowed that the auricles
contract at the Same time and also the Ventricles
do the same, and their Dilatation is called Diastole,
their Contraction Systole: therefore when the
auricles contract or are in their Systoles, the 
Ventricles are both at the same time in their 
Diastole or State of Dilation, and Vice Versa:
and it seems reasonable to Suppose this is the Case, 
or the Heart woud not be in Continual Motion & the 
Circulation would not be carried on regularly; for
now when the right Auricle contracts to force the 
Blood into the right Ventricle, the left auricle
at




129
at the same moment of Time contracts to force
the Blood into the left Ventricle, by which means
both Ventricles are filled with Blood at the Same
Time and are in their Diastole; and when the
right Ventricle contracts to force the Blood into
the Pulmonary Artery, the left at the Same
Time contracts to throw the Blood out of it into
the Aorta: thus the Circulation is carried on by
the alternate action of the Auricles & Ventricles, ye.
Auricles being in their Systole while the Ventricles
are in their Diastole & Vice versa -
Wounds of the Heart are allways Mortal; tho' 
we have heard of a Case some time Since of a 
man at the Savoy who lived some time after
receiving a wound in his Heart; and a man
was lately carried into the London Hospital
who had received a Wound which penetrated 
into the Heart, and he lived Several Days after
it - The Heart Being Vascular is liable to 
all the Disorders that other Vascular Parts are, 
viz, Inflammation, Suppuration &c: and
we frequently hear of Abcesses forming in
the Heart & evacuating themselves into the 
Pericardium




130
Perciardium: these are allways mortal: there 
are some Instances of Ossifications in the Arteries
near the Heart & in their Valves - vid. Philosoph.
Transaction no. 376 - We sometimes meet with 
aneurisms or Enlargements of ye Auricles &
Ventricles with Coagulated Blood in them -
The Death of his late Majesty was occasioned by
a Rupture of one of the Ventricles -
We have observed that in the fœtal State the 
two Auricles communicate with each other by
the Foramen Ovale, and the Pulmonary Artery
communicates with the Aorta by Ductus arteries - 
by which mechanism the Circulation is carried 
without the use & assistance of the Lungs, which
have only a small qty of Blood sent to them just
Sufficient for their Nourishment; for part of
the Blood that is emptied into the right auricle
passes into the left thro the Foramen ovale,
whilst the rest passes into the right Ventricle but
part of this likewise passes immediately into 
the aorta, when the Ventricle contracts, by the 
Direct. arterios. so that a very small portion
Circulates thro the Lungs by the Pulmonary 
Artery 




130
Artery: but immediately after Birth a wonderful
change is brought about upon the Circulation; the
Canales Arterios being supposed to close up immediately
as also does the Foramen Ovale, by which 
means all the Blood of the right auricle is thrown
into the Pulmonary Artery & circulated thro the
Lungs - The Foramen Ovale has sometimes however
been found in Adults not entirely closed 
but there never was an Instance of the Ductus
Arterios. being found open in Adults -
On the Peritonæum &
Abdominal Viscera
Having described the Viscera of the 2 Smaller Cavities
the Cranium & Thorax, it now remains to consider
those of the largest of the three, the abdomen; and in
doing this I shall observe the Same Rule as in 
the Description of the other two, by first pointing
out the membranes - The Abdominal Viscera
are all covered & surrounded by the Membrane
called Peritonæum which is reflected over the
greatest part of them like the Pleura is over
the




132
the Thoracic Viscera - 
The external Surface of the Peritonæum is rough
on account of the Cellular Membe. which adheres
to it. It has the appearance of Ligaments upon 
it's Surface all of which terminate at the Navel,
they are three below & one above it: that above
the navel is the Ligamt. [suspensor] Refundum of the Liver
which is the remains of the Umbiblical Vein
of the Fœtus in Utero, which after Birth closes
up & becomes a Ligament: the 2 lateral ones
below the navel are the remains of the Umbilical
arteries of the Fœtus which likewise close up
after Birth; and that in the middle is the 
Remains of the Urachus. The internal Surface
is smooth & even - The Peritoneum lines the
whole Cavity of the Abdomen forming one Compleat
Bag, and is reflected over the Surfaces of the Liver
Spleen Intestines &c. and adhere to the Spine
posteriorly, where it forms a Duplicature which
is continued from thence, with a qty. of Cellular
Membrane between the 2 Lamina, and runs
over the outer Surface of the Intestines; all the
Vessels likewise of the Intestines which pass to & 
from




133
from them run between this Duplicature which is 
called the Mesentery. Next to the Peritoneum
immediately under it lies the Omentum or Epiploon
floating loosely in the Cavity - The Viscera
in the Cavity of the Abdomen are not properly contained
within & surrounded by the Peritoneum, 
tho it is common to say that they are Surrounded 
by it - I mention this Circumstance that you
may be apprized of it, if every the Question is
proposed by men who are fond of Cavelling abt.
Such nice Points -
The Processes of the Peritoneum are only continuations 
of it over the different Viscera in the 
Cavity, as the Liver &c  - and these are called
internal Processes; there are some anatomists
who say that it has external Processes, and
the Tunica vaginalis is they say an external
Process; but this is a Mistake, for we non
do not [mistake] call that Tunic a Process
of the Peritoneum [cross out]
[cross out] as, after it has descended 
into the Scrotum with the Testis, all
Communication is entirely shut up between 
it




134
it and the Abdomen unless at the Time the Testis
passes into the Scrotum a small portion of any of  
the contents of the abdomen passes along with it &
prevents the Peritoneum closing round the Cord, and
when this happens it produces that species of Hernia
called Hernia Congenita; hence it is, that 
this Species of Hernia is produced in our Infancy
only, tho it may not be so much as to merit our
Notice till or after Puberty - Dogs & some other
Animals may be said to have external Processes
of ye Peritoneum because the Communication
between the Cavity of the Abdomen & the Testis is
never shut up but allways free & open, hence 
these animals very often have the Hernia Congenita
without any Inconvenience to them except
the weight - Therefore we are to understand by ye.
Internal Processes all the Coats which the Peritoneum
gives to ye. Difft. Viscera, and by the external
no other than the Tunica Vaginalis which is only 
properly called a process of ye. Peritoneum in Dogs
& those animals which have the Communication 
between the Abdomen & Testis open - There is 
allways a small quantity of Water found within 
the




135
the Peritonœum and if accumulated in too great
Quantity is the Cause of ye. Ascites, as that of ye.
Pleura is of ye. Hydrops Pectoris - It is disputed
whether this Fluid is Secreted by Glands or deposited
by Vessels; but no Glands can be shewn here
and therefore it is the most reasonable to Suppose 
it deposited by Vessels; it's use is the same to the
abdomen as the Liquor Pleura is to the Thorax &c.
The Peritoneum has many fine Vessels spread upon 
it, some of which are Supposed to deposit the above Fluid
and others absorb the Superfluous part of it &c. - It 
serves not only as a Covering to the Viscera of the Abdomen 
but also by its attachment to them keeps
them confined in some measure & prevents their being
displaced -
A general View of the Viscera
of the Abdomen -
The Peritoneum being removed, the Epiploon or
omentum presents itself to over view, lying loosely over
the Intestines: this being turned aside we see the
Liver Situated on the right Hypochondrium occupying
allmost all that Space, & adhering to the inferior
Surface of the Diaphragm; it is divided into 2 Lobes
the 



136 
the right & left, the last of which lies partly
over the Stomach, which is situated in the left
Hypochondrium inclining across the Spine and 
having passed to the right of it, it meets the
first of the Intestines called Duodenum at which
place it is called the Pylorus - On the inferior part
of the largest Lobe of the Liver is placed that membranous
Bag called the Gall-Bladder, which is 
not allways covered by the Liver by often projects
beyond the Edge of it especially in Strong Expirations
when the Liver is drawn upwards by the Diaphragm:
hence the Reason that this Bag is often wounded 
when the Liver remains unhurt by penetrating
wounds of this Part which some assert is impossible.
When we remove the Stomach the Spleen appears 
situated under the left or great Extremity of the
Stomach called Cardia where the Œsophogus enters,
it's inferior part rests upon the upper part of the 
left Kidney - The action of the Diaphragm must 
compress this Viscus & the Stomach also from its
connections with them - The pancreas cannot be
seen without removing the Intestine, but it lies 
under the great Curvature of the Stomach to the 
left



136
of the Duodenum to which it adhæres, and then
runs across the Spine to the left & its Extremity
lies in Contact with the Spleen -
The Epiploon or Omentum is a thin membranous
Bag, resembling a tucked up Apron, hanging
down from the Stomach loosely over the Intestines 
as low down at the Navel, but sometimes
much lower reaching even into the Pelvis : it 
is generally fixed to the Duodenum, to the great
Curvature of the Stomach and to the arch of the 
Colon Superiorly; hence when it descends into 
the Scrotum in Hernia, it causes a Sickness
& violent pain in the Region of the Stomach in 
conseqce. of it's attachment to the Stomach & its
drawing it by that means downwards. It has
a no. of Vessels ramifying thro it, and is interlarded
with more or less Fat in proportion to the Habit
of the Person: Some Say that by its Oil or the Fat 
which is contained within it the abdominal Rings
often; become relaxed & by that means paves the 
way for Hernia; but this opinion is groundless,
as the Rings are tendinous & inelastic, & consequently



137
consequently will not dilate by any means or be 
rendered more yielding or extensible by any unctuous
matter whatever, and therefore cannot be 
affected by the Omentum tho it shoud lie in immediate 
contact with them - Hence it may perhaps be
asked what is the Cause of Ruptures in general
if we will not admit this as one? The most common
& general Cause I believe is a mal-formation
of the Rings, i.e. they are so large as to 
admit ye Intestines to push thro them with 
very little or no Force or at least no more, 
than is exerted in Crying &c as in young Children, 
whom we find are more commonly afflicted with 
Hernias than adult, and as they are more freqt.
in those so they are less dangerous than in these;
in Children they will easily return on lying down
and are supported by a proper Bandage & by that
may be cured without the operation being necessary
whereas in adults we are often oblidged to have 
recourse to the operation for the Safety of the Patient.
The Omentum appears at first to be a Single Membrane
but it is a Compleat Bag or Pouch which 
may



138
may be made very apparent by blowing air into 
it between its attachment to the Stomach & Colon.
The principal use of the [Colon] Omentum seems
to be to lubricate the Intestines & Viscera by
it's being loaded with so much Fat, to prevent adhesions
of them & the Peritoneum, as when it is
wanting as is sometimes the Case being wasted or consumed
by Disease there has a general adhæsion of 
the Subcontained Viscera & the Peritoneum taken
Place - Sometimes it has been found very much
enlarged, which was the Case of a Girl lately in
the Hospital whose abdomen was greatly enlarged
and distended without the least Fluctuation;
the Disease was suspected to be in the Integuments
only and a Caustic was applied on both Sides of 
the Abdomen on the most prominent parts of it:
this afforded her no relief & she died shortly after.
On opening the Cavity the Surgeons found the Integuments 
very thin and the Tumour occasioned entirely 
by a thickening & enlargement of this membrane
which appeared of an almost incredible Thickness.
The Situation of the Intestines is such that the 
Smaller lie in Folds in the middle of the Cavity 
and



139
and entirely surrounded by the larger - The
Duodenum begins at the right Extremity of 
the Stomach called the Pylorus and runs in
a folded Direction for about 12 Hands Breadth in
Length: right side of the Spine it crosses
over to the left Kidney, then to the right and 
again to the left side when it takes the name
of Jejunum, which being continued in a convoluted 
form a little way is called then Ileum:
these three make up the small Intestines. The Ileum
terminates in the first of the large Intestines His
Cœcum at the appendix Caci, from which the Cœcum
is continued for some distance & then commences
Colon, tho there are no marks which can be discovered
to point out the exact Termination of 
the one & beginning of ye other of these Viscera; however
as soon as the Colon begins, it mounts upwards
in an oblique Direction passing under the 
right Lobe of the Liver then under the great Curvature
of the Stomach across the Spine to the left
Kidney where it takes the name of Rectum wch.
is continued to the Anus - From Seeing the Situation 
& attachment of these Viscera to the
Liver, Stomach &c. it is easy to conceive what great
Service



140
Service warm Clysters may be of when any of
these Parts are inflamed or diseased: they will
assist in a double Capacity, first in emptying
the Rectum & large Intestines of hardened or
indurated Fœces which perhaps were the Cause 
of the Inflammation or by their lying there
might keep it up, and secondly by their pleasing
and agreeable warmth they serve as Fomentations
to all the Intestines & parts adjacent,
and for this Purpose they ought to be thrown up 
in large Quantities much larger than is usually
ordered, for there can no Inconvenience ensue
from the quantity as the large Intestines will
contain a very large quantity. Of the good Effects
of large & frequently repeated Clysters we have
often Instances in the Stone & Inflamn. of the 
Bladder where they act only as Flatus's and by
that means relaxing the Parts often remove 
suppression of urine - I have known a Tumor
formed externally near the umbilical Region by 
hardend Fœces contained within the Cæcum -
under the two Lobes of the Liver lies the Meso-
Epiploon which is a membrane Similar to the 
Omentum



141
Omentum; and under this to the left of the 
Stomach is Situated the Meso-Gaster, in which 
are Situated the Hepatic & Cystic Ducts of the 
Liver going to the Duodenum - The Situation
of the Stomach is across the Spine, but its exact
Situation must be altered by its State of Distention
either with Aliment or Flatus, at 
which time its' Fundus reaches low down and
pushes the other Viscera downwards, and it
likewise extends high up & presses against 
the Diaphragm - hence it is evident that a
wound may injure the Stomach at this time
which at anoyr. time when it was flaccid
& empty woud not touch it. -
The Mesentery is that Membrane by which the
Intestines are fixed to the Loins: it is only a Duplicature 
of the Peritoneum as has been before observed -
By its attachment to the Intestines it confines
them in Folds, which seems to have been designed
by Nature that the Aliment might be longer in
passing thro these Canals in the Human than in
some of the Animal Species; for Instce. the Wolf &
Cormorant which we are told have but one Straight
Intestine



142
Intestine; hence they are more Voracious, tho their 
Hunger is sooner Satiated and returns more freqtly -
whereas by the great Length of the Human Alimentary
Canal the Lacteals have more time to collect all the 
Chyle fom the Aliment before it is ejected by the anus.
I have already observed that all the Vessels which 
pass to & from the Intestines run between the two Lamina
of this Membe. [cross out] and the Mesenteric
Glands as they are called are also situated between them thro which run the Lacteals. Some assert that this membrane
serves to prevent the Twisting of the Intestines
and their being entangled with one another in their peristaltic
Motion; and indeed a Twisting of the Intestines,
tho' the Term is often used, never can happen.
on accot. of their attachments to the Loins - An Intersusception 
may happen, i.e. when one part of an 
Intestine pushes itself a little way into anoyn. Part
of it either from [cross out] above downwards, or vice versa; 
this Disorder is sometimes attended with most excruciating
Pain &c. and if not speedily remedied by
V.S. Fotus's, Clysters, aperitives &c. Death will ensue
or it terminates in what is called Iliac Passion - I 
have freqtly. observed these Intersusceptions in Children,
in Some, 20 or 30 of them; and in them perhaps they may
be attended with no Inconvenience, pain or Danger -
It



143
It is common to see the Mesenteric Glands greatly enlarg'd 
& diseased in Scrophulous Habits, and in such Constitutions
as have a Disposition in them for Cancers we find 
the cancerous Virus often falls upon these Glands: hence
it is not unusual to enquire of such Patients if they 
have had Pains in the Bowels before we extirpate any 
cancerous Tumour from any Part of the Body, and
if they complain of Pain in these Parts we have great
Reason to suspect the Virus has fallen upon these
Glands and caused them to be much vitiated -
The Vena Portarum is formed by the Junction of all
the difft. Veins which return the Blood from the Intestines
&c. and is the Secretory Vessel of the Liver; the
Hepatic artery Serving only to carry Blood to this Viscus for
its nourishment - The Ductus Hepatic is the excretory 
Duct of the Liver which meeting with the Duct. Cystic
coming from the Gall-Bladder they unite & form the 
Ductus communi Choledochus which carries the Bile 
into the 1st of the Intestines, the Duodenum -Thro
this Duct I have known Several Gall Stones pass &
dilate it considerably; and it is owing to an obstruction
of this Duct by these Gall Stones that the Gall cannot 
pass into the Duodenum & therefore is absorbed into the
Habit & produces amongst other causes the Jaundice -
The Oesophogus is the beginning of the Alimentary 
Tube

* I once saw small granulated bodies, about ye. tiny of millet Seeds,
between the [??cular] & the internal coat of this canal; to which,
some anatomist might give the name of Glands. 2 Kin subject they
were very [???rory]; but though I often looked for them afterwards
I was never able to discern any in a vast number of Subjects which
I had an of [?]ts of examining - Vid. a preferation
of this in W. Elies theyeura, which I would at the time I
discovered those little bodies - Bayuham

144 
Tube, and is partly membranous & partly muscular.
It begins at the upper & posterior part of the Neck where
the Pharynx terminates which is opposite the cricoid Cartilage
of the Trachea; it passes down behind the Trachea,
and when it gets into the Cavity of the Thorax, to the left
of the Aorta and piercing thro the Muscular part of the 
Diaphragm terminates in the [right] left Orifice of the Stomach
called Cardia - It is composed of a difft. no. of Coats 
according to different authors, some say it has two, other
three, four, and some five - The 2 first are nothing but
the Covering given it by the Pleura in the Thorax, and 
the Cellular membrane which adheres to it; the 3d.
is its muscular and is 2 orders of muscular Fibres
one running Circularly the other longitudinally; the
longitudinal enlarge the Carnal for the Passage of the 
aliment, whilst the Circular contrast to propel it
onwards towards the Stomach - The 4th Coat called 
it's Nervous is only a little cellular membrane lying 
between the Muscular & the internal or cuticular Coat [cross out]
In this cellular membrane some have described Glands *
which they say deposit a Mucus on the inside of the Oesophogus
to lubricate it; but I never could discover any
Glands or excretory Ducts here and I believe there are
none and that the mucus is deposited here by Vessels:
the Vesalian Glands at the inferior part of this Canal
are only Lymphatic glands [which may absorb a part of this]
[cross out]




145
[cross out] The principal use of the mucus is to lubricate
the Passage & besmear the aliment to facilitate it's Passage
into the Stomach - The 5th or internal Coat is 
called Villous from the number of little Hairs standing
upon its Surface: it is the same in the Stomach & all the
Intestines and is very vascular, hence it serves to transmit
the mucus to it's internal Surface thro some of it's Vessels -
Some say that the internal Coat is a Continuation of 
the Cuticle lining the Fauces, which descends thro' all
the Intestines quite to the anus; but this is absurd -
The whole alimentary Canal is liable to Strictures in 
the same manner as the Urethra but especially the 
Oesophogus, which till lately were looked upon to be
incurable; but Dr. Munckley, Physician to Guy's
Hospl. relates the Cases of several Patients whom 
he has cured by Mercurial Frictions on the Part in
such quantity as to excite a moderate Discharge
of Saliva taking care to prevent it's affecting the 
Glands too much by interposing cathartics at proper 
Intervals - A Man in St. Thomas's lately had 
a considerable thickening of the Thyroid Cartilage
of ye. Trachea whereby the Oesophogus was so much
compressed as to render Deglutition very difficult; it
was occasioned by a violent Cold, and the Trachea was
so much obstructed as to render his Breathing very 
laborious 

Since the delivery of this Lecture Mr. S. has reasons
for thinking that in all those cases where Mercl.
Friction [cross out] is Said to have cured it is very
doubtful whether any stricture really existed.
In true Strictures of the Œsophogus he recommends
the Introduction of moderate sized Bougies repeated
at proper intervals according as the patient
can bear it as [the] a method that he 
had [cross out] made use of with great relief to
a Lady who was under his care for this 
Complaint. Since the melancholy [cross out] of poor
[illegible], I have attended this Lady; who very justly
attributes her present Existence to the above
mode of Treatment. The Size of the Bougie,
Manner of Introducing it, with a particular
history of ye. Case, I [illegible] to present, in a
Paper, to the editor of the London observatory
B

146
laborious & Difficult and his Speech was so faltring as
not to be heard - The operation of Bronchotomy was proposed
& woud have been performed had he not found
relief from the method just recommended which was
thought proper to be tried before the operation shoud be
concluded upon. A small quantity of mercl. ointment 
was rubbed in every night and a Flannel kept round
his neck, a cathartic Solution being given at proper 
Intervals, by which he found relief in a few days & 
was perfectly cured by it -
The Stomach is said to resemble a Bag-Pipe in
Figure; we find it much larger in Some than in 
others; it is supposed to be larger in proportion to the 
appetite and is often found large in People addicted
to gluttony and in hard drinkers the coats are found 
much thickened; but this is not always constant 
The Pylorus is generally thickened in people subject
to freqt. Vomitings; and I have seen a large Fungus
of the Polypus kind in the Stomach similar to the 
Polypi of other Mucus membranes: - freqt. Vomitings
without any apparent Cause may Sometimes denote
this Fungus in the Stomach - The Stomach is divided
into it's Fundus or great Curvature, the Small 
Curvature, & its two orifices called Cardia & Pylorus
It




147
It has 4 arteries spent upon it, viz, the Corona, Gastrica
dextra and Sinistra, and anoyr. Small one -
There is a great analogy between the Stomach and 
Oesophogus in their Structure, and there are the same
number of Disputes concerning it's Structure; but 
the Oesophogus has only 2 Coats, where as the Stomach 
may be properly Said to have 3: the first is a continuation
of the Peritoneum and is called its membranous;
under this is the Muscular which is composed 
of two orders of Fibres running one in a longitudinal 
Direction which is external, the other the internal
order taking a Circular Course: they are Stronger
in some Parts than in others, and by the different Actions 
of these Fibres they serve to move the [stomach] Contents
of the Stomach in different Directions & assist in some
measure in Digestion.. The next is the villous Coat which 
is very vascular and when injected appears an entire
Series of Blood Vessels. These Coats are Seperated
from each other by Cellular membrane, and the internal 
villous Coat is much more Spacious than the Muscular 
which will account for the Rugæ observable on the 
inside of the Stomach when it is empty - The Gastric
Glands which are Supposed to deposit a Fluid to assist 
in Digestion are said to be Situated in the Cellular
Membrane between the villous & Muscular Coats; but I
believe

* It is the opinion of a celebrated Surgeon &
Anatomist that the gastric Tissue acts as
a Menstruua upon the Aliment in digestion;
[cross out]
[cross out] that when the Stomach is empty
it will prey upon its coats, and that it is
of so acrid a nature as [cross out] even to erode
[cross out] the Coats of the Stomach after death.
I have myself seen many instances 
of this in children.
B

148
believe that there are no Such Glands for I never 
coud discover any by repeated Experiments, & I
make no doubt but this Fluid is deposited by Vessels. *
The Orifice called Cardia is that where the Oesophogus
enters and is larger than the Pylorus which is where it 
meets the Duodenum, and at which place it has a
Stricture or rather a Circular Valve the use of which
is said to be to prevent the aliment passing out of the 
Stomach before it is properly digested to mix with the 
Bile & pancreatic Juice: hence we find that when 
we have swallowed any hard substance which is not
so easily digested as Aliment, a considerable Pain is 
felt some time after at this Orifice which is occasioned
by it's endeavoring to get thro this Orifice - We have
frequently Strictures in this Part occasioning Pain in 
the Stomach, Inflammation & vomiting, and if not speedily
removed will occasion Death, as even Fluid Aliment
cannot Pass - with regard to Digestion, vid. Chap. on
the Course of the Chyle - page -
The Intestines are of the same Structure with the 
Stomach, [illegible] muscular Coat giving them their Peristaltic
motion - Their Internal Surface like that of the 
Oesophogus & Stomach is lubricated or lined with Mucus
which is deposited in Follicles by Vessels in the same
manner



149
manner as in the Stomach; and these Follicles are
very visible - The Length of the Intestines is different 
in different Subjects; in general, I believe they are about
5 or 6 times the Length of the whole Body, tho some say 
more - on the inner Surface of the Intestines are a No.
of Valves called the Valvulæ Conniventes taking a Circular
Course & hanging down in the Canal; they are only Elongations 
of the inner Coat which project & hang loose in 
them and admitting the fæces to pass in any Direction
as we see very often in Injecting Clysters which will 
pass even into the Stomach. The use of them is certainly
to enlarge the Surface of ye Canal by which means more
Lacteals may arise from it to absorb the Chyle so that
none may pass with the Fæces thro the Anus but
be carried into the Circulation for the Nourishment
of the Body - The use of the Intestines is to to perfect
Digestion, Separate the Chyle, and Contain the Fæces
& expell them by the anus - The Absorption of the 
Chyle is principally performed in the Small Intestines
for which Reason we find the Lacteals more Numerous
in them than in the large, which receive the 
fæces after most of the Chyle is drained from them &
absorbed by the Lacteals in the Small ones. 
The Duodenum is the first of the Intestines & is one of 
the 



150
the small; it is about 12 Fingers breadth in Length &
passing from the right to the left side commences Jejunum
It is not connected to the Stomach & adjacent Parts by the 
Mesentery, but by the Peritoneum which covers it &
it is observed that it's Coats are thicker than those of
the other Intestines - Digestion is perfected in this
Gut; for the Ductus Choledochus & Ductus Pancreaticus
open into this Intestine and empty their 
difft Fluids of Bile & pancreatic juice which mixes 
with the aliment & is supposed to be necessary to compleat
Digestion: hence we find but few Valvulæ Conniventes
above the place where these Ducts enter the 
Gut but immediately below they begin to be very numerous -
The Jejunum is next, but we cannot fix the exact 
place where it begins or where it terminates: it's only 
Peculiarity is its' great no. of Valves which are much
more numerous than in the Ileum -
The Ileum is the 3d. & last of the small Intestines &
takes its name from its Situation in the Iliac region,
from whence it descends in Folds or Convolutions most 
inclining to the right Side - This Gut is most freqtly
forced down in Hernias - The Ileum terminates.
in 



151
in the Cæcum which is the 1st. of the large Intestines
and is known by its appendix. This Gut is differently
described by difft. authors, some calling the appendix
of it the Cæcum whilst others say that this 
large Gut is continued some distance beyond the 
appendix Cæci and then commences Colon - The 
appendix is considered as a Reservoir for Mucus
with which it is generally filled and which I look 
upon to be intended to Soften the indurated Fæces
which are now by the time they arrive at this Place
become quite hard being drained of almost all
the Chyle, and to lubricate the Passage that they
may pass the easier; on this Intestine are observed
3 longitudinal Bands, which I imagine serve
to shorten the Canal when they act & thus strengthen 
the Intestine in propelling the Fæces thro it- The
Valv. Cæci are Similar to the Valv Connsvint - 
The appendix Cæci is very large in Quadrupeds; -
and in Fish they are very numerous - I generally
reckon the Cæcum about 4 Fingers breadth in 
length - The principal peculiarity of this Intestine
is that where the Ilium terminates there is placed
a Valve which is so situated that it will permit
the Fæces to pass freely towards the anus, but will 
prevent



152
prevent its Return back out of the Cæcum into the 
Ileum, tho it will admit Fluids to pass backwards
as is seen in Clysters sometimes - The Colon has 
many fatty Bodies upon its Surface which are calld
appendices Epiploriæ and are Similar to the omentum
in other parts - about its middle upon the 
inner Surface are placed many Valves - The Rectum
is the last Intestine: it's muscular Coat is stronger
than any of the others but the villous more Smooth &
even - It has the Peritoneum reflected over its anterr.
Surface which is there called meso-rectum - It is 
connected inferiorly to the Levatores & Sphincter
ani muscles and is surrounded by a no. of fatty 
Bodies or substances - On its internal Surface are
a no. of Follicles which contain a Mucus to lubricate
the passage for the easier Expulsion of the Fæces.



153
Of the Liver ~
This Viscus is situated in the upper part of the
Cavity of ye right Side immediately 
under the Diaphragm & extending low down, its
left Lobe lying over part of the Stomach & Pylorus -
its' Superior Surface is smooth rounding & convey,
the inferior Surface is irregular & uneven - the Superior
Surface tis under the intercostal muscles and its
inferior turned towards the Spine - It's Ligaments
are the Ligament. Suspensorium, Ligament.
Rotundum & 2 lateral, and Coronary; tho' in reality they are
not ligamentory: the first & last are continuations
of the Peritoneum by which it is attached
to the Diaphragm & kept suspended: the Ligamt.
rotundum is the remains of the umbilical Vein
of ye. Fætus - Being fixed to the Diaphragm it
obeys the motion of that muscle and is raised
or lowered by the action of it - all animals which 
have much motion in their Backs have their 
Livers divided into many lobules, as the Cats &
Dogs &c. but the human Liver is divided into two 
Lobes only by a Fissure in its middle; tho some anatomists
make three, calling a little Eminence on the 
inferior

* The Ligamt. Rotundum is sometimes found pervious
in Adults, having Blood circulating thro it; and
this Circumstance we ought to recollect whenever we
are to make an Incision in this Part of the abdomen -
In making Incisions in the abdomen 3 Cautions
are to be observed viz, the above as one; another, to
avoid wounding any considble. Branch of ye. Epigastric
Artery. -

154
inferior Surface ye. 3d. Lobe under the name of Lobulus
Spigelii - There are two other Eminences on its inferior 
Surface called Portæ, between which the Vessels run
to the Liver - There are several Depressions also on
the inferior Surface; the most remarkable of which is 
filled up by the gall Bladder, and anoyr in the 
great Lobe which is formed by the right Kidney upon 
which it rests, as also one in the left where it rests 
upon the Stomach - The Liver is not divided into two
perfect Lobes like the Lungs, tho it has several Fissures
in it, the most remarkable of which is that [in] 
which is caused by the Ligamt. Rotundum * [This] 
The Vena protarum enters at the inferior part
[where] at which place it is called glyssens Capsula 
The Vena Potarum is made up of the Veins coming 
from the Intestines, Spleen, pancreas &c all of 
which Joining, form one Trunk at Glyssens
Capsula. It is the only Vein in the Body which performs
the office of Secretion: it ramifies thro the Substance
of the Liver, some of it's minute Branches terminating
in the Pori bilarii which uniting form the Duct
Hepatic. the excretory Duct of the Liver; the others
terminate in some of the Hepatic Veins which return
the



155
the Blood brought by the Hepatic Arteries into the
Vena Cava; and these Veins generally enter the Cava 
in three Branches a little before it enters the right 
Auricle - They have no Valves - The Hepatic Artery
come from the Cæliac and serves to carry Blood 
entirely for the Nourishment of the Liver & has
no share in the Secretion of Bile, which is performed
entirely by the Vena Portar [um]
The Jaundice is only an Error Loci of the Bile:
for the Pori Bilarii being obstructed either from a 
Schirrus in the Liver or Stones blocking up the Passage 
into the Duodenum, it is returned back &
passes into the Hepatic Veins & by them into the 
Vena Cava & so into the general Mass, tinging
the Cutis &c. of a yellow Hue -
There have been and still are great Disputes abt.
the manner in which Secretion is performed in the 
Liver (and indeed in other Glands); some being 
for the Malpighian or Follicular Doctrine, others
for the Ruyshian or Vascular: as I never coud 
discover any thing like Follicles in the Liver or in
any of those Glands concerning which the Disputes
exist

* Vid. Lind on Diseases of warm Climates. P. 88 to 97.

