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+This eBook, including all associated images, markup, improvements,
+metadata, and any other content or labor, has been confirmed to be
+in the PUBLIC DOMAIN IN THE UNITED STATES.
+
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+Project Gutenberg (https://www.gutenberg.org) public repository for
+eBook #64754 (https://www.gutenberg.org/ebooks/64754)
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-The Project Gutenberg eBook of Structure and Functions of The Body, by
-Annette Fiske
-
-This eBook is for the use of anyone anywhere in the United States and
-most other parts of the world at no cost and with almost no restrictions
-whatsoever. You may copy it, give it away or re-use it under the terms
-of the Project Gutenberg License included with this eBook or online at
-www.gutenberg.org. If you are not located in the United States, you
-will have to check the laws of the country where you are located before
-using this eBook.
-
-Title: Structure and Functions of The Body
-       A Hand-Book of Anatomy and Physiology for Nurses and others
-       desiring a Practical knowledge of the Subject
-
-Author: Annette Fiske
-
-Release Date: March 08, 2021 [eBook #64754]
-
-Language: English
-
-Character set encoding: UTF-8
-
-Produced by: MFR and the Online Distributed Proofreading Team at
-             https://www.pgdp.net (This file was produced from images
-             generously made available by The Internet Archive)
-
-*** START OF THE PROJECT GUTENBERG EBOOK STRUCTURE AND FUNCTIONS OF THE
-BODY ***
-
-
-
-
-Transcriber’s Notes:
-
-  Underscores “_” before and after a word or phrase indicate _italics_
-    in the original text.
-  Equal signs “=” before and after a word or phrase indicate =bold=
-    in the original text.
-  Small capitals have been converted to SOLID capitals.
-  Illustrations have been moved so they do not break up paragraphs.
-  Typographical and punctuation errors have been silently corrected.
-
-
-
-
-[Illustration: The human skeleton (Lewis).]
-
-
-
-
-                  STRUCTURE AND FUNCTIONS
-                           _of_
-                         THE BODY
-
-         A HAND-BOOK OF ANATOMY AND PHYSIOLOGY FOR
-     NURSES AND OTHERS DESIRING A PRACTICAL KNOWLEDGE
-                      OF THE SUBJECT
-
-                            BY
-                   ANNETTE FISKE, A. M.
-
-    GRADUATE OF THE WALTHAM TRAINING SCHOOL FOR NURSES
-
-                       _ILLUSTRATED_
-
-                  PHILADELPHIA AND LONDON
-                  W. B. SAUNDERS COMPANY
-                           1911
-
-        Copyright, 1911, by W. B. Saunders Company
-
-                    PRINTED IN AMERICA
-
-                         PRESS OF
-                  W. B. SAUNDERS COMPANY
-                       PHILADELPHIA
-
-                       TO MY FATHER
-                            and
-                  TO DR. ALFRED WORCESTER
-
-        as those who have perhaps most helped me in
-        the formation and realization of my ideals
-           this book is affectionately dedicated
-
-
-
-
-PREFACE.
-
-
-Although there are already in existence many books on anatomy and
-physiology for nurses, none with which I am acquainted has seemed to me
-to provide in concise form just the knowledge needed by the nurse in
-her profession. Most of them, moreover, separate the anatomy from the
-physiology and all treat the different systems of tissues separately,
-first the bones, then the muscles, and so on. These defects, as they
-seem to me, I have attempted to correct not only by weaving the
-physiology in with the anatomy, but by treating first the general
-structures found throughout the body and then describing the structure
-and function of each part in detail. Thus, the first chapter is devoted
-to a description of the general structure of all the tissues, a
-separate chapter being devoted, however, to the skin, its appendages,
-and function, including the sense of touch. Then the head with its
-bones, muscles, and organs of special sense is described, while the
-brain is treated with the rest of the nervous system, thus forming the
-connecting link between the head and the body. In the same way the
-back, chest, abdomen, pelvis, and extremities are taken up in turn and
-the bones, muscles, blood-vessels, nerves, and special organs of each,
-together with their functions, described.
-
-Although written more particularly for nurses I am in hopes that
-this book may prove useful to any others who may desire to acquire a
-practical knowledge of anatomy and physiology.
-
-Besides the usual text-books, I am much indebted for material to notes
-taken in lecture courses given by Dr. Fred R. Jouett and Dr. F. J.
-Goodridge of Cambridge, Mass., at the Cambridge School of Nursing, and
-by Dr. Vivian Daniel of Watertown at the Waltham Training School for
-Nurses.
-
-I wish particularly to express my gratitude and appreciation for the
-kind and helpful criticism given me by Dr. Eugene A. Darling, Assistant
-Professor of Physiology, Harvard College.
-
-                                                      ANNETTE FISKE.
-    _May, 1911._
-
-
-
-
-CONTENTS.
-
-
-                              CHAPTER I.
-                                                                  PAGE
-    COMPOSITION AND GENERAL STRUCTURE OF THE BODY                  11
-       Chemical Constitution of the Body, 11--The Cell, 12--The
-           Fundamental Tissues of the Body, 13--Epithelial
-           Tissue, 14--Connective Tissue, 15--Structure of Bone,
-           17--Bone Formation, 18--Chemical Composition of Bone,
-           18--Classification and Function of Bones, 19--Joints,
-           20--Muscle, 21--Action of the Muscles, 23--Physiology
-           of Muscle, 24--Cilia, 27--The Blood, 27--Arteries,
-           27--Veins, 28--Capillaries, 28--Lymphatic System,
-           29--Lymphatic Vessels, 31--Lymphatic Glands,
-           32--Lymph, 32--Glands, 35--Ductless Glands,
-           36--Nervous Tissue, 36.
-
-                              CHAPTER II.
-    THE SKIN, ITS APPENDAGES AND ITS FUNCTION                      39
-       The Skin, 39--Appendages of the Skin: Nails, 40--Hair,
-           40--Sebaceous Glands, 41--Sweat Glands, 42--Sweat,
-           42--Temperature Regulation, 43--Fever, 45--Sense of
-           Touch, 45--Touch Corpuscles, 46.
-
-                             CHAPTER III.
-    THE CRANIUM AND FACE                                           48
-       The Cranial Bones, 48--Frontal Bone, 49--Parietal
-           Bones, 49--Occipital Bone, 50--Occipito-frontalis
-           Muscle, 51--Temporal Bones, 51--Sphenoid or Wedge
-           Bone, 52--Ethmoid Bone, 53--Turbinated Bones,
-           53--Ossification of Sutures, 53--Bones of the
-           Face, 53--Superior Maxillary Bones, 54--Antrum of
-           Highmore, 54--Malar or Cheek Bones, 54--Lachrymal
-           Bones, 54--Palate Bones, 54--Nasal Bones, 55--Vomer,
-           55--Inferior Turbinated Bones, 55--Inferior
-           Maxillary Bone or Lower Jaw, 55--Sublingual Gland,
-           56--Submaxillary Gland, 56.
-
-                              CHAPTER IV.
-    THE ORGANS OF SPECIAL SENSE                                    57
-       The Nose, 57--The Sense of Smell, 58--The Mouth, 59--The
-           Hyoid Bone, 60--The Teeth, 60--The Sense of Taste,
-           61--Salivary Glands, 61--The Tonsils, 62--The Ear,
-           63--Eustachian Tubes, 63--Sensation of Hearing,
-           65--The Eye, 66--Lachrymal Gland, 68--Coats of the
-           Eye, 68--Light Rays and Sight, 70--Accommodation,
-           72--Color Perception, 73.
-
-                              CHAPTER V.
-    THE NERVOUS SYSTEM                                             75
-       The Cerebrum, 75--The Cerebellum, 78--Pons Variolii,
-           78--Medulla Oblongata, 78--Spinal Cord,
-           79--Brain-centers, 81--Motor Tract, 82--Sensory
-           Tract, 82--Reflex Action, 83--Cranial Nerves,
-           83--Spinal Nerves, 84--Brachial Plexus, 85--Sacral
-           Plexus, 85--The Sympathetic System, 87--The
-           Sympathetic Nerves, 87.
-
-                              CHAPTER VI.
-    THE BACK                                                       88
-       The Spine, 88--The Vertebræ, 88--Muscles of the Neck,
-           92--Muscles of the Back, 93.
-
-                             CHAPTER VII.
-    THE CHEST                                                      96
-       The Sternum, 97--The Ribs, 97--Costal Cartilages,
-           98--Muscles of the Chest, 98--Diaphragm, 98--Mammary
-           Glands, 100.
-
-                             CHAPTER VIII.
-    THE HEART AND CIRCULATION                                     101
-       The Heart, 101--The Pericardium, 101--Cavities of the
-           Heart, 103--The Endocardium, 103--The Valves of
-           the Heart, 103--Circulation, 105--Circulation in
-           the Fetus, 106--Arteries, 107--Veins, 109--Portal
-           Circulation, 109--Pulmonary Circulation, 110--Nerves
-           of the Heart, 110--Heart Sounds, 111--The Heart
-           Beat, 111--Factors Affecting Circulation, 112--The
-           Pulse, 113--Blood Pressure, 114--Nerve Supply of the
-           Blood-vessels, 115--The Blood, 116--Composition
-           of the Blood, 116--Coagulability of the Blood,
-           117--Blood-corpuscles, 118.
-
-                              CHAPTER IX.
-    THE LUNGS AND RESPIRATION                                     121
-       The Larynx, 121--The Trachea, 123--The Thyroid Gland,
-           124--The Thymus Gland, 124--The Bronchi, 125--The
-           Lungs, 125--The Pleura, 125--The Mediastinum,
-           126--Respiration, 127--Air, 129--Respiratory
-           Sounds, 129--Changes in Air in Lungs, 129--Effect
-           of Respiration on Blood, 130--Nervous Mechanism of
-           Respiration, 130--Variations in Respiration, 131.
-
-                              CHAPTER X.
-    THE ABDOMEN AND THE ORGANS OF DIGESTION AND EXCRETION         132
-       The Abdominal Cavity, 132--Muscles of the Abdomen,
-           132--The Peritoneum, 134--Abdominal Regions,
-           134--Salivary Digestion, 136--The Pharynx, 139--The
-           Esophagus, 138--The Stomach, 138--Gastric Digestion,
-           139--Vomiting, 140--Intestinal Canal, 141--The Small
-           Intestine, 142--Intestinal Digestion, 143--Absorption
-           in Intestine, 144--The Large Intestine, 145--Food and
-           Metabolism, 147--The Liver, 149--The Gall-bladder,
-           152--The Pancreas, 153--The Spleen, 153--The
-           Suprarenal Capsules, 154--The Kidneys, 155--The
-           Urine, 156--The Ureters, 159--The Bladder and
-           Urethra, 159.
-
-                              CHAPTER XI.
-    THE PELVIS AND THE GENITAL ORGANS                             161
-       The Pelvis, 161--The Male Generative Organs, 164--The
-           Prostate Gland, 164--The Testes, 165--The Penis,
-           165--The Female Generative Organs, 165--The Ovaries,
-           165--The Fallopian Tubes, 166--The Uterus, 167--The
-           Vagina, 168--The External Genitalia in the Female,
-           169--The Vulva, 169--The Mons Veneris, 169--The Labia
-           Majora, 169--The Labia Minora, 170--The Clitoris,
-           170--The Meatus Urinarius, 170--The Hymen, 170--The
-           Fourchette, 170--The Perineal Body, 170--The
-           Perineum, 170.
-
-                             CHAPTER XII.
-    THE UPPER EXTREMITIES                                         171
-       The Shoulder Girdle, 171--The Clavicle, 171--The Scapula,
-           173--Shoulder Muscles, 174--The Humerus, 175--Upper
-           Arm Muscles, 176--The Ulna, 177--The Radius,
-           178--The Wrist, 180--The Hand, 181--Meta-carpals,
-           181--Phalanges, 181--Muscles of the Forearm,
-           182--Muscles of the Hand, 184--Joints of the Upper
-           Extremity, 185--Blood Supply of the Upper Extremity,
-           185--Nerves of the Upper Extremity, 186.
-
-                             CHAPTER XIII.
-    THE LOWER EXTREMITIES                                         187
-       The Femur, 187--Thigh Muscles, 189--The Patella,
-           192--Joints of the Lower Extremity, 192--The Tibia,
-           194--The Fibula, 194--The Ankle, 195--The Foot,
-           195--Metatarsals, 195--Phalanges, 195--Muscles of the
-           Leg, 196--The Blood Supply of the Lower Extremity,
-           198--Nerves of the Lower Extremity, 199.
-
-    INDEX                                                         201
-
-
-
-
-STRUCTURE AND FUNCTIONS OF THE BODY.
-
-
-
-
-CHAPTER I.
-
-COMPOSITION AND GENERAL STRUCTURE OF THE BODY.
-
-
-Anatomy is the study of the physical structure and physiology the study
-of the normal functions of the human body.
-
-=Chemical Constitution of the Body.=--In the body only twenty elements
-have been found. These include carbon, oxygen, hydrogen, nitrogen,
-sulphur, phosphorus, calcium, magnesium, manganese, chlorin, potassium,
-and fluorin. For the most part they appear in very complex and highly
-unstable combinations, though oxygen and nitrogen may be said to exist
-uncombined in the blood, alimentary canal, and lungs. Hydrogen also
-occurs in simple form in the alimentary canal, but as the result of
-fermentation, not as an element of the body.
-
-Of the organic compounds some contain nitrogen and some do not. The
-most important of the former are the proteins, which are found only in
-living bodies and consist of carbon, hydrogen, oxygen, nitrogen, and
-sulphur combined in very similar proportions. The important proteins in
-the body are the serum albumen and fibrin found in the blood, myosin in
-muscle, globulin in the red blood-corpuscles, and casein in the milk.
-Similar to the proteins but capable of passing through membranes are
-the peptones, the final result of protein digestion, from which the
-albuminoids differ in that they contain no sulphur. Ferments containing
-nitrogen exist in all the cells of the body, though more particularly
-in those of the digestive organs, and the coloring matters, as the
-bilirubin of the bile, are nitrogenous.
-
-The organic substances that do not contain nitrogen are the
-carbohydrates or starches, the hydrocarbons or fats, and the acids, of
-which the most important is carbon dioxide, given off by the lungs.
-
-The inorganic substances are water, which forms a large percentage of
-all the tissues and from one-fourth to one-third of the whole body
-weight, sodium chloride or common salt, which plays an important part
-in keeping substances in solution, potassium and magnesium chloride,
-and hydrochloric acid, found in the stomach.
-
-=The Cell.=--Although the body is a very complex organism, the cell
-is its unit or foundation. In fact, the body begins life as a single
-protoplasmic cell, the ovum, which is frequently compared to the
-amœba, a microscopic animal consisting of a single cell of protoplasm
-or living substance--a substance not well understood as yet--but
-possessing practically all the functions of the human body. For,
-although it has no organs and is homogeneous in structure, the amœba
-can move by throwing out a process, and can surround and absorb food,
-which it builds up into new tissue, discarding the waste. The ovum,
-however, differs from the amœba in that it has a transparent limiting
-membrane and contains a darker spot, the nucleus. This in turn contains
-another smaller spot, the nucleolus, while through the protoplasm,
-which is semi-fluid, extends a fine network that seems to hold it in
-place.
-
-The _ovum_ is very small, about ¹/₁₂₅ inch in diameter, and after
-fertilization grows by segmentation, the nucleus dividing in two and
-the protoplasm grouping itself anew about the two nuclei. This division
-continues, each cell dividing and forming two, or sometimes four,
-new cells, all of which at first appear alike. By degrees, however,
-differentiation takes place and different groups of cells assume
-different characteristics. Thus the various tissues are gradually
-developed, each with a structure and a function of its own, and are
-distributed among the various organs, each organ consisting of several
-tissues. During the process of growth and even after full growth of the
-body is attained old cells are continually dying and being replaced by
-new ones.
-
-The typical cell is circular, but through being squeezed together
-in the tissues or for some other reason the cells vary in shape in
-different parts, being at times hexagonal, spindle-shaped, or columnar.
-Yet, whatever their differences in shape or other characteristics, they
-all live the same sort of life. All protoplasm absorbs oxygen when it
-comes in contact with it and in the process of combining with it is in
-part burned or oxidized, with the consequent setting free of heat and
-other forms of energy and the formation of carbon dioxide. So long as
-the body is alive, therefore, whether it is in a state of activity or
-of rest, it is the seat of constant chemical change throughout all its
-cells, and to these chemical changes are due all the forms of energy
-manifested by the body. For energy is never destroyed, though it may
-appear in a different form, and the elements of the human body are
-so combined that their energy may be liberated and manifested in the
-different functions the body exhibits.
-
-=The fundamental tissues of the body= are the epithelial tissues, the
-connective tissues, including the cartilaginous and bony tissues, and
-the muscular and nervous tissues. Of these the epithelial tissues serve
-as a protection to the surface of other tissues; the connective tissues
-together form a framework for the support and general protection of the
-other tissues; while energy is expended by muscular and nervous tissue,
-the latter directing the former in its movements. All the tissues are
-inter-dependent and the organs work together. Besides cells every
-tissue contains a certain amount of lifeless matter, the intercellular
-substance, which was at some time produced by the cells.
-
-[Illustration: FIG. 1.--Epithelium: 1, pavement epithelium; 2, columnar
-epithelium; 3, ciliated epithelium; 4, stratified epithelium.]
-
-In =epithelial tissue= there is little intercellular substance, the
-cells being close together and arranged generally as a skin or membrane
-covering external or internal surfaces. When there are several layers
-of cells, the deepest are columnar in shape and the others become
-more and more flattened and scale-like as they approach the surface,
-where they are gradually rubbed off and replaced by the growth of new
-cells from below. This stratified epithelium, as it is called, is
-found wherever a surface is exposed to friction, as in the skin and
-in the mucous membrane of the mouth, pharynx, and esophagus, and in
-that of the vagina and the neck of the uterus. In simple epithelium,
-where there is only a single layer of cells, the cells may be pavement
-or hexagonal, columnar, glandular, or ciliated, according to their
-different functions. The flat pavement cells occur where a very smooth
-surface is required, as in the heart, lungs, blood-vessels, serous
-cavities, etc. None of these surfaces communicate directly with the
-external surface of the body and the name endothelium is substituted
-for epithelium. The columnar form of cell in the intestine facilitates
-the passage of leucocytes between the cells. In glandular epithelium
-the cells vary according to the gland in which they occur, their
-protoplasm being filled with the material the gland secretes. Finally,
-ciliated epithelium is composed of columnar cells with cilia or little
-hair-like processes upon their free surface which serve to send
-secreted fluids and other matters along the surfaces where they occur,
-as in the air passages, parts of the generative organs, the ventricles
-of the brain, and the central canal of the spinal cord.
-
-=Connective tissue= has a great deal of intercellular substance. One
-form, _areolar tissue_, is composed of a loose network of fine white
-fibers with a few yellow elastic fibers interspersed and with cells
-lying in the spaces between the fibers. It connects and surrounds the
-different organs and parts, holding them together, yet allowing free
-motion, and is one of the most extensively distributed of the tissues.
-It is continuous throughout.
-
-[Illustration: FIG. 2.--Section of bladder epithelium. (Hill.)]
-
-Closely allied to the areolar is the _fibrous tissue_, in which the
-white fibers lie close together and run for the most part in one
-direction only. This is found in ligaments, joints and tendons, as also
-in such fibrous protective membranes as the periosteum, dura mater, the
-fasciæ of muscles, etc. Fibrous tissue is silvery white in appearance
-and is very strong and tough, yet pliant. It is not extensile.
-
-_Elastic tissue_, on the other hand, has a large predominance of
-yellow elastic fibers and is very extensile and elastic, though not so
-strong as the fibrous. It is found in the walls of the blood-vessels,
-especially the arteries, in the walls of the air tubes, in the
-ligaments of the spine, etc.
-
-_Fatty or adipose tissue_ is formed by the deposit of fat in the cells
-of the areolar tissue and is found in most parts where the areolar
-tissue occurs, though it varies largely in amount in different parts.
-It is found pretty generally under the skin, fills in inequalities
-about various organs and about the joints, and exists in large
-quantities in the marrow of the long bones. In moderate amounts it
-gives grace to the form and constitutes an important reserve fund.
-
-[Illustration: FIG. 3.--Adipose tissue (Leroy): _a_, Fibrous tissue;
-_b_, fat cells; _c_, nucleus of fat cells; _d_, fatty acid crystals in
-fat cells.]
-
-_Cartilage_ consists of groups of nucleated cells in intercellular
-substance. It is very firm, yet highly elastic, and serves in the
-joints to break the force of concussion of the harder and less elastic
-bones. Except when it occurs at the end of a bone, it is covered with
-a membrane called the perichondrium, which carries its blood supply.
-In the nose, ear, larynx and trachea it serves to give shape, to keep
-the passages open, and to afford attachment for muscles. Most of the
-skeleton of the fetus consists of cartilage, which later develops into
-bone.
-
-_Bone._--In bone the intercellular tissue is rendered hard by the
-deposit of mineral salts, the resulting material being of great
-strength and rigidity. The texture may be close and dense like ivory or
-open and spongy, the difference lying merely in the fact that the one
-has fewer spaces between the solid particles than the other. There is
-usually a hard, compact layer on the exterior of the bone, as that is
-where the greatest cross-strain comes, especially in the long bones,
-while within is the cancellous or spongy tissue, which gives lightness
-to the bone and is capable of withstanding enormous pressure, though it
-can bear little cross-strain.
-
-[Illustration: FIG. 4.--Cross-section of compact bone tissue. (After
-Sharpey.)]
