Annex – Anatomy Notes of Cline’s lectures by James Windsor, surgeon, Liverpool presented to his brother, John Windsor, surgeon, Manchester, by Mary / the relict of James Windsor, who died Dec. 1, 1840 / on the 25th of Feb. 1841  Anatomical Lectures Introductory Lecture H Cline [illegible] 4 [illegible] [illegible] 6 [illegible] [illegible] 8 [illegible] [illegible] 10 [illegible] [illegible] 12 [illegible] [illegible] 14 [illegible] [illegible] 16 [illegible] [illegible] 18 [illegible] [illegible] 20 [illegible] [illegible] 22 [illegible] [illegible] 24 [illegible] [illegible] 26 [illegible] [illegible] 28 [illegible] [illegible] 30 [illegible] [illegible] 32 [illegible] [illegible] 34 [illegible] [illegible] 36 [illegible] [illegible] 38 [illegible] [illegible] 40 [illegible] [illegible] 42 [illegible] [illegible] 44 [illegible] [illegible] 46 [illegible] [illegible] 48 [illegible] [illegible] 50 [illegible] [illegible] 52 [illegible] [illegible] 54 [illegible] [illegible] 56 [illegible] [illegible] 58 [illegible] [illegible] marrow – the cylindrical bones have a cancellated structure, in the flat bones it is called diploe – the earthy part of bone consists of phosphate of lime and magnesia – the periosteum of a fowl in guinea is black, & hence these birds is said to have black bones- Venereal Nodes do not commence in the periosteum itself, as some have asserted, but in the bone but afterwards the disease is extended to the periosteum, if it begun in the periosteum it would have extended towards the surface and not have descended into the bones The bones of birds are found to contain air & derive it from their communication with the lungs, the bones of the bird are filled by openings from the muscles and parts about the neck &c, thus the bird is rendered specifically lighter than it otherwise would have been if the bones had been filled with marrow, which in man and 60 quadrupeds serves at a reservoir of nourishment The effusion of blood from the medullary artery after amputation, may generally, be stopt by breaking down a little of the cancellated structure & thereby entangling the coagulum –In the incipient stage of the infn in the bone it is lighter, & that porous appearance is produced from assertion but it the infn continues it is heavier from increased deposit Morgagni mentions a case of ossification of the pia matral covering of the medulla spinalis – A case similar to which occurred at fr Thoht the man had tetanus and died – some bones are so thin as not to have any cancelli, for if they had they would be too heavy, being hollow makes them lighter and gives them more strength – A hollow cylinder is stronger than a solid one containing the same quantity of matter – If they had been solid with the same quantity of matter, they would have been far weaker the cavities don’t compound with the exteriors – there is the same quantity of bony matter in the middle of the thigh bone as near the ends- the periosteum at the ends of bones are for the insertion and origin of muscles and ligaments The cylindrical bones of the young have no cancelli - Bones have a vascular covering called periosteum upon which the vessels first ramify to supply the bones Arteries of bones anastomose – ʒi of muriatic acid to a pint of water will remove the earthy part of bones – Bones possess absorbents which is proved by processes being absorbed, & by the teeth of salivated persons becoming loose who had taken mercury – the bones are also supplied with nerves, but can't see deleted 62 deleted by the eye, altho' very evident from the very uneasy pain experienced under inflamation of any bone - the marrow is contained in a membrane, & supplied by the artery that enters the bone – this artery does not allow of transudation as formerly thought to prevent the bones from becoming brittle, it is merely a reservoir of animal oil, this membrane is not very sensible but when inflamed ulcers form within the bone - - Lecture 10th H Cline - On the appendages of Bones - Cartilage is commonly denominated guile there are three kinds, one kind supports parts and preserves form, for instance the ear and nose- cartilage connected to the ends of the ribs, which allow of more motion, - the two other kinds are both alike in structure, an elastic, moderately filled with blood, have absorbents & nerves – the next is articulating cartilage to named from being connected with the joints it is white and smooth externally, but is rough next the bone, highly elastic fibrous, the fibres running directly from the surface to the bone- Injections have never been pushed into cartilage - cartilage is tinged with bile – it will ulcerate M Hunter made many experiments upon cartilage, but never made it exfoliate cartilage may be exposed & not inflame never granulates, this kind is insoluble in heath and disease, which is of great advantage – its elasticity is of great use then is another kind of cartilage called an inter–articular cartilage, as in the knee – sternum, & collar bone - it makes the bones adapt themselves better to the articulating surfaces – Ligaments which are generally intended for tying or binding, the bones, muscles & tendons 64 together – of a silvery white colour, they are unyielding- not elastic- the fibres are more separate than those of cartilage – by care the fibers can be separated by maturation the vessels distributed to ligaments are small, they have various names according to their situation – two ligaments in the knee joint crossing each other, called crucial ligaments – one at the hip joint called ligamentum tua - another kind surrounding the ends of bones called capsular there are ligaments called elastic, only one specimen which is placed between the back parts of the vertebra- this kind seems to relieve muscle -the Lion & Cat have this kind of ligament in the paws - the vertebral ligaments are intended to relieve the muscle of the back – The Synovial Membrane This is found in the capsular ligaments of joints– it is highly vascular & will supplied with nerves – their use it to secrete synovia to lubricate the joint - that part of synovial membrane which covers cartilage is not sensible (altho' the other part is very much so) and does not secrete - this mucous or joint oil is confined between the two cartilages of the joints - We are sometimes compelled to cut into joints which is attended with great danger The knee joint is the most common to take out loose bodies that are sometimes found in this joint - the patient should be kept very still & quit after the removal of any extraneous body, & should be allowed to sleep the inflammation will keep up the secretion & also put the wound open – the ligaments about joints are frequently diseased, especially those about the knee, may be either acute or chronic, the acute comes on in the synovial membrane – the chronic 66 chronic most commonly begins in the ligaments altho’ occasionally the synovial membrane becomes affected – if the infm be in the acute stage bleeding will be necessary – but if chronic must give wine & use a full diet attending particularly to the stomach and constitution – sometimes dropsical affection follow – stimulating plaisters and pressure may be used after the infm has subsided to increase the absorption, & thus remove the effusion – In dislocations the ligaments are torn – it is the power of the muscles that prevents the reducing of dislocations, & so great is the power of the muscles, that it is told of a man in Paris, who was to be executed that a horse was yoaked to each limb and could not sever any one of them from the body, however the horse must have been weaker than our dray horses – they are sometimes reduced by bleeding and blister In some cases, dislocations are very easily reduced owing to the flaccid and soft state of the parts – in others a Surgeon may try for hours & fail, but the muscles have been so tired out & rendered so flaccid, that another surgeon comes and accomplishes the reduction immediately, but does not deserve credit for any great skill - Lecture 11th & H Cline - On the structure of the appendages of bones- On the periosteum, when situated over bone it is called periosteum when on cartilage is called perichondrium &, but upon the head pericranium this membrane is whitish, but there is one exception in the owl of guinea – it is supplied with large vessels - where ligaments and tendons are inserted it is inseperable from the bone, without cutting – it is very painful when inflame 68 but not in an uninflamed state, altho well supplied with nerves, its use is for the vessels to ramify, before they enter the bone- it was supposed that the Periosteum was the seat of lues venerea Mr - said that it began in the bone, generally in the tender parts of the bone- when the periosteum is raised over a node, it is found to be thickened it is probable after a time that the venereal action extends from the bone to the periosteum when suppurating nodes are opened matter is not found but a glary matter like synovia – On the form of Bones Bones are divided into four kinds – some are cylindrical – some flat – others spherical, & others again irregular – bones have eminences and depressions which same for joints – the depressions are called fossæ – some have grooves called sulci, & some have small holes called foramina – On the joints vary in form according to the motion they have to perform Galen has divided the joints into three divisions & those three each into three more joints are membranous as in the head which are of use by presenting fractures – in old people joints become ossified in the head & will continue as fissures- the as pubis is united by the cartilaginous joint – the ribs are also joined cartilage - females sometimes suffer from the cartilaginous joint of the pubis, by being stretched in difficult labour & baring considerable weakness in the pelvis - the ligamentous joint sums designed for extensive motion, but as the motion is extensive the joint is weak, when great motion & strength is required a number of joints are furnished as in the wrist and back- there are cartilage ligamentous joints, as the vertebra which are joined together by which is sometimes called intervertebral 70 intervertebral substance – ossification is very incomplete at birth, altho' some are properly formed viz the ribs- lower jaw, and ear – some animals cannot see or hear when they are born as the Puppy & Kitten – this temporary provision is of two kinds membranous and cartilaginous – the dura mater and pericranium preserve the bone in the limbs – the temporary substance is cartilage – it was originally thought that bone grew like a tree, strata upon strata, but this opinion has been long overturned, knowing that it begins in the middle as in the patella- originally it is all cartilage – when ossification commences two little specks are seen in the middle which are patches of cartilage these are taken up by the absorbents as the bony matter is deposited – the small stem of bone may be turned like a such out of a shell, which proves that bone is not made of cartilage as was formerly thought – ossification varies a great deal in the time of its being finished- many bones have their extremities distinct from their bodies which are called epiphyses, some of which remain ununited to the bodies of the bone till the age of 21- The progress of ossification in the flat bones is different from that in the cylindrical bones – the fibres in the flat bones goes in a radiated direction – longitudinally in the cylindrical bones – then is a continual absorption & formation of bone going on in our bodies – when bones are broken they become readily united by ossific matter being deposited which is called callus when this happens & the animal is fed on madder, the callus will be red – the absorbents will remove a superabundant quantity of callus; if the madder be discontinued the bone being absorbed, the red portion is removed which proves the continual deposition 72 and absorption of bone - Lecture 12th H Cline Osteology- The skeleton is arbitrarily divided into three parts - Head – Trunk and Extremities – the bones are extremely complicated those of the trunk are most simple the bones of the spine are called vertebrae of which there are 24 these are divided into three classes – the 1st are the Cervical, the 2d are the Dorsal, & the 3d are the Lumbar -7 Cervical, 12 Dorsal and 5 Lumbar – the vertebra are divided into three, the body which is round the upper & under sides are flat – have seven processes– two forming joints above two below - two transverse processes & one spinous process & the hole or canal for the passage of the spinal marrow the cervical vertebra differ from the dorsal & lumbar – In the cervical, the bodies are much smaller, are not flat but hollow the transverse processes are smaller & have a hole in them for the passage of the vertebral arteries – the cuticular processes are placed obliquely – differ also in being lighter the spinous processes are bifid, & receive the muscles and vessels – the canal is large and triangular – The Dorsal – the body is round – flat above and below – the transverse processes are larger and stronger to support the ribs – the articulating surfaces are perpendicular – 2 facing backwards 2 forwards – the spinous process sharp and pointed downwards - The Lumbar Differ remarkably from the rest in being larger & oval- the body is broader – the upper articulating processes tend towards each other- the lower from each other – the transverse processes are long and slender – the spinous processes short – deep, sharp on the upper and hollow on the under side the canal is less than those of the upper 74 but is triangular, the dorsal receives the aorta after it has made the curve – the 7th has the heart acting upon it, the bifurcation of the aorta on the 4th lumbar – The atlas has no body, has two deep articulating surfaces on the upper part to receive the condyles of the os occipitis, has no spinous process- the transverse processes have foramina and grooves, the hole appears large but it is partly filled by bone – the 2nd cervical vertebra called dentata having a process like unto tooth 7th differs from the others in the spinous process not being bifid, the vertebral artery does not pass thro' the hole in it, but is for the passage of a vein the first dorsal has an articulating surface articular surfaces on their for a whole rib- the 11th & 12th have no articular surfaces on their transverse processes, in the other the ribs rut each upon two vertebra – the 1st & 2nd lumbar vertebra are commonly dislocated, the others are said sometimes to be dislocated, but they are at the same time fractured Lecture 13th H Cline On the bones of the pelvis In the young subject there are eight, in the adult four – the Iliume, Ischium, os pubis os sacrum & os coccygis –the os innominate has the crista – the anterior superior spinous process, & the anterior inferior spinous process in the front, & on the back of the crysta is the posterior superior & inferior spinous processes – the acetabulum – Is deepest at the upper part – the crysta has two labia giving rise to the external oblique & transversed in the anterior superior spinous process gives rise to the sartorius, & the anterior inferior gives rise to the rectus – the dorsum Ilii is chiefly for the origin of the glutei – the venter ilii is filled by the iliacus internus – the line forming the boundary of the pubis is called 76 the lema ilio putima or innominate – near the venter is a rough ligamentory surface which is joined with the os sacrum – the os innominate have a many holes for arteries to enter – the ilium is sometimes fractured may be simple or compound – the made of treatment is to put a strong bandage round the hips & to be freely bled – I have seen cases of compound fracture – do well - Ischium called the hip bone- the upper part forms the lower part of the acetabulum, it has a spinous process forming the attachment of the sacro sciatic ligament – below is a notch over which the tendon of the obturator internus plays- the lawn part which is rough is called the tuberosity of the ischium which is covered by cartilage on the inner side of the tuberosity runs the internal pudendal artery – the crus penis is attached to the rough part of the ischium the ischium is perhaps never broken alone Os Pubis This bone is of the most importance - it is divided into body symphisis & crus – the body has a depression in which is the femoral artery & vein are found externally between the anterior superior spinous process of the ilium and the symphisis pubis – the inner part of the bone is called the symphisis which is joined by cartilage – one part of the abdominal ring is situated on the spinous process of the os pubis, the other on the symphisis pubis – if the hernia be on the outside of the os pubis it is femoral hernia – if on the symphisis outer side it is inguinal – the ligamentum terse goes from the acetabulum over that part of the os pubis – the line on the top of this bone is the linea ileo pectinea the pubis is sometimes broken from 78 caning is passing over the lower part of the pelvis, the bladder is generally ruptured Formation of the acetabulum- 2/5th of the ilium – rather more of the ischium & 1/5th of the os pubis – there is a large foramen formed by the pubis and ischium called foramen ovale, thyroidium magnum & obt. there is also the ischiatic notch, formed for the passage of the sciatic nerve – the gluteal, the ischiatic & internal pudendal arteries & for the passage of the penniformis muscle, it is bound below by the sacro sciatic ligament –Dislocation of the thigh bone- when dislocated upwards it rests upon the dorsum ilii the leg is shorter by three inches & the knee is turned inwards when downwards is in the foramen ovale the leg is longer – when backwards is in the ischiatic notch, not more than 1/2 an inch shorter, sometimes no shorter at all The head of the bone placed in the pubis is another kind of dislocation Lecture 14th Dr Cline Os Sacrum – Used by the ancients in sacrifice – it is triangular – concave towards the rectum – convex posteriorly – in the young subject it is divided into seven portions, on each side are found four holes, thro’ the upper three branches of the great sciatic nerve passes, on the superior part is an articulating surface to the last lumbar vertebra – behind an articular processes to the articular processes of the last lumbar vertebra the hole that transmits the spinal marrow is triangular – posteriorly one processes – on the sides are two surfaces one part for the union of the sacrum & the other part for the insertion of ligaments & muscles to the bottom part 80 is united the os coccygis in some cases, this bone & the os coccygis form a right angle the anterior part being so concave – Os Coccygis - Is composed of four bones in the infant – concave anteriorly & convex posteriorly- the first bone is united by cartilage to the sacrum, has two transverse processes and two cornea – it is sometimes loosened from the sacrum, & gives pain which sitting by stretching the ligaments which pain is fell down the thighs – The male pelvis differs considerably from the female pelvis – the female pelvis is about half the weight of the male pelvis the anterior superior spinous process & crista of the female are crated- the male & female an both double cones – the greatest diameter of the male is at the shoulders, gradually becoming narrower above and below – the brim of the female pelvis, is longer from side to side than from the pubis to the sacrum in the male they are both alike, at the lower part the difference is greater – the tuberosities of the ischium are placed at a much greater distance than in the male females roll in their gait because the acetabular are placed at a greater distance from the central line of the body, & consequently have to incline the shoulder of the other side whenever they stride The bones of the thorax – The thorax is composed of 37 bones – 12 dorsal vertebra 24 ribs and sternum – sometimes there are only 11 ribs at one side, at other times 13 The ribs are divided into head, angle, & body about three inches from the head in the 6th & 7th ribs is found the angle – the body is smooth on the outside but more so on the inside – the upper angle is round – the lower sharp behind which edge the inter 82 costal artery passes – the anterior extremity is expanded- the arched form of the ribs assist in giving strength when injuries have been sustained – the head forms the articulatory process, & rests upon two vertebra, an inch from the head is a tubercle, & between the head & tubercle is seen a smaller one – the ribs differ extremely in figure, the uppermost one is very much curved, it has a hollow groove, for the passage of the subclavian artery – it is contorted in three ways – its edge is forwards and backwards, & not upwards and downwards as in the others – the head has only one articulating surface – the 11th & 12th differ also – in only having one articulating surface – are nearly straight & called floating ribs – have no tubercle or groove – the ribs are divided into true and false 7 true & 5 false – the 7th is the longest rib, the 12th has the greatest degree of motion – decrease as they go upwards 84 the true ribs are joined by cartilage to the sternum – the next three are joined by cartilage to the 7th rib, & the two last to the muscles – the sternum in the infant is divided into three bone 1st & 2nd bone & cartilage Insiformis – the first bones convex before & concave behind, one articulating surface for each clavicle, one for the first rib & half of one for the 2nd (directly behind the 2nd bone is the heart) it has half an articulating surface for the 2nd rib – whole ones for the 3rd 4th 5th & 6th and half a one for the 7th, the cartilage insiformis is bony in the old man, the linia alba is attached to it, shaped like a broad sword – the motion of the ribs is upwards and downwards, at the same time that the sternum advances and retreats – Inspiration consists in raising and advancing the ribs & sternum depressing The diaphragm, & thus enlarging the thorax in every direction, Respiration is just the wan to what takes place in inspiration The ribs are liable to be fractured – when many are broken on both sides the lungs are compressed and the patient dies – in some cases the intercostal arteries are torn – blood is effused, matter is formed as well as serum & the patient dies by the lungs being penetrated, in some cases, the fractured end remains in the lung or tears it considerably when this takes place the patient dies from inflamation – Case Mr. Travers had a case in which the 6th & 7th ribs were broken & the diaphragm torn close to the liver- the intestines rushed thro’ the opening into the thorax & the man died – when the ribs are broken on both sides, bandages are improper, by pressing down the sternum & ribs respiration is impeded - & suffocation follows Lecture 14th M Cooper On the bones of the upper extremity - the upper extremity is divided into four parts - the shoulder – the arm – the fore arm and the hand – the hand into three the carpus metacarpus, and fingers – the clavicle is shaped like the letter S the body of the bone is bent forwards and downwards – the scapular end has a small articulatory surface - on the under side is a strong mark made by the subclavius muscle – the sternal extremity of this bone is triangular, between this bone and the sternum is a moveable cartilage – about an inch from the sternal end is a protuberance for the insertion of a ligament by which it is joined to the first rib – the bone is attached at one end to the sternum, the other to the acromion scapula – its use is two fold – it raises the scapula, & it throws 86 the shoulder joint a long way from the side The cat tribe – the kangaroo – the bat- the monkies have shoulders although in some of this tribe then are ligaments instead – when broken the shoulder approach each other – the scapular end of the bone slides under the sternal end, & this portion seems to project – Treatment – the shoulders are to be kept back and not forwards – the arm & scapula to be directed by a short sling applied to the arm – In fractures of the clavicle the three indications are to carry the shoulder outwards upwards and backwards – the first is answered by the pad in the axilla – the 2nd by the short sling, & the third by the stellate bandage but the two first are principally to be relied on - In applying the bandage, it should not pass over the fractured extremities of the bone, as in pressing unequally it is very liable to cause a laceration, & thus convert a simple into a compound fracture – It is The Scapula. Said to be triangular, it is convex on one side, & concave on the other- it is divided into two parts by the spine, the extreme part of which is the acromion above the spine is a hollow, called fossa supras pinata, & another hollow below called fossa infra- spinata – the superior edge is called the superior costa – the lower edge is called the inferior costa – the apex of the bone is when the glenoid cavity is for the head of the os humori – it has a narrow part called the cervix - it has a process near the glenoid cavity called the corocoid process situated on the inner side of the joint the posterior edge is called the basis, the superior part of which is called the cup angle the inferior part the inferior angle – the outside is called the dorsum, the inside the venter which last receives the subscapularis muscle, opposite to the superior costa, and 88 between it and the coracoid process, is a fissure or notch for the passage of an artery, it covers 6 ribs below the first, its only attachment to the bones of the chest is to the clavicle its use is to form a socket for the os humour the motions of this bone are upwards & downwards, a little forwards and backwards it assists in the motions of the arm Subject to three kinds of fracture – 1st – a fracture thro’ the body of the bone, 2nd kind when the acromion is broken off – 3rd fracture of the neck – the fracture thro’ the body is easily detected & should be treated in the same way as fractured ribs- The fracture of the acromion is generally pretty evident a cushion is to be placed in the axillar a short sling and roller to confine the arm to the body, & thus keep the patient from moving it – when the neck of the bone is broken there are the several appearances of dislocation – viz the loss of the prominum of the shoulder, & generally the hollow immediately below the processus acromion by elevating the shoulder, the natural appearance is immediately presented, and in letting it go it as quickly vanishes, this will generally be found to be the case in fractures of the neck & acromion scapula if further proof is wanted press the thumb firmly on the coracoid process – rotate the humerus which will immediately convey the sensation of the crepitus – cushion in the axilla – short sling & roller are the modes of care – these fractures are very tedious generally requiring 11 or 12 weeks, during all which time the bandages must be allowed to remain on – To ascertain the fracture of the acromion, roll the os humori in its cavity, &c crepitus will be felt, it is cured by applying a sling under the elbow & 90 arm & thus keep the broken portion of bone in its place by the head of the os humori being kept firmly upwards – Fracture thro’ the neck is to be detected in the following manner, apply the fingers firmly on the coracoid process of the scapula, then roll the humorus The crepitus may be distinctly felt – the treatment of this fracture is similar to that of the fractured clavicle with this addition, that a tolerably large ball should be placed in the axilla, so as to keep the head of the os humori firmly thrust upwards – The Os Humori is divided into head–body & extremes on its outer side is situated a large tuburcle, on the front is another, tube in which is a subcus for the tendon of the long head of the biceps, the bottom of the bone is divided into the articulating surfaces, one for the radius the other for the ulna The fracture of this bone are of three kinds the first thro’ the body - the 2d thro' the neck the appearance of which is very much like the dislocation – grasp the head of the os humori and roll it – if the head obeys the motion it is not fractured – if not it is fractured – The third species is at the condyles & is the most frequent – appearance like that of dislocation – Treatment keep the arm bent, and apply a roller kept moist round the joint, but not tightly and a jointed tin splint so that a little motion may be allowed in about 10 days in Children & three weeks in adults Os Humori, the most common situation of fracture is thro the body of the bone fracture is more difficult to detect when high up, frequently occur in children at the condyles and not uncommonly mistaken for dislocation. In the examination of fractures in general, the crepitus will not 92 be felt except the broken ends of the bone be brought into opposition, therefore in endevouring to detect a fracture, extension should be made at the same time – In fracture of the body of the bone use splints bandges and a long sling, in fracture of the bone near its head there are the same appearances as in fracture of the cervix scapula – it will be detected by grasping the head of the bone and rotating the arm- in addition to the treatment of the other fracture there should be a pad in the axilla – In fracture of the condyles, a piece of wetted paste board is to be applied, & a roller passed above and below the joint, but not over it, the arm is to be kept in a flexed position, & passive motion by are in about a forthnight Lecture 15th M Cooper The Fore arm - The bones of the fore arm are two – the Una & Radius- The ulna is lengthened lengthened by a process called olecranon, to receive the insertion of the triceps, an inch below is the coronoid process, between which is the articulatory surface for the trochlea of the humerus – the lower extremity of the bone is marked by the insertion of the pronator quadratus muscle, this bone is not articulated to the wrist only to the radius, by an articulating surface on its side – on the side of the coronoid process is an articulating surface for the radius – on the inside at the bottom is the styloid process, formed for the attachment of ligaments, & forms that process on the inside of the wrist that we feel so easily – the body of the bone is triangular this bone is subject to two species of fracture, one thro’ the body which is easily detected by rolling the hand, & by laying ones fingers on the bone the crepitus may 94 be felt- the other fracture is that of the olecranon this fracture is not united by bone but by ligament – the arm is to be extended & kept still – It is highly necessary to distinguish between a fracture of the olecranon and the condyle of the os humori, the treatment being quite different – The Radius – Is divided into head, tubercle, and body – An inch below the head is a tubercle for the insertion of the biceps, the body is triangular – it is a good deal expanded on the lower part, it has a process on the outer side of the lower part called the styloid- close to this is the articulatory surface to the three bones of the carpus opposite to the styloid process on the inside is a small articulatory surface for the ulna this bone is joined to the os humori & ulna above – the carpus and ulna below – Pronation and supination is effected by the rolling of the Radius on the Ulna – It is liable to fracture 96 fracture sometimes in the centre, but more generally about 2 inches above the carpus In treating fracture of this bone, the hand is to be kept in the half supine position the sling not reaching beyond the wrist because then the hand hangs down, & keeps the lower end of the bone in apposition The bones of the carpus are eight, those of the meta carpus five- 12 phalanges of the fingers, of the thumb 2- the first bone of the carpus is called scaphoid 2d lunar 3rd cuneiform (joined to the radius) 4th orbicular on the inner side of which runs the ulnar artery – the 2nd row of bones in the wrist are four also – 1st trapezium 2d trapezoides 3d os magnum 4th os cuneiform under which set of bones pass the tendon vessels & nerves to the fingers – Metacarpal bones, those of the thumb shortest & thickest, the middle finger has the longest The upper part of each is called basis – middle part body – & lowest part head – Phalanges The first are longer than the second – the 2d longer than the third – the first have articulating surfaces with the metacarpal bones- the 2d & 3d by pulleys which do not allow of lateral motion – frequently on the thumb and little finger are small sesamoid bones at the joints with the metacarpal bones – splints and a ball are to be used in fractures of the phalanges - The Os Femoris – Is divided into its head body and condyle – the head forms the larger parts of a sphere, in the middle of the head is the depression for the ligamentum teres, the neck is situated obliquely back in old age transversely at the outer part a little below the head is the trochanter major, nearly three inches below from the top of the trochanter major is the trochanter minor, this lesser trochanter is for the insertion of the psoas and iliacus internus – this bone is naturally arched, it has a rough line posteriorly called linea aspera- the lower extremity forms two condyles, the outer one shorter than the inner, each has an articulatory surface for the tibia, not the fibula- behind and below the two condyles is a hollow for the popliteus artery & ischiatic nerve, one articulatory surface in the front for the patella - There are great varieties in the shape of this bone, some are straight in which cases the persons are weak – This bone is liable to three species of fracture, one in its body where it generally overlaps another thro' its neck, in old people it is broken within the capsular ligament in which case union never 98 takes place – a ligament is formed for union instead of bones – a fracture just below the trochanter major or minor is the most difficult to manage, the muscles pulling up the upper extremity of the bone the lower end being left at some distance The person should be kept as near the sitting posture as possible, & the knee drawn considerably upwards, by these means the fractured ends of the bone are put in apposition and a good union is effected. Lecture 16th Cooper The Patella – Is said to resemble the heart on the anterior part it is rough for the tendon of the rectus femoris – it has two articulating surfaces the largest for the external condyle & the smallest for the internal condyle, it serves as a moveable lever to give power to the extensor muscles, in some [illegible] 100 foot- A Cooper has effected are union in this way, but say, he thinks it impossible when it is broken across - The Tibia - So called from its similarly to a pipe – is divided into head, body and malleolus, on the fore and upper part is a process for the attachment of the ligamentum patella – the fibula does not enter into the composition of the joint about four inches above the ankle joint the bone is the most slender & therefore most liable to be broken in this part at the bottom part internally is the malleolus internus, behind which is a groove for the passage of the tendon of the tibialis anticus- its head forms two unequal surfaces, between which is a depression for the crucial ligament – viewing it on the outer side is the articulating surface for the fibula- one third below the top of the bone is the hole for the medullary artery, an oval articulating surface at the bottom for the astragalus - it is joined above with the of femoris & patella – below to the astragulus & fibula – This bone is more frequently fractured than any other bone in the body sometimes obliquely broken into the upper joint – in this case the linch should be kept straight, but if below the joint should be slightly flexed - The Fibula. Divided into head, body and malleolus – the head has ans articulating surface with the tibia - it has a projection at the bottom – & dislocation of the Tibia cant happen without a fracture of the fibula, the body of the bone is rounded on its outer side- has three lines, one for the insertion of the interosseous ligament, the other for the attachment of the perinci muscles 102 this joined above with the tibia, below to the tibia & astragalus – it is situated a little behind the tibia – it is frequently fractured three inches above the joint may be ascertained by grasping the leg and rotating the foot the crepitus will there be felt – if not attended to by the assistance of splints the person will walk on one side of his foot - The Foot – Is divided into Tarsus - Metatarsus - and Phalanges – The Tarsus has 7 bones – Calcis – astragalus – naviculare cuboid, & the three of a cuniformia- the os calcis forms the heel – is joined to the astragulus- astragulus - articulated to the tibia and fibula – the os naviculare resembles a boat, the cuboid bone has a groove for the peroneus longest – the cuneif bones called external, middle, & internal all united to the os naviculare – the heel differs much in length in different persons- a person springs, walks, jumps and dances better for having a long heel The tendon of the gastrocnemii being removed further from the center of motion becomes stronger – There are five metatarsal bones these have interosseous muscles like the metacarpal bones – the os calc is & the heads of the metatarsal bones of the great and little toes form the arch of the foot – description of the chinese foot when young the two least toes are turned underneath the foot, & the two next are put under the metatarsal bone of the great toe, thus the foot appears as if there was only one toe – Phalanges 12 & 2 to the great toe, they differ from the fingers in being much shorter, the great toe like the thumb has no 2d phalanx- the great & 2nd toe have each a sesamoid bone - 104 Lecture 19th A Cooper The Bones of the Skull The skull is divided into two parts, the cranium and the face – those of the cranium 8 of the face 12 – the head is narrow in the front, & broad behind – the greatest depth is from the top to the foramen magnum – It is usually oval, sometimes very round, and sometimes very long, in a long head there is a depression in the direction of the sagittal suture – the skulls of different sections differ, in the negro the fore head is narrower forwards, the orbits of the negro are at a greater distance than the english the upper & lower jaw in the negro advance further than those of the english – The monkey tribe, the forehead recedes, & the lower part of the face project a great deal, in the dog the jaw projects farther and in the horse the bones of the face are very large, the skull of the negro is smaller than that of the english proved by filling each with water the weight of the brain in the negro 48 oz in the English 52 oz the powers of the mind do not depend on the quantity of brain the weight of the elephants brain is 8 pounds & two drachms dissected in fr Thro’ Hospital the weight of the human brain rarely exceeds 3 pounds – according to gall and Spurzheim Love resides in the occiput corporal powers below- Moral qualities on the top- Intellect in the fore head - The skull of carible an indian chief exhibit a remarkable instance if the recession of the forehead, & this person was known to be a man of judgment and learning –A narrowness of the summit of the head i.e formed like the ridge of a house slanting obliquely downwards from the top denotes idiotism 106 A head flat on the top is a mark of reflection – a long head denotes deep reflection & judgment – a short head denotes more of ready wit and quick attainment. In the adult the bones are in two tables divided by a diploe - but in old age this diploe is absorbed & in infants there is no diploe care therefore should be taken in using the trephine either in very young or in old persons – The bones of the skull are eight in number, and connected by sutures- The first is the coronal sutures beginning an inch and a haft behind the orbit passes over the skull, & connects the os frontis to the two parietal bones - the 2d is the sagittal which begins from the center of the coronal & goes to the apex of the lambdoidal suture anting the two parietal bones [cross out] The sagittal suture in the young subject is extending down to the crown, dividing the os frontis in to two- 3d the frontal suture if it exists - 4th The Lambdoidal suture which begins at the root of the mastoid process, and proceeds over to the other mastoid process use to join the os occipitis to the parietal bones – there is an aditamentar suture lambdoidale for the purpose of uniting the os occipitis to the temporal bone, there are little bones in this suture called of a triquetra – The squamous suture formed by the temporal bone wrapping over the parietal bone, a portion descends to the basis of the skull unitary the temporal bone to the os frontis – The transverse suture beginning at the lower extremity of the coronal crossing the orbits of the eyes & nose use it to unite the bones of the head to the bones of the face – The base of the skull 108 is divided into three parts – outer, middle, and posterior – The outer extends between the os frontis & the anterior clinoid processes, containing the spine of the os frontis – the crista galli to receive the dare mater, the cribriform place and the foramen cacum, orbita plates or processes, supporting the basis of the brain The middle division – extending between the anterior clinoid process before, & the posterior behind, between which is the pituitary gland in the cella turcica, a cavity on each side for the middle lobe of brain – openings 1st the foramen opticum 2d f. lacerum 3rd rotundum 4th or ale 5th pinosam 6th caroticum – The posterior division- which is the largest on the fore and middle part is the cuneiform process of the os occipitis, the petrous portion of the temporal bone on the side- the os occipitis forming a crucial ridge, above for the cerebrum below for the cerebellum The foramina are the auditiara, lacera condy loidia, magnum – this division of the base of the skull is comprehended between the posterior clinoid process, & the os occipitis, If asked what are the foramina of the skull, the following will be the answer – 1st optica – 2nd laura 3rd rotunda 4th ovalia 5th spinosa 6th carotica 7th auditira – 8th lacera basis cranii 9th condy loidea & 10th foramen magnum. Lecture 20th M Cooper The external base of the skull - It is divided into three parts or divisions First between the os frontis & pterigoid process we have the septum narium or mastoid plate, two turbinated or sponge bones – two depressions on each side which form part of the orbits - the foramen optica - lacera and rotunda are in this 110 division of the skull- on each side of the spongy bones are the ethmoid cells communicating with the nose, and affecting in forming the voice – The second division – between the pterigoid process and the styloid process, in the center of which is the processes azygos & cuneiformia on the fore part the pterigoid processes, at the root of these is a foramen for the eustachian tube – the meatus auditorius at the root of the zygomatic process- the pterigoid process is divided into two plates, behind [cross out] which is the spinous process, on the side is the hollow to receive the lower jaw – the foramina, on the ovalia – spinosa – carotica, on the side of the cuneiforms process is a hole which in the natural state is filled up with membrane, & not for the passage of anything more than a small artery – the third division – From behind the styloid process to the os occipitis- we see first the condyloid processes, then the styloid processes surrounded by vaginal process, external to this the mastoid process foramina lacera basis cranii – condyloid and magnum are in this division of the skull – the posterior surface of the occiput has arches for the insertion of muscles – The os frontis- convex on the fore part – concave posteriorly, the external part is marked by two processes, when ossification has commenced – the superciliary ridges are divided by two processes, called the external cingular processes the lower & fore part of the bone has the nasal process on each side of which are the two internal cingular processes - in the front part of the bone are sinuses 112 communicating with the nose, & assists in forming it – are wanting in females – It is frequently the subject of fracture – the trephine may be applied on any parts except on the line of the suture, the danger of wounding the bone before the whole bone is penetrated is very great, when fractured over the sinuses it is needless - The Parietal Bone – forms the lateral part of the head – the most prominent surface is the point when ossification begins – It has four edges, bounded by the following angles– anterior superior & posterior inferior angle – this last contains the artery of the dura mater in the anterior inferior angle, the other two angles are the anterior inferior & posterior superior – in the posterior inferior is the lateral sinus of the dura mater, strongly marked by the anterior in the inside, there is a free communication from the scalp to the dura mater by vessels passing thro' the skull, & in this way the dura mater is often affected by wounds on the scalp- This bone is frequently broken - it would be bad practice to apply the trephine on the sagittal suture, the situation of the lateral sinus should be avoided, but if it should be necessary to operate on three parts, the bleeding might be stopped by plugs of lint - Lecture 21st A Cooper Os Occipitis – Concave externally convex internally – the lower part has two condyloid processes for the union with the allies – the holes are the foramen magnum – condyloidea post & anter. a semicircular ridge is marked on this bone for the attachment of muscles below which is a smaller one for the attachment of smaller ones, anterior to the condyloid process is the cuneiform 114 process upon which depends the strength of the skull – it joins anteriorly the sphenoid bone, & posteriorly forms the foramen magnum – it is divided into four cavities internally by a crucial ridge, above is situated the cerebrum, below the cerebellum joined by the lambdoidal suture to the parietal bones, to the temporal bone by the aditamentum suture lambdoidale This bones is liable to fracture – and if the operation should be performed in line with the sagittal suture, the brain is liable to be wounded – it should & may be performed with safety on either side - Os Temporis - Is divided into its squamous and petrous portion – the upper edge wraps over the parietal bone – anteriorly and inferiorly causes the zygomatic process, posterior to this is the mastoid process, at the root of this is the cavity for the condyle of the lower jaw and anterior to this is the meatus auditorius externus- internally is the petrous portion, entering the internal organs of hearing – The eustachian tube foramen innominatum, & the foramen auditirum are the holes to be ricked in the petrous portion of this – the styloid and vaginal processes are situated on this bone foramen caroticum and style mastoidium on the foramina of this bone- This bone is but rarely broken – when broken the temporal muscle must be divided in the direction of its fibres, & carried back, thus destroying its action, must not be divided across- Sphenoid Bone - Is divided into body and aloe – on the upper part of the body of this bone are the clynoid processes, between which is the cella turcica for the pituitary gland – viewed on the fore part is the processes azygos, on each side 116 the sphenoid sinuses – the alæ divided into two part forming the orbit, & part assisting in forming the temporal bone, near which are the pterygoid processes divided into two plates the foramina – are the foramina optica - lacera orbitalia superiora – rotunda – ovalia- spinosa- (pterygoidea which transmits the vidian nerve) The Ethmoid Bone So called from is similarity to a sieve at its upper portion- at the fore and upper part is the crista galls going up to the os frontis to form the foramen cacum- on each side is the cribriform plate transmitting the olfactory nerves, at the under part is the nasal plate proceeding from the crista galli on each side are the spongy or turbinated bones for the expansion of the olfactory nerves- this bone has the most complicated stricture of any bone in the body, & A Cooper shewed the ethmoid bone of an american which has two triangular plates of bone pointing towards & covering the sphenoid sinuses – its situation is between the two orbits Lecture 22d A Cooper The bones of the face – Six pair – and two single bones – 2 Ossa Nasi – 2 ossa Maxillae super 2 ossa malarum – 2 ossa palate 2 ossa spongios. 2 ossa unguis – 1 os vomer 1 maxill. infer – The os nasi hollow before transversely and behind assists in forming the bridge of the nose, united above to the os frontis, at the sides to the os mala & opposite os nasi – below tipped with cartilage when fractured – to the treated by introducing a pair of forceps into the nostril –The superior maxillary - This bones is the largest of the upper jaw, on the upper and fore part is the nasal plate, in which is the ductus ad nasum for the lachrymal duct, on the outside 118 of this is the orbitar foramen, for the passage of the nerve – affected by Tic Doleureux – below is the alveolar process, on the inner & lower part is the palatine portion of this bone in which is the foramen incisivum – above is the antrum maxillae – the 1st & sometimes the 2nd molar tooth communicate with this cavity with the intervention of membrane the only opening into it – in its covering substance is from the nose – the antrum is liable to inflamation from various causes & being lined with a membrane is affected by the suppurative inflamation, when the disease is ascertained it is achieved to chew the first or 2nd molar tooth, & to separate the membrane so as to allow the escape of the matter & then introduce a wooden plug to keep the orifice open till the discharge ceases – Os Mala of simple form body and five processes – 1st superior 2nd inferior - 3d- internal orbiters 4th zygomatic & 5 super maxillary - Os Palate – Situated behind the superior maxillary bone – divided into palatine portion – pterygoid – nasal - & the orbiter – form a part of a foramen, per the transmission of a nerve to the roof is the mouth – Os Spongios. Infer. – Situated within the nose – a small portion attaches it to the outside of the nose, upon which is expanded the pituitary membrane under this bone ends the lachrymal duct Os Unguis – Situated in the fore part of the orbit – is as thick as writing paper divided into two surfaces by a ridge before which is placed the lachrymal sac, & behind which it forms a part of the orbit, in gular internally when attached to the os ethmoides, and anteriorly attached to the nose – the duct is sometimes imperforate thro’ the os unguis 120 The Vomer Attached to the processes azygous & nasal plate of the ethmoid forming the upturn nasium, the inferior edge is joined to the palate bone – The bones of the orbit are seven - 3 to the head & 4 to the face – To the head os frontis- os ethmoid os sphenoid To the face – super maxilla – os mala- os unguis - & the os palate – the foramen lacera infr. orbitarius filled up by membrane within the orbit – The lower jaw – Is divided into symphysis – sides – angles and processes – In the infant this bone is in two portions – on the sides are seen the alveolar cavity for 16 teeth – above the angle are two processes – the posterior called condyloid the inferior coronoid, a foramen thro’ which passes a nave of some magnitude exactly in a line drawn from between the two bicuspides downwards from 1/2 to 1/4 of an inch below the alveolar process - When this bone is dislocated, the condyloid process is thrown under the zygomatic process the best mode of reduction is the following place the handle of two forks on the molares of each side, then place yourself behind the patient, & pull upwards at the and of the chin, the condyloid processes will then enter the cavities, & the forks may then be disengaged – Os Hyoides - Situated or the upper part of the pharinx under the tongue, on its sides are two cornea, at the joint connected with the body are two appendages the cornea are commonly short A curious specimen in which they were lengthened to about ten times there usual length, a portion of bone then proceeded from there lengthened cornea of at about an inch in length , which joined the processus styloideus and in all forming a curios and gnat length the of bone 122 Lecture 23d A Cooper -s On the muscles of the abdomen They consist of five pairs – the following lines are to be unmarked – 1st Linia Alba – extending from the uniforme cartilage to the pubis – semilunaries from the cartilage of the 7th rib to the spinous process of the os pubis- linea transversales – extending across from the semilunar to the white line - the lower part of the abdomen is covered by fasciæ – there are holes in the lines for the vessels, for vessels are sometimes the seat of herniæ – the tendon stretching from the spinous process of the ileum to the spine of the pubis, forms an arch over the femoral vessels called Pouparts ligament crural arch & fallopiuses ligament The abdominal ring is formed by two columns of this ligament attached to the os pubis, thro' which passes the spermatic chord in the male – and in the female the ligamentum rotundum – the umbilical chord passes thro’ this tendon – Obliques descendens externus Arises by eight heads from the 8 lower ribs, digitates with the senates major anticus, and intermixes with the pectoral muscle – is inserted into the spine of the ilium, cartilago ensiformis, linea alba, pubis on the same side. on which it arises & into the opposite os pubis, into the spinous process of the pubis & into the linea ilio pertinea by gimbernats ligament –Use bends the body on one side obliquely, both acting together depress the ribs, and expelling the contents of the abdomen, viz faces urine & fœtus- Obliqus ascendens internus – Arises from the outer half of pouparts ligament from the spine of the ilium from the sacrum & their 124 inferior lumbar vertebræ- inserted into the cartilage of the 7th rib & five false ribs into the cartilage ensiformis, & the pubes behind the abdominal ring the tendon of this muscle passes behind the abdominal ring & closes the opening- Use- to bend the body in the opposite direction to the external oblique the tendon divides into two portions one goes above the rectus the other below it – Transversalis Arises from the 7 inferior ribs – the 12th dorsal vertebra, and four of the lumbar vertebræ, os ilium, and outer half of pouparts ligament – Inserted into the cartilago ensformis, linea alba the pubes behind the abdominal ring and pouparts ligament – Use – to compress the abdominal viscera, and in expiration Rectus Arises from the ligament that joins the symphisis is pubis, going upwards to be inserted into the 5th 6th 7th ribs & the cartilage ensiformis - This muscle is divided into separate portions by the lineæ transversales, bounded externally by the linea semilunaris, & internally by the linea alba- Use to bend the body forwards behind this muscle lies the epigastric artery & veins passing obliquely upwards and inwards – Pyramidalis- Arises from the ligament of the pubis - Inserted into the linea alba usually half way between the pubis & umbilicus – Use to compress the bladder & to assist in the evacuation of the urine – Pouparts ligt at the groin splits into three portions two ascending and one descending, sends down the fascia lata of the thigh - sends up the fascia transversalis, & lines the inner side of that muscle, in this fascia is the opening thro’ which the spermatic chord in the male & round ligament in 126 the female passes – when this and the peritoneum is removed, we see the fascia iliaca covering the iliacus internus, exactly between the spinous process of the ilium and the linea alba, the spermatic chord enters the abdomen a little above the iliac artery The inguinal hernia passes anterior to the choid, & external to the epigastric artery inguinal canal extends from the internal opening formed by the fascia transversalis to the external forming in the tendon of the external oblique – The femoral vessels are inclosed in a sheath with a septum between the artery & vein formed on the fore part by the fascia transversalis, and on the back part by the fascia iliaca- the anterior crural never is not included in the sheath with the artery & vein but lays externally to the sheath – femoral hernia is first received into this sheath, & is situated [illegible] Lecture 24th & H Cline - The Muscles of the Head - Occipito Frontalis- Arises from the protuberant behind the occipital bone as far as the mastoid process becomes muscular on the fore head – Inserted into the skin of the forehead and a slip into the dorsum of the nose - Its use is various, if the whole of it contracts, the scalp is drawn backwards the eye brows and skin of the forehead upwards – This muscle is liable to a peculiar kind of inflammation and suppuration which is extremely tedious, scapes in to the tendinous 128 and cellular membrane underneath when matter is formed under fascia or tendinous expansion it must be let out early – Corrugator Supercilii Arises from the inner angular process of the frontal bone - Inserted into the middle of the eye brow – Use wrinkles the eye brow, when both act, the eye brows are drawn together and downwards – the hairs of the eye brows elevated by which the eyes are shaded from any sudden & strong light – Atottens Aurem Arises from the tendon of the occipito frontalis - Inserted into the upper part of the ear Use- Raises the Ear – Petrapentes Auris Arises from the root of the mastoid process Inserted into the back part of the concha of the ear – Use draws the ear backwards – Anterior Auris – Situated anteriorly when found- Arises from the posterior part of the zygoma Inserted into the back part of the helix anteriorly – Use to draw the ear forwards Compressor Auris – Arises from the alæ of the nose – Inserted into the extremity of the os nasi & cartilage joined to it Use to compress the extremities of the nostrils Orbicularis palpebrarum - Arises from the orbiter process of the superior maxillary bone continued under the skin of the under eye lid and temple, mixes with the corrugator supercilli & occipito frontalis & takes part of its origin from the process of the super maxilla – Inserted into the skin of the eye lids – Use moves the eyes lids and presses them together – Levator anguli Oris- Arises from the hollow of the superior maxillary bone, below the foramen infra orbitarium – Inserted into the angle of the mouth – Use To draw up the angle of the mouth as in the expulsion of joint- Zygomaticus Major Arises from the os mater mar its lineation with the temporal bone – Inserted 130 into the corner of the mouth – Use draws the corner of the mouth upwards and backwards as in laughing – Zygomaticus Minor frequently wanting - Arises from the upper and prominent part of the os mala – Inserted into the upper life near the corner of the mouth - Depressor anguli oris – Arises from the outer edge of the fore and lateral part of the lower jaw- Inserted into the angle of the mouth uniting with the zygomaticus major and Levator anguli oris – Use to pull down the corner of the mouth, as in expressing anger and crying – Levator Labii super alæque nase- Arises by two fleshy attachments one from the edge of the orbit, the other the other from the process of the superior maxillary bone- Inserted into the upper lip and alæ of the nose- Use to draw up the lip and alæ of the nose in dilating the nostril Depressor Labii Superiors alægue nase Arises from that part of the upper jaw which supports the incisors & two cuspidate teeth – Inserted into the upper lip and alæ of the nose – Use Depresses the upper lip after being raised by other muscles – Depressor Labii Inferioris Arises from the symphisis of the lower jaw runs obliquely upwards Inserted into the lower lip- use to assist in opening the mouth – Levator Labii Inferiors Auris from the lower jaw near the roots of the incisor and cuspidatus teeth – Inserted into the under lip & skin of the chin – Use to raise the parts when it is inserted – Buccinator Auris from the lower jaw basis of the coronoid process and molar tooth from the maxilla superior and last molar tooth & pterygoid process Inserted into the angle of the mouth – Use to assist in the mastication of the food - Orbicularis Oris vel sphincter labiorum This is a sphincter muscle which surrounds the 132 mouth, & forms a considerable part of the lips this muscle sums to the formed by the muscles already described- Use to drink water from the surface of water – Platysma Myoides Arises very thin from the dense cellular membrane below the clavicle runs over the neck & lower jaw – Inserted into the angle of the mouth & face – Use – assists in drawing down the lower jaw, skin of the face and angle of the mouth wrinkles the skin of the neck in shuddering – the Os Hyoides to which many muscles are attached, is situated a little above the thyroid cartilage – Digastricus Arises from the digastric fossa of the temporal bone become tendinous, attached by its tendon to the os hyoides & joint up to be inserted into the symphysis of the lower jaw Use draws the os hyoides backwards if that bone be still, draws the lower jaw downwards Stylo Hyoideus - Arises from the styloid process of the temporal bone- Inserted into the Os hyoides it is split by the tendon of the digastricus – Use draws the os hyoides up- wards & backwards – Sterno Hyoideus Arises from the upper bone of the sternum from the extremity of the clavicle & cartilage of the first ribs – Inserted into the Os hyoides Use draws the os hyoides downwards - Omo Hyoideus – Arises from the superior costa of the scapula, & semilunar notch Inserted into the os hyoides – Use draws that bone downwards & to one side – Mylo Hyoideus Arises from the chin inner side of the lower jaw – Inserted into the os hyoides use when the lower jaw is fixed it draws it upwards, but when the os hyoides is fixed it draws the jaw downwards – Genio Hyoideus Arises from a process behind the symphysis of the chin internally Inserted into the os hyoides – Use draws the os hyoides upwards when the jaw is fixed & when the os hyoides is fixed downwards 134 Lecture 25th H Cline on the muscles of mastication The aponeurosis of the temporal muscle is attached to the zygomatic arch, to the os frontis & to the parietal bone- a troublesome abscess is frequently formed under this fascia & the matter gravitates into the mouth – Temporalis – Arises from the external angular process of the frontalis, from the side of the parietal bone from the aponeurosis, from the squamous portion of the temporal bone continued under the zygomatic arch- Inserted into the coronoid process of the lower jaw, & continued down to the basis of that process – use elevates the lower jaw- Masseter Arises from the superior maxillary bone from the zygomatic each – Inserted into the angle of the lower jaw, continued upwards towards the coronoid process & symphysis use to elevate the lower jaw – Pterygoideus Internus Arises from the pterygoid process of the sphenoid & palatine bone –Inserted into the inner side of the angle of the lower jaw Pterygoideus Externus – Arises from the external plate of that process & from part of the tuberosity of the os maxilla, & from the root of the temporal process of the sphenoid bone- Inserted into the cervix of the lower jaw, and the ligament of the joint Use The lateral motions of the lower jaw are chiefly performed by these muscles & when both are acting being the jaw horizontally forwards – The Tongue Is divided into apex & basis, between which is the body, the red surface is named the dorsum – Genio Hyo- Glosses arises from the protuberance at the back of the lower jaw – Inserted into the os hyoides, the whole of the under side of the tongue – Use – cuts variously on the tongue – when the anterior fibres covered 136 the lip is drawn downwards – when the posterior fibres act, the base is drawn downwards & when the middle fibres cut the tongue is concave – Hyoglossers – Arises from the os hyoides from the bare to the cornea – Inserted into the whole of the sick of the tongue – Use draws the tongue downwards and backwards – Lingualis Arises from the root of the tongue laterally- Inserted into the tip of the tongue. Use shortens the tongue and brings it backwards – Stylo glossus Arises from the styloid process of the temporal bone- Inserted into the sick of the basis of the tongue & continued towards the lip Use draws the tongue upwards and backwards – Larynx composed of five cartilages which in advanced life become ossified below the larynx we have the air tube or trachea passing into the chest – cartilages thyroid – cricoid – arytenoid epiglottis – The sides of the thyroid cartilage called wings which are bounded by four projections projections called cornea –two super & two infer the two super forming the edge of the alæ & the two infer forming the lower edge of the aloe, a projection in front behind which is a large cavity or pouch called the pharynx terminated by the esophagus Stylo pharyngeus. Arises from the styloid process – Inserted into the side of the pharynx near the cornea – Use draws the pharynx upwards & backwards- Constrictor pharyngis infer Arises per the side of the thyroid cartilage – inserted into a white line at the back of the pharynx constrictor pharyngis medius. Arises from the ligament that connects the os hyoides to the cornea of the thyroid cartilage & part from the cornea of the os hyoides – Inserted into the cuneiform process of the os occipitis and into a white line at the middle of the posterior surface of the pharynx 138 Constrictor pharyngis super Arises from the cuneiform process of the os occipites from the pterygoid process of the sphenoid bone from the upper and under jaw & back part of the buccinator - Inserted into the white line at the back of the pharynx – The use of these constrictor muscles are to lesson the capacity of the pharynx, & thus assist in sending the food into the stomach & when vomited to throw it into the mouth – Circumflexus seu tensor palate - Arises from the spinous process of the sphenoid bone from a portion of the eustachian tube – Inserted into the velum pendulum palate & semilunar edge of the os palate – Use to stretch the velum – Levator Palati Mollis Arises from the petrous portion of the temporal bone, & part of the eustachian tube- Inserted into the soft palate Use draws up the soft palate & shuts up the passage to the nose – Constrictor 140 Isthmi faucium – Arises from the side of the basis of the tongue – Inserted into the arch of the fauces – Use to contract the isthmus of the fauces – Palato pharyngeus Arises from the root of the uvula, from the tendinous expansion of the circumflexes palate – Inserted into the thyroid cartilage & pharynx Azygos Uvulæ – Arises from the back part of the os palate – Inserted into the tip of the uvula – sterno cleido mastoideus Arises by two heads one from the clavicle- the other from the superior bone of the sternum – Inserted into the mastoid process of the temporal bone & the transverse ridge behind that process – When one muscle acts, the head is bent much to one side, when both act, the head is bent forwards - Lecture 26th H Cline Structure of the Larynx – 1st Thyroid cartilage 2d the crycoid cartilage next in size - The two arytenoid and 5th The epiglottis – The thyroid is the largest forms the upper and fore part It is formed of two lateral portions, or alæ, united in front, when they form a projection in the male, called pomum Adami – From the upper and posterior angle of each alæ, a process extends upwards, called the superior corner- From the lower and posterior angle, a similar but shorter process reaches downwards, named the inferior cornu – Cricoid or annular cartilage Is placed below the thyroid – It forms the under and back part of the larynx – It is narrow in front, but increases in breadth at the sides and back part – The two arytenoid are of small size, and of a pyramidal shape they are situated at the upper and back of the crycoid cartilage – The epiglottis shaped Like a leaf is placed just below the root of the tongue, & covers the upper opening into the larynx – The larynx is lined by a very vascular membrane and supplied with nerves – the sacculi pharingis are found between the ligaments and the thyroid cartilage - the opening to the trachea like a chink or cleft is called rima glottides - The larynx is essentially necessary to our voice which is very much assisted by the ligaments & muscles, attached to the different parts of the os hyoides and thyroid cartilage Venereal ulcers on the ligaments of the larynx are frequently mistaken for phthisis pulmonalis – Muscles situated about the larynx – Sterno Thyroideus Arises from the superior bone of the sternum – Inserted into the thyroid cartilage – Use draws this cartilage downwards 142 Crico Thyroideus – Arises from the anterior and lateral parts of the crycoid cartilage – Inserted into the inferior cornum of the thyroid cartilage – Use to pull forwards & depress the thyroid, or to elevate & draw backwards the cricoid cartilage Crico arytenoideus posticus – Arises from the back of the cricoid cartilage – Inserted into the basis of the arytenoid cartilage – Use stretches the ligaments & opens the rima glottides Crico Arytenoideus lateralis – Arises from the side of the cricoid cartilage –Inserted into the outer side of the arytenoid cartilage Use to open the rima glottides by pulling ligaments from each other – Thyreo Arytenoideus Arises from the inside of the alæ of the thyroid cartilage – Inserted into the anterior part of the arytenoid cartilage Use to pull the arytenoid cartilage forwards- Arytenoideus Obliquus- Arises from the basis of one arytenoid cartilage – Inserted into the tip of the other arytenoid cartilage Use when both act they pull both arytenoid cartilage towards each other Arytenoideus Iranversus Arises from the whole length of one & passes across to be inserted into the whole length of the other arytenoid cartilage – Use There two last draw the two arytenoid cartilages together & close the rima – Aryteno Epiglottideus Sometimes found although but very rarely – Thyrco Epiglottdeus – Is also only found occasionally The use of both are to close the epiglottis - Pectoralis Mayor – Arises from the 5th & 6th ribs from the whole length of the sternum & the sternal extremity of the clavicle – Inserted into the os humori by two heads without the groove for the long head of the biceps – Pectoralis Minor Arises from the 3rd 4th and 5th ribs – Inserted into the coronoid process of the scapula – Use Draws the shoulder downwards and forwards - 144 Subclavius – A rises from the cartilage of the first ribs Inserted into the clavicle, & continued at fore at the ligament connected with the corocoid process of the scapula. These muscles draw the arsm forwards & over the breast – Senatus Magnus Arises from the 9 superior ribs a little back from their anterior extremities, digitating with the external oblique – Inserted into the whole of the basis of the scapula – Use draws the basis of the scapula downwards & forwards & when the scapula is fixed assists in respiration - Trapezius – sur cucullaris- Arises from the ridge at the back of the os occipitis, adheres to its fellow on the opposite side from the spinous process of the 6th & 7th cervical vertebra & from the whole of the dorsal vertebra - Inserted into half of the clavicle, acromion process of the scapula & spine of that bone – use when the whole of the muscle acts the scapula & shoulder an drawn backwards when the superior fibres acts the scapula is drawn [cross out] backwards – when the transvers fibres act - drawn backwards when the inferior fibres act - drawn downwards – Latissimus Dorsi - Arises from the posterior part of the crista of the ilium from the sacrum from the spinous processes of the lumbar vertebra & 7 inferiors of the dorsal & from the four inferior ribs – Inserted into the inner edge of the groove of the os humori for the bicess Use To pull the arm backwards and downwards and to roll the os humori phomboideus Major Arises from the spinous processes of the four superior dorsal vertebra – Inserted into the back part of the basis of the scapula, below the spine at far as its inferior angle - Phomboideus Minor – Arises from the spinous process of the three inferior vertebra of the neck, & from the ligamentum nuchæ Inserted into the base of the scapula – Use These muscles draw the scapula backwards 146 and obliquely upwards – Levator Scapulæ Arises from the transverse processes of the five superior crucial vertebra – Inserted into the upper angle of the scapula continued downwards towards the spine – Use Draws the superior angle of the scapula upwards Serratus Supra. Posticus- Arises from the spinous processus of the thru inferior vertebra of the neck & two dorsal vertebra – Inserted into the 2. 3. 4 & 5th ribs at their angles – Serratus Infer Posticus – Arises from the spinous processes of the 2 infer. dorsal & three superior of the lumbar vertebra Inserted into the four last ribs – Use Draws down the ribs - Lecture 27 th (Green) Muscles in the regions of the vertebral column – Cervical & occipital region- Splenius Arises from the ligamentum nucha from the spinous processus of the five inferior cervical & 4 super dorsal Inserted into the transverse processes of the five inferior cervical & of the four superior dorsal vertebra, & adheres to the ligamentum nucha at the third vertebra of the such the splenii recede from each other so that part of the complexus muscle is seen – Complexus Arises from the transverse processes of the five superior cervical and 7 superior dorsal vertebra, running an additional fleshy slit from the spinous process of the first vertebra of the back – Inserted into the protuberance and part of the arched ridge of the os occipitis Irachela Mastoideus – Arises from the transverse processes of the five infer vertebra of the neck, & transverse processes of the three superior dorsal passes under the splenius inserted into the root & back part of the mastoid process – Transversalis Colli Arises from the transverse process of the five Superior dorsal vertebra- Inserted into the 148 transverse processes of the whole of the cervical vertebra except the first & the last- The muscles of the deep cervical occipto region – Pertub capitis Porticus Major – Arises from the spinous processes of the two cervical vertebra passes obliquely upwards & outwards growing broader in its ascent – Inserted into the os occipitis below the arched edge. Rectus capitis Posticus Minor Arises from the back part of the atlas – Inserted under the former into the os occipitis near the foramen magnum Obliquus Capitis Super Arises from the transverse process of the atlas – Inserted into the os occipitis- Muscles of the vertebral region – Sacro Lumbalis Arises from the side & spinous process of the sacrum from the transverse processes of the lumbar vertebra from the posterier part of the spine of the ilium & from all the spinous processes of the lumbar vertebra – Inserted into the angle of each of the ribs by a long & their tender Longissimus Dorsi – Arises in common with the last muscle – Inserted into all the ribs except the two last and into the transverse processes of all the dorsal vertebra from the upper part of this muscle a round fleshy slip ascends & joins with the cervicalis descendens - Spinalis Dorsi – Arises from the three infr dorsal and two super lumbar vertebra - Inserted into the 9 superior dorsal vertebra – Semi spinalis colli – Arises from the transverse processes of the 6 super. dorsal vertebra Inserted into the spinous processes of all the cervical vertebra – Semi-spinalis Dorsi – Arises from the transverse processes of the 8 9 & 10th dorsal vertebra – Inserted into the spinous processes of the four superior dorsal & 2 inferior cervical verte Multifidus Spinæ – Arises from the spinous processes & back part of the sacrum & from the 150 adjoining part of the os ilium, from the oblique and transverse processes of all the lumbar vertebra from the transverse processes of all the dorsal & those of the cervical except the three first - Inserted into the spinous processes of all the vertebra of the loins & back, & six inferior of the neck – Interspinales - Are small bundles of fibres, which are situated between & attached to the spinous processes of the contiguous vertebra they are only distinctly fleshy in the cervical vertebra & are five in number Each arises double from the spinous processes of the lower vertebra and is inserted into the spinous process of the vertebra above – Intertrans versales – Arises from between the transverse processes filling up these spaces – in the neck are bifurcated & double in the back small and and sturdier – in the loins strong & fleshy – Muscles on the fore part of the neck – Anterior deep region of the neck Longus Colli – Arises from the bodies of The three superior dorsal, & transverse processes of the 3.4.5 & 6th cervical vertebra – Inserted into the bodies of all the cervical vertebra on the fore part – Rectus capitis internus Major Arises from the transverse processes of the inserted into os 3.4.5 & 6th cervical vertebra occiputis little before the condyloid process Rectus capitis internus minor – Arises from The fore part & side of the first cervical vertebra Inserted into the roots of the condyloid process of the os occipitis – Rectus Capitis Lateralis Arises from the front of the transverse process of the atlas – Inserted into the os occipitis Lateral cervical region - Scalenus Anticus - Arises from the transverse processes of the 4. 5 & 6th cervical vertebra – Inserted into the upper part of the first rib near to its cartilage. Scalenus Medius – Arises from the transverse processes of all the cervical vertebra Inserted - Inserted into the back of the first rib having a passage for the sub clavian artery 152 between it & the anticus – Scalenus Posticus Arises from the transverse process of the 5th & 6th cervical vertebra – Inserted into the second rib - The Diaphragm forms a septum between the thorax and abdomen - Lecture 28th (Green) - Triangularis Sterni - Arises from the edge of the cartilage insiformis, & half of the middle portion of the sternum- Inserted into the cartilages of the 3.4.5 & 6th ribs –Intercostales Externi - Arises from the lower edge of each rib as far as the cartilage – Inserted into the upper edge of each rib – Intercostales Interni – The fibres of which run downwards and backwards & decussate with those of the externi continued no further back than the angles – Levatores Costarum - Are portions of the intercostales externi, which arise from the transverse processes of the vertebra - & terminate in the ribs immediately below- Depressores Costarum – Are portions of the intercostales internii which at the lower part of the cheek pass own one rib, an inserted into the next below it - Quadrates Lumborum - Arises from the crista of the ilium attached to the transverse processes of the lumbar vertebra Inserted into the last side – Psoas Parvus Arises from the two superior lumbar and last dorsal vertebra – Inserted into the brim of the pelvis – Psoas Magnus – Arises from the bodies and transverse processes of the last dorsal and all the lumbar vertebra Inserted with the iliacus – Iliacus Arises from the transverse process of the last lumbar vertebra from inner labium of the ilium & from the venter of that bone Inserted into the trochanter minor - Obturator Internus - Arises from the os pubis and os ischium or half of the circumference of the obturator foramen & part of the membrane – Inserted into the cavities below the 154 trochanter major- Coccygeus Arises from the spinous process of the ischium – Inserted into the extremity of the sacrum & side of the os coccygis Gluteus maximums Arises from the posterior part of the labium of the ilium from the side of the sacrum & coccyx & from the inferior sacro sciatic ligament – Inserted into the trochanter major Gluteus Medius Arises from the outer part of the labium of the ilium & from the dorsum of the ilium – Inserted into the outer & back part of the trochanter major – Gluteus Minimus Arises from the dorsum of the ilium from the anterior superior spinous process of the ilium & continued as far as the notch Inserted into the upper and fore part of the trochanter major. Pyriformis Arises within the pelvis from the 2. 3. & 4th pieces of the sacrum Inserted into the cavity at the root of the trochanter major – Gemini - Divided into two – the first cerise from the spinous process of the ischium the inferior from the tuberosity of the ischium and the sacro sciatic ligament – Quadratus Femoris Arises from the tuberosity of the ischium Inserted into the ridge between the two trochanters Fascia lata of the thigh – Extends from the outer labium of the ilium, from pouparts ligament from the capsular ligament & from the gluteus maximus – Outer crural region Tensor vaginæ Femoris- Arises from the anterior superior spinous process of the ilium Inserted into the fascia lata of the thigh a little below the trochanter major Sartorius Arises from the anterior superior spinous process of the ilium, continued down over the fore parts of the thigh & going to the inner part is inserted into the upper part of the tibia just below the tubercle - Lecture 29th (Green) Muscles on the anterior region of the thigh Rectus Femoris – Arises by two tendons 156 from the anterior & inferior spinous processes of the ilium & from the dorsum – Inserted into the patella – Vastus externus – from the root of the trochanter major & outer side of the linea aspera- Inserted into the upper part and side of the patella - Vastus Internus Arises from the fore part of the thigh above & trochanter miner & from the inside of the linea aspera Inserted into the upper part & side of the patella Cruralis vel Cruræus – Arises from the fore part of the femur & outside of the bone - Inserted into the base of the patella – Inner Crural region – gracilis Arises from the os pubis nr the symphysis – Inserted into the inner & upper part of the tibia – Pectineus Arises from the upper & fore part of the os pubis Inserted into the upper part of the linea aspera – Triceps adductor femoris Divided into three – Adductor Longus Arises from the os pubis near the symphysis & ligament of the symphysis – Inserted into the middle of the linea aspera – adductor Brevis Arises from the upper & fore part of the os pubis below the former muscle – Inserted into the upper part of the linea aspera – Adductor Magnus – Arises from the ramus of the pubis - os ischii & tuber ischii Inserted into the whole length the linea aspera, and internal condyle the artery passes towards the ham thro this muscle – Obturator Ext. Arises from the os pubis & ischium forming the obturator foramen, & from the ligament filling it up – Inserted into the cavity below the trochanter major – Posterior crural region Semitendinosus – Arises from the upper and back of the tuber ischii with the long head of the biceps Inserted into the upper and back part of the tibia – Semimembranosus Arises from the upper & back part of the tuber ischii – Inserted into the upper 158 and back part of the head of the tibia - Biceps Flexor Cruris - Arises by two heads one from the upper and back part of the tuber ischii the short head from the upper part of the linea aspera, join & are inserted into the upper & outer part of the head of the fibula – The tendon of this muscle forms the outer hamstring whilst the tendons of the semitendinous & membranous forms the inner string – Popliteus – Arises from the external condyle of the femur – Inserted into the inner & upper part of the tibia- gastrocnemius Externus – Arises by two heads from each of the condyles of the femur, descend & unite & are attached to the tendon of the internus forming the tendo achillis – Gastrocnemius Internus Arises from back part of the head of the fibular, back part of the tibia uniting with the tendon of the externus Is inserted into the os calcis – Plantaris – Arises from the upper and back part of the external condyle of the Inserted into the upper & back part of the os calcis – In treating either complete or partial rupture of the Tendo Achillis - Rest will be necessary a relaxed state of the extensors of the leg and thigh evaporating lotions & much also be employed, when completely ruptured or divided a roller should be applied over the muscles of the leg, but not over the ruptured tendon Tibialis Anticus – Arises from the under part of the head of the tibia from the outer surface of the bone & aponeurosis of the leg and interosseous ligament – Inserted into the os cuneiforms & base of the metatarsal bone of the great toe. Extensor communis Digitorum Pedis - Arises from the heads of the tibia and fibula and interosseous ligamt Inserted by four tendons into the four lesser toes expanded to the phalanges of each joint a tendon passes from this muscle to the base of the little toe & called by some Peroneus 160 Tertius- Extensor Proprius Pollicis - Arises from the fore part of the fibula Inserted into both bones of the great toe - Aponeurosis Plantaris - Attached posteriorly to the tuberosity of the os calcis & continued forwards to the bases of the great toe - Lecture 30th (Green) - Tibialis Posticus- Arises from the posterior parts of the heads of the tibia & fibula from the whole of the interosseous ligament Inserted into the upper and inner part of the os navicular- cuneiform internum and medium – Flexor Longus Digitorum Pedis Profundus Perforans – Arises from the back part of the tibia, a little below its head- Inserted by four tendons into the extremity of the last joint of the four lesser toes Flexor Longus Pollicis Pedis- Arises from the posterior part of the fibula –Inserted into the last joint of the great toe - Peroneus Longus – Arises from the anterior angle of the fibula, Inserted into the outside of the root of the metatarsal bone of the great toe and os cuneiform- Peroneus Brevis Arises from the external angle of the fibula Inserted into the root, and external part of the metatarsal bone of the little toe – Extensor Brevis Digit Pedis Arises from the fore & upper part of the os calcis – Inserted by four tendons into the first phalanx of the four greater toes- Flexor Brevis Digitorum Pedis Perforatus Arises from the os calcis, & from the fascia plantaris – Inserted by four tendons into the 2d phalanx of the four lesser toes. Flexor Digitorum Accessories Arises from the os calcis Inserted into the outside of the tendon of the Flexor Digitorum longus – Lumbricales Pedis - Arises by four beginings from the tendons of the 162 Flexor Long. Digit. Inserted by four slender tendons into the inside of the four lesser toes Abductor Tollicis – Arises from the os calcis, from a ligament – which extends from the os calcis to the os naviculare, from the insists of the os navicular, & cuneiforme internum and from the fascia Plantaris – Inserted into the internal sesamoid bone, & base of the first phalanx of the great toe - Flexor Brevis Pollicis Arises from the os calcis & cuneiforme extunum -Inserted by two tendons into the external & internal sesamoid bones, & first phalanx of the great toe – Adductor Pollicis Pedis Arises from a ligament extending between the os calcis & cuboides & from the root of the 2-3-& 4th metatarsal bones- Inserted into the external sesamoid bone, & root of the metatarsal bone of the great toe - Abductor Minimi Digiti - Arises from the os calcis & fascia Plantaris - Inserted into the base of the metatarsal bone of the little toe and outside of the first phalanx Flexor Brevis Minimi Digiti – Arises from the os cuboides, & root of the metatarsal bone of the little toe – Inserted into the base of the first phalanx of the little toe – Transversalis Pedis Arises from the anterior extremity of the metatarsal bone of the little toe - Inserted into the metatarsal bone of the great toe- Interossii Interni – Prior Medii Digiti Pedis Arises tendinous and fleshy from the inside of the root of the metatarsal bone of the middle toe- Inserted into the inside of the root of the first bone of the middle toe – Prior Tertii Digiti Pedis Arises from the inside & infirm part of the root of the metatarsal bone of the third toe- Inserted into the inside of the root of the first bone of the third toe – Prior Minimi Digiti Pedis Arises from the inside of the root of the metatarsal 164 bone of the little toe- Inserted into the inside of the root of the first bone of the little toe – Interossei Pedis Externi Bicipites – Prior Indicis Pedis Arises by two origins from the roots of the metatarsal bones of the four and [cross out] great toes – Inserted into the inside of the roof of the first bone of the fore toe – Posterior Indicis Pedis – Arises from the roots of the metatarsal bones of the fore and middle toes – Inserted into the outside of the root of the first bone of the fore toe – Posterior Medii Digiti Pedis Arises from the roots of the metatarsal bones of the middle and third toes – Inserted into the outside of the root of the first bone of the middle toe - Posterior Tertii Digiti Pedis – Arises from the Roots of the metatarsal bones of the third and of the little toe Inserted into the outside of the root of the first joint of the third toe- Deltoides Arises from the posterior third of the clavicle from the acromion & shine of the scapula – Inserted into the middle of the os humori - Supra Spinatus- Arises from the superior fossa & from the superior costa and spine Inserted into the great tuberosity of the os humori - Infra Spinatus – Arises from the inferior fossa from the base to the angles, from the inferior costa- Inserted into the great tuberosity of the os humori – Teres Minor – Arises from the inferior costa of the scapula – Inserted into the great tuberosity of the os humori – Teres Major – Arises from the inferior angle of the scapula- Inserted into the inner side of the groove for the long head of the biceps - Subscapularis- Arises from all the internal base and surface of the scapula – Inserted by a strong tendon into the lesser tuberosity of the os humor- Coraco Brachialis Arises from the coracoid process of the scapula, & Inserted into the os humori – Biceps Flexor Cubiti Arises by two heads, the long one from the upper edge of the glenoid cavity 166 the short one from the coracoid process of the scapula unite, and are inserted into the tuberosity of the Radius – Brachialis Internus Arises from the middle of the os humori – Inserted into the coronoid process of the ulna – Triceps Extensor Cubiti - Arises by three heads, first a long one from the inferior costa of the scapula 2d a short one from the os humori below the great tuberosity 3d head called Brachialis Externus from the middle of the os humori, & from a ridge extending to the inner condyle, unite and inserted into the olecranon – Anconeus - Arises from the external condyle of the os humori – Inserted into the outside of the olecranon, & posterior edge of the ulna- Palmaris Longus – Arises from the internal condyle of the os humori – Inserted mar the root of the thumb & aponeurosis pulmonis Palmaris Brevis – Arises from the annular ligament – Inserted into the skin of the hand Lecture 31st (Green) Superficial anterior region continued Flexor Carpi Radialis – Arises from the internal condyle and upper part of the ulna, passes behind the ligamentum carpi annulare & thro’ the fossa of the os trapezium – Inserted into the fore and upper part of the metacarpal bone which sustains the four finger – Pronator Teres Arises from the internal condyle & coronoid process of the ulna – Inserted into the outer and back part of the middle of the Radius – Flexor Carpi Ulnaris - Arises from the internal condyle & from the side of the olecranon & ulna – Inserted into the os pisiforme – Flexor Sublimis Pert Arises from the coronoid process of the ulna & from the inner condyle of the os humori, & fore part of the Radius – Inserted by four tendons into the 2d phalanges of the four fingers - Deep Anterior Region—Flexor Profundus Perforans- Arises from the fore and upper 168 part of the ulna and interosseous ligament - Inserted into the bones of the third phalanx of the four fingers by four tendons perforating the tendons of the sublimis perforatus – Flexor Pollicis Longus Arises from the anterior surface of the radius and from the interosseous ligament It has generally another origin by a separate slip from the inner condyle of the os humori or from the coronoid process of the ulna it sends out a strong tendon, which passes with the tendons of the former muscles into the hands & runs between the heads of the flexor brevis Inserted into the 2d bone of the thumb Its tendon is inclosed by a peculiar synovial bursa – Pronator Quadratus – Arises from the inner & four part of the lower portion of the ulna it fibres pass transversly Inserted into the fore and outer part of the opposite portion of the Radices – Posterior superficial region - Extensor communis digitorum - Arises from the external condyle of the humorus and aponeurosis covering it - Inserted by four tendons into the whole phalanges of the fingers – Extensor Carpi Ulnaris Arises from the external condyle of the humorus and from the ulna- Inserted by a long tendon into the upper and back part of the metacarpal bone which supports the little finger- Posterior Deep Region – Extensor ossis metacarpi pollicis – Arises from the back part of the ulna from the interosseous ligament & from the radius Inserted into the os trapezium & base of the metacarpal bone of the thumb – Extensor primi internodii Pollicis – Arises from the middle part of the ulna and interosseous ligament - Inserted into the first bone of the thumb Extensor secundi internodii Pollicis Arises from the middle & back part of the alna Inserted into the second bone of the thumb Indicator – Arises from the back part of the ulna - Inserted into the back part of the fore finger – Laternal or radial region 170 Supinator Radii Longus – Arises from the ridge extending above the outer condyle, Inserted into the outer side of the base of the Radius - Extens. Carp. Rad. Long. Arises from the ridge extending above the outer condyle – Inserted into the back part of the base of the metacarpal bone of the fore finger – Ext. Carp. Rad. Brev. Arises from the outer condyle & from a ligament extending from it to the radius – Inserted into the base of the metacarpal bone of the middle finger Supinator Radii brevis - Arises from the outer condyle, ulna, & ligament of the joint – Inserted into the head neck & tubercle of the radius – Middle Palmar Region Lumbricales Arise from the tendons of the flexor profundus – Inserted into the first joints of the fingers – outer Palmar Region Abductor Pollicis – Arises from the os trapezium & ligamentum carpi annular – Inserted Into the outer side of the root of the first bone of the thumb – Flexor Brevis Pollicis - Arises from the os trapezoides, os magnum, and os cuneiforme of the carpus – Inserted into the os sessamoidea & first bone of the thumb - Flex. Ossis Metac Pol. Arises from the os trapesium & ligamentum carpi annulare – Inserted into the fore and outer part of the metacarpal bone of the thumb – Adductor Rollicis - Arises from the metacarpal bone of the middle finger – Inserted in to the root of the first bone of the thumb – Abductor Indicis Arises from the os trapezium & from the inner side of the base of the metacarpal bone of the thumb – Inserted into the outer & back part of the root of the first bone of the finger Abductor Minimi Digiti – Arises from the os pisiforme and ligamentum carpi annulare Inserted into the inner side of the root of the first bone of the little finger – Flexor Profnius Minimi Digiti – Arises from 172 the hook like process of the os unciforme & the adjacent ligamentum annulare - Inserted into the root of the first bone of their finger – Adductor Minimi Digiti - Arises from the edge of the hook like process of the os unciforme & from that part of the annular ligament near to it – Inserted into the inner & anterior part of the metacarpal bone which supports this finger – The interossei muscles occupy the spaces between the metacarpal bones – They arise from the sides of the metacarpal bones and an inserted tendinous, partly into the first joints of the fingers and partly intermixed with the tendinous expansions of the extensor digitorum communis, they are divided into the internal & external The interossei interni 3 in number, arise with single heads and are seen in the palm of the hand – the interossei externi 4 in number, have double heads, & are seen both in the palm & back of the hand - Lecture 32d (M. Cooper) The ligaments – The intervertebral substance composed of ligaments of ligament cartilaginoues substance – A substance approaching to mucous is found on the internal part of this substance – The mucous forms a pivot for the motion of the spine, besides this intervertebral substance three are other ligaments, the anterior common spinal ligament covering the whole of the front of the spine – the common posterior ligament, found within the vertebral canal, & send out lateral portions to cover the intervertebral substance The crucial ligaments on the sides of the vertebra extending from one vertebra to the other in an oblique direction, between the transverse processes are ligaments called intertransverse ligaments & between the spinous processes there are interspinal ligams A C. related a case of fractured atlas – A girl 174 who was obliged to support her head, whenever she wished to move it in any direction – Another when the spinous processes of the three last lumbar vertebræ were broken and laid flat down without the action of the spinal marrow being interfered with- AC never saw dislocation of the ribs- but saw in a lady when there was an unnatural motion between three of the ribs & the sternum – occasioned by a violent fit of coughing at which time she heard something crack- when the capsular or connecting ligament was ruptured, It was treated by bandage & as if a fractured rib - The subclavian ligament situated between the spinous processes – the capsular ligament surrounding the articular processes of the ribs The perpendicular ligament, passing from the foramen magnum to the dentiforme process of the 2d vertebra. The lateral ligament passing from the dentiform process, to the 1st vertra & os occipitis The only dislocations of the vertebra that can possibly happen is that of the first and second vertebra when either of these take place the spinal marrow is compressed, the extremities are rendered paralytic the faces pass off involuntarily – the bladder has not the power of discharging the mine – the intestines are moved by the peristaltic power which is involuntary- The bladder has naturally a voluntary power until such a degree of debility comes on, that the patient very shortly after the loss of the fraction of this organ sinks – If the injury be in the loins the patient will live for many weeks – in general death ensues in about six weeks. If in the dorsal vertebra, seldom live longer than a fortnight or three weeks in general accompanied with great inflammation of the intestines and flatus – If in the cervical vertebra the upper & lower extremities are paralyzed scarcely lives a week generally about the 4 or 5th day dies 176 If between the 2 and 3 vertebra – respiration is quite stopped consequently life also, because the phrenic nerve comes from that part- Fractures of the spine occur without displacement of the vertebra – The circulation in paralyzed limbs goes on as well as in others not paralyzed, and blisters will act as well in the one & as the other The ligaments of the Ribs – capsules of the tubercles consist of synovial membrane which connect the circulating surfaces of the tubercles with those of the transverse processes of the vertebra external transverse ligaments, arise from the extremity of each transverse process, pass transversely outer ends, and are attached to each tubercle - Internal ligaments of the neck of the ribs, Arise from the lower part of each transverse process, and descending obliquely become fixed to the neck of each rib below that with which the process is connected – External ligaments of the neck of the the ribs – Arise from the transverse processes externally, descend obliquely in an opposite direction, & are attached to the upper and outer part of the necks of the ribs - The sternum has two ligaments, anterior and posterior serving to connect the ensiforme