156
exist. I am inclined to be of Ruysch's Opinion, that 
the Branches of the Vena Portarum terminate immediately
in the Pori biliarii without the Intervention of 
any Follicles -.
Wounds of the Liver are very dangerous as indeed are 
those of the other Viscera & all penetrating wounds in 
which we shoud endeavour as much as possible to prevent 
the external air getting into the Cavity which woud increase
the Inflammation Subsequent to those wounds. 
Slight wounds of ye Liver may not be fatal, but if the 
wound is deep a profuse Hæmorrhage will ensue
which will prove mortal - We shoud endeavour to
mitigate the Pain, Inflammation & Symptomatic 
Fever which is generally very high, by freqt. V.S.
Diluents, aperients, Enemas, Fotus s externally &c.
The Liver is also liable to Inflammation, Suppuration, 
Abcesses &c. and abcesses pointing externally
may be opened by Caustic & do well in a good Habit *
And in obstinate Jaundices & Dropsies we frequently 
find hard Schirrus Knots which may be felt by 
pressing upon the Region of ye Kidney and these will 
sometimes remain after the Disorder is removed: in
Such Cases however, the Disorder will return again 
very



157
very soon, so that we can only palliate the Disease
from time to time, unless we can resolve these hard
Schirri which in bad Habits and where ye Disorder
has been of long standing it is very difficult to effect.
The Gall Bladder is a membrane Bag of a 
Pyramidal or Comical Form situated at the inferior
part of the Liver and near the Pylorus of the Stomach
so that when the Stomach is distended with aliment
presses upon the Bag & forces out the Bile into 
the Duodenum to mix with the Alimt. as it is thrown
thro' the Pylorus into that Intestine; at which time
the Bile is most wanted - The Gall-Bladder is 
divided into it's Fundus, Cervix & Body: it has 
three Coats similar to those of the Stomach, viz,
the Membranous which is a Continuation of the 
Peritoneum, the Muscular & Villous; the inner
villous Coat however is not so smooth & villous -
It is very Vascular; its artery comes from the Hepatic 
& is called the Cystic Artery - It's Duct runs 
a little way from it & then meets with the Ductus
Hepaticus and uniting form the Ductus Commun-
Choledochus which enters with an open mouth 
into



158
into the Duodenum - The Ductus Cystic is of the 
same Structure as the Cyst itself at it's beginning at 
the Cervix of ye. Cyst are placed little Values which
are loose & floating like the Valv. Conniventes of the 
Intestines - It is dispute in what manner the Gall 
Bladder is filled with Bile whether by Regurgitation
or by other Ducts in the Liver besides the Pori Bilarii
which are called Cysti-hepatic Ducts and which 
are said to empty Bile into the Cyst & by 
the means fill it; but I never coud discover any
of these Ducts and it is now the general opinion 
that there are none Such and that the Gall-Bladder
is filled by the Bile being brought by the Pori bilar.
into the Duct Hepat. & by this into the Duct Com.
Cholidoch. which by some means or other shall be 
obstructed as by alimt. in the Duodenum &c and 
the Bile not having a free easy Passage into the Duodenum
regurgitates thro the Duct. Cystic into the 
Gall Bladder which serves for a Receptacle or 
Reservoir for the Bile till it is wanted or till [cross out] 
it accumulates and distends the Cyst and then 
it passes out occasionally into the Duodenum:
and from this it is evident that all the Bile does not 
Pass



159
pass into the Gall-Bladder, but that some of it
goes thro the Duct Hepatic. immediately into
the Duodenum - What confirms this opinion of
the Regurgitation of Bile thro the Duct Cystic
into the Gall-Cyst, notwithstanding there are some
who say the Valves of ye Duct will prevent it, is
[the] a Case [crossed out] in which there was a Stricture upon 
the Duct. Cystic & that Side of the Duct [was]
[observed] next to the Duct. com. Choledoch. was 
observed to be greatly dilated by the attempts of 
the Bile to regurgitate but on the other side of ye.
Stricture next to the Bladder it was small all most
impervious - Stones are often found in the Gall
Bladder, and it is the general opinion that they 
are formed by the transudation of the finer parts
of the Bile which leaves the grosser parts behind
& concretes & form Stones - These Stones are difft.
from those of the urinary Bladder, being specifically
lighter than water -



160



161
Of the Spleen
It's Use is so little known that it may be justly considered as the
Opprobrium of Anatomists - 
It is situated deep down in the left Hypochondrium 
and is well defended externally by the Ribs; it's Colour is
a dusky brown - In some Subjects, I have found two or three 
Spleens, but in general there is but one; when there are more 
they are smaller in proportion - Upon the external Surface
there are Several small Fissures -
This Viscus has 3 Surfaces, 2 Extremities & 2 Edges -
The Surfaces are Superior, which adheres to a Ligamt. of a 
convex form; and 2 Inferior, one flat turned towards the 
Ribs to the left, the other more convex & rounding -
The Extremities are Superior & inferior - on the Superior
Extremity rests the great extremity of ye Stomach forming
a Cavity or rather Depression more or Less visible in
difft. Subjects:- the inferior Extremity rests upon the 
upper part of ye. left Kidney which forms anoyr. Depression
It is every where covered by the Same Peritonœal Coat
reflected over it as the Liver of other Abdominal Viscera,
and has no other Coat, tho' some describe it as having anoyr.
proper Tunis under this, which is the Case in Sheep &
Calves, but in the Human Spleen two cannot be Shewn;
in young Subjects it has the appearce. of 2 Coats just where 
the Vessels enter, but this appearce. is Lost in adults -



162
& Lymphatus 
The Vessels of this Viscus are Arteries, Veins & Nerves;
The Artery is a large Branch of ye. Caliac and taking a
winding Course enter the Spleen in an Oblique Direction
by several Branches at its interior Surface, 
at which place Veins return in the same manner
as the Arteries enterd, and these Veins have a 
considerable Share in forming the Vena Portar.
of ye. Liver - The Lymphatics are very numerous
and in Calves very apparent, if it is first macerated
in Water till the Blood is drained out of it and 
by a small Puncture made into it air is thrown into 
it; by which a number of them will become inflated -
The Substance of ye. Spleen seems to be very Similar
to that of ye Liver, tho rather more delicate and 
of a more blue or darkish Colour, which from it's resemblance
to Blood coagulated induced the Ancients
to call it Parenchyma-
The Structure of it is variously described; some
have said it is Cellular & reticular, other Vascular
& Follicular, & even Glandular; which last
opinion Ruysch & Malpighi were of, but Ruysch
lived long enough to be convinced of his mistake in
Supposing it to be Glandular, for no Glands or 
Cells have been discovered by any fair Experiments
yet made - It is very Vascular which is all that we



163 
know perfectly of its Structure at present - Some who have
adopted the opinion of its being Cellular have compared
it to the Penis, but this Hypothesis can by no means
be supported, for if this was the Case there must be 
another Series of Blood Vessels to absorb the red Bloods,
which cannot be demonstrated: but to prove it to be
Cellular they first inject Water into it till it is entirely
drained of its Blood and being dryed it will appear 
Cellular, but this cannot be allowed to be a fair
Experiment; for we know the Spleen is of so delicate a 
Texture that ever so little Force is sufficient to break 
down its Vessels & hence when dry it will appear
Cellular; it is so delicate in young Subjects that we
can seldom succeed in Injecting it without Extravasation
from a Rupture of its Vessels, tho injected
with a greatest Care & gentleness; in a leaky & successful
preparation this way by Injection it appears
to be a Series of Blood Vessels -
Those who assert it to be Glandular, speak entirely
from the appearance they may have observed in
the spleens of Brutes, which is not to be seen
in the Human Spleen -
It's Size is different at different Times, not 
only when diseased but when in a Sound State: it
is said to be larger or Smaller in proportion to the Pressure



164
Pressure of the Stomach upon it; thus when the Stomach is
full it presses most upon it and by its Pressure forces
the Blood out of the ye. Splenic Vessels and consequently
makes it Smaller than when the Stomach is empty, at
which time the Pressure being removed, the Vessels
again become distended and the Spleen enlarged.
By Disease it is capable of being enormously enlarged, 
and what is very remarkable in Such Cases is,
that it will Still preserve not only its Figure but
its natural appearance without any apparent
marks of Disease - In one Subject which I dissected
the Spleen weigh'd 9 Pounds - 
It's use is not known tho many experimts. have
been made upon Animals to ascertain this; we
we told of a Bitch who had the Spleen taken
from her & yet afterwards had Pups; Dogs have 
had their Spleens taken out and no Visible Alteration
has followed; tho some contradict this and
Say that the Animal becomes more voracious,
mangy, and Surly ever after - Some Suppose it
Secretes a Fluid which passes by the Vasa
Brevia into the Stomach to assist Digestion;
but as these vessels are Similar to all other
Arteries it is not probable that any fluid of this
kind passes thro them. Dr. Mead is of opinion, & 
it is probable it may, that it assists in Digestion



165
but in what manner he is at a loss to determine unless
it is by a fluid conveyed thro the Vasa Brevia, 
which we have already observed is not probable -
Dr. Stukely has wrote an elaborate Treatise upon this 
Viscus, in which he mentions a remarkable Instce.
of a Dog without a Spleen, which Dr. Mead
then a Student at Leyden had procured in 
order to remove it, but, says he, the Dr. upon 
opening the cavity & searching for the Spleen, found
that one of his fellow Students had already.
removed it with the same intent as he himself
proposed to do it, to observe whether the Loss of it
woud be attended with any material alteration:
or not - Some, from observing its loss attended with
no inconvenience to the Dog, have supposed it to
be of no Service to ye. animal. but Dr. Mead Observes 
that the Dogs after the Spleen was removed, became
very peevish & Curlish, and their Stomachs were always
greatly enlarged if they survived it long:
I myself dissected a woman in this Theatre 
and found no Spleen or the least appearance of 
Pus in the Cavity of ye. Abdomen, but the Stomach
was enormously enlarged - 
This Viscus is seldom wounded as it is so well
defended by the Ribs; wound of it if deep and the



166
artery is divided are generally mortal; and they are 
more dangerous than wounds of the Liver as the 
artery is larger; if the wound is not deep & the 
artery not divided, some part of it will Slough 
away & no bad consequence ensue; the Dressings
Shoud be entirely Superficial with dry Lint &c -
I have heard of a Dragoon in ye. late wars in 
Flanders who was wounded in this Viscus, a 
considerable portion of which pushed thro the wod.:
he was not brought to ye. Surgeon till the 
next day, yet by proper applications he recovered, 
a great part of its mortifying & Sloughing
away -
The Ancients thought the Body contained
two Sorts of Bile, the one secreted by the Liver
which they called Choler; the other from the
Spleen which they called atrabilis; and a
Redundancy of this last was supposed to 
be the Cause of Melancholy & maniacal
affections; however this Doctrine hath been
long since expunged -
It is now the general opinion amongst Anatomists
that it assists the Liver in forming the 



167
Bile, by producing some change upon the Blood wch. 
is sent to it and which is then carried by the 
veins into the Trunk of ye. Vena Portar.
where it mixes with the other Blood & Fluids 
brought from the viscera of ye. abdomen and
there uniting all together constitute a Fluid
proper for the formation of Bile -
Of the Pancreas ~
The Pancreas is situated lower down in the Cavity than
the last viscus and lies transversly across the 
Spine under the great Curvature of ye Stomach.
It somewhat resembles the Tongue of a Dog in Figure.
Winston divides this Gland into two Parts the little and 
the great Pancreas, but this is unnecessary and improper;
its' broad Part which resembles the Root of ye.
Tongue adheres to the Duodenum and is what Winslow
calls the great Pancreas; it then becomes more narrow 
as it passes towards its apex which Winslow 
calls the small Pancreas - 
It has two Surfaces, one towards the abdominal
muscles, & the other towards the Spine -
It is a fine Instance of ye. conglomerate Gland and is
very Similar to the Parotid & Submaxillary Glands,



168
putting on when opened the same corpuscular appearce.
and we find it affected by Mercury in the same manner
they are; and Astrue gives it as his opinion that the
Diarrhœa which frequently attends especially at the begining 
of a Salivation is caused by the mercury affecting 
this Glands so as to produce a greater Secretion and 
Discharge of ye. Pancreatic Juice which in every respect
is similar to the Saliva of ye. Salivary Glands -
There are various Opinions about the manner in which 
Secretion is carried on in this Gland: some say it is 
performed by Vessels which terminate in 
Follicles; whilst others say it is vascular & that
there are no Follicles but that the vessels terminate immediately 
in the Tubes which form the Excretory Duct
This Gland seldom becomes diseased -
Vessels sent to it do not come from any particular
Part, some come from the Splenic, others from other
Parts and they enter it from one Extremity to the other.
The Excretory Duct runs along the middle of it from the
Apex and gradually becoming larger as it approaches the 
broad part where it adhæres to the Duodenum into which the 
Duct opens and discharges the Juice Secreted: and as it
passes along it has many Small Ducts entering it on 
both Sides thro its whole Length - This Duct is very
transparent and requires great care in finding it; it
was



169
was not found out till the last Century when Wurtzon
discovered it in 1640 for before his Time it was mistaken
for an artery; he was assassinated the Evening
after he publickly demonstrated it, and it was supposed
by order of his cotemporary Anatomists thro Envy at
his making the Discovery, but it afterwards appeard
that this opinion was groundless - The Duct enters the
Duodenum near the place where the Ductus commen. 
Choledoctus enters by which means the Pancreatic
Juice & Bile are mixed together as soon as they get
into the Duodenum; I have seen, however, an Inste.
where they entered at some Distance from each other,
but this Seldom happens -
There have been many & various opinions about the
use of this Gland, and it woud be needless to insert 
them here; the modern & most probable is that it secretes
a fluid which is very necessary in Chylification &
in some measure assists in compleating Digestion in the 
Intestines, assisted by the Bile - Some say they tried their
Experimt. of removing this Glands and no ill Effect ensued
but others contradict they & say that other Glands became 
Diseased upon the Renewal of this - many 
Experiments have been made to know the nature of its
Juice and some have asserted it to be Acid; but none



170
of the Experiments ought to be depended upon, and it is 
the opinion at present that its Juice is not aud but 
exactly Similar to the Saliva of ye Parotid & Submaxillary 
Glands - I am of opinion that the Parotid
& submaxillary Glands are the only ones that Secrete
the Saliva in ye. mouth & that the Lingual & other 
Glands situated about the Fauces only Secrete a Mucus
to lubricate the Passage -
It may not be improper at the Place to follow the 
Course of ye Aliment and therefore I shall just run
over it in a short manner -
The Aliment being taken into the mouth is there ground
down by the Teeth and impregnated with the Saliva,
it is then thrown into the Pharynx which is a muscular
Bag situated at the upper extremity of ye. Œsophogus
which is a continuation of ye. Bag, and thro which 
the aliment passes into the Stomach where it undergoes
its principal Change of Digestion -
It woud take up too much time to give the
many opinions with Respect to the manner in wch.
Digestion is performed; let it suffice to say that 
Booerhave adopted all the Different opinions of its
being performed by Heat, by the Action of ye. Stomach 
& abdominal muscles, by a menstruum, Exercise &c.
and said that all of them might probably concur &



171
assist in Digestion: and this opinion seems to be generally
come into -
The Alimt. having undergone a proper Change in the 
Stomach is then thrown thro' the Pylorus into the 
Duodenum where it is mixed with the Bile & Pancreatic
Juice: at this Place we suppose Chylification
to take Place and that Absorption begins; not 
but I believe that there absorbt. Vessels in the Stomach,
but the Absorption of ye. Chyle chiefly is performed in the
Small Intestines in which there are much the greater
number of Lacteals situated; from thence the Alimt.
is propelled onwards to the anus by the Peristaltic
Motion of the Intestines, and when it arrives into
the great Intestines it is generally by that time
become hard & is called Fœces which by its Stimulus
promotes the Excretion of it thro the Anus - It 
is beyond a doubt that Lacteals or at least absorbents
are Situated in the Rectum and other Large Intestines
as well as small, tho' not so numerous in those
as in the last -



172
Of the Course of the Chyle -
The Intestine we have seen are composed of an entire muscular &
membrane Canal extending from [illegible] Pylorus to 
the anus, & lying in Convolution &c- On the inner
surface of ye. Villous Coat of ye. Intestines [ar????] the Lacteals 
which are vessels so called on accot. of their carrying 
a white nutritious Juice of a Milky Nature called 
the Chyle - The Lacteals are very seldom to be seen in
Dead Subjects, and never, unless the Body is opened
Soon after Death: the usual method shewing them
is to feed an animal, a Dog generally, with Milk for 
some time and about 1/2 an hour after he has been well 
fed, to kill him and immediately open the Body, when 
they [may?] be seen in great numbers filled with a white 
Milk Fluid; this tho' a very cruel one is the only 
method by which we can have a perfect view of 
them: I have seen some of them in Malefactors executed
at Tyburn on opening the Bodies soon after Execution.
Heister relates ye. Case of a man who returning home 
from a Feast was murdered on the Road, & he being 
called in soon after, saw a great no. of these Vessels in
the Small Intestines - They exist in Birds, but 
the Chyle in them is of a Pale & more limpid Colour than 
in other animals; they are likewise known to exist
in



173
in Fishes, tho' it was usually said they did not, untill 
Mr. Henson at Dr. Hunter's evidently proved their Existence  - 
Some assert they are only in the Small Intestines;
they are certainly much more numerous in them 
than in the large, but if the Rectum has not any Lacteals
it is beyond a doubt that it has absorbent Lymphatics,
and we know there are vessels in the Stomach 
which have a power of Absorption, tho' they are so minute 
as not to be easily discovered, and there is no doubt of Lymphatics 
or absorbent vessels existing, in all Parts of ye. Body - The 
Lacteals have a great number of Valves in them -
The Chyle then, being absorbed by these Vessels which 
arise with open mouths on the internal Surface of ye. 
Villous Coat of ye. Intestines, passes thro the different Coats
of the Intestines, and running between the two Lamina
of ye. Mestentery passes thro the mesenteric Glands to the 
Receptaculum Chyle -
The Lacteals are divided into different Orders, which I 
think quite unnecessary; the common method is to divide
them into those of ye. first & those of ye 2d Order; they
are called Lacteals primi generi [crossed out] 'till their arrival
at the mesenteric Glands, and having passed thro them
they then commence those Secundi generii -
By the Receptaculum Chyle we do not mean to
Signify a Bag or Reservoir for the Deposition of ye. Chyle,
for it is only the beginning of the Thoracic Duct and is 
formed




174
formed by the meeting of several of ye. Lymphatics bringing 
Lymph from different Parts of ye. Body and entering at
this Place with Several Branches of ye. Lacteals, and 
which together form the Thoracic Duct making it here
pretty large and hence it has been called Recept. Chyle.
In some few Subjects it is so much larger at this Place as
to make it properly called a Receptacle or Oval Bag, but this 
is very rare - It is situated just above the Emulgent Arteries
to the right of ye. Spine and Aorta, almost behind the last,
so that [it] the Diastole of ye. Aorta it is compressed; - it is 
placed between the last of ye. Dorsal &c the first of ye Lumbal
Vertbræ lying under the right Crus of ye. Diaphragm -
The Course of ye Duct Thoracic from thence is directly upwards
to the right of ye. Spine between the Aorta & Vena Azygor
and passing under the great Curvature of ye. Aorta gets
into the neck & terminates generally in the left Subclavian
just at its Junction with the internal Jugular.
I say generally in the left Subclavian because it is 
sometimes found to terminate in the right - It sometimes
terminates in two Ducts abt. 1/2 an Inch from
each other, but most commonly single - Dogs are observed 
to have 2 Thoracic Ducts generally -
Picket first discovered the Thoracic Duct by Accident
& hence it has been sometimes called by his Name - It
is thin but very strong & elastic - Authors commonly 
Describe




175 
describe it as having Several Coats but it appears to me to be 
one compact & firm membrane not capable of Seperation
without Violence and Laceration; the membranous Coat as
it is called is nothing more than the Pleura which lies upon it,
and can no more be called a Tunic than it can be said to be 
a Tunic to the Aorta which is covered by it ye. Same
Manner - There are many Valves in the Thoracic Duct, but
not so numerous as in the Lymphatics -
The Chyle being received into the Lacteals which arise small &
gradually enlarge in their Passage to the Duct is by this means 
in some measure prevented from returning back into the Intestines,
but it is chiefly prevented by the Valves, and is propelled 
onwards at first in the smallest part of the Lacteals
by the action of ye Muscular Coat of ye Intestines till it
gets into the mesenteric Glands when it is pushed forward
by the [motion] action of ye. Mesenteric arteries & other Vessels
here to the Receptac. Chyle, from whence it is carried forwards
by the Action of ye. Diaphragm, Aorta &c -
Wound in any part of this Duct it is most probable
woud prove mortal, especially in the Cavity of ye Thorax,
as the Chyle would not only pass thro the wound & the Patient
woud become emaciated Soon for want of nourishmt.
but likewise on account of their Situation it is scarsely
Possible that the Aorta, Vena Azygos or Vena Cava shoud
escape



176
escape being Wounded - An Atrophy or Marasmus may
be brought on by an Obstruction in this Duct and it is commonly 
found upon Dissection of People who died of an 
Atrophy that this Duct is Straightend or totally obstructed
hence the Blood is deprived of its Nourishment., the Chyle. The 
mesenteric Glands become Sometimes discovered & enlarg'd & [in]
in a great measure obstruct the Passage of the Chyle thro them
hence the Patients waste away by degrees in proportion to the
degree of Obstruction; they are generally found indurated in
Scrophulous Patients and in Children often appear greatly
enlarged -
Some anatomists have thought that the red Veins or 
Veins which carry red Blood absorb as well as the Lacteals
& Lymphatics, by Mr. Jno. Hunter lately proved in a Satisfactory 
manner by Experiments that they do not  -
The Lymphatics are a Species of Vessel arising from all
the different Superficies of ye whole Body both external & internal
and even from the Bones themselves - These are absorbent 
vessels and terminate chiefly in the Course of the Chyle
but some few terminate in some of ye large Veins. They are
called Lymphatics on account of their carrying a fine [cross out]
colourless fluid, and are fine Pellucid Tubes - They are very
Similar to the Lacteals, having many valves, and as the Lacteals
pass thro the mesenteric Glands so the Lymphatics pass thro 
Glands




177
Glands in different parts of ye. Body, which are called Lymphatic 
Glands; their method of passing thro these Glands is a
little Singular, for just as a Lymphatic enters a Gland it
divides into two, three or more Branches and ramyfying thro
it's Substances it Collects it's Branches together again as it
passes out of the Glands and passes on towards anoyr.
Gland which it enters in the Same manner &c.; but the 
use of these Glands & the Vessels running in this manner 
thro them is not understood; it is supposed to attenuate the 
Lymph, as the Lymph by mixing with the Chyle in the 
Thoracic Duct is thought to render it more fit for 
Nutrition than it woud have been without it by thinning 
of it -
These Glands are of different Sizes & Colours in different 
Parts of ye Body; they are of ye. conglobate kind and are 
covered by a Smooth proper membrane - Disputes 
have run very high concerning the Structure of them, some
anatomists alledging them to be cellular, and others 
contradicting it; Dr. Monroe Senr. & Dr. Hunter had a 
Paper War for some time about them, & we find Dr. 
Monroe very Severe upon Dr. Hunter for asserting they 
were Cellular; and he says he can produce Several Instances 
of Experiments which he made upon these Glands where three
or four Branches of the Lymphatics have entered a Gland 
and 




178
and ramifying thro it have collected its Branches together
again without depositing their Fluid in Cells in the Substce.
of the Gland but have passed out of the Gland as usual: on
the other hand Dr. Hunter proves they are Cellular - I am
of opinion that some of them are Cellular & others not, at 
least I have not been able to discover Cells in them all -
It has been a matter of dispute whether the Lymphatics
were Absorbents or not; but I think it admits of little 
Doubt if we consider their Similarity with the Lacteals
in the Intestines in every respect, and as these are absorbents
it is highly probable those are so likewise: indeed
I think that their Power of absorption is very evidently
proved both by Diseases & Experiments; for Instances, the 
Lues Venerea is received by Absorption & is cured by rubbing
Mercury on the Skin, which being absorbed or taken up by these
Vessels is conveyed into the Circulation & thus excites a Salivation 
by which the venereal virus is conquered: the
Ascites is another Instance of the Power of these Vessels
performing Absorption - [Dr. Hunter, when on this Subject,
is said to speak of the Plague as well as Lues venerea, 
to skew the Power of Absorption in the Lymphatics - There 
is no anatomist who now doubts of ye. Lymphatics
having this Power, but the Doctrine of ye. Plague's
being communicated this way is new, and Dr. Hunter 
builds,




179
builds this opinion upon an Information which he has lately 
received from Doctr. Mackenzie who lately came from 
Constantinople where he resided many years, and who 
says, that it is not uncommon in that City which is 
never free from the Plague, to find one Side of a Street
infected from house to House with it whilst the opposite 
Side is perfectly free from it; this he attributes to their 
not holding any Intercourse with Those of ye. infected Side.
Another Circumstance is that there are men who are constantly 
employed in burying the Bodies of those who die
of the Plague and make no Scruple of handling them
when Dead but are very cautious not to touch them till
they are Cold, and these People, notwithstanding their office
escape the Disease - whether this Doctrine of its being communicated
by the Touch only is true or not Physiologists
must determine - This is the by the by] - The following Experiment
is sufficiently convincing of ye. the Lymphatics' having
the Power of absorption; Take a Dog, open the Cavity of
the abdomen and pour a qty. of warm water into it,
Sew the wound up close and in a few Hours examine
the Cavity and the water will be found to have been 
all absorbed: this Experiment has been frequently 
tried and always succeeded-
It was the opinion of Anatomists till very lately that
the



180
the Lymphatics were only Continuations of the Arteries, &
they supposed three Orders of Vessels, viz, the Sanguiferous
carrying red Blood, the 2d, the Serous carrying only Serum
and the 3d. the Lymphatics carrying a Fluid a degree finer
than the Serum - They supposed these Vessels must
be continuations of ye. Arteries because they observed 
that by throwing Quicksilver into them some of its Globules
woud pass into the Lymphatics; but this is no proof
at all, for the Injection is thrown with so much Force
& Violence that an Extravasation is bought on into the 
Cellular Membrane into which there are a no. of Lymphatics 
opening, and part of the Quicksilver gets 
into some of them & distends them - Let us suppose 
a Person from Coition with an Inflected Person shall
have a Shancre on the Penis which being neglected, the 
consequence of this will be a Buboe in the Groin, which
agrees exactly with the Course of the Lymphatics, they 
running from the Penis thro the Groin & making their
way to the Thoracic Duct: The Venereal Virus may
be taken into the Habit by a Wound in any part of the 
Body and a confirmed Pox may be produced, as by 
a wound in the Finger from which the Virus being 
taken up by the Lymphatics causes a Swelling and 
Sometimes an abcess in the arm Pits, and this Swellg.
takes the same Course with the Lymphatics in this
Part.