-
-=Structure of Bone.=--The hard substance in bone is always arranged
-in lamellæ or bundles of bony fibers, which in cancellous tissue
-meet to form a kind of lattice-work, while in the dense tissue they
-are generally arranged in rings about the Haversian canals, channels
-through which the blood-vessels pass through the bone longitudinally.
-Between the lamellæ are spaces called _lacunæ_, in which lie branched
-cells, the spaces being connected with each other and with the
-Haversian canals by numerous tiny canals or canaliculi, by which
-nutrient material finds its way from the Haversian canals to all parts
-of the bone.
-
-Within the bone is the medulla or _marrow_, which is of two varieties:
-the yellow, which is largely fat and is found in the long bones of
-adults, and the red, which is nearly three-fourths water and is found
-in most of the other adult bones and in the bones of the fetus and of
-the infant.
-
-Lining the medullary and cancellous cavities is a delicate connective
-tissue lining, the _endosteum_, which contains many bone-forming cells,
-while on the outside of the bone, except at the articular ends, is the
-_periosteum_ with its outer protective layer and its inner vascular
-layer containing osteoblasts or bone-forming cells. The periosteum is
-essential for the growth of new bone where the old bone has died, and
-if the periosteum is removed from healthy bone the part beneath is
-liable to die, as it is by the constant growth of the osteoblasts that
-the bone grows and is renewed. In the repair of broken bones tissue is
-formed between and around the broken ends.
-
-=Bone Formation.=--Most of the skull and face bones begin as
-membranes of connective tissue, that is, are formed in membrane.
-Bones are also formed in cartilage, the bone formation in this case
-beginning from centers of ossification, where the deposit of lime
-salts in the intercellular substance begins, the salts coming to the
-centers dissolved in the plasma. Such a center of growth in a bone
-is called the epiphysis and is separated from the main part of the
-bone or diaphysis by cartilage until full growth is attained, when
-ossification becomes complete. So in surgery, in working on the bones
-of children, part of the epiphysis should always be left for the sake
-of future growth. The outer shell of compact tissue is deposited by the
-periosteum.
-
-=Chemical Composition of Bone.=--Chemically bone is composed of about
-one-third organic or animal matter, largely gelatine, and two-thirds
-inorganic matter, including various salts of calcium, magnesium, and
-sodium. In young children the animal matter predominates and the bones
-are soft and often bend instead of breaking, only the outside shell on
-one side giving way, as in “green-stick” fracture. In rickets there is
-a deficiency of lime salts, but the increased brittleness of the bones
-in old age is due, not to increase of mineral matter, but to the less
-spongy texture of old bones.
-
-=Classification and Function of Bones.=--There are in the body some
-two hundred bones, which may be classified as long, short, flat, and
-irregular. Occasionally an irregular bone develops in a fontanelle, the
-membranous opening at the juncture of the sutures of the skull. This
-is known as a Wormian bone. It is not, however, included in the two
-hundred, as are not the sesamoid bones or bones developed in tendons,
-with the exception of the patella or knee-cap.
-
-Long bones are developed in cartilage and consist of a shaft, two
-extremities, and various processes. They are more or less curved to
-give them strength and grace. They serve as supports and act as levers
-for purposes of motion and the exercise of power. Since a hollow
-cylinder is just as strong as a solid one of the same size, the weight
-coming only on the outer shell, the great bones which are accountable
-for weight and which need to be light themselves have hollow shafts,
-composed chiefly of compact tissue with a central medullary canal. The
-ends, however, are expanded in order to make better connection at the
-joints and to afford broad surfaces for muscular attachment, cancellous
-tissue being used in them for lightness and strength. The large spongy
-ends also give elasticity and lessen jar, and by bringing the tendons
-to the bone at a greater angle increase their effectiveness. Blood is
-brought to the long bones not only by the vessels of the periosteum but
-by the medullary artery, which penetrates the compact tissue by the
-nutrient foramen and divides into an ascending and a descending branch.
-
-Short bones are spongy throughout. They are used for strength and where
-little motion is required.
-
-Flat bones are composed of two thin layers of compact tissue with a
-varying amount of cancellous tissue between, and are for protection and
-muscular attachment. The cancellous material between the two layers or
-tablets of the skull is called the diploë.
-
-Eminences and depressions occur on bones and when they are not
-articular are for the attachment of ligaments and muscles. If they are
-articular, they help to form joints.
-
-As a whole the bony framework serves to keep the soft parts in place,
-to support and protect them, and to aid in locomotion. The bones of the
-head and trunk support and protect organs; those of the arms are for
-tact and prehension; those of the lower extremities are for support and
-locomotion.
-
-Normally bones have little sensibility, but when inflamed they are
-extremely sensitive and painful.
-
-=Joints.=--The bones are connected with and move upon one another by
-means of joints. These joints are of three kinds: 1. Immovable, where
-the adjacent margins of the bones are closely applied, with little
-fibrous tissue between, as in the sutures of the head; 2. those with
-limited motion, which are very strong, the parts being connected with
-tough fibro-cartilage; and 3. freely movable. In this last group the
-articulating surfaces are covered with cartilage, which again is
-lined with a delicate synovial membrane which secretes a small amount
-of lubricating fluid, the synovial fluid, to reduce friction. Their
-surfaces are also sometimes deepened by the presence of inter-articular
-fibro-cartilages. Bursæ or sacs of synovial membrane occur outside the
-joints under tendons and ligaments to reduce friction.
-
-The nature and extent of the motion of a joint is defined and the bones
-are held together by strong bands of fibrous tissue or ligaments, these
-ligaments being more fully developed in joints where there is great
-freedom of motion or where there is great weight to be supported. In a
-ball-and-socket joint, such as the hip, there is a ligament in the form
-of a strong capsule which surrounds the joint on all sides and limits
-its motion, while hinge joints, like the elbow, and pivot joints, such
-as that formed by the atlas on the axis, have lateral ligaments that
-allow of freer motion. In the shoulder-joint, which is the most freely
-movable joint in the body, the capsular ligament is very lax.
-
-In general the kinds of motion possible in joints may be said to be
-flexion, extension, abduction, adduction, circumduction, and rotation.
-
-When much violence is applied to a joint and no dislocation results, as
-in a sprain, there is often much stretching and even laceration of the
-ligaments.
-
-=Muscle.=--The flesh, which forms a large proportion of the weight of
-the body, consists of muscular tissue. Of this two kinds are found:
-1. The striated or striped muscle of animal life, which is under the
-control of the will and so is known as voluntary muscle, and 2. the
-unstriped or smooth muscle of organic life over which we have no
-control, that is, the involuntary muscle. Each fiber of striped muscle
-has an elastic, membranous sheath, the sarcolemma, and consists of
-rod-shaped cells with a nucleus along the edge, set end to end and
-having crosswise striations. In unstriated muscle the fibers, which
-have no sarcolemma, consist of oval or spindle-shaped cells, with
-a nucleus much smaller than that of striped muscle and situated in
-the middle. In both kinds of muscle the fibers are bound together
-with connective tissue and blood-vessels into fasciculi or bundles,
-and many bundles go to make up a muscle. The muscle in turn has a
-connective tissue envelope or sheath, the fascia. These fasciæ are
-found throughout the body, the superficial ones being just beneath
-the skin, while the deep ones not only form sheaths for the various
-muscles but form partitions between them and serve to strengthen their
-attachments. The striped muscles are those of motion, while the
-unstriped occur in the hollow organs, surrounding the cavity and in
-some cases lessening its capacity by their contraction.
-
-An intermediate form of muscle known as cardiac muscle occurs in the
-heart. Here the fibers have striations but the nucleus is generally in
-the middle of the cell and the fibers branch and run together.
-
-[Illustration]
-
-[Illustration: FIG. 5.--Voluntary muscle (Leroy). _A_, Three voluntary
-fibers in long sections: _a_, three voluntary muscle fibers; _b_,
-nuclei of same; _c_, fibrous tissue between the fibers (endomysium);
-_d_, fibers separated into sarcostyles. _B_, Fiber (diagrammatic): _a_,
-dark band; _b_, light band; _c_, median line of Hensen; _d_, membrane
-of Krause; _e_, sarcolemma; _f_, nucleus. _C_: _a_, Light band; _b_,
-dark band; _c_, contracting elements; _d_, row of dots composing the
-membrane of Krause; _e_, slight narrowing of contracting element aiding
-in production of median line of Hensen.]
-
-In life muscle appears more or less translucent and is contractile and
-alkaline, but in death it loses its translucency and becomes rigid,
-at the same time giving off in decomposition much carbon dioxide, so
-that its reaction is acid. This phenomenon of the muscles becoming
-rigid in death is called rigor mortis and occurs generally a few hours
-after death, though it may come at once or be considerably delayed.
-It may last anywhere from a few moments to several days but generally
-lasts from twenty-four to thirty-six hours. It is probably due to the
-formation in the muscle of myosin, a substance which probably comes
-from myosinogen in the living muscle and which is closely akin to
-the fibrin of blood. Probably the myosin or what precedes it causes
-clotting of the muscle just as fibrin or what precedes it causes
-clotting of the blood.
-
-[Illustration: FIG. 6.--Three voluntary muscle fibers from an injected
-muscle, showing network of blood capillaries. (Hill.)]
-
-The muscles vary in shape in different parts of the body, being long
-and slender in the limbs and broad and flat in the trunk. They are
-attached chiefly to bones but also to cartilages, ligaments, and skin,
-either by means of tendons, which are cords or bands of white inelastic
-fibrous tissue, or by means of aponeuroses, membranous expansions of
-the same nature. Most voluntary muscles consist of a belly and two ends
-or tendons. The origin is the fixed point from which it acts while the
-movable point upon which it acts is known as its insertion.
-
-=Action of the Muscles.=--When attached to bones, muscles are
-distributed in three ways: 1. When it is necessary to produce much
-motion rapidly, a short muscle is used. 2. When a part needs to be
-moved far and much contraction on the part of the muscle is, therefore,
-needed, the muscle is very long, as in the case of the sartorius
-muscle, which shortens half its length. 3. Finally, where less distance
-has to be covered but greater power is required, tendons are used, as
-in this case the contraction is powerful but does not carry the part
-far.
-
-In performing the mechanical work of the body the muscles are aided by
-the fact that the bones, to which they are largely attached, are set
-together loosely and form a set of levers, on which the muscles act
-to perform certain definite acts. All three classes of levers occur:
-1. where the fulcrum is between the weight and the power, as in the
-case of the head, which is balanced by the muscles of the neck on the
-vertebræ; 2. where the weight is between the fulcrum and the power, as
-when a person raises himself upon his toes; and 3. where the power is
-between the fulcrum and the weight, as when the biceps is used to raise
-a weight held in the hand. The erect position of the body is difficult
-to maintain because the center of gravity is high up, and it is by the
-contraction of many muscles in the legs, thighs, back, abdomen, and
-neck that the body is balanced upright upon the feet.
-
-=Physiology of Muscle.=--_Irritability_ or sensitiveness to stimulation
-and _contractility_ or the power to contract are the two most important
-functions of muscle. Contraction occurs in response to nervous energy
-brought by the nerves, a nerve filament going to each muscle fiber,
-into which it plunges, its substance being lost and its sheath
-becoming continuous with that of the muscle fiber. Any irritant,
-as heat, electricity, etc., when applied to the nerve, causes the
-muscle to contract. Moreover, muscle has an irritability of its own
-and can contract independently of the nervous system. In contracting
-it shortens and thickens, bringing the two ends closer together, and
-becomes firm and rigid. The amount of contraction depends upon the
-strength of the stimulus and the irritability of the muscle. The
-minimal stimulus is the least stimulus that will cause a contraction
-and the maximal is one that will cause the greatest contraction. The
-work done depends in like manner upon the strength of the stimulus.
-During contraction certain sounds are given off called muscle sounds,
-which can be heard with the stethoscope but have no special
-significance.
-
-The muscles which have the greatest power of rapid contraction are
-generally attached to levers. Indeed, striated muscle is characterized
-by the rapidity and strength with which it works, though its rhythmic
-motion is slight. Smooth muscle, on the other hand, is characterized
-by its great force, considerable rhythm, considerable tone, and slight
-rapidity, that is, its contraction is slower and lasts longer than that
-of striated muscle. Cardiac muscle is characterized by great rhythm and
-force, fair rapidity, and slight tonicity, tonicity being the amount of
-tone or readiness to work. For even in sleep muscle is always in tone,
-that is, ready to do its work. It is this that makes the difference in
-appearance between a living and a dead person and enables one to spring
-to his feet at night if he hears a noise, a thing he could not do if
-his muscles were wholly relaxed. Thus, rapidity is the great function
-of striated, tonicity of smooth, and rhythm of cardiac muscle. In
-paralysis the muscles droop and lose their tone. Muscles are frequently
-the seat of rheumatic disorders.
-
-When set free, potential energy accomplishes work. In muscle there is
-a good deal of potential energy, which is set free as heat and as work
-accomplished. Even when the muscles are at rest, chemical changes are
-going on and heat is being produced, though more heat is produced when
-they are functioning. If the body depended upon its gross motions for
-all its heat it would grow cold while a person rested. The respiratory
-organs, however, and the heart are always working and chemical changes
-are constantly taking place.
-
-Ordinarily a muscle has some object in contracting, such as the raising
-of a load, and it contracts voluntarily more or less according to
-the weight of the load. The amount of work done is calculated in
-foot-pounds or gram-meters, that is, the energy required to raise one
-pound one foot or one gram one meter. As a rule the muscles with the
-longest fibers, as the biceps, do the most work and those with a large
-number of fibers do more than those with less. It has been calculated
-that whereas an engine gives back one-twelfth of the energy of the coal
-consumed, muscle liberates one-fourth of the energy brought to it in
-the form of food. During activity the glycogen or sugar in the muscle
-is used up and the muscle becomes more acid, owing to the lactic acid
-that is formed. The carbon is taken in and carbon dioxide given off.
-Nitrogen puts the muscle in condition to do its work but is not so
-much used up in the work as is the carbohydrate material. So it is the
-non-nitrogenous matter that does the work and any increase in urea, the
-end-product of protein metabolism, is mere wear and tear.
-
-Sudden heat or cold causes muscular contraction and moderate heat
-favors both muscular and nervous irritability. Moderate cold, however,
-lessens the force of contraction and below zero muscle very largely
-loses its irritability without necessarily becoming rigid.
-
-While well supplied with blood, muscle will contract without fatigue,
-but if the blood supply is shut off, it soon loses its irritability
-and becomes rigid. The more a muscle is used in moderation the more it
-develops, but after it has done a certain amount of work it becomes
-exhausted, losing its irritability or power to respond to stimuli
-and later becoming rigid. Such fatigue is due to the production of
-certain poisonous waste products which have a paralyzing effect on the
-nerves and which are ordinarily gradually carried away in the blood,
-but which sometimes, if produced to excess, accumulate too fast for
-the blood wholly to remove them. Usually the nerve becomes exhausted
-first and the muscle substance later. So long as it is connected with
-the nervous system a muscle will respond to stimuli, but when the
-nerve becomes tired, degeneration is more rapid. In fact, the degree
-of exhaustion is determined by several factors, as by relation to the
-central nervous system, variations in temperature, blood supply, and
-functional activity, the process being more rapid in warm than in cold
-blooded animals.
-
-=Cilia.=--A few motions are accomplished by tissue that is not
-muscular, as in the case of the cilia attached to the cells of the
-respiratory tract, which lie flat on the free surface and then lash
-forward, serving in the air cells to keep the air in motion and in the
-tubes to send secretions from below upward and outward and to keep out
-foreign bodies. Cilia are also found in the female genital tract, where
-they aid the passage of the ovum from the ovary to the womb. They act
-together, though apparently not governed by the nervous system. As in
-the white corpuscles of the blood, whose motion also is not muscular,
-the changes that take place in ciliated epithelium are probably about
-the same as those in muscular tissue, that is, contractile.
-
-=The Blood.=--To most of the tissues just described nourishment is
-brought in the blood, which circulates through the body in a system
-of hollow tubes, the arteries and veins, whence it is distributed
-through the agency of the lymphatic system. There are no blood-vessels,
-however, in the epidermis, epithelium, nails, hair, teeth, nor in the
-cornea of the eye. The vessels that carry the blood from the heart
-are called arteries, those that return it veins. The former begin as
-large vessels and gradually decrease in size; the latter begin as small
-vessels and form larger and larger trunks as they approach the heart.
-
-The _arteries_ have three coats: 1. a thin, serous coat, the internal
-or intima; 2. a middle or muscular coat, and 3. an external coat of
-connective tissue. The middle coat is the thickest and is the one that
-prevents the walls from collapsing when cut across. Except in the
-cranium, each artery is enclosed in a sheath with its vein or veins,
-the venæ comites. Usually the arteries occupy protected situations and
-are straight in their course. Where a vessel has to accommodate itself
-to the movements of a part, however, it may be curved, as in the case
-of the facial artery which is curled on itself to allow for movements
-of the jaw. They anastomose or communicate freely with one another,
-thus promoting equality of distribution and pressure and making good
-circulation possible even after the obliteration of a large vessel.
-
-The _veins_ have three coats like the arteries, but they are not so
-thick and the muscular coat is not so highly developed, so that the
-walls collapse when cut and have no elasticity. There are constrictions
-on the surface of many of the veins due to the presence of valves.
-These valves are formed of semilunar folds of the lining membrane
-and are arranged in pairs. They serve to prevent the blood, whose
-circulation in the veins is sluggish, from flowing back.
-
-There are two sets of veins, the superficial and the deep, which
-communicate with each other. In fact, all the veins, large and small,
-anastomose very freely, especially in the skull and neck, where
-obstruction would result in serious trouble, throughout the spinal
-cord, and in the abdomen and pelvis. The deep veins accompany the
-arteries in their sheath, while the superficial ones have thicker walls
-and run between the layers of the superficial fascia under the skin,
-terminating in the deep veins. In the skull the venous channels take
-the form of sinuses, formed by a separating of the layers of the dura
-mater, with an endothelial lining that is continuous with that of the
-veins.
-
-The _capillaries_ are intermediate between the arteries and the veins,
-the final division of the arteries and the first source of the veins.
-They are tiny vessels with but a single coat, continuous with the
-innermost coat of both arteries and veins and consisting practically of
-one layer of cells with a small amount of connective tissue between.
-They spread in a great network throughout the tissues, forming plexuses
-and being especially abundant where the blood is needed for other
-purposes than local nutrition, as in the secreting glands. Their
-diameter is so small that the red corpuscles have to pass in single
-file and may even then be squeezed out of shape. As they have no
-muscular tissue in their walls, they have no power of contracting.
-Their walls, however, like those of the smaller arteries and veins, are
-porous and by virtue of this quality they play an important part in the
-economy, since in them the exchange takes place between the tissues and
-the blood.
-
-The arteries in general carry freshly oxidized blood and the veins
-blood from which the oxygen has been largely used up and which contains
-waste material. In the pulmonary system, however, the case is reversed,
-the pulmonary arteries conveying venous blood, as it is called, from
-the heart to the lungs to be oxidized and the veins returning the blood
-after it has received its new supply of oxygen.
-
-The pumping of the blood through the arteries is assisted by the
-contractions of the muscular coat, while the elastic tissue, of which
-it contains a certain amount, gives elasticity to the walls and enables
-them to stretch and so to accommodate the larger blood supply forced
-into them at each beat by the heart. The walls of the veins have not
-the power of contracting and the blood is pushed through more by
-gravity and the action of the arteries than by any action of their own.
-
-The walls of all the vessels are nourished by tiny blood-vessels in
-the outer coat, known as _vasa vasorum_, and the nerves that regulate
-the action of the arteries are the vasomotor nerves from the vasomotor
-center in the medulla. Sufficient impulse goes from this center to the
-blood-vessels all the time to keep them somewhat contracted, in a state
-of tone, that is, which is increased or diminished as the blood supply
-is to be diminished or increased.
-
-=Lymphatic System.=--The lymphatic system also extends throughout
-the body and consists of a system of channels, spaces, and glands
-very closely related to the circulatory system and containing a fluid
-called lymph. There are three principal parts to the system: 1. the
-lymph spaces, which are open spaces, with no definite walls, in the
-connective tissue framework of the body, more frequent near arteries
-and veins and especially so among the capillaries; 2. the lymph
-capillaries or small vessels which connect the lymph spaces; and 3. the
-lymphatic vessels, of which there is a deep and a superficial set, the
-latter accompanying the superficial veins on the surface of the body,
-the former accompanying the deep blood-vessels.
-
-[Illustration: FIG. 7.--Diagram showing the course of the main trunks
-of the absorbent system: the lymphatics of lower extremities (D) meet
-the lacteals of the intestines (LAC) at the receptaculum chyli (R.C.),
-where the thoracic duct begins. The superficial vessels are shown in
-the diagram on the right arm and leg (S), and the deeper ones on the
-left arm (D). The glands are here and there shown in groups. The small
-right duct opens into the veins on the right side. The thoracic duct
-opens into the union of the great veins of the left side of the neck
-(T). (Yeo.)]
-
-The _lymph spaces_ are generally small, though there are some large
-serous cavities, such as the abdomen, that may be considered as
-extended lymph spaces.
-
-[Illustration: FIG. 8.--Diagram of a lymphatic gland, showing afferent
-(_a. l._) and efferent (_e. l._) lymphatic vessels; cortical substance
-(_C_); medullary substance (_M_); fibrous coat (_c_); sending trabeculæ
-(_tr_) into the substance of the gland, where they branch, and in the
-medullary part form a reticulum; the trabeculæ are surrounded by the
-lymph path or sinus (_l. s._), which separates them from the adenoid
-tissue (_l. h._). (Sharpey.)]