cartilage & the ribs to the sternum – The clavicle the interclavicular ligament stretching from the ends of the clavicle above & behind the sternum connecting the two bones together - The capsular connecting the clavicle to the upper part of the sternum with a middle cartilage between it & the sternum – The Rhomboid ligament – Passing from the clavicle to the first rib. The scapular end has three ligaments – The capsular uniting the clavicle to the acromion – The trapezoid passing from the under part of the clavicle to the coracoid process The conoid passing in the same direction as the last in the specimen shewn as the ligament was converted into bone – Clavicle 178 liable to dislocation at both extremities, sometimes projecting over the surface of the sternum drawing the shoulders backwards – A thick cushion to be put in the axilla on both sides – a roller 8 yards long applied round the shoulders in the form of a figure of 8 and a compress on the dislocated extremity – Sometimes dislocation backwards that is behind the sternum in this case the asophagus is pressed upon, a little deformity will remain of which the patient should be apprized – Mr Davy of Benugary had a case of this kind in which he cut down upon it and sawed off about an inch of the sternal extremity was a case of deformity of the spine The scapular and is also sometimes dislocated over the point of the scapula, ascertained by passing the finger over the spine of the scapula & thus meet with the projecting point of the clavicle The treatment the same as the dislocation at the other extremity, a slight projection will remain, & the motion of the limb will be a little lessened AC never saw the clavicle dislocated under the sternum from accident - Lecture 33d (Mr Cooper) Ligaments of the Scapula & dislocations of the shoulder joint- Anterior or triangular ligament- Is broad flattened and of a triangular figure Its broad extremity is attached to the convexity of the coracoid process, it becomes gradually [illegible] & is fixed to the posterior edge of the acromion, from its edge a layer of dense cellular membrane extends under the deltoid muscle, & projects over the shoulder joint - It thus assist in presenting a displacement of the os humori upwards- Posterior Lig - Is stretched across the semilunar notch, from the superior costa, to the root of the coracoid process of the scapula, & forms that depression into a passage for the super dorsal vessels & never of the scapula – Besides these there is 180 a band from the root of the acromion to the edge of the glenoid cavity, and another, which extends from the root of the coracoid process, & is also fixed to the lip of bone which bounds that cavity- The capsular ligament is in the form of a loose bag, which is attached above to the circumference of the glenoid cavity and below to the neck of the os humori, inclosing the head of that bone – It is strongest above and thinnest on the inner side – At the under and fore part, at its edge, is a small aperture for the passage of the tendon of the long head of the biceps, & the capsular ligament sends off a process to inclose the tendon in its descent – A C never saw this tendon broken in dislocation of the shoulder joint- The os humori is most frequently dislocated of any joint in the body, it may be dislocated in three directions First forwards and downwards and called laxation in the axilla – the deltoid muscle loses its rotundity a hollow between the process acromion may be fell, when you attempt to bring the elbow to the side, the patient can’t bear the pain that is occasion because the arm is lengthened, ask the patient if he can raise his hand to his head which very rarely can be done excess in old females and relaxed persons, the head of the bone is in the axilla & may be felt by raising the upper arm in an horizontal direction, It is placed on the inner side of the inferior costa of the scapula a little below the glenoid cavity The tendon of the subscapularis is always torn as well as the capsular ligament – The first object is to fix the scapula, by passing a towel or strong bandage under the axilla, or which is better a girth with a hole in it for the arm to pass thro’ by which mean the body of the patient & scapula are held steady - 182 and then apply a wetted roller round the arm fastened with a tape, when the pulley or force is applied it must be in an oblique direction, and whilst the extension is making, the surgeon is to apply his knee into the axilla, and at times rotate the arm – In private practice I should direct the patient to lay in an horizontal direction & then take hold of the wrist & put my heel into the axilla thus making a lever of my heel & left the head of the bone into its cavity – In women it is better to let them sit in a chair or form, applying your knee and thigh to the axilla, & by pressing upon and extending the elbow you may easily reduce the luxation – The principal muscles resisting you in the attempt to reduce it, when in the axilla are the supra spinatus and the deltoid as proved by a dissection of the shoulder joint that never had been reduced the head could not be put into the glenoid cavity until these muscles were cut though- therefore the extension should be made in the horizontal or rather above that direction, not rather below as formerly advised – In the dislocation below the clavicles, the extension should be made rather below the horizontal line, the chief muscle assisting in the reduction is the pectoral- Lecture 34th (M Cooper) Dislocations of the shoulder joint contin - The 2d species of dislocation is forwards under the pectoral muscle – Deltoid muscle is depressed the acromion projects & the elbow cannot be brought to the side; Under the middle of the clavicle & on the inner side of the coracoid process the head of the humorous may be felt - roll the humorous & you feel the motion under the clavicle – The force required in reducing this dislocation, being greater than when in the axilla, the pulley is therefore the best 184 thing to be used, the surgeons heel is of no use in this case – The extension is to be made in the same direction as that in the axilla If any length of time has elapsed after the dislocation forwards it is better not to attempt the reduction, as there would be great violence and tearing of muscle as well as the axillary plexus occasioned – At the utmost don’t attempt it after a month or six weeks has elapsed The 3rd species is backwards – Head lodged upon the inferior costa of the scapula & under the spine, stretching the humorous, [cross out] [cross out] you find at once the nature of the accident – three only have occurred to A C knowledge – The reduction of this dislocation is easy, the arm is shortened - Dislocations are liable to be confounded with fractures of the acromion, in which the deltoid sinks as in dislocation, to ascertain this fracture, lay your hand upon the acromion roll the humorous & you feel the crepitus another way of ascertaining it, is to lift the elbow upwards which seeming to be a dislocation is reduced, but let the elbow drop & the appearance of dislocation is removed this unites by ligament generally and not by bone – Dislocation may be confounded with a fracture of the neck of the scapula – the head of the bone sinks into the axilla carrying with it the glenoid cavity – To ascertain – Roll the os humori, which you Rup your finger upon the coracoid process which communicates the crepitus, another method is, to put your hand into the axilla & raise up the shoulder, the head of the humorous seems to be reduced remove your hand & the appearance of reduction vanishes Fracture of the neck of the os humori may be confounded with it, to ascertain this lay hold of the head remaining in the glenoid cavity roll the os humori & you will directly feel the crepitus Ligaments of the Elbow – Brachia 186 Radial Ligament – Brachia Cubital ligament on the sides of the arm – capsular ligament enclosing the extremities of the bones – the coronary ligament of the radius situated on the neck of that bone allowing its rotatory motion but confining it– the oblique ligament passing from the coronoid – process of the ulna to the tubercle of the radius – and preventing a too free rotation of the radius - the capsular ligament most vascular above the condyles – the interosseous ligament- the fibres pass from the radius to the ulna downwards, having hole in it for the passage of the arteries – Injuries of the Elbow joint – The common dislocation is backwards, the ulna projecting beyond the os humori & the arm is found in a state between flexion and extension- to reduce this fix the os humori between your knee or a bedpost and draw gently the fore arm forwards, you will then find the bone will return into their places when the head of the bone is dislocated on either condyle the same extension and method reduction will be required – sometimes the ulna is dislocated separately – dislocation of the radius alone is also of frequent occurrence the interosseous ligament is torn, and the head thrown upon the external condyle of the humorous, this is very difficult of reduction, the arm is in a state of semiflexion, the arm can neither be flexed or extended – the best method of reducing this is by simple extension in a line with the fore and upper arm, by laying hold of the wrist and extending it, you only act upon the radius or at least in a very small degree upon the ulna – and in this way the head of the radius will be found to slip into its place – fractures of the condyles are liable to be confounded with dislocation to distinguish fracture of the 188 external condyle, take the elbow in your hand roll the hand & if fracture you will feel the crepitus – To distinguish fracture of the internal condyle roll the Ulna – Treatment- Keep the arm in a bent state & use evaporating lotions - at the end of three weeks passive motion may be begun, but if a child at the end of ten days – Another injury of the elbow is fracture of the coronoid process of the ulna every time the arm is extended the ulna projects behind – Fractures of the olecranon are liable to be mistaken, in these fractures the arm must be kept extended – and in fractures of the condyles, the arm must be kept at right angles - The olecranon rarely unites by bone- The condyles if broken within the capsular ligament – unite by ligament - When the internal condyle is broken there is the appearance of dislocation- Deformity remains after fractures of the condyles - Fracture of the coronoid process of the ulna unites by ligament, and whenever the arm it extended there is the appearance of dislocation of the Ulna, having lost the support of this process slips behind the condyle Lecture 35th M Cooper Ligaments of the Wrist – Capsular ligament inclosing the Radius and three first bones of the wrist viz the scaphoid lunar and cuneiforme - External transverse ligament - Internal transverse ligament called Radio Carpal & Ulna carpal ligaments - Laxiform ligament between the Ulna and Radius – between the ulna and the cavity of the joint is a moveable cartilage preventing the ulna forming any part of the joint – The wrist joint is dislocated two ways, backwards and forwards, Extension ulna is generally sufficient for the reduction – There is an injury to be mistaken for 190 dislocation forwards, violent swelling arising from the tendons being stretched, is in a person attempting to save himself from falling by throwing out his hand – To determine which it is, ascertain whether the Radius, Trapezium and metacarpal bone of the thumb are in a line – if there is dislocation they will not & vice versa – In fractures of the Radius with dislocation of the Ulna, the hand should be kept in a half supine state, bent and in a sling allowed to hang down, and the splints extending as far as the extremities of the metacarpal bones- Care of compound dislocation of the ulna related, which required amputation, but these cases give time – rarely requiring amputation at the first – In the accident similar to dislocation forwards after the use of evaporating lotions &c it should be strapped with the Emp. Am. C. Hyd – AC. never saw any of the bones of the wrist singly dislocated – A sprain consists in the laceration of a tendon or ligamentous structure- Ligaments of the Hip Joint The capsular ligament enclosing the joint and neck of the femur, strong on the fore part & weaker on the back part, lined by the synovial membrane, as is all the capsular ligaments in the body - Ligamentum Teres – proceeding from a hollow in the acetabulum to one in the head of the femur The use of this ligament is to prevent dislocation of the thigh bone when the thighs an widely extended – The first dislocation of the femur is upwards resting on the dorsum of the ilium, the head of the bone is turned back, & the trochanter advanced upon the ilium, the leg shortened from 2 1/2 to four inches, the knee turned inwards and advanced a little on the other knee – the toe resting upon the tip of the other foot, allowing slight rotation outwards but none inwards 192 To reduce this, the pelvis is to be fixed by putting a bandage between the thighs and drawn upwards, a wetted roller round the thigh to which the pulley is to be fixed – the thigh is to be drawn in an oblique direction with respect to the body so that it approaches over the other thigh – In preparation lesson the muscular energy by blading & producing nausea or fainting – 6 weeks & 2 days is the longest time AC. has known this sort of dislocation to remain unreduced & afterwards to be reduced – Dislocation downwards – The head of the bone is in the foramen thyroideum - the limb from 2 to 3 inches shorter the foot is longer not turned either inwards or outwards, but if anything a little outwards the knee cannot be approximated to the other the head of the bone cannot be felt at the superior part of the thigh as some say except in a very spare subject – The body in this dislocation dislocation is bent forwards, the knee advanced and the toe just touches the ground- To reduce this dislocation, it must be done on the same principle as that of the humorus in the axilla viz apply a girth round the upper part of the thigh & make the extension directly outwards, draw the leg inwards across the other if it be an old dislocation, another girth should be applied round the pelvis - Dislocation in the ischiatic notch Called downwards & backwards more proper & backwards and upwards, the knee and toe turned inwards a little – limb from 1/2 an inch to an inch shorter, the heel does not reach the ground, very little distention is required to reduce this, the same girth to the upper part of the thigh & pelvis is required, & the pulley applied above the knee, the direction for reduction must be at right angles with the body, and great 194 pains must be taken to preserve that direction from the body gradually sliding backwards after the head is brought to the edge of the acetabulum, rotate the thigh & the head will then sink into the acetabulum – This is the most difficult of any of the three or four – In reducing the dislocation upon the dorsum ilii and ischiatic notch, when the head of the bone is brought down to the edge of the acetabulum, a towel is to be put round the upper part of the thigh which is to be powerfully pulled upwards by the neck of an assistant standing upon the table - Nausea should be produced by tartar emetic in repeated doses before the attempt at reduction and after the debility is occasioned it is to be increased by bleeding – If much faintness has been produced or the dislocation been of long standing, no noise will be heard when the bone goes into the socket, the patient himself will not be aware of it, & it will not be known till the pulleys are removed – Dislocation on the pubis – Limb not more than from ½ an inch to 1 inch shorter, can’t be straightened, the knee & foot is turned outward the head of the bone may be felt in the place of the large glands in the groin, there is very little motion – the knee can be advanced about 12 inches – the trochanter major reach into the acetabulum – A socket for the neck formed in the body of the pubis this can only be mistaken for fracture of the neck of the thigh bone To reduce this – Lay the patient on his side then pass a girth between the thighs & over the pelves – the pulley applied above the knee is to be drawn downwards & backwards as far as the patient will allow, this dislocation is as difficult to reduce as that in the ischiatic notch – This accident is liable to be confounded wait the luxation of the joint – The neck 196 of the femur is sometimes broken with in the capsular ligament, ligamentous matter is thrown out & there is no attempt at a bony union- The nich of the bone is absorbed- The bony union is attempted in any animal – The knee is turned out – Leg shortened by 2 1/2 inches, the knee can be bent outwards and forwards – To ascertain this accident from dislocation, draw down the limb very much Roll the limb and you then feel the crepitus Fracture within [cross out] the capsular Ligament- The muscles draw the fracture ends as under, effusion taking place within the ligament, which hinders the contact of the ends of the bone- A union takes place by bone- The union within the capsular ligament of this joint as well others is only by ligament – The reason is, the want of periosteum, which is the chief agent in the secretion of bony matter altho’ the capsular capsular ligament is made up synovial membrane which also lines it, but has only the power of secreting ligamentous matter Small quantities of bony matter may be secreted by the vessels of the bone itself, but not sufficient for the union of the fractured portion Lecture 36th (M Cooper) Ligaments of the Pelvis [illegible] 198 Tibia – Oblique ligament passing from the external condyle of the os femoris to the head of the Tibia & inserted into the semilunar cartilage The capsular ligament surrounding the lower extremity of the os femoris, and connect to the head of the Tibia, it then splits into two one part connected to the ligamentum patella the other part passing over the joint under the ligamenturn patella – this capsular ligament is very much strengthened by the tendons of the vasti muscles - The crucial ligaments passing from the back part of the cavity between the condyles, the anterior is inserted into an eminence on the fore part of the head of the Tibia – the posterior inserted a little behind the former – The semilunar cartilage formed with thick edges on the outer sides, and gradually becoming thinner, the outer edge attached by ligament to the outer edge of the Tibia - Sacculus Mucosus- formed under the tendon of the Rectus – containing synovia to lubricate the passage of the tendon sometimes the seat of disease - This joint is liable to many injuries 1st to dislocation of the patella, either externally or internally to reduce this elevate the heel and straighten the limb & then throw the patella into its situation, sometimes dislocated upwards by tearing the ligamentum patella – A splint to be applied under the thigh, a strap over the tendon of the Rectus which will keep it in its place – The Tibia is liable to be dislocated in four ways from the os tumoris inwards – outwards, backwards & forwards when dislocated inwards, the external condyle is brought into the place of the internal one – when dislocated forwards the circulation is stopped by the popliteal 200 artery being pressed upon by the head of the Tibia, as well as the nerve, which under The limb destitute of sensation- In compound dislocations of the knee joint, amputation is quite necessary AC. has only seen one case – Mr Hey has described a peculiar dislocation – called a partial luxation of the os femoris, and in fact a dislocation of the semilunar cartilages falling behind the condyles, the patient in this case is unable to extend the limb – Reduced by bringing the heel as close to the buttock as possible, & thus allowing the cartilage to pass again into their places – This accident is produced by the toe being caught in a fold in the carpet, or by a person attempting to turn himself in bed, at a time when the foot is prevented from being carried on with the act of the limb the weight of the bed clothes will occasion it - The interosseous ligament passing from the tibia to the fibula, with a hole in the upper part, thro’ which passes the anterior tibial artery, & some of the fibres of the tibialis posticus muscle - The capsular ligament at the head of the fibula The capsular ligament at the lower extremity connecting it to the Tibia – The bursa mucosa under the tendon of the rectus is liable to enlargement from an accumulation of synovia which is best relieved by a blister kept open by some stimulating ointment Women accustomed to kneel are liable to swellings upon the patella, may be cured by the Emp. Am. c. Hyd. blister & seton these enlargements should never be opened or removed- There is but little inflamn that follows dislocations of the knee joint – A man of the name of Bridges 202 dislocated his knee and a year afterwards had a compound fracture of the upper part of the tibia, he now walks very well. In cases of compound dislocation, amputation is necessary – In treating dislocations of the ankle joint, two things require particular attention – To begin early with passive motion and to keep the foot at right angles with the leg – the which ought also to be observed in compound fractures of the leg – In compound dislocations of the ankle joint, if the bones are much comminuted, remove the loose portions if they be small, but if the tibia be obliquely broken & the pieces be large it will be necessary to amputate – The advantages of sawing off the ends of the bones, are, that constitutional irritation is very much lessened granulations more readily arise from the sawn extremities of the bones, so that two grand objects are gained – diminished constitutional constitutional irritation and a far shorter period being incurred for the cure – the absorption of the cartilage being so very slow, and even after the ends of the bones have been sawn off a good degree of motion is preserved both between the tibia and astragalus & between the astragalus and other bones of the tarsus – The bones being shortened, the spasm of the muscles is prevented which so usually occurs in these cases – Two cases – one in Guys, the other in fr Thot illustrative of the two modes of treatment – AC. decidedly recommends the sawing off, of the extremities of the bones apply a bit of lint wet in the blood of the wound, a many tailed bandage & one splint Lecture 37th (A Cooper)- Ligaments which connect the bones of the leg with those of the tarsus, namely with the os calcis, the astragalus, & the os naviculare - 204 1st Deltoid – Arises from the malleolus internus, spreads as it descends, and is attached below to the astragalus, the os calcis & the os naviculare - 2d Anterior – Arises from the anterior part of the outer malleolus, & passing obliquely forwards & inwards, becomes fixed to the fore & outer part of the astragalus – Perpendicular Arises from the extremity of the outer malleolus & after descending nearly perpendicularly, is fixed below to the outer side of the os calcis Posterior – Arises from the inner & back part of the outer malleolus, passes nearly transversely inwards, & is attached to the back part of the astragalus, besides these ligaments the joint is further strengthened by ligamentous fibres, which extend upon the capsule from the tibia to the astragalus – Synovial Membrane – Arises from the margin of the articular surfaces of the tibia & fibula, and is attached to the circumference of the articular surfaces of the astragalus Lecture 37th (Mr Cooper) In the center of the Tarsus is an articulation formed by the astragalus and os calus on the one hand & the os naviculare and cuboids on the other, thro’ which is it very convenient to amputate- Short ligaments unite the tarsal bones - Dislocations of the ankle joint – There are thru dislocations of this joint - inwards outwards and forwards – Dislocation Forwards - Appearances – heel elongated- fore part of the foot shortened, fibula fractured, and the tibia thrown upon the os naviculare - To reduce this – Simple extension pressing at the same time upon the tibia - generally will effect a reduction of this dislocation A partial dislocation forwards sometimes happens – the fibula is broken, the tibia is on the fore part of the astragalus, & posterior part of the naviculare – this is likely to cause some deception, and to distinguish it – It will be found that the toe cannot be approximated or bent up towards the leg, without great pain although it may be extended, attention to this will not fail to distinguish this accident from a common sprain – Dislocation inwards- The tibia is thrown upon the inner side of the astragalus, the fibula is broken & rests upon the astragalus, the malleolus externus remains in its place – A piece of the tibia is sometime broken off – Simple extension & passing the tibia outwards will be sufficient in its reduction – afterwards laying the limb on its side – Dislocation outwards - The malleolus internus is broken off – the tibia is thrown on the outer side of the astragalus, the external malleolus sometime broken, the sole of the foot is turned outwards – To reduce this simple extension will be sufficient, the limb must be laid on its outer side, the patient wont be able to use his limb for three or four months Compound dislocations of the ankle joint – The plan to have saved these limbs would have been to have attempted immediate reduction AC. thinks there is great advantage in removing the ends of the bones by which constitutional imitation is lessened the muscles also are thrown into a state of relaxation – the cartilages are generally ulcerated away if allowed to remain, there has been no fatal termination in the ends of the bones being sawn off- In cases of oblique fracture of the tibia, it is sometimes necessary to amputate – A very old man with compound fracture of the ankle joint, it is better generally to amputate – and in cases when the bones are much shattered, and the soft parts excessively bruised, it will be better to amputate, as in those cases mortification 208 mortification frequently follows – The laceration of arteries is another reason why we should amputate – An accident of this kind with laceration of the anterior tibial artery has been known to be saved – Never amputate from extreme suppuration – exfoliation of bone – mortification, or tetanus succeeding these accidents Lecture 38th (M Green) On the viscera of the Thorax The chest is at the upper part of the body and of a conical figure – The contents are the organs of respiration and circulation, viz – the Lungs and the Heart, & their reflected membranes - the pleura & the pericardium – the mediastinum forming a division of the thorax into two – The pleura is a semitransparent membrane, rough externally from the cellular substance, and smooth internally covered by a condensed serous fluid in the dead subject – in the living it is a vapour - It is a reflected membrane that is to say it covers the lungs then turned back to line the parietes of the chest, thus a bag containing nothing but vapour is formed – begins at the side of the sternum continued backwards to the dorsal vertebra and upwards as high as the clavicle – it is then carried forwards covering the lung pulmonary vessels & the pericardium, & then again attached to the edge of the sternum below it covers the convex side of the diaphragm The approximation of the two pleura is called the mediastinum, which is divided into two parts anterior & posterior The remains of the thymus gland is said to be contained in the anterior mediastinum, together with cellular membrane & adipose substan opposite the 6th rib the two pleura separate Its structure – When macerated it appears to be composed of filaments, its vessels appear but few & small in number in a healthy state – but 210 under inflammation, vessels numerous and observable but in a healthy state they won’t admit the red particles of the blood – It is also furnished with nerves and absorbents – This membrane is frequently the subject of inflammation, under which the patient complains of great pain in some particular part accompanied with fever and cough, these serous membranes are subject to the adhesive inflamn In dissection of a person who dies of Pleuritis There is redness, and a larger proportion of fluid with coagula floating in it, the lymph thrown out when death is not the consequence, becomes organized & forms adhesions – adult bodies are seldom opened without some slight adhesions being seen, this inflammation when it runs high goes on to the suppuration stage, & matter being formed is either contained in a bag, or diffused thro the whole cavity of the pleura, sometimes the fluid of the pleura is accumulated in large quantities, which produces great difficulty of breathing, the circulation is somewhat impeded are said to arise from diminished absorption or increased secretion but it is thought chiefly to arise from the latter – The pleura is sometimes very much thickened which forms a nidus for the deposition of bony matter, & hence bone is sometimes found in the pleura – The thymus gland is formed of two lobes, each having a superior and inferior corner, plentifully supplied with vessels, but has no executory duct – The heart & pericardium The exterior of the pericardium rough, broad below, narrower above, when cut open the internal surface is smooth and polished, lubricated by a serous fluid called Liquor Pericardii from ʒii to ℥i with previous symptoms of disease - It is also a reflected membrane like the Pleura thus the heart is enveloped twice by the pericardium - On cutting open this membrane we see the pulmonary artery – conveying the blood 212 from the heart to the lungs, the aorta conveying the blood to all parts of the body – The two venæ cavæ – and the four pulmonary veins – there are the eight primitive vessels in the body – The heart is placed behind the sternum, its base is placed upon the dorsal vertebra, with its apex pointing obliquely forwards, outwards & downwards - pulsation is felt in the interval between the 5th – 6th ribs – The pericardium is a similar membrane to the pleura, in its nature, structure, and disases – Persons laboring under pericarditis, complain of great pain in the part & cough, but if distinct, no acute pain will be felt on inspiration, the pulse quick and irregular, attended with fainting, the deposited lymph forms adhesions, which are marked during life by peculiar symptoms – as palpitations great disturbance in the circulation, the pulse intermittent and irregular, the inflammation sometimes goes on to suppuration, the liquor pericardia is subject to great increase, usually accompanying hydrothorax, sometimes this membrane becomes thickened & in part ossified It is attached to the middle or cordiform tendon of the diaphragm, and this prevents the stoppage of the circulation, when a man stands upon his head- The inflammation is frequently occurring in persons who have been subject to rheumatism, of which it sums to be a metastasis - The Division of the Abdomen into Regions – Divided first into three regions the upper the Epigastric – the middle the Umbilicus the lowermost the Hypogastric - there regions an determined by lines in their measurement and on again subdivided into three more as follows – Upper middle part called scrobiculus cordis, & into right and left hypochondriac regions – Umbilical – middle part called umbilical - sides the iliac regions – Lower – middle part the pubic, the sides the inguinal regions 214 The posterior part is divided into two, the right and left lumbar region Lecture 39th (Green) Of the situation of the viscera of the Abdomen – Contains three kinds of organs viz the Chylopoietic - the Urinary and the genital organs – Between the abdominal parietes and the peritoneum, are the umbilical vessels, called in the adult the ligaments of the peritoneum- The peritoneum rough externally where connected to the parietes of the abdomen , internally smooth and polished, lubricated by vapour in the living subject, when condensed in the dead subject is like serum – Tis a reflected membrane like the pleura, its structure like that of other serous membranes – Inflammation of this membrane is attended with tenderness on pressure and symptomatic fever, not so liable to adhesion as the pleura, from the continual motion of the bowels- On opening the abdomen the following parts present themselves, the liver the gall bladder, the stomach & the omentum The liver occupies the whole right hypochondrium, the scrob. cord. and part of the left hypochondrium – The stomach is divided into two surfaces, anterior and posterior, two concavities greater & lesser – two extremities cardiac and pyloric, at each of which are two orifices of that name; – the left or cardiac extremity is smaller than the right or pyloric – Situated in the left hypochondrium extending somewhat into the scrobiculis cordis – the anterior surface faces upwards & forwards, the posterior surface downwards and backwards – The Intestines Divided into two portions, the upper into small intestines, duodenum, jejunum & ileum, the lower or great into Cæcum, colon and rectum – The duodenum begins at the 216 Pylorus, & runs first upwards & outwards & then downwards being bound down to the spine by the mesentery and mesocolon at which part begins the jejunum and ileum 2/5 jejunum & 3/5 Ileum – the ileum terminates in the beginning of the large intestines, viz the cæcum with its appendix