181 
Part which shews that they are principally affected by
the Virus - the same observation holds good in any other
part of ye. Body, hence a knowledge of their Course
is very necessary & useful. Since this Discovery of ye. Lymphatics
some Surgeons have attempted ye Cure of Scrophula 
& indurated Tumours which are very common
to Children of relaxed Habits and appear in the Neck
by rubbing mercury upon the Head which being absorbd
by the small Lymphatics there, is conveyed to the Diseased
Glands in the Neck; and this method bids [cross out]
fairer for Success than by applying it immediately on
the Tumour which can have no effect in resolving the
obstruction; and it can answer no purpose to apply
the ointmt. below the Part, because tho it is
absorbed yet the Lymphatics which take it up do not
run thro the diseased Glands in ye. Neck, and therefore
can have no Effect upon them - It is therefore
very necessary that we should attend to the Course of the
Lymphatics, to the Gland that is affected & from what 
part the Lymph flows to it, and at that part we  
are to rub our Ointmt., e.g. for an indurated Gland
in the Groin, the ointmt. is to be rubbed on the 
Legs; if in the arm pit, on the wrists; or if in the 
Neck, on the Head &c. - Some Surgeons attempt the 
Cure



182
of white Swellings by the use of Mercurl. Ointmt. applied 
immediately on the Part, but from what has been said
the absurdity of this may be easily conceived, and if
any good effects can be derived from the use of Mercl.
Ointmt. it must be applied as above directed - 
The Lymph is forced on in its Vessels in the Same
manner as the Chyle in the Lacteals, i.e. by the action
of ye adjacent muscles, Vessels &c -
Mr. Baker one of ye Surgeons to St. Thomas's
Hospl. received the Infection by opening a Bubo & at
the Same time having a small wound on his Finger,
which after recg. the Venereal Virus put on a very
foul appearance & wou'd not heal till he underwent
a Salivation; it was attended with great Pain
& Tension quite up to the Axilla in the Course of 
the Lymphatics - Instances have been known of People
receiving the Infection from kissing Women in the Streets
who had the Disease; and in all these Cases ye.
Glands of ye Neck become swelled and a Rigidness may
be felt in the Course of ye Lymphatics which absorb'd
the Virus from the Lips into the Neck -

Remarks upon Vision, from a Lecture of 
Mr. Warner -
Before we say anything of Vision it may be necessary to premise
a little concerning Light; whatever Light is, we know that it
runs in a Straight Direction quaqua versum and will continue
to run strait always unless they it meets with some obstruction:
the farther the Rays are from the Luminous Body the thinner, i.e.
the greater Distance they must be from one another; and according
to the Bodies which its Rays pass thro, or meet with in their
Passage, they are either Reflected or refracted; the first happens
when they fall upon a Polished opaque Body which the cannot pervade,
hence such Bodies become Luminous and different Colours
are produced according as the Parts are Capable of reflecting
Such or such particular Rays; Black only has no Reflection,
because it absorbs all the Rays: if a Ray of Light meets
with a polished opake Body, it is reflected back again in the
same Direction, i.e. if it falls perpendicular it is reflected in
the same Direction; if with any degree of Obliquity, it is reflected
with the same degree - Refraction happens when the Rays pass
thro any pellucid Body, except when they fall perpendicularly 
then they go on in the same Direction; when a Ray falls Obliquely
from a Rarer to a denser Body or Medium, as from Air into
Water, it is thereby refracted & brought more to a perpendicular,
but the contrary happens when the Ray passes from a
Denser to a more Rare Medium, for Rays passing [illegible]
obliquely thro water into air are thereby more refracted from a
Perpendicular - From this Refraction a Convex Glass burns,
by collecting the Rays together, for by its Density they are 
collected

183
On the Organs of Vision
The Situation of ye Eyes hardly need any explanation, therefore 
shall only observed that they are Situated in two Cavities 
at the inferior Part of ye Forehead which are called Orbits
and in which a considerable body of Fat is lodged which
Serves for the free motion of ye Eyes & to prevent those
Injuries which they woud receive from Blows & Frictions 
against the Bony Orbits - 
Some anatomists divide the [Eye] Organs into external & internal;
others into the Globe of ye Eye & its appurtenances;
which last I shall follow -
By the Appurtenances, I mean all those Parts which some 
call external Organs of Vision, and are, the Supercilia 
or Eye Brows, the Palpebræ or Eye-Lids, the 
Cilia or Eye-Lashes, Glandula Lachrymalis, 
puncta Lachrymalia, and the canincula ~
Lachrymalia, with the muscles of ye. Eye &c -
and of these I shall speak first -
The Supercilia are those arched Rows of Hair situated
at the upper part of the Orbits somewhat raised & prominent
by the great quantity. of adipose membrane under them &
under that there is a Slender plan of muscular Fibres running 
transversely and are called Corrugations Coiteri vel Superciliorum;
these muscles act when we frown -

refracted & collected to a Point at some distance from the 
Glass where they cross one another - By this Refraction of the
Rays the objects become inverted, as the Picture of a Candle
passing this a Magnifier will be found inverted on a Piece
of Paper held at a proper Distance from the Glass: the Same
happens in passing thro the Crystalline Humour of the Eye,
as we may see by cutting part of ye. Coats of the Eye at the
Posterior part and applying a piece of Paper in their
Stead; The Eye then forms a true Chamera Obscura.
The Anterior Coat of ye Eye is made transparent for the
Passage of ye Rays, and also more convex than the other
Parts that all the Rays may be collected to pass thro the
Pupil: the Choroides is made vascular to nourish the whole 
& perhaps Seperates the fine Juices for the Support of ye. 
Humours: the Iris is loose to allow contraction & Dilatation 
to the Pupil and is properly suspended in the aqueous
Humour without any impedimt. to its action: the use of 
the Iris seems to be to shade the Retina from too much Light;
if we observe a Person looking at any Luminous Body we
see the Iris contract, whereby fewer Rays of Light can
pass to the Retina: but when he directs his Eye to an opake
Body the Pupil is dilated to admit as many Rays of Light
as possible; and the Nigrum Pigmentum is black, that 
no reflection may happen: the Retina is expanded upon 
the whole & is supposed to be the immediate organ of 
Vision - The Aqueous Humour, besides supporting the Iris,
begins the Refraction of ye Rays of Light which is afterwards

184
The Use of ye. Eye-brows seems to be to break & divide the Rays
of Light and to prevent their falling perpendicularly from above 
upon the anterior part of ye. Cornea when we are looking at Objects
directly before us, which woud, interrupt Vision & render the sight
of the Object we were looking at imperfect to use they serve also
as Diverticula to the Sweat preventing its getting into the Eyes
which it woud be apt to irritate & inflame from it's acrid
Saltness - The ancients supposed the Eye-brows as useless on
as placed here merely us an Ornament to the Face: however
they are certainly very necessary & useful for the above purposes,
and it is said that those whose Eye brows are but thinly covered wth.
Hair or who have white Eye-brows cannot see so perfectly as
those who have large Eye-brows thick set with Hairs or who
have dark ones and on their accot. it is customary in some
Countries to paint the Eye-brows Black -
The Cutis & Cuticles are the Same here as in any other part 
of the Body, but the membe. Cellularis is of ye. adipose kind being
greatly loaded with Fat; and in this Respect it differs from
the Cellular Membrane of ye Palpebræ, which is of ye. [cross out] Reticular
kind having little or no Fat, hence we see Extravasations of Blood 
from Blows or any Accidental Cause Spread so far & quick abt. the 
Eyes -
The Palpebræ are two in no. to each Eye, the upper & lower, and 
besides being composed of the common Integuments above mention'd 
the upper has a Slender plan of muscular Fibres which is the 
Termination of ye Elevator Palpebræ Superioris proprius; under 
the Reticular membrane there is likewise a Slender plan of 
Muscular

afterwards compleated by the principal Refractor the Crystalline;
the Vitreous serves to keep the Retina always expanded
and the Vitreous Humour always at a due Distance from
it for the Rays to be brought to a point on it: and on 
this Refraction and collection of the Rays to a Focus on the
Retina does distinct Vision depend, and is brought about
by it; but as this always happened in the inverted order 
as before mentioned, it may be asked why we see objects in 
their proper order or Position when they are represented on the
Retina Topsiturvy? I believe this happens merely from use
& the assistance of our other Senses; and this seems to be the
case because if we stand on our Heads, the objects appear
the same as when stand on our Feet, which coud 
happen from no other Cause -
The advantages we derive from two Eyes more than one needs not 
be mentioned - The variety of motions given to them serve instead 
of a greater no. of Eyes - And as in Vision it is necessary we
shoud exclude all objects but that we are looking at so Experience 
teaches us to direct both our Eyes to the Same Thing;
hence Children born with weak & bad Eyes commonly Squint,
because the Bad Eye is useless, and this kind of Squinting
may be sometimes Cured by covering the good Eye for Some 
time because that directs the bad one to the object & thereby
improves or strengthens it; but this method requires a
great deal of Care & Caution - It may be asked why we don't 
see objects double, as we have two Eyes? the same Question

185
muscular Fibres running Circularly which is called Orbicularis
Palpibrarum and is common to both Eyelids; it is inserted tendinous
into the Nose at the inner Angle of the Eye - The Elevator palpebræ
Super prop just mentioned is liable to relaxation & when relaxed
the upper Eye-lid falls down over the upper part of ye Eye & 
causes a partial Blindness - Internally the Eye-lids are 
lined with a fine Membrane which is a continuation of the
Conjunctiva & not of the Cuticle as some say because it is very 
Sensible & vascular which the Cuticle is not. Between this
membrane & the muscle called orbicularis there is a hard
Ligamentous Substance of a Semilunar form which is very 
thin posteriorly but gradually grows thicker as it approaches
to the Edges of the Eyelids where it is called Tarsus which is
properly a Ligamentous Substance & not Cartilage as it is 
said to be; in Cows & other large Quadrupeds it appears of a 
yellowish Colour, but in the human Eye it is commonly 
white - The use of it is to prop out the Eyelids & to 
keep their Edges regular & even & serves to adapt the Eyelids
to the shape & Figure of ye. Globe of ye. Eye -
The use of the Eyelids is obvious, they serving not only to defend
the Eyes from external Injuries at all times but also 
by being almost in Continual motion they diffuse the Tears
over the external Surface of ye Cornea by which means it 
is kept always moist & transparent which is absolutely necessary
to Vision; and by their motion all extraneous Bodies
such as Dust &c. is washed off -
The Cilia are two Rows of Hair placed upon the Edges of the
Eyelids just without Side the Tarsus; those Hairs situated on
the

Question may be asked of ye Ears why we don't hear two 
Sounds - Seeing is certainly learnt as the other Senses,
and I believe Infants do not see objects distinct but all
in Confusion, till they learn to fix on them by degrees thro
the Direction of yr. other Senses - I knew an Instance
of a Boy of about 12 years of Age who was couched for 
a Cataract; at first all was Confusion: I saw him
8 Days after, and then he coud not lay hold of any
object with Certainty; he coud see it, but if he wanted
to take anything off the Table &c he woud put his
Hand down at a Considerable Distance from the Object
on the Table, but by degrees he learnt to fix upon it
The Crystalline Humour being too flat is insufficient
to bring the Rays of light to a point soon enough; hence
such Eyes are assisted by convex Glasses, which do not
magnify the objects as is supposed, but only assist the
Crystalline to bring them to a point on the Retina. The
contrary to this is that of Purblind Eyes in which on
accot. of the Crystalline Lens being too Convex the Rays are
brought to a Point before they fall upon the Retina, and
these sort of Eyes are rather better than worse by age
which brings the Crystalline to a more flattend Figure.

186
the upper Eyelid have their Points turned upwards, and those of the
Lower, downwards - They serve to break off any of the Rays of 
Light which may have escaped from above thro the Eyebrows,
but they serve chiefly to keep off insects as small Flies &c.
& prevent them from getting into the Eyes - 
If we look on the inner Surface of the Eyelids we may observe 
a number of white Lines running in a Straight direction 
towards the Edges of the Eyelids; in large animals they are
very plain: these are the excretory Ducts of the Ciliary
Glands terminating on the inner Edge of ye Eyelids & in
which there is an Oily or rather thick Sebaceous matter
lodged. which is secreted by the Ciliary Glands, and which  
mixing with the Tears [are] is said to blunt them acrimony 
& likewise to form a Varnish with which the Cornea is
kept moistend & transparent; for was the Cornea to become 
dry, it woud become not only Painful to us, but 
in some measure lose its transparency: for this Reason
it is that we cannot look earnestly at any object long
together without moving or shutting the Eyelids in order to 
diffuse this varnish over the Cornea - It is not unusual 
in Colds to find the Eyelids when we first wake in a 
morning closely united & Sticking together, which is caused
by this thick oily matter Secreted in greater quantities & becoming
inspissated in the night forms a Cement - 
The Ciliary Glands are very Similar to the Sebaceous
Glands of ye. Cutis and as we often See the inspissated
Fluid



187
Fluid in the last forming small Knots in the Face & other Parts,
with a small degree of Redness & Inflammation, so in the Eyelids
we often have the Same appearance from the Same Cause, for 
which Authors recommend the Extraction of one or more of the
Cilia in order to make an opening for the Fluid contained
within the Tumour to be evacuated; but if we consider that
the mouths of ye. Ducts of yese. Glands are placed on the inside
of ye Tarsus and the Cilia are situated on the outside
we shall find that no good can be derived from it but that
it is prejudicial, tending rather to increase than diminish 
the Inflammation; and the best way of treating them 
is by the application of warm emollient Lotions &c. wch.
with commonly cure in a few days -
Glandula Lachrymalis was by ancients 
called Innominata as they did not understand its use;
for they thought that the Tears were Secreted by the Caruncula
Lachrymalis & for this Reason in old writers we find this 
Carunell described for the Lachrymal Gland - It is a
Gland of ye conglomerate kind situated in a Sulcus
in the bony Orbit at the Superior Part of it near the external 
Canthus of the Eye -
The use of it is to Secrete the Tears which are conveyd
from it to the Eye thro' Several Excretory Ducts which it
has belonging to it; and tho' no anatomist doubts of the Existence
of these Ducts yet they are very difficultly seen in the 
the Human Body; they may be found in the Eyes of Brutes.
but not without some difficulty even in them - This Gland
is



188
is so situated as to be compressed by the Action of the orbicularis
muscle which acts when we are most in want of the Tears; 
this is evident from our moving the Eyelids when the Cornea has 
become dry from keeping the Eyelids asunder, in order to moisten
it afresh, and by this motion of the Eyelids more Tears are
pressed out of ye Gland; and thus there is a continual 
Supply of Tears - when we are asleep but few Tears are Secreted, 
because the Orbicularis muscle is inactive & the Eyes
are kept sufficiently moist by the Palpebræ covering it.
we find this Gland tho' Small is capable of Secreting a large
quantity of Tears whenever any extraneous Body has got
into the Eye at which time the Tears are most wanting
to wash out the Body; Passions of ye Mind are capable
of affecting this Gland, thereby producing a very increased
secretion from it -
The Angles or Canthi, commonly called the Corners of ye. Eye
are formed by the Junction of ye upper & lower Eyelids &
are two, the external which is the Sharpest or most acute
& the Internal which is next to the Nose and is wider on
account of a little fleshy Substance placed between the Eyelids
in this angle, and is called Caruncula Lachrymalis -
Near the inner Canthus of ye. Eye on the inner Edge
of ye. Tarsus are Situated two little orifices one on each 
Eyelid opposite each other, called the Puncta Lachymalia,
which are the mouths of 2 Small Tubes serving 
to take up & convey all the Superfluous Tears into the
Lachrymal



189
Lachrymal Sac, which is a little Bag situated close to the
Nose, from which a Canal is continued into the nose
called Ductus ad nasum thro which the Tears pass
into the Nose - Thus the Tears are first secreted by
the Glandula Lachrymal. from whence they pass to the 
Eye and are then taken up by the Puncta Lachrymal.
carried into the Saccus Lachrymalis and from thence
thro' the Ductus ad Nasum into the Nose -
The Lachrymal Sac is a Small oval Bag situated
near to the nose in a Sulcus in the inferior part 
of the orbit; in young Subjects it is more prominent
than in old, hence it will be more easily cut into in
performing the Operation for the Fistula Lachrymalis -
Immediately over the upper part of this Bag is placed
the Tendon of ye orbicularis muscle which we are directed
not to divide in performing the operation for Fistula
Lachrymalis, but it is of no Conseqce. whether it is
divided or not, as it is my opinion that an Inversion 
of the Eyelids &c. are not brought on by the Division 
of this Tendon but is owing to bad Treatmt. after the 
operation with Escharotics &c. But there is no necessity
for dividing it at all & it may be avoided by
beginning our Incision into the Sac below the Tendon;
in order to do which an assistant may pull the Eyelids
from



190
from the Nose by which the Tendon will be made to project
and the Incision is then to be begun below it and a Sufficit.
distance from the Nose -
The Caruncula Lachrymalis is a small fleshy emmince.
Situated between the Eyelids in the inner Canthus of the 
Eye - Its use is to keep the Eyelids at this place separated
during our being asleep that the Superfluous
Tears, if there are any, may not be obstructed or presented
from passing into the Puncta Lachrymalia -
The Muscles of the Eye are 6 in No. to each Eye, which 
take their names from their different Actions, and are divided
into straight and oblique - The Straight are 4 in No.
arising from the Bottom of the Orbit and act as Antagonists
to each other; they are called the Attollens, Deprimens, Abductor
& Adductor: the Attollens & Deprimens are placed
opposite each other one Superior the other inferior & act as
antagonists against each other; the adductor is situated
laterally and draws the Eye to the Nose, & the Abductor
is its opposite & antagonist - The Oblique are 2,
the Obliquus Superior & Inferior; the Obliq. Superior
arises from the Bottom of the Orbit & running to the inner
Angle of ye. Eye very near to the Bone, there passes thro
a Cartilaginous Pully from whence it goes to be inserted
tendinous near the Insertion of ye. Attollens -




191
The Obliques Inferior arises near the inferior Edge of the ~
Orbit near the nose and running obliquely upwards & outwards
is inserted near the Tendon of the Abductor.
The names of these muscles describe their uses; they all
assist the Eye in performing a compleat Rotatory Motion
tho the 2 Last are the chief in doing this -
The Tendons of them are all inserted into the Sclerotica
close to the Edge of the Cornea and their Expansion forms
the Tunica Albuginea or white of ye. Eye, tho' some, &
among these Dr. Hunter, describe this & the Conjunctiva 
together as only one Coat under the name of Tunica
Adnata; but as they may be easily Seperated especially
in young Subjects they ought properly to be called by two 
distinct Names, viz. the Conjunctiva & ye. Albuginea.
The Figure of ye Eye is supposed to be altered when all [cross out] the
straight muscles act together; that is when a Person looks at any
object placed very near to the Eye, all these acting together
draw the Eye deeper down into the Orbit and its Figure becomes
more flattened -
The adepts placed at the Bottom of the Orbit is 
rather softer than the Fat in other parts of ye. Body & serves
the Purposes already mentioned - It is often wasted by 
long Illness and hence the Eyes appear Sunk deep in
the Orbits; and sometimes it becomes diseased & puts on
a fungous 



192
a Fungus fleshy Appearance; this Disease is called a Canun
of ye. Eye, and when very large ye. Eye is turned out of 
the Orbit & the muscles put upon the Stretch which 
renders the Extirpation of ye. Eye necessary -
Having Seen all the difft. Appendages of ye. Eye we shall 
now proceed to the examination of ye. Eye itself called the 
Globe - This is a very curious Organ & ought to be well understood 
by every Surgeon, but it too frequently happens
that Surgeons for want of an anatomical knowledge of
the Eye, are unable to treat ye. different Disorders to which 
it is Subject, and are often at a Loss to account for the
different appearances observeable in ye. Eyes when they 
become diseased. It is owing to this alone that some of 
the most curious & ingenious Operations in Surgery have
fallen into the Hands of Empirics & Itinerants, who are
not allways men of ye. greatest Honesty & Learning -
The anatomy of the Eye has been differently described by 
every anatomist who has wrote or Spoke of this Organ and
it is partly owing to this, that it's anatomy is so little understood,
as they create a confusion by it; to avoid this I shall 
endeavour to explain it in the most plain & easy manner
& make use of as few technical Terms and divisions in 
the difft. Coats &c. as possible - 
The Figure 




193
The Figure of ye Globe of ye. Eye is nearly Spherical but 
not entirely so, the anterior part of it being a little prominent 
representing the half of a smaller sphere placed 
upon a larger one - It is divided into the Containing
& the Contained Parts: the first are the Coats 
of which I shall first speak and then examine the 
Contained Parts, which are the Humours -
The Coats then are 5 in number and are divided into 
2 Partial & 3 entire - the 2 Partial are, the Conjunctiva
& Albuginea; the 3 entire are, the Sclerotica, 
Choroides & Retina - The Conjunctiva is the most
external & Retina the internal -
The conjunctiva has already been taken notice of 
as being a fine membrane lining the internal Surface
of ye. Palpebræ from whence it is reflected & lies loosely 
upon part of the posterior, all the middle & part of ~
the anterior portion of ye. Globe of the Eye as far as the
Edge of the Cornea where it firmly adheres to it -
There are Several Considerable advantages derived from 
this Reflection of ye. Conjunctiva: it prevents any 
Extraneous Bodies, that may happen to get between
its outer Surface & the inner one of the Eyelids, from -
passing so far back behind the Globe as to render~
Extraction impracticable; for Instance if any Gravel,
or Dust

*. Young Children in the first month of their age
very frequently are troubled with [the] an Inflammation 
of this Membrane with a Discharge
of Matter from the Eye when pressed, which sometimes
is so great as to threaten a Loss of the Eye. 
For the Cure, Emollt. Pultices, Fomentations &c.
Mr. Warner
I have seen several cases of this kind all/of
which terminated happily; except one: in this
the Inflammation was so violent and obstinate 
that it was communicated to the Cornea transparent,
upon which a Speck remained after the 
Inflamn. was subdued - The last applications Seemed
to be [collyi???] & pultices of Goulards vegeto - minl.
water - 

194
Dust or Insect be got between the upper Eyelid & the
Eye, it can pass no farther than the Reflection posteriorly,
therefore if you direct the Patient to look down & you ~
at the same time pull the Eyelid upwards, this membrane 
will be bought forwards & you may then see &
easily extract the extraneous Body with the Point
of a Brobe, which is as good as anything, armed with
a little soft Lint; if it is between the Eye & the lower
Eyelid, direct your Patient to look upwards &c -
This membrane is commonly the seat of Inflammation *
in the Eyes, such as happen from Cold or any such cause,
when its minute vessels appear distended with red Blood,
and if the Inflammation is suffered to proceed or continue
for any Length of time the Inflammation may be communicated
to the other Coats; hence an adhesion takes
place, and therefore we are to endeavour to remove the 
Inflammation as expeditiously as Possible by freqt. &
copious V.S. which Topical & general Evacuations, 
Fomentation, Pultices &c - ; for tho' the Inflammation
may be removed after it has continued so long & violent 
as to Cause an adhesion, yet opacity or dulness of 
Sight is brought on by this thickening of its Coats, which 
no art can afterwards remedy -
The vessels of this membe. are very numerous & beautiful
when



195
when injected with red wax -
The Albuqinea lies next, immediately under the Conjunctiva
and takes its name from its white appearance. We have 
already mentioned what this is * and as there is nothing 
remarkable in it; we shall go on with the Description of 
the next Tunis, the 3 entire [&] take them in the order as
they lie one above the other - 
The most external of these is the Sclerotica which 
is a Strong, thick & tough membrane; the middle &
posterior is opake, the anterior clear & transparent,
and hence has been distinguished by the names of Cornea
opaca & transparens; but we are to understand
that it is one & the Same Tunic under two different 
names; all that Part of it which is opake we shall
call Sclerotis, & the anterior transparent part, Cornea.
The Sclerotis is vascular tho' not so much so as the Conjunctiva;
it is very hard, firm & thick at the posterior
part of it where the optic nerve from whence it 
gradually becomes thinner as it approaches the Cornea:
in most parts it appears streaked & of a brownish Complexion -
The Cornea at its first commencement is very 
thin but becomes thicker as it approaches to the middle part
of it, where it is equally transparent but much thicker,
and
* page



196
and it is this Thickness that forms the Convexity of the Eye
or that prominence before mentioned to be on the anterior
Part of ye. Eye = it is composed of several different Lamina
which may easily be seperated from each other. It is said 
there are a great no. of Pores in this Tunic thro which the
aqueous Humour, which lies immediately under it, passes
& mixes with the Tears, but this is only Conjecture & believe
in not true, for tho' in the Dead Subject the Aqueous
Humour will be lost in 24 Hours sometimes, yet it does 
not prove the Existence of these Pores, as the Humour
may be and in all probability really is absorbed by vessels
which perform Absorption during Life - The external Surface
of the Sclerotis is smooth in every part except where the 
Tendons of ye. muscles are inserted into it. The Cornea is
reckoned [illegible] the Smoothest membrane' in the Body, and
this smoothness is requisite & necessary, that the Rays of 
Light might Pass on without any Interruption thro it;
for was there any roughness or irregularity on it, all
objects woud appear distorted more or less in proportion to 
the Irregularity; this is evident if we look at Objects
thro rough or irregular Cut Glass; and in People who 
have Specks in or towards the middle of the Cornea from 
Small Pox, wounds of the Cornea &c. this Circumstance
allways turns out; different names have been given to these 
opacities of the Cornea, as the albuga, Ungula, proptosis &c
& there have been instances where they have been removed by blowg
Levigated -



197
Levigated Glass into the Eye thrice a day mixed & triturated with
the finest Sugar; but for ye. most part they fore ever remain
in spite of every thing that can be done, as a stronger Escharotic
than the preceeding cannot be used to this part - It is
beyond a Doubt that the Cornea is vascular tho' its Vessels
do not carry red Blood as that woud obstruct Vision
but the strongest proof of its vascularity is it's again
uniting and healing after being wounded, which parts that
are not vascular will not do, as the nails, Hair &c - according
to Haller the Cornea has very few Nerves sent to it for 
he says, that it is almost insensible - 
Old People losing the Convexity of ye. Cornea are oblidgd
to make use of Convex Glasses to supply the Defect, & 
again on the contrary, when there is too great a convexity 
of this Coat it renders people near Sighted & 
such are oblidged to make use of Concave Glasses; thee Causes
& manner in which these different effects are produced will 
be explained hereafter -
The Choroides is the entire Coat of the Eye & 
lies immediately under the Sclerotis to ye. internal Surface of
which it is Slightly attached by its vessels piercing thro
the latter to be spent on the First: we can trace this Coat 
from the Optic Nerve, which it closely embraces & surrounds as
it enters the Eye, to the Edge of ye. Cornea where it very clearly
adheres



198
adheres to the Sclerotica, and then seperates itself from it &
hangs down in a Circular form loose & floating in the Aqueous 
Humor dividing it into its 2 Chambers as they are
called: here it loses it's name & is called Iris, which is of 
different Colours not only in different animals but sometimes 
in the same Eye, giving the different Colours to the Eyes
of different People, as black, Grey, Blue &c; and it is 
likewise thicker than the other part of the Choroides, 
for which Reasons it is said by some to be a distinct 
Membrane from the Choroides; but I cannot by any means
allow this to be true, for seeing that the Cornea is of a difft.
appearance from the Sclerotica we might with equal 
propriety call them two distinct & seperate membranes
which no person say to be the Case, and therefore I woud 
have it understood that the Choroides & the Iris are
one & the same membrane with this difference only, that 
all that part which lies under & is connected to the 
Sclerotica is called Choroides, and that part which 
lies floating in the Aqueous Humour is called Iris.
The Choroides is a fine thin vascular membrane; it's Vessels
creep along the Sides of ye. optic nerve & getting upon it, 
takes many vertical & winding turns upon its Surface;
the Iris is likewise vascular -
On the internal Surface of the Choroides next the Retina
there is lodged a large quantity of Black Paint or Matter,
called Nigrum Pigmentum, which is found in all animals



199
animals; but in Brutes it is situated on the external 
Surface of the Choroides between it & the Sclerotica;
and all Animals which feed upon Grass or at least
all those that are properly Graminivorous Animals, have
the Choroides of a Green Colour, which enables them to
See grass with less light & with greater facility
than we can - This Green Colour is called the Uvea - 
The use of the Nigrum Pigmentum in the Human 
Eye is to prevent the Rays of Light from being 
reflected back upon the Retina, which woud have been 
the Case had it been white; as white reflects all Colours,
which Black does not but has a power of absorbing 
the Rays of Light - If it had been white we should have
had a double tho imperfect Impression of all objects
and our Vision would not have been so distinct as it 
is; and all animals whose Choroides is almost White 
can see Objects as well in the Night as in the Day on 
accot. of their having a Double Impression, but their 
Vision is not so perfect as ours -
The Iris is not an entire membrane, but in the 
middle it is deficient forming a small Hole or 
Perforation called the Pupil, thro which the Rays of Light
pass to the Retina thro the Crystalline Humour wch.
lies immediately behind this Hole - In the Human
Eye the Figure of ye. Pupil is quite Circular, but in
different




200
different animals it is of different Shapes, & best adapted
to their different way of living in all animals; thus 
it is circular in us, because this Figure enables us
to see all objects every different equally advantageously;
and for the same Reason it is also circular in some 
animals who are the Prey of others, as Fowls &c; but
graminiverous animals have their Pupils oblong &
horizontal - whilst other animals which seek their
Prey upon the Ground and climbing &c as Cats &
all that Species of Animals which hide in the Earth,
have their Pupils perpendicularly oblong which is
most convenient for them to look upwards & downwards 
as their Prey offers -
We find in the Human Eye that the Pupil
is not always of ye. Same Size, for it has a manifest 
power of Contraction & Dilation in proportion 
to ye. number of ye. Rays of Light thrown upon it:
this alternate Contraction & Dilation seems to be 
performed by the Fibres of the Iris running in different 
Directions, some appearing to run Circularly, others
longitudinally - These Fibres are not to be seen but in 
preparations of this membrane; and some anatomists
on Accot. of this action of the Iris have thought it to be
muscular, whilst others deny it & say that it cannot
be muscular because there is no Point for the Muscles
Muscles



201
Muscles to act from or upon, which however is no argument
as the Same Objection might brought against the Heart's
being muscular which nobody denies; but whether it is muscular 
or not I will not take upon me to say -
The Pupil is observed to be most dilated when we are in a 
Dark Place which few Rays of Light enter, in order that
it may take in as many Rays as possible the better to enable 
us to see in such dark Places; on the Contrary when we are 
in a light Place it becomes very small & contracted, in order
to prevent too many Rays of Light falling upon the Retina
which woud make too strong an Impression upon it &
render Vision imperfect, and this we may be convinced of by
looking at the Sun or any Luminous Body - This Change 
in the Size of the Pupil is not brought about Instantaneously
from the one to the other, & this is the Reason why 
a Person going immediately out of a Dark into a light
Place (& vice versa) cannot see till some little Time after .
for the Pupil, whilst the Person is in a light Place, being 
small & contracted must have time to dilate itself sufficiently
in the Dark & then objects appear Visible to the Eye
which were not so before the proper Dilatation of ye Pupil:
the same Change takes place on coming out of a Dark
into a light Place, for the Pupil being greatly dilated
in the Dark, the Light on accot. of a great number of Rays
being received into the Eye, is too powerful for the Retina
to bear and causes the same Dimness of Sight as when 
we



202
we look at the Sun; but after being in the Light for Some
time the Pupil has had time to contract itself to such
a Size as will admit of a proper number of Rays to
make us capable of Vision - And thus we accot. for People
who have been long confined to Dark Places, as Dungeons &c.
seeing objects which are invisible to others at their first
entrance into such Places -
It is very necessary that we shoud know whether the 
Crystalline Humour Adheres to the Iris or not in the Disease
called the Cataract, because when it does adhere, it is 
laid down as a Rule not to perform the operation: and
this we are discover by observing whether the Iris has this 
Power of Contraction & Dilatation, which may be discovered
by keeping the Eyelids shut for Some time and Suddenly 
open them in a light place, and if there is no adhesion 
the Pupil will be observed to contract itself from being 
enlarged & Dilated during the Time the Eyelids were Shut;
if on the Contrary we find no alteration take place we may 
be certain that there is an adhesion & the operation is then
not to be performed -
At the Place where the Adhesion of the different Coats 
of the Eye takes place viz, around the Edge of ye termination
of the Sclerotis & beginning of the Cornea there is observeable a white 
Ring, which is described by authers as a Ligament & hence
is called Ligament Ciliare; but it is not by any means of
the nature of a Ligament and is nothing more than a white
appearance



203 
appearance formed by the adhesion of the Coats of ye. Eye in
this part - 
From this Place there a great no. of small floating 
Filaments called processus Ciliares, running like So many
radial Lines from a Small Circle to a larger one: they
lie upon & every where embrace the Circular Rim of the 
Chrystalline Humour - Some Anatomists have thought that
they were Glandulr., but the general Opinion is that they 
are Vascular -
The Nigrum Pigmentum before Spoken of is always
found in greatest quantities near these Processes; and it 
is supposed that the Reason why it is so is, that it is 
to prevent the Rays of falling obliquely upon the 
Retina which woud have created a Confusion in Vision -
Some consider this Nigrum Pigment. as a real Tunic, but 
it cannot with the least propriety be called one, because
it may be easily washed off from the Choroides & will tinge
the Water a black muddy Colour -
The 3d. & last entire Tunic is by much the thinnest of 
all the Coats of ye. Eye & is called the Retina: it is continued
from the Optic Nerve immediately under the Choroid
as far as the Ciliary + Processes and cannot be traced any
farther tho' some Say it is continued over & gives a Coat to 
the Crystalline Humour - 
It is supposed that this membrane is the immediate Seat of
Vision, that the Figure of every object we look at is painted
in



204
in Miniature upon it & from thence conveyed to the Brain
by the Optic Nerve - 
Its Vessels are very minute; its receives two very small
Branches of Arteries, one from the Choroid, and the other runs
from the Center of the Nerve -
The Optic Nerve enters the Globe of Eye laterally
& Obliquely towards the Nose - It is more pulpy than
the other nerves without the cavity of ye. Cranium - Some have
thought that the Coats of ye. Eye were an Expansion of 
this nerve & its Coats; that the Sclerotica was a continuation
& Expansion of ye. Dura-Matral covering of ye. Nerve; the 
Choroides, of ye. Pia-matral; and the Retina, of the
medullary part of ye. nerve itself; but Winston denies
this absolutely: the Structure & appearance of the Coats
of ye. Eye are very different from those of ye. Nerve, [cross out] 
& the Nerve itself, especially the cast; which seems to 
prove that Winston is right in contradicting the old 
opinion -
There remains one more Membrane to be spoke of which 
is observable in the Eyes of Fœtus's only, generally of
about 5 mos. old. It is called membrana Pupil aris 
and cover the anterior part of ye. Globe of ye. Eye. It
is said that Dr. Sands 60 years ago saw it notwithstanding
some have asserted it to have been discovered long since
that time - It is thought to serve some purpose in 
defending the Eye of ye. Fœtus, but it's use is not well known.