-
-The _lymphatic vessels_ have delicate, transparent walls, with three
-coats like the arteries, though much thinner, and anastomose even
-more freely than the veins. They have a beaded appearance due to
-the presence of numerous valves, which form constrictions on their
-surface. The right lymphatic duct, which is only about an inch long,
-drains all the lymphatics of the right half of the upper part of the
-trunk, the head, and the neck approximately, while the thoracic duct
-drains those of the rest of the body. The latter, which is the largest
-vessel of the system, begins opposite the second lumbar vertebra
-with a bulb-like reservoir for the lymph or chyle, the receptaculum
-chyli, and extends up along the spinal column for a distance of
-about eighteen inches to the seventh cervical vertebra, where, with
-the right lymphatic duct, it empties into the left subclavian vein
-at its junction with the internal jugular, thus establishing direct
-communication between the lymph spaces and the venous system. The
-orifices of both vessels are guarded by semilunar valves to prevent
-regurgitation of the blood.
-
-[Illustration: FIG. 9.--Central (superficial) lymphatic glands of the
-axilla. (After Leaf.)]
-
-The _lymphatic glands_ are small oval glandular bodies and occur here
-and there along the course of the lymphatics. Before entering one of
-them the vessel breaks up into several afferent vessels which form
-a plexus within and then emerge again as several efferent vessels
-which soon unite to form one trunk. These glands occur chiefly in the
-mesentery, along the great vessels, and in the mediastinum, axilla,
-neck, elbow, groin, and popliteal space.
-
-The _lymph_ varies in character with the locality, being a little
-thicker and more opalescent in the lacteals, as the lymphatics of the
-small intestine are called, especially during digestion, when fat is
-present. Here it is called chyle. Otherwise it is generally a clear,
-transparent and slightly opalescent fluid, which, owing to the presence
-of fibrin, clots when drawn from the body and allowed to stand. In
-fact, it resembles blood plasma very closely in composition and, as it
-also contains a certain number of corpuscles or leucocytes that just
-correspond to the white corpuscles of the blood, it is practically
-blood without the red corpuscles. These leucocytes have considerable
-power of amœboid movement and are thought by some to play an important
-part in the absorption of food.
-
-Owing to intracapillary pressure, the lymph transudes into the
-lymph spaces and bathes the tissues, being carried away again by
-the lymphatics. The amount of transudation is determined by the
-blood pressure--the greater the pressure, the greater the amount of
-transudation--and is increased by some organic action of the cells in
-the walls of the vessels. In the process of transudation a certain
-amount of solid matter goes through the wall of the vessel and it is
-probable that certain protein elements can be carried thus from the
-blood-vessels to the lymphatics, though they do not pass through the
-capillary wall as readily as other substances. Some lymph is also
-probably formed by the action of the tissues themselves, though the
-process is not understood.
-
-All muscular movements, active or passive, including the respiratory
-movements, tend to drive the lymph on its way by pressure, the valves
-of the vessels keeping it from flowing back. Moreover, its flow is
-from the capillaries to the veins or from a region of high pressure to
-one of less pressure. There is probably also some contraction in the
-walls of the vessels themselves, and the continual formation of lymph
-helps to drive it along. If an obstruction to the circulation occurs,
-however, back-pressure results and causes too great transudation. In
-that event a limb becomes swollen, pale, and generally cool. It pits
-on pressure, the pressure driving the lymph out and there being no
-circulation to bring it back. This condition is called œdema and occurs
-in liver, kidney, and heart troubles, being generally first observed at
-the ankles. In ascites, hydrothorax, hydrocephalus, and pericardial and
-pleural effusions the fluid corresponds to lymph in its composition and
-the large amount is due to excessive formation of the fluid, which is
-normally present in small quantities.
-
-Lymph gives the tissues substances from the blood that they need and
-carries off those they do not, whether waste or substances of use to
-other tissues. Because they thus absorb certain materials not needed
-by the tissues and convey them to the circulation, the lymphatics have
-also been called absorbents. Indeed, lymph may be spoken of as the
-middleman between the blood and the tissues.
-
-Another function of the lymph is to lubricate. Thus, the synovial fluid
-of the joints is lymph and the pleuræ and the pericardium contain lymph
-or serum to reduce the friction between the adjoining surfaces as much
-as possible. The brain and spinal cord do not quite fill the cavities
-of the cranium and the spinal column but float on a cushion of lymph,
-the cerebro-spinal fluid. When the brain, which is subject to increase
-and diminution in size, increases in size, it drives the lymph out, and
-when it diminishes, the lymph returns.
-
-The lymph glands serve as a protection to adjacent parts and when it
-leaves the gland the lymph is purer and richer in leucocytes than
-when it entered. In fact, they filter harmful matter from the lymph
-and apparently also form white corpuscles. Normally they can with
-difficulty be felt, but in disease, if the leucocytes are unable to
-destroy or carry off the poison, the lymph carries it along to the
-glands, which swell and become tender. If the infection is not severe
-the swelling goes down and the tenderness passes after a short time,
-but if it is severe, there may be suppuration and abscess formation
-and the gland even perhaps be destroyed, giving its life for the
-health of the part. Thus a wound in the foot, if infected, may cause
-irritation and enlargement of the glands at the knee and in the groin.
-
-The lymphatic glands are frequently the seat of tubercular infection,
-especially in the neck, and are enlarged in scarlet fever, tonsillitis,
-and diphtheria. In syphilis there is general glandular enlargement, and
-the glands in the groin become enlarged in all diseases of the genital
-organs. In malignant growths, such as cancer, the extension of the
-disease is often along the lines of the lymphatics.
-
-=Glands.=--Of glands in general a word might now be spoken. They are of
-two kinds, excreting and secreting, and, when simple, are formed by the
-folding in of a free surface, as in the case of the salivary, gastric,
-and sebaceous glands, the cells at the gland becoming so modified as to
-be able to perform the function of excreting or secreting. In racemose
-glands the gland is broken up into many pockets. Excreting glands take
-from an organ or from a part substances which have outlived their
-usefulness and are to be cast out of the body, while the secreting
-glands form from the blood substances that did not exist in it before,
-but which are of use to the body, as the ptyalin of the saliva. A
-strict line cannot, however, be drawn between the two kinds of glands,
-most glands partaking more or less of both functions, though the
-sebaceous and sweat glands are probably purely excreting glands and
-the salivary glands are almost purely secreting. The glands, moreover,
-are more or less interchangeable in their functions, that is, they
-have vicarious function, and one gland can take up and do for another
-what that other is for some reason unable to do. In jaundice, where
-there is stoppage of the bile duct, the kidneys help out the liver by
-excreting the bile. If one kidney is removed the other does work for
-both, and the glands of the skin may help out the kidneys or _vice
-versa_. Hemorrhage from the lungs sometimes occurs in suppression of
-the menses.
-
-In a general way the _function of glands_ is chemical. They filter out
-by osmosis, selecting the useful parts for secretion and the useless
-for excretion. In the chemical action that goes on considerable energy
-is given off, as is shown by the amount of pressure in the glands and
-by the fact that their temperature is higher than that of the blood.
-They all work in a reflex manner, being under the control of the
-central nervous system. Thus, what is eaten affects the nerve terminals
-in the mouth, the sensation passes to the nervous system, and an
-impulse is carried by the motor nerves to the salivary glands.
-
-Most of the glands have ducts to convey away their secretion to other
-parts of the body or to send excretions out of the body, but there are
-also _ductless glands_, which, though they seem to have some important
-function in the process of metabolism, are not well understood. Most
-of them seem to manufacture some substance that is absorbed by the
-tissues and that plays an important part in the bodily metabolism,
-though nothing is secreted by them externally. They are said to have
-an internal secretion, whereas the glands with ducts have an external
-secretion. The liver has both forms of secretion, the bile which is
-sent out and the glycogen that is stored. The ductless glands are the
-thymus and thyroid glands, the suprarenal capsules, and the pituitary
-body in the brain.
-
-=Nervous Tissue.=--Presiding over all the organs, muscles, and
-blood-vessels, as the source of all action and all sensation, are the
-nerves. Nervous tissue is of two kinds: 1. the gray or vesicular, which
-originates impulses and receives impressions, and 2. the white or
-fibrous, which conveys impressions. The gray matter consists of large
-granular cells of protoplasm containing nuclei, which give off many
-branches or dendrites. From the under surface there usually comes one
-main branch, the axis-cylinder process. These processes sometimes give
-off branches and sometimes not, but they form the nerve fibers and
-carry impulses away from the nerve cells. The cells of the processes
-are elongated in shape, have a nucleus, and are placed end to end, with
-a definite constriction between them.
-
-Each axis-cylinder process is surrounded by a sheath called the
-medullary sheath, while each nerve fiber consists of a central
-axis-cylinder process surrounded by the white substance of Schwann
-and enclosed in a sheath. A bundle of these fibers invested in a
-fibro-areolar membrane called the neurilemma constitutes a nerve, and
-of these the white matter is formed. The blood supply is brought by
-minute vessels, the _vasa nervorum_.
-
-[Illustration: FIG. 10.--Longitudinal nerve fiber (diagrammatic): _a_,
-Axis-cylinder; _b_, medullary sheath; _c_, neurilemma; _d_, nucleus;
-_e_, node of Ranvier. (Leroy.)]
-
-The nerves of the cerebro-spinal system preside over animal life and
-have to do with voluntary acts, while those from the sympathetic
-system regulate organic life and are quite independent of the will.
-Both sensory and motor nerves extend all over the body, accompanying
-the arteries in a general way. The sensory nerves end on the surface
-in plexuses, in end bulbs situated in the papillæ of the skin, or
-in tactile corpuscles, these last occurring more especially where
-there is no hair. The motor nerves end peripherally in plexuses or
-by end plates. The central terminations of the motor nerves and the
-terminations of sensory nerves in special organs, except where they end
-in a cell, are not well understood.
-
-Like muscles, nerves are probably never at rest, for through them the
-muscles get their tone. When a nerve acts, no heat is produced and
-there is no change in the nerve afterward, as there is in muscle.
-Probably nerve impulse is the transmission of physical rather than
-chemical changes along the fiber, the atoms of the nerve being set
-in vibration and the vibrations being transmitted along its length.
-Stimulation is produced by physical injury, by chemical influence, by
-electricity, by heat, and the message is always referred to the nerve
-termination. Thus, if the nerve at the elbow, over the “crazy bone,” is
-touched, a tingling is felt in the fingers rather than at the point of
-pressure. A person who has had an arm or leg amputated will frequently
-speak of his fingers or toes on that side being cold, or complain of
-pain in them, because the scar below the point of amputation tightens
-around the nerves and pinches them.
-
-It is through the nerves that people get in touch with the outer world
-and that they judge of size, weight, etc. All careful adjustment of the
-muscles is under the control of the nervous system.
-
-
-
-
-CHAPTER II.
-
-THE SKIN, ITS APPENDAGES AND ITS FUNCTION.
-
-
-The whole exterior surface of the body is covered by the skin, an
-excreting and absorbing organ, which serves as a protection to the
-parts beneath and is also the organ of touch. It has two layers,
-a superficial and a deep. The superficial layer, the epidermis or
-cuticle, is composed wholly of epithelial cells, of which the deepest
-layer is columnar and moulded upon the papillary layer of the derma,
-while the intermediate layers are more rounded and the surface ones
-flat. The deepest layer also contains the skin pigment, which causes
-the variation in shade between the Indian, the negro, and the white
-man. Below the epidermis, which is chiefly protective, is the tough,
-elastic, and flexible tissue of the derma or true skin, in which are
-vested most of the activities of the skin. Its surface is covered
-with papillæ, which are more numerous in the more sensitive parts.
-Each papilla contains one or more capillary loops and one or more
-nerve fibers, while some terminate in an oval body known as a tactile
-corpuscle. Beneath the papillæ is the reticular layer, composed of
-interlacing bands of fibrous tissue and containing blood-vessels,
-lymphatics, and nerves, as well as unstriped muscle fibers where hair
-is present.
-
-[Illustration: FIG. 11.--Vertical section of skin.]
-
-At the apertures of the body the skin stops and is replaced by _mucous
-membrane_, an integument of greater delicacy but which consists
-fundamentally of the same two layers, a superficial, bloodless
-epithelium and a deep fibrous derma. It is continuous with the skin,
-but is much redder and more sensitive and bleeds more easily. The
-passages and cavities that it lines, unlike those lined by serous
-membranes, communicate with the exterior of the body and are for that
-reason protected against contact with foreign substances by mucus,
-which is thicker and more sticky than the lymph that moistens the
-endothelium found on serous surfaces. Mucous membrane is found in the
-alimentary canal, the respiratory tract, and the genito-urinary tract.
-In cavities, like the stomach and intestines, which are subject to
-variations in capacity, it is thrown into folds or rugæ. The mucus is
-secreted by small glands in the membrane.
-
-=Appendages of the Skin.=--The skin has various appendages. On the
-dorsal surface of the last phalanges of the fingers and toes are
-flattened and horny modifications of epithelium, the _nails_. They have
-a root embedded in a groove of skin by which they grow in length and a
-vascular matrix of derma beneath them which gives growth in thickness.
-To their growth in length there seems to be no limit.
-
-The _hairs_ also, which occur all over the body, except on the palms
-of the hands and the soles of the feet, are a modification of the
-epithelium. Each hair has a bulbous root springing from an involution
-in the epidermis and derma called the _hair follicle_, into which one
-or two sebaceous glands empty. It is raised by involuntary muscle
-fibers and grows by constant additions to the surface by which it is
-attached. This growth seems, however, to be limited, and when its term
-is reached the hair falls out and is replaced by another. The horny
-epithelial cells that go to form the hair contain the pigment that
-gives it its color.
-
-[Illustration: FIG. 12.--Skin and longitudinal section of hair: _a_,
-Epidermis; _b_, corium; _c_, sebaceous gland; _d_, fibrous root-sheath;
-_e_, glassy membrane; _f_, outer root-sheath; _g_, inner root-sheath;
-_h_, expanded bulbous end of hair; _i_, papilla of hair; _j_, arrector
-pili; _k_, adipose tissue. (Leroy)]
-
-Like the hairs, the _sebaceous glands_ are situated in all parts of
-the body except the palms of the hands and the soles of the feet. They
-lie in the papillary layer and empty into the hair follicles, except
-occasionally, when they empty directly upon the surface of the skin.
-They secrete an oily substance, _sebum_, the débris resulting from the
-degeneration of the epithelial cells of the gland itself, which serves
-to keep the hair glossy and the skin soft and flexible.
-
-The _sweat glands_, on the other hand, are more frequent on the palms
-and soles and though sometimes found in the derma are usually situated
-lower down in the subcutaneous cellular tissue. They are least numerous
-on the back and neck. Coiled up in the lower layers of the skin, they
-discharge the sweat through a spiral excretory duct upon its free
-surface.
-
-The _sweat_ is a clear, colorless, watery fluid with a salty taste,
-an alkaline reaction, and a characteristic odor that varies with
-the individual. If very scanty, it may be acid in reaction. Besides
-water it contains a small percentage of solids, as inorganic salts,
-especially sodium chloride, fatty acids, neutral fats, and at times,
-especially in some diseases of the kidneys, urea, that is, the
-end-products of the metabolism of starches and fats chiefly. There
-is usually also some carbon dioxide, whence the expression cutaneous
-respiration.
-
-The sweat serves to keep the skin moist and in good condition, to
-remove outworn and poisonous or irritating matters, and to regulate
-the temperature. As a rule it evaporates upon reaching the surface, in
-which case it is known as invisible or insensible perspiration, but if
-conditions of the atmosphere are not favorable to prompt evaporation,
-as when the air is damp, the skin becomes damp and there is visible
-perspiration.
-
-Though an abundant supply of blood increases the action of the sweat
-glands, they are regulated by definite secretory nerves rather than
-by the vasomotor nerves. In a cold sweat the action is probably due
-to some disturbance of the nerve supply without increase of the blood
-supply. Ordinarily perspiring is a reflex act due to the stimulation
-of the afferent cutaneous nerves, as by the application of heat, but
-sometimes, as in cases of strong emotions, involuntary impulses are
-sent from the brain to the spinal centers and so arouse the action
-of the glands. Atropin has the power of preventing the secretion of
-sweat by paralyzing the terminations of the secretory nerves, while
-pilocarpin produces an opposite effect in a similar way.
-
-On account of these sweat glands the skin becomes next in importance
-after the kidneys in the excretion of waste products. The quantity of
-sweat excreted varies greatly and is hard to measure. It is influenced
-by the temperature and humidity of the surrounding air, by the nature
-and quantity of food and drink consumed, by the amount of exercise,
-the relative activity of other organs, especially the kidneys, and by
-certain mental conditions. The hotter it is, the greater the amount of
-perspiration. In damp weather there may be less perspiration, but it
-does not evaporate and is therefore more in evidence.
-
-Ordinarily man has a temperature of 98.6°. The source of this body heat
-or temperature is the general body metabolism, muscular activity, and
-activity of the glands, especially of the liver, which is constantly
-active, the blood in the hepatic vein being warmer than that in any
-other part of the body. The tissue of the brain also is said to be
-warmer than the surrounding blood, and the heart and respiratory
-muscles, which are in constant activity, are responsible for much of
-the body heat. The amount of heat generated in the body, therefore,
-varies at different times, according as a person is awake or asleep,
-quiet or active.
-
-=Temperature Regulation.=--The temperature is regulated by variations
-in the production and loss of heat, less being known of its production
-than of its loss. It has been calculated that four-fifths of the energy
-of the body is converted into heat, one-fifth into work. As the minimum
-amount of heat produced in twenty-four hours is sufficient to raise 10
-gallons of water from 0° to boiling-point, it is evident that if there
-were not some way for the escape of much of this heat the body would
-become hotter and hotter and finally destroy itself. The temperature,
-however, except on the surface, is uniform, heat being lost as fast
-as it is produced. For, although oxidation at any point raises the
-heat of the blood at the point, this heat is carried by the blood to
-other parts, to which the surplus is given up, while blood cooled in
-the skin goes to the hotter inward parts to cool them and be warmed
-itself. In fact, heat is expended by conduction and radiation, through
-respiration, perspiration, and heat given to the urine and fæces. It
-is, therefore, largely, 75 to 80 per cent., carried off through the
-skin and the lungs; 60 to 70 per cent. is lost by radiation to the
-air and other bodies with which the body comes in contact; 20 to 30
-per cent. is lost by the evaporation of sweat, 4 to 8 per cent. by
-the warming of expired air, urine and feces, and 1 to 2 per cent.
-by cold food that is taken in. Radiation acts more favorably where
-the surroundings are cool and the air in motion, as on a breezy day.
-Conduction is carried on best where the surrounding air is cool,
-especially if it is moist, for moist air is a better conductor of heat
-than dry air. Evaporation is very important in hot weather or where men
-work in hot air.
-
-Even in health the temperature may range from 98.6° to 99.5°, and a
-degree or two below or above is not dangerous. When a person first
-gets up in the morning his temperature is apt to be subnormal, but
-after food and exercise have been taken it becomes normal and stays
-so till the end of the day, when, if the person is tired, it may go
-up a little. If a person is tired out, the temperature is apt to be
-subnormal. There is also in the body what is called the vital tide,
-which is highest afternoon and evening and lowest in the morning.
-
-The rate of production of heat varies greatly in different people. One
-person uses a certain amount of tissue more quickly than another, that
-is, he lives faster. Moreover, size makes a difference in that a small
-body has more surface to its weight than a large one and so has to
-produce the same amount of heat at a faster rate in order to maintain
-the right temperature. Taking food increases heat, probably because
-of the muscular effort needed to eat it. Muscular work is another
-factor. And finally the whole matter of heat production seems to be
-under the control of the nervous system. Not much is known on this
-point except that there is a heat center in the medulla which plays an
-important part in heat production and whose influence is seen where
-the temperature shoots way up in disease just before death. It is now
-thought that fever is due to a disturbance of this nervous mechanism,
-though just what the disturbance is is not known.
-
-_Fever_ is a condition of increased bodily temperature, due to
-increased production or to decreased loss of heat. As a rule, in all
-fevers the metabolic changes in the body are increased. Hence the
-patient becomes emaciated in a long fever. The frequent increase in the
-amount of urea during fever shows an increase in protein metabolism.
-The temperature in fevers rises as high as 106° and in sunstroke
-sometimes to 110°. Except in sunstroke a higher temperature than 106°
-generally means death. Subnormal temperature is due to a decrease in
-the bodily metabolism and so to lessened heat production. As a rule,
-if the functions are all active, especially that of the sweat glands,
-a person can be exposed to severe heat without the temperature being
-affected, though sometimes on a hot summer day it may be up half to one
-degree. The cause of heat-stroke with its high fever is unknown, but
-probably it is due to some effect on the heat center in the brain. Heat
-prostration is also due to prolonged exposure to heat, but is generally
-accompanied by a subnormal temperature. The effect of cold, as in
-freezing, is to diminish all the metabolic activities of the body. The
-temperature can be artificially regulated more or less by variations of
-food, varying amounts of exercise, by drugs, etc.
-
-=Sense of Touch.=--Before passing on to a discussion of the individual
-parts, a few words might well be said of the sense of touch, since that
-is general and resides largely in the skin, whose other functions have
-just been described. It may be regarded as the form from which all
-the other special senses have developed, certain portions of the body
-having become more sensitive than others to certain vibrations, as the
-eye to those of light. The internal organs probably have little sense
-of touch.
-
-[Illustration]
-
-[Illustration: FIGS. 13, 14.--Meissner’s corpuscle from man; ×750.
-(Böhm, Davidoff, and Huber.)]
-
-Touch is useful only within arm’s reach but there gives one a sense of
-space that sight does not give. It is practically determined by the
-_touch corpuscles_, which are found in the skin over almost the entire
-body, though they are more numerous in some places than in others,
-the distribution of the corpuscles determining the sensitiveness of
-the skin. These touch corpuscles are protoplasmic bodies containing
-nuclei, about which are entwined filaments from the cutaneous nerves.