cæci vel vermiformis, the colon passes up in the right iliac to the gall bladder, there passes across the abdomen, descends in the left iliac fossa, and then forms the sigmoid flexure, opposite to the base of the sacrum & terminates in the rectum – The lesser omentum extends from the concave surface of the liver to the lesser curvature of the stomach, containing in its duplication the vessels of the liver after forming glissons capsule which contains the hepatic vessels, behind this capsule is situated the foramen of winslow The greater omentum attached to the stomach and colon – The Spleen is a spongy mass of an oval shape, and purple hue situated deep in the left hypochondrium between the stomach and false ribs – The Pancreas A conglomerate gland, extends across the spine to the duodenum to which it is attached. Lecture 40th (Green) Posterior Mediastinum - formed by the two pleura upon the dorsal vertebra, forming a covering for the æsophagus, the aorta, the vena azygos, and the thoracic duct, sometimes it also contains the 8th pair of nerves, and the upper part of the trachea – Glissons Capsule, contains the bile ducts (the duct hepat duct cystic, & duct com. choledicus) – terminating in an orifice obliquely in the duodenum, the hepatic artery, a branch of the cæliac, the vena porta formed by the veins of the chylopoietic viscera and ramifying in the liver like an artery 218 also the nerves and absorbents – The structure of the alimentary canal by which is meant the whole canal from the mouth to the anus The asophagus- of a cylindrical figure, begins at the cricoid cartilage, passes thro’ the diaphragm to the cardiac orifice, compound of muscle, and membrane, the muscular part consists of two kinds of fibres, longitudinal and circular, by which it can be contracted in both its dimensions- the membrane of the mucous kind, and redder than that of the pharynx, has many follicles for the secretion of mucous, is of the nature of the skin, pustules of small pox are sometime found on this membrane – JH Green has never seen this - The Stomach – Has three coats, the puritanical the muscular and the villous, the muscular coat has two sets of fibres – Sir E Humes opinion of the stomach's internal coat is of two different kinds – the inner or villous coat, furnished with villi from whence its name somewhat dispensed in folds, of a redder colour than the æsophagus, rather yellow, sometimes approaching to a purple hue – Its capacity varies, larger in those who eat chiefly of vegetable food, it is furnished with mucous glands - but not perceptible except enlarged from disease – pyloric orifice furnished with an imperfect valve, to hinder the food from passing too quickly into the duodenum - the villous coat is very vascular – The stomach derives its vessels from the caliac artery and its nerves from the 8th pair and great sympathetic – The Intestines – furnished with three coats like the stomach - the inner coat furnished with villi, more conspicuous than those of the stomach, also the valvula commissutes, to increase the surface of the absorbing membrane, extremely vascular, has also mucous glands, glandular aggregate 220 and glandula solitura – The duodenum layer or more capacious, than any of the other intestines equal length – The duct pancreat et duct com choled terminates in this portion of the intestines – the jejunum – coats are said to be thicker, & furnished with more valvulæ connimutes than the ileum - The ileum is still less in diameter - The absorbent vessels in the small intestines are very numerous, as in shewn by the nutriment being principally absorbed from them – The large intestines differ from the small, in having uneven surfaces, and being furnished with appendices, epiploicæ have three coats like the small intestines the mucous membrane differs also, are well furnished with villi but not so many absorbents - The valve of the ilium situated at its extremity, & beginning of the cæcum and colon, formed of two semilunar flaps each formed by a projection of the inner coat - The cacum forming a blind pouch with its appendix, generally found full of mucous its use is not known – The colon – Its surface very irregular with prominences and corresponding depressions internally – The rectum, the muscular coat differs from that of the other intestines, its inner coat furnished with numerous folds, which appear like prominences, and are likely to deceive a person when examining the rectum, supposing them to be disease - Lecture 41st (Cline) The Liver – The superior part is towards the diaphragm – convex – The inferior part covering other viscera & concave, its colour when in a healthy state of a reddish brown has a peritoneal coat, the reflected portions of which form the ligaments – viz the right and left lateral – the suspensory – the coronary - and the round ligament – The Liver is divided 222 into three lobes - the right and left separated by the suspensory ligament, the right lobe is the longest, on the under and at the same time at the upper part is found the lobulus spigelii situated between the left lobe & the inferior cava – A fourth lobe is occasionally found called the lobulus quadratus between the left lobe and gall bladder. Many depressions are found on the underside, in the right lobe a large one for the right kidney, between the two lobes is a groove, called the fissure of the liver, for the ligament rotund – A depression for the ascending cava, another between the right lobe and the lobulus spigelii for the gall bladder – The porta or gate of the liver situated nearly in the middle of the inferior surface, so called from being the place where the blood vessels enter, and the excretory ducts come out – The vena portæ – formed by the veins returning from the stomach, intestine, spleen and pancreas – It is a vein of large size, and in the porta divides into two, and from thence immediately ramified through the substance of the liver – The hepatic artery Arising from the porta, divided into two, called the right & left hepatic artery which an ramified thro’ the liver – The hepatic veins – Two or three generally originate from the inferior cava, after passing the diaphragm some smaller ones an also found to arise where the vena cava enters the substance of the liver – The Ductus Hepaticus - Arises from numerous branches which unite in the porta - The Pori Biliarii - are seen on cutting into the substance of the liver, which are only the minute branches of the biliary duct – The Acini with penicilli radiating from them - The liver is liable to be ruptured – The venous blood is brought from the chylopoietic 224 chylopoietic viscera, and is thought to be a great agent in the secretion of bile – The hepatic artery is for the nourishment of the viscus, all other glands secrete from arterial blood- Mr Abernathy had a case in which there was no vena porta, but the hepatic artery, was far above its usual size – Mr William has also had a case of the same nature – The Bile – It is of great use in digestion, the natural stimulus to the intestines, as a continued supply of it is not necessary, the gall bladder intended as a reservoir – Structure of the gall bladder – in its shape pyriforme, divided into body, fundus, and neck – it has two complete coats and a partial one, which is the peritoneal, being in some parts attached to the bone, a muscular coat, whose fibers are scarcely demonstrable, and a membranous one having a honey comb appearance, the internal coat secretes a fluid to defend it from the bile The duct Cysticus – has a torturous course not allowing a quick passage for the bile, the bile is poured by the asini into the ramifications of the duct hepaticus, and is carried by this duct from the porta to the duodenum and when not required passes by the ductus cyst. into the gall bladder – A specimen of enlarged gall bladder shewn, about the size of a large pigs bladder when completely distended, supposed to have originated from a partial obstruction in the duct com. choled. It appeared as a tumour at the scorobic cord taken for an abscess & so opened – The calculi found in the gall bladder and ducts, when dried are specifically lighter than water – vary very much in colour, the centre of some will be dark coloured while the exterior is almost white, some have the appearance of wall nuts, others like gun powder – In some cases they have been found to occupy the whole of the gall bladder, the white ones supposed 226 to be formed from the mucous of the internal coat, the darker coloured ones from the inspissated bile – In the passage of calculous concerting it is found that the dusts grow or enlarge, and do not stretch, a specimen shewn where the gall bladder was completely attached to the duodenum & thus forming a ready communication - Disease of the liver – In opening abscesses it is very necessary to wait, till they point in a very direct manner, at which time, the diseased parts become attached to the parietes of the abdomen, thus secluding the possibility of the matter escaping into the cavity of the abdomen Pus from abscess in this organ is discharged in many ways, sometimes spit up from the lungs into the stomach bile has been known to be spit up from the lungs, and gall stones found in the lungs – Hydatids are frequently found in the liver, and discharged sometimes by the mouth and anus. - Lecture 42d (Cline) On the liver continued – The liver is liable to the disease which Mr Hey called fungus hæmatodes, dram drinking induces disease of the liver – the natural appearance is destroyed when cut into, appears granulated, in some cases it enlarges in others it diminishes- Tubercles are found also in the liver, and said by some to be found in scrophulous constitutions – This viscus is observed at times to be very hard, and called schirrous liver, but different from constitutional cancer – Most diseases of the liver, are accompanied with dropsy of the abdomen, from an increased secretion of the exhalant arteries, Obstruction in some of the hepatic ducts gives rise to jaundice The Spleen – Of an oval shape – has a coat of peritoneum in common with the other viscera, one side convex which is is contact 228 with the diaphragm – on the opposite side there are two concavities in the outer of which, part of the stomach is lodged, and in the other the Kidney It is divided into its anterior and posterior edges, in which are occasionally found notches sometimes two spleens are found, a large & small one by the side of it - H Cline has seen one in the omentum, at a distance from the larger, at the middle of the two eminences the vessels enter – This viscera is very vascular – It appears that its presence is not necessary to life – A soldier in the battle of Dettingen lost his spleen by a wound in the side, lived & was well after – Injuries or wounds of the spleen are very dangerous from its great disposition to hæmorrhage even a very small wound from a pointed interment has been known to produce fatal consequences from hæmorrhage. It is but rarely diseased – HC has only seen one case in which there was abscess in the spleen and never inflammation – In intermittent fever, the spleen is frequently found enlarged and sometimes to a very great size- It is occasionally found very small. H.C. has once seen scrophulous tumours in the spleen, the peritoneal coat sometimes becomes cartilaginous and even ossified – Pancreas – Is from 8 to 9 inches long and 1 1/2 wide divided into left and right extremities, the right extm. or head, attached to the duodenum – the left extremity to the kidney – The head is sometimes called the little pancreas of Winslow It is a conglomerate gland, thro’ its center a a duct is running, which unites with the duct com choled just before it enters the duodenum, the duct of the little pancreas has a different termination from the duct of the great pancreas, entering by itself the duodenum, the fluid scented by this organ 230 is similar to the saliva – This viscera is seldom diseased – HC has only seen it once schirrous- Calculi are occasionally found in the duct which resemble those found in the ducts of the salival glands – The process of digestion – The food in the stomach fd a little while after death to be in the state of a soft pulpy mass called chyme, there propelled into the small intestines, where it is acted upon by the bile and pancreatic juice; the chyle is there formed, to be absorbed by the lacteals for the nourishment of the body - The Ancients thought digestion was effected by trituration thro’ the means of heat, by putrefaction &c_ The true theory is, that it is by a chemical process, assisted by the gastric juice which is the solvent of the food - In proof of its solvent power, when the vital principle is extinct, it will dissolve the stomach itself – occasionally may be seen poitions of the diaphragm and lungs dissolved, especially in children, the digestion is also expedited by mastication & the partial solution of the food by the saliva – In children it appears the gastric juice is peculiarly active Currants – raisins & most seeds, if the external coat is not broken will resist the action of the gastric juice – The food after being subjected to the action of the stomach, is propelled into the duodenum to be acted upon by the bile and pancreatic juice – The mass thrown about by the vermicular motion of the intestines is brought in contact with the orifices of the lacteals, the valvulæ conniventes increase the surface of absorption, insinuate themeselves into the mass of aliment. As soon as the mass enters the large intestines it assumes the smell off and then are called faces The appendix vermiformis is a gland, and 232 probably secretes a peculiar fluid_ It is thought by some that there is a second process of digestion going on in the large intestines - The peristaltic motion can be inverted, & vomiting reinduced, if violent the contents of the small intestines are ejected by the mouth, very rarely that the contents of the large intestines are thrown up by the mouth – It was formerly thought that the red particles of the blood were manufactured in the spleen, by which is was intended to balance the liver, by others it was thought to take up any superfluous water from the stomach – Dr Haightons theory is the most probable one – The splenic artery in its passage gives off branches, to the greater curvature of the stomach, and when the stomach is distended, and requiring a large proportion of its secretion, compresses the artery, by which but little care pass to the spleen, & the rest passes to the stomach by the vasa brevia the splenic artery at the same time, gives off branches to the pancreas, & so under the above circumstances the pancreas, as well as the stomach will be abundantly supplied with blood, at a time when its peculiar secretion is required- Lecture 43d (H. Cline) On the Lungs – Resembles the cloven foot of the ox- Vary very much in colour, are red in children and middle age, and in old people are of a darker purple, they are divided into lobes, the right lobe larger, and divided into three portions, the left lobe smaller & divided into two portions; - This formation is but adapted to the various motions of the ribs, and thus slide over each other to accommodate themselves to those parts, are enveloped in a shining membrane or coat called the pleura, when macerated or allowed to putrefy, and the coat taken off, they seem to be made up of lobuli a cells, which 234 are lined with a very vascular membrane, but this membrane lining the air cells, cannot in the human subject be examined, being so very minute, the air cells are united by a reticulated membrane which makes up the substance of the lungs – The Trachea – commences at the bottom of the cricoid cartilage, & descends anterior to the asophagus, composed of a number of cartilaginous rings or bands, connected by elastic ligament the extremities of the cartilages are united by transverse muscular fibres – Is lined with a very vascular membrane, supplied with mucous glands to lubricate and defend it from the passage of the air – the use of the elastic ligament between the cartilages is obvious for it this tube had not been elastic, when the head or chin was much elevated the lungs would have been disturbed when depressed & become tortuous – Is occasionally wounded, sometimes by cutting the throat, when partially wounded the edges may be approximated by the position of the head if completely wounded may be brought in contact by suture, taking care not to pierce the lining membrane of the trachea – It divided into right and left bronchia – the right is largest The structure of the bronchia are the same as that of the trachea, the cartilages are insensibly lost in the ramifications of the lungs about the bronchia are formed the pulmonary absorbent glands, formerly supposed to pour out a dark colored fluid into the bronchia The blood vessells of the Lungs - The pulmonary artery arises from the right side of the heart, divides into the right and left pulmonary branches – There are four pulmonary veins going to the left side of the heart, it is supposed the lungs are nourished by the extreme branches of the pulmonary artery – The bronchial arteries go to the bronchia for the nourishment of them and their 236 branches – if the lungs are wounded, blood is extravasated, and respiration impeded, death is therefore a pretty certain consequence- The lungs are passive organs, depending upon the air or intercostal muscles – The Heart – Is composed of two sides right and left – The blood comes from all the veins of the body to the right side goes to the lungs then brought to the left side by the pulmonary veins – The atmospheric air- Composed of 21 oxygen gas – 78 azote and a small quantity of carbonic acid gas – the oxygen gas contains the acidifying principle and latent heat enters the lungs and meets the blood loaded with carbon, which acts upon the oxygen & forms carbonic acid gas in which combination the latent heat of the oxygen is given out, and transmitted thro’ the blood vessels to the whole body, at the same time that the carbon of venous blood is absorbed & carried of – those animals that have a double heart, [cross out] the circulation is supplied with a larger proportion of heat (98°) than those which have but a single heart this heat is to be kept up thro’ the changes of the atmosphere – The circulation thro the veins is slow, and therefore the blood has time to collect a large portion of carbon by the decomposition of which a greater quantity of heat is evolved, & the body enabled to withstand the vicissitude of climate and season, as the body is found in all situations to support an equal temperature this is Dr Crawfords M.D theory of Sr Thohs- Mr- Brodies experiments endeavoring to prove animal heat kept up by means of the nervous system, are considered not so satisfactory as those above of Dr Crawford The presence of carbon in the body it seems is necessary, but when it becomes over saturated as in the inhalation of carbonic acid gas & death is usually the consequence; – the lungs an to be considered as excretory organs, carrying 238 off that portion of carbon which would otherwise be prejudicial- Sighing – occasioned by the mind, being so occupied, as not to have allowed respiration to have gone on sufficiently, a deep inspiration is taken to make up for it – When the lungs float, the child has breathed but in numerous instances the child will breathe a few times, and from various causes yet die – The lungs when in a putrid state will become specifically lighter than water We must judge therefore by the marks of external violence &c, and not decide from the floating or sinking of the lungs in water- Diseases of the Lungs – Inflamation – when it exists for some time, coagulated lymph is effused into the cells they become very solid, & then the specific gravity is increased, & resembles very much the liver occasionally terminates in abscess which breath into the bronchia, is spit up – A common disease pthisis pulmonalis – Scrophulous disease of the bronchial glands, likely to be mistaken for Phthisis pulmonalis – A bag like a bladder is sometimes found on the lungs, which is an enlargement of one of the air cells, one of these bags is generally found in a broken winded horse, which renders his expiration so difficult as is observed – Nothing wastes the body so much as a difficult transmission of the blood thro’ the lungs, as we observe in all persons laboring under diseases of there organs – When the bronchial glands are affected, matter is spit up, & there are the common symptoms of phthisis, but it is a mild and tractable disease compared with phthisis. Lecture 44th (H Cline) The structure of the heart – In form resembles a cone, divided into apex and basis the side which rests upon the diaphragm 240 is flat, bounded by two edges, called right and left, is composed of two auricles and two ventricles Its apex or point is turned towards the left side, therefore the right auricle and ventricle in sight are called anterior – Tshe right auricle on its superior part gives origin to the superior cava; the inferior part to the inferior cava, on the superior part is an appendix the orifice of the coronary vein, close to the inferior cava – the internal part of the auricle is lined by a polished membrane like the veins, the appendix of the auricle is fasciculated- A small tubercle between the orifices of the two cava called the tuberculum Loweri- The orifice of the coronary vein with its semilunar valve – the valvula nobites at the orifice of the inferior cava - The right Ventricle – shape triangular, at the upper part is the commencement of the pulmonary artery when opened appears thicker than the auricle, fasciculated fleshy bundles projecting from its sides called carnæ calumnæ, Two openings one from the right auricle, another from the pulmonary artery – The bicuspid valve formed by the [cross out] cortina tendinea or tendons of the carnææ columnæ – At the beginning of the pulmonary artery are three valves called the sigmoid or semilunar, two on the fore part & one on the back part of the artery - It has in its middle a small body or thickening called corpusculum sesamoideum or arantii – Left Auricle – receives from each side the pulmonary veins – it terminates to the left and somewhat anteriorly, in a projecting appendix which is all that can be seen of the left auricle in the natural situation of the heart – Below and anteriorly the auricle is terminated by a large opening by which it communicates with the left ventricle namely, by the auriculo ventricular opening Left Ventricle – Its from is conical, somewhat 242 like the less end of an egg – In consequence of the thickness of its parietes, it does not become flatted when empty like the right, but appears rounded transversely- It is longer than the right ventricle its apex projecting more – The left ventricle terminates superiorly by two openings, the auricular and the opening of the aorta- From the auricular opening which is the larger, is continued a membranous fold (cortina tendinea) which has commonly two projections, the one opposite to the margo obtusus, & the other opposite to the aortic opening – To this curtain the chorda tendinæ before spoken of an attached, & this is formed the bicuspid or mitral valve of the auricular opening – It has three semilunar valves, which resemble those of the pulmonary artery, but are thicker and stronger, opposite to them are three depressions or enlargements of the aorta, called the sinuses (sin Valsalva) In the two anterior sinuses a little about the edge of the valves are the openings of the two coronary arteries- The semilunar valves have their corpora sesamoidea at the points of their junction, are to make the valves more complete, without which the edges of the valves would not meet, and of course not hinder the retrograde motion of the blood - The Partition between the two auricles is called the Septum in the middle of which is the foramen ovale in the fœtus, there is also a septum between the two ventricles the whole of which belongs to the left ventricle as described by Hunter – The Coronary arteries Arise from the aorta above the semilunar valves the right coronary artery goes to the right auricle and ventricle and to the septum The left coronary artery goes between the left auricle and ventricle, and these two arteries anastomose with each other in the substance of the heart – The coronary vein – returns the blood to the heart after 244 being distributed over the substance of the heart by the coronary arteries – The extremities of the coronary arteries, communicate with the interior of the ventricles as water injected into those arteries, passes into the cavities Lecture 45th (Cline) On the circulation of the blood From the right auricle, the blood passes thro’ the ventricular opening into the right ventricle, then passes into the pulmonary artery, this vessell carries it thro’ the lungs, and is returned by the pulmonary veins to the left auricle, from which by the ventricular opening it passes into the left ventricle, from which the aorta carries it to all parts of the body except the lungs, and returned by the veins to the right auricle The vena cava infer. has the valvula nobilis Eustachii – the coronary vein is furnished with a semilunar valve, the superior cava has no valve- The foramen communicans is furnished with a tricuspid valve, to prevent its regurgitation into the auricle – The three semilunar valves at the orifice of the pulmonary artery with their corpusculum sesamoideum – The mitral or bicuspid valve in the foramen communicans of the left ventricle – The semilunar valves of the aorta prevent the regurgitation of the blood into the left ventricle – Dyastole – Is the dilatation of the heart or relaxation of its muscular fibres – Systole – Is the contraction or expelling action of the heart – The auricles do not expell the whole of their blood, but the ventricles do The auricles contract together, and the ventricles also contract together, by the distention of the auricles the heart is thrown against the ribs assisted at the same time by the contraction of the ventricles – In man and the mammalia in general, the heart is double and have a double circulation – in cold blooded animals the heart and circulation are single, the two ventricles 246 ventricles being synchronies or contracting together The blood is thrown into the pulmonary artery and aorta at the same time (The Vis a – Tugo explained) Respiration and circulation are so hemiseccted that when the latter is hurried, the former is quickened, also to make the necessary changes in the blood, it will be found that there are 7 pulsations to 4 respirations in general - The large veins near the heart pulsate, and in very thin delicate females, even the jugular vein may be seen to pulsate, which arises from part of the blood being thrown back into the veins during the contraction of the auricle – The heart contracts with more force in proportion, as it is distended but if too much distended the action becomes weak, the same applies to the vesica vinœ In cases of suspended animation when bleeding is proper, it is better to draw it from the veins as near the heart as possible, the thyroidial or external jugular- The circulation in the womb The child is enclosed in membranes & floats in water, the funis consists of two arteries and a vein The umbilical vein arises from the placenta goes into the abdomen of the fœtus, and empties itself into the vena porta – The foramen ovale in the septum of the two auricles, furnished with a valve to hinder the blood from flowing back into the right auricle – The two umbilical arteries arise from the internal iliac artery forming a part of the chord, they go to the placenta in which they ramify, and join with the branches of the umbilical vein – The blood in the placenta, is sent by the umbilical vein into the abdomen, a large portion circulates in the liver, a part goes by the ductus venosus to the inferior cava, then conveyed into the right auricle, a part of which goes to the right ventricle, the larger part into the left auricle, and from thence to the corresponding ventricle, from the right ventricle 248 it goes to the substance of the lungs by the pulmonary artery, although most part goes by the ductus arteriosus to the aorta – As soon as the child is born it fills the lungs with air, when expanded, the blood readily goes by the pulmonary artery thro’ the lungs - the canalis arteriosus becoming soon obliterated, the blood is brought in greater abundance into the left auricle, & thus opposing the flow of blood thro’ the foramen ovale - The digestive organs being now wanted for the purpose of nourishment, no blood comes by the umbilical vein, but more is carried to the inferior parts of the body - The foramen ovale is occasionally open thro life, the valve sometimes supplies the place of the membrane, but in cases when the blood escapes into the left auricle, a blueness of the face & are the consequences, sometimes the septum of the ventricle is defective, and the aorta arises from both ventricles – The heart has occasionally been ruptured from its more violent contraction, when the particles have been thin, the blood escapes into the pericardium George 2d died of this – A very small quantity of blood escaping from the heart is sufficient to destroy life – The heart has been occasionally wounded – A man lived 8 hours after the heart had been transfixed by a bayonet - The effects of rupture and wounds of the heart differ in this, that in cases when the heart has been ruptured in which cases the parietes are found very thin, death is the immediate consequence, but in cases of wound, the muscular fibres contract, and prevent so sudden an effusion of blood, life is therefore supported for a while – Polypus of the heart is a very rare disease, and is often confounded with coagulated lymph thrown out in the ventricles which adheres so firmly 250 to their fasciculated structure as to appear like polypi – The only two cases that H Cline ever saw of Polypus in the heart, were both constitutionally affected with cancer - Inflamtion of the heart and pericardium being generally followed by adhesion if the pericardium to the heart and other extensive adhesions in the chest – Very labored respiration and palpitation are the usual symptoms, sometimes called rheumatism of the heart – Ossified valves of the aorta are not uncommon occurrences, when advanced produces great uneasiness, and ultimately fatal, attended with strong pulsations of the heart, which may be felt as low as the 9th rib- The heart in those cases is found nearly as large as that of a little bulloch- The pulse at the wrist is irregular and intermittent, two strokes are felt at the heart where one only is felt as the wrist, attended with frequent sighing - Angina Pectoris – Arises from ossification of the coronary arteries – Ino Hunter died of this disease, attended with tightness of the chest - and pain extending down the arms, producing these effects from some sympathetic affection Lecture 46th (Green) On the Teeth – During life we are provided with two sets of Teeth, temporary and permanent – In case tooth we distinguish the crown and its basis, the neck and fang are 32 in number 16 in each jaw, more sometimes are found generally the increase is in the incisores, but are more frequently fewer in number – Divided into incisores /4/- cuspidati /2/ bicuspides /4/ and molaress /6/- distinguished by the form of their crowns and member of their fangs – Incisores, convex anteriorly, concave posteriorly with a sharp cutting edge, the two middle ones are the larger cuspidati – the top or crown of their teeth 252 come to a point, the fang is much longer - Bicuspides – Armed from having two points on their bases, the fang has the appearance as if two had grown together – Molares - The bodies are largest round the basis and the basis has several eminences, those of the lower jaw have two fangs, & those of the upper jaw three fangs, there are frequently found exceptions the two posterior molar teeth (dentes sapientiæ) differ in their bodies as well as their fangs in being smaller – The teeth of the upper jaw are generally larger than those of the lower jaw The basis of the teeth of both jaws do not come into exact apposition, but the middle of the bases of the teeth are opposite to the interstices of the other jaw – The structure of the teeth – They are hollow within the crown and of the same form extending down each fang in which are found the peculiar vessels of the teeth – The nerves of the teeth are from a branch of the 5th pair called the dental branch – In old people the cavity becomes obliterated and the bases of the teeth are found in some people to be quite smooth but never worn through – The solid part is composed of enamel & bone – The enamel only covers the crown, thickest on the grinding surfaces and cutting edges, is extremely hard, and when struck with steel, fire will be seen as if the steel had been struck with a flint – The enamel is unorganized, if dissolved in acid, no membrane is left behind as in bone – In some nations the negroes for instance file the incisors anteriorly, in others posteriorly – The fangs of the teeth are composed of the same substances as the other bones of the body - The only method of ascertaining the vascularity of the fang is by feeding the animal with madder – no injection will pass 254 into them – the teeth are fixed in the alveoli of the jaw, they are connected to the socket by periosteum – The form of the teeth is adapted to the food of the animal – In carnivorous animals the teeth are more pointed grinding surfaces to the teeth