205
Of the Humours of the Eye
The Humours of the Eye are the contained parts, and
are 3 in Number, the Aqueous, Crystalline & Vitreous.
The Aqueous is so called from its being a thin watery
clear & transparent Fluid -
The Crystalline, is so called from its resemblance to
Crystal Glass -
The Vitreous is so called from its resemblance to 
melted Glass, is of a Gelatinous Consistence, less 
Solid than the Crystalline, but less fluid than the
aqueous -
The Aqueous Humour is Situated most anteriorly
immediately behind the Cornea; next to this, immediately 
behind the Pupil, is placed the Crystalline wch.
lies in a Bed in the Vitreous, which is the most posteriorly 
Situated & occupies nearly 2/3 of the Eye. By 
this Situation it is evident that the Rays of Light 
must pass thro all of them to get at the Retina,
The Aqueous Humour is divided into two Portions
called Chambers by the Iris hanging down within it,
and these are called anterior & posterior Chambers:
all that Space occupied by the Aqueous Humour between 
the Cornea & the forepart of ye. Iris is called the anterior
and that space behind the Iris between it & the Crystalline 
Humour is called the posterior, and is the smallest
of 



206
of the two. This Humour is said by some to be of a Spirituous 
Nature & will not freeze; in this Country the 
weather is seldom so severe as to freeze it before it
disappears, which it does often in 24 hours after Death,
being either evaporated by transudation as some say
thro the Cornea, or which is most probable being absorbed;
but in ye. northern Climates it is often froze.
The Aqueous Humour, & indeed all the Humours of ye. 
Eye, is deposited by Vessels and there are no doubt 
absorbent Vessels to absorbe it again by which means
there is a continual Supply & Circulation kept up; for 
it is supposed that if it was to stagnate long, it
woud become putrid -
The use of the aqueous Humour seems to be principally
to defend the Crystalline from Injuries and to keep 
it in its place, and likewise to preserve the Convexity 
of the Cornea, for as soon as the aqueous Humour is 
discharged by any accidt. &c. the Eye looses its natural 
convexity upon the Cornea which becomes loose &
depressed and the Sight becomes totally or in a great
measure lost, till the aqueous Humour again accumulates
& distends the Cornea to its former Convexity 
by which means Vision will be restored - A remarkable
Case of this Sort happened to a Boy who had the 
Aqueous Humor discharged by a Blow from a Cricket
Ball.



207
by which the Eye lost it's Sight & Convexity till the
aqueous Humour again accumulated & distending
the Cornea which was flaccid the Boy recovered his
Sight again - This proves the Circulation of this 
Humour - It will not Coagulate with Ardent Spts.
as the Liquor Pleuræ &c. does -
Behind the Aqueous lies the Chrystalline Humour
it is enclosed in a fine membrane called its' Capsule
which is a continuation of the Tunica Aranca of
the Vitreous Humour: it's Situation as before observed
is behind the Iris & surround by the Ciliary Processes;
it is of a Lenticular Form, hence called 
the Crystalline Lens, rounded & convex anteriorly, and
like a turning Glass refracts the Rays of Light & 
collects them into a Focus upon the Retina, for
which purpose it is kept at a proper distance from 
it by the Vitreous Humour, in a Cavity in which,
one half of it is buried; the other part is prominent 
beyond the Surface of ye Vitreous - It is of different
Colours & Consistence at different Ages in the Same
Person; in Children it is white i.e. of a more watery
Colour, in adults it becomes of a yellowish 2 Colour,
and at last in People very far advanced in Years it
becomes almost black; hence we may account for
the



208
the Complaints which old People make frequently of 
mists appearing before their Eyes or of Insects, as Flies
dancing before them, which in time proves a Blindness.
It is said to be more fluid in Children than in Adults.
This Humour is the Seat of that Disease called 
the Cataract which is nothing more than an opacity
of it & from which no age is Exempt - I shall now only
observe with respect to the disease that some people
who are affected with it can distinguish Day from 
Night; and this imperfect Vision is accounted for differently
by different authors: Mr. Sharpe says that the Rays
which pass to the Retina & cause this sense of Light do not
pass thro the Crystalline but obliquely on each side of it;
but I am of a different opinion, for I can't think that
any Rays can pass this way on accot. of the situation of 
the nigrum Pigment. placed between the Ciliary processes,
it seems more probable that it is owing to the difft. degree
of opacity and that in proportion to that the Rays
pass immediately thro it more or less, seeing that this
Power of distinguishing Day from Night is not given
to all persons who have Cataracts, which it woud be 
if Mr. Sharpe's Supposition was true - There are difft.
methods of remedying this Disease of which I shall 
Speak particularly when on the operations -
The 



209
The 3rd. and last Humour of the Eye is the Vitreous;
its Situation is posterior & occupies the greatest part of 
the Globe of ye. Eye, giving it its Spherical Figure: it
is enclosed in a proper membrane of its own, which from 
its fineness is called Tunica Aranea which can only be 
seen in water and is said by some to be cellular & that
the Vitreous Humour is contained within these Cells. This 
Humour taken out of ye. Eye & suffered to Stand 12 Hours
will entirely waste away together with it's Tunic, no Traces
of which will be seen - This Tunic as before observed is continued
over the Crystalline Humour giving it a Coat & 
by this means creating a Slight Adhesion between the 
2 Humours -
The use of ye. Vitreous is to keep the Retina Expanded
& to preserve the Crystalline at a proper Distance from 
the Retina that all the Rays of Light may fall upon
it in a Point or Focus -
Of Vision -
Vision consists in the Union of all the Rays which 
come from an object exactly in one Point on the Retina,
and every Ray has it's innate Colour which is represented
on that Part of ye. Retina on which it falls; this Point
or Union of all the Rays on ye. Retina is called ye. Focus
by means of which, the Image of ye. object is painted and the 
Sense



210
Sense of it conveyed by the optic nerve to the Brain: It is the
Use of the Different Humours & Coats of ye. Eye to collect these
Rays together in such a manner that they may meet exactly
and form this Focus upon the Retina and this is what we
called distinct Vision; but if the Eye is so formed by Nature
or altered in its Figure by Disease that these Radial Lines
coming from an Object do not thus untie exactly in one Point
upon the Retina, then Vision becomes imperfect or Obscure
As in a Dark Chamber that has a Hole in it furnished wth.
a Convex Glass, if the Paper that is to receive the Image of 
the Objects be either nigher to or farther off from the Glass than its'
due Distance, the Representation there on will be imperfect
& confused, because the Rays are not brought to a Focus, wch.
if they had the objects wou'd have been painted of their proper
Shape, Figure, Colours &c.; it is just so in the Eye if the Crystalline 
Lens is too near or too far off the Retina; and this 
Fault may be either owing to the natural Formation of ye. Eye
as too great a Convexity or Concavity of ye. Crystalline & Cornea,
or to Diseases producing the discharge of ye. Aqueous Humour
as from Blows &c by which the Eye loses its convexity & becomes
flatten'd: either of these Cases will produce imperfect vision; if
the Eye is too Convex, the Rays form a Focus before they reach 
the Retina and this is the Fault of their Eyes who are near
Sighted; ye. Contrary, if the Eye is too little Convex, then
the Rays for want of being Sufficiently refracted by the proper 
Convexity of the Cornea or Crystalline Lens do not meet soon enough 
upon



211
upon the Retina, but fall upon it scattering & seperate & the same
Effects produced as in the other Case, tho' the Causes are immediately
different; this last is commonly the Cause of a Defect of Vision
in Old People, and therefore they are oblidgd to supply the Defect
by Convex Glasses, by means of which the Rays are collected
& form a Focus on the Retina, and from this it is obvious
that Spectacles help old People not by magnifying the Objects
but by the above means; what still further confirms this is 
that such People cannot read ye. largest Print without
Spectacles & yet with them they can read the Smallest -
People who are Couched for a Cataract have this same Defect,
on account of ye. Extraction or Depression of ye. Crystalline Lens
hence they are oblidged to make use of the assistance of Convex
Glasses - Mr. Martin in these Cases recommends the Glasses
to be made Lenticular. i.e. convex on both Sides as they woud
best answer to the Figure of ye. Crystalline Lens, and on that
accot. he apprehends they woud be of greater utility - on the 
contrary those who have too great a Convexity of ye. Eye are oblidgd
to use Concave Glasses in order lessen the too great refractive
Power of the Cornea &c. or in other words, these Concave
Glasses make the Rays diverge so, that the Cornea & Crystalline
shall be sufficient just to bring them together again
in such a manner that they shall not meet before they get
exactly upon the Retina; and for this Reason such are helped 
by holding the object very near, for the Rays are then more 
diverged than when the Eye is farther off from the object -



212
Of the Course of the Arteries
The Structure of the Arteries has already been explained; I
Shall therefore now point out on that Subject before us their 
Course beginning at the Heart with the aorta & tracing all
its principal Branches -
The Aorta arises from the left Ventricle of the Heart,
mounts upwards and immediately forms it's Curvature - It is divided
into Aorta Ascendens & Aorta Descendens; all that Part
of it between its Exit from the Heart till it makes it's
Curvature, or as some say, till the Subclavians go off, 
is called the Aorta Ascendens; and from its Curvature it
takes the name of descendens and is continued down on 
the left of the Spine under ye. Peritoneum & Diaphragm, 
as soon as it passes the last of which it runs immedi
upon the middle of the Spine till it arrives at the Loins
where it loses its name and divides into two Branches 
which are called the Iliacs; this place is called its Bifurcation -
The first Branch the Aorta Sends off is the Coronary
Artery; which we saw when upon the Heart, & therefore shall
proceed to the next -
From its Curvature arise Sometimes one, two, 3 or 4
Branches: these are the Carotids & Subclavians: most 
commonly there are 3 Branches, the left Carotid, and Subclavian
going



213
going off in Seperate Trunks, and the right Carotid going
off in one Trunk and sending off the right Subclavian.
These Vessels are sent to the inside & outside of the Head, to 
the Neck, part of the Thorax, Arms &c - we shall first
follow the Carotids -
These run on each side of the Trachea in one Trunk as high
up as the Os Hyoides where they divide each into 2 Branches 
one the external the other internal Carotid: the first sends off 
several small Branches to the Trachea, Thyroid Gland &c.
the last sends off no Branches till it gets within the Cavity of 
the Cranium -
The first Branch sent off from the external Carotid, which 
we shall follow, is the Super-Guttural, which runs in an
inflected Direction & is Spent upon the Thyroid Gland, in it's
course to which, it sends off a few Branches to the Trachea.
The 2d. is the Sublingual which runs along upon the Horns of
the Os Hyoides and is spent on the Tongue & other Parts
adjacent -
The next is very small, called the maxilla inferior, and is
spent chiefly on the mastoid muscle -
The Maxilla Superior or Genial is the next & is a pretty
large one: it runs over the Lower Jaw where it tis immediately
upon the Bone, runs over the Masseter Muscle in
a winding or rather zigzag manner, sends of a Branch to 
each



214
each of the Lips which are called the Labial arteries, and then
mounts upwards and is spent upon the inner angle of the Eye, 
and is called Angular Artery -
This artery where it runs upon the Bone of the lower Jaw
may be divided, when pressure will be sufficient to stop the
Hæmmorrhage - In the operation for thee Hare-Lip we divide
the Labial Branches of it -
The next artery is the occipital which gives off small
Branches to the mastoid muscle under which it passes 
near it's Insertion into the Os Occipitis and under the Splenius, 
and is spent upon the Occiput, many of it's Branches 
Anastomosing with the Branches of the Temporal & the
following.
The Posterior Auricular is next and is a small Vessel so
as hardly to deserve the name of an artery sometimes; it is 
spent chiefly on the Cartilage of ye Ear, but some of its
Branches anastomose with those of the occipital and the
Temporal -
The Internal maxillary is situated so deep down that it
can hardly be wounded but by Gunshot; it sends off Branches
to the Teeth, to the Temporal Muscle, the Pterigoides
muscles, the Orbits &c. and it sends off one considerable 
Branch to the Dura Mater which is the Principal Artery 
this membrane has - 




215
The external Carotid now passes up before ye. Eac & when it 
reaches the Ligomatic Process takes the name of ye. Temporal;
this divides into 3 Branches, the anterior, a Middle & posterior.
The posterior anastomoses with the Branches of ye. occipital 
& auricular; the anterior Branch is what is divided in 
bleeding in the Temples, and some of its' Branches anastomose
with other Branches of Arteries coming from the Orbits -
The Internal Carotids cannot be shewn but upon Preparation
where the Cranium is opened & the Brain removed &
therefore I shall now go to the Subclavians which come next
in order; and shall speak of ye. Internal Carotid at anoyr.
Time -
The Subclavians; they take a winding Course outwards
from their origin, then pass under the Clavicle where they 
loses their name and [is] are called axillary they passes over the 
first Rib and lie immediately upon it by which means, it may
be compression by pressure upon this Place. - In it's Course
to the axilla it sends off several Branches, the first is
The Thoracic which is very small -
The next is a considerable Branch called the Vertebral,
which run along under the transverse Processes of the Vertebræ
of the Neck & passing backwards enters the great Foramen,
and having got within the Cranium anastomoses with the 
internal Carotid -



216
The mammaria interna runs immediately under & across
the Cartilages which articulate Ribs to the Sternum &
not as some authers say, under the Sternum itself; and 
passing near the Xiphoid Cartilage is continued upon the
Recti muscles (on their internal surface) of the Abdomen
and goes to meet & anastomose with the Epigastric -
The Cervical is next, which divides into 2 Branches, the 
posterior & anterior: the first sends off Branches to the 
neck in different Parts, and the Anterior sends off
Branches to the Thyroid Gland, Oesophagus &c -
The Intercostalis Superior runs over the 4 first Ribs.
and in some subjects is a Branch of the Internal mammary.
The Axillary Artery Sends off many Branches, some of which 
take no name - The first remarkable one which it sends off is
The external mammary, called by some the Superior Thoracic;
The vessel not only Serves for the nourishment of the Breasts,
but, in women, as a Secretory Vessel; bringing Blood for the 
Secretion of Milk - It is the Branches of this Vessel that
are divided in Amputating the Breast; and it may not be
amiss to observe that in proportion to the Ground the Disease
has gained in the Habit, the Hæmorrhage in the operation will be more or
less from them; for, in Cancers, the Vessels are generally much
distended, and in this Case the Hæmorrhage will be often very 
great; and therefore we may always, almost, form a prognostic
whether



217
whether the Disease will be apt to return or not: when the 
Hæmorrhage is great, I have always observed that the wound
did not heal, or if it did, the Disease made its appearance
again soon in some other Part - the Cancerous Virus often 
corrodes these Vessels, and the Patient is generally worn
away by degrees from their continual Bleeding -
The Humeral artery takes a winding Course round the
Head of ye. Humerus & is Spent upen the Capsular Ligamt.
& Deltoid Muscle - 
The Subscapular is sometimes a considerable artery & is 
spent upon the muscles of the Scapula & part of the Pectoral -
The Axillary Artery having continued it's Course till
it passes the Tendon of the Pectoralis major, there drops the 
name and commences Brachial - This runs under the 
deltoid muscle and close to the inside of ye. Biceps, at
which place it his close to the Humerus & is coverd
externally by common Integumts. only; it keeps the name 
of Brachial so far as it runs in one Trunk, and when 
it divides into two, [called] it gives the Radial & Ulnar Arteries.-
Before it divides, it sends off many muscular [cross out]
and several Collateral Branches, which frequently 
anastomose with the Radial & Ulnar -



218
The Place of its Division into Radial & Ulnar is very 
various in different Subjects; sometimes it is below the Joint
of the Elbow, sometimes at the Joint, or one, two, three
Inches or more above it; in some Subjects I have Seen it
divide so high up as not to take the name of Brachial 
at all, i.e. it divided before it passed the Tendon of the
Pectoral; in general however it more commonly divides below
than above the Joint and passing in one Trunk under
the Tendinous Fascia immediately sends off the two above
mentioned Vessels -
The Direction, Size & no of ye. Collateral Branches wch.
run from above the Joint to anastomose
with the arteries below, is very various; and this, together 
with the uncertainty of ye. Division of the 
Brachial Artery, renders the Operation for the 
Aneurism here very uncertain: if the Trunk of the Vessel
is tied & the Arm mortifies, it is owing to there not
being a Sufficient Number of Collateral Branches to
Supply the arm below -
The Ulnar Artery immediately after it's commencement
sends off some muscular Branches and one considerable
Branch called the Interossens which runs along upon
the forepart of ye. Ligamt. till it arrives at the Quadratus
muscles, under which it dips down and goes to be
Spent upon the Back of ye. Hand; the Course of the Ulnar



219
Ulnar is generally deep down under the Muscles in the 
Direction of ye. Ulna and Sending off Small Muscular
Branches to ye. different muscles of ye. arm till it arrives
at the wrist; here it runs under the Carpal Ligament
tho' sometimes above it, and is spent upon the inside of 
the Hand & Fingers -
The Course of the Radial is more Superficial than the 
Ulnar being often covered by common Integumts. only, and
running sometimes over & sometimes under the Carpal Ligament
send a Branch to the Thumb and is then continued
a little forwards and makes a circular Turn
from the Thumb towards the Little Finger it meets
& anastomoses with this Ulnar forming the arterial
arch in the Palm of ye. Hand; from this Arch
there are generally sent 4 Branches which run
in a Straight Direction to the first Joint of the Fingers
one Branch to each, where they all divide into two 
Sending off one on each Side of each Finger to their 
Extremities where they are lost in the Integuments - This
arterial arch is not always constant but wherever it
is wanting the arteries still have a Communication
only their Anastomosing Branches run in a different
Direction -
If the Arterial Arch or the Arteries at the wrist
should be wounded which is frequently the Case. I would 
recommend



220
recommend Pressure to be used to stop the Hæmorrhage
in preference to the Needle & Ligature; because the 
Tendons being here very numerous you would be liable to
take one of them up with the Vessel or by exposing them
endanger bringing on Inflammation; Suppuration &c.
if not the Loss of ye. Limb; and in general Pressure 
alone will Succeed by which we run no risque of the 
above dangerous Symptoms -
The Internal Carotid we have observed give off no
Branches till it gets within the Cavity of the Cranium;
as soon as it does this it sends off a Branch thro the 
Foramen opticum to the Orbit which passes out of the 
Orbit thro the Notch or Foramen on the orbitan Process 
of ye. os Frontis & is spend upon the Forehead, Some
of its Branches anastomsing with the Branches
of ye. anterior Temporal -
The Carotids then divide and each sends off a Branch 
to the other forming a Communication between the two.
The Vertebral as soon as they get into the Cranium
unite into one which is called the Basilary; this
soon again divides into two, each of which sends 
off a Branch to communicate with the Carotids;
by which means there is a free Communication
between all the four, and this is what Willis
calls the four fold Arch: from these 4 Vessels
and -




221
and their Anastomosing Vessels, the Brain is supplied
with Blood; the Anterior & middle Lobes of ye. Cerebrum
are Supplied by the Carotid; the posterior Lobes, Cerebellum
& Medulla Spinalis from the Basillary Arteries - The
Basilary sends off a few small Branches to the Dura
mater & the internal parts of ye. Ear -
What is peculiar to these Arteries is, that when 
they enter the Cranium they make many Inflections
& windings and are much thinner appearing like 
Veins more than Arteries - These Circumstances
Seem to be contrived by Nature to prevent the too
forcible Circulation thro them on Accot. of the tender
Texture of ye. Brain; for by their Thinness, the Coats
are rendered weaker in their action and Consequently
the Blood is propelled with less Force thro them that
if the Coats were as thick as those of other Arteries
of the same Diameters; and by their winding Course
the Circulation is rendered more Slow -
We now go to the Aorta Descendens: this divided into 
its' Thoracic & Abdominal Portions; the Thoracic is that
part which lies above the Diaphragm; the Abdodminal
is the part from the Diaphragm to its Division into 
the 2 Iliacs -
The Thoracic Portion diminishes very little in Size in
it's



222
Passage, the Branches which are sent off from it being very
Small - The first of which are distributed to the Œsophogus,
Bronchia & Trachea, tho' these do not allways
go from the Aorta but sometimes from the Intercostals.
The Intercostals are so called on account of their running
between the Ribs upon the [the] Intercostal Muscles: they 
run almost at right Angles from the Aorta, and as the 
Aorta runs to the left of ye. Spine the Intercostals of the 
right side it is evident must be the longest. They
do not run in the Suleus observeable on the inferior Edge
of the Ribs, but upon the internal Surface of ye. Intercostal 
muscles rather nearer to the inferior than Superior
Edge of each Rib - 
In performing the operation for the Empyema, two 
Cautions are to be observed, the one is, to avoid wounding
these arteries, the other to avoid wounding the
Lungs - In order to avoid the first, Surgeons direct us
to make our Incision as near the upper Edge of the
inferior Rib as possible; but this method is attended 
with this Inconvenience, that the Matter discharging
over the Rib so near it's Edge will be apt to render
it Carious -
Several Branches are sent off from the Thoracic Portion
to the Lungs & Heart for their nourishment; & also to 
the Œsophagus - the first goes off to ye. Lungs & is called Bronchial
or Ruyschian; those to the Œsophagus are called Œsophageas.



223
As soon as the Aorta passes below the Diaphragm [cross out]
it's Abdominal Portion begins, and the first Branch it
sends off is the Phrenic or Diaphragmatic which is spent
upon the Diaphragm on its inferior Surface -
The next is a very considerable Artery, called the Caliac
which soon divides into 3 Branches; the first of which 
is called the Coronary and is spent on the Stomach; the
2d. is called the Splenic & goes to the Spleen - and 
the 3d. is the Hepatic which is sent to the Liver for 
it's Nourishment; in it's Course it sends off several 
small Branches to different Parts, the Gall-Bladder &c.
and one considerable one to the Stomach called the Gastrica 
Dextra, and a small one which is likewise spent
on the Stomach & is called the Pylorica which anastomoses
with the Coronary in the small arch of the Stomach;
the Gastrica Dextra runs under the Intestines & over
the Pylorus and continues its Course upon the great
Curvature of ye. Stomach, its Branches frequently 
anastomosing with the Branches of the other arteries
of ye. Stomach - 
Splenic in it's Course to the Spleen Sends off
Branches to different Parts, as the Pancreas Stomach
&c. It gives off one to the Stomach which is spent upon
the left Extremity and called the Gastrica Sinistra
in opposition to the gastric. dextra which runs from
the



224
from the right Extremity of the Stomach along the great
Curvature towards the left extremity - A little farther
on towards the Spleen some Small Branches go
off from the Splenic to the Stomach called Vasa
Brevia -
The stomach then we see has 4 principal arteries
sent to it, viz, the Coronary, the Pylorica, the Gastrica
Dextra, and Sinistra, besides the Vasa
brevia -
The next Artery is the Mesenterica Superior; this
is spent chiefly on the Intestines, going off in one 
Branch from the Aorta but soon dividing into Several
which have frequent anastomoses with each other
before they arrival at the Intestines after which they 
are spent in very numerous Branches upon the 
Intestines; they all run before they get to the Intestines,
between the Duplicature or Lamina of the 
Peritoneum called the Mesentery - The first 
considerable Branch it sends off is called it's
anastomosing Branch which passes between the 
Lamina of ye. Meso colon and anatomoses with
a considerable Branch of the Mesenterica Inferior.
The next in Course are the Emulgents which 
enter




225
enter the Sinuses of the Kidneys sometimes in one, two 
three or 4 Branches - From these sometimes a
Small Branch is sent off to the Capsulæ Renales
& is called the Capsular Artery -
The Spermatics go off next of which I shall
speak when upon organs of Generation, and 
therefore I shall only observe here that they
generally arise about midway between the
Emulgents & the Mesenteric. Inferior -
This last generally divides into 3 pretty considerable
Branches; the 1st mounts obliquely
upwards & goes to meet the anatomosing Branch
of ye. mesenterica Superior: the next is continued
to that part of ye. Colon which runs in the left
Side of ye. Cavity of ye. Abdomen; and the 3d. is
sent to the forepart of the Sacrum, the lower part
of ye. Colon & upper part of ye. Rectum; the Branch
which is spent upon the Rectum is a pretty 
considerable Vessel in the Adult and lies in the 
way of being wounded in Cutting for the Fistulæ
in Ano if the Sinus runs high up and we 
follow it to the Bottom; therefore I wou'd never 
dilate farther than I coud reach with my 
Finger




226
Finger, by which means as the artery is not very 
large low down on the Rectum we avoid a 
Hæmorrhage which may prove fatal if the
Vessel is wounded high up; and the Patients
always do as well with a small Dilatation as
if the Sinus was dilated to the Bottom -
The next is the Lumbal which soon plunges under
the Psoi Interni muscles & passing over the upper
part of ye. Sacrum runs out laterally upon the 
fore part of the Pelvis & is spent upon the Muscles 
of ye. Abdomen; some of it's Branches anastomose
with the Branches of ye. Epigastic Extern.
The last artery which the Aorta Gives off
before it's Bifurcation is the Sacral, which runs
along on the fore-part of ye. Sacrum -
The Aorta now divides into the 2 Iliacs: which 
run some little Distance and again divide into the 
External & Internal Iliacs -
The external Iliac passes along the fore part
of ye. Psoas Muscle & thro' the Ligament, Popartii
& then commences Crural -




227
The internal Iliac dips down into the Cavity of the 
Pelvis and gives off several Branches called the 
internal Pudendal which are spent upon the Prostate
Gland, Vesiculæ Seminales, Bladder; & to the Pudenda
in women -
It next sends off a large one which is called Glutæa
and which passes in the Sacro Sciatic Notch thro the
great Foramen Ischii to be spent on the glutei
Muscles -
It send off anoyr. called the Ischiatic from which 
The umbilical Arteries in the Fœtus are Sent from the
internal Iliacs
The next, the external Pudendal, likewise arises
from the Ischiatic in the Pelvis, and passing out of 
the Pelvis runs on the outside of it under the Sacro
Sciatic Ligaments and over the great Tuberosity
of ye. Ischium, from whence it mounts upwards upon 
the forepart of the Pubis & is continued on the Dorsum 
Penis in men, in women upon the Clitoris.
In it's passage it sends off vessels to the Rectum
called the Hæmorrhoidal.
The obturator is the only Branch remaining to 
be described before we come to the Crural - It commonly
arises from the Internal Iliac near the 
place




228
place where the Umbilical Arteries of ye. Fœtus 
go off, but sometimes it is a Branch of ye. Epigastric; 
it passes thro the Hole which is observeable
in the Ligament which fills up the great Foramen
Ischii & is spent upon the muscles of the upper 
part of the Thigh -
Thro this Place where the artery passes thro the
great Foramen a Hernia sometimes passes as
it is said, and called by Mr. Sharp Hernia Foraminis
Ovalis; an operation is recommended in a 
Strangulation of it, but it is so hazardous that 
I believe few Surgeons would be bold enough to 
perform it -
The External Iliac passes along the Course 
of ye. Psoas muscle & under poparts Ligament
into the Thigh; just before it passes under the
Ligament it sends off the internal Epigastric
Artery which runs inwards a little & then turns 
upwards and runs along upon the Recti
muscles of ye. abdomen to the upper part of
them where it meets with anastomoses with the 
Internal Mammary -




229
In the operation for the Hernia Cruralis we are
liable to wound this Artery if we divide the Ligamt.
by cutting upwards; if on the other Hand, to avoid
this Artery, we shoud cut thro the Ligamt. obliquely
we are in danger of wounding the Spermatic Vessels;
So that I woud not recommend the Dilatation of the 
Ligament at all, but endeavour to return the Hernia
by the use of Fomentations, Glysters &c -
Near this Artery goes off another smaller one called 
the Epigastric externa, which runs obliquely outwards
& anastomoses with some of ye. Branches of the Lumbal
artery -
As soon as the external Iliac passes below the 
Ligament. popart. it is then called Crural, which 
runs over the Pubis and along the forepart of the 
Thigh a little Distance & then runs obliquely towards 
the Inside where it lies upon the Bone and
at which place the Compress of ye. Tourniquet is 
applied in Amputations, and is continued in 
an inflected or winding Course into the Ham where 
it takes the name of Popliteal which name it keeps 
till




230
till it divides into the Posterior & Anterior Tibial -
In it's Course it sends off many muscular Branches 
to be Spent on the Muscles of ye Thigh, and one to the 
Labia Pudenda in Women and to the Scrotum in Men 
called Pudend. external - It likewise in some Subjects 
sends off some Collateral Branches from above
which anastomose with some of its Branches or 
again enter the main Trunk some distance below.
The Poplitea gives off several small Branches 
to the Ligaments about the Joint and then soon
divides into the Posterior & anterior Tibial -
The Anterior soon pierces the Interosseus Ligamt.
along the fore part of which it then runs & passing 
on the outside of the Leg runs over the Tarsus & 
metatarsus to the extremity of ye metatarsal
Bone of the first & 2d. Toe where it pierces thro 
to the Bottom of the Foot & anastomoses with the 
Posterior Tibial forming an Arch similar to
that in the Palm of ye Hand and from which,
arteries go off to the Toes similar to those of the 
Fingers