-Where the corpuscles are absent the filaments of the cutaneous nerves
-themselves play an important part. The finger tips have a very delicate
-sense of touch and the tip of the tongue is the most sensitive part of
-the body. Hence spaces in the mouth seem larger than elsewhere. By
-the transmission of sensations of touch to the brain the sensation is
-localized and the tactile sensation becomes a tactile perception.
-
-There are three main divisions of the sense of touch: 1. sensations of
-touch proper or tactile sensation; 2. sensations of temperature, and
-3. sensations of pain. The temperature sense is the transmission by
-the skin of sensations not so much of a certain degree of heat or cold
-as of the difference between the temperature of an object and that of
-the skin. The longer an object is in contact with the skin, the less
-conscious the person is of it, not only because it becomes of the
-same temperature, but also because he becomes accustomed to it. There
-also seem to be in the skin, besides the touch corpuscles, two other
-terminal organs with separate nerve fibers, the one for detecting heat,
-the other cold; for there are places on the body where heat can be
-detected and cold cannot, and _vice versa_.
-
-Sensations of pain may be merely an exaggeration of tactile sensation,
-as in too hard pressure or too great heat, but there seems to be also
-a sensation of pain in the skin. All organs are said to have common
-sensibility to pain and any exaggeration of this sensibility causes a
-sensation of pain. All the special senses require a certain amount of
-judgment in the interpretation of the sensations they convey.
-
-
-
-
-CHAPTER III.
-
-THE CRANIUM AND FACE.
-
-
-The intelligence and all the special senses, except the sense of touch
-already spoken of, are gathered together compactly in the head, where
-they are carefully protected with bony tissue. Covering the brain is
-the skull or cranium, which is made up of eight bones, the frontal, the
-occipital, two parietal, two temporal, the sphenoid, and the ethmoid,
-while the bones of the face are fourteen in number, two nasal, two
-superior maxillary, two lachrymal, two malar, two palate, two inferior
-turbinated, the vomer, and the inferior maxillary. For the most part
-the bones are arranged in pairs, one on either side.
-
-=The Cranial Bones.=--The cranium or skull is especially adapted for
-the protection of the brain and the bones are flat and closely fitted
-to its surface. They have two layers of bone, the outer and the inner
-tables, of which the outer is the thicker, and between these is a
-tissue filled with blood-vessels, the _diploë_. In the infant, whose
-brain has not yet attained its full size, opportunity must be left
-for growth and the skull therefore consists of a number of bones with
-interlocking notched edges, where growth takes place, but in the adult
-it forms one solid covering of bone.
-
-The line where the edges of two cranial bones come together is called
-a _suture_. The suture between the frontal bone and the forward edges
-of the two parietal bones is called the _coronal suture_, that between
-the two parietal bones at the vertex of the skull is known as the
-_longitudinal_ or _sagittal suture_, and that between the occipital
-bone and the back edges of the parietal bones as the _lambdoidal
-suture_.
-
-Where the coronal and sagittal sutures meet is a membranous interval
-known as the _anterior fontanelle_, while the _posterior fontanelle_
-is at the juncture of the sagittal with the lambdoidal suture. These
-fontanelles--so called from the pulsations of the brain that can
-be seen in them--close after birth either by the extension of the
-surrounding bones or by the development in them of small bones known
-as _Wormian bones_, the posterior one closing within a few months,
-the anterior by the end of the second year. In rickets, however, the
-anterior fontanelle remains open a long time, sometimes into the fourth
-year.
-
-[Illustration]
-
-[Illustration: FIG. 15.--Cranium at birth, showing sutures and
-fontanelles.]
-
-The =frontal bone=, as its name implies, forms the fore part of the
-head or forehead. It joins the parietal bones above and the temporal
-bones on either side. At the lower edge are the supra-orbital arches,
-each with a supra-orbital notch or foramen on its inner margin for
-the passage of the supra-orbital vessels and nerve, the nerve most
-affected in neuralgia. Just above the arches on either side are the
-superciliary ridges, behind which, between the two tables of the skull,
-lie the frontal sinuses. On the inner surface the frontal sulcus for
-the longitudinal sinus runs along the median line.
-
-The =parietal bones= are the side bones of the skull. They meet each
-other in the sagittal suture at the median line above and join the
-frontal and occipital bones at either end, while below they touch upon
-the temporal bones, the temporal muscles being attached in part along
-their lower surface. These muscles are inserted into the coronoid
-process of the lower jaw, which they thus help to raise and to retract.
-
-[Illustration: FIG. 16.--Front view of the skull. (After Sobotta.)]
-
-The =occipital bone= is at the base of the skull and at birth consists
-of four pieces. In the lower, anterior part is the foramen magnum, an
-oval opening through which the spinal cord passes from the skull down
-into the spinal canal. Half way between the foramen and the top of the
-bone is the external occipital protuberance for the attachment of the
-ligamentum nuchæ which holds the head erect. The inner side of the bone
-is deeply concave and is divided by a cross-shaped grooved ridge into
-four fossæ, the internal occipital protuberance being situated where
-the arms of the cross meet. The occipital lobes of the cerebrum lie in
-the two upper fossæ and the hemispheres of the cerebellum in the two
-lower ones. In the grooves upon the ridge are the sinuses which collect
-the blood from the brain.
-
-The occipital and frontal muscles, united by a thin aponeurosis, cover
-the whole upper cranium and are known as the _occipito-frontalis
-muscle_. At the back this is attached to the occipital bone, while
-in front it interlaces with various face muscles. It is a powerful
-muscle and raises the brows, wrinkles the forehead, and draws the scalp
-forward. Long hair grows on the skin over it as a further protection
-against blows upon the skull and sudden variations in temperature.
-
-The =temporal bones=--said to be so named because the hair over them
-is the first to turn with age--are situated at the sides and base of
-the skull and are in three portions: the squamous or scale-like, the
-mastoid or nipple-like, and the petrous or stony portion. The squamous
-is the upper portion and has projecting from its lower part the long
-arched zygomatic process, which articulates with the malar bone of the
-face and from which arises the _masseter muscle_, one of the chief
-muscles of mastication, which has its insertion in the ramus and angle
-of the lower jaw. Just above the zygomatic process the _temporal
-muscle_ has its origin in part, while below is the _glenoid fossa_ for
-articulation with the condyle of the lower jaw, the posterior portion
-of the fossa being occupied by part of the parotid gland.
-
-The rough mastoid portion of the temporal bone is toward the back and
-affords attachment to various muscles, of which the most important are
-the occipito-frontalis and the sterno-cleido-mastoid. Within it are the
-mastoid cells, which communicate with the inner ear and are lined with
-mucous membrane continuous with that of the tympanum. They probably
-have something to do with the hearing. In children they often become
-the seat of inflammation (mastoid abscess) in infectious diseases and
-the mastoid bone has to be cut to let out pus that has collected.
-As the lateral sinus is directly behind the mastoid bone, there is
-very great danger of going through into the sinus and causing a fatal
-hemorrhage.
-
-[Illustration: FIG. 17.--Side view of the skull. (After Sobotta.)]
-
-The petrous portion, which contains the organ of hearing, is between
-and somewhat behind the other two portions, at the lower edge of the
-temporal bone, wedged between the sphenoid and the occipital bones. On
-its outer surface is the _external auditory meatus_, and from below
-projects a long sharp spine called the _styloid process_, to which
-several minor muscles are attached. In the same angle between the
-petrous and squamous portions lies the bony Eustachian tube.
-
-The =sphenoid= or =wedge bone=, so called because in the process of
-development it serves as a wedge, lies at the base of the cranium,
-forming as it were the anterior part of the floor of the cavity
-containing the brain. It is a large, bat-shaped bone and articulates
-with all the cranial and many of the facial bones, binding them all
-together. It has a body, two large wings, and two lesser wings and,
-appears on the outside of the skull between the frontal and the
-temporal bones behind the zygomatic process. In the adult the body of
-the sphenoid is hollowed out into the sphenoid sinuses, in which pus
-sometimes forms.
-
-=The Ethmoid Bone.=--In front of and below the sphenoid and extending
-forward to the frontal bone is the ethmoid, the last of the cranial
-bones. It consists of a horizontal cribriform or sieve-like plate, from
-either side of which depend lateral masses of ethmoid cells. To the
-inner side of these masses are attached the thin curved _turbinated
-bones_, superior and middle, while between them is a vertical plate
-that forms the bony septum of the nose. Rising from the upper surface
-of the cribriform plate is another vertical plate, the _crista galli_,
-with the olfactory grooves on either side for the reception of the
-olfactory bulbs, filaments of the olfactory nerve passing down through
-the perforations of the cribriform plate to the nose. For the brain,
-which fills almost the entire cavity of the cranium, is supported
-by the sphenoid and ethmoid bones internally, as it is protected
-externally by the other cranial bones.
-
-=Ossification of Sutures.=--If premature ossification of all the
-sutures occurs, _idiocy_ results, while in _cephalocele_ there is a gap
-in the ossifying of the bones so that the membranes or brain protrude.
-In _rickets_ the forehead is high and square and the face bones
-poorly developed, so that the head looks larger than it really is. In
-_Paget’s disease_ the bones enlarge and soften. This affects the head
-but not the face and often the first thing noticed is that the hat is
-too small. _Craniotabes_ is thinning of the bone in places, the bone
-becoming like parchment and being easily bent. It is generally caused
-by pressure of the pillow or the nurse’s arm.
-
-=Bones of the Face.=--The facial bones serve to form the various
-features of the face, which after all are merely organs of special
-sense. Many delicate muscles control the facial expression which,
-consciously or unconsciously, reflects the character of their owner.
-
-Surgically the most important of the facial bones are the two _superior
-maxillary bones_, because of the number of diseases to which they
-are liable. They meet in front, together forming the upper jaw, and
-with the malar bone help form the lower part of the orbit of the eye.
-They are cuboid in shape and are hollowed out into a pyramidal cavity
-called the _antrum of Highmore_, which opens by a small orifice into
-the middle nasal meatus and which sometimes becomes infected and has
-to be tapped. The nasal process for articulation with the frontal and
-nasal bones has, at its lower edge, a crest for the inferior turbinated
-bone, and close beside this on the inside, extending down from the
-upper edge, is a deep groove which, with the lachrymal and inferior
-turbinated bones, helps to form the lachrymal canal for the nasal tear
-duct. The bones give attachment to many small muscles, connected for
-the most part with the nose and mouth, of which the masseter is the
-only important one.
-
-The two _malar_ or _cheek bones_ are small quadrangular bones, which
-form the prominences of the cheeks and help form the orbits of the
-eyes. Projecting backward from each is a zygomatic process for
-articulation with the zygomatic process of the temporal bone, while a
-maxillary process extends downward for articulation with the superior
-maxillary. Here again the most important muscle attached is the
-masseter. If the malar bone is crushed great deformity results.
-
-The _lachrymal bones_ are two small bones, about the size and shape of
-a finger-nail, situated at the front of the inner wall of the orbit. At
-the external edge is a groove which lodges the lachrymal sac above and
-forms part of the lachrymal canal below.
-
-The two _palate bones_ are at the back of the nasal fossæ and help to
-form the floor of the nose, the roof of the mouth, and the orbit. Each
-has a vertical and a horizontal plate, and it is these last that by
-their juncture form the _hard palate_. Oftentimes in cases of hare-lip
-_cleft palate_ also occurs, the result of incomplete development. To
-remedy the consequent opening in the roof of the mouth, which makes
-articulation difficult, operation is generally resorted to, though
-sometimes a plate is fitted over the opening by a dentist.
-
-The _nasal bones_ are two small oblong bones which articulate with the
-frontal and superior maxillary bones and with each other. They form the
-bridge of the nose, the rest of the nose being wholly of cartilage,
-except for the _vomer_, a bone shaped like a plough-share, which forms
-part of the nasal septum, articulating along its anterior edge with the
-ethmoid and the triangular cartilage.
-
-The two _inferior turbinated bones_ lie along the outer walls of the
-nasal fossæ. They are thin scroll-like bones covered with mucous
-membrane and serve to heat the air as it passes in. Sometimes when one
-has a cold, the membrane and the bone too swell up and close the nares.
-Loss of the sense of smell in a bad cold may be due to such swelling
-and the consequent impeding of the entrance of odoriferous particles--a
-condition that would likewise interfere with the sense of taste. Part
-of the bone is sometimes removed, to enlarge the passage, enough being
-left to warm the air.
-
-Lastly, there is the _inferior maxillary bone_ or _lower jaw_. This
-has a horseshoe-shaped body and two _rami_, one at either end. Each
-ramus has a pointed process in front called the _coronoid process_,
-into which is inserted the temporal muscle. At the back, and separated
-from the coronoid process by the sigmoid notch, is the _condyle_, which
-articulates with the glenoid fossa on the temporal bone. The rami also
-give attachment to the masseter muscle at its point of insertion. In
-adult age the ramus is almost vertical but in old age the portion of
-the jaw hollowed out into alveoli for the teeth becomes absorbed and
-the angle of the jaw becomes very obtuse. On the inner side of the jaw
-near the middle on either side is the fossa for the _sublingual gland_,
-while the _submaxillary gland_ lies in a fossa farther back on either
-side.
-
-Sometimes the lower jaw is dislocated and when once this has occurred
-it is liable to occur again, the ligaments becoming stretched.
-
-
-
-
-CHAPTER IV.
-
-THE ORGANS OF SPECIAL SENSE.
-
-
-=The Nose.=--The nose, the organ of the sense of smell, is composed
-of a framework of bones and cartilages, the bridge being formed by
-the two nasal bones, and the septum by the vomer and the triangular
-cartilage. It consists of two parts, the _external nose_ and the
-internal or _nasal fossæ_, which open to the face by the anterior nares
-or nostrils and into the pharynx by the posterior nares. Externally it
-is covered with skin, internally with ciliated mucous membrane. The
-_fossæ_ have the inferior turbinated bones along their outer walls and
-are divided into three parts known as the _superior_, the _middle_, and
-the _inferior meatus_, the middle one connecting with the antrum of
-Highmore, while into the inferior meatus the lachrymal canal empties.
-There are many small muscles of which little use is made, although in
-forced respiration, as in pneumonia, where every aid to breathing is
-called into play, even the alæ nasi or nostrils are made to exert what
-muscular power they possess in order to supply more air.
-
-[Illustration: FIG. 18.--The nasal cavity. (After Sobotta.)]
-
-Not only is most of the air breathed in through the nose and warmed in
-its passage through, but the nose is the organ of smell and by means
-of the peculiar property of its nerves protects the lungs against
-deleterious gases and helps the taste discriminate. The _olfactory_
-or _first cranial nerves_, after emerging from the brain, lie on the
-under surface of the frontal lobe and rest on the ethmoid bone in what
-is known as the _olfactory tract_. Each nerve ends in a bulb-like
-termination called an _olfactory bulb_, which rests on the cribriform
-plate and sends little terminal fibers down through to be distributed
-to the nasal cavities, especially to the upper half of the septum of
-the nose, the roof of the nose, and the anterior and middle turbinated
-bones. For in the mucous membrane of the upper nasal cavity are
-specially modified epithelial cells called _olfactory cells_, which
-play an important part in the conduction of smell. Hence when one
-wishes to smell anything especially well he sniffs it up.
-
-Probably the _sensation of smell_ is caused by odoriferous particles
-in the atmosphere being breathed into the nose, where they affect the
-olfactory cells, which transmit the impulses to the olfactory nerve
-and so to the brain. Whereas a certain amount of moisture in the nasal
-cavity seems to be essential for accuracy of smell, the presence of
-too much or too little interferes with it. The mucous membrane has a
-certain power also of distinguishing different smells at the same time,
-though this power varies greatly in different people, one smell often
-wholly overpowering all others.
-
-The cartilage below the bridge of the nose is sometimes attacked
-in _syphilis_ and _cancer_, and _lupus_ often begins on the nose.
-_Deviation of the septum_ may occlude all air from one side of the
-nose, an effect also produced by _polypi_, generally of the turbinated
-bone. Either condition is easily remedied. _Nosebleed_, though
-generally unimportant, may be serious in adults.
-
-=The Mouth.=--The mouth is of great importance as an entrance for fresh
-air to the lungs when the nasal passages are for any reason impeded
-and as the resonant chamber from which proceeds the voice, man’s
-chief means of communication with his fellows. Its chief value may be
-said, however, to reside in the fact that it is the vestibule of the
-alimentary canal. It is an ovoid cavity lined with mucous membrane and
-is bounded in front by the _lips_, at the sides by the _cheeks_, below
-by the floor and tongue, and above by the _hard palate_ anteriorly and
-by the _soft palate_ posteriorly, the _uvula_ depending from the latter
-like a curtain between the mouth and the pharynx. Shape is given to the
-mouth by the bones of the upper and lower jaw and its size is altered
-by the lowering and raising of the latter, which is quite freely
-movable.
-
-[Illustration: FIG. 19.--The hyoid bone. (Toldt.)]
-
-At the back of the mouth, at the entrance to the pharynx, are the
-_anterior_ and _posterior pillars_ of the fauces, which contain
-muscular tissue, and between which on either side are thick masses
-of lymphoid tissue, the _tonsils_. The floor of the mouth is formed
-largely by the _tongue_, which completely fills the space within the
-lower teeth. Its base or root is directed backward and downward and is
-attached by muscles to the hyoid bone and the lower jaw, the _hyoid
-bone_ being a horseshoe-shaped bone lying just below and as it were
-within the inferior maxillary. The base of the tongue is attached also
-to the epiglottis and at the sides to the soft palate by the anterior
-pillars. Except at its base and the posterior part of its under surface
-the tongue is free, but a fold of mucous membrane, the _frenum_, holds
-it somewhat in front. Thus it possesses great versatility of motion and
-serves as an auxiliary in articulation, mastication, and deglutition.
-
-=The Teeth.=--Securely embedded in either jaw are the teeth, nature’s
-instrument for the first preparation of the food for digestion through
-tearing and grinding. The _incisors_, which are in front, have wide
-sharp edges for cutting the food. Next come the _canine_ teeth with a
-sharp point for tearing it, while at the back are the _molars_ with a
-broad flat top for grinding.
-
-There are two sets of teeth: 1. the _temporary_ or _milk teeth_,
-twenty in number--four incisors, two canines, and four molars in
-each jaw--which appear at from six months to two years, and 2. the
-_permanent teeth_, thirty-two in number--four incisors, two canines,
-known as _eye teeth_ in the upper jaw and as _stomach teeth_ in the
-lower jaw, four bicuspids, so called because they have two cusps where
-the molars have four or five, and six molars in each jaw--which come
-from the sixth to the twenty-first years. The first to appear are the
-two lower middle incisors, which come at the age of six months. The
-last to appear are the _wisdom teeth_, the farthest back of the molars,
-which come at the age of twenty-one years or thereabouts.
-
-Each tooth consists of a crown or body above the gum, a neck, and a
-fang or root within the gum. The body is of dentine or ivory with a
-thin crust of enamel and contains the _pulp_, a vascular connective
-tissue containing many nerves. Beginning at the neck and covering the
-fang is a layer of cement or true bone.
-
-=The Sense of Taste.=--The sense of taste lies chiefly in the _taste
-buds_ as they are called which are filled with _gustatory cells_
-and are found in the papillæ of the tongue, principally in the
-_circumvallate papillæ_ at the back of the tongue, which are few in
-number and arranged in a V-shape. There is also a certain power of
-taste in the tip and sides of the tongue but little in the upper
-surface or dorsum. Only five special tastes can be distinguished:
-bitter, sweet, acid, sour, and salt, but sometimes more than one
-can be distinguished at a time, as bitter and sweet. Every one can
-distinguish between different tastes but the power varies in different
-people and with different conditions. Certain tastes seem to be better
-distinguished in certain places, as sweet at the tip and bitter at the
-back of the tongue. Moreover, the sense of taste is very dependent
-upon the sense of smell, especially in the case of aromatic and savory
-substances, which one really does not taste but smell. If one held his
-nose and closed his eyes he would not know from the taste whether he
-was eating onion or apple. This leads to the habit of pinching the nose
-when taking nauseous medicines.
-
-To be tasted a substance must be in solution. Friction against the
-tongue, lips or cheek increase the sense of taste. A temperature of
-100° Fahrenheit favors taste, while both great heat and great cold
-impair it.
-
-There are probably at least two nerves of taste, the lingual branch
-of the trifacial or fifth cranial and the gustatory branch of the
-glosso-pharyngeal.
-
-Along with the sense of taste there are other senses in the mouth which
-play an important part, such as _pressure_ and the _sense of heat and
-cold_, and it is often hard to distinguish them from the pure sensation
-of taste, which indeed is always accompanied by them.
-
-=Salivary Glands.=--On either side of the mouth are three racemose
-glands for the secretion of the _saliva_, which serves to soften and
-lubricate the food and partially to digest starches by means of its
-ferment, _ptyalin_. The _parotid gland_ is the largest and is below and
-in front of the ear, opening by _Stensen’s duct_. The _submaxillary
-gland_ is below the jaw toward the back on either side and its duct
-is _Wharton’s duct_. The _sublingual gland_ lies beneath the mucous
-membrane of the floor of the mouth and opens by eight to twenty tiny
-ducts beside the frenum, the _ducts of Rivinus_. The activity of the
-glands depends upon the blood supply; the more blood the greater their
-activity.
-
-[Illustration: FIG. 20.--Dissection of the side of the face, showing
-the salivary glands: _a_, Sublingual gland; _b_, submaxillary gland,
-with its duct opening on the floor of the mouth beneath the tongue at
-_d_; _c_, parotid gland and its duct, which opens on the inner side of
-the cheek. (After Yeo.)]