of carnivorous are not so necessary as to graminiverous animals in some graminiverous animals we observe very large cuspidate as in the elephants, and an intended as weapons of defense – The teeth of many animals especially graminiverous are formed of different layers as of enamel & bone so as to form an uneven surface for the grinding of vegetables – The teeth of men form a medium, between the carnivorous and graminiverous and is with some others an omniverous animal- The gums are of a very firm Texture- externally vascular, does not posses much sensibility. Lecture 47th (Green) On the Teeth continued The Temporary Sett – They consist of 20 teeth only- 4 incisores -2 cuspidati – 4 molares- A pulpy substance contained in a membrane is found in the alveoli before they are cut thro’ the gums, both of which are vascular The membrane from there of the gums, the pulp from the vessell afterwards to supply the tooth – the crown of the tooth is first formed by the deposition of bony matter in the pulp afterwards the fang shoots out from the crown- the membrane deposits the enamel and as the membrane does not extend further than the crown, the fang is not covered with enamel – The cutting of the teeth happens at very various times from 4 months to 14 – those of the under jaw can cut first in general The middle incisores of the lower jaw appear first, then the corresponding of the upper jaw then the lateral ones of the lower, & thus the corresponding ones of the upper jaw – The 256 anterior molares follow next in the same kind of succession than the cuspidati, and the posterior molares last of all according to the order Sometimes the teeth of the upper jaw, are cut before those of the lower jaw, and when the teeth are cut out of order the irritation occasioned is far greater – Dentition frequently produces greater irritation & sometimes even death - John Hunter was the first who properly explained the method of dentition – Eruptions very frequently attend dentition called red gum often mistaken for muscles, convulsions, laying the foundation for hydrocephalus and hemiplegia attend, Digestive organs are very much disturbed – Lancing the gums (with a convex lancet) is an excellent method of relieving these distressing and frequently fatal diseases may be lanced very generally without any ill consequences whatever, as it is well known that new formed parts are more readily aborted than old ones As soon as the temporary set are formed the rudiments of the permanent set are established from a bag which is given off from the pulp of the temporary tooth, which is the embryo of the permanent one – The permanent teeth observe the same order in coming forward as the temporary- They appear in the following order – molares- middle incisores - lateral incisore, anterior bicuspids – posterior bicuspids posterior molares - & dentes sapientiæ- occasionally one or two teeth make their appearance in old age, after most of the others have dropped out – Diseases of the Teeth - The most common cause of injury to the teeth is the deposition of tartar, which appears to be phosphate of lime from the saliva produces ulceration of the gum, & foter of the breath, separates the gum from the tooth Tooth powder should be reduced to an impalpable powder, no acid should be used - 258 as it cuts upon the enamel, charcoal or prepared choak may be used – Caries is the most common disease, beginning within the tooth, molares most chiefly and then the incisores, some persons are particularly liable to caries, sums sometimes to be connected with the digestive organs or their functions – If the cavity be much exposed, the tooth should be extracted, to prevent the very serious consequences that are frequently arising inflammation, irritation & suppuration and even death – have been known to arise from the transplanting of teeth, and in two instances where it was had recourse to, the persons whom the teeth had been planted, had the symptoms of syphilis – it being supposed that the persons from whom the tooth or teeth had been taken, was subjects of that disease Lecture 40th (Green) Common Integuments – Were formerly considered five in number - now divided into Cutis, cuticle and rete mucosum- The cutis vera covers the whole of the body, and enters the cavities, connected by cellular membrane of different lengths and thicknesses, thin on the lips, glans penis &c thick on the head &c It is colourless presents numerous furrows and folds, in a direction contrary to that of the muscular fibres, it is very elastic composed of filaments matted together, closer externally than internally is very vascular and sensible, the shin being a scenting and absorbing surface their pores have been diligently sought for – openings have been discovered for the hairs, sebaceous follicles and for the passage of the sweat, numerous ridges of papilla, especially on the fingers and toes, and parts where feeling is more acute reduced to jelly by long continued boiling The skin in a case of wound or ulcer is reproduced, but possesses less living power 260 and vascularity than the old skin- The insensible perspiration is continually passing off from the body in the form of vapour, and when great quantities accumulate it is condensed into sweat It is supposed 4 ½ pounds of sweat is passing from the skin in about 24 hours- The secretion from the skin and lungs will exceed half the quantity of ingesta- The perspirative matter reddens litmus paper, from containing lactic acid The use of perspiration is to cool the body, and some say to carry off noxious matters – Carbonic acid is given off from the body, or rather the oxygen of the atmosphere uniting with the carbon forms carbonic acid – this secretion keeps the cutis moist, if repressed it chaps - It was originally thought that living in moist places was a cause of dropsy from absorption Absorption does not take place unless the skin has been abraded, or friction been used, proved by many valuable experiments of two French authors- Lecture 49th (Green) Common integuments continued – The cuticle epidermis or scarf skin, covers the whole of the body, and entering the outlets with the cutis it is firmly connected to the cutis, although the rete mucosum internus, serum effused as in blisters is under the cuticle, it frequently put off after fevers &c, also in old people with varicose veins, and diminished energy of circulation, lime water and rolling are good applications, varies in its thickness like the cutis, very thick in the hands and feet corses are thickened cuticle, and in old people care should be taken not to injure the true skin, it is inorganised, and composed of scales Morgagni supposed it was the extremity of the vessels of the cutis, others thought it was the dried secretion of the true skin - The Rete Mucosum- Situated between the cutis and cuticle, discovered by Malpighi 262 The colour of the skin it situated in this mucous membrane – Some have said that the cuncesians have no rete mucosum- although they in themselves differ in colour, it will be reproduced although it does not appear to be vascular its use is not understood – The Nails - Are horny and seem transparent, convex in both directions, divided into neck, body & tip or that part which is not attached, on its inner surface are lamina, which correspond with the surface of the article, it is retained in its situation by the skin, the cutis extends under the nail, but is there more thin vascular and sensible, its growth is its production from the root, the nails serve as defence for the ends of the fingers – Whitlows are often occurring and are situated under the fold of the skin at the root of the nail – The Stain – It is more in quantity in the middle ages of life such hair terminates in a conical point, if it has never been cut, the root is called the bulb which is composed of a tendinous membrane and a vascular one, the hair is hollow, containing an oily or mucous like substance the hair is very strong, in proportion to its thickness, in where wet elongates, therefore forms a very delicate hygrometer, Plica Polonica, a disease called platted hair, a frequent disease in Poland and amongst the inhabitants of Litheranix- Scald Head – Tinea Capitis contagious, minute vesicles appear about the roots of the hair, burst & there form thin laminated scabs, sometimes extending over all the scalp – If much inflamation be present, poultices, and fomentations should be used first, showing the head - Tar and sulphur ointment – Iron- sulph. argent Nit – diluted nitric & muriatic acid The constitution at the same time must be attended to by alterations Tonics &c - 264 The treatment of this disease is very difficult and even after the use of this long catalogue of medicines or remedies, will very frequently not at all yield, but will probably get better either from no application whatever or some very simple one – Navus Maternus mentioned which is a vascular congeries – Guinea Worm Jigger - Lecture 50th H Cline – On the Eye – Is divided into the globe and its appendages – (The cornea transparens, surrounded by the opaque cornea) 1st appendage the eye brows moved by the occipito frontalis, conugator superatii and orbicul. palpeb. 2d. The eye lids – The superior palpebra or eye lid is more moveable than the lower- their union at the corners of the eye, called Canthi where they are connected by a ligament commonly called the tendon of the orbicularis palpebrarum to the nasal process of the maxilla inferior. Under the skin of the eye lids, is a reticular membrane, without adipose substance beneath which is found a thin fascia extending to the edge of the orbit – Orbicularis palpeb. Levator palpeb super Arises from the upper part of the optic foramen, adheres to the periosteum continued over the bull, and inserted along the edge of the upper eye lid – Use draws up the lid - The Palpebra exclude the superfluous rays of light, spread the tears over the surface of the eye, this muscle sometimes becomes paralyzed and the person has to throw his head back to receive the rays of light. The tunica conjunctiva vel adnata – its structure varies in different parts, that part which lines the eylid is mucous, vascular and sensible, the part which covers the ball of the eye, is neither very sensible or vascular – This membrane forms a smooth surface to prevent friction, and by its reflection hinders bodies from passing to the back of the eye – the villous portion secretes a florid protect it from the tears, when extraneous 266 bodies are between the eye and lid, a probe bent and covered with lint is to be introduced, and swept from the outer to the inner canthus - as bodies are by the action of the eye lid, always carried towards the inner canthus - This tunic is very liable to a scrophulous inflammation especially in poor children, which is to be treated by a tonic plan nourishing diet, leeches applied to the neighbouring parts to unload the vessells, but not the general antiphlogistic plan – Vin Opii- Ung Hyd Nit – Agent. Sit ge i Aqua ℥i ♏︎ will each of them form good applications – Inflamation followed by specks on the transparent cornea – Within the lids are found two bodies named super & inferior tarsi, semilunar in their shape, concave before and convex behind – The edges where they touch are thick and are gradually and insensibly lost upon the lid, upon the edges also are found the orifices of several excretory ducts from the glands of Meibonius or glandular ciliares, which when squeezed, give out a fluid like what ouses out of the sebaceous glands as the follicles of the skin This fluid prevents the sticking together of the two eye lids – H Cline thinks it forms a mound or blockade to hinder the tears from running over, when secreted in great quantities The Stye- Is formed upon the lid, sums to arise from an obstruction of the glands of Meibonius which being inspissated, inflames and suppurates – the extremities of their ducts become inflamed, ulcerate & form what is called a blear eye it is scrophulous, the constitution must be attended to – and the Mag Hyd Nit applied at first diluted and then the strong- the eye lids in the morning are found very fast glued together – known by the name of Lipitude – The eye lashes are a double row on each lid, and impede the too numerous rays of light, & shut 268 out the entrance from other extraneous substances on the Tears – The lachrymal gland, is of a yellowish white colour – oval – under the outer side of the orbicular plate of the or frontis several small excretory ducts perforate the conjunctives & from the fluid on the ball of the eye – The ducts in the ox are formed frequently to contain worms – Near the inner canthus are found two small orifices, upon the edge of the lid, called puncta lachrymalia, terminating in the lachrymal sac, situated behind the tendon of the orbicularis, or ligament of the inner canthus a portion extends both above and below the ligament, it is lodged in a depression of the os unguis, from the sac is continued the ductus ad nasum, terminating under the inferior turbinated bone – The tears are secreted by the lachrymal gland, and brought by the ducts into the conjunctiva & globe of the eye and made by them to escape thro’ the puncta lachrymalia, & then are conveyed into the sac from whence by the ductus ad nasum, are carried into the nose – Substances that initiate the nostrils, increase the flow of tears – Sternertatories are useful to thou persons who complain of a day eye- The eye lids of persons who are insensible, are to be kept closed, else blindness is apt to follow the dryness of the conjunctiva occasioned by the exposure – H Cline once saw a case in which there was no lachrymal gland, and very imperfect vision seemed to be the consequence. The Caruncula lachrymalis if examined by a magnifying glass minute hairs are found upon it – It has been supposed that these carunculæ direct the tears into the puncta – A slight fold of the conjunctiva, called valvula semilunaris which is particularly found in fowls and quadrupeds to observe the eye from too strong a light In the orbit is a quantity of adipose substance 270 which being absorbed in old people & produce the sunken Eye- Levator oculi- Arises from the upper part of the edge of the optic foramen spread over the ball- & inserted into the opaque cornea near the transparent one (the upper and fore part) Depressor Oculi – Arises from the lower edge of the optic foramen, and is inserted opposite to the former - Abductor Oculi – Arises from the outer edge of the optic foramen, and inserted into the outer side of the ball of the eye- Adductor Oculi- Arises from the inner side of the edge of the optic foramen, and inserted on the inner side of the opaque cornea Obliquus Superior - vel Trochlearis – Arises from the optic foramen, and inserted into the Tunica Sclerotica – Obliquus Inferior Arises from the anterior edge of the orbitar process of the superior maxilla, and inserted into the tunica sclerotica – If the 4 muscles (Levator, Depressor, Abductor, and Adductor) act together, they draw the eye directly backwards some animals can do this in a great degree but man has this power in a small degree The oblique muscles roll the eye on its own axis – The white appearance of the eye, arises from the tendons of these six muscles, which are inserted round the transparent cornea Squinting sometimes arises from an improper position of the os from some cause or other one of the muscles of the ball, becomes contracted Lecture 51st H Cline- On the Eye Continued – The globe is not or regular sphere, the transparent cornea is more convex than the other part of the globe at the posterior part, but not exactly in the centre or axis enters the optic nerve a little to the inner side – The globe is composed of three tunics, and three humours according to this school, some anatomists teach more The sclerotic – transparent cornea and choroid 272 coat are the three tunics – The three humours are the aqueous, the crystalline and vitreous – The sclerotic is a shining white membrane continued from the optic nerve to the transparent cornea – The opaque cornea is an undefined portion of the sclerotic, which is seen white when the eye lids are open- The tunica albuginea is nothing but the expansion of the tendons of the muscles of the globe inserted on the sclerotic coat – The transparent cornea becomes changed at death, medical men can observe this change to take place a few hours before death – It is a very firm resisting tunic, laminated and composed of flakes, united by a close reticular membrane, when the eye is macerated this tunic falls out entire, it cannot be injected although it is vascular & completely organised, if divided unites by adhesion like other parts of the body, has but very little sensibility but its ulceration proves that it has absorbents – The choroid, which is immediately under the sclerotic, it is a very delicate and vascular membrane, is like a bed for the vessells to ramify on – The arteries are two in number, communicate with the nerve, perforate the sclerotic tunic and ramify on the choroid The veins are five and come out on the sclerotic coat, making several turns as they pass out called vasa Porticosa – The nerves of this coat, and other parts of the eye, come from the ciliary plexus, perforate the sclerotic coat and ramify upon the choroid, and other parts of the eye – This coat when it has reached the edge of the sclerotic coat, is reflected or bent in and forms the ciliary processes, which have a serrated appearance – The ciliary ligament situated at the root of the ciliary processes and attached to the sclerotic coat, at its junction with the transparent cornea & also to the 274 choroid coat- It is better called ciliary body for we do not know that it is ligament The Pigmentum Nigrum – Is so called from being like a black paint or mucous, lining the inside of the choroid coat & ciliary processes It is a fine delicate membrane, probably composed of cells, containing a fine black coloured fluid – The apparent colour of the choroid coat, depends upon the pigmentum nigrum The Iris – On looking thro’ the transparent cornea, we are the colored iris, or the pupil, or the vacuum in the middle, it varies in its colour – In Europeans it is of all colours, from thin mixing with all nations, can only be seen distinctly in the living eye, is supplied with vessells of considerable size, placed in a remarkable manner, coming from the choroid coat, in serpentine lines, freely anastomose round the iris at its connection, and form the Zona Major the smaller edge surrounds the pupil, called Zona Minor – has great power of self motion has muscular fibres disposed in two orders, longitudinal or radiated and circular – H Cline supposes that an elastic ligamentous substance is within the iris, by the relaxation of which the pupil becomes dilated, which state of dilatation he supposes to be a state of rest It has been supposed to be a part of the choroid coat, but in strict anatomy is not - sometimes called uvea but Cline likes the name of his better, because anatomists sometimes call the back part, lined with the pigmentum nigrum only uvea – It has its nerves from the ciliary plexus, and is capable of being dilated from the application of Ext. Belladonna - for which fact we our indebted to Dr Saunders When the eye is diseased and the pupil contracted coagulated lymph is likely to shoot across, and thus completely obstruct vision - The Bellad. relaxes the iris & thus the sight is 276 retained – The pupil in man is round, in the ox, sheep & it is oval which oval is horizontal In the cat kind the oval is perpendicular and can be contracted to a mere line – In the fatus there is no orifice in the iris, filled up by the membrana pupillaris, which is absorbed about the 7th month – The Retina appears like a delicate membrane, under the pigment nig. like a price of ground glass it is an expansion of the optic nerve, lining the pigm. nig. is continued on the lateral parts of the eye, as far as the ciliary processes, supplied by a vessell called the central artery, running thro’ the centre of the optic nerve – In the eyes of quadrupeds there is a beautiful greenish membrane situated at the sides of the optic nerve, between the retina and pigm. nigr. called Tupetum, but no membrane of this kind is observable in the human eye – In carnivorous animals, it is white The crystalline humour or Lens – Is perfectly transparent in the living animal, but when exposed becomes rather opaque, is not spherical but made of two convex surfaces which are united, the posterior more convex than the anterior differing in degree, where these seem to join is called the edge – which is connected close to the ciliary processes – Is of a fibrous structure, it is laminated seen very distinctly when boiled, and can be taken off like the layers of an onion, increases in density towards its centre, where there is a spherical nucleus is surrounded by a membrane called its capsule, containing a little water for the lens to float in, this capsule is vascular it retains the impulsion of the finger - The Vitreous Humour – Appearing like glass, the largest of the three humours surrounded by a delicate membrane called tunica vitrea (ascaris hyaloidea) which like the humour is quite transparent. The tarries 278 sends processes which form cells in which the humour is contained – sometimes the humour will coagulate in alcohol but not often, it is rarely coagulated by boiling water, generally melting In the anterior part is a concavity for lodging the posterior half of the crystalline lens, at the edge of this lens the tunica asanea splits, one part goes before the lens, the other pint behind it, at the edge where this tunic splits it is called the ciliary zone, which is a canal probably formed by the tunica vitrea which is called the canal of Petit – It contains no fluid and its two laminæ, which are closely applied to each other may be rendered distinct by inflation The anterior lamina is sometimes called membrana coronæ ciliaris or zonula ciliaris & has a striated appearance, the eye should be frozen and then dissected, this humour is supplied with blood by an artery that comes along the centre & branches from the choroid coat, we can not make so good a lens as this is one may be made of the same shape, but there it will not be of the same density all thro’ its substance, the crystalline on the other hand is dense in the middle, & becomes less so gradually towards its surface - The Aqueous Humour – Situated anteriorly perfectly transparent water between the transparent cornea and iris, part of it is found behind the iris, before the ciliary processes and crystalline lens, anterior to the iris is called the anterior chamber, posterior to the iris is called the camera port the anterior is 2/3 larger than posterior These camera are lined by a peculiar membrane, containing the aqueous humour from which it is probably secreted it is a complete capsule – Lecture 52d H Cline On the Economy of the Eye – 280 In the first place it will be necessary to consider the light, the rays of which pass in right lines from the surface of all luminous bodies – The sun is 70 millions of miles from the earth, to which the light passes in 8 minutes – H Cline conceives that the light arives at the earth by a force a tergo, and not that an individual ray passes from the sun to the earth in 8 minute the rays of light an reflected from those bodies which in themselves are not luminous, the angle of incidence is equal to the angle of reflection The rays of light in passing thro’ a denser medium are refracted or bent out of a straight line and there in proportion to the density of the medium, it is also refracted in passing from a rarer to a denser medium – The rays in passing from passing from a denser medium to a rarer are inclined towards a horizontal line – On the contrary, the rays in passing from a rarer medium into a denser are inclined perpendicularly this is illustrated by a piece of money in a basin, or post in the water which appears broken, fishes appear nearer to the surface than they actually are, which must be attended to in shooting pike &c - The rays of light passing in various directions, strike upon the retina, in passing from any luminous point, the rays must be brought to a focus exactly upon the retina, which produces distinct vision - when they are brought to a focus either too soon or too late we have indistinct vision - If the light impinges the media perpendicularly, it will not be refracted – At the focus or that point of light at which the rays are converged, must fall upon the retina, if they fall short or go from this vision the light will be indistinct – We do not correct the inversion by habit or couching them as some have supposed, we see young animals who run about as soon as they are born, and 282 never mistake their motion, in either running galloping or sacking – The rays of light crossing each other in the humours of the eye, present the object upon the retina inverted, but this does not affect the mind, some say it is produced by custom, but this is not the case – The density and convexity of the transparent cornea, with the aqueous humour refract the rays first, the crystalline lens bend them inwards still more, no artist can make so perfect a lens, as it regains a lens of different density to make a perfect one – the rays are continued thro the vitreous humour, and thrown upon the retina after having struck the retina, are refuted and absorbed by the pigments nigr, thus where we fancy we see a black body, there is a blank upon the retina. In ferretts and rabbits, that have red or ferretty eyes as they are called, either have no pigm. nigr. or only a colorless one, & therefore the rays are reflected thro’ the pupil, this occurs in the human eye sometimes, and in such persons vision is indistinct in a strong light, from the dazzling in the eye occasioned by the rays being reflected, & passing out at the pupil, the iris is intended to prevent a too great number of rays, from entering the lens, & dilates when they come to the eye in too great a number – the graminiverous animals have horizontal pupils, & can easily see behind them to elude their pursuers- In carnivores animals the pupil is perpendicular, by which the animal is assisted in seizing his prey – Short and long sight depend upon the difference in the convexity of the transparent cornea – The sense of seeing may be improved, as well as the other senses – A butcher thinks he is a blockhead if he cannot tell the weight of an ox to a few pounds Persons who have a convex cornea, are found to be short sighted, the rays being brought to a focus too soon, there is a natural short sight, & what is brought on by continually viewing small objects, as watch makers &c - Some persons have 284 their eyes of two different focal distances – when the cornea is too convex, wear a slightly concave glass and vice versa, short sighted people have their vision elongated by the cornea in old people becoming less convex, some persons see things very quickly, others require the object to remain some time before them, some can see object at a great distance with great accuracy. H Cline relates a case of the Men in a boat at sea – There is an insensible spot upon the retina, supposed to be the part when the central artery enters thro’ the optic nerve – The focus must be upon the retina to produce perfect vision, but the eye has the power of adjusting the focal distance, which is produced by an effort. Dr Hunter by marking experiments upon himself, found that by an effort of the mind viz, he fancied he saw the Sunny Hills, this gave him no pain, (he was laboring under ophthalmia when he tried the experiment) Des Cartes supposed that the lens was a muscle and the ciliary processes its tendons- Dr Young holds the same opinion with respect to the muscularity of the crystalline lens, others think the adjustment depends upon the ciliary processes, & other that the ciliary zone has the effect – Belladonna has [cross out] not only the power of contracting the iris, but also that of dilating the pupil, but for a while to destroy the power, the eye has of adjusting itself to the various foci – This power of adjustment has been supposed to arise from the convexity of the transparent cornea being increased or diminished. H Cline supposes it to be managed by the vitreous humor, he conceives that it has a power of self-motion which may startle many probably, from concurring that motion depends only on fasciculated structure. Hydatids have evidently the power of self motion, & an only composed of a delicate membrane & fluid, also some of 286 the zoophytes when the vitreous humors is taken out after death, neither mechanic or galvanic stimulus, by experiment stimulates the iris in the same way – could not be affected by any mechanical stimulus, but the galvanism produced slight motion in its fibres. According to this theory of H Cline, the vitreous humour has the power of contracting and as it were in part of expelling the Lens & thus of adjusting the focal distance, by increasing the distance from the lens to the retina The eye loses the power of adjustment in old age – Objects do not appear double, altho we have two eyes, as long as the eyes look both in sight lines, but if one bends out of the cornea, we then see two objects at once, people who squint from birth only see one object – Dr Saunders – treated the Egyptian ophthalmia with bleeding and the antiphlogystic plan, and found it generally successfull, others who held a different opinion treated it in the opposite way, by tonics and stimulants this is followed by a thickend state of the conjunctiva – The Gutta serena In generall not much relief is to the obtained but when it arises from an excess of the humors it may be relieved by the depleting plan Dropsical state of the eye from too great an accumulation of the aqueous humour - Lecture 53d (Green) On Taste – The tongue and salivary glands with the cheeks – The lips are extremely vascular the cutis vera with numerous papillæ, attached by a fold of lining membrane to the jaws, the angles are called the connissures – The cheeks, the vascularity depending or capable of being increased by the mind, under the integuments there is a quantity of feel-glands, at the edges of the lips called labial glands, on the cheek and velum to secrete mucous, thought by some to secrete the saliva, are situated under the membrane – The lips are subject to cancer 288 the lower lip chiefly, appearing at first like a crack or pimple, a small crust is formed on the surface, this falls off, and an ulcer is observed - appearing sloughy, edges hard, everted & irregular not much pain in general altho’ at times severe darting pains are felt and bleeding – extending thro’ the whole lip into the cheek – the bone is affected as well as the glands becoming hard – The only treatment is the removal of the diseased portion if not removed before the glands are affected will be of no use, to remove it two incisions are necessary to meet – Ulcers - Sometime appear on the lips very much like cancerous sores, these generally arise from disorder of the digestive functions - alterative medicines must be used and stimulating applications to the part, no application so effectual as arsenic, in proportion of ʒi to ℥i of cerat. Calum. and Opii ʒi ♏︎ applied to the part until it sloughs, the actual cautery is sometimes used – the Tongue – Attached at its base to the os hyoides, divided into base, body, and lip or apex the body is divided into dorsum, & raphe, its under surface the edges or sides – It has several muscles inserted into the substance of the tongue is plentifully supplied with blood, there is no anastomosis between the arteries that supply it from each side – The Papillæ on the cutis or surface of the tongue, are divided into three kinds, capitatæ, lenticulous, and conicæ, the first a good deal like mushrooms, and situated on the back part of the tongue, the second like the top of bell glass on the middle of the tongue & the third like small cylinders with round tops – on the tip – It is also well supplied with mucous follicles especially at the back part- The frænum is sometimes so short as to require being divided – is frequently divided when it is not necessary, and produces swallowing of the tongue as it is called, often producing death by suffocation, in cutting it 290 the lingual arteries may be wounded – When the division is necessary it is very evident as the tongue cannot be protruded beyond the gums, and the child sucks badly – Wounds of the Tongue - Caused by being bitten thro’ in epilepsy, must be kept in contact by sutures, the lower jaw to be kept applied to the upper, and spoon victuals only allowed – great bleedings are sometimes accompanying their injuries, are to be remedied by tying the lingual arteries if common means fail. M Green advises the actual cautery – Cancer attacks the Tongue - appears like a hard schirrous tumor, or like an ulcer with the usual appearances of cancerous sore, and proceeds in the usual way - with laminating pains and bleedings – The only methods offering a chance of cure, are either by ligature or the knife, when the disease is at the lips, the ligature can easily be applied - Inflamation sometimes attacks the The Tongue, Leeches may be applied, if not sufficient a longitudinal incision may be made to evacuate a large portion of blood The tongue is subject to œdematous enlargement a bandage may there be applied, if neglected a solid deposit will be made, and dangerous symptoms follow – Ulcers on the tongue like to Cancers are sometimes observed, arising from disorder of the digestive