231
The Posterior plunge under the Gastrocnemii
muscles and runs on the Inside of the os Calcis
just above which, it lies close to the Tibia; after it
passes beyond the os calcis it dips down into the
Bottom of the Foot and divides into two Branches
the external & internal Plantaris, one of which 
is Spent upon the Foot, the other runs to meet the
anterior Tibial as before mentioned to send off
Branches to the Toes -
In its Course to the Foot it sends off one
considerable Branch called the Fibular, which 
lies close to the Fibula at the usual place the
amputation of the Leg and on this acct. is very
troublesome sometimes to secure from Bleeding: the 
best way to secure it is to pass the Concave part of the 
needle close to the Bone thro the Interosseus Ligamt.
and to bring it back thro the Ligamt. again near
to the Tibia & make the Ligature -



232
On the Female Breasts
The female Breasts are situated on the Anterior
parts of ye Thorax resting upon the fifth Rib, one on 
each Side - this Situation of the Breasts is peculiar
to ye Human Body alone for in Brutes they are
always found on the abdomen -
Their Figure is somewhat resembling half a Globe
their Size different in different women & various in 
the same Subject at difft. Times - In young Girls
they are very small and scarsely more visible more than
in the male till Puberty; they then grow & increase
considerably till the Age of 21: they differ in Size
likewise in proportion to the Corpulency or Leanness of
the Person . they grow smaller as old age advance -
Near the Centre on the external part is
a remarkable Prominence called the Nipple, round
which upon a Circular plane are situated many little 
Emminences which seperate a Fluid to moisten the nipple
with - The Breasts are larger in pregnant Women & those
who give Suck, as are likewise the Nipples; - it is 
like the Breast covered with common Integuments, only
the membrane here is of the Reticular Kind and in the
Breasts of the Adipose: they Circle round the Nipple is 
called Areolus and is white in Children but in Adults
is




233
is of a brown Colour, and during pregnancy grows
darker which continues during the Time of Suckling
Children; in Old People it is almost black - Internally 
the Nipple is composed of many lactiferous
Tubes which are only the Excretory Ducts of ye. Glandular
part of ye. Breasts by which the Milk which 
is secreted by the Glands is conveyed to ye. Nipple:
the Number of these Tubes is Various; in some women
I have seen only Six, and in others 15 or 16; they 
have no Valves, tho' some think they have in order
to prevent the Milk from flowing out when the Chd.
does not Suck, but we know when the Milk is collected
in large Quantities it will flow out of itself;
hence it is probable they fall into Folds when empty
but when they again become distended if the Child is
not suffered to Suck, some part of ye. Milk will flow
out -
The Breasts are covered externally by common Integuments
having a large Body of Fat under them,
and under this Fat is lodgd the Glandular Substance, 
which Secrete the Milk and which may be easily
distinguished from the Fat by it's white Colour,
the Fat being generally of a yellowish Complexion here:
The Breasts have Vessels & ye. Same as all other Glandular parts:
the



234
the lactiferous Tubes have no direct lateral communications 
with one another, tho' they anastomose with each
other by their small Branches, as is evident by injecting
Quicksilver into them; for if you pour it into one
Branch you will distend a great many; hence it is 
evident they communicate with each other in their
Ramifications thro the Substance of ye. Breast; and
it is common when a Tumour is formed in the Breast
from an obstruction in one of these Tubes to hear it
called an indurated Gland of ye. Breast or one of the 
Glands of ye. Breast swelled, which implies there are
more than one Gland in the Breast; but this is improper,
because there is only one glandular Substance
from which all these Tubes arise seperately -
The Vessels sent to the Breast are external &
internal Mammillary; the external is principally
bestowed upon the Breast, but the internal sends only 
a small Branch to it, the rest of it being spent upon the
Intercostal Muscles &c - the Veins are the same as 
the Arteries -
There is a great Sympathy between the Uterus & the 
Breasts; for Instance, during the Catamenia the 
Breasts swell, and we see ye Secretion of Milk only
whilst the Uterus is in a gravid State or in such
Women as give Suck who Seldom or never have 
the



235
the Catamenia during that Time: and the Diseases
of ye Uterus commonly causes a Disease in the Breast
& so vice versa; for when there is a Schirrus or Cancer
in the Breast the Virus is generally communicated to 
the Uterus: but how these Effects are produced is not
well known, or the Secretion of the Milk either; some
would account for them by the communication there is
between the Epigastric & internal mammary; but
tho' these do communicate their Branches are very Small
and unable to carry on so large a Secretion; for most of 
the Vessels sent to the Breast are from the external
Mammillary; and they suppose that the Pressure of 
the Uterus in the gravid Stale forced a greater quantity
of Blood into Mammillary arteries which caused
the swelling the Breasts & afterwards the Secretion of
the Milk in them; but the absurdity of this Reasoning
is evident - Men are frequently found to have 
Milk in their Breasts, hence it is highly probable
that the milk is produced by some other Cause than the
Pressure of ye. Uterus, and with which anatomists
are not at present acquanted with; at least no Hypothesis
has yet been advanced but what may be overset
by Objections which may be readily made against it -
It is a very bad method to use Repellents, as
Diachylon Plaister &c. to the Breast of Women after
Delivery

N.B. At the Time the Breasts are forming in young
Women from about 13 years of age to 16 or 17, it
is not uncommon for them to have a Small hard knot
generally situated near the Nipple which sometimes
is attended with a good dial of Pain and may be
mistaken for an incipient Cancer and treated accordingly;
but these Knots are of no Conseqe. & will
generally disappear when the Breasts are perfectly
formed, and [sometimes] the Patient may in the mean
time take some opening mede. now & then & wear
a mercl. plaister on the part. In these Patients
the Menses are generally obstructed or never have
appeared, which was the Case in a Girl of 17 years 
of age who had one of these Knots near the nipple 
which gave her much Pain and for which she came
to the Surgery of St. Thoss. to ask advice: Mr. Martin
looked at it and immediately pronounced it to be
one of those kind of Knots and directed her to take 

236
Delivery without the previous use of opening Medicines
internally; this is said to be often done to stop the Discharge 
of ye. Milk, but very bad consequences often
follow it; for at this Time Women are very liable to 
take Cold and the Milk Stagnating in their Breasts
Causes Indurations which frequently turn out an
obstinate Schirrus, and if there is any cancerous Virus
in the Habit at the Time it falls upon the Breast 
and produces an incurable Cancer; and at best 
after treating it with it with emollient Cataplasms &c
which cannot be too much recommended in these Cases,
Suppuration is brought on and they will be longer
or shorter Time getting well in proportion to the Depth of
the Seat of ye Matter: In these Abcesses nothing can 
be applied with so much Benefit as warm emollt.
Cataplasms, and they ought never to be opened with a
Knife or Lancet but suffered to burst of themselves.
Dr. Huck during the late war in America used 
no other method with the Solider's Wives, and notwithstanding
the Hardships they underwent during the 
Campaign they all did well; notwithstanding they
were oblidged to make use of Water instead of Milk
in the Poultices - Observat. - It is really painful
to witness (as I have done in many cases) the horrid mischiefs
arising from a different mode of treatment - Incision
following incision; Tent after Tent; acrid, sharp and corrosive 
injections; together with Calomel & other prepns. of 
mercury

some gentle Purges every now & then & to wear a
mercl. Plaister on it and in order to promote the 
Flux of the Menses directed Pediluvium om. Norte
He said he had seen several young women who 
had the same Complaint; and in one young Girl
he was called to consult with astlan who [cross out]
was a Cancer Curer & had pronounced it to be
a Cancer and intended to have applied his 
escharotic powder, but when Mr. Martin saw
the Breast he undeceived the Parents of the Girl
by telling them what the Case was, [cross out] the Empiric
was dismissed, and the Knot disappeard
without the Girl's having the Pain of it's being 
destroyed by the escharotic - He said that it
is sometimes found in Breasts of young men
just before they arrive to years of Puberty - On 
this subject vid. mereagri diseased caus. morber.
Of Mercury given internally -of this Mrs. Wm. Rowzie is 
one remarkable instance - and the Lady of a Genta. of
Note in Caroline another. The latter lady hath almost 
had her constitution ruined by the treatment just
described; in which the calomel was given so as to
salivate. In both these cases I was called in just in time
to save suffering the parties from further mischief & pain, & to prevent
the utter ruin of their health as well as entire destruction 
of the Breasts, by recommending mild, lenient applications,
with Bark. In another woman where tents were

237
The Course of the Veins -
The larger Veins generally take the same Course as the 
Arteries and sometimes the Same names; therefore I
shall not trace them from their extreme Branches
towards the Heart nor dwell particularly upon 
them, but only mention the principal -
As we reckon'd only 2 arteries, viz, the Aorta & 
Pulmonary, so we shall reckon only three Veins, 
these are the Pulmonary, Vena Cava & the Vena 
Portarum: the first we have seen when upon the
Lungs - The Cavas which are Called Superior & Inferior
I shall trace with their Branches from their 
Trunks to their Extremities which is the Reverse of 
the Circulation in them, and such as accompany 
the arteries & take the Same name I shall take 
no notice of - 
The Cavas attend the Aorta thro the Cavities of the
Thorax & Abdomen: the first Branch the Cava
Superior Sends off is the Vena Azygos, sometimes
singly, sometimes in two Branches -
The Super Cava Soon divides & sends off the two 
Subclavians; the right Subclavian divides under
the Clavicle and is then called Axillary: the left Subclavian
were used, the tent slipt into the Sinus and buried 

buried itself in the lower part of the breast, from whence 
it could not be extracted for Several months; 
at the end of which time it had worked its way towards
the inferior part of the breast near its basis, where 
the matter which I prevented from having a face exit
from the orifice above by proper application appointed
and [illegible] the whence it was easily extracted.

238
Subclavian is longer than the right and gives off three
Veins, the external & internal Jugulars & the Vertebral:
the external Jugular which is the smallest is the 
Vein we open when we bleed in the Neck; the divisions
of ye. right Subclavian is the same; tho' there is 
sometimes a Variety here -
The axillary divides into two Branches at the 
Head of ye. Humerus; these are commonly called
the Cephalic which is superior, and the Basilic
the inferior; these send off many cutaneous Branches
as they pass along and form one considerable
one frequently in the middle lying superficially
over the Tendon of ye. Biceps in the Cubit called
mediana from its Situation between the Cephalic &
Basilic: there is such a variety in their Branches
that we may never meet with two Subjects alike:
the Basilic is commonly the largest; their Branches
frequently anastomose with each other & grow smaller 
as they approach the Fingers -
The Cava inferior when it gets into the Cavity of the 
Abdomen, sends off its first Branch the Phrenic
others to the Kidneys, Liver &c all of which 
take their Names from the Arteries they accompany;




239
the Cava getting into the Pelvis divides at the Same
Place the aorta does and takes the names of Iliacs
like the Iliac Arteries, and are divided into externl.
& internal, and pass out with the arteries under the 
Ligament Popartii, commences Crural, passes along
with the Crural artery into the Ham and is there
called poplitœa which divides into many difft.
Branches which are distributed to the muscles
of ye. Leg, Foot &c. and likewise sends off several
Cutaneous Veins, the principal of which is called
the Saphena which passes along upon the lower
& forepart of the Tibia gets upon the Foot & is there
lost - we shoud avoid wounding this Vein in 
making Punctures above the ankles to discharge
the water in an anasarca as every Drop of Blood
is of great Consequence to dropsical Patients, & 
we may easily avoid it making the Punctures
not too near the Tibia -




240






241
On the Common Integuments.
By the Word Integuments is meant a Covering for the other Parts;
old Authors differ in their Accots. of these; some asserting there were five
proper membranes included & meant by the Name of Integuments
viz, the first, the Cuticle, 2d, Rete Mucosum; 3d.. Cutis, 4th. 1
Panniculus Carnosus; 5th membrana Cellularis: this last is by
present anatomists considered as a component Part & as such 
it was described in ye. beginning of this Course of Lecture; and
what is called Panniculus Carnosus is only a thin Plane of Muscular
Fibres running along ye. Cutis in Quadripeds, by the Assistance of 
which they are able to Shake off anything troublesome on their 
Skins, as Dirt, water, Flies & by these muscular Fibres
acting & corruguting the Skin; and some Animals as Dogs
& Horses have these Fibres much stronger than others; the 
Porcupine also has them exceeding strong by which means 
they are enabled to dart their Quills some Distance with
very great Force: we might be led to imagine that such
a Plan of Fibres existed in the human Body from many
Parts having this Power of moving the Skin as the Lips. Forehead
&c. & what bears a Stronger resemblance, the thin plan of muscular
Fibres in the Neck called Platysma Myoides; but this 
as well as the Fontales in the Forehead we call a Cutaneous
Muscle, and do not allow the Existence of this Panniculus Carnol.
in the human Body, tho these Cutaneous Muscles bear a great
resemblance to it & answer Similar purpose to us, therefore
we shall consider only three parts as making & composing the 
Integumts.



242
Integuments, viz, the Cuticle, Rete Mucosum, & the Cutis -
The Cuticle or Epidermis is what Nature has given us for an
external smooth Covering, very thin & finely polished: it is thickest
in those parts where the greatest Friction is, as in the Palms of the 
Hands of hard working People, Smith's for Instance, who have it
so thick in their Hands as to be able to hold hot Iron for
Sometime with little Inconvenience which would burn anoyr.
Person whose Cuticle was thin; in People who walk much
we may cut into the Heel or Ball of ye. Foot for an Inch or
more & no Blood follows or Pain felt; for it is not vascular,
and on that accot. if divided will not again unite, but a new
Body is formed by ye Vessels Sent to the Cutis - it is softest
where it is kept moistend and no Friction upon it, as in the Face
between the Fingers &c - In Blisters we destroy the Cuticle
& Rete Mucosum, but Nature soon regenerates a new one wch
How the Cuticle is formed has been variously conjectured; some
have supposed it formed by a Fluid sent from the Cutis &
being exposed to the air is inipissated & hardened by it; this 
Doctrine may be confuted at once by observing that the Cuticle
exists in a Fœtus in Utero; Some say it is formed by a 
number of Seals - but at present no Satisfactory Hypothesis
has been Started - If the Cuticle is stripped off from
the Cutis, the last becomes exceeding Sensible & the least & most 
gentle Touch creates pain, which shews that the Cuticle was 
designed as an external Defence to the Tender Cutis which woud 
have




243
have been too irritable & sensible without it, and instead of the 
Touch conveying a pleasing Sensation to us, the Feel of ye. Softest
Body woud have given us Pain -
The Hair is considered as an appendage to the Cuticle, as
is likewise the Nails - The Hair is Vascular and its Vessels
contain a Fluid for its nourishment; sometimes this Fluid is
dryed up; & the Hair becomes dry & falls off for want of its &
this the good Effect of Bears Grease & other unctuous Bodies are
accounted for in recovering the Beauty of ye. Hair, serving the
Purpose of ye. above oily Fluid - At the Root of every
Hair is Seated a Small Gland which is supposed to be the 
Seat of ye. Tinia or Scald Head - The Colour of ye. Hair varies
in different People & in different Climates - It is Said to Serve.
as a defence against Cold & other Injuries, on the Head; and 
also as a defense against Friction - It is in largest quants.
on the Head, ye. Pubis & under the Axilla; tho there is
some in every Part of ye. Body to prevent Excoriations of the 
Cuticle from Frictions against our Cloaths &c -
The Nails cannot be injected, which proves they are not Vascular,
tho' they seem to be nourished in the same manner as
the Cuticle - their Situation we are well acquainted with -
The Nails we find are continually growing, but notwithstanding,
if one is divided it will not unite, but the divided
part will in time be shoved off by the Succeeding new one - Some
Surgeons have thought the nails to be continuations of the 
Tendons, but the one can be proved to be vascular, the 
other not, and therefore this opinion cannot be true -




244
The Rete mucosum is the 2d. Covering and from its Similarity 
from Experiments to the Cuticle it is called a Second Cuticle
adhering very closely to the first, from which it cannot be
Seperated without great care & difficulty - It is said that the
Colour of this membrane constitutes ye. Difference between the
African & European; but by experiments both it & the Cuticle
have an equal share in Causing the different Colour, for we
see the Palms of ye. Hand of a Black grow white by Friction,
hard Labour &c - Some have said that the Rete
mucosum was tinged yellow in a Jaundice; if we admit
this, it must be allowed to be vascular, but the preparations
of it shew that it is not in the least Vascular any
more than the Cuticle - It is observed that the hotter the
climate is, ye. deeper will be the Colour of these Tunics;
thus in France, Italy, Spain & Portugal, they are Yellow;
in Africa, black; in Germany rather darker than in England
&c -
&c The method of Seperating these Tunics from the Cutis is
by throwing a piece of Integumts. into Boiling Water &
then Seperate the Cutis from them, and afterwards by 
maceration the Rete mucosum will peal off from the
Cuticle -
Immediately under the Rete Mucosum lies
the Cutis: it is this Tunic in Quadrepeds with which 
Parchment is made - Haller says it is only the 
Cellular




245
cellular Membrane more compacted; but I am of a different
Opinion - The Cutis is elastic and exceed Vascular. being 
formed of Arteries, Veins, Nerves, Lymphatics - All Tumours
and Abcesses prove its Elasticity which expands it, and as the
Tumour lessens or when the Abcess is openend, it has a power of 
contracting itself again to its natural appearance; the contractile 
Power is very evident in the Scrotum in the Hydrocele:
The Cutis, like the Cuticle, is thinnest where the least Friction
is used &c [?] - it has two Surface, the external & internl.;
the External or that which is next the Rete Mucosum is 
endued with great Sensibility from the least Touch, which
is said to be owing to the Nerves terminating upon it in blunt
Points called Papilla pyrammidales - these Papilla are endured 
with the Sense of Feeling in all Parts of the Body; they are
very numerous on the Apex of ye. Tongue where by some the Sense
of Taste is principally placed; and they are also very numerous
at the Extremities of ye. Fingers & Toes which appear by Maceration
to have a double Row of them, and also upon the Glans
Penis: an artery Vein & absorbent may be traced going to them.
The Vessels of ye. Cutis are Supposed [by] some to be Serous; others,
Sanguiferous & Lymphatic - The Colour of ye. Part depends the No.
of Sanguiferous Vessels sent to it; thus the Cheeks are more or less
Pale in proportion the number of ye. Sanguiferous Vessels: in Emaciated
People and after Death the Face changes to pale Colour,
and we see that the Circulation in these Vessels is affected very 
much & differently by Passions of ye. Mind, as Fear, causing Paleness; Shame
great



246
great Floridness, called Blushing. &c. tho' this Happens differently
in different People; thus, in some anger causes a redness, in others
Paleness &c - if you make an Incision into the Cutis you have
first a Discharge of Blood, then of Lymph &c -
Authers describe two Orders of Glands belonging to the Cutis; the
1st. called miliary from their resemblance to millet Seeds;
and the Sebaceous or Fatty Glands which are principally Situated
about the Ears both behind them & on the Inside; but they are
properly Follicles or Reservoirs containing a kind of dewy
Matter which exhales & serves as a preventative to the air
affecting the Cuticle by keeping this last always moist;
for was the Cuticle to become dry as happens sometimes in 
hot weather from this mucus being dried up or exhaled by
the Heat of ye. Sun faster than it is secreted it gives us a 
painful Sensation upon the part; and this is what ye. common
People call Sun-burnt; and we find by rubbing the
Part any Oily matter it softens the Parts & the uneasiness
goes off the Same happens after shaving in Cold weather,
when if we go into the Cold air immediately after it the 
Faces Smarts, & will often become chopped as it is called which
is nothing more than the mucus being shaved off the cuticle
becomes dry & cracks, but by rubbing it & warming the Face
the Glands Secrete more mucus & the Smarting ceases -
this Oil or mucus often inspissates in the Follicles of the Cutis
and



247 
form little Abcesses, commonly called Worms, which are most 
frequent in the Face - They are to be cured by emollients & keeping
the Face clean shaved &c -
The Cutis has a no. of Pores or Foramina thro which exhales
the insensible Perspiration which is now proved to be general 
throughout the Surface of ye. Body. In warm Climates it is 
discharged in much greater Quantities than in cold northern
Countries: Exercise increases this Perspiration, and the
Contrary happens to those of a Sedentary Life; when the
Perspiration is checked moderate Warmth & Plentiful Diluting
Liquors promote, on the contrary cold weather checks it very 
much - The capillary Arteries sent to the Cutis are so very Minute
that they cannot be seen but in ppns. and we are told that
they send off this perspirable Matter thro' the Foramina or Pores
Per Saltus: there are another order of Vessels very numerous upon 
the Surface of ye. Cutis, and these are the Absorbents which 
are the Lymphatics: the expelling Vessels of Perspiration are 
called the Exhalents, and the Absorbt. Vessels or Lymphatics
are called Inhalents - Mercury rubbed on the Skin
in the Cure of ye. Lues Venerea daily proves the Existence of the
Absorbents or Inhalents; and likewise a Person bathing
in warm water shall absorbe a quantity of ye. Moisture
from the Water, as we see by this making a larger quantity
of urine & oftener than he commonly does out of it -
Sweat is nothing more than an increased Discharge of 
this




248
this insensible Perspiration - After the Sweat or Mater.
perspirab. gets out of these Pores it mixes with the Mucus in
the Follicles which renders it accordingly more greasy in
some places than in others, as the mucus is of different Consistences
& nature in different part of the Body; it is more
greasy behind the Ears & under the armpits than in other
parts of ye Body, therefore we find that the Sweat is 
more unctuous and of a different & stronger Smell



249
Of the Organs of Taste 
The Tongue is the principal Organ concerned in Taste & forming
the modulation of ye. Voice, as well as assisting the Aliment
in its Passage to the Œsophagus &c - There are a great no.
of nervous Papillæ on ye. Apex of ye. Tongue, and hence it has
been generally allowed the chief sent of ye. Sensation we call
Taste - It is divided into it's Apex, Edges, lower Extremity commonly
called it's Root, and the Basis - It is composed of many
muscular Fibres running in many different Directions so that
it is impossible to trace them far into it's Substance; Several
muscles are concerned in forming the Tongue, as ye. Genis-Gloss, 
Stylo-Glossus, Basis-Glossus; which serve to move it in
different Directions - it is covered by a thick spongy Coat
which is a Continuation of ye. Cuticle and is called Epiligua.
on it's Superior Surface it has a great no. of Small Eminences
which are largest towards it's Root where they are called Papillæ
Capitatæ, and there is one large one called the Foramen Caeum:
out of all these Papilla oozes out a mucus which serves to 
Lubricate the Tongue &c - hence they have been considered as Glands;
oftentimes this mucus in some places inspissates and fills up the 
Foramen Caeum at the Root of ye. Tongue & is mistaken by Surgeons
for an Ulcer of ye. Tonsils; but it may be soon be distinguished by 
arming a Probe & wiping off the Mucus and washing it with 
detergent Gargarisms &c - The Basis of ye. Tongue is attached
to ye. Superior part of ye. os Hyoides, and what are called Ligaments
of ye. Tongue are no more than Continuations of ye. Cuticle 
loosely upon these Parts; the Ligament continued under the




250
Tongue near its Apex is called the Frænum and is only a
continuation of its Coat; when it is continued quite to the 
Extremity of ye. Apex it binds down the Tongue, prevents
Masticution, Speech, & in Children sometimes, Sucking &c.
and is called Tongue-tyed, which is remedied by dividing
it with a knife or pair of sharp pointed Scissars, 
avoiding two small arteries which run upon the inferr.
surface of ye. Tongue on each side the Frænum wounding
of which might bring on a troublesome Hæmorrhage; wch.
if it shoud happen the Child shou'd not be put to Bed or Suffered
to Suck soon after, least he shoud be Suffocated [by] the
Blood - The Vessels of the Tongue are continuations of ye. -
Branches of the Carotids (internal) running over the Os Hyoides:
it has an artery on each Side called Sublingual - the Veins are
pretty large, lying deep under the Cuticle, and are very Visible on
the inferior Part where they are ordered to be opened Sometimes
in Anginas, & with Success - it receives 2 Branches of Nerves
from the 9th. Pair on each Side of it many of which are said to terminate
in the Papillæ Pyramidales at the apex of ye. Tongue which
after a minute Injection look red, therefore it is probable they 
each of them have an artery Vein & nerve sent to them -
The Lips are covered [by] externally by Cuticle, Cutis & Cellular
Membrane; internally by Cuticle only; under it the Muscular
Fibres belonging to them - if we macerate them & examine them
afterwards with a Glass we find a great no of little Bodies
continued under the Papillæ Pyramidales, by some called 
Glands, of a fatty appearance, and authers assert they have 
Excretory




251
excretory Ducts which are continually distilling Mucus into 
the Mouth; I have often searched for these Ducts, but never
could discover them, therefore cannot determine whether they 
are Glands or only Continuation of the Cellular membrane.
The Ligaments of ye. Lips are the same as those of ye. Tongue, viz,
a Continuation of ye. Cuticle -
The Gums are hard elastic Bodies surrounding & helping to
fasten the Truth in their Sockets; they appear very Vascular
when injected, and are said to be covered externally only by 
Cuticle - They become greatly affected by Mercury, and are
often attacked by the Scurvy -
The Bony Palate is covered by the Velum Palati,
which is in part bony & in part Tendinous; under this covering
is continued a part of ye. Cridus Membe. of ye. Nose; and
between these are a no. of little Eminences called Glands
having a appearance, tho they are not So distinct as in 
the Lips; supposed to secret a mucus for Lubricating ye. Parts - 
The muscular part of ye. velum Palati hangs down backwards
& is called the Uvula, hanging down & forming a 
considerable Projection immediately over the Pharynx & has 
some Share in modulating the Voice, as is evident in Venereal
Patients, who, when this is diseased or ulcerated have snuffling -
The Tonsils are two Glands placed at the Root of the Tongue
opposite the Uvula which rests between them when the mouth is 
shut - They are a Series of Tubes, from which mucus is continually



252
continually distilling & passing laterally to besmear the Alimt.
as it passes into the œsophagus - these are liable to become
greatly enlarged so as to require the Extirpation of them &c -
The Checks like the Lips are every where covered by common
Integumts. externally & are muscular; internally by cuticle
under which are a great many Glandular Eminences as in the 
Lips which serve the same purposes - 
There are three Species of Glands called Salivary, which
are the Parotid, Submaxillary, & Sublingual - tho' I 
believe the two first secrete Saliva & the other I take to be only 
a Mucus Gland -
The Parotid is a fine Instance of ye. conglomerate
Kind similar in Colour & Structure to the Pancreas.
it is situated behind the Process and upon the Superior Condyl
of ye. lower Jaw placed upon the Tendinous &c upper
part of the masseter Muscle, which is wisely contrived
by nature, for had it been placed upon the fleshy part
of ye. muscle it woud have obstructed the Action of the 
Muscle in Mastication & the Saliva woud have been
obstructed in its Passage thro the Duct into the mouth,
but now the Tendinous part of the Muscle pressing upon the 
Gland during Mastication which is the Time the Saliva is
most wanting produces an increased Discharge from it.
It receives its arteries & Veins from a no of small Branches 
in the



253
in the adjacent Parts as the Pancreas does, for neither of these
Glands have a proper Artery of its own sent to it - it's Excretory
duct is a ramyfying Tube made up of a no. of smaller Tubes,
it runs over the masseter Muscle & piercing thro the Buccinator
near its middle is then continued a little forwards & opens into
the Mouth between the 2d & 3d of ye. Dentes Molares of the upper
Jaw, at which Place there is prominence which will point out its 
[Int??nce]. In wounds & abcesses of ye. Cheek we ought to be well
acquainted with the Course & entrance of this Duct, as wounding
it would be attended with disagreeable circumstances
on accot. of the Saliva discharging itself continually down the 
Cheeks; therefore in opening abcesses or dissecting Tumours
from this part of the Cheek, I woud advise the Passing 
the Skllet of a Catheter into the Duct thro the Orifice which
opens into the Mouth & keeping it there during the operation
which will guide the Operator to avoid it.
Surgeons frequently Speak of ye. Extirpation of this Gland
& have constructed a Bandage for the Operation; but I 
am of Opinion that this Gland is not so often diseased as 
they commonly suppose: we often meet with Abcesses in Indurations
upon or near it, which are mistaken for an Enlargement 
of the Gland itself - and if we consider that in 
removing this Gland we run a great risque, and indeed it is 
almost unavoidable, of wounding the Carotids, I think no
Person woud attempt it; for tho' no very bad consequence-
might



254 
might follow the wounding the external Carotid yet a division
of ye. internal one would prove almost Instantaneous Death;
and the Surgeons who talk so freely of this operation never mention
as Mr. Gooch does, the very troublesome Circumstance that
occurred to him in extirpating a small part of this Gland,
viz. that of ye. Saliva pouring out in large Quantities
down the Cheeks: this is a proof yt. it was only an Induration 
of some of ye. Lymphatics near the Gland, as in the 
Scrophula, & not in the Gland itself: however whenever the 
Duct is wounded do not attempt to prevent the Saliva
discharging upon the Cheeks by plugging up the Wound
with Tents as was the old Practice, but try with Superficial
Dressings only, to heal ye. Wound, and if they will 
not succeed I woud carry a Seton thro the Check in order
to divert the Discharge; the French proposed a hot
Skillet to be passed thro, to make an artificial openg:
but the Thoughts of Fire carries too much Dread with it,
& the Seton answers the Intention better; - was a Patient to
apply to me with a Division of this Duct, I woud try
what Pressure upon that Part of it next to the Gland
might do by preventing a Flow of ye. Saliva to the wound,
as we do in Hæmorrhages from Arteries & Veins, & make
use of Superficial Dressings to the Wound -



255
The Submaxillary Gland is of the conglomerate kind
of a yellow Colour situated under the arch of the Lower Jaw,
and extending under the Tongue; it receives it's arteries &
Veins from different adjacent Parts - It seperates Saliva
and in Salivations appears tumefied under the Chin & therefore
we advise Flannel to be wore over these Parts - It 
sends off a large Duct called Wharton's Duct which opens
into the Mouth near the Sublingual Gland between the 2d. & 3d.
of ye. Dentes Incisoses of ye. lower Jaw on each Side of the 
Frænum -
The other Glands are the Sublingual - Some Authors have 
contended whether they are or are not continuations of the last
but I never could discover any Fluid of a Salival Nature coming
from them, and I imagine them to be mucous Glands like
the Tonsils composed of a no. of Follicles -
Heister describes two other orders of Glands, ye. one called 
Molares, ye. others Buccinatores, from their Situations; but
I believe no such glands do exist, and wht. he took for them
were only little fatty appearances which are in every part of 
the Body Serving merely to fill up Interstices -