-
-=The Tonsils.=--The tonsils vary in size and in _tonsillitis_ swell and
-may even meet in the median line. They are frequently removed. When
-they are enlarged one often gets a _third tonsil_ or _adenoids_, a
-lymphoid growth at the back of the pharynx which causes mouth-breathing
-by day and snoring by night. A child with adenoids is starved for air
-and what air is breathed in is not warmed. The growth should be removed.
-
-A short frenum produces _tongue-tie_, which may be remedied by
-snipping. Cancer of the tongue is fairly common and necessitates
-a radical operation. In mumps the parotid glands are inflamed and
-enlarged.
-
-=The Ear.=--The special organ of hearing is the ear, to which there are
-three parts, the external, the middle, and the internal ear.
-
-The _external ear_ consists of the _pinna_ or expanded cartilaginous
-portion, for the concentration and direction of sound waves, and the
-_external auditory canal_, partly cartilage, partly bone, which is
-directed forward, inward, and downward and conveys sound to the middle
-ear.
-
-[Illustration: FIG. 21.--The small bones of the ear; external view
-(enlarged). (After Gray.)]
-
-The _middle ear_ or _tympanum_ is an irregular cavity in the petrous
-portion of the temporal bone. Its outer wall is formed by the _membrana
-tympani_ or _drum_, an oval translucent membrane placed obliquely at
-the bottom of the external auditory canal. The middle ear communicates
-with the inner ear through the _fenestra ovalis_ or oval window and
-contains the _ossicles_, the _malleus_ or hammer, the _incus_ or anvil,
-and the _stapes_ or stirrup, which are arranged in a movable chain from
-the drum to the oval window. The _malleus_, which is connected with
-the membrana tympani, articulates by its head with the body of the
-incus, while the stapes articulates with the _incus_ by its head and is
-connected by its base with the margin of the oval window. Connection
-is made between the middle ear and the pharynx and the pressure of the
-air upon the drum made equal on either side by means of the _Eustachian
-tubes_. These tubes are about an inch and a half long, have cilia, and
-convey wax and other matter from the ear to the pharynx. Occasionally
-in a cold or for some other reason they become stopped up and trouble
-results in the middle ear. Some of the _mastoid cells_ also connect
-with the middle ear and may become infected, causing mastoid disease.
-
-[Illustration: FIG. 22.--Interior view of left bony labyrinth after
-removal of the superior and external walls: 1, 2, 3, the superior,
-posterior, and external or horizontal semicircular canals; 4, fovea
-hemi-elliptica; 5, fovea hemispherica; 6, common opening of the
-superior and posterior semicircular canals; 7, opening of the aqueduct
-of the vestibule; 8, opening of the aqueduct of the cochlea; 9, the
-scala vestibuli; 10, scala tympani; the lamina spiralis separating 9
-and 10. (From Quain, after Sömmerring.)]
-
-The _internal ear_ consists of various chambers hollowed out in
-the petrous portion of the temporal bone. There is an _osseous
-labyrinth_, consisting of a central cavity known as the _vestibule_,
-three semicircular canals, and the _cochlea_, and within the osseous
-labyrinth, surrounded by _perilymph_, is the _membranous labyrinth_,
-of like form, filled with the _endolymph_. Communication exists
-externally with the middle ear by the _round_ and _oval windows_ and
-internally with the _internal auditory canal_, through which passes
-the eighth cranial or auditory nerve, the special nerve of hearing,
-which is distributed to the inner ear only. When the auditory nerve
-enters the ear through this internal auditory meatus it divides into
-two branches, of which one goes to the vestibule and the other to the
-_organ of Corti_, a group of specially modified epithelial cells in
-the cochlea of the membranous labyrinth, which is very important in
-transmitting the impulses to the brain. The nerve also breaks up into
-very small branches and is distributed practically throughout the wall
-of the labyrinth.
-
-The _sensation of hearing_ is the result of impulses transmitted to the
-auditory nerve and so conveyed to the auditory center in the brain.
-It is caused by sound waves which travel through the air from their
-point of origin and enter the external ear. This collects and selects
-the waves of sound and helps one to a certain extent to determine the
-direction from which the sound comes. As they pass through the external
-meatus the sound waves are collected into a comparatively small area
-for transmission to the middle ear, where, by means of the drum, they
-set in vibration the chain of ossicles. Through these the vibrations
-are in turn transmitted to the oval window, being intensified in the
-process. Here again they are taken up by the perilymph, from which they
-pass through the wall of the membranous labyrinth to the endolymph,
-affecting the epithelial lining of the labyrinth in such a way that the
-impulses are transmitted to the auditory nerve, more particularly in
-the vestibule, from which the vibrations enter the cochlea. They also
-affect the cells of the organ of Corti in like manner as they pass from
-the perilymph to the endolymph. The membrane that covers the fenestra
-rotunda or round window relaxes and expands as the vibrations strike
-it, thus serving to eliminate the shock of impact.
-
-_Musical sounds_ are caused by rhythmical or regularly repeated
-vibrations, while irregular vibrations give rise to noises. In
-musical sounds loudness is determined by the height or amplitude of
-the vibrations, pitch by the length of the wave, and quality by the
-number of so called partial tones. A sensation of sound cannot be
-produced by less than 30 vibrations a second and the ordinary person
-cannot hear more than 16,000 vibrations a second. Different sounds
-can be distinguished when they follow each other as closely as by one
-one-hundredth of a second.
-
-All sound does not come through the canal of the ear. The bones of the
-head vibrate and carry sound. So there are instruments for the deaf
-which are put in the ear and others which are placed between the teeth.
-
-The _semicircular canals_ are not essential to hearing but have
-something to do with a person’s power of maintaining his equilibrium.
-Injury to them may cause dizziness and loss of equilibrium.
-
-=The Eye.=--One more feature, perhaps the most expressive, remains to
-be described, the eye. The senses are all modifications of the original
-cutaneous sensibility and the nerve of sight is no more sensitive to
-light than any other nerve. It therefore needs an end organ that is
-sensitive to the motions of the ether in order to give impressions of
-light. This organ is provided in the eye, which is not only itself
-capable of being moved in every direction, but is placed in the most
-movable part of the body, the head, which can be turned in almost a
-complete circle. The _eyeball_ is spherical and lies in the cavity of
-the orbit upon a cushion of fat, where it has a large range of sight
-but is securely protected from injury by its bony surroundings. The
-sunken eyes following protracted illness are due to the using by the
-system of the fat on which the eyeball ordinarily rests.
-
-Each _orbital cavity_ is formed by the juncture of some seven bones and
-communicates with the cavity of the brain through the _optic foramen_
-and through the sphenoidal fissure. Above the orbits are arched
-eminences of skin, the _eye-brows_, from which several rows of short
-hairs grow longitudinally and which serve to protect the eyes and to
-limit the amount of light to a certain extent, as in frowning.
-
-Still further protection is afforded by the _eyelids_, longitudinal
-folds of skin, the one above, the other below, which close like
-curtains over the eye. Beneath the external layer of skin in the lids
-is fatty tissue and then the orbicularis palpebrarum muscle by means
-of which they are closed. They are kept in shape by the tarsal plates
-or cartilages, in whose ocular surface are embedded the _Meibomian
-glands_, whose secretion prevents the free edges of the lids from
-sticking together. Along these edges grows a double or triple row
-of stiff hairs, the _eye-lashes_, which curve outward so as not to
-interfere with each other and also to prevent the entrance into the eye
-of foreign bodies. Lining the inner surface of the lids and reflected
-thence over the anterior surface of the sclerotic coat of the eye is
-a mucous membrane, the _conjunctiva_, which is thick, opaque, and
-vascular on the lids but thin and transparent on the eyeball. The
-angles between the lids are known as the _internal_ and the _external
-canthus_.
-
-[Illustration: FIG. 23.--The external ocular muscles. (Pyle.)]
-
-_Muscles_ and _Nerves_.--The eyeball is held in position by the ocular
-muscles, the conjunctiva, and the lids, while surrounding it, yet
-allowing free movement, is a thin membranous sac, the _tunica vaginalis
-oculi_. The superior and inferior recti muscles at the upper and lower
-edges of the ball turn the eye up and down; the internal and external
-recti at the inner and outer edges turn the eye inward and outward; and
-the superior and inferior oblique rotate the eye. The nerves supplying
-these muscles are the third or motor oculi, the fourth and the sixth.
-
-The _lachrymal gland_, which is about the size and shape of an almond,
-is situated at the upper and outer part of the orbit. It secretes a
-fluid which keeps the anterior surface of the eye bathed in moisture
-and is ordinarily drained away through the lachrymal sac in the inner
-canthus, whence it passes by the lachrymal ducts into the nose. When
-the amount secreted is excessive, it overflows the lower lid as _tears_.
-
-[Illustration: FIG. 24.--Diagram of the lacrimal apparatus. (Pyle.)]
-
-_Coats of Eye._--The membranes or coats of the eye are three in number:
-an outer or sclerotic, a middle or vascular, and an inner or sensitive.
-
-The _sclerotic coat_ is a rather thick, fibrous, protective membrane.
-Where it passes in front of the iris, however, it is thinner and
-transparent and is known as the _cornea_. The cornea projects somewhat
-and, as it were, resembles a segment of a smaller sphere set into the
-rest of the sclerotic.
-
-The middle or vascular coat, known as the _choroid_, carries
-blood-vessels for the retina or sensitive coat in its inner layer
-and has an outer layer of pigment cells that excludes light and
-darkens the inner chamber of the eye. The folds of the choroid at its
-anterior margin contain the ciliary muscles and are known as the
-_ciliary processes_, while the name _iris_ is given to the little
-round pigmented, perforated, curtain-like muscle just in front of the
-crystalline lens. The posterior surface of the iris is covered with a
-thick layer of pigment cells to prevent the entrance of light except
-through the central opening or _pupil_, and its anterior surface also
-has pigment cells that give it its color, though the difference in the
-color of people’s eyes is due rather to the amount of pigment present
-than to its color, a small amount of pigment being present in blue eyes
-and a large amount in brown and black eyes. Variations in the size
-of the pupil are brought about by contractions of the circular and
-radiating fibers of the iris, contraction of the circular fibers making
-it smaller and those of the radiating larger. The pupil is constricted
-for near objects and during sleep, and is dilated for distant objects.
-In a dull light also it dilates to let in more light, and in a bright
-light it contracts. The appearance of the pupil is often important as a
-means of diagnosis and in etherization.
-
-[Illustration: FIG. 25.--Vertical section through the eyeball and
-eyelids. (Pyle.)]
-
-Lastly there is the innermost _sensitive coat_ or _retina_, which has
-eight layers, the outer one containing some pigment cells and the
-next the rods and cones, in which the power of perception is supposed
-to lie, branches of the optic nerve being distributed over it in all
-directions. In fact, the retina is formed by a membranous expansion of
-the optic or second cranial nerve, the special nerve of sight, which
-passes into the orbit through the optic foramen at the back and enters
-the eyeball close to the _macula lutea_ or _yellow spot_. The exact
-spot where the optic nerve enters the retina is not sensitive and is
-known as the _blind spot_. In the center of the macula lutea, however,
-which is in the middle of the retina posteriorly, is a tiny pit, the
-_fovea centralis_, in which all the layers of the retina except the
-rods and cones are absent, and at this point vision is most perfect.
-It is, therefore, always turned toward the object looked at, and when
-one wishes to see an object distinctly, he must keep moving his eyes
-over it that the rays from each part may fall in turn upon the fovea
-centralis.
-
-Directly behind the pupil is the _crystalline lens_, a rather firm
-gelatinous body enclosed in a capsule, which is transparent in life
-but opaque in death. The lens is doubly convex and is held in place
-by the suspensory ligaments, which arise from the ciliary processes.
-In front of it is the anterior chamber of the eye, filled with a thin
-watery fluid called the _aqueous humor_, while the larger space back of
-it, occupying about four-fifths of the entire globe, is filled with a
-jelly-like substance known as the _vitreous humor_.
-
-The chief artery of the eye is the _ophthalmic_.
-
-_Light Rays._--The eye is practically a camera and its principal
-function is to reflect images. Although there are several refracting
-surfaces and media, for practical purposes the cornea alone need be
-considered. Except for those rays which enter the eye perpendicularly
-to the cornea, whose line of entrance is called the _optic axis_, all
-rays are refracted when they enter the eye and the point at which they
-meet and cross each other behind the cornea is called the _principal
-focus of the eye_. To focus properly, all the rays from any one point
-on an object must meet again in a common point upon the retina, their
-_conjugate focus_. In the normal eye all the rays from an object are
-focused on the retina and form upon it an image of the object which, as
-in the camera, is inverted, because of the crossing of the rays behind
-the cornea. Once focused on the retina the light traverses the various
-layers to the layer of rods and cones, where chemical action takes
-place and affects the little filaments of the optic nerve, by which the
-message is carried to the brain.
-
-[Illustration: FIG. 26.--Diagram showing the difference between (_A_)
-emmetropic, (_B_) myopic and (_C_) hypermetropic eyes. (American
-Text-book of Physiology.)]
-
-When the eye is at rest the pupil and lens are in their normal
-condition and at such times the eye sees only distant objects. The
-ability of the eye to focus upon objects at different distances is
-called _accommodation_ and to accomplish it three things are necessary:
-1. change in the shape of the lens; 2. convergence of the axes of the
-eyes, and 3. narrowing of the pupils.
-
-When the eye is directed toward distant objects, the muscle fibers
-in the ciliary processes relax, causing tightening of the suspensory
-ligaments and consequent flattening of the surface of the lens.
-Otherwise an image would be formed in front of the retina; for the
-greater the convexity of the lens, the greater the angle of refraction.
-Such accommodation is passive and so not fatiguing. To look at nearby
-objects, on the contrary, the ciliary muscles contract, drawing the
-choroid forward and allowing the suspensory ligaments to relax, so that
-the lens bulges in front. This is an exertion.
-
-In order to accommodate properly, moreover, both eyes must work
-together and the axes of both eyes must be directed toward the object.
-Therefore, in looking at nearby objects the axes of the eyes converge,
-drawn by the internal recti muscles. In _strabismus_ or _cross eye_,
-where the axes of both eyes cannot be directed toward the object at the
-same time, the rays fall upon one part of one eye and upon a different
-part of the other eye and two separate images are seen.
-
-Finally there is concentric narrowing of the pupil by contraction of
-the circular fibers of the iris, by which means various side rays that
-would come to a focus outside the retina are excluded.
-
-All the muscles of accommodation, the ciliary muscles, the internal
-recti, and the sphincter pupillæ, are under the control of the third
-nerve.
-
-Connected with this power of accommodation and dependent on it are the
-two conditions of _near-sightedness_ or _myopia_ and _far-sightedness_
-or _hypermetropia_.
-
-The normal eye is emmetropic and is almost perfectly spherical, but
-in the near-sighted or myopic eye the ball, instead of being round,
-is flattened from above down and so bulges in front. Consequently,
-owing to the greater distance from the lens to the retina, images are
-formed in front of the retina. Only nearby objects can be seen clearly,
-because the farther the object from the eye the farther in front of
-the retina the image is formed. Concave glasses are worn to enable
-near-sighted people to see at a distance. Hypermetropic or far-sighted
-eyes are flattened from before backward and can see only objects at a
-distance clearly, as those nearby form images behind the retina. For
-such eyes convex glasses are worn.
-
-As the ordinary person approaches middle life, he becomes able to see
-better at a distance than near to. This _presbyopia_, as it is called,
-which is practically far-sightedness, is due to a partial loss of the
-power of accommodation in the lens, the result of a general loss of
-elasticity in the parts.
-
-Another very common defect is _astigmatism_, a failure of the rays to
-focus upon a point, owing generally to a flattening in the surface of
-the cornea.
-
-_Color perception_ is also an important function of the eye. The waves
-of hyperluminous ether when of a certain rate of vibration give the
-sensation of heat and when their vibrations are more rapid they give
-the sensation of light. Each of the primary colors of the spectrum
-gives off a pretty definite number of light rays which travel through
-the air and enter the eye, the number of rays determining the color
-thrown upon the retina and the velocity determining the intensity of
-the color. Occasionally when light is passing through into the eye it
-is broken up as in a prism and the person gets a sensation as of all
-sorts of colors, _chromatic aberration_. Total or partial absence of
-sensitiveness to color is called _color blindness_. It is commonest
-in the form of inability to distinguish between red and green and is
-probably due to a defect in the retina.
-
-Sometimes a hair follicle on the lid becomes infected and a _sty_
-is formed. _Pink eye_ is conjunctivitis or inflammation of the
-conjunctiva. A Meibomian duct may become stopped and cause bulging, or
-there may be a sagging down or _ptosis of the upper lid_ in certain
-diseases, as meningitis, apoplexy, and more especially syphilis.
-_Rodent ulcer_ often begins by the eye or on the cheek.
-
-
-
-
-CHAPTER V.
-
-THE NERVOUS SYSTEM.
-
-
-The nervous system, which regulates all the vital processes of the
-body, physical and chemical, and which is situated partly in the head
-and partly in the trunk, may well form the connecting link between the
-description of the head and that of the trunk. It has two divisions,
-the cerebro-spinal system and the sympathetic system. The former
-consists of the cerebrum or brain proper, the cerebellum or little
-brain, the pons Varolii, the medulla oblongata, the spinal cord, and
-the cranial and spinal nerves; the latter of a series of ganglia or
-aggregations of nerve centers. The brain, which includes the cerebrum,
-cerebellum, pons, and medulla, occupies the cranium and the spinal cord
-is contained within the bony framework of the spinal column. In the
-male the brain weighs about 49 ounces and in the female 44, while in an
-idiot it seldom weighs more than 23 ounces.
-
-The =cerebrum= or brain proper has two parts or hemispheres, roughly
-oval in shape, each of which has five lobes separated by fissures, the
-frontal, parietal, occipital, and temporo-sphenoidal lobes, and the
-central lobe or _island of Reil_ at the base of the brain. The chief
-fissures are the _longitudinal fissure_, the _fissure of Sylvius_
-at the base of the brain, and the _fissure of Rolando_ between the
-frontal and parietal lobes. There are also five serous cavities
-called _ventricles_, the two lateral and the third, fourth, and fifth
-ventricles, of which the first two, one in either hemisphere, are the
-most important. Around these cavities is the _brain substance_, which
-is made up of two tissues, the white and the gray, the latter forming
-the outer part of the brain to the depth of perhaps half an inch, and
-the white matter forming the rest. The outer or gray part is called
-the _cortex_ and is largely made up of nerve cells. It might be called
-the active part of the brain. The white part consists largely of nerve
-fibers which are given off from the nerve cells and are carried down
-into the spinal cord.
-
-The surface of the brain is convoluted, the ridges being separated by
-deep furrows or sulci, by which means a great extent of gray matter
-is secured. The furrows contain fluid from the subarachnoid spaces
-and vary in number and depth according to intelligence. While the
-convolutions are not uniform in all brains, the principal ones are
-constant.
-
-Both the brain and the spinal cord are covered by three membranes, the
-dura mater, the arachnoid, and the pia mater. The _dura mater_ is dense
-and fibrous and lines the interior of the skull, being firmly adherent
-to it at many points. In fact, it constitutes the internal periosteum
-of the cranial bones. The _arachnoid_ is a delicate serous membrane,
-with two layers, lubricated to prevent friction, which divides the
-space between the dura mater and the pia mater, bridging over the
-convolutions and enclosing the subdural and subarachnoid spaces which
-are connected with lymphatics and contain a serous secretion, the
-_cerebro-spinal fluid_. This fluid forms an elastic water cushion, on
-which the brain rests, and prevents concussion. The _pia mater_ is
-vascular, containing blood-vessels, lymphatics, and nerves, and is
-closely attached to the surface of the brain, dipping down into all the
-sulci.
-
-At the base or under surface of the brain are some very important
-structures. The _olfactory bulbs_ lie beneath the frontal lobe and
-projecting back is the _olfactory tract_, through which the olfactory
-nerves come from the brain. Back of the olfactory tract is the _optic
-commissure_ where the optic nerves coming from the brain cross each
-other. And back of the commissure again is the _optic tract_, where
-the optic nerves emerge from the brain. At the base of the brain are
-also the exits of the twelve cranial nerves.
-
-[Illustration: FIG. 27.--Base of brain. (Leidy.) 1, 2, 3, cerebrum;
-4 and 5, longitudinal fissure; 6, fissure of Sylvius; 7, anterior
-perforated spaces; 8, infundibulum; 9, corpora albicantia; 10,
-posterior perforated space; 11, crura cerebri; 12, pons Varolii; 13,
-junction of spinal cord and medulla oblongata; 14, anterior pyramid;
-14ˣ, decussation of anterior pyramid; 15, olivary body; 16, restiform
-body; 17, cerebellum; 19, crura cerebelli; 21, olfactory sulcus; 22,
-olfactory tract; 23, olfactory bulbs; 24, optic commissure; 25, motor
-oculi nerve; 26, patheticus nerve; 27, trigeminus nerve; 28, abducens
-nerve; 29, facial nerve; 30, auditory nerve; 31, glosso-pharyngeal
-nerve; 32, pneumogastric nerve; 33, spinal accessory nerve; 34,
-hypoglossal nerve.]
-
-Upon entering the brain the _arteries_ run a tortuous course, the
-tortuosity breaking the force of the blood stream in the small vessels
-where congestion would be with difficulty relieved. The basilar artery,
-which is formed by the juncture of the two vertebrals, divides into
-the two posterior cerebrals, each of which joins one of the anterior
-cerebrals by a posterior communicating artery. The two anterior
-cerebrals also are joined by an anterior communicating artery, thus
-completing the circle. The circle thus formed at the base of the brain
-is called the _circle of Willis_ and provides for a good supply of
-blood in event of an accident to any vessel. The blood is returned to
-the general circulation through the cerebral veins and sinuses formed
-by the separation of the dura mater into two layers.