organs, the same treatment as to ulcers of the lips will be found of use, leeches and narcotics (Conium) borax & honey ʒi to ℥i – The Parotid gland Situated to the zugoma downwards to the angle of the Jaw – The duct passes from the masseter, & perforates the Buccinator near the Molar Teeth – this duct is sometimes wounded, which requires the particular treatment as described – this gland is subject to a peculiar inflammation called mumps contagious when this infln recedes, the breast 292 In females is affected, & the testicles in the male is the subject of cancer – The submaxillary gland, situated under the lower jaw, its duct terminates in the franum of the tongue, this duct is subject to a disease called ranula, the duct is obstructed & the fluid is collected – the tumor must be opened, & the surface of the sac rubbed with lunar caustic – if not attended to, the tumor becomes hard by being repeatedly filled with solid matter calculous concretions are forming in this duct The sublingual gland under the tongue, its structure like the others Lecture 54th (Mr Green) On Smelling – The nose is divided, into radix base, dorsum, alæ, columna and nostrils, the upper part is bony -& the lower part cartilaginous 5 in member – The septum has two laterals cartilages and two forming the opening of the nostril Sebaceous follicles are very numerous about the nose, the internal nose is divided into cavities The internal membrane of the nose is known by the name of sneiderian & is one of the mucous kind it is soft and spongy in its texture, especially when covering the turbinated bones, it is of a redder colour than other mucous membranes, furnished with mucous follicles to lubricate the periosteum It is very vascular, and very plentifully supplied with nerves, from the olfactory and 5th pair, pass between the membrane and the bone – The vessels are situated superficially therefore hæmorrhages are frequently occurring both of an active and passive kind Descriptive cause and treatment of Epistaxis in the robust and young styled active hæmorrhage Passive Hemorrhages are frequently connected with visceral complaints especially of the Liver – it is most effectually checked by applying dossills of lint wetted in the Ol Turb Rectif - 294 if this should fail, both the anterior and posterior openings of the nose, are to be plugged up with lint, by passing a small bougie into the back part of the nose, & drawing it thro’ the mouth &c. Polypus – Generally adheres to one or other of the turbinated bones – chin sometimes from the Eustachian tube, or antrum maxillaee, description and made of extraction or cutting thro’ the neck of the polypus – Cysts upon the membrane of the nose called Hydatids In old people there is another form of Polypi called Cancerous, but being of the nature of fungus hæmatodes, have a purple hue, readily bleed, and are very painful at times, all that can be done, is to mitigate the sufferings by narcotics, tonics, and nourishing diets, occasionally occurring in younger persons 30 et al - The membrane occasionally forms a pouch, in which a fluid is effused, requiring the use of astringents &c - the posterior Ethmoidal cells opening into the upper and back part, about the superior turbinated bones- the anterior ethmoidal cells in common with the frontal cells below the superior turbinated bones into the middle chamber of the nose, the opening of the antrum maxillare is into the middle chamber of the nose, or between the two turbinated bones The ductus ad nasum - The opening is under the inferior turbinated bone, these cavities are lined by the membrane of the nose, all of which are subject to inflammation - Frontal sinuses – antrum maxillare arising from decayed molar teeth – Opening into the fauces The velum, the uvula, and pillars of the fauces, formed by the doubling of the lining membrane – Tonsils – studded with opening leading to a cellular cavity, from which mucous is secreted, liable to inflammation relived by being freely scarified, blisters, and antiphlogystic plan, sometimes terminates 296 in suppuration – are also subject to chronic enlargement, astringent gargles to be used, & touched with arg. nit. cup. sulph solut in the mouth and spit out - It will be necessary if these fail to remove it, either by ligature or the knife- the application of the ligature is very difficult and there seems no great objection to the use of the knife, as no considerable hæmorrhage has ever been known to be produced by it – The Pharynx – Situated at the back of the mouth, lined by membrane – It has seven openings - two for the nose separated by the septum two for the eustachian tubes, one for the mouth one into the larynx covered by the epiglottis, and one into the asophagus, lined with a mucous membrane - Thyroid Gland – Situated at the upper part of the trachea, compound of two lobes of a reddish brown colour, when cut into appears granulous or cellular, is very vascular its use is not known, but supposed to be of use use before birth, it is liable to infn which often goes on to suppuration- Bronchocele is a gradual enlargement of this gland, occurs in mountainous countries, in women more than men, when cut into appears composed of cysts spilled with fluid, burnt sponge has been generally recommended, but there does not appear to be much reliance to be placed upon it – It is also subject to schirrous which is harder than bronchoecle, painful and occurring late in life – The inflammation of the thyroid gland should be treated by active means, as the matter has been known to burst into the trachea, should therefore be opened early – It is said to be scrophalous but this has not been proved as the general health is never impaired - An Italian physician has recommended that a seton should be passed thro it, one of the lobes is sometimes filled with a fluid, & contained in a cyst – as in hydrocele- 298 Lecture 55th (M. Green) On the Ear – The organ of hearing is divided into the external and internal ear – The external or auricle, is distinguished into the pinna and lobus The pinna is the whole superior part, the round margin of which is called the helix, with a projection within called the anti-helix, encircling the concha – Tragus or small eminence lying over the meatus, and connected to the under and fore part of the helix – Anti–tragus, opposite the former, less considerable below the inferior extremity of the antihelix – Fossa innominata situated between the helix and anti-helix – Scapha Situated between the two divergent extremities of the anti-helix – Concha – Is a large cavity bounded by the helix, tragus, anti-helix – and anti-tragus The cartilage gives the form to the Ear, covered by the common integuments, having numerous sebaceous follicles, the cartilage is covered with muscles, which are small and indistinct they are the Helicis Major – Arises from the anterior acute part of the helix upon which it ascends. Inserted in to the helix – Helicis Minor From the under and fore part of the helix Inserted into the helix near the fissure in the cartilage opposite the Concha - Tragicus Arises from the middle and outer part of the concha, at the root of the tragus, along which is runs Inserted into the point of the tragus – Anti-tragicus- Arises from the internal part of the anti-tragus – Inserted into the tip of the antitragus – Transversus Auris – Arises from the prominent part of the concha – Inserted into the outside of the anti-helix – The action of these muscles is indistinct, chiefly placed about the concha The external ear is sometimes defective, and the meatus covered by a film of skin- The meatus auditorius externus, beginning at the concha, and terminating at the tympanum 300 one inch in length, it is chiefly tortuous in its course and is formed partly of cartilage, and partly of bone lined by the common integuments, & terminating very thin upon the membrana tympani, numerous sebaceous follicles are also observed & small hairs An external defect of the ear, is generally connected with internal malformation, & therefore nothing is gained by making an artificial opening – When there is inflamation of the membrane, the meatus is inflamed, producing ear ache about the situation of the ceruminous glands, the canal being bony great pain is experienced – The ceruminous glands – Situated at the upper & back part of the meatus, covered by integuments, whose ducts terminate in the meatus – The cerumen it is unlike wax, is soluble in warm water, & when inspissated produces deafness – Extraneous bodies sometime get into the meatus, are to be removed with as little violence as possible – Inflammation of the membrane [cross out] in the membrane lining the meatus produces ear ache – Internal Ear The internal ear comprehends the tympanum the labyrinth, and certain passages connected with these – Membrana Tympani- Is a their strong membrane, oval placed obliquely, fixed in the groove of the bones, concave a little towards the meatus externus, formed of the cuticle externally, and periosteum internally, with its proper membrane intervening Sir C Home – Dissecting the membrane in the elephant, was led to think it was muscular, supplied with vessels which seen in a radiated direction - Tympanum – A cavity of an irregular form, situated in the petrous portion of the temporal bone, above the glenoid cavity within the membrana tympani, and outer side of the labyrinth, there are several openings into the tympanum. 302 The fenestra ovalis, both sides convex upwards filled by stapes, bounded by the promontory below - Fenestra rotunda, situated at the under and back part of the promontory, Eustachian Tube – Is situated at the inner & fore part of the tympanum, terminating at the upper part of the pharynx 1 ½ inch in length, expanded below, upper third compound of bone, the lower two thirds of cartilage, a canal from the throat to the tympanum for air – An opening at the back part of the tympanum, communicating with the mastoid cells – The tympanum contains four small bones, called ossicula auditus- are the Malleolus, Incus, os orbiculare and Stapes - The Malleolus has its head supported by its neck a handle or manubrium its two processes, gracilis and brevis – The Incus, a thick body, with two lateral sinuses, forming a cavity for the malleus has two cuera – Os Orbiculare – attached to the extremity of the incus, is less than a Millett Seed Stapes – placed horizontally, its base is in the fenestra ovalis, has two auras, base, head like a stirrup- These bones are very dense, are moved by the following muscles – Tenso Tympani - Arises from the cartilaginous portion of the Eustachian tube the fibres are collected into a long round muscle, that passes thro’ the canal above mentioned, and enters the tympanum by a slender round tendon- the tendon issuing thro a small aperture at an obtuse angle to the line of the muscle, makes a turn towards the manubrium of the malleus – Inserted into the manubrium of the malleus a little below the long process – Levator Membrana - Tympani Arises from the extremity of the spinous process of the sphenoid bone, and from the Eustachian tube, takes its course backwards and outwards towards the glenoid fissure. Inserted by a short tendon into the long process of the malleus – Stapedius – Arises from the cavity of the 304 eminentia pyramidalis in which it is contained, it has a very short tendon, which passes thro an opening in it. Inserted into the posterior part of the neck of the stapes – The tympanum is lined by periosteum, which becomes at times inflamed, producing great pain & delirium to be treated by active measures, but generally terminates in suppuration, ulcerates & produces irremeadible deafness – Fungous Polypus has been removed from the ear - Lecture 56 th (M Green) On the Ear- Contd – Labyrinth consists of the vestibule, the cochlea, & the three semi–circular canals – Vestibule, has to the outer side the tympanum to the inner the meatus auditorius internus, anteriorly the cochlea, behind the semicircular cancels. The shape of the vestibule irregularly spherical it is about the size of a grain of barley, there are several openings in it which communicate with the neighbouring parts, to the outer side the fenestra ovalis, but which is dosed as, has been before described, an opening into the cochlea, called aquæductus vestibule – Semicircular canals, 3 in number behind the vestibule 1st superior or vertical canal 2d – oblique or semicircular canal, 3d exterior or horizontal canal, all terminating in the vestibule & are enlarged at their termination elliptically – The 1st has one above distinct, one below in common with the 2d – the 2d has one below, & one in common with the first, the third has one above & one below distinct – Cochlea – Is so named from its resemblance to the shell of a snail – placed anteriorly to the vestibule, & before the meatus internus & has it direction obliquely downwards and outwards so that its base is towards the meatus internus, with its apex facing outwards – The cochlea is constructed with a modiolus or central pillar, around which are wound a spiral tube & a spiral lamina lying within the spiral tube 306 and dividing it into two canals – Begins at the vestibule, makes two turns and a half round the modiolus, and terminates in the infundibulum at a hook like process called processus amulus By the aid of the membrane, the lamina makes a complete septum, and divides the spiral tube into two canal, one of which is called the scalæ tympani, from its having an aspect towards the tympanum, the other the scalaæ vestibule, from its communication with the vestibule – A small passage called aquaductus cochleæ, these cavities are lined by a diluent periosteum, & a pulpy membrane containing a fluid, upon which membrane the auditory nerves are ramified – of the œconomy of the Ear – Sound is not a material substance and is the result of the vibrations of bodies – The vibrations are continued from vibrating bodies by the elasticity of the ear - no sound is produced by a bell in an exhausted receiver, shewing the necessity of a medium, sounds are very indistinctly indistinctly heard on the tops of mountains – Water has the power of conveying sound tho’ indistinctly solid bodies in some measure will propagates sound – Sound travels 1061 english feet in a second calculated at Paris – Reflections if distinct produce Echo- whispering galleries must travel or an ellipsis – The concha collects & reflects the sound in the meatus audit ext. assisted by its torturous course, agitates the membrana tympani effected by the air rushing in from the eustachian tube – The ramification of the auditory nerves upon the pulpy membrane are found to be necessary, as the examination made upon animals, all exhibit this appearance – Obstruction in the eustachian tube is a cause of deafness – from enlarged tonsil from a collection of mucus in catarrh, siphilitic ulcer a hole in the membrana tympani, produces very inconsiderable deafness – Mr A Cooper in persons who are deaf, from obstructed eustachian 308 eustachian tube, found that opening this membrane relieved the deafness very much – Tshe causes of deafness, are generally supposed to be nervous origin then persons complain of sounds in the ears – Mr. Saunders found that incipient cases might be relieved by the antiphlogistic plan- Mr. Cline in examining the ear of a person who had been deaf from birth, found the fluid contained in the pulpy membrane was careous – Mr. Green inspected another case of the same kind, in which there were no morbid appearances - Lecture 57th (M Green) On the art of making preparations - Its use in preserving natural and morbid parts Two methods are used the wet & the dry – The fluid used in the wet is Sp. V. R. The method of injections were first induced, about the end of the 19th century by Harvey who used water coloured or ink- A Dutch Surgeon afterwards used melted tallow, introduced into England by Dr. Nichols which at first was objected to – the materials used are various, resin, wax, tallow, oil, &c - Injections are divided into coarse, minute, and mercurial – for the coarse – bees wax and resin of equal weight, & as much Sp. T. R. as will make it of proper consistence to support its own weight, & not to snaps when struck upon The fine–size colored for their purpose is the best, for the arteries red, for the veins vellow coloring matter should be finely powdered, bright & light – The red usually is vermilion The yellow – Kings yellow – blue prussian blue is the best – and indigo for the green – verdigris which should be of light hue as it grows darker for the black – lamp or ivory black for the white – For common purposes amaethon pipkin is as good as any thing it should be constantly stirred – For preparing the subject adapt a pipe to the size of the vessell, and plug the orifice, put the subject into hot 310 water – If heat is not at hand, red lead and linseed oil mixed to the consistence of a paint, and there thinned with the Sp. T. R. – Mercurial injections are used for very minute vessels - Dried preparations – A young liver subject without any feel left about, a male is better than a female, hollow parts, as the bladder or intestines distended with air, uterus stuffed with horse hair, these preparations should be dried as quick as possible, by being exposed to a free current of air, when dried, they should be varnished with a spirituous varnish there or form coats thick – Wet Preparations – If the colon is to be preserved, should be immediately put into Sp. V R. fort. being first passed thro different soakings in water; Delicate preparations should have rectified spirit, proof spirit will do for bulky ones – Ask at a glass shop for a Surgeons tyover, which is to be suspended in the glass, and covered over by a bit of macerated bladder, then place a bit of milled had and another piece of bladder, both of which are to be tied tight round the neck of the glass, then painted or varnished over - Sp. Terrb. Rectip is used, when the colon is to be preserved for a preparation – Preparations of the bones – should be made from persons of middle age, first soaked in water and there bleached – Lecture 58th (M Green) The Brain – The membranes are three - Dura Mater – Pia Mater, and Tunica Arachnoides called menanges – Dura Mater – adheres very firmly to the calvarium, appears rough and cellular serves as a periosteum internally to the bones of the head, it is extended into the vertebral canal its internal surface smooth and unconnected, except at the falces, lubricated by a serous secretion The cavity between these two membranes extends not only over the surface of the brain 312 but likewise along the whole length of the spinal marrow- The structure of the dura mater is dense, firm, and tendinous like – has no regular laminated structure, tho’ some anatomists have described its layers – It is not very vascular but supplied by a branch of the submaxillary artery vertebral, and internal carotid, The Veins return the blood, & found exterior to the arteries The Dura Mater sends off many processes – First called falx major, arising from the crista–galli and continued in the direction of the sagittal suture, and attached to the process at the back part of the os occipitis, formed by two layers of the dura mater, terminating in a curved edge between the lateral lobes – it is sometimes wanting, without any inconvenience being produced and is sometimes so narrow as to be of no use Tentorium- or two transverse processes, attached behind to the horizontal spine of the os occipitis and petrous portion of the temporal bone, and to the posterior clinoid processes of the sphenoid bone. The processes tho’ called transverse, give a tense covering to the cerebellum, rather in the form of an arch or vault, which is supposed to defend it from the pressure of the cerebrum superincumbent – Inferior Process or Falx extending from the under part of the tentorium to the perpendicular spine of the os occipitis dividing the two lobes of the cerebellum – In the dura mater, are found the returning vessells of the brain, they are triangular and have no valves – The superior Longitudinal Sinus – Begins at the crista–galli, extending along the upper part of the falx, & terminating in the lateral sinuses, opposite to the tuberosity of the os occipitis – on opening this sinus, are seen the opening of the veins of the pia mater, near which are seen small bands called chorda Willisii, and little bodies called glandulæ Pacchioni, the veins of the pia mater 314 run in a direction, to meet the current of the blood in the sinus – Lateral Sinuses – Extending from the extremity of the longitudinal sinus, along the groom of the occipital bone, & over part of the parietal, & terminating in the internal jugular vein - Torcular Herophili – Obtained this name from the exploded notion that the blood is squeezed as in a torcular or wine press – It is formed by the vena magna galeni, passes downwards and backwards, & terminates in the left lateral sinus. There are the four which are important, with respect to the size and function The others have been thus enumerated 1st Inferior longitudinal sinus 2d Circular Sinus (of Rielly) 3 Cavernous sinuses 4 Superior Petrosal Sinuses 5 Inferior Petrosal sinuses 6 Occipital Sinuses – In Green's manual for the particulars of these sinuses The dura mater is next to be raised in order to display the tunica arachnoides- Tunica Arachnoides Situated between the dura & pia mater has its smooth surface opposite to that of the dura mater, connected to the pia mater by the reticular membrane – Bichat conceived it to be a reflected membrane, & like the other membrane in structure and function, he opposes it to be reflected upon the dura mater – Pia Mater Situated immediately under the arachnoid membrane – It is extended not only over the whole surface of the brain entering also into its layer divisions, but dips in between the convolutions quitting the tunica arachnoides, and envelopes each eminence and depression of its surface It is also continued into the interior of the brain in order to line its different cavities forms a bed for the vessells of the brain appears to be nothing more than a network composed of vessells and reticular web – Its texture is tender, it varies in thickness and consistence at different parts – The larger branches of vessells derived from the base of the brain, take their 316 course thro’ the pia mater, ramify and divide minutely, so as to form an intricate network of vessells from which minute branches only penetrate the substance of the of the brain - Lecture 59 (M Green) Brain Continued - The brain includes these different parts – Cerebrum, Cerebellum & Medulla Oblongata – Cerebrum – Is divided into two hemispheres by a longitudinal fissure, and each divided into three lobes, the surface is separated by many convolutions – On separating the two hemispheres we see between them the corpus callosum which connects the two hemispheres – upon the corpus is the raphe and transverse striæ – upon making a section above the ventricles, the centrum ovale is observed this section likewise shews the two substances of which the brain is principally composed – The darker substance on the outside is called the cineritious from its greyish or ash colour or cortical from its surrounding, like a bark, the inner parts of the brain – The inner substance is called medullary it is white in colour, and much more abundant The lateral ventricles will be laid open by cutting down on the sides of the corpus callosum, on opening which are seen the corpus striatum plexus choroides & thalamus nervi optici - The ventricles are separated by the septum lucidum, which is seen by gently raising the corpus callosum, it is broad in the middle narrow posteriorly and anteriorly, connected above to the corpus callosum, below and behind to the fornix, anteriorly to the curved part of the corpus callosum – Septum – Is formed by two thin medullary layers, between is a fissure called fossa sylvii or by some the fifth ventricle – corpora Striata – Are two pyriform bodies of cineritious colour, one situated in each ventricle – They are placed obliquely, their narrow extremities being situated backwards, & on the outer side of the 318 thalami nervosum opticorum, their anterior or larger extremities placed forwards – Thalami Nervosum Opticorum – Are two bodies of a white colour they are situated behind the corpora striata & to their inner side; They appear of a rounded figure, are larger behind than before, anteriorly they are lengthened, become narrower and conveys Tænia Semicircularis – In the groove between the corpora striata & thalami, a medullary band is seen on each side - The ventricles are extending by three cornua - the anterior posterior & inferior or descending – the anterior bending forwards & outwards, the posterior extending outwards & backwards upon the inner side of which is the Pes Hippocampi Minor or eminentia Digitalis - the inferior or descending cornu, forming a considerable bond, & then turning forwards towards the sella turcica, a projection on its inner side called Pes Hippocampi Major – Hippocampus Major or cornu amonis, in this cornu is seen the plexus choroides, on the inner side of the cornu amonis is seen the Tænia Hippocampi or fimbria hippocampi- Plexus Choroides, is a vascular fold of pia mater partly covering the thalami nervosum opticorum, & continued backwards upon them Fornix – Is situated beneath the septum and forms a vaulted covering to the third ventricle, from which it has received its name – on cutting thro and raising the Fornix is seen the Vena Magna Galeni, formed by the veins of the plexus choroides and terminates in the Torcular Herophyli, sometimes two are found – The upper border is convex the under concave, striated in its under surface rounded anteriorly, and divided into two processes called cornua, terminating in the Eminentia Mammillares in the base of the brain – Two crura proceed posteriorly from the fornix, & terminate in the cornua of the lateral ventricle Between the two Thalam. of. Opt. is the Third 320 Ventricle – In this ventricle are the three commissures commissura mollis, connecting the two Thal. N. Oph. commissura anterior extending transversely - Commissura posterior- is a small transverse band of medullary substance at the upper and back part of the ventricle, above the iter a tertio ad quartum ventriculum – Two passages – one the ad infundibulum, as it had anteriorly to the infundibulum – 2d The a tertio ad quantum ventriculum this opening is at the posterior part of the third ventricle – Pineal Gland – Is a small body, ovoid placed upon the corpora, quadrigemina & of a dark cineritious colour, situated near the inner and upper part of the third ventricle, has two peduncles, within it or near it is found a yellow hard semitransparent substance made up of rounded grains called by Soemmering acervulus cerebri – In four cases of insanity inspected there were none of these grains found - Corpora Quadrigemina – consist of four rounded projections projections - The two upper called the nates – the two lower the Testes – these support the Pineal Gland & form the upper part of the Aqueduct Sylvii – They are situated between the posterior extremities of the thalami, below the pineal gland anterior to the cerebellum & above the crura cerebri composed internally of cineritious substance - Lecture 60th (M Green) The Base of the Brain – Is divided into three lobes, (some reckon two) an anterior – a middle, divided from the anterior by the fossa Sylvii, and a portion resting upon the tentorium – In the middle are the crura cerebri, between which is a depression Between the crura which forms the floor to the third ventricle is the eminentiæ mammillares infundibulum, pituitary gland, and the origin and junction of the optic nerves – Cerebellum The cerebellum is divided into two lobes – The Processes Vermif. Inf. is under the cerebellum & between its lobes, in the cerebellum there is a cavity called 322 the fourth ventricle – At the under part is the pons Varolii, a process of medullary matter extending over the crura cerebri, & base of medulla oblongata Medulla Oblongata – Extending from the cruciform process of the os occipitis to the atlas – Is has two pair of eminences the corpora pyramidalia and olivenia - The number of the cerebral nerves has been variously estimated from different views of the division of the brain from considering some nerves now as separate, now as parts of other – These may be said to be clever pair – 1 Olfactory- 2 Optic 3 common Oculo muscular or motores oculorum 4 Inner oculo muscular or Pathetici – 5 Trigeminal – 6 Outer oculo muscular or abducentes – 7 Auditory – 8 Facial – 9 Glosso pharyngeal – 10 Pneumo gastric or par vagum 11 Lingual – The Fourth Ventricle – in the ventricle of the cerebellum – It is of a triangular figure of which the base is placed anteriorly – The base is continued without interruption into the calamus scriptorius - Its interior surface consists of medullary substance substance, which continuing anteriorly to the corpora quadrigemina, posteriorly to the medulla oblongata inferiorly & laterally to the pos Varolii spreads itself in the inferior in an arborescent manner In the middle of the medullary substance of each hemisphere, placed rather inwards is a long, rounded firm, vascular body, internally medullary surrounded by a cineritious border, which has numerous forked projections, it is called the corpus rhomboideum- Lecture 61st (A Cooper) Male organs of generation - Scrotum Compound of common integuments, passing from each side, and uniting at the raphe, extending from the franum to the anus, the scrotum & perinæum supplied with blood, from the external & internal pudendal arteries – The external pudendal is divided in two operations, Castration & inguinal hernia in the first it need not be taken up till the end of the operation, in the last should be 324 taken up immediately – The veins terminate generally in the femoral vein & internal pudendal vein – The absorbents are easily injected, and mercurial ointment is easily absorbed when applied to the scrotum- The scrotum is subject to diseases principally the chimney sweepers cancer – the soot received in the folds of the scrotum, has the power of producing a specific disease, shews itself at first like a wart, but if roughly handled bleeds then has an encrusted surface, under which it is found ulcerative, which quickly extending becomes furyous, & has the everted edges which cancer usually puts on – The absorbent glands of that side become affected, & death is brought on by the glands ulcerating, & opening into the neighbouring vessells, this disease is very vascular, & after the removal of the diseased part, bleeds freely – The raphe is supplied with numerous follicles, discernable only in disease, & the discharge from there is sometime very difficult to cure, & when corner astringents fail, an infection must be thrown in by the same way as in the puncta Lachrymalia & when this fails the testicle is to be laid open The skin of the scrotum may be ulcerated differently from that of the chimney sweepers cancer, arising from the foul state of the bowels and imitation about the anus – The yellow wash should be used, & the Pil Plummer or Hyd e cret taken – The chimney sweepers cancer will form in other parts of the body when the skin is wrinkled as in the face & thigh If the diseased part is removed early, before it has extended by absorption, the disease may be cured, or an enlarged gland may be removed from the groin – The scrotum is subject to a disease called Elephantiasis, and affecting the loose cellular membrane & there is an effusion forming a solid matter which constitutes the disease – It occurs in west Indians generally in those from Barbadoes. AC. once saw 326 some appearance of muscular fibre, & that was in a Negro- In removing the diseased parts in its usual form, it is necessary to have sufficient skin to cover the testicles – A muscle called Dartos is said to exist in the scrotum but AC says he never found one, & its action is not like that regular action produced by muscular fibre. On the inner side of the scrotum, there is a loose cellular tissue, connecting it to the coats of the Testicle, there is a septum in the middle of this tissue, air thrown in on each side does not meet – Testicle – on opening the tunic vaginitis testis, we have the testicle exposed, within this cavity in the living body is a habitus in the dead body this is condensed at in the other cavities of the body – The testicle is situated obliquely, the posterior extremity is lower than the anterior – The epidydimis is of a semilunar form, & attached to the outer side of the testicle – The Tunic Vag. Testis is a reflected membrane & therefore the testicle is behind it – The use of the S.V.S is to elude the pressure from the thighs, & to give it facility of motion – It is liable to disease. Hydrocele in which some cartilaginous bodies are sometimes connected Is liable to a collection of extravasated & coagulated blood arising from blows &c The situation is the same at the water in Hydrocele there is one portion of the testicle not covered by peritonæum – Effusion of water will sometimes take place between the inner portion of the tunic albuginea – the reticular membrane is easily filled with mercury Spermatic Chord – This is covered below the ring by an expansion of the external oblique and when hernia descends it is behind this tendinous expansion, & this expansion forms a bag for the hernia – The cremaster muscle is derived from the lower edge of the internal oblique & transversalis, descends thro’ the abdominal ring, covering at first