256
Of the Organs of Smelling 
The different Hypothesis concerning the Seat of this Sense
woud be irksome to mention - ye. Seat is generally supposed to
be on ye. Inside of ye. Nostrils; and it is said that People 
who live at remote Distances from large Towns have their
smell more perfect than those who live in them; this appears
to be owing to the different State of ye. Air, it being more clear
& serene in the Country; and we are told that the Savages in 
some parts of America can trace one another many miles
by Smell alone -
The Nose is divided into its Body,
ale, Lobe, Extremities, & Ridges; & it is seperated longitudinally
into two equal parts internally by a Septum - It
is covered externally by ye. Cuticle, and laterally under it
are a thin Plan of Muscular Fibres in some parts; and under 
the Cartilaginous part is a fine membrane said to be a
Continuation of ye. Perichondrium which is no more than a 
Continuation of ye. Periosteum - I have known some old Physicians 
recommend Bleeding in the Nose in violent Head
achs - The Septum is part Boney & part Cartilaginous;
the Course of ye. Nostril on each Side this Septum is inflected,
running backwards over the Velum Palati and opening or
terminating in the upper part of ye. Pharynx: the whole 
Passage of them is lined by ye. Cridus membe. under which 
laterally are placed some small Bones called ossa Turbinata [??]
vel



257
vel Spongiosa; these are on each Side, one is a portion of 
the Ethmoides & the other a distinct one - The ethmoidal
Bone is only a Series of Cells, as is the maxillary Sinus, which 
communicates with the nostrils; these cellular Bones are 
Seldom found alike in two Subjects, being very irregular & intersected
by long bony partitions: besides these Sinuses there are
also others which communicate with the Nose, viz, the
frontal, all which discharge a quantity of Mucus with wch.
the Cridus Membrane is always kept moistened, when 
ever we are in different Position; thus, when we are Erect
it comes from the frontal Sinus; when the Head is inclined 
to either Side as in Bed then it pours out of ye.
maxillary Sinuses, and when we lean forwards & downwards,
from the Ethmoidal Sinus - The membrane by wch.
this Mucus is secreted is called the Cridus membe.; there
are many little Eminences upon it's Surface which have 
been taken for Glands but are only Follicles which I consider 
as Reservoirs for the Mucus - This membrane is 
Subject to a Disease called Polypus, which we meet with 
sometimes in all other mucus membranes in the Body:
it is more difficult to Cure according to its Seat, vid. 
operations; but we shoud take care not to mistake an
Elongation of ye. membrane for a Polypus as it is sometimes
done & an Incurable Ozœna has been the Conseqce.
of



258
of [attempting] the Extraction & Abcesses may form in the Ethmoidal
Cells rendering the Bone Carious & are very troublesome to heal. -
Some assert that the frontal Sinuses are formed by the
action of ye. frontal Muscle, but this is erroneous; we 
find this Sinus is often affected with a Caries, for the 
Cridus membrane lining them is liable from its Vascularity 
to Inflammation & Suppurating, the matter has 
not a free Exit, hence it causes a Caries of ye. Bone
with Exfoliation &c. I have seen several of these Cases,
and they are always attended with great Pain in 
the Part & about the Face, particularly under the Orbits,
attended with Sudden Discharge of fœtid Matter
into the Mouth & Nose; these will try the Patience
of any Surgeon: I woud advise Sternutatories to
promote a Discharge by Sneezing; but never to make
an opening externally into them. These Sinuses
have a certain Share in the Smell, as we see those 
Patients who have had them destroyed, have this Sense
as well as the Sense of Taste very much impaired -
on the inside of ye. Nostrils are placed a great no. 
of Hairs to prevent any extraneous Body getting upon
& adhering to this Membrane -
The mucus in the nose was by old Surgeons supposed
to



259
to [be] proceed from the Pia mater thro the different Perforations
in the Ethmoidal Bone, but a Person the least
versed in anatomy will know that the Communication
between them is entirely Stopped up & that these Perforations
serve for the transmission of Vessels - thus
the common People think that the Snuff they take,
passes into the Brains by this way -
Just behind the Nostrils is situated the Eustachian
Tube, which is sometimes advised to be syringed in Deafness
for which purpose a Straight Syringe is best-
On the Organs of Hearing -
Some anatomists have divided these into three Parts
the external, middle & internal. The external prts.
are very irregular & cannot be well described; the generl.
Division of them is into ye Ala or Wing, the Penna or
Lobe: the ale is the upper part of the Penna the lower.
the external parts of ye Ear are covered by common 
Integuments with Cartilage under them - Some 
Say there are many sebaceous Glands, but they appear
to be only Follicles [situated] as in the Cutis of the
Face & other Parts - The Cartilage is continued to
form the Concha which grows thinner as it approaches 
towards



260
towards the Meatus auditorius; the ala has no proper 
muscles to it, but the Penna has a few muscular Fibres
sent to it -
The meatus auditorius runs in an oblique Direction
towards the Face, and is a Continuation of ye. Concha
only the Cartilage is very thin; it is composed of Cartilage
covered by Cuticle & Cutis - when we examine the Ear
to see whether any thing is in the meatus auditorius
we shoud draw the Ear obliquely forwards with one
Hand & with the other keep the Ala backwards
by which means we bring the meatus auditorius to a
Straight Direction; and when we Syrynge the Ears we
shoud direct the Tube a little obliquely towards the Face.
The Larger semicircular Eminence of ye. External Ear
is called the Helix, the smaller or lower Eminence is 
called the anihelix - The meatus auditor. is lined
internally with little glandular Bodies which are sometimes
visible to the naked Eye which deposit a
Sticky mater of a yellow Colour called Cerum or wax,
which is defence to it; this sometimes inspissates &
Stops up the Passage causing Deafness which is the
most common Cause of that Complaint, which is
remedied by a drop of oil poured now & then into the Ear
which Soften the wax & renders it easy to be extracted
Mr.



261
Mr. Cowell made use of a piece of fresh Cabbage Stalk
cut into the Shape &c of ye Passage which was introduced 
& kept there for some time & produced a good 
Effect in Softening the Wax -
The meatus Auditior. having run a little Distance
obliquely towards the Face is then reflected backwards
a little & then becomes bony; the bony part is a long
Canal lined by the membrana Tympani [which is]
[a fine membrane] which is a fine membe. spread
over the Cavity called Tympanum: on this membrane
it is supposed the Sound Strikes; it's Situation is
different in the Fœtus & Adult, in the Fœtus it is 
not perpendicular as in the adult, but oblique -
The Tympanum is formed entirely of Bone; it has
two Cavities in it in the fœtus but only one in  
adults; in the cavity of ye. Tympanum are placed 
the Inius & Mallius which are articulated to each 
other and are also connected to the 3d. Bone of the Ear
called Stapes; the Tympanum has 4 Foramina in
it, one of which is the Eustachian Tube which is 
partly membranous, Cartilaginous & Bony and opens
into the Mouth near the upper & back part of the 
Velum Palati, hence People who are Deaf commonly

The Organs are by some divided into external & internal -
by the first we meant all those [illegible] that situated without the Abdomen and Pelvis as the Testicles, which may be called the
primary organs of Generation, the Penis, and the Scrotum;
by the latter, the Spermatic Arteries & Veins, Vase deferent:
Vesicula Seminales & Prostate Gland. The urinary organs
are likewise divided in a Similar manner.
Others again would have then [cross out] each divided into the
preparing, Continuing & propelling organs; The
Kidneys & Testicles they would call the preparing organs
of Urine & Semen; the Bladder & Vesical Seminal the 
containing parts; and the Penis & Urethra the common
expelling parts - these are each liable to objection
and it is of very little consequence to attend much to
either:
[Before] Previous to the particular description of

262
commonly open their mouth when People are talking:
an obstruction in this Tube may be the Cause of Deafness in
some measure for which we are told to Syringe it, which 
may be done by carrying the Syrynge thro the nostril wh. 
will lead it straight to the orifice of ye. Tube in the 
velum Palati - If deafness proceeds from a defect of 
the auditory nerves then nothing will remedy it -
For a particular Description of ye. Ear vis monroe
osteology, Chisilden's anatomy or Du Verney's Treate.
of the ear -
On the Male Organs of Generation.
There is such an intimate Connection between the Urinary &
Genital Organs, & they are So blended together, that
I shall consider them together & speak of them as is
most convenient for Shewing their Situation &c -
The Genitals are, the Penis, Testicles, Vesiculæ
Seminales, prostate Glad, Scrotum, Spermatic Artery
& Veins &c - The Urinary Parts are the Kidneys.
ureters, Bladder & urethra which last in common to both.
The Spermatic Arteries are two in Number, generally
arising from the Aorta between the Emulgents
& mesenteric inferior, and running one on each to 
each

of the organs, a general description of the parts as they appear
dissected for Lecture is to be given.
* These Arteries vary exceedingly in their origin; sometimes they 
arise as here described and are allways represented so in
Drawings; but they are sometimes observed to run from the 
Emulgents or one or both sides, sometimes from the Phrenic 
artery on one side & from the aorta on the other &c. -

263
to each Testicle* - They have a long Course to run before
they reach the Testicles, which some have said was 
purposely designed by Nature that the Circulation
thro them shoud not be too rapid for the more easy Secretion 
of Semen; but this notion as well as their
arising Small & growing larger as they approach the
Testicles for the Same reason as above, I pay no regard
to; the last is absolutely not true & with regard to the 
other, at the first Formation of the Testicles Nature has 
followed the same rule that she does in every other part of 
the Body; which is, to send off the Arteries & Veins to difft. 
Parts from the nearest large Branch to the Part; which 
is the Case with regard to the Testicles, to which it is 
most convenient for the [Vessels] arteries [to be sent] to be sent from 
& Vena Cava
the Aorta whilst in the abdomen in the Fœtus - The 
Artery then passes downwards & Soon meets with the Veins
when they are closely connected by cellar membrane and pass onwards to the abdominal Rings where
they meet with the Vas Deferens
which, together with the Nerve, form the Spermatic
Cord, & pass out of ye. Abdomen thro the Rings together
the Artery and Vein are Seperate at their Origin but approach
nearer to each other as they pass downwards, and at the Abdoml.
Ring they adhere so closely together that it is with great difficulty 
that they can be seperated; hence some anatomists affirm that they
anastomose with each other & make an Experiment to prove it;
but it is quite contrary to the course of Nature that their Trunks 
shoud

* A preternatural Distension of these Vessels is frequent
and sometimes is taken for a Hernia by those who are not
well acquainted with Anatomy -

264
Shou'd communicate; and their Experiment Seems to shew that their 
Collateral Branches (for each of them send off Branches in their Passage)
have some communication & by this means Quicksilver pourd
into the artery from above a Ligature made on it may pass out of 
the Artery into the Vein - 
The Spermatic Veins are generally two in Number: they do not
both Spring from the Cava; the right commonly does, but the left
allways comes from the Emulgent of that Side, which has given 
rise to many Hypothesis about the Reason of it, and one principal 
one is, that if it had come from the Cava. it must have passed 
over or under the Aorta whose Action woud have impeded the 
Circulation thro it which is by this means prevented; but this is 
of no Consequence, and the true Reason is, that the Emulgent
was the nearest large Vessel to the Testicle whilst in the Cavity of 
the abdomen - The veins have no valves whilst in the Abdomen but 
as soon as they have passed the Rings the Valves are then very 
Numerous -
The Spermatic Artery, Vein & Excretory Duct of ye Testicles as 
they pass thro' the abdominal Ring are connected together by a 
quantity of Cellular membrane and are enclosed in a thin tendinous 
Expansion sent from the Abdominal Muscles, & which
is called the Tunica Vaginalis of the Spermatic Rope by Mr. Sharpe;
these Vessels thus connected together with the Nerve form what is 
called the Spermatic Rope or Cord, ye Figures of which is Pyramidal;
which is occasioned by these Vessels after they pass thro the
Ring towards the Testis beginning to be inflected & rolling backwards
& forwards in many Serpentine Convolutions gradually become 
wider & wider as they approach nearer to the Testis -
A preternatural Distension of these Vessels *are frequent, and 
sometimes *are taken for a Hernia by those who are not well 
acquainted

* The distention is of the Veins and should be remedied by 
tracing the parts by means of Cold applications, cold bath, 
and removing every kind pressure that might serve to 
impede the circulation. Here we are speaking of a mere
Simple Varix, unattended with any painful sapuptory;
but this distention may sometimes be owing to a cancerous
disease; in which case the Testicle itself is generally 
affected and it is accompanied with a great deal 
of pain &c - it is evident and therefore that the
cure is to be attempted in a different manner
from that above mentioned - In Strong athletic
people who have abstained from Venery for a great 
Length of time the vas deferens is said to become
distended, painful & hard like a tense chord, frightening
the person, in whom it happens, so much as to induce
them to apply to Surgeons for relief, not knowing from
whence the [cross out] complaint proceeded - A case of
this kind I once Saw in a young Sailor who applied
to me on this accot. and as I had no doubt of the
case I recommended a remedy that is too obvious, to 
need mentioning which had [cross out] an affect that
was no doubt pleasing in a double Sense to the
Patients from when heard no more of the complaint afterward
+ A young Lad was sent up from Rochester to St. Thomas', hospital
who was said to have a strangulated Hernia; which proved to be
nothing more than than the Testicle on one Side lodged [in], and forming
a Tumour in the Groin -
B.

265
Acquainted with anatomy * [crossed out]-
[crossed out]
[crossed out]
[crossed out]
The Testicles are two in No; tho' some authors say 
they have sometimes found 3 or more, yet it is probable they
mistook a Swelling in the Scrotum or an Enlargement of
the Epididimis for a Testicle: - it may happen that a
Person shall have but one Testicle or none at all in the 
Scrotum & yet shall be able to beget Children; in which Case
there is no doubt but that the Testicles are still within the 
Cavity of ye. Abdomen, having met with some obstacle to their
passing thro the Rings at the usual time, either from their 
Size or ye. smallness of the Rings by which they were detained
in the Cavity - Sometimes we meet with one lying half way 
thro the Rings & forming a Swelling in the Groin; and there
have been Instances of such being mistaken for Buboes &
treated accordingly with warm Plaster &c - [illustration]
The Situation of the Testes in a Fœtus is generally on the
fore part of the great Psoas muscles just below the Kidneys;
but they are supposed to be lower down in a Fœtus of 9 Months
than in one of 5 months as they gradually descend; they 
are at this Time covered by the Peritonœum & may be considered
as long as they remain in the Cavity of ye. Abdomen as
a Viscus or Viscera, being as complete in every respect as in 
the adult only more minute,. the Epididymis lying loosely upon
it & the Vas deferens taking its course now downwards into 
the



266
the Pelvis but in the adult it mounts upwards from the Scrotum;
the only difference is, that there is a kind of soft Ligament called
Gubernaculum which is peculiar to the Fœtus & is broader;
above, when it adheres to the Testicle & narrow below at the 
bottom of the Scrotum; this is likewise covered by Peritonœum as
far as the Rings, and in adults it is lost in the Scrotum. 
Mr. John Hunter thinks it is muscular & membranous, and 
that it is a Portion of ye. Cremaster Muscle which in all
Quarupeds is very strong and from Dissection of Rams &
Hedge-hogs he takes his opinion: in the Human body the
Cremaster is very weak - In Quadrupeds the Cremaster, a portion
of it at least, descends & helps to form the external Covering of 
the Testicles according to Mr. J Hunter; but in the human Body 
we know this Muscle is so very Small that it can act with 
but little force in drawing up the Testicles which is the use
assigned to it; it's Fibres are so small as hardly to deserve the 
name of a Muscle - The use of the Gubernaculum is to
facilitate the Passage of the Testicles thro the Rings by going
before them & gradually dilating the Rings - It has been
supposed that the action of the Diaphragm in Respiration
forced the Testicles out of the Abdomen, but we have Instances of
their being in the Scrotum at the Birth before the Diaphragm
has acted at all -
Thus we have Seen the Testes & it's Vessels whilst in 
the Abdomen entirely covered by a reflection of the Peritonœum
consequently when they descend they must carry a Portion of
the Peritoneum thro the Rings with them into the Scrotum;
where



267
where it takes the Name of Tunica Vaginalis, and all communication
is now Shut up between the Cavity of ye. Abdomen & 
the Testes, by this Tunic closely embracing & Surrounding the
Cord and adhæring to it- In Quadrupeds however this communication
is allways open - It will be requisite to carry
this in our minds, in order to form a true Idea of the Hernia 
Congenita & the Difference there is between it & the other
Ruptures: by the Hernia Congenita is meant that Species 
of Ruptures where the Contents of the Hernia lie in immediate
Contact with the Testicle, which Mr. Hunter first demonstrated
in a clear Light in the following manner: The 
Tunica Vaginalis we have deserned is a continuation or
Process of ye. Peritonœum including the Testis & its Vessels &c
all of which pass together thro the abdominal Rings which are
tendinous & inelastic, and as soon as they have Passed
thro, all communication is shut up between the Abdomen &
Testis; but at the Time they pass thro', if a piece of Omentum
or Intestines shoud pass down with the Testes, it will not
perhaps descend quite to the Bottom of ye. Scrotum, but not
withstanding will prevent the Tunica Vaginalis embracing
and adhæring to the Cord & thus woud prevent the Communication 
being closed up and in time as it descends more &
more comes in immediate Contact with the Testis: Thus
if any Body insinuates itself between the Cord & the Vaginal 
Tunic. at the Time of the Descent into the Scrotum,
the Passage is ever after free and there is [a] an open communication
between the Testis & cavity of ye. Abdomen: this is always the 
Case in Dogs & other Quadrepeds, hence we more frequently
meet with Ruptures of this Kind in them, which they bear 
without



268
without any great Inconvenience except the Weight when very 
large - But the Hernia Inguinalis or Scrotalis which are most
frequent in us, are occasioned by a Descent of omentum or 
Intestines or Both; thro the Abdominal Ring, and as they 
are contained within the Peritoneum, they must take that
along with them and still be enclosed within it and hence
it is called the Sac or Bag of the Hernia which lies seperate
from the Testis & upon the external Surface of ye Tunica Vaginal.
whereas in the Hernia Congenita there is no distinct Bag to contain 
the Hernial Contents but they lie in immediate contact with 
the Tunica alluginea of the Testis; and as the Last are
first formed in our Infancy only, they are not so frequent
as the common Scrotal Hernia which may happen at any 
time of Life; and tho the Hernia Congenit. may remain unnoticed 
for many years by a Small Portion of the omentum
forcing itself between the Cord & Tunic, yet afterwards by
some accident or other it is forced down & becomes a true
Hernia Congenita in the Adult -
The Coats of the Testes are two, the Tunica Vaginalis
& the Tunica Nervia or Albuginea -
The Tunica Vaginalis we have shown to be a process of the 
Peritoneum and in Structure every way Similar to it, having 
its external Surface rough with a quantity of Cellular membrane
of its internal Smooth & even - It's Extent is as high up as the
Superior part of the Epididymis where it adheres to the Cord;
from thence it lies Loose & Seperate from the Testicle in every
part except at the Posterior part where the Epididymis is 
situated and at this Place it adheres to the Testicle and is 
reflected over the Testicles in the Same manner as the Peritoneum
is



269
is over all the Peritonæal Viscera, and Adheres to the Tunica
Nervia; the Tunica Vaginalis is kept seperate from the anterior
Part of the Testicle by a thin watery Fluid Similar to the Liq:
Pleura, Peritonæi &c. which when it accumulates in too large
a Quantity constitutes the Disease called a Hydrocele. Many 
Causes have been given by different writers upon the Subject, of the
Occasion of this Accumulation, and Morgagni was of opinion that 
the Disease was owing to the Rupture of Some of ye. Hydatids wch.
are small red Globular Bodies found in almost every Testicle
& at every Age adhering by a Slight thread to the Body of the 
Testicle & sometimes to the Epididymis and was supposed to 
Serve as Glands for the Secretion of this Fluid; they seem to be
natural Appearances but their rise is not known as I cannot
think they are in any shape assisting in the Secretion of this 
Fluid, which I look upon to be entirely Vascular, that it is continually
deposited by Exhalent Vessels & as fast taken up by Inhalent 
Lymphatics or Absorbents; and it is my opinion that the
Disease is owing either to a Rupture of some of these Vessels,
or to a Relaxation in the Absorbents by which they are rendered
incapable of absorbing the Water as fast as it accumulates.
and I am of opinion it is often owing to a Rupture of the
Lymphatics from the Case of a Gentn. who was my Patient,
who whilst he was in the Play-house & was very warm, felt 
something crack very distinctly in the Scrotum, from which time
water was gradually collected & formed a Hydrocele of which I
cured him by Caustic -
The Cure for this Disease is either radical or Palliative:
the first is done by discharging the water from time to time as it
accumulates

Mr. Else is mistaken in supposing the Tunica Vaginalis
sloughs, as he asserts it does, in the cure of the Hydrocele
by Caustic. I had an opportunity of proving the contrary
by dissection in a man who died in the hospital 
a fortnight after the Caustic had been applied.
The cure was going on favorably, but the Tunica
vaginalis was every where perfect & sound, except
where it had been destroyed by the action of the 
Caustic, which had penetrated quite thro' the Substance
of the tunic. vaginal. to absorb the circumference
of an english shilling, and the part thus
killed was nearly seperated from the healthy
tunic; in every part of which on its
internal Surface, as well as on the external 
Surface of the tunica albuginea Testis, 
were the most evident appearances of the 
adhesive inflammation. The preparation
I made is carefully preserv'd in the museum
of the Teacher of Anatony* at the London 
Hospital; and I have now no doubt of the 
fact that the radical cure of the Hydrocele
by Caustic, or by any other means (except
excision) is by adhesion.
*Mr. Wm. Blizard. to whom I disposed of
it amongst a variety of other valuable &
beautiful preparations of difft. parts of the 
human body

270
accumulates by Puncture with a Lancet: the other is by creating
an Inflammation of Tunica Vaginalis by different methods which
Sloughs away & the Disease by that means Cured & prevented
from a Return - Vid. Else on Hydrocele -
There are a few muscular Fibres spread upon the upper parts of 
this Tunic, called the Cremaster muscle; and tis said the more strong
these are, the more Salubrious the Person is. - The use is said to 
be to draw up the Testes in Coition & at other Times -
The Tunica Nervia lies immediately under & is connected to 
the reflected Coat of ye. Tunica Vaginalis; it is a Strong thick 
tough, white membrane immediately enclosing the Substance
of the Testicles and adhering to it -
The Substance of the Testes appears of a brown Cineritious
Colour which is composed of a Series of Arteries, Veins, Nerves,
Lymphatics & excretory Ducts with their connecting membranes; and
what is remarkable of these Vessels is, that they are observed to 
be smaller in the larger Animals than in the Small inproportion
to the Size of the Animal; thus in a Horse they are so minute
& interwoven that it is impossible to unravel them; in a human
Subject they may be partly unravelled, and in a Rat after proper 
maceration they may be unravelled entirely into one String. A
French Author has computed that if they could be entirely unravelled
& drawn out in a human Testicle, the String would measure 
500 miles in Length -
The Secretion of the Testicles seems to be Vascular & performed
in this manner; the Spermatic Arteries ramify very minutely 
thro the Testis and some of its Branches terminate in the Veins
which return the Superfluous Blood, whilst other Branches terminate



[illustration]
The Figure is designed to represent the Testicle with the Epididymis
adhering to it at each Extremity. In the Body of ye Testis are to
be seen many Small Tubes running, as is supposed, from the Extremities of 
the Arteries and conveying Semen into the longitudinal Line the Rete
from the Superior Extremity of which, the Vasa Eferentias go off to
form the Epididymis
1. The Rete
2. The Vasa Eferentia
3. The Epididymis, which terminates in
4. The Vas Deferens -




271
in a no. of Small Semineferous Tubes which convey the Semen that
has been Secreted during the Course of the Arteries thro the Testes, into 
the Vas deferens: these Tubuli are very fine & run in many directions
and meeting in the middle of the Testes they form several layer Vessels
lying close to each other & running from one Extremity of the Testis
to the other and is called the Rete, from the upper Extremity of
which a number of Tubuli are continued and passing out of the
Testicle go to terminate in & form the Epididymis at the Posterior
part of ye. Testicle, which is only a continuation & convolution
of these Tubes, and from which the Vas deferens is continued in a convoluted
Form for some distance, mounting upwards & passing thro
the abdominal Ring with the Artery & Vein; after it has got thro
the Ring it seperates from the Artery & vein & passes downwards
in an oblique Direction thro the Pelvis & empties the Semen into the
Vesicula Seminalis, which are situated near the neck of ye. Bladder 
on it's inferior Surface -
Within the Substance of the Testis are observable a no. of white
Cords running in a transverse Direction between the minute
filamentous Strings of the Testis, which appear to be continuations 
of the Tunica Nervia. Their use is not known -
The Epididymis sometimes becomes indurated & is mistaken
for a Schirrous Testicle for which the Operation of Castration
has been performed; I have [cross out] known it cured by cold Bathing, & 
if from Venereal Cause rubbing mercurial Ointmt. upon it; in general
however, it will give way to no application whatever - These
Indurations seldom prove Cancerous which those of the
Testis often do -
The Epididymis adheres to the Testis at the Posterior Part, Lies 
loose & seperated from it in the middle & again adheres to it at it's anterior
Part



272
Part, where the Vas deferens goes off from it - It is covered by the Tunica 
Nervia which is thinner here than upon the Testes; it has a Branch
of ye. Spermatic artery sent to it, and a little Twig of a nerve at its
lower or anterior Extremity -
Urinary Organs -
There is a vascular Substance Situated at the Superior
Extremity of each Kidney, called Capsula or Glandula
Renalis, generally of a Triangular Figure, tho this is various
as well as its Size: it is placed between the Diaphragm
& the Kidney, it's inferior Part resting upon the Superior
Extremity of ye. Kidney & it's Superior Part lying under the 
Diaphragm - Anatomists differ about the Structure &
use of it - It has been said that it is larger in the Fœtus
than in the adult: it is certainly larger in Proportion; but
it is larger in the Adult than in the Fœtus, tho it does
not increase in Size in proportion to the Kidneys & other
Parts, and in old People it wastes & become wrinkled.
It receives its arteries from the Aorta commonly, but sometimes
from the Emulgent & Phrenic - it has a large
Vein coming from it which runs into the Emulgent; it is
lodged behind the Peritonœum as well as the Kidneys
and like them Receives no Peritonœal Covering, only the
Peritonœum lies before it - It is covered by a fine membrane
proper to it & the Kidneys - It's Colour in the 
Fœtal State is of a florid red which it gradually 
changes



273
changes to a brownish yellow and in Old People to dark
complexion - some have thought it to be a Gland, but as
no Excretory Duct has ever been found belonging to it, I can't
see the propriety of calling it a Gland; Vesalius thought
he had discovered it's Duct, but he was mistaken, for 
it was only a Small vein which run from the Emulgents
to the Testes in men & the Ovaries in women, which he
took for the excretory Duct, hence he thought it served 
some Purpose in Generation - It's use is not known, 
but as we always find it much larger in proportion
in the Fœtus than in adults it is probable it serves
some particular purpose to the Fœtus which is not
so necessary in the adult -
The Kidneys are the primary organs of
Secretion of Urine as the Testes are of Semen. In Shape
& Figure they somewhat resemble a Windsor-Bean.
The Superior Extremity lies a little below the inferior Surface
of the Diaphragm; it's inferior Extremity is generally 
even with the Spine of ye Ilium tho' Sometimes it is 
lower down; it's anterior Surface lies immediately behind
the Peritoneum & ye posterior Surface is turned towards the
Quadratus Lumborum & the Sacro-Lumbal mass. The Situation
in general is between the last of the false Ribs.
& the Spine of ye Ilium - In anatomical Plates the right
Kidney is generally delineated as the highest, but in the 
Human Body they are nearly opposite & if either is higher
up



274
up than the other it is the left; but there is seldom any diffce.
& when it does happen the right is generally pressed down by
the Liver: and in Diseases there is as Viscus so liable to be 
displaced in the abdomen as these are & they are sometimes
found almost wasted away & very small, at other times greatly 
enlarged -
The external Surface of ye. Kidneys is smooth & even
in adults & appears to be a conglomerate Gland; but 
in the Fœtus it is of a very fine conglomerate appearce.
being divided into many little Globes which disappear
gradually as we advance towards Puberty - They are not
covered by a Process of the Peritonœum as some have asserted
but they lie behind it & are covered by a large Body of
Cellular membrane greatly loaded with Fat which is 
of a firmer Consistence than the Fat in other Parts of the
Body & is called Serum or Duct: some say that ye. greater
the quantity of Fat there is here, so much the more liable 
twill the Person be to Sabulous Concretions in ye. Kidneys
& this they woud accot. for fat People being more liable
to the Gravel then others; but I don't know that this is true
neither does it seem at all probable that this Fat shoud
produce this Effect - The Kidneys are covered by a fine
thin Membrane which is composed of two lamellæ as
appears by maceration; it is called the Tunica proprea
and it is smooth on both its Surface, which is different
from the Peritonœum - The Vessels sent to the Kidneys
are



275
are the same as in all other Glands; the Arteries come from
the Aorta & generally arise in one Trunk each on each side the 
Aorta, but enter the Kidneys very often in two or 3 difft. Branches
each, and it is not uncommon to see the Emulgent on one
Side entering the Kidney in one Trunk and on the other side,
in the Same Subject in two or 3 - the right Emulgent artery from
the Course & situation of ye. Aorta must be the longest, but it
is the Reverse with the Veins, the right being the shortest &
the left the longest as it has to cross the Spine to get to the 
Cava; hence it is conjectured that the right Kidney is more 
liable to Sabulous Concretions than the left. In Cats & Dogs
and all animals that have much motion in their Backs
ye. Kidneys are of ye. Conglomerate Kind - The Arteries 
ramify thro the Substance of the Kidneys with the Veins as
in all other Glands; but whenever we find any Large Vessels
going to any Part which carry more Blood than can be requisite
for it's nourishment, we may conclude that the Blood
is sent there to undergo some material Change, as in the
Lungs, Liver &c,; and this is the Case in the Kidneys
for ye. Emulgent artery is very large & carries much more
Blood to the Kidney than is necessary for its Nourishment
alone; however the Lungs & Liver have particular Vessels
Sent to them for their Nourishment, but the Kidneys have
no arteries sent to them for that purpose, but are nourished 
by some of the Ramifications of the Emulgents.
The number of Kidneys is generally two, but I have learned 
of



276
of Instances of three being found Seperate & distant with 
each a Seperate Excretory Duct, & sometimes we hear of Instces.
of only one, but having two excretory Ducts & two Arteries,
which was probably owing to a preternatural Enlargement
of the Two & increasing till they Joined, an Instance of which 
I have in a preparation; this is called a Horse-Shoe Kidney. 
The Substance of the Kidney is divided by Winston into its
Cortical, Tubular & mammillary Parts; but in reality it
ought to be said to be composed of only two Parts, the Cortical
& Tubular, as what he means by the mammillary
part is no more than the Tubule terminating in Blunt 
Points: - The cortical is the external part which is
exceedingly vascular & hence supposed to be the principal
& immediate Seat of Secretion, which is performed here & 
the Secreted Fluid is carried by Vessels into the Tubular
Part, which is much less vascular than the Cortical &
not so florid of consequence; the Vessels from the Cortical
Part take rather a reflected Course tho' not so much as
authors describe + There appear a no. of Corpuscles or little
Eminences by some lookd upon as inspissated adeps lodged
here, but this I cannot determine; if you inject a Kidney 
by the Vein they entirely disappear, but inject by the artery
& you will find them still to exist -
There are very high disputes about the manner of Secretion 
in the Kidney as in other Glands; some being for the 
Follicular Doctrine & others say it is vascular; but 
it



277
but it is not of much consequence for us to know which it
is, more than as a matter of Satisfaction -
We are not to look upon the Tubular Part as made up
entirely of ye excretory Ducts coming from the Cortical part,
tho' it is thro them that the Fluid is conveyed from the
cortical part; at the extremities of these Tubuli are formed 
little Papillæ from whose orifice there are continually distilling
small Drops of the Secreted Fluid into the Infundibula 
of the Pelvis of ye Kidney & in the dead Subject we
can frequently press the Urine out of these Papilla
The Pelvis of the Kidney is nothing more than a Dilatation 
of ye. Ureter or Excretory Duct at its origins from 
the Kidney, & from the Pelvis there go off many Continuations 
of its Substance, like the Fingers of a Glove
going off from the Glove, which are distributed thro the
Tubular part of the Kidney and embrace with open 
mouths the Papilla from which the Urine drops
into them & is conveyed into the Pelvis & thro the Ureters
into the Bladder; they are called Infundibula.
The Kidneys are liable to the same Disorders that
all other Parts are that are Vascular; they are frequently 
attacked with Inflammation, Abcessuses &
sometimes Schirrosities have been found in their Subste.
indeed they are more liable to Inflammation from Sabulous 
Concretions formed in the Infundibula, which if 
not



278
not carry'd off into the Ureters & so into the Bladder may
form Calculi in the Kidneys & often excite Inflammation
& at last create and Abcess or ulcer in the Kidney.
We know that in all parts lined with a mucous membe.
there is a quantity of mucus discharged with the Secreted
Fluid which pass thro them as in the Urethra &c - and 
this Mucus is loddged here to defend the Parts the Kind
Passes thro from the Acrimony of the Fluid & there will
always be an increased Discharge of ye. Mucus in 
proportion to the Irritation of ye. Membrane; therefore
When any calculous Concretions are lodged within
any of these Parts upon this mucus membrane, by 
it's attribution against it, it wears it away & the Salts
of ye. Urine irritating the membrane now robbed of its
Defence in this Part causes great pain & Erosion of
the membrane with brings on Inflammation of 
all the Mucus membrane with an increased Discharge
of Mucus continually flowing away with the
urine, and this is frequently mistaken for Pus &
the Patients are said to have Ulcers in the Kidneys, &
as we allways find a greater Quantity of Mucus in the 
Pelvis of ye. Kidney in a sound state it is most probable
if it is discharged in large Quantities that it proceeds
from that Part - It is a matter of some Conseqce. for
as to be able to distinguish this increased Discharge of
Mucus



279
from Pus, & this can only be known by the Symptoms of 
Excoriation, the Smell of the Pus &c -
From what has been said it will appear evidt. that the
operation of Lithotomy of ye. Kidneys can never be successful;
for whenever there is a Stone in them it must be
lodged; in the Infundibula or Pelvis so near the Entrance
of the great Vessels that they must be inevitably wounded 
in the operation which woud produce a Hæmorrhage wch.
no art could stop; besides if we consider the great qty.
of Flesh we have to cut thro before we get to the Kidney 
as all the Sacro Lumbal Mass, I think no man in his 
Senses woud undertake it; and I am of opinion that in
all the Cases related [to] where it is said to have been performed, 
that the Stone had worked it's way out of the 
Kidney & formed a deep seated abcess in the Sacro-lumbal 
mass which being opened a Stone has been found
& hence the operation was said to be performed of cuting
for the Stone in ye. Kidneys with Success if the 
Patient did well: as we have Instances of Stones in the 
Gall-Bladder doing the same & working their way thro
the Peritonœum point externally upon the Abdomen wch.
being opened they are taken out & the Abcess heals: and
the same thing has been related of Stones in the neck of 
the Bladder of urine forming abcesses in Perinos vid.
a Case of Gooch. -




280
Tho it woud seem more regular to proceed non to describe
the Urinary Bladder & Urethra, yet I leave that & go to the 
remaining parts of Generation & describe them first, 
after which I shall speak of the content of ye. Male Pelvis.
The Scrotum is a loose membranous Bag serving 
as a Purse for the Testicles, divides internally
into two equal Parts, each containing a Testicle, by a
membrane called Raphe or Septum Scroti, which is a
continuation of ye. Raphe in Perinœo & may be traced
externally in a darkish Line running from the Perineum
to the upper part of the ye. Scrotum - The Scrotum
is composed of ye. Cutis & Cuticle and it's Cellular
Membrane which is of ye. Reticular kind - The Testes
lie loose in this large Bag, and the Reason assigned
for the largeness of it is, that if the Testes had been
confined more closely in a smaller Bag or if it had 
been adipose, they woud not have played or receded
in it so free & consequently woud have been more 
liable to Injuries from Blows or Pressure - Some 
Authers say there is a muscle belonging to the Scrotum
which is called Dartor & that by this it has it's
contractile power, but I never could discover any muscular 
Fibres in it by Dissection or Maceration -
The Septum I have observed was a membranous Partition 
dividing



281
dividing the Scrotum internally into two equal Parts
each of them in closing a Testicle & by this means
Shutting off all Communication between one Testis
& the other: this prevents their being in Contact with 
each other, so that one Testicle may be diseased without
affecting the other which woud have been the 
Consequence had it been otherwise, and likewise
prevents the Injuries which Friction against each
other might cause: This membrane is continued from
the external Line or Raphe', and is Cellular as appears
from preparations; there are some who deny that
the Septum excludes all communication from one
Side of ye. Scrotum internally wth. the other, from observing
that by blowing air into one side of the Scrotum
you will equally distend both; bt this is owing to some
of the tender Cells of the Septum being broke thro' by the
Force with which the air is thrown into them; but the 
most convincing proof of it's Existence is the Hydrocele
of one Side of ye. Scrotum only -
The Scrotum is vascular like other common Integuments
and upon the Septum a pretty considerable
artery is running which shoud be one Reason why 
in Castration we shoud carefully avoid wounding 
the 



282
the Septum, but the most material Objection to our 
wounding this Membrane in this operation if it is of
one Testicle only is, the Exposure of the other Sound
Testicle to the external air, to the Dressing &c. which 
woud bring on a dangerous Inflammation; and
therefore we shoud be very careful in dissecting away
the Testicle from it, but if ye. Testicle shoud adhere
in such a manner to it or has rendered it
diseased, that we shoud be under a necessity of removing 
it along with the Testicle, in order to obviate 
the ill Symptoms which might arise in consequence
of ye. Exposure of ye. other Testicle, we shoud
make an artificial Scrotum for it with the Integuments;
this you had an opportunity of seeing me
do with a Patient who had a Cancerous Testicle 
taken out with which I was oblidgd to remove
a part and indeed almost the whole of ye. Septum
which occasioned the other to be exposed naked to 
the air, but by drawing over the Integuments & making 
a Stitch or two to confine them over the Testis
the Inflammatory Symptoms which woud probably have
ensued were obviated & the Patient did well -
The Scrotum being of ye. Reticular kind of cellular
Membe.



283
membrane, we must not be Surprised if we meet with 
large Extravasations of Blood in the from a Slight
Blow or Injury rec'd upon or near above it; and likewise 
that is the Reason why we see it so much distended
with water in Dropsies - vid. Lecte. on the 
memb. Cellularis -
The Penis needs no description as to its Situation, 
Size, Shape &c - It is compos'd of an infinite 
no of Ligamentous Columns or Sheaths, divided
into 3 Parts or Columns; the 2 Superior are called 
corpora Cavernosa, the inferior one called Corpus
Spongiosum - The Copora Cavernosa arise one on 
each Side from the inferior part of ye. Knobs of ye. 
Ischium, and running upwards towards the Pupis
Some distance Seperate, afterwards meet & run in
close contact with each other and form the upper part
of the Body of the Penis; before they unite they are
called Crura Penis; they go to terminate at the 
Extremity of ye. Penis in two blunt Points on which
the Glands Penis rests - These Bodies are extremely
cellular internally and all their Cells communicate 
readily with each other, for by Injecting at either Crus all
of them will be distended; and on the inside these Cells 
are



284
are frequently intersected by strong white Ligamentous
Fibres or Sheaths which appear larger as they approach
the Extremity and are of the Same nature as those on
the external Surface. The Septum Penis is only the
Union of the 2 Corpora Cavernosa by means of the Continuation 
of Several of these Cords, and by it we are
not to understand such a Partition between these two 
Bodies as the Septum of ye. Scrotum is between the two 
Testes; for it is evident from Injections, that there 
is an open & free communication between the Cells of 
the one and those of the other - The use of these
cords is to prevent the too great Distension of the 
Cells in Erection - It is plain that when two 
Cylindrical Bodies are laid in contact [with] horizontally parallel
with each other that there must be a vacuity
or a longitudinal Cavity formed above & below, & this
is the Case with the Corpora Cavernosa, the Superior
Cavity of which is on the Back of the Penis & is
filled up by the Artery Sent to the Penis & the Vena
Magna Penis; the inferior cavity is filled up by 
the Corpus Spongiosum - There seems no material
Difference in the Structure of these three Bodies, only 
the Cells of ye. Corp. Spongios. are finer than those of the 
Corpora



285
Corpora Cavernosa - The Corpus Spongiosum is large
at its Origin forming a large Knob or Protuberance
in Perinœo which is commonly called the Bulb of the
urethra, it is then continued along the inferior part
of ye. Penis growing gradually Smaller till it gets 
towards the Ends of ye. Corpor. Cavernos. when is expands
itself & forms the Glans Penis which is provd 
to be nothing more than a Continuation of this Body.
The Urethra runs thro' the middle and is surrounded & 
closely embraced by the Corpus Spongiosum thro' its
whole Length till it passes out at the Extremity of
the Glans - 
The Muscles of ye. Penis are the Erections wch.
are two plans of Slender muscular Fibres arising
from each Crux of ye. Ischium a little below the Crus
of ye. Penis, laterally; they are called Erectores from 
their Supposed office of forcing the Penis against
the Pubis when in action & stopping the Circulation
of ye. Blood thro the Veins of ye. Penis produced Erection
but whoever considers their Origin & Situation must
see that their acting will have the direct contrary
Effect on the Penis by pulling it from the Pubis
& that they can have no share in causing Erection -
The



286
The other muscles are called Acceleratores Urinæ, wch.
arise from the Crus of the Ischium laterally near the 
Bulb of the Urethra which they entirely Surround as do
the Erectores the Crura of ye. Penis: these are also
but Slender plans in muscular Fibres and are attackd
to the Corpus Spongios. and when they act are supposed
to compress the Bulb of ye. Urethra and assist in expelling
the Urine - There is a small plan of muscular 
Fibres which take a transverse Direction
running over the Perinœum transversely & hence
called Transversalis; they are part of the last
mentioned muscles but are so small as hardly to be 
seen -
The Arteries of the Penis arise from the internal
Iliacs & are called Pudendal; they Pass along the
Crura Penis & ramify thro it's Substance; some are
supposed to terminate in open mouths (Portis
apertis) between the Cells & extravasating their
Blood, distends the Cells & Causes Erection when
the Veins are prevented from returning it from the 
Cells - The Veins come from the internal Iliac
Veins and ramify thro the whole Substance of the
Penis but are much more numerous towards its
Extremity or Glans, which by injecting by the Vena 
Magna



287
magna appears an entire compages of Vessels: some
of the Ramifications of ye. Veins are also supposed to
terminate in the Cells cum portis apertis in order to
absorb the Blood extravasated by the arteries - There
are likewise spent upon the Penis a great no of 
nervous Febrillæ particularly upon the Glans where
they appear in small pyramidal Papillæ & which 
make it so exceeding Sensible -
That the Branches of ye. Vena Magna do absorb
Blood I am confident from the Experiments I have 
made; for Animals have been killed in the act
of Coition & these Cells have been found always distended
with Blood which must afterwards have
been absorbed by the Veins; but this is different
from all other Parts of the Body, for the Veins
of ye. Penis & Clitoris are the only that we
know or Suppose to absorb red Blood -
It may perhaps be ask'd in what manner Erection
is brought about; various are the Conjectures about it,
but no satisfactory ones are yet produced; it is in general
supposed to be by Blood brought by ye. arteries being
deposited in the Cells of ye. Penis and distending them
and increase it's Size & Heat till the Semen is ejected
when



288
when the Blood is absorbed and the Penis again recedes
to it's former Size - but it is necessary that a Stricture
shoud be formed upon the Veins at the Time of Erection
that the Blood may be obstructed prevented from returng.
as fast as it is deposited in the Cells by the arteries;
how this Stricture is formed we have no probable or reasonable
accot., as all the Causes that have hitherto
been given are either false or frivolous; we know that
the mind is greatly influenced at that Time, but
whether so much as to produce this Effect, or from
what other Cause it is produced is unknown -
The Integuments of the Penis are Similar to those
of the Scrotum the Cellr. membe. being of the reticular
Kind & liable to become distended with water in Dropsies;
The Cuticle is continued from the Prepuce over the 
Glans, at the Basis of which there are a no. of Follicles, 
by some called Glandulæ odoriferæ, in which 
is deposited a Sebaceous matter to Lubricate these
Parts; it is discharged in great Quantities Sometimes
& by the Heat of ye Parts it inspissates &
forms a white Cerumen, which if not washed off now &
then, may irritate the Parts, creating a disagreeable
& troublesome Stiking especially in hot weather, with an
increased Discharge which has been mistaken for
a



289
a Gonrrhœa sometimes; People with tight Prepuces are very 
liable to this Complaint, & which is easily cured by Lotions of 
milk & water, Barley water &c. or if the Prepuce is inflamed
& tightend so as to prevent the Glans from being 
denuded, Injections of Barley Water & Milk & water may be
used, or desiring the Patient every time he makes water
to pull the Prepuce over the Extremity of ye Glands &
compress it whilst he makes water & by that means
the water will force its way backwards between the
Prepuce & Glans & wash off the matter - Sometimes
however it is requisite to dilate the Prepuce if it is-
greatly tightend [&] - A Gentn. applied to me sometime
ago who had been taking medus. for a Gonorrhœa
for two Years & had tried every method to stop the 
Discharge but without effect; upon Examination 
I found he had a tight prepuce which I divided & 
found large Incrustations of this thick matter from
which all the Discharge proceeded; all this was
washed, clean off, and the Excoriations which it had
Caused as well as the wound of the prepuce 
healed in a short time by the use of Emollient
Cataplasms &c without a grain of Mercury  ~
The Prepuce is only a Doubling of the Cuticle &
Cutis



290
Cutis with a quntity of Cellular Membe. between 
it, and is continued over the Glans serving as a
Covering to it; and it is this that is removed in Circumcision -
It sometimes happen in Stone Patients 
especially in Children that it is greatly elongated by 
their pulling it when they feel the Pain at the End
of ye Penis: and in Sailors who have been long voyages
at Sea with a Lues on them, when they return we often 
meet with the Prepuce much elongated & with hard 
schirrous Knots in it which we are to attempt to
disperse by Merce. Frictions &c but if we do not
Succeed we must have recourse to Circumcision or 
the Removal of all the Elongated part - The operation
has been misrepresented by many Surgeons
particularly in France; they have said that they
had removed the Glans Penis when it has been 
only one of these Schirrous Knots with an elongated
Prepuce, and afterwards finding the Glans, in
France they have endeavoured to make their Patients 
believe that by the Prayer of the Priests or
[illegible] like Impositions that are grown again; by
this means acquiring applause instead of Censure
for their Ignorance -




291
at the inferior Part of theGlans there is a small
Cord called the Frænum, which is formed by the Cutis
& Cuticle: it is attached to the Glans near the Orifice
of the Urethra, and in some Children it will be continued
quite over the Orifice by that means causing an 
obstruction of ye. Urine untill a Puncture is made into 
it - Sometimes it requires to be totally divided, which 
may be done with a Lancet or Small crooked Sharp -
pointed Knife: there are some Surgeons who object to
this operation on accot. of our wounding two small Vessels
which run by the Side of it from which they say a troublesome 
Hæmorrhage will ensue; but if there shoud be a
necessity for the operation this objection woud have no 
weight with me, as the Hæmorrhage may be easily 
restrained by pinching up the mouths of ye. Vessels wth.
the Fingers for a little while -
The Ligamentum Suspensorium is a few ligamentous 
Fibres running from the Pubis to the Corpora
Cavernosa serving to attach the Penis to the Pubis & to
Suspend it -



292
The Bladder & Rectum are the Contents of the 
Male Pelvis -
The Bladder is somewhat of an oval Figure & is divided 
into it's Surfaces, Edges & Extremities; it's Apex
Fundus & Body I coud wish were laid aside as they 
only create Confusion - The Anterior Surface is turnd
towards the Pubis, the Posterior, towards the Sacrum; its
upper Extremity when it is distended with water
is turned towards the Abdominal Muscles & then 
rises above the Pubis but when empty it lies below,
hence the reason why there is in Suppressions of Urine,
a Tumour to be felt on the lower part of the Abdomen
just above the Pubis & where we may often feel
the fluctuation in the Bladder when greatly distended [?]
it's inferior Extremity rests upon the Rectum - It's 
Anterior Surface is not covered by ye Peritoneum but wth.
Cellular membrane only; the Upper Extremity is covered
posteriorly by the Peritoneum which is likewise contind.
on [cross out] all the Posterior Surface & to its lower Extremity, but
not quite to the Neck of ye Bladder, and from hence it is
continued & reflected backwards giving a Covering to the 
anterior part of the Rectum where it is called Meso-Rectum



293
Meso-Rectum; this is the Course of the Peritoneum 
thro the Pelvis, and from this we may see how [cross out] it
is that the water in the Ascites sometimes forces itself
down into the Pelvis between the Reflection of the Peritoneum
upon the anterior Surface of the Rectum & ye.
inferior Extremity of ye. Bladder and forming a Tumour
in Perinœo, or between the Rectum & neck of ye. Bladder
in women; a Rupture may likewise happen here
by the Intestine passing down which may become Strangulated:
In the lateral operation for the Stone we
are liable to cut thro this Peritoneal covering if our
Incision is carried too low down or prosecuted too far
upon the Bladder, which might occasion a protrusion 
of ye. Intestines and we therefore shoud be upon our
guard and take care to avoid it -
The Structure of ye. Bladder is nearly analogous
to that of ye. Stomach & Alimentary Canal; it has
a membranous, muscular & nervous Coat with
Cellular membrane intervening between them; its
nervous Coat is not Villous like that if the Stomach
& Intestines in which respect it differs from them.
It's



294
It's external or membranous Coat is only a Partial 
one, being only a continuation of ye. Peritoneum
on the posterior Part of it; the Cellular Coat as
it is called is nothing more than a Body of Cellular
Membrane every where investing the Bladder, and 
underneath this is the Muscular Coat which is
described in Books as if the muscular Fibres were
very apparent to ye Eye, and authors have given different 
Names to difft. Plans of Fibres according
to their Supposed Action, but all they mean is a
thin Plan of red muscular Fibres running in various 
Directions, and so slender as scarsely to deserve 
the name of Muscles; in some they are scarsely
visible, and yet some authers describe the Bladder
as having 3 proper Muscles to it; one they call
Detrusor Urine, the 2d. constrictor Urina & the 3d.
Sphincter Colli Vesciæ; they are allways more visible 
towards the Neck of ye Bladder & prostate from whence
they appear Scattered all over the whole Bladder some
running obliquely upwards, some Circularly, others longitudinally -
We are told that the use of these Muscular
Fibres is to propel the Urine & the Sphincter
Colli prevents the Urine from being expelled so often
as



295
as often as it woud have been, had their been no such
Fibres, but I believe it has but little power in doing this
and it is not a circular plan of muscular Fibres like
the Sphincter Ani, Arcs &c & cannot be looked upon
to have the action & use here as the Sphincter Ani has
in preventing an Expulsion of ye. Fœces: neither do 
I suppose that the other part of ye. muscular Fibres
can have much if any power in expelling the urine
which is performed chiefly by the Abdominal muscles
acting & the Diaphragm together pushing down 
the Viscera upon it & compressing it -
In Suppression of Urine when the Bladder is immoderately 
distended, these muscular Fibres are put upon 
the stretch & giving way they are seperated from each 
other, and if the Suppression continues for Some
time they are kept so long seperated, that when the 
water is discharged they have lost all their contractile
Power & are not able to recover it for some time and
at this time the inner Coat of ye Bladder falls into 
Plicœ or Folds between the Seperated Fibres & forms Sacculi
or little Bags; several Instances of which I have
Seen - Hence it is that we may account for some
People who have the Stone being easier at some times
than



296
than at others; for the internal Coat of ye. Bladder is
extremely sensible irritable consequently must be
greatly affected by the Stone when it is rolling about
loosely in the the Bladder but when it gets into one of
these Sacculi it remains fixed there and gives very 
little Pain except in uneasiness from it's weight if
it is large; this will account for our feeling the
Stone sometimes & at others not; and hence we always 
make it a Rule not to cut the Patient but when we
are able to feel the Stone at the Time - Luckily for 
Mrs. Stephens such a Patient as this tried her mede.
for dissolving the Stone; he had been previously examined 
and a Stone was found which by the Feel 
appeared to be a large one; after using the mede.
for some time he got perfectly easy & remained so during 
his Life; he was often Searched for the Satisfaction
of ye Surgeon & indeed of ye Public, and no 
Stone ever be felt afterwards; hence it was supposed 
by all the Surgeons who examined him before & after
the taking the mede. that the Stone was dissolved, except 
Mr. Nourse of Bartholomews Hospital who much to
his Credit woud not believe that a mede. coud act
as a Dissolvent at so distant apart: Mrs. Stevens
however



297
however got the promised Reward of 5000 £ for her 
discovery of this Supposed Lithrontriptic: but to the great
disappointment of the Surgeon who thought the Stone dissolved 
& to the Public; when the man was opened
after Death & the Bladder examined several of these 
Sacculi were found in it & in one of them the Stone.
The Bladder often becomes inflamed & greatly 
thickened after, and in this case it will often
form Rugæ on the internal Surface which 
have a rough Feel when the Catheter or 
Staff is introduced - 
The nervous coat is similar to that of ye. Stomach
& Intestines & cannot be said to be a proper Coat.
under this lies the internal, or villous Coat as
some have called it, but it is improperly calld
a Villous Coat, for it does not appear villous like
that of ye. Stomach & Intestines, but is perfectly
Smooth & even -
There are some who think the internal Coat of 
ye. Bladder & urethra to be a continuation of 
the Cuticle reflected back from the Glans Penis,
and



298
and also that the internal Coat of the Stomach
& whole Alimentary Canal is a continuation of 
the Cuticle lining the Fauces; but this is an 
absurd way of arguing, for were we to admit 
it to be true it might with the same propriety
be said to be continued thro all the Vessels
of the Body at the Arteries, Veins & passing
by the Lacteals from the Intestines &c -
The internal Coat is loose & when empty falls
into Folds -
The Ureters are two long Canals, the excretory 
Ducts of the Kidneys, one coming from
each Kidney and in a sound state about
the size of a Goose-Quill, entering the Bladder
one on each Side, when they are rather
Smaller; they enter laterally & obliquely into 
the Bladder, first penetrating obliquely the 
external membs. Coat, then running a little 
way [they penetrate] between it & the Muscular 
Coat they penetrate it & so passes on into the 
Bladder



299
Bladder thro its internal Coat in the Same manner -
It has been said that their Structure is 
the same as the Bladder, but I never could trace
any muscular Fibres here & I think there can be none
sent to them; because if a Stone once passes thro them to 
dilate them which is often the Case, they never contract
but ever after remain dilated; and in long Suppressions
of Urine when these Canals become distended either by 
the Urine being detained in them or from a Regurgitation
back from the Bladder into them they always continue
of the same size; and this Shews they have no Power of
Contraction like the Bladder has - The obliquity of
their Entrance into the Bladder prevents the Regurgitation 
of the Urine into them in common, but when the 
Bladder becomes much distended I am inclined to think 
that a Regurgitation does happen, and what confirms
me in the opinion is that in some Nephritic
Patients I have seen the Ureters Just at their Entrance
into the Bladder enormously dilated - Some People
observing how quick then diluting Liquors will sometimes 
Pass to the Bladder have supposed that there was 
some Communication between the Stomach & it by 
Vessels passing immediately from one to the other, thinking
that



300
that it is impossible they shoud pass thro the Lacteals
into the Circulation & then Secreted by the Kidneys with 
such Rapidity & Celerity; but whoever Considers the largeness
of the Emulgt. Arteries will not think it extraordinary
or that nature deviates from her usual Course
in performing so quick & large Secretions by these Emunitories;
and no such Vessels as have been supposed
coming from the Stomach to the Bladder have ever yet
been found - I have before observed the Pelvis of the
Kidneys was only an enlargement of these Canals, and
this with the Ureters, Bladder & Urethra are all lined wth.
mucus and like all mucous membranes are liable to fleshy
[illegible] called Polypi, as we have instances in the nose &c.
I once attended a Gentn. who had a very large Fungus
of this kind in the Bladder, pieces of which frequently 
came away with his Urine at which time he felt very 
great Pain & oftentimes had an obstruction of Urine
previous to its coming away; and tho never free from Pain
(which is not the Case with Stone Patients for they have 
Intervals of rase) he lingerd out a Life of Torture
for many years: on Examination after Death the Bladder
was found preternaturally thickened & a Large 
Polypus adhæring to it, [in] some parts of which were encrusted
over with a gravelly matter - This is a most cruel
Compt.



301 
Complaint as no Relief can be got from art: Women who 
have these Polypi in the Bladder stand a better chance 
for Relief than men on accot. of the Shortness of their Urethra:
Mr. Warner mentions a Case of a Woman who had
one of these Polypi in the Bladder which he extirpated 
by a Ligature conveyed to it by the Tonsil Instrument &
the woman did well - In such Patients the Bladder is 
much diseased & they frequently have complaints Similar
to those of a Stone, and on Searching, a Roughness
is felt which young Practitioners are liable to mistake
for a Stone, but the Feel of a Stone is very difft. &
nothing but Experience can make them Judge of the 
difference - In these Cases there is allways an amazing
Discharge of Mucus which is very fœtid often -
The Prostate is placed at the Inferior and Anterior pt.
of the Bladder; it is a tough formed Substance by some 
called a Gland, and resembles a Chestnut in Size in 
Figure; it is divided into its' Body, Apex & Basis: it's
broad part or Basis is turned towards the Bladder & 
adheres to it; the lower or narrow part is the Apex, & the
middle its Body: it may be easily felt in passing the
Finger up the Rectum, and is at once distinguishd by
an experienced Surgeon by the Feel. The Urethra does not 
pass



302
pass thro the Center or middle of this Gland but lies in a 
notch on the Superior Part of it. It has been thought to Secrete 
a thin Mucus in Coition, which secretion is brought
about by an affection of ye. Mind; but this is mere Hypothesis.
it is surrounded by a quantity of Cellular membrane; in 
venereal cases it is liable to partake of ye. Inflammation
of ye. Urethra & adjacent Parts and Sometimes it suppurates 
& if ye. matter is not discharged very early by an 
Incision thro the Perineum, before it points externally,
it lays the Foundation of Sinuory Ulcers, incurable Fistulæ
communicating even with the Cavity of ye. Abdomen;
therefore as soon as we have Reason from preceding Symptoms
to suspect Matter is formed & can perceive the least 
Fluctuation underneath the Perinæum, we are not to 
wait to be confirmed in it by the Matter's pointing
externally but make an Incision without delay thro' 
the Perinæum to discharge the matter, & by this early
operation & proper Treatment after it, we may save our
Patient with Credit - The Dressing shoud be quite Superficial
as in the Stone - 
The Vesiculæ Seminales are Situated behind the Prostate
lying upon the inferior & posterior Part of the Bladder.
They receive a Periotonæal Covering from the Peritonæum
which is only partial, besides which they have a proper 
Tunic; [illegible] and some say under this they have a muscular 
Coat 



303
Coat, but this I never could discover, neither coud I ever find the
Glands which some assert they have - They may be unravelled
with great Care bathe the Testes appearing to be one continued
Tube, running from below upwards & taking many windings
form two Bodies or Lobes Seperate at the upper Part but
united below at the lower Part towards the Urethra. The
Vasa deferentia are observed were continued from the 
Epidydimi & passing along with the Spermatic Arteries &
Vein thro the Rings of ye. Abdomen run downwards from 
thence thro the Pelvis and passing between the 2 Lobes
of the Vesiculæ Seminales at their upper part, they meet
& Join together at the lower part of ye. Vesic. Seminal. wth.
which they then communicate & from thence go out in one 
Trunk into the Urethra where there is a little eminence
called the Virum Montanum; they likewise have lateral 
communications with the Vesiculæ Seminal. as they pass 
along between their Lobes: hence it appears that the Vesic
Seminal are Reservoirs for the Semen which is brought
from the Testes by the Vasa differentia as fast as it is secreted 
by the Testes and deposited in the Vesic. Seminal.  
till the time of Coition when it is thrown out with great
Force thro the Urethra. This Ejection of the Semen is not
perfomed as some say by the muscular Coat of ye. Vesci.
Seminal: because even if such a Coat does exist it is so 
weak as not to be capable of performing so powerful an 
Action



304
Action, but it seems to be performed principally by the 
Sphincter & Levatores ani which are put in action at
that time - 
There are some who for the sake of starting new Hypotheses
have given it as their opinion that the Semen comes
immediately from the Testes in Coitu & that the Vesic.
Seminal. are only mucus Glands, but this opinion is 
so trifling that it does not deserve to be confuted -
The urethra is a membranous Canal leading from the 
Bladder and serving for the Passage of the Urine & 
Semen - it is covered in some part by Cellular Membe.
in others not which is between the Prostate & bulb of ye. 
Urethra, where it is entirely Membranous. The Urethra being 
cut open it's internal Surface appears Smooth & even being 
lined like the Bladder with a fine Sensible membrane wch.
is everywhere besmeared with mucus, and upon it's Surface
are a no. of little orifices or Follicles called Lacuna wch.
contain a Mucus to Lubricate the Parts with; soon
after its origin from the Bladder there appears a little
Eminence on its internal Surface called Caput Gallinaginis
or veru-Montanum at which place the Semen
enters into it, and near it are several Foramina
which are said to be the mouths of the Excretory Ducts
of the Prostate - Between the accelleratores urinæ &
the



305
the Bulb of the Urethra, there are a certain no of small Gland
called Cowpers Glands, which however are not allways to 
be seen in every Subject -
The Lacuna are situated in every Part of the Urethra &
are the Seat of ye. Gonorrhea, in which the venereal 
Virus irritates the and creates an Inflammation on 
the internal surface of the Urethra with a increased
discharge of mucus from these Follicles; and the Colour
of it depends upon the Degree of Virulence or the Inflammation -
Gonorrhæas an frequently attended with obstructions
in this Passage, which are most commonly occasioned 
by strictures & not by Caruncles as was formerly Supposed;
and are Cured by the use of Bougies - These stricts.
sometimes obstruct the Passage of the Staff in Searching
for the Stone; and sometimes the Corpus Spongiosum &
Veru Montanum are affected & partake of the Inflamn.
and are so swelled as to obstruct the urine - Cured by 
removing the general Inflammation by Bleeding, Forments.
&c- The Veru montanum is often so large as to 
obstruct the Passage of the Staff in Sounding for the 
Stone - 



306
Of the female Organs of Generation 
These are divided into external & internal; the external
are all those Parts which appear without Dissection, and
are the Mon Veneris, the Labia, Nymphæ, Clitoris,
Perinæum, and some rank the Hymen & the Vagina, but
this last improperly: the internal parts are the Uterus
& it's Appendages which are the Ligamenta Lata, Ligament
rotundum, Ovaria, Fallopian Tubes, Vagina &
Spermatic Vessels ~
The Mons Veneris is that Rising situated on the 
upper & fore-part of ye. os Pubis & covered with Hair wch.
is supposed to partly ornamental but chiefly serves to
defend the parts from Injuries from Friction &c. - this
Prominence or Rising is caused by a large Quty. of Adeps
under the Common Integuments. From this is continu'd
the Labia which reach to within about an Inch or 
thereabout of ye. Anus gradually growing thinner
from their origin till they meet; from their Termination
to the Anus is called Perineum which is very short &
without any Raphi - When a woman is erect, the 
Labia at their Superior Part are a little Seperated by the 
Glans Clitoidis, but lie in contact from thence to their
Termination; just as they do this, at the Beginning of 
the



307
the Perinæum there is the transverse Ligament running
from one of ye. Labia to ye. Other called the Frænum, wch.
is all ways torn in the first Labour and sometimes in the 
first Coit. -
The Clitoris is situated in the Superior part of the Pudenda
immediately under the Os Pubis to which it's Body 
is attached by a Ligament, and from thence it hangs
down with it's Glands & prepuce between the Labia: the Prepuce
like the Prepuce in males is only a doubling of the
Cutis & Cuticle serving to cover the Glans, and from it,
on the seperating the Labia, there appears a continuation
of this doubling of ye. Integumts. on each side called
the Nymphæ - A little below the Clitoris there is a small 
Eminence immediately under which is the meatus urinar. 
which leads into the Bladders a little below this we 
have the Os Vagina. at the Entrance of which is placed a
fine Circular membrane which exists only in Virgins 
and is called Hymen; this is commonly torn in the
first Coit & its lacerated parts from those little Eminences
called Carunculæ myrtiformes which are visible in
most women at this Place ~
The Contents of the female Pelvis are the Uterus,
Urinary Bladder & Rectum, which are all situated
one above the other & lie upon each other; the Bladder wth. 
the



308
the Urethra is uppermost; under this, the Uterus & Vagina, & 
below them the Rectum: the Peritoneum is reflected upon 
some parts of all these & give [crossed out] an entire Covering
to the Uterus; it is reflected over the Superior Extremity &
posterior Surface of ye. Bladder as in Men, from thence
it passes onwards to the lower part of ye. Anterior Surface
of the Uterus and is reflected upwards & over its upper
Extremity and down the posterior Surface running a little
way upon the posterior part of ye. Vagina from whence
it is continued over the Anterior Surface of ye. Rectum as 
in Men - From hence it is obvious that in ye. Ascites
water may pass down between the Uterus & Rectum &
from a Tumour in Perinæo, or it may be felt by introducing 
a Finger up the Vagina; and a Descent of ye.
Intestines may happen here (as in men between the
Rectum & Bladder) causing an Hernia; but these Cases
are very rare: if ye. water in an Ascites shoud work
it's way down into the Pelvis & buy down in Perinæo 
it may be discharged by a puncture with a Trochon
in Perinæo -
The Urethra, Vagina & Rectum are all hollow Tubes
obeying the Course & direction of the Sacrum; the 
Urethra makes a small Curvature downwards & upwards
& hence the Female Cathether is made a little innervated
at its extremity; the Vagina makes a larger 
Curvature



309
Curvature than the Urethra, & hence in introducing the 
Finger up it, we are to pass it backwards a little 
towards the Sacrum & then bring it forwards & upwards.
The Rectum makes a larger Curvature than either -
The Curve of the Urethra we ought to attend to
in passing the Cathether, which is done in this manner.
The woman is laid on her Back & covered by the Bed -
cloaths, you take the Cathether in one Hand and with the 
other you feel for the Pubis, carry a Finger downwards
between the Labia, feel for the Clitoris and continue carry
your Finger downwards till you find the little Emince.
below which is the orifice of ye. Meat. Urinar., you then
keep your Finger fixed just below it & pass the Catheter
upon the Finger with the Concave part to the Pubis & 
gently moving it about it will soon slip into the Urethra
& will easily pass into the Bladder -
N3. It is the Practice in midwifery for the Woman to 
lie on the left side; and I have been told by some
Practitioners in midwifery, that the best & most certain
way of hitting the Meat. Urinar. under Cover is to keep
the Fore-finger of ye. left Hand just in the mouth of the 
Vagina & presses gently with it upwards against the 
Pubis, the Catheter is then to be passed along this Finger
into 



310
the Vagina a little way, it is then to be slowly & cautiously
drawn out of the Vagina & the Point moved a little upwards
and by gently pushing & moving it about it will easily &
readily pass into the Urethra -
The uterus is placed loose in the Pelvis & its Situation
is rather oblique inclining a little to the right Side.
It's Figure is somewhat Triangular or rather resembling a flattened Pear and it is divided into
it's Fundus, Surfaces, Sides & Neck - From each side
goes off what is called the Ligamt. Latum, which is 
only a continuation & doubling of ye Peritoneum; and
from the upper part of its Body are sent off the Ligamt.
Rotun. which may be traced upwards thro the Abdominal
Rings thro which they pass & are spent upon
the Labia: the Ovaria or female Testicles are two Oval 
Bodies one on each Side of ye Uterus at some distance
from it between the doubling of the Ligamt. Lata; to 
these the Spermatic Vessels which are two arteries &
two Veins are sent and which take their origin in the 
Same manner as in the male - From the Horns or two 
superior angles of ye Uterus the Fallopian Tubes are
sent off which run some distance between the two 
Lamina of ye Ligamt. Lata & terminate in Several 
Jagged Threads called Morsus Diaboli -



311
The Structure of the External Organs -
The Mons Veneris is a Rising formed by a larger
Quantity of adipose membrane and is covered with 
Hair as before mentioned -
The Labia are only a continuation & doubling of the 
Cuticle & Cutis with Cellular membrane between which 
is Reticular, & hence they are so liable to be distended wth.
water in Dropsical Habits; there are a no of Follicles
Situated within the Labia which contain a Mucus
to lubricate the Parts -
The Labia interna or nymphæ are continuations of the 
common Integuments. and likewise have a no. of Follicles 
containing Mucus - They are liable to become elongated 
sometimes projecting without the external Labia when
they are very troublesome & require to be taken off, which 
may be done with a pr. of Scissors or a Knife; this most 
commonly happens to women who use much Exercise.
In Virgins they are generally firm, but in women who 
have used much Coition they are Lax & all ways
Swell in the time of Coit to grasp the Penis more
closely - In Africa & other hot countries it is said
that they are in common very large, insomuch that
it gave humorous Medical Gentn. occasion to say, when asked
about it (as he had been in Africa) that they were
so long as to be drawn on like a pair of Boots. 
Their



312
Their use is said to direct the Stream of ye. Urine &c.
The Hymen is differently situated in difft. women
i.e. in some it is nearer, in others farther from the external
mouth of ye. Vagina, but in common it is placed 
at the the mouth of it - It is doubted by some whether it does 
exist but I believe it allways does in every Female
before they arrive at the age of Puberty, but when the 
menses come on they generally destroy it & it then 
forms the Carunculæ myrtiformes -It is generally of a 
Semilunar Figure but sometimes it is entirely Circular,
with a Hole in the middle of it, and in such the menses 
do not break down or destroy it - It sometimes
happens in Children that this membrane mounts upwds.
& obstructs the Passage of ye. urine by being Spread over
the orifice of ye. Meat. Urinar. in which Case the
urine will generally point at the orifice & a Puncte.
must be made with the point of Lancet into it;
it more frequently happens that it is imperforate &
by this means Stops up entirely the Passage of the Menses
and it is seldom discovered till there is quantity
of menstrual Discharge lodged behind it and forming
a Tumour which at last will obstruct & cause a Suppression
of Urine; a Case of this sort happened to Mr 
Warner



313
Warner, in which the Girl wou'd not discover what was
the matter with her, but had her Water drawn off by
the Catheter from time to time & took many Medes. for
a Suppression of urine till the Tumour formed by the 
Lodging of ye. menstrual Flux showd itself, when the
Cause of the Compt. was immediately known & remedied 
by opening the imperforated Hymen & the Girl after
wards did well in a Short time -
It sometimes happens that when it is circular & has
a Perforation in the middle of it, it is so strong as 
not to be broke down by the Penis & many of ye. women
of ye. Town have been first led to Submit themselves
to the Embraces of Men, when they have had this, wth.
a presumption that they are in no danger of being 
got with Child on accot. of this membe. obstructing the 
Penis - In these Cases a Surgeon is sometimes 
called in to divide it, which is best done by making
a Crucial Incision thro it with a Lancet - Dr. 
Mackenzie has been oblidged several times to divide
this membrane before he coud deliver Women -
Mr Else has two preparations of the Hymen of two
women in which it is almost perfect; and one of the
women was to all appearances 60 year of age & the 
other was that of Mary Edmonds who was hung for murder 
Seeing



314
Seeing that the Hymen is most commonly destroyed by the 
flowing of ye. Menses before marriage, the notion of those
women who have it not, having lost their virginity will 
appear Groundless; however it's Existence is a presumptive
proof of Virginity, notwithstanding that many of the
women of ye. Town have it &c -
Carunculæ myrtiformes are the remains of this membrane, 
and may be seen at the Entrance of ye. Vagina
in those women who have not had many Children, but 
in those who have bore a great many and likewise in
those who use much Coition they are worn away and cannot
be Seen -
The Clitoris is very similar to the Penis in Men in 
all its Parts except the want of a Corpus Spongios. & 
urethra; it is like the Penis ligamentory & Cellular
& its Cells an distended with Blood causing Erection
in Coition; it has a Glans & prepuce like the Penis
Its Body is formed by Crura arising from the Ischium
& running obliquely upwards till they get under the 
Pubis & then they unite into one & is attached to the
Pubis by a Ligamt. - It's muscles & Vessels are Similar 
to those of ye. Penis - It is look upon to be 
the seat of Pleasure in Coition in Women & is so situated 
that



315
that the Glans undergoes Friction in Coition, by which means
the Venereal orgasm is sooner brought about - It is sometimes
enlarged by Disease; and in some young Women
it is so large as to project beyond the external Labia, in wch.
Case it is subject to Friction in walking which Causes
a Furor Uterinus - Surgeons are sometimes called to
amputate the Superfluous part, which is an easy 
operation, & the Hæmorrhage is soon stopped by Styptics .
The Plexus Retiformes is situated near the Crus
Clitoridis and appears of a red Colour seeming to be a
Series of Veins as they have a Communication with the
Vena Cava, and there is likewise a free communication
from them to the Crura Clitoridis, for by blowing air 
into the Crux, you distend the Plexus first & from them
the air will pass into the Cava. 
The Vagina is a membranous & muscular canal 
serving for the admission of the Penis in Coitu, the
Passage of the Catamenia & Fœtus &c; internally it is
lined with a fine membrane, said by Some to be a
continuation of the Cuticle, but it is very different
from the Cuticle: on its internal Surface there runs
a small Longitudinal Eminence from each side of which 
are observed a no. of Rugæ running Circularly which 
are



316
are very plain in young women, but in those who 
have had many children they are generally obliterated.
There are likewise a no. of Follicles on its internal 
Surface in which mucus is deposited to lubricate
the Parts; these are described as Glands by Some, but 
they are only Follicles to contain the mucus which is deposited
there by Vessels - It's posterior Extremity is 
connected to the Uterus, surrounding its Cervix, and
havg. the os Tincæ projecting into it -
At the Posterior part between the Vagina & rectum 
are several small glands called Cowpers Glands whose
Ducts are said to terminate on each side ye. Vagina
on it's internal Surface; in some these Ducts are very 
plain, in others not to be seen -
The Vagina has no muscles but those Fibres surrounding
it at it's mouth & called Sphincter Vagina.
The Urethra is very short in women, hence the Reason
why they so seldom require the operation for the Stone.
It is surrounded thro its whole length by a tough hard
Substance called the female Prostate which we are obliged
to cut thro in cutting for the Stone, and hence it will 
appear that the old method of forcing open the Passage
by a Blunt Gorget was very cruel & much more dangerous 
than the Present method, as the Inflammation in the
first 



317
first wou'd be much greater on accot. of the Violence
done to the parts by forcing in the Forceps & by that
means lacerating instead of cutting them as in
the present method which is by introducing a Straight
Director into the Bladder and holding it level wth.
the Groove upwards a cutting Gorget is carried along
the Groove strait into the Bladder, by which means
the Prostate is divided laterally & [the Crus of] the 
Clitoris is safe from being wounded: It a Knife
is used instead of ye Gorget, the Groove of the
Director is to be turned obliquely outwards to the
right Side that the Knife in passing along in it
may divide the prostate laterally; a Gorget is 
then to be introduced into the Bladder, the Director
withdrawn and the Forceps introduced &c.
The Uterus is the principal organ of Generation; 
it is supposed to resemble a Pear in Figure
which is a little flattend, but this is altered in
old women who have had many Children - It is 
divided into it's Surface, Edges, Extremities,
Body, Horn or Angles, Cervix & Fundus.
The 



318
The inferior Surface rests upon the Rectum, the
Superior is turned towards the Bladder; Its Edges
are two, one turned to each side of ye, Pelvis; it's 
Extremities are great & small, the great Extremity or
Fundus is superior, it's small turned downwards &
forms it's Cervix, in which is situated the Os Tincæ
as it is called; the middle is its Body; and a
little below its Fundus we have it's Horns or Angles
from which go off the Fallopian Tubes - It is allways
larger in women who have had Children than
in those who were never pregnant, and is capable of 
being enormously enlarged in Pregnancy. It's Cavity 
answers to the Figure of it externally -
The Structure of it is variously described by difft. Authers;
it is commonly said to have 3 Coats, the membranous, 
muscular, and Cuticular; the 1st. is only a continuation
of ye Peritoneum, & the others cannot be Seperated
without Violence: the inner Coat is a Continuation
of ye internal membrane of ye Vagina - It's Substce.
in Virgins is firm & Compact, but in Pregnancy becomes
more open & spongy & hence appears as thick
if not thicker as it increases in size [crossed out] Pregnancy 
advances



319
advances; it is thickest at its Cervix and thinnest
at it's Angles; and is different Colours in difft.
Parts, in some Places whitish, & others red Some
think it is muscular from it's having a Power of 
Contraction; but I must own I never coud discover
any muscular Fibres in it, and the Part which is
said to be muscular has not that red fasciculated
appearance which muscles have, and we may account
for Contraction of ye Uterus in the Same
manner as the arteries contract & Dilate, by their 
Elasticity - There are the Same appearance of 
Rugæ & a longitudinal Eminence at its Cervix as
there is in the Vagina but these disappear in wom- 
who have had many Children; and there are Follicles
on it's internal Surface which contain a Mucus
to lubricate it; this mucus we are told is some 
times secreted in such large Quantities as to stop 
up the - mouth of ye. uterus & Cause Barrenness -
The Vessels of the Uterus are very Numerous -
The Fallopian Tubes are so called because he first
discovered that they were hollow; they go off one from
each angle or Horn of ye Uterus and are about 5 or
6



320
6 Finger's breadth in Length and running between
the Lamina of ye Ligamenta Lata terminate
near the Ovaria in the morsus Diaboli: the
Canals when thy first goes off from the Uterus are
very small bardly admitting a hog's Bristle, but
they increase to the size of a Google - Quill in
their Passage; when blown up with air they appear
convoluted with Strictures in different Parts
where they are supposed to have valves. By Disease,
as in the ascites they becomes much elongated;
and sometimes their Canals are closed up at 
the Extremities, which according to our present Notions
of Generation causes Barrenness -
The Structure of these Canals are said by some
to be muscular, membranous, Glandular, & Cellular:
I never saw anything like muscular
Fibres in them, or Glands; its membranous Coat
is nothing but the Covering given them by the Ligamenta 
Lata; the internal Coat is a continuation
of the internal Coat of ye Uterus & in some Plans
project & forms Folds similar to the Valvulæ Conniventes



321
Conniventes of the Intestines - They are vascular:
and their use is said to be to convey the Semen thrown
into the Uterus in Coitu to the ovaries to be impregnated
& from thence to reconvey it back again to 
the Uterus where it tis till the Birth -
The Ovaria are connected to the Uterus by the
Ligamenta lata, between the 2 Lamina of wch.
they are situated, about two Fingers breadth
from the Uterus, in the unimpregnated State
lying near the Cervix  Uteri: they are of different 
Size in different women; in healthy young Wom:
they are generally as large as a Pidgeons Egg, but
in old women they are commonly worn away much 
Smaller. Externally they are Smooth & even and
are of an oval Form with their Sides a little 
flattened; their Structure internally is different
from that of ye. Testes, they appear, white & Cellular
with a no of little Bags or Follicles called Ova
which are lodged in the Cellular Substance of them,
which contain a kind of Gelatinous Fluid which 
appears to be of a Lymphatic nature, as it hardens
by boiling: sometimes we meet with other membranous



322
membranous Bags in the Ovaries called Hydatids, which
are distendd with Water in Dropsies of ye. Ovaries, in
which Disease they are very large Sometimes - 
Their external Covering is only a Peritoneal one
being situated between the Doubling of Peritoneum
continued from they Uterus under the name of 
Ligamt. Lata: the other Tunic is a proper one.
Formerly they were Supposed to be Similar to the Testes
in Men & that they Secreted Semen, but I do not 
believe they are Secretory Organs -
The Ligamenta lata have been described as only 
continuations of ye. Peritoneum -
The Ligamenta Rotunda are membranous:
they are very apparent in pregnant Women and appear 
at that Time of red Colour, but in young
& unimpregnated Women they are perfectly white,
& in old women they are of a blue Colour. They 
go off from the Uterus thro the abdominal Rings
& are lost in the Labia, on which account they 
are supposed to assist in generation, for being 
affected by the Friction in Coitu they convey a Sense
of Pleasure to the Uterus.



323
The Uterus has 4 arteries sent to it, 2 Spermatic
& 2 Pudendal, which last come from the internal
Iliacs and are spent upon the Uterus in a Serpentine
Course and are distributed on the internal
Surface in a very Singular manner - From these
Vessels the Menstrua flow -
The Veins are Similar in their Course to the 
arteries; they appear to have no Valves -
With Respect to Conception, little can be said
about the manner of its Performance, worthy of 
Notice; the present recd. Opinion of this operation 
of Nature Seems to be the most plausible of all
the Hypotheses yet Started, tho' it is not without 
it's objections; and it is This - The male Semen
is thrown into the Uterus by the Penis in the Coit,
at which Time the fallopian Tubes are Supposed 
to be dilated to receive it and convey it to the 
Ovaries where it is impregnated by one of the ova; 
it is supposed that this Time ye. ovaries are 
closely embraced by the Fimbriæ of ye. fallopian
Tubes or mosus Diaboli as it is called and that 
an adhæsion takes Place, till one of ye. membranous



324
Membranous Bags containing the Ovum bursts & mixing 
with the Semen impregnates it, after which it is 
again returned by the fallopian Tubes & deposited 
in the Uterus - Fœtus's have been found
lodged in the fallopian Tubes, which seems to confirm
the opinion that the Impregnation takes 
Place in the Ovaries & afterwards is conveyed to 
the Uterus -



325
Lecture on Preparations and 
Injections &c - 
Ruysch was the first who brought this art to 
any degree of Perfection, tho Injections were used before
his Time by Malpighi & others - The use of 
Injections was recd. with great opposition at first,
the Opponents alledging that the Parts thus Injected 
& prepared put on a very different aspect
in them to what they were in their natural State
in the living Subject: this in some measure is true 
but yet their use & assistance to Students in 
anatomy are very great & evident -
'Till within this few years this act was kept 
a Secret by Anatomists, but now to the Honour
of ye. Profession is made public -
It cannot be taught by words, but must be 
learned by Practice & [umocaried?] application; 
for we must expect to fail Several Times before
we succeed in making a good preparation, as 
it depends upon many nice Circumstances; the
Syringe shoud neither be too hot nor too cold, shoud
be



326
be well cleaned & well valved; the Injection shoud
be of a proper degree of Heat, of a proper Consistce.;
the Pipe well Secured at the mouth of the Vessel & 
kept in a proper Direction; the Injection shoud not
be thrown in with too much Force lest the Vessel
Shoud burst &c. The Subject shoud be first macerated
and all the Blood Squeezed out of the Vessels; 
it is to be put into [Cold] Warm water & suffered
to remain in it long enough for it to acquire a 
warmth equal to the natural Heat -
Preparations are of two kinds, the hard &
the Soft; the hard are commonly kept dry & 
the Soft wet, but there are some exceptions to 
this Rule - In making hard prepe. we rob
the Part of all the Cellular Membe., the Oil 
and the Blood, and all Superfluous Parts.
Wet pps. are commonly preserved in Spirits
the dry'd ones covered over with Varnish -
Injections are of two Sorts, the fine, and the 
Course; the fine is for injecting the minute
Vessels, the Course for distending the large 
Branches



327
Branches after the fine small ones are filled -
Injections are of Various Colours, red, blue, green
yellow, white, and black. The fine red which is used
to inject the minute Vessels is, equal parts of
Terebinthte. & brown Spts. varnish, with a Sufficient qty.
of Vermilion finely Levigated - the Tallow Injection
is often used especially for injecting Fœtus's - The
Injection shoud be of a proper Consistence, and 
to try it, it may be thrown into Cold Water: if it is 
too thick a little Turpentine varnish may be added, 
if too thin it may be kept on the Fire till Some 
of ye. Varnish is evaporated: it shoud be of such
a degree of Heat as for us to bear our Finger in
it - many difft. Injections are made use of each
of which has its use; for wet preparations, suet
of Turpent. Varnish, fresh Butter & Vermillion are
very good, to inject any part very minutely, as
for Instance the Villous Coat of ye. Intestine &c.
Solutions of Glue likewise may be used, but it 
is not a good Injection -
Gum Arabic, and Isinglass dissolved make good 
Injections for fine ppe. that are to be dried & kept
in



328
in Spirits as of ye. Cutis, Tendon, Bones, Ligamts
&c. which are best preserved in Sp. Terebenth. after 
being well dried; Injections of ye. Cutis shoud be
kept stretched upon a Board till quite dry -
The Wet Preparations, i.e. such as are not to be
dried, are best kept in malt Spts. which are 
to be changed as often as they grow foul; they'll
be clearer & keep so longer, if to a Pint of Spts.
is added ʒi Spt. Salis - The mouths of ye. Glasses
are to be well Stopped, with a Bladder &c - 
The apparatus for Injecting .... the Vessels,
for common Injection are a Syringe with a no.
of Pipes of different sizes and a stop Cock:
The syringes are generally of Brass & are of different 
sizes according to the size of ye. part to be prepared;
and there should be a different one for each different 
coloured Injection - The Stop Cock is of use
when a great qty. of Injection is required, as in 
the Heart of an Adult -
Supposing we are to inject a Subject. It is 
to be macerated in Cold Water 2 or 3 days in order
to 



329
to drain out as much Blood as possible; having 
done this, it is to be put into warm water till it 
has acquired a degree of Heat equal to the Natural
in order to favour the Running of ye. Injection; before
it is put into warm water the Pipes may be
fixed to the vessels, which shoud be as near the 
Size of ye. Vessel it is to be fixed to as possible, &
well secured with a Ligature - In preparing
young Subjects for the Arteries we don't macerate 
the whole Body but the upper & lower Extremities 
only are put into warm water for an
hour & half or 2 Hours previous to the Injecting 
it, which is all the maceration necessary or that
can be given it. During this maceration the
Syringe & Injection is to be got in Readiness:
and the Subject being laid in a Straight Direction, 
the fine Injection is to be thrown in till
we meet with a Resistance, we are then to desist
& withdraw the Syringe, suffering a little of ye.
Injection to run out of the Vessels; the Course
Injection is then to be injected -



330
After the Subject has laid long enough for the
Injection to get cold, we then proceed to Dissection, 
in doing which all the Adeps, Cellular membrane
and superfluous parts of ye muscles are to be remov'd 
but as many of the muscles shoud be left as can
conveniently -
After Dissection they are to be preserved either wet
or dry - If we wish to keep them in Spts., wet,
Spt. Terebinth. is best, in which they are to be Suspended
in a Glass by threads & the Glass well stopp'd
with a Bladder; in 2 or 3 months the Spts. will grow foul
& must be changed, when if we intend to keep the ppn
for a length of Time, the Glass must be Stopped by
first tying a Bladder over it after having gumm'd
the mouth on the outside with a Solutn of Gum. Arab.
and upon the first Bladder a plate of Lead is to be 
put, cut as near the size of ye mouth of ye Glass as
possible, over which a Second Bladder is to be tied 
by which means the Spts. will be prevented from
Evaporating -
If we are to dry the Subject, supposing it to be
for the Blood Vessels, after dissection it is to be put 
into 



331
into the best posture for shewing the Blood Vessel's 
& kept so till dry; it is to be placed in an open
Airy Place & every day the oily matter which 
exudes must be carefully scraped off and Sprinkled
with Spts. Tereb. till quite dry, after which it may
be varnished with the Shining Varnish; and
be exposed to ye. Air very freqtly. to destroy vermin -
If we want to keep the Parts dry without
Injecting, as the Penis, cellular membrane 
of ye. Intestines &c. we are to blow air into 
them from time to time till they become dry
To preserve the Valves of ye. Heart, it may be 
injected with Tallow & after it has become perfectly 
dry the Tallow may be melted out by 
placing the Heart before a Fire - The method
of Injecting a Heart, as is commonly done, is to 
fix a Pipe into both auricles & inject first wth.
red to fill the Ventricles & afterwards file the auricles
with yellow, and the Coronaries may be filled 
with Quicksilver -
The Testicles may easily be injected by the Vasa
deferentia with Quicksilver.
The Penis, by ye. Crura Penis to fill the Corpora 
Cavernosa



332
Cavernosa, and to distend the Glans, either by the
Veins or the Corpus spongiosum - They may be
kept either wet or dry -
The Placenta may be injected & looks very well,
when it succeeds & the Arteries are filled with red
& the Vein with yellow or white &c.: the Valves of ye. 
Veins must be previously broke down with a probe.
The best method of injecting a Fœtus is by the Umbilical
artery: a Child may be injected by Carotids
Iliac, or brachial arteries, but best by the aorta
Superior; and when the Injection appears thro the 
Cornea in the Iris it is a proof it has run well &
we must desist from forcing any more into them,
for fear of rupturing some of ye. Vessels - 
The Corroded Preparations, such as of ye. Liver.
Lungs, or Kidneys are very beautiful when the 
arteries & Veins are injected with different Colours;
the Injection used for this Purpose should be
softer than Common, because the Spt. Salis will
harden it & render it too brittle - The method of
making them is by throwing the Parts into Spt.
Salis after the Injection has cooled and they are 
to



333
to remain in it till all the Parts are Corroded & 
destroyed by ye. Spts. leaving only the Injection.
Thus in the Lungs the air Tubes, Arteries.
and Veins may be Shewn in Green, red, and 
yellow Colours, or according to Fancy: in the 
Kidneys, the Emulgt. Arteries & Veins with 
the Excretory Ducts: and in the Liver, the 
Vena Portar. & Hepatic Artery &c -



334
The following Injection & Varnishes are most in
use -
Dr. Nicholl's
Coarse Injection }
ꝶ  Rezin flav ℔ij }  
Ceræ flav - ℔j  }  
Terebinth Varnish q.l.m.} 
Fine Injection.
ꝶ Terebinth Varnish q.s. 
Vermilion q.s.m.
Dr. Monroes
Coarse -    
ꝶ Ceræ flav ℥xij  
Sevi Ov ℥xiij  
Vermilion q.v.m.
Fine
℥. Ol. Terbinth q.v.
Vermilion q.s. ad Color.
Dr. Hunter's 
Coarse 
ꝶ Sevi ov. depurat ℥iij 
Rogin. flav. ℥viij    
Cera flav. ℥iij. ℔i   
Fine
ꝶ. Tereb. Varnish ℥iv
Ol. Dule. ℥iss.
Vermilion q.l.m
Colours for Injections
Vermilion, Orugo Oris, King's Yellow,
Ivory Black, Prussian Blue - White Wax.

335 - 
Varnishes
Shining Varnish
ꝶ. Rezen flav.
Colophon āā. ℔ij
Sp. Vini Rect. Cong. ij m
Hard white Spt. Varnish.
ꝶ. Gum. Juniper ℥viiss
Spt. Vini Rect. Cong iij m. f. Solutio. l. a.
Turpentine Varnish.
ꝶ. Ol. Terebinth ℔ij
Rezin. Flav ℥xiv m
Brown hard Sp. Varnish -
ꝶ. Gum Juniper. ℔iiss
Shell. Lac. ℥viij
Sp. Vini rect. Cong iij m--