-
-The =cerebellum= is about one-seventh the size of the cerebrum and
-weighs about 5 ounces. It lies in the lower occipital fossæ of the
-skull and is oblong in shape and divided into two lateral hemispheres
-by a transverse fissure. It is made up of both white and gray matter,
-of which the former predominates, the gray being external as in the
-cerebrum. The cells are about the same as in the cortex and its surface
-is traversed by queer furrows. Of its function little is known but it
-probably plays a most important part in the coördination of the nervous
-and muscular acts by which the movements of the body are carried on.
-
-At the back of the cerebrum and below the cerebellum is the =pons
-Varolii=, which forms a connecting link with the medulla oblongata or
-bulging part of the cord. It is made up essentially of white matter or
-nerve fibers, though there is a small amount of gray matter in which
-are found the nuclei of some of the cranial nerves.
-
-In the =medulla oblongata=, which is about 1 inch long and extends from
-the pons Varolii to the upper border of the atlas or first cervical
-vertebra, the gray matter is not necessarily external to the white but
-is found in patches in the white. The gray matter here corresponds more
-or less to that of the spinal cord and the white matter is continuous
-with that of the cord. From the medulla arise the fifth to twelfth
-cranial nerves and the vasomotor nerves. The cardiac nerve has its
-center here and here too are the centers of respiration, phonation,
-deglutition, mastication, and expression. In the medulla the nerves
-that arise in the cerebrum cross over from one side of the body to
-the other on the crossed pyramidal tracts. The importance of this
-crossing of the nerve fibers is seen in apoplexy, when a blood-vessel
-is ruptured in the brain and hemorrhage causes pressure, generally on
-the motor tract. Paralysis of the nerves and of the muscles to which
-they go results. The paralysis is generally of one side of the body,
-the opposite side from that on which the injury occurred. The seat
-of injury in the brain or cord can frequently be determined by the
-situation and extent of the paralysis.
-
-=Spinal Cord.=--Extending down from the medulla through the spinal
-column is the cord. Its length from the foramen magnum, where it
-begins, down through the vertebræ to the lower border of the first
-lumbar vertebra, where it ends in a very fine thread-like process with
-no special function, called the _filum terminale_, is 17 to 18 inches.
-Just before it ends a number of nerves are given off in a tail-like
-expansion known as the _cauda equina_ or horse’s tail. It is not
-uniform throughout its length but presents two enlargements, a cervical
-enlargement in the lower cervical region, and a lumbar enlargement in
-the lower dorsal region, where the nerves are given off to the arms and
-legs respectively. The membranes are the same as those of the brain
-and are continuous with them, but here the dura mater is not attached
-to the bony walls enclosing it. For the cord does not fit closely
-into the canal but is as it were suspended in it. The _subarachnoid
-space_ communicates with the ventricles of the brain by the _foramen of
-Majendie_ and is filled with _cerebro-spinal fluid_ for the protection
-of the cord. In cerebro-spinal meningitis or spotted fever this fluid
-is infected and for diagnosis lumbar puncture is performed.
-
-[Illustration: FIG. 28.--Different views of a portion of the spinal
-cord from the cervical region, with the roots of the nerves. In _A_ the
-anterior surface of the specimen is shown, the anterior nerve root of
-its right side being divided; in _B_ a view of the right side is given;
-in _C_ the upper surface is shown; in _D_ the nerve roots and ganglion
-are shown from below: 1, the anterior median fissure; 2, posterior
-median fissure; 3, anterior lateral depression, over which the anterior
-nerve roots are seen to spread; 4, posterior lateral groove, into
-which the posterior roots are seen to sink; 5, anterior roots passing
-the ganglion; 5´, in _A_, the anterior root divided; 6, the posterior
-roots, the fibers of which pass into the ganglion, 6; 7, the united or
-compound nerve; 7´, the posterior primary branch seen in _A_ and _D_
-to be derived in part from the anterior and in part from the posterior
-root. (Allen Thomson.)]
-
-If a cross-section of the cord is made, it is found to have a pretty
-definite structure. It is roughly circular and is divided by certain
-fissures, of which the most important are the anterior and posterior
-median, the latter being rather a dividing line or septum. By them
-it is divided into halves connected by a small band in the middle
-called the _commissure_. The white matter is exterior to the gray
-and is divided by it into four columns, which again are divided into
-tracts according to certain groups of nerves that travel through
-them. The most important tract is the direct pyramidal tract in the
-anterior column. The gray matter is arranged in the form of a letter H
-practically, consisting of two lateral halves, more or less crescentic
-in outline, connected by a narrow band, the _gray commissure_. Each
-half is divided into two _horns_, the anterior, toward the front of the
-cord, and the posterior, toward the back, the former being generally
-much thicker and heavier than the latter. The structure of the gray
-and of the white matter is essentially the same as in the brain,
-but the proportion varies in different parts of the cord, the white
-predominating in the cervical region and the gray being much better
-developed in the lumbar region, where the nerve cells for control of
-the lower extremities occur. The gray is least well developed in the
-dorsal region. Through the center of the cord runs a small hole or
-canal filled with cerebro-spinal fluid, the _central canal of the cord_.
-
-[Illustration: FIG. 29.--Functional areas of the cerebral cortex, left
-hemisphere. (A. A. Stevens.)]
-
-The brain is the seat of intelligence and will, the center of all
-voluntary action. Molecular change in some part of the cerebral
-substance is the indispensable accompaniment of every phenomenon of
-consciousness. Indeed, the brain is never in a state of complete
-repose, there being dreams even during sleep. The brain is not
-sensitive to injury in the sense of pain. It can be lacerated without
-much pain.
-
-Various centers exist in the brain, of which the most important perhaps
-is the _motor center_. The _visual center_ is in the occipital lobe,
-the _auditory center_ in the temporal lobe, the _speech center_ in the
-third left frontal convolution. Thus the impulses of the senses have
-been located, though the function of many parts, the so called _silent
-areas_, are still in obscurity.
-
-The _motor center_, that is, the center for motion of the skeletal
-muscles, is situated about the fissure of Rolando and is divided into
-three parts, one for the legs, one for the face, and one for the arms,
-the one for the legs being uppermost and the others below in the order
-mentioned. Fibers from these cells extend down through the brain and
-cord to the muscles, the fibers being collected into well-recognized
-bundles and the whole known as the _motor tract_. There may be one long
-fiber from a cell in the brain down through most of the cord or there
-may be a succession of shorter fibers that are not actually connected
-but are in close contact with each other. In the upper pons the fibers
-for the face cross to the opposite side, while the rest keep on down
-through the medulla, and as they emerge from the medulla they too cross
-to the other side and keep on down in the crossed pyramidal tract.
-A few fibers do not cross but come down the direct pyramidal tract,
-which, however, disappears part way down. The _crossed pyramidal tract_
-is the true motor tract and in it the fibers are continually sending
-branches to the cells in the gray matter, where they connect with the
-anterior horn.
-
-The anatomy of the _sensory tract_ is not so well understood. By it
-impulses are sent to the brain by the peripheral organs, practically
-the surface of the body. The sensory fibers connect with the sensory
-cells in the posterior horn, from which fibers are sent to the brain,
-practically the reverse of motor action. There are three chief sensory
-tracts, which are supposed to transmit different sensations, one pain,
-one muscular sensations, and the third sensations of touch. All these
-tracts, of which the chief is the _direct cerebellar tract_, in passing
-up the cord pass to the opposite side at different levels and then go
-on to the cortex of the brain.
-
-The action of the nerves is similar to reflex action, only that an
-effort of will is needed to send an impulse from the brain. It is by
-the help of the brain along this line that an infinity of artificial
-reflexes or habits is acquired, for which volition is needed in the
-beginning but which are later done unconsciously. Herein lie the
-possibilities of all education.
-
-The brain and spinal cord work together, the cord acting as a medium
-between the brain, in which all the higher psychical processes, such as
-will, thought, etc., originate, and the muscular apparatus. The cord,
-however, has some action entirely independent of the brain, as is seen
-in _reflex action_. This action is entirely involuntary, so that the
-cord is sometimes spoken of as the seat of involuntary action, commonly
-called reflex action. All unconscious acts are reflex acts, as when the
-hand is drawn away from a hot iron. If an impulse is sent along one
-of the sensory fibers, it enters the cord through the posterior horn,
-where its nerve cell is found. Then, through some connection between
-the nerve cell of the sensory fiber and that of the motor fiber the
-impulse is transmitted to the motor cell and another impulse is sent
-out of the cord along the motor fiber of the nerve to the muscle.
-One of the commonest reflexes is the _knee-jerk_. Reflex action is
-important because the reflexes are interfered with, delayed, destroyed,
-or increased in different diseases. The time normally required for a
-reflex act is very brief, that for the knee-jerk being about three
-one-hundredths of a second.
-
-The nerves of the head, known as the _cranial nerves_, arise from the
-brain, while the rest of the body is supplied by the spinal nerves,
-which come off at intervals from the spinal cord. The cranial nerves
-consist of twelve pairs: (1) The olfactory or nerve of smell, (2) the
-optic or nerve of sight, (3) the motor oculi, (4) the patheticus, which
-controls the eye, (5) the trigeminus or trifacial, a nerve of general
-sensation, motion, and taste, (6) the abducens, a motor nerve, (7) the
-facial nerve of the face, ear, palate, and tongue, (8) the auditory or
-nerve of hearing, (9) the glosso-pharyngeal, nerve of sensation and
-taste, (10) the pneumogastric or vagus, which is both motor and sensory
-and governs respiration, the heart, and the stomach, (11) the spinal
-accessory, to the muscles of the soft palate, and (12) the hypoglossal,
-the motor nerve to the tongue.
-
-The _spinal nerves_ also are arranged in pairs: Eight cervical pairs,
-twelve dorsal or thoracic, five lumbar, five sacral, and one coccygeal,
-these titles denoting their point of origin near the vertebra of the
-same name. Each of these nerves arises by two roots, an anterior motor
-root from the anterior horn of gray matter and a posterior sensory root
-from the posterior horn, the latter having a ganglion upon it. After
-emerging from the cord the two roots unite to form the nerve, that the
-nerve may contain both motor and sensory fibers. The motor fibers are
-called efferent because they carry impulses _from_ the cord, while the
-sensory are called afferent because they carry impulses back _to_ the
-cord. After leaving the cord the nerves unite to form plexuses, which
-again divide into various nerve trunks and are distributed to the
-muscles.
-
-The first _cervical nerves_ pass out of the spinal column above the
-first cervical vertebra and the other cervical nerves below that
-and the succeeding vertebræ, while the other spinal nerves emerge
-each below the corresponding vertebra, as the first dorsal below
-the first dorsal vertebra, etc. After emerging they break up into a
-large anterior division and a small posterior division, the posterior
-branches supplying the spine and the dorsal muscles and skin, the
-anterior the rest of the trunk and the limbs. The _cervical plexus_ is
-formed by the anterior divisions of the first four cervical nerves, the
-_brachial plexus_ by the last four cervical and the first dorsal or
-thoracic nerves, the _lumbar plexus_ by the four upper lumbar, and the
-_sacral plexus_ by the last lumbar and the four upper sacral nerves.
-
-The only important branch of any of the four upper cervical nerves,
-which in general supply the neck and shoulders, is the _phrenic_, which
-is distributed to the pericardium, the pleuræ, and the under surface of
-the diaphragm.
-
-The _brachial plexus_, as its name implies, supplies the arms and has
-a number of important branches, as the circumflex to the shoulder, the
-musculo-cutaneous to the upper arm, the elbow-joint, and the outer
-surface of the forearm, the internal cutaneous to the inner side of
-the arm, the median to the pronators and flexors and the fingers on
-the radial side, and the ulnar to the elbow and wrist-joint. The
-musculo-spiral runs down the spiral groove to the external condyle of
-the humerus or upper arm bone, where it divides into the radial and the
-posterior interosseous, the former going to the thumb and two adjacent
-fingers and the latter to the wrist-joint and the muscles on the back
-of the forearm. Sometimes, in fracture of the humerus the callus thrown
-out pinches the musculo-spiral and causes pain.
-
-The dorsal or _thoracic nerves_ supply the back with their posterior
-divisions and their anterior divisions are the _intercostal nerves_.
-
-The _lumbar nerves_ supply the abdomen, pelvis, and thigh, the chief
-branches being the ilio-hypogastric to the abdomen and gluteal region,
-the ilio-inguinal to the inguinal region and scrotum, the external
-cutaneous and genito-crural to the thigh, and the obturator to the
-thigh and the hip and knee-joints. The anterior crural descends beneath
-Poupart’s ligament and divides into an anterior and a posterior
-division which supply the thigh muscles, its branches going to the
-pelvis.
-
-[Illustration: FIG. 30.--Diagrammatic view of the sympathetic cord
-of the right side, showing its connections with the principal
-cerebro-spinal nerves and the main preaortic plexuses. (Reduced from
-Quain’s anatomy.)]
-
-The _sacral plexus_ supplies the organs of the pelvis, the thigh, and
-the leg. Its chief branches are the great sciatic, the largest nerve in
-the body, and the small sciatic, which go to the buttocks and thigh.
-The great sciatic runs down the back of the thigh and divides at the
-lower third of the thigh into the internal and external popliteal
-nerves, the former of which passes along the back of the thigh to the
-knee, where it becomes the posterior tibial, which in turn divides
-at the ankle into the internal and external plantar. The external
-popliteal descends along the outer side of the popliteal space and
-divides an inch below the head of the fibula into the anterior tibial,
-which supplies the flexors and skin of the ankle-joint, and the
-musculo-cutaneous, which sends branches to the skin of the lower leg
-and the dorsum of the foot.
-
-=The Sympathetic System.=--Joined to the cerebro-spinal system by
-intervening cords is the sympathetic system. This is made up of two
-series of ganglia, one on either side of the spinal column, connected
-by longitudinal bands and extending from the base of the skull to the
-coccyx. They do not form an independent nervous system, each ganglion,
-which seems to resemble the motor cells of the spinal cord, being
-connected by motor and sensory fibers with the cerebral system.
-
-The _sympathetic nerves_ are mostly gray, non-medullated fibers and
-are distributed to viscera, secreting glands, and blood-vessels, whose
-movements are involuntary and feelings obtuse. They form networks upon
-the heart and other viscera and send branches to the cranium to the
-organs of special sense. There are three main plexuses: The _solar
-plexus_ behind the stomach, which supplies the abdominal viscera; the
-_hypogastric plexus_ in front of the prominence of the sacrum, whose
-nerves go to the pelvic organs; and the _cardiac plexus_ behind the
-aortic arch for the thoracic viscera.
-
-Over these nerves one has no control. A blow in the region between the
-costal cartilages and below the sternum is a solar plexus blow and is
-very upsetting.
-
-The sympathetic system serves to maintain vitality in all the important
-portions of the system and one of its important functions is to keep up
-communication between one part and another, so that when any organ is
-affected the others will act accordingly and help out to the best of
-their ability.
-
-
-
-
-CHAPTER VI.
-
-THE BACK.
-
-
-[Illustration: FIG. 31.--The spinal column. (Church and Peterson.)]
-
-=The Spine.=--The trunk may be roughly divided into the back, the chest
-or thorax, the abdomen, and the pelvis. By the back is denoted the
-spinal column with its muscles, blood-vessels, etc., and the spinal
-cord already described. The spine or vertebral column, which serves the
-double purpose of holding the body erect and of protecting the cord, is
-usually about two feet, two inches in length. In its course there occur
-several curves, which serve to give springiness and strength and, with
-the intervertebral cartilages, to mitigate the force of concussion from
-blows and falls. The curve is convex forward in the cervical region,
-convex backward in the dorsal, forward in the lumbar, and backward
-again in the sacral region. There is most freedom of motion in the
-cervical region.
-
-As is the case with the other bones, the _vertebræ_ are specially
-adapted in shape and size to the needs they are called upon to fill.
-Strength and flexibility, with a minimum bulk, a channel for the cord,
-and passages for the numerous nerves and blood-vessels are some of the
-requirements which, in combination, they meet to an astonishing degree.
-They are thirty-three in all, and are divided into groups according
-to the region in which they occur: seven cervical in the neck, twelve
-dorsal or thoracic, five lumbar, five sacral, and four coccygeal.
-
-Although the vertebræ of the different groups differ more or less
-in size and shape in accordance with the various demands of their
-positions, they all have certain general characteristics. Each has
-a body, two laminæ, two pedicles, two transverse processes, and one
-spinous process. The _pedicles_ extend back from the body on either
-side and support two broad plates of bone, the _laminæ_, whose juncture
-at the back completes the _spinal foramen_ for the passage of the cord.
-At their juncture is the _spinous process_, which can be felt beneath
-the skin, while the _transverse processes_ project from the juncture of
-the laminæ with the pedicles. All the processes are for the attachment
-of muscles that move the spine. The _body_ is formed of cancellous bone
-with a compact layer outside. Transversely it is slightly oval, while
-its upper and lower surfaces are flat, except in the cervical region,
-where the upper surface is concave laterally and the under convex
-laterally and concave from before back. Between the bodies are disks of
-fibro-cartilage, which increases motion and springiness. The _spinous
-process_ or _spine_ is short in the cervical region, long and directed
-downward in the dorsal region, thick and projecting almost straight
-out in the lumbar region. The pedicles are notched above and below so
-that when articulated the notches of two vertebræ join to form the
-_intervertebral foramen_ for the outward passage of nerves and the
-inward passage of blood-vessels.
-
-The distinguishing mark of the _cervical vertebræ_ is the foramen in
-each transverse process, through which the vertebral arteries run to
-the skull. They are also smaller than the dorsal and lumbar vertebræ.
-The _dorsal vertebræ_ are distinguished by having on the transverse
-processes and on the body smooth articular surfaces called facets and
-demi-facets for articulation with the ribs. The _lumbar vertebræ_ are
-the largest and heaviest and have the thickest spine. By the time the
-sacral region is reached, however, the vertebræ have only a rudimentary
-spinous process. Moreover, in adult age the sacral bones grow together
-and form one triangular bone, the _sacrum_, which has a broad base
-called the _promontory of the sacrum_ and a blunt apex. It is concave
-in front and convex behind and has an articulating surface for joining
-the pelvic bones. In the case of the _coccyx_ also the four original
-bones, all rudimentary in character and supposed to be the survival of
-a tail, grow together to form one bone. Together the sacrum and coccyx
-form the posterior wall of the true pelvis.
-
-[Illustration: FIG. 32.--A type of vertebra. (Leidy.) 1, Body;
-2, pedicle; 3, lamina; 4, spinal foramen; 5, spinous process; 6,
-transverse process; 7, articular process.]
-
-[Illustration: FIG. 33.--The sacrum, from before. (Drawn by D. Gunn.)]
-
-Some of the dorsal vertebræ are peculiar in the arrangement of their
-facets and demi-facets, while among the _cervical vertebræ_ are several
-whose peculiarities should be more carefully noted. Thus, the first
-cervical vertebra or _atlas_ supports the head and has practically no
-body, the place of the body being taken by a narrow anterior arch of
-bone and an opening, continuous with the spinal foramen, into which the
-_odontoid process of the axis_ fits, being held in place by ligaments.
-At either side on top is a facet for articulation with the occipital
-bone. There is almost no spine. The second vertebra or _axis_ has
-surmounting the body the odontoid process, with a facet in front for
-articulation with the atlas and one behind for the transverse ligament
-to move over. The seventh cervical vertebra or _vertebra prominens_
-has a very long spinous process--hence name--to which is attached the
-_ligamentum nuchæ_. It can be felt very distinctly on the living.
-
-Running from the skull down through the spinal column into the sacral
-vertebræ and formed by the joining of the spinal foramina of the
-individual vertebræ is an opening called the _spinal canal_, which
-holds the cord. The cord, however, stops practically at the first
-lumbar vertebra, where it splits up into the _cauda equina_, only the
-_filum terminate_ extending farther down.
-
-Occasionally the laminæ do not form completely and the membranes of the
-cord may bulge out and form a tumor, or the cord itself may come out
-also. This generally occurs in the lumbar region, where it is known as
-_spina bifida_. If in case of fracture of a vertebra there is paralysis
-of the parts below due simply to the pressure of a fragment of bone
-upon the cord, it may be completely cured by removal of the fragment.
-If, however, the cord suffers injury, the paralysis will remain.
-_Humpback_ or _Pott’s disease_ is caused by the tubercle bacillus,
-which eats away the bodies of the vertebræ so that the column caves in
-and the spinous processes are thrown out in a hump or kyphos.
-
-[Illustration: FIG. 34.--Muscles of the right side of the head and
-neck: 1, Frontalis; 2, superior auricular; 3, posterior auricular; 4,
-orbicularis palpebrarum; 5, pyramidalis nasi; 6, compressor naris; 7,
-levator labii superioris alæque nasi; 8, levator labii superioris;
-9, zygomaticus major; 10, orbicularis oris; 11, depressor labii
-inferioris; 12, depressor anguli oris; 13, anterior belly of digastric;
-14, mylohyoid; 15, hyoglossus; 16, stylohyoid; 17, posterior belly of
-digastric; 18, the masseter; 19, sternohyoid; 20, anterior belly of
-omohyoid; 21, thyrohyoid; 22, 23, lower and middle constrictors of
-pharynx; 24, sternomastoid; 25, 26, splenius; 27, levator scapulæ; 28,
-anterior scalenus; 29, posterior belly of omohyoid; 30, middle and
-posterior scalenus; 31, trapezius. (Dorland’s Dictionary.)]
-
-=Muscles of the Neck.=--Before speaking of the muscles of the back
-a few of those of the neck had best be taken up. They are numerous
-but mostly of minor importance. Largest and most important is the
-_sterno-cleido-mastoid muscle_, which has its origin on the upper part
-of the sternum and the inner third of the clavicle and is inserted into
-the mastoid process of the temporal bone. It passes obliquely across
-the side of the neck and serves to flex the head to the side and to
-draw the face in the opposite direction. When both muscles contract the
-head is flexed on the neck and the neck on the chest. In _wry neck_
-or _torticollis_ this muscle is constantly contracted. The _platysma
-myoides_ arises from the fascia over the pectoral, deltoid, and
-trapezius muscles and is inserted into the lower jaw, the angle of the
-mouth, and the loose tissue in the lower part of the face. It wrinkles
-the skin of the neck and depresses the lower jaw. In the cow and horse
-it is so highly developed that by it the skin can be contracted all
-over the body to drive off flies. The _rectus capitis anticus major_
-arises from the third to the sixth cervical vertebræ and is inserted
-into the occipital bone, serving to flex the head. The _scalenus
-muscles_ have their origin on the lower cervical vertebræ and are
-inserted into the first and second ribs, thus aiding in the elevation
-of the ribs as well as in lateral flexion of the neck. The head is
-held upright by the _ligamentum nuchæ_, which rises from the external
-occipital protuberance and is inserted into the spinous processes of
-all the cervical vertebræ except the first.
-
-=Muscles of the Back.=--The chief back muscles are the trapezius
-and the latissimus dorsi, which together cover in the back pretty
-thoroughly. The _trapezius_ arises from the occipital bone, the
-ligamentum nuchæ, and the spinous processes of the seventh cervical
-and all the dorsal vertebræ and is inserted into the outer third of
-the clavicle or collar bone and the acromion process and spine of the
-scapula or shoulder blade. It is thus triangular in shape and covers in
-the neck and shoulders, serving to draw the head back and to the side.
-It overlaps the latissimus dorsi.
-
-The _latissimus dorsi_ has its origin by aponeurosis from the spinous
-processes of the six lower dorsal and all the lumbar and sacral
-vertebræ, from the crest of the ilium or hip bone, and from the three
-or four lower ribs, swings across the side, dwindling in size, and is
-inserted by a small tendon into the bicipital groove of the humerus or
-upper arm bone, thus covering in the part of the back not covered by
-the trapezius. It draws the arm down and back, raises the lower ribs,
-and draws the trunk forward, as in climbing. The flat muscles of the
-back and abdomen have a tendency to flatten out into aponeuroses, such
-as occurs in the origin of the latissimus dorsi.
-
-The _levator scapulæ_, from the transverse processes of the upper
-cervical vertebræ to the posterior border of the scapula, serves
-to raise the angle of the scapula, and the _rhomboideus major_ and
-_minor_, from the ligamentum nuchæ, the seventh cervical, and the upper
-dorsal vertebræ to the root of the spine of the scapula, draw the
-inferior angle back and up.
-
-[Illustration: FIG. 35.--Muscles of the trunk from behind (left side,
-superficial; right side, deep): 1, Sternomastoid; 2, splenius; 3,
-trapezius; 4, latissimus dorsi; 5, infraspinatus; 6, teres minor;
-7, teres major; 8, deltoid; 9, external oblique of abdomen; 10,
-gluteus medius; 11, gluteus maximus; 12, levator anguliscapulæ; 13,
-rhomboideus minor; 14, rhomboideus major; 15, part of longissimus
-dorsi; 16, tendons of insertion of iliocostalis; 17, supraspinatus; 18,
-infraspinatus; 19, teres minor; 20, teres major; 21, serratus magnus;
-22, upper, and 22´, lower part of serratus posticus inferior; 23,
-internal oblique; 24, gluteus medius; 25, pyriformis and superior and
-inferior gemelli; 26, 26´, portions of obturator internus; 27, tendon
-of obturator internus; 28, quadratus femoris. (Dorland’s Dictionary.)]
-
-The _blood supply_ in the cervical region and about the shoulders comes
-from branches of the subclavian artery, such as the suprascapular and
-the transversalis colli. Lower down the supply comes from the posterior
-branches of the intercostals, dorsal branches of the lumbar, and
-branches of the internal iliac.
-
-The muscles of the back are supplied by the _spinal nerves_, the spinal
-accessory also going to the trapezius muscle.
-
-
-
-
-CHAPTER VII.
-
-THE CHEST.
-
-
-The chest or thorax occupies the upper part of the trunk in front and
-is a dome-shaped cavity containing and protecting the heart and lungs.
-Its walls are formed by the dorsal vertebræ at the back, the ribs at
-either side, and the sternum and costal cartilages in front, all well
-covered with muscles. The floor is formed by the diaphragm. Through the
-upper opening of the chest pass the trachea, the esophagus, and many
-important vessels and nerves.
-
-[Illustration: FIG. 36.--Thorax (anterior view.) (Ingals.)]
-
-The shape of the chest may vary in disease. Thus, in rickets there is
-the prominent “pigeon” breast and the rosary, that is, a bead at the
-juncture of each rib with the costal cartilage, while in emphysema the
-chest is enlarged in all directions and barrel-shaped. In severe cases
-of lateral curvature it is distorted but may be improved by exercises.
-
-=The Sternum.=--The sternum or breast-bone is a long narrow bone and
-has three parts, the _manubrium_ or handle above, the _gladiolus_ or
-sword, and the _ensiform cartilage_ at the lower end. On either side
-are notches for the costal cartilages; for the first seven ribs as
-well as the clavicle articulate with it. Except for some muscles along
-the edges it lies directly under the skin and the ridge between the
-manubrium and the gladiolus can be felt in the living, a fact which
-assists in determining the position of the different ribs in cases of
-fracture, as the second rib articulates at this point.
-
-[Illustration: FIG. 37.--A and B, typical ribs; C, first rib; D,
-twelfth rib. 1, head; 2, neck; 3, tuberosity; 4, grooved edge; 5,
-shaft; 6, oval depression for costa cartilage.]
-
-=The Ribs.=--The ribs are twenty-four in number, twelve on each
-side, of which the upper seven, which articulate with the sternum
-by individual cartilages, are called _true ribs_, the other five
-_false ribs_. Of the false ribs the upper three articulate indirectly
-with the sternum through the seventh cartilage, with which their
-cartilages unite, while the other two have their anterior extremities
-free and are called _floating ribs_. All the ribs slope down toward
-the front and are by nature more freely movable in women than in
-men. Most of the ribs have a head divided by a little ridge into two
-facets for articulation with the dorsal vertebræ, a flattened neck,
-a tuberosity at the base of the neck with a facet for articulation
-with the transverse process of the vertebra below, an angle, and a
-shaft, which is externally convex and is grooved on its lower edge
-for the intercostal vessels and nerve. The first and second, eleventh
-and twelfth ribs, however, are somewhat peculiar, the first two being
-shorter, flatter and rather broader than the rest and the first having
-only one facet on the head, while the last two have only one facet on
-the head and no neck or tuberosity.
-
-The _costal cartilages_ serve to prolong the ribs and greatly increase
-the elasticity of the chest wall. They grow longer down to the seventh
-and then decrease again in length.
-
-The ribs, except the first and second, which are protected by the
-clavicle, are frequently _broken_. Such a break causes pain in
-breathing and sometimes the end of a rib pierces the lung tissue
-and swelling all over the body results, due to the presence of air.
-_Caries_ or death of the rib is also frequent. _Fracture of the
-sternum_ occurs occasionally, generally from direct force, as from a
-blow with the knee in foot-ball, and there may be dislocation between
-the manubrium and gladiolus.
-
-=Muscles of the Chest.=--The spaces between the ribs, from the
-tubercle of the rib behind to the cartilage in front, are filled by
-the _external intercostal muscles_, which pass downward and forward
-from the lower border of one rib to the upper border of the one below.
-There are, therefore, eleven pairs of these muscles. There are also
-eleven pairs of the _internal intercostals_, which commence at the
-sternum and extend back to the angle of the rib. These extend downward
-and backward. The external intercostals raise and evert the ribs in
-inspiration, the internal depress and invert them in expiration.
-
-The chief respiratory muscle, however, is the _diaphragm_, a somewhat
-fan-shaped muscle that forms the floor of the chest cavity. It takes
-its origin from the ensiform cartilage, the six or seven lower ribs and
-their cartilages, and from the upper three or four lumbar vertebræ,
-that is, from the whole of the internal circumference of the thorax,
-and is inserted into the central cordiform tendon. It has several large
-and several small openings for the aorta, the esophagus, the venæ cavæ,
-the thoracic duct, and various nerves, and its surfaces are covered by
-serous membranes, by the two pleuræ and the pericardium above and by
-the peritoneum below. It partially supports the heart and lungs. Convex
-toward the chest, it becomes flattened in contraction and so increases
-the capacity of the chest. It aids in all expulsive acts, as sneezing,
-coughing, laughing, urinating, defecating, vomiting, and childbirth.
-_Hiccough_ is spasm of the diaphragm.
-
-[Illustration: FIG. 38.--Interior view of the diaphragm. (Leidy.)
-1-3, The three lobes of the central tendon, surrounded by the fleshy
-fasciculi derived from the inferior margin of the thorax; 4, 5, the
-crura; 6, 7, the arcuate ligaments; 8, aortic orifice; 9, esophageal
-orifice; 10, quadrate foramen; 11, psoas muscle; 12, quadrate lumbar
-muscle.]
-
-The _arteries_ of the chest are the intercostal branches of the
-subclavian and the thoracic aorta, the phrenic, mediastinal, and
-intercostal branches of the internal mammary, and the thoracic branches
-of the axillary.
-
-The _nerves_ are the intercostals and phrenics.
-
-=Mammary Glands.=--On the outside of the chest walls, lodged in the
-fascia of the pectoral muscles, are the mammary glands, accessory
-organs of the generative system. They exist in both sexes but are
-only rudimentary in the male. In the female they are small before
-puberty but enlarge as the generative organs become more completely
-developed, forming two hemispherical eminences, one on either side,
-between the third and seventh ribs. During pregnancy they increase once
-more in size preparatory to the secretion of the milk, and in old age
-they atrophy. From the middle projects a small pinkish-brown conical
-eminence, the _nipple_, surrounded by a paler area, the _areola_. After
-the second month of pregnancy both nipple and areola become darker in
-color, a point of great diagnostic value in early pregnancy.
-
-The mammary glands themselves consist of lobules of gland tissue with
-a central lactiferous tubule, the lobules being gathered into lobes
-with fatty tissue between. From the juncture of these tubules result
-fifteen or twenty excretory ducts, the _tubuli lactiferi_, which
-converge toward the areola. Beneath the nipple they dilate, forming the
-_ampullæ_, and then contract again to pass out through the nipple as
-straight tubes.
-
-_Breast abscess_ occurs most commonly in nursing mothers, as where
-a part is most active there is most danger of abscess. Many benign
-_tumors_ of the breast, as the fibrous tumors, occur and are especially
-common in young women. If a fibrous tumor is allowed to develop it may
-become cancerous. _Cancer_, however, generally occurs after the age of
-forty and is usually due to some irritation, as to a blow from a ball.
-
-The _arteries_ of the breasts are the thoracic branches of the
-axillary, the intercostal, and the internal mammary.
-
-The _nerves_ are from the thoracic cutaneous.
-
-
-
-
-CHAPTER VIII.
-
-THE HEART AND CIRCULATION.
-
-
-=The Heart.=--Shielded within the chest are, as has been said, the
-heart and lungs. The heart lies on the left side behind the sternum
-and the cartilages of the fourth to seventh ribs in a closed, conical,
-membranous sac, the _pericardium_, which is attached by its base to the
-central tendon of the diaphragm, and whose point extends up between
-the pleuræ of the lungs. This sac has an external fibrous layer and an
-internal serous layer that is reflected back over the heart itself,
-forming a closed sac, within which a thin fluid is secreted that serves
-to reduce friction during the movements of the heart, the two inner
-surfaces sliding over each other with every beat.
-
-[Illustration: FIG. 39.--The heart. (Stoney.)]
-
-[Illustration: FIG. 40.--Left auricle and ventricle, opened and part of
-their walls removed to show their cavities: 1, Right pulmonary vein cut
-short; 1´, cavity of left auricle; 3, 3´, thick wall of left ventricle;
-4, portion of same with papillary muscle attached; 5, the other
-papillary muscles; 6, 6´, the segments of the mitral valve; 7, in aorta
-is placed over the semilunar valves; 8, pulmonary artery; 10, aorta and
-its branches. (Allen Thomson.)]
-
-The heart itself is a hollow conical organ composed of cardiac muscle,
-a combination of smooth and striated fibers found nowhere else in the
-body. It lies obliquely, base up, between the lungs, suspended by the
-great blood-vessels and with the apex directed downward, forward, and
-to the left, the apex beat being normally felt in the fifth intercostal
-space, one inch inside and two inches below the left nipple. In size
-it varies in different people and is generally smaller in women than
-in men. On the average it is five inches long, three and a half inches
-broad, and two inches thick. A man’s heart usually weighs about eleven
-ounces and that of a woman nine ounces. It never leaks except from
-disease and such leakage is fatal.
-
-_The Cavities._--The heart contains four cavities, two _auricles_ above
-and two _ventricles_ below, with a longitudinal septum between the
-auricle and ventricle on the right and those on the left. The posterior
-surface is largely made up of the left ventricle and the anterior of
-the right ventricle. The right auricle, which receives the blood from
-the general circulation, has a capacity of about two fluid ounces and
-is larger than the left, which receives the blood returning from the
-lungs, though its walls are thinner. Of the ventricles the left is the
-larger and its walls are about three times as thick as those of the
-right, for it has to send the blood all over the body. All the cavities
-are lined with smooth, transparent, serous membrane, the _endocardium_,
-which is continuous with the intima of the great vessels.
-
-[Illustration: FIG. 41.--Orifices of the heart, seen from above, both
-the auricles and the great vessels being removed: _PA_, Pulmonary
-artery and its semilunar valves; _Ao_, aorta and its valves; _RAV_,
-tricuspid, and _LAV_, bicuspid valves; _mv_, segments of mitral valve;
-_lv_, segment of tricuspid valve. (Huxley.)]
-
-_The Valves._--The opening from the auricle into the ventricle on
-either side is guarded on the ventral side by a valve formed of folds
-of endocardium. The valve on the right side has three flaps or cusps
-and is called the _tricuspid valve_, while that on the left has two
-flaps, larger and thicker than those of the tricuspid, and is known as
-the _bicuspid_ or _mitral valve_. The flaps of either valve are kept
-from being forced into the auricle in closing by fine tendinous cords,
-the _chordæ tendineæ_, which are attached to the _columnæ carneæ_,
-muscular bands or columns projecting from the walls of the ventricle,
-which contract and hold the chordæ tendineæ taut. The opening into the
-pulmonary artery is from the posterior part of the right ventricle
-and is guarded by the _semilunar_ or _pulmonary valve_, while the
-aortic opening from the left ventricle is guarded by a similar valve,
-the _aortic valve_, the most important valve in the body. All these
-valves are planned primarily to prevent regurgitation of the blood
-during contraction of the heart muscle. Pressure in the ventricle must
-exceed that in the arteries before the semilunar valves will open and
-the blood can be driven out, just as the auriculo-ventricular valves
-remain closed until the pressure in the auricles exceeds that in the
-ventricles.
-
-The _heart beat_ is caused by the twisting of the heart upon its axis
-during contraction of the muscle. Normally it beats rhythmically and
-regularly, whatever a person does, at a rate of about seventy-two
-contractions to the minute in the adult. To the regular _cardiac
-cycle_, as it is called, there are two periods, the _systole_ and the
-_diastole_, the former representing the period of contraction of the
-ventricles, when the blood is sent to the lungs and over the body,
-and the latter representing the period of rest following the emptying
-of the ventricles, during which they are refilled. Contraction of
-the heart occupies one-fifth of the time of one beat, dilatation
-two-fifths, and the pause two-fifths. There are really two systoles,
-one of the auricles and one of the ventricles, but they come so close
-together that they are practically simultaneous so far as sound is
-concerned, though they can be distinguished by sight. During systole
-the tricuspid and mitral valves close sharply to prevent regurgitation
-into the auricles, while the semilunar valves open to let the blood
-out. The cardiac cycle is, therefore, as follows:
-
-[Illustration: FIG. 42.--Diagram of the circulation. (After Kirke.)]
-
-=Circulation.=--The blood, after it has given off its oxygen and
-collected carbon dioxide, returns to the heart through two main
-channels, the _superior_ and _inferior venæ cavæ_, the former bringing
-the blood from the upper part of the body, including the head, neck,
-and arms, and the latter from the lower part below the diaphragm. The
-two vessels empty along with the _coronary sinus_, which is guarded
-by the _coronary valve_, into the right auricle. At the same time
-that they empty into this auricle the four _pulmonary veins_, the
-only veins that carry arterial or oxygenated blood, are emptying the
-fresh blood from the lungs into the left auricle. When both auricles
-are full, they contract and send the blood into the ventricles, the
-_auricular systole_. As the blood comes through into the ventricles it
-probably comes around by the walls and closes the auriculo-ventricular
-valves, though just how the valves close is not certain. When the two
-ventricles are full they in turn contract, the _ventricular systole_,
-and the blood is forced out, that in the right ventricle passing to the
-lungs for its new supply of oxygen through the _pulmonary artery_, the
-only artery to carry venous blood, and that from the left ventricle
-entering the aorta for general distribution through the body. Following
-the systole is a pause, the _diastole_, while the heart fills again.
-
-[Illustration: FIG. 43.--The fetal circulation.]
-
-_Circulation in Fetus._--In the fetus there is direct communication
-between the two auricles through the _foramen ovale_, which normally
-closes at birth, though occasionally it remains open. There is also
-communication between the pulmonary artery and the arch of the aorta
-through the _ductus arteriosus_. The freshly oxidized blood comes
-to the fetus through the placenta, from which it is brought along
-the umbilical cord in the umbilical vein to the liver and thence to
-the inferior vena cava, where it mixes with the blood from the lower
-extremities. By the inferior vena cava it is carried to the right
-auricle, where the _Eustachian valve_--a valve between the inferior
-vena cava and the auriculo-ventricular opening, larger in the fetus
-than in later life where it serves no special purpose--guides it across
-the auricle and through the foramen ovale to the left auricle. From
-this auricle, together with a small amount of blood from the lungs,
-it goes to the left ventricle and is distributed by the aorta almost
-entirely to the head and upper extremities. Hence their large size and
-perfect development at birth. Returned from the upper extremities by
-the superior vena cava, the blood enters the right auricle again and,
-passing over the Eustachian valve this time, descends to the right
-ventricle, from which the greater part passes by the pulmonary artery
-and the ductus arteriosus to the descending aorta, though a small
-amount keeps on through the pulmonary artery to the lungs. In the aorta
-it mixes with the blood from the left ventricle and part goes to supply
-the lower extremities, though the greater part is carried back to the
-placenta through the two umbilical arteries. The fact that the greater
-part of the blood traverses the liver accounts for its large size at
-birth, while the lower extremities, which receive for the most part
-blood that has already circulated through the upper extremities, are of
-small size and imperfectly developed.
-
-=Arteries.=--After birth the arterial blood for the general circulation
-leaves the heart by the aorta, the main distributing artery of the
-body. Through this and its branches it is carried throughout the body
-in what, with the return of the venous blood by the venæ cavæ and other
-smaller veins, is known as the _systemic circulation_. The _aorta_
-ascends from the left ventricle and arches backward to the left over
-the root of the left lung to descend along the spinal column at the
-left to the fourth lumbar vertebra, about opposite the umbilicus,
-where, considerably diminished in size by the branches it has given
-off, it divides into the two _common iliacs_. For convenience its
-different parts are named, according to their position, the _ascending
-aorta_, the _arch of the aorta_, and the _descending aorta_, the last
-being subdivided into the _thoracic_ and the _abdominal aorta_.
-
-[Illustration: FIG. 44.--The aortæ and their branches. (Leidy.)]
-
-From the ascending aorta come off the _coronary arteries_ which supply
-the heart muscle itself, as the coronary sinuses carry off the venous
-blood from the heart. From the arch are given off the _left common
-carotid_ and _left subclavian_ and the _innominate_, which divides into
-the _right common carotid_ and _right subclavian_.
-
-The _common carotids_ pass up the neck behind the sterno-cleido-mastoid
-muscles in a line from the sterno-clavicular joint to a point midway
-between the mastoid process and the angle of the lower jaw and divide
-opposite the upper border of the thyroid cartilage into the _internal_
-and _external carotids_, of which the former with its branches supplies
-the anterior part of the brain, the eye and forehead, and the latter
-the neck and face.
-
-The _subclavian_ is the artery of the upper extremity but its vertebral
-branch goes to the brain, where with its fellow it forms the _basilar
-artery_, whose branches together with the branches of the internal
-carotid form the _circle of Willis_ at the base of the brain. Other
-branches of the subclavian are the _thyroid axis_, with branches to
-the neck and shoulders; the _internal mammary_, with branches to the
-chest walls, mediastinum, and diaphragm, such as the musculo-phrenic
-and superior epigastric; and the _superior intercostal_. At the lower
-border of the first rib, over which it passes, the name _axillary_ is
-substituted for _subclavian_, while at the lower border of the axilla,
-where it starts down the arm, it is called the _brachial artery_. At
-the elbow the brachial divides into the _radial_ and _ulnar arteries_.
-The _axillary artery_ sends branches to the chest and shoulder and is
-more frequently injured than any other artery except the popliteal.
-_Aneurism_ may occur in it and is very likely to occur in the thoracic
-aorta.