the fore part 328 of the chord, afterwards surrounds it, and is inserted into the tunic vaginal, on its outer side, then is sometimes a voluntary muscle, to draw up the tunic and with it the testicle – The chord is composed of the spermatic arteries, they arise from the fore part of the aorta, between the superior & inferior mesenteric arteries, pass out of the abdomen at the opening of the fascia transversalis turns inwards to the inguinal canal, in passing out of the internal ring it is external to the epigastric artery passes forwards out at the external ring, & descends to the testicle – The spermatic veins begin from the testicles, pass along the chord as far as the abdomen, & then separate, the right terminates in the vena cava, the left in the left emulgent veins – The Vas Deferens is distinct from the artery, and situated behind half – an inch, arising from the posterior & lower extremity of the testicle enters the abdomen by the two rings, separates from the artery & vein, descends into the pelvis by the side of the bladder, & then to the posteriors part of it, & is connected with the duct of the vesiculæ seminales, & these ducts united pass thro’ the prostate gland, & terminate in the urethra, the vas defer. has an artery distinct from the spermatic, arising from the internal iliac artery, must be secured in the operation, all these are covered by two coats of the peritonæum, a proper & a reflected covering – The chord as it passes out of the internal ring, derives a tendinous covering which descends with it into the scrotum In the operation for castration, the vas defer is not to be included in the ligature passed round the artery and vein, to prevent its retraction, should be recurred before the operation is proceeded with – H Cline Surn Case In which a gentleman operating neglected to secure the chord and it retracted, & the abdominal ring was of necessity slit up - The artery of the Vas Deferens 330 is found closely applied to the vas def. in its descent and in the operation of castration requires taking up- A branch of the epigastric artery also descends upon the chord – Lecture 62nd A Cooper Male organs of generation continued Testicle - Tunica albuginea being act open, the seminiferous tubes are exposed, this tunic is of a tendinous structure, very much like the dura mater A fluid is sometimes effused between the dose covering of the tun. vagin. testis & tunic albug. which is found in cysts, the epidydimis is not covered by this coat, having a coat distinct from the testicle – The spermatic artery is serpentine in its course, especially near the testicle, it then ramifies upon the tunic albuginea, & from thence sending of minute branches into the substance of the testicle, like unto the brain – In the horse ram & bull, the spermatic artery makes many convolutions, before it comes to the testicle The Veins arise from the extremities of the arteries, form a plexus upon the epidydimis & before they arrive at the ring by in to meet to form the spermatic vein, before which they freely communicate – The veins sometimes become enlarged, & have the name of Varicocele, generally occurs on the left side for the left vein terminates at right angles with the emulgent vein, & thus obstructs the entrance of the blood, should be frequently washed with cold water, & a bandage to be applied, no tightness about the abdomen liable to be mistaken for hernia, you feel it composed of a number of cords, & by pressing upon the cord at the abdominal ring you increase the size of the tumour, by compressing the spermatic vein and not the artery – The Varicocele disappears in the recumbent posture but is enlarged by coughing – the finger pressing upon the ring admits only the egress of blood 332 and the veins fill under the eye, The application of a truss will be very injurious, the disease may be prevented from increasing, but is rarely curable The body of the testicle is made up of ducts, which are much convoluted, the tubuli seminiferi make up the greater part of the testicle, and are disposed in bundles, separated by processes of the tunica albuginea, these tubes pass to the back part of the testicle, & form the reta from 12 to 14 tubes pass from the testicle to the epididymis called vasa efferentia, these are also serpentine in their course, there vasa efferentia terminate in a duct – The absorbents of the testicles are very numerous, and terminate in the glands just below the emulgent arteries and kidneys – The nerves proceed from the loins, which accounts for the pain in the back, complained of by those who have infn of the testicle, they are from two sets a superior & inferior spermatic plexus – In young subjects the testicle is in the abdomen, the tubuli seminiferi are not distinct – In birds the testicle varies at different periods, being very large at those times when they copulate, & very small at other times, in old people the testicles become wasted & are sometimes from disease completely absorbed – The testicles are naturally found below the kidney in the loins, from the kidney descends a gubernaculum to direct its descent into the scrotum thro’ the abdominal ring At the 8th month it begins to discend, and at birth it is within the scrotum & the cavity is generally shut – The testicle in its descent carries before it the peritonæum & thus has a coat of peritoneum closely investing it, another which is called the reflected portion, between these two the water of hydrocele is lodged, here also hernia congenita is formed, where the opening in the abdomen is not shut, when it is shut above & close to the testicle, there is a cavity left, between this 324 is the seat of hydrocele of the chord – The pain of inflamed testicle is an obtuse pain, felt in the loins and gives a sensation as if pressed, from the density of the Tunic Aberg. By the frequent anastomosing branches below the abdominal ring the injection will pass contrary to the circulate of the blood – The epididymis is made up of bundles of convoluted vessels, & is one vessel wound up, & if unrolled would be of great length After infln of the testicle, a swelling is found the epididymis hard and knotty – The artery of the vas deferens freely anastomoses, with the spermatic artery near the testicle – A small piece of bony matter is found deposited upon the vas deferens, & many pieces are found between the vesiculæ seminales – Dr Rigby of Norwich has two Daughters by his first marriage, & after 64 years of age had ten children, & three were twins once- The testicles of sparrows, are different at different seasons, one testicle sufficient for procreation – Erections & Emissions continue for 3 mo. after the removal of both testicles at 12 mo the powers of erection & emission cease Those that have been castrated after manhood will have beard, that is to say retain it, as well as their voice, & for some time have desires for females – But when boys loose their testicles they will have no beard, no desire for the female and no power of voice – The knowledge of the descent of the testicle, was first made known by John Hunter. Extravasated injection in the abdomen, runs down into the scrotum, carrying the peritonæum before it, before the testicle has descended into the scrotum - Lecture 63d M Cooper – Organs of generation (Contd)- The Kidneys are placed in each Loin, resting upon the Quadratus Lumb. on each side, the right one is lower than the left, a quantity of adeps is found and in each kidney, opposite the spine is a hollow in 336 which the vessels enter, the upper part curved more than the lower directly above the kidney and between it and the spine is the capsula renalis- The arteries are called the emulgents passing from the side of the aorta below the origin of the superior mesenteric the right emulgent artery is the longest – The veins are called the Emulgents which terminate in the Vena Cava, the left is the longest, immediately under the right emulgent artery is found the receptaculum chyli – The Ureters – proceed from behind the artery and vein in the kidney, crosses the process muscle obliquely, & passes over the bifurcation of the common iliac, downwards behind the bladder, & artery it about an inch behind the prostate – Stones are sometimes felt thro’ the loins, in the beginning of the ureters, & occasionally abscesses are formed from which stones pass out Glandula Renalis – A broad surface resting upon the top of the kidney, like in shape to the comb of the cock – The arteries of this organ are from the emulgents the phrenic and the aorta, The veins terminate in the emulgent vein. There is a cavity in this organ in which is contained a dark coloured fluid, called atra biliaria, the veins seem to arise from this cavity, as well as from the extremities of the artery – The use of this is not known, its function is connected with the fatal state, as it does not grow but decreases after birth – The Kidney is sometimes resting upon the brim of the Pelvis & has been found on the basis of the sacrum within the cavity of the pelvis- Its form also varies frequently, sometimes taking upon itself the form of the horse shoes. It is partially covered by the Peritonæum, under this it has a complete covering called its capsule, which also turns inwards to its substance with the vessels - The artery before it enters divides into branches - The anterior part of the kidney is called the cortical – The tubular part is the part when the excretory ducts arise, the vessels go to the cortical part, the veins take the same 338 course as the arteries – The tubular substance, begins from the inner side of the cortical substance, then tubes are disposed in radii, which all meet in one part, and which is called the mammillary process, of which there are many in the kidney. Surrounded by a membranous bag called the infundibulum, which sends out a membranous tube into the cavity of the kidney called its Pelvis, from whence the center proceeds Two centers occasionally proceed from the Pelvis of one kidney, sometimes uniting soon at other times entering the bladder separately – The arteries are situated upon the first lumbar vertebra, there is a fungous projection within the capsula renalis in which the vessells seem to terminate – The capsula renalis is very vascular- If the kidney is wanting the glandula renalis is found existing, which proves that its function is distinct from the kidney – The left kidney is more frequently found out of its usual place than the right. A.C. has seen two instances in which the left kidney was situated at the basis of the sacrum, between the bifurcation of the aorta – Under the most minute injection of the kidney the tubular structure is not injected – The commencement of the ducts are called cryptæ or corpora globosa – Inflamn of the kidney is attended with vomiting & pain, prompt measures are requisite as the infn may produce suppuration & death in a short time – In chronic inflammation, there is pain, the urine is white, & has flakes of adhesive matter from the pelvis of the kidney a pellicle too is produced upon the surface of the urine – The disposition to hæmorrhage in the kidney, remarry & in fact continues, so that persons are liable to its returns – After the use of brisk purgatives, the preparation of Turpentines. All the different kinds of stimuli produced in the bladder, exist also in the kidney The kidney most frequently forms stones, and are found about the age of 60 or from that to 63 – 340 AC. Says the cause of Diabetes resides in both the stomach & kidney, the principles of the sugar are formed in the stomach, & by the power of the kidney, the sugar itself is formed – it can’t be distributed in the form of sugar either in venous or arterial blood – The Ischuria Renalis is a paralytic state of the bladder, no urine is secreted, a fullness of the vessells is produced thereby & apoplexy – Inflamation [cross out] stops the secretion of urine – (Garrick it is said died of this disease) Treatment- general & Local bleeding, to rub the scarified part with Tart. Antim, or apply a cataplasm sinap no blisters – in chronic infn a seton on the loins – plummers pill at night, & Epsom Salts in the morning – The kidney is sometimes the subject of hæmorrhage may be cured by the recumbent posture and Balsam of Copaiba – sometimes loses its glandular structure arises from stricture in the urethra – The whole of the structure of the kidney being absorbed & nothing but a shell left. Calculi frequently form in the kidney & they give a good cast of the glandules structure of the organ – It is liable to two species of hydatids, small ones sometimes pass by urethra, the other species are found growing upon the surface of the kidney, & found by Dr Marat to contain urine – Turpentine may be given as it kills all the inferior animals - It is rarely affected with scrophula- It is the subject of fungous hæmatodes AC. has never seen cancer of the kidney – Diabetes – A large quantity of saccharine urine is secreted, the quantity scented is not more than the fluids taken in – there is no morbid appearance in dissection – The kidney is rather flaccid- A either arterial or venous blood contain saccharine matter in those who laborer under diabetes - therefore the secretion of saccharine urine is dependent on the kidney alone – the kidney is found on dissection more flabby than usual without any alteration of structure – A case of Ischemia Renalis 342 followed by apoplexy which is an universal consequence - Lecture 64th (A Cooper) Organs of Generation (Contd) Penis- Is covered by common integuments, the doubling of which forms the prepuce, on each side of the franum is situated an opening from the glandula odorifera - The prepuce of children is contracted, sometimes so much as to produce a natural phymosis- An accumulation of sebaceous matter produces infn & matter is formed Treatment- Dose of the Hyd. Lubm every night & the use of are injection under the prepuce of Lig. Pl. Ac. Dil – The prepuce is sometimes attached to the glans by adhesions for which nothing can be done Paraphymosis of the glans penis cannot be returned, the prepuce is to divided, this is sometimes a natural disease – The Penis adheres to the Pubis by a strong ligament, passing from the dorsum to the symphysis, is covered by a tendinous tendinous sheath which is elastic – Is composed of three bodies two corpor. cavernos. & one corpor. spongios. The corpora cavernos. proceeding from the two crura & their interior composed of a number of cells – Cuvier thought that the corp. cavernos. of the elephant was vascular and not cellular – The cells of one side are separated from those of the other by a septum the internal pudendal artery passes on the dorsum enters the bodies of the corp. cavern. by three distinct branches – the corp cavern. are covered by a strong clastic membranous ligament with tendinous like fibres, the corp. spong. also, but not as strong – Corpus Spongiosum. The first part of which is called the bulb, having reached the extremity of the corp. cavern. & terminates in the glans penis, its artery is a branch of the internal pudendal, necessarily divided in the operation for stone – It is vascular 344 and not cellular, the vena magna ipsius penis returns the blood, & within the abdomen forms a plexus not described by anatomists, the lower part of the bladder is encircled by veins - Erector Penis – Accelerator Urinæ - Sphincter Ani – Transversus Peranæi – Transversus P. Alter – Levator ani – Constrictor Urethra Wilsonii are the perinæal muscles – with the ligam. penis – Lateral view of the Pelvis The bulb of the corp. spongios. The membranous part of the urethra, the prostate gland - the bladder – the vesicula seminales – the vas deferens – the center - & the rectum – The bladder may be punctured in three ways, above the Pubis – from the rectum, & at the side of the prostate gland, which last is the best, and now always practiced – Directions for introducing the catheter, & performing the operation for stone in the bladder – The penis like the scrotum is subject to elephantiasis which is a disease in which the infn attaches the absorbent vessells, they become relaxed, & pour out a fluid which soon coagulates, & the part is thus enlarged considerably, the fluid is effused into the cellular tissue – The corp. spong- has its blood from two sources, the artery of the bulb, & the arteries in the dorsum penis If the Ts. Perinæi is not divided in the operation for stone it offers great resistance in extracting the stone – The Bulb – Behind it is the membranous portion of the urethra directly under the symphysis pubis and behind the axis of the symphysis the prostate gland is found – In introducing the catheter, you are to stand at the patients left side, & pass the instrument perpendicularly down, till you meet with obstruction, which is offered by the membranous portion of the urethra, the hand is there inclined downwards between the thighs 346 and the point of the catheter passes up into the bladder – In Lithotomy – an incision is made from the symphysis pubis, to opposite the middle of the areas by the side of the raphe The transversus perinæi, and Perinæi Alter are both to be completely divided, or they obstruct the passage of the stone, the incision is made down between the crus & the bulb, and the Accelerator Urinæ is turned aside, & carried down to the staff of the instrument, thro’ the membranous portion of the urethra, the back of the gorget is to be placed in the groove of the staff, & carried obliquely upwards into the bladder, dividing the lateral lobe of the prostate – In passing the staff into the bladder, the extremity is to rest upon the stone, the gorget will then pass upon the stone, & thus when you introduce the forceps, sliding them upon the gorget you then immediately find the stone - Lecture 65th (A Cooper) The Bladder &c &c - Is of an ovoid figure – The fundus is smaller than the cervix, arising from the urine gravitating in the fœtus, the form is like that of the quadruped – it has three tunics – the peritonæal which is incomplete – 2d coat the muscular, composed of distinct fleshy fibres which proceed in two directions, one set passing from the prostate over the fundus to the prostate again, the other set are circular and under the former, & thus the whole of the bladder is covered by muscular fibre – this coat is altered much by disease, the muscularity increasing very much by the increase of its use in cases of stricture – a specimen shewn in which this coat was an inch thick – The last and internal coat is a mucous membrane which lines the bladder – its use it to secrete a fluid for the defence of the bladder – from the urine in this coat are three openings, one into 348 the urethra, and the terminations of the ureters about one inch from the prostate – The bladder is commonly found empty, and no cavity at all left in those persons who have been executed, the bladder is much thickened in stricture & stone The mucous membrane is very vascular, it covers the extremity of the ureters, so as to form valves, & so complete that air thrown into a bladder, & trod upon will burst, thus it is evident when enlargement of the valves take place, they are enlarged from the urine not being able to enter the bladder, and not from regurgitation – If the internal coat of the bladder be injected, & floated in water it will be found villous in its appearance - The internal coat secretes a mucous, an increased flow of which produces Catarrhus Vesicæ – Opening of the mucous membrane, protrude between the muscular fibre, & form parietes in which stones are becoming lodged, & thus eluding the sound - Polypus of the bladder occurs rarely, a specimen shewn which is the only one in London Hydatids are found sometimes – Fungous occasionally occurs, & is known by large discharges of blood, which is not attended with pain- Infn of the inner membrane is occurring both in the active & chronic form - In the acute – bleeding, praying, & the hip bath, Leeches blisters & tartarised antimony or cataplasm. sin. must be had recourse to – In chronic infn of the bladd- an alternative treatment will be necessary the initable bladder for which AC. relies most upon inelastic hollow bougies, introduced into the urethra to prevent the internal coat being initiated by the urine The bladder is sometimes lacerated from a blow upon the abdomen when distended with urine – A Case occurred in the hospital with symptoms of Peritonitis, then was 350 no discharge of urine when the catheter was introduced Died in three days – Prostate Gland Attached to the neck of the bladder, composed of two lobes, connected by a smaller one together described by Sir E. Home – When the urethra is opened, within the prostate is seen the orifices of the duct from the vesicula seminales- the urethra passe thro’ this gland, but not thro’ the middle of it but at its superior part – Is made of elastic ligamentous substance supplying a milk like fluid which being mixed with the semen gives it that white appearance, the semen is itself a clear mucous – The enlargement of the third lobe of the prostate is what is producing those dangerous symptoms known by the name of diseased prostate the two lateral lobes are rarely found diseased In the caput gallinaginis are three openings the two opening on each side, common to the vesicula seminales & vas deferens – The enlargement of the third lobe offers the resistance in passing the catheter, under enlargement of the lateral lobes, the urethra is also enlarged so that you probably may pass one little finger- The pores in the prostate sometimes form calculi composed of the phosphate of lime, either in the pores singly, or in a bag where there are many – Known by introducing the finger into the rectum, & rubbing the prostate - The vas def. becomes united to the inner side of each vas def. & terminate by a common opening at the side of the caput gallinaginis – Vesiculæ Seminales The apex of each is attached to the base of the prostate gland, the base in the cavity between the bladder & rectum- the vas. defer pass between them – The fluid of the vesiculæ seminales – is of a dark brownish colour it is clear mucous in the living subject – Haller stated that each vesicula is a tube very much 352 convoluted which has been found to be the case Ino Hunter was the first who found out that they secreted a fluid peculiar to themselves, and not the reservoirs of the semen as was the former opinion – At the extremity of the vas defer- is a structure similar to the vesicula semen. which secretes a fluid similar to that – The vesicula secrete a peculiar fluid – Hunter found in animals that the vas def. & vesiculæ semen terminate separately, & are not reservoirs of the semen as has been supposed – In a man who had lost a testicle, the vesic. semin. was found full of a fluid – H Cline Surn found in the gelding the same fluid as in the stallion – The use of the prostate fluid, that of the vesiculæ seminales & of Cowpers glands are to assist the passage of the semen on the urethra – The fluid of the vas defer. & the testicle form a small quantity of the fluid of emission – The Vesic. Semin. is filled with a solid secretion when there is chronic enlargement of the testicle – Cowpes glands are sometimes diseased. AC. has only seen one case – The Lacuna Magna oppos. the frænum, but at the upper part of the urethra. At the orifice of the glans contracted within dilated, & at the bulb contracted appearing like a stricture, & just before this it is dilated into a point – The Urethra The membranous part of which is an inch in length, reaching from the apex of the prostate to the bulbs extremity of the corp. spongios – Situated over the bulb Cowpers glands are found behind the bulb & below the membranous portion of the urethra, about the size of a pea, in number 2 each sending a duct into the urethra, the membranous portion is muscular & there only, being completely surrounded at that part. [cross out] The length of the urethra is 9 inches, varies in its size in different parts 354 large at the glans, at the bulb, & between the bulb & the prostate, is contracted where the urethra joins with the bulb, it is again enlarged at the membranous portion- The whole of the internal membrane is lined with lacunæ a large one op. the crura glandis called lacuna magna – Lecture 66th (M Green) The Arteries – The aorta is divided into the ascending and descending aorta – The aorta first turns over to the left side, & thus forms the arch of the aorta, from which are given of three considerable trunks – the arteria innominate, the left common carotid, & the left subclavian – The coronary arteries arise from the ascending aorta – The arteria innominate divides into two vessells, the right common carotid & the right subclavian- The common carotid, ascends upwards by the side of the trachea, by the upper side of the thyroid cartilage, then divides into the external & internal The external carotid is continued as high as the neck of the lower jaw where it terminates, by dividing into the temporal & internal maxillary arteries – The anterior branches are the superior thyroideal 2 the lingual & 3 the facial – The Superior Thyroideal sends off a laryngeal and a thyroid branch – The Lingual gives off branches which are distributed to the adjacent muscles and pharynx – Hyoideal branch – Dorsal branches Sublingual branch- Ranine Branch - The Facial Is generally the largest of the three anterior branches & arises a little above the last – It varies however in size and origin – It passes upwards & forwards under the jaw behind the digastricus, & stylo hyoideus & is then duply embedded in the submaxillary gland – It is next continued upwards over the side of the jaw, & is situated superficially at the under and fore part of the masseter, It then passes towards the corner of the month, aped after making several turns it proceeds by the side of 356 the nose towards the inner angle of the eye It sends off – Inferior palatine branch - glandular branches Submental branch – Small branches distributed to the masseter, & to the muscles & skin of the cheeks and lips – Inferior coronary artery of lip - Superior coronary artery of the lip- Branches distributed to the nose, cheeks parts about the inner corner of the eye, & middle of the forehead, & by these branches the facial artery terminates – The internal branch is the ascending pharyngeal distributing branch to the pharynx – The posterior branches are the occipital, & the posterior aural – both of which giving off branches – Temporal – gives off branches to the parotid gland, branches which are distributed to the masseter muscle – a transversalis faciei - Deep temporal – forms communication with the deep temporal branches of the internal maxillary - The external carotid just before it divides into temporal and internal maxillary has been wounded in a school boy, the hæmorrhage was suppressed by compulsion, but the pressure being severe, sloughing was produced, & when the slough came away the artery again bled furiously. H Cline Surn was called, he applied a small piece of sponge to the mouth of the vessel, adhesion was produced, & the hæmorrhage stopped, It being so deeply hid in the parotid gland renders the taking it up almost impossible - In opening the temporal artery Green advises the skin to be punctured up and cut thro’ as preferable to cutting down transversely upon the artery, after passing a probe under the vessell & tying it, then divide it & the bleeding will cease, the danger of spurious aneurism is thus prevented – - Lecture 67th H Cline - The internal maxillary passes off from the external carotid, continued behind & below the condyloid process of the lower jaw, gives off branches of small size to the ear – Spheno Spinal – Temporal branch a masseteric branch, a buccal branch – Pterygoideal branches, an alveolar branch – infra orbitar branch descending palatine branch – lateral nasal branch Internal Carotid – Separates from the common carotid opposite the os hyoides, passes to the basis, & enters the foramen caroticum vel spinale rises up by the side of the sella turcica in a tortuory course, & unites with the opposite internal carotid – Where it passes up under the anterior clinoid process it detatches the ophthalmic artery Its branches c c the branches of the ophthalmic are subject to considerable varietes in origin, size and number – lachrymal – central of the retina ciliary – muscular branches – ethmoidal – supra orbitar branches – internal angular or nasal branch this branch is frequently described in anatomical works as a branch of the facial artery – Leeches applied to the internal angle of the eye are most efficacious in relieving ophthalmia - by relieving the branches of the angular artery & couse the ophthalmia – Arteries of the Cerebrum The right subclavian arises from the arteria innominata - The left subclavian from the arch of the aorta, is longer than the right – continued under the clavicle & there becomes axillary - The subclavian bend outwards & upwards, & are continued between the scalenus anticus and medius – over the first rib, these regularly bends downwards behind the clavicle, there is occasionally variety in the origin of the subclavians, the right arising sometimes from the aorta instead of from the arteria innominate - Branches of the left subclavian 1st The vertebral 2d Inferior Thyroidal 3d Ascending Cervical 4 Supra Scapular 5 Superficial Cervical and into the inferior which consist of the 7 Internal mammary and 8 superior intercostal These branches are commonly given off just before the artery passes between the scaleni muscles but they differ considerably in size, in number, in the point of origin. - 360 Lecture 68th H Cline The Axillary Artery – This is the continuation of the subclavian, passes the edge of the latissimus dorsi becomes the brachial artery – After the subclavian passes the clavicle it is immediately under the pectoralis minor emerging from the edge of this it is found by the inner side of the coraco brachialis– The branches of the axillary are first the humoral thoracic distributed to the pectoralis major deltoid, & skin of the shoulder, in tying the axillary these large branch must not be forgotten – 2d Supr thoracic or external mammary artery separate from the axillary, runs upon the anterior part of the thorax to the Pectoralis Major & Minor & serrat. major and female breast – 3d Inferior Thoracic arises a little below the pectoralis minor distributed to the lateral parts of the chest to the serrat majr. & Latiss. dorsi Infra Scapular – generally the largest branch from the axillary artery – Arises from the lower edge of the subscapularis muscle, along which it takes its course but soon divides into an internal & a dorsal branch sometime anastomoses with the supr scapular artery necessary to be aware of this & these branches in tying the axillary artery – Anterior Circumflex- Arises opposite the upper part of the tendon of the latissimus – bends round the bone & is distributd to the deltoid &c - Posterior Circumflex - Arises from above the tendon of the latissimus, bends round the bone in an opposite direction, & distributed to the deltoid, ligament of the shoulder & adjacent parts Brachial Artery – Passes from the axilla to below the bend of the elbow, where it terminates by dividing into the radial & ulnar arteries during the greater part of its course it is situated to the inner side of the arm – As it descends it is placed more superficially and anteriorly at the bend of the elbow it is opposite to the middle of the articulation at the anterior part of the elbow it divides into the radial and ulnar, at the middle of the arm the artery is most superficial & nearest the bone - 362 & this is the best place for the application of the tourniquet – It gives off the anterior profunda humori – The ramus anastomoticus major and minor – Minute muscular branches – Ulnar larger than the radial, dips underneath the muscles arising from the inner condyle, & is placed on the outer side of the flexor carpi ulnaris – it then becomes superficial on the basis of the ulna & is found on the outer side of the os orbiculare – it is then superficial in the palm of the hand tending towards the fore finger making the superficial palmar arch, from the outer side of which branches are given off – two to the little finger 2 to the ring – 2 to the middle, & one to the fore finger, called the digital arteries – also to the soft parts in the palm – The Radial Beginning from the brachial at the bend of the elbow, is found between the pronator teres, and supinator radii longus, then becomes superficial on the inner side of the pronator radii teres it is there found anterior to the base of the radius continued over the trapezium & between the metacarpal metacarpal bones of the fore finger and thumb – Latis becoming deep in the palm of the hand, it form an arch in the palm of the hand called the ra palmer arch sending branches to the soft parts 2 to the thumb, & one to the fore finger – The ulnar & radial arteries anastomose freely in the palm of the hand - The radial and ulnar arteries are sometimes given off high up even as far as the middle of the upper arm and sometimes given off separately from the axillary artery – In the operation for aneurism it is necessary first to make pressure upon the artery to see whether it stops the pulsat and if are find that does not we may apprehend there is a high division, and must seek for the other branch – In these high divisions of the radial and ulnar arteries they are situated very superficially, and liable to be wounded in bleeding, especially the radial – Wounds of this artery generally happen, when it is given off high up - 3 364 moore