-
-From the _thoracic aorta_ branches go to various of the chest contents,
-while the _abdominal aorta_ supplies the abdominal viscera. Among the
-branches of the abdominal aorta are: the _celiac axis_, which has a
-gastric, an hepatic, and a splenic branch; the _superior_ and _inferior
-mesenteric_ to the intestines; the _renal_; the _suprarenal_; the
-_spermatic_ or _ovarian_; the _inferior phrenic_; and the _lumbar_.
-
-The _common iliacs_ divide at the upper edge of the sacrum into the
-_external_ and _internal iliacs_, of which the latter with its branches
-supplies the walls and viscera of the pelvis and the inner part of the
-thigh. The external iliac and its branches go to the thigh, leg, and
-foot.
-
-=Veins.=--Of the veins few need be mentioned by name. The deep veins
-have the same names as the arteries they accompany, though there are
-two _innominate veins_ where there is only one innominate artery,
-the _subclavian_ and _internal jugular_ veins on either side joining
-to form an innominate vein and the two innominates in turn forming
-the _superior vena cava_. Of the superficial veins the _external_
-and _internal jugular_ correspond to the common carotid arteries and
-return the blood from the head and face. The external jugular vein is
-important because it is the largest superficial vein in the neck and
-is often cut in suicide. The _median vein_ is found at the bend of
-the elbow and is used in letting blood and in giving salt solution,
-while the _basilic_ is on the inner side and the _median cephalic_
-on the outer side of the upper arm. _Varicosity_ often occurs in the
-_internal_ or _long saphenous_ and the _external_ or _short saphenous_
-in the leg. The _inferior vena cava_ is formed by the juncture of the
-two _common iliac veins_.
-
-=Portal Circulation.=--The portal system of veins includes four large
-trunks which collect the blood from the viscera of digestion, the
-_superior_ and _inferior mesenteric veins_ from the intestines, the
-_splenic vein_ from the spleen, and the _gastric_ from the stomach.
-These join together to form the _portal vein_, the only vein that
-breaks up into capillaries. This divides and ramifies through the
-liver, whence it emerges as the _hepatic veins_. The whole is known as
-the portal circulation.
-
-=Pulmonary Circulation.=--Of the pulmonary circulation and its vessels
-a few words might also be said. The _pulmonary artery_, which carries
-the blood from the right ventricle to the lungs, is only about two
-inches long and divides into a right and a left pulmonary artery, which
-pierce the pericardium and go to their respective lungs. The right one
-is the larger and longer, for it has farther to go and gives off a
-branch to supply the third lobe of the right lung. The vessels finally
-divide and subdivide, terminating in the _pulmonary capillaries_.
-The venous capillaries then gather together to form a main vein in
-each lobule, these veins uniting into two trunks for each lung, the
-_pulmonary veins_, which empty into the left auricle.
-
-=Nerves of Heart.=--The muscular fibers of the heart have the power
-of rhythmical contraction. Independent nerve centers or ganglia are
-also found in the muscular walls and influence the mechanism of the
-heart, especially the acceleratory mechanism. Thus, in some of the
-lower animals the heart can be removed from the body, and if placed in
-normal salt solution will go on beating for some time. The heart is
-controlled, however, by two nerves, the _vagus_ or _pneumogastric_ and
-the _sympathetic_. Of these the vagus is the inhibitory mechanism. It
-acts as a check and makes the heart’s action regular and rhythmic. If
-it is cut, the action of the heart becomes very rapid and irregular.
-The sympathetic is the acceleratory mechanism. When the vagus alone
-is stimulated, it first slows, then stops the heart, for it weakens
-the systole and prolongs diastole. Acceleration follows stimulation
-of the sympathetic, both the rapidity and the force of the beat
-being increased. When a person faints from a blow in the abdomen, it
-is because the pneumogastric is affected and inhibits the action of
-the heart. The work of the heart is very dependent upon its nervous
-condition and functional diseases of the heart are practically wholly
-due to nervous derangement.
-
-=Heart Sounds.=--Through the stethoscope two heart sounds may be heard.
-They are known as the first and second sounds. The first is a soft,
-rushing sound, stronger and louder than the other, and is caused in
-part by the contraction of the muscle itself when the blood is forced
-out and in part by the closure of the auriculo-ventricular valves.
-The second sound is shorter and sharper, a snap, and is caused by the
-closure of the semilunar valves when the contraction of the ventricles
-ceases and they begin to refill. In certain diseased conditions, where
-the edges of the valves are roughened, they do not snap properly and
-the sound varies from the normal.
-
-=The Heart Beat.=--The rate of the heart beat is proportionate to the
-size of the person and increases in rapidity as the size diminishes.
-If the ear is placed over the abdomen of a pregnant woman, the heart
-of the fetus can be heard beating very rapidly. In prolonged labor it
-may become more rapid or very faint and warn the doctor that something
-should be done. The usual rate of the pulse in the fetus is 140 to 150
-times a minute, though it varies with size and sex. At birth it drops
-to 140 to 130; for the first year it is 130 to 115; for the second
-year 115 to 105; for the third year 105 to 95; from the seventh to the
-fourteenth years 80 to 90; from the fourteenth to the twenty-first
-years 75 to 80; from twenty-one to sixty 60 to 75. In old age it rises
-a little and is 75 to 80. The rate is higher in the average woman
-than in the average man and increases with exercise, with increase of
-temperature, and in high altitudes, where the atmospheric pressure is
-less.
-
-At each beat of the heart from four to six ounces of blood are
-expelled into the pulmonary artery and the aorta, and in 22 or 23
-beats all the blood in the body passes through the heart. The power
-exerted by the heart every minute in thus driving the blood upon its
-course has been estimated as sufficient to raise its own weight,
-three-quarters of a pound, the height of the Washington monument or 150
-meters; for the ventricles have to force the blood into vessels already
-full.
-
-=Factors Affecting Circulation.=--There are three main factors in the
-circulation: 1. the systole, which gives the blood its first impulse;
-2. the peripheral resistance in the capillaries, which serves to hold
-it in check, slowing the circulation and doing away with its rhythmic
-character, and 3. the elasticity of the walls of the arteries.
-
-If a ligature is tied about an artery, there is a swelling on the side
-toward the heart, while in the case of a vein, the swelling is on the
-side away from the heart, that is, the swelling is in either case on
-the side from which the blood comes. When an artery is cut, however,
-the blood comes out rhythmically in spurts, though from a cut vein it
-oozes slowly and regularly. For the blood is pumped out by the heart
-rhythmically and its rhythmic beating against the walls of the artery
-is felt in the _pulse_, which follows slightly after the beat of the
-heart itself. The pulse is due to the fact that the vessels into which
-the blood is forced are already full. This causes a local dilation at
-the beginning of the artery which passes with diminishing force along
-its entire length, the distention being due to the fact that more force
-is needed to drive the blood through the small arteries and capillaries
-than to stretch the elastic walls of the aorta and the large arteries.
-It is this elastic character of the arteries that makes the blood flow
-constant, for otherwise the blood would come intermittently in jets, as
-it is pumped from the heart. The elastic walls of the vessels, however,
-offer a certain resistance to the pumping of the fluid through them and
-at the same time, by relaxing between whiles, allow a certain amount of
-fluid to be retained in them, so that they continue full and the flow
-is more or less constant. The insufficient outlet also helps to make
-the flow constant.
-
-By the time the blood reaches the veins its rhythmic character has
-been done away with, but though there are no elastic walls in the
-veins, it still has force enough after the slowing in the capillaries
-to return to the heart. In this it is aided to a certain extent by
-the valves and by the action of the skeletal muscles as they contract
-and expand, especially in the arms and legs, where the blood runs
-perpendicularly and there is a high column to be supported. There are
-also more veins than arteries, each large artery having two large
-veins, the venæ comites, to help get the blood back to the heart, and
-the veins anastomose freely. Thus, if the blood cannot get back by one
-channel it does by another. In parts like the brain, where it is very
-important that there should be no compression, since any disturbance
-of circulation would lead to serious results, the vessels are enclosed
-in thick walls, and in the liver, through which all the blood passes
-and where compression is sure to cause trouble, the veins are simply
-caverns carved out in the organ and have no walls. They lie open when
-the organ is opened. _Varicose veins_ are the result of valves giving
-way through inherited weakness or disease so that others have an unduly
-large weight to support.
-
-=The Pulse.=--The _pulse wave_ is characterized by a quick rise and
-a slow fall, though this cannot ordinarily be distinguished by the
-finger. In some slow fevers, however, the fall is very long and
-distinct ripples can be felt. This is known as the _dicrotic pulse_.
-With age the arterial walls grow stiffer and more rigid and less
-adapted to their work. In certain cases of heart disease the heart does
-not transmit all the beats to the pulse and to get the true rate the
-heart must be listened to.
-
-The rate at which the pulse wave travels varies with the size of the
-artery and the force of the heart beat but is about 15 to 20 feet
-a second. The flow is most rapid in the arteries because they are
-nearest the heart, where the pressure is greatest, and slowest in the
-capillaries, where the area is greatest, the sectional area of the
-capillaries, known as the _peripheral area_ because it is farthest from
-the heart, being larger than that of the large arteries. Thus rapidity
-of flow varies with pressure and with area.
-
-=Blood Pressure.=--Liquids, moreover, are incompressible and exert
-pressure on the walls of the tubes through which they pass. The amount
-of pressure depends upon the inflow and outflow, increasing directly
-with the inflow and inversely with the outflow, that is, the smaller
-the outlet the greater the pressure, and _vice versa_. The pressure
-is also greatest nearest to the inflow and gradually decreases with
-distance until at the point of outflow there is practically no
-pressure. So, in the arteries the blood pressure is greatest in the
-large vessels nearer the heart and gradually decreases as they branch
-into smaller and smaller vessels. In passing through the capillaries,
-owing to their small size and resultant increased friction, the
-blood meets with more resistance, the peripheral resistance, and
-this resistance usually regulates the pressure in the arteries. The
-greater the peripheral resistance, as a rule, the greater the arterial
-pressure. The pressure in the capillaries is very slight and in the
-veins there is practically no pressure. In fact, in the large veins
-near the heart the pressure is negative and the blood is almost sucked
-into the heart.
-
-Pressure, then, is greatest in the arteries and least in the veins,
-while the rate of flow is fastest in the arteries--300 to 500
-millimeters a second--and slowest in the capillaries--75 millimeters
-a second--being a little faster again in the veins--200 millimeters a
-second.
-
-Blood pressure is gauged by opening a vessel and inserting a
-_manometer_, the pressure being determined by the height to which the
-mercury is raised. In man the pressure in the arteries is 120 to 160
-millimeters. It is considerably heightened during inspiration by the
-increased pressure of the lungs on the heart and great vessels. In
-pericarditis the opposite is true.
-
-When the blood pressure is high, the _pulse_ is small and travels fast,
-because the wall of the artery is already highly stretched. Such a
-pulse is hard and incompressible. A large pulse occurs where the heart
-is strong and the pressure is low, owing to peripheral dilatation. A
-low-pressure pulse is soft and compressible if the heart beat is weak.
-A slow pulse is generally stronger than a rapid one.
-
-The _nerve supply of the blood-vessels_ comes from the spinal cord
-through the vasomotor nerves, which are connected with the sympathetic
-system and are distributed to the smooth muscle fibers of the vessels.
-They are of two classes, the _vasoconstrictors_, which diminish the
-lumen of the vessels, and the _vasodilators_, which increase the size
-of the vessels. By these nerves the general tone of the arteries is
-kept up. They are distributed chiefly to vessels in the skin and
-in the abdominal organs and the constrictors are probably the more
-important. When the constrictors are stimulated, three phenomena occur:
-1. diminished flow through the vessel, due to its diminished size; 2.
-increased general arterial pressure, and 3. increased flow through
-the other arteries. When the dilators are stimulated the opposite
-effect is produced: 1. the flow through the vessel is increased; 2.
-there is decreased arterial pressure, and 3. there is decreased flow
-through the other arteries. The palor of fright is due to the action
-of the vasoconstrictor nerves of the face and blushing to the action
-of the vasodilators. Heat stimulates the vasodilators so that more
-blood goes to the skin, perspiration begins, and the body is cooled by
-evaporation. Cold stimulates the vasoconstrictors and the blood is kept
-within the body, where it cannot cool. If a part has too much blood,
-an impulse passes by the vasoconstrictors to lessen the supply, while
-if more blood is needed a message goes to the central nervous system
-and an impulse passes by the vasodilators to flush the organ. The more
-active a part is in functioning the greater the number of capillaries,
-except in the brain, which has only large vessels. The vessels of the
-intestines contain much blood and are capable of containing all the
-blood in the body.
-
-=The Blood.=--The blood itself, which thus circulates through the body,
-carrying nutrition to the tissues and removing waste, is a complex
-fluid of a bright red color. Its amount has been calculated to be
-about one-thirteenth of the body weight. One-fourth of it is generally
-in the heart, lungs, and large arteries and veins, one-fourth in the
-liver, one-fourth in the skeletal muscles, and one-fourth variously
-distributed through the other organs. If there is too little blood, the
-vital processes cannot go on as they should, while too great a supply
-causes weakness rather than strength. So the tendency is to keep the
-amount constant and any blood added is disposed of and any blood lost
-is replaced. In starvation it is the last tissue to be used up, for on
-it the life of the other tissues depends.
-
-_Composition._--In composition the blood is practically the same in
-all arteries and fundamentally the same everywhere, but in passing
-through certain organs certain substances are added to or taken from
-it, so that its character changes more or less. Thus it varies somewhat
-in composition in different parts of the body, as in the liver and
-kidneys. It has five main functions: 1. the conveying of fuel from the
-digestive tract to the tissues, or force production; 2. the carrying of
-oxygen to the tissues; 3. the carrying of tissue-building materials,
-or tissue building; 4. the distribution of heat; and 5. the removal of
-waste products.
-
-The blood is slightly alkaline in reaction, of a saltish taste, and has
-a specific gravity of 1055. Its temperature is about 100° Fahrenheit or
-37.8° Centigrade. It is made up of two parts, the _plasma_ or fluid
-portion and the _corpuscles_ or solid portion. The plasma, again, which
-is transparent and almost colorless, consists of two materials, the
-_blood serum_ and _fibrin_. Fibrin does not exist as such in the body
-nor in freshly shed blood, but there is a substance named _fibrinogen_
-which is worked on by another substance, the _fibrin ferment_, to form
-fibrin. Both fibrin ferment and fibrinogen can be isolated from the
-blood.
-
-_Coagulability._--In the body the blood is perfectly fluid and under
-normal conditions does not coagulate. But, though fluid when first
-shed, upon standing it gradually becomes viscid, that is, in two or
-three minutes, then jelly-like, in five to ten minutes, and grows
-firmer and firmer until there finally appears around this jelly-like
-mass or clot a yellowish fluid, the _serum_. The _clot_ is made up of
-the corpuscles and fibrin. If some blood is drawn and set on ice until
-the corpuscles settle, the plasma can then be drawn off, and after it
-has stood a while in a warm place coagulation will take place, a mass
-of fibrin forming in the middle. It takes from one to two hours for
-clotting to be complete. In very slow clotting at a low temperature the
-white corpuscles appear in a layer on top of the clot, the buffy coat.
-
-Of _fibrin_ little is known, but its formation is the most important
-step in clotting, as its presence is absolutely essential. If it
-is removed by whipping, the blood will not clot. It is a delicate,
-stringy material, elastic and contractile, and contains certain salts
-of lime and magnesium, upon whose presence its power of coagulation
-depends. The coagulability of blood differs in different people and is
-occasionally so little as to make operation dangerous.
-
-The most favorable temperature for clotting is that of the body,
-extreme heat preventing it and cold delaying it. That the blood does
-not clot in the body must be due to some relation between the blood
-and the walls of the arteries and veins that prevents it, just as the
-walls of the stomach are not digested by the juices secreted. Though
-coagulation does not normally take place in the body, it does take
-place when a blood-vessel is injured or when the blood comes in contact
-with the air, a wise provision of nature, as otherwise the tendency
-would be for bleeding to go on indefinitely after injury. The greater
-the surface with which the blood comes in contact the more quickly it
-clots. Injury to the vessel wall itself is necessary; the endothelium
-must be cracked. Under extreme injury the muscular coat of the vessel
-undergoes spasmodic contraction and partially closes it. Hence a wound
-caused by tearing is less likely to bleed than one due to cutting.
-
-The valves of the heart, which are covered with endothelium, are
-frequently the seat of fibrin coagulation, bits of the fibrin thus
-formed giving rise to conditions in various kinds of heart trouble. Or
-the bits of fibrin float in the blood and perhaps lodge in the small
-vessels of the brain and cause apoplexy. Pus in various parts of the
-body will set up coagulation in nearby arteries. In fact, the presence
-of any foreign substance in the blood causes clotting.
-
-[Illustration: FIG. 45.--Cells of blood: _a_, Colored blood-corpuscles
-seen on the flat; _b_, on edge; _c_, in rouleau; _d_, blood platelets.
-(Leroy.)]
-
-=Blood-corpuscles.=--The solid parts of the blood are the red
-corpuscles, the white corpuscles, and the blood plaques or plates.
-It is to the _red corpuscles_, or _erythrocytes_ which number about
-5,000,000 to the cubic millimeter of blood, that the color of the
-blood is due. Under the microscope they appear as small, spherical,
-biconcave discs with a slightly greenish-yellow color, which have
-a tendency to form in rouleaux. They are homogeneous, with no
-limiting membrane, and are made up of a fine network of tissue, the
-_stroma_, in which is embedded the hemoglobin or coloring matter.
-This hemoglobin is a crystalline body and the most complex substance
-known to chemists. The corpuscles are very flexible and can squeeze
-through small apertures, as in the tiny capillaries, and regain their
-shape. They are probably formed chiefly in the red bone marrow at the
-ends of the bones, which under the microscope shows red corpuscles in
-various stages of growth, and also in the spleen, for which no other
-use is known. Their function is to carry oxygen, which forms a chemical
-combination, though an extremely loose one, with the hemoglobin. As the
-tissues are more greedy of oxygen than is the hemoglobin, they rob the
-corpuscles of it.
-
-[Illustration: FIG. 46.--Various forms of leucocytes: _a_, Small
-lymphocyte; _b_, large lymphocyte; _c_, polymorphonuclear neutrophile;
-_d_, eosinophile. (Leroy.)]
-
-The _white corpuscles_ or _leucocytes_ are much fewer in number,
-about one to from 300 to 700 of the red, the average number being
-5,000 to 10,000 to the cubic millimeter. They are larger than the red
-corpuscles, colorless, and spherical when at rest. Their structure is
-more definite, there being a definite cell substance or protoplasm
-and one or more nuclei, which vary more or less in shape and size.
-The corpuscles are classed in accordance with these variations in the
-nuclei. They are most numerous during digestion and are probably formed
-in the lymphatic system, constantly passing from the lymphatics to the
-arteries and veins. For they have the function of amœboid movement by
-which they not only wander from place to place in the blood, keeping
-close to the sides of the vessels, but pass through the walls of the
-capillaries, probably between the cells which form their lining, into
-the lymph spaces. This is known as _migration of the white corpuscles_.
-In inflammation they collect in the inflamed area to assist in allaying
-the inflammation by absorbing and carrying off its products. For they
-carry waste products and destroy poisons, acting as scavengers and
-protectors of the body. When they are unsuccessful and the inflammation
-gets the better of them, they become _pus corpuscles_.
-
-Besides the corpuscles there are seen floating in the blood small
-disk-like substances with no special characteristics, the _blood
-plaques_ or _plates_, whose function is unknown.
-
-In _anemia_ the red corpuscles are diminished and the white corpuscles
-and blood plaques increased in number. After excessive bleeding normal
-salt solution is injected, subcutaneously or by rectum, as being nearly
-equivalent to blood serum in composition, and the renewal of the
-solid elements is left to time. The length of time needed for their
-restoration is about a week, except in the case of the hemoglobin,
-which takes longer.
-
-
-
-
-CHAPTER IX.
-
-THE LUNGS AND RESPIRATION.
-
-
-Besides the heart and the great vessels the chest contains the lungs,
-the chief organ of respiration, which, with the rest of the respiratory
-system, will now be treated. The nose and mouth, through which the air
-first enters the body, have already been spoken of. From them the air
-passes through the larynx to the trachea, thence to the bronchi, and so
-to the lungs, where the supply of oxygen for the tissues is taken from
-the air by the hemoglobin of the blood.
-
-=The Larynx.=--The larynx lies in front of the pharynx at the upper
-and fore part of the neck, where it causes a considerable projection,
-known as _Adam’s apple_. It is a triangular box, base up, flattened
-at the back, in front, and at the sides, but becoming cylindrical
-below. Above it opens into the bottom of the pharynx and below into the
-trachea. It is lined with mucous membrane. Its opening at the base of
-the tongue is closed during swallowing by a little door-like valve of
-fibro-cartilage, the _epiglottis_, to prevent the entrance of food.
-
-Nine _cartilages_ go to make up the larynx, of which the most important
-are the thyroid and cricoid cartilages and the epiglottis already
-mentioned. The _thyroid_ is the largest and is open behind, its two
-alæ or wings meeting in an acute angle in front and forming the Adam’s
-apple, always more prominent in the male than in the female. It is
-attached above to the hyoid bone and has cornua or horns on either
-side, top and bottom. The _cricoid_ or ring-like cartilage resembles
-a seal ring with the stone placed posteriorly. It is stronger than
-the thyroid and forms the lower part of the cavity of the larynx.
-Inside and resting on the upper border of the cricoid are the two
-smaller _arytenoid_ or pitcher-like cartilages, pyramidal in shape,
-and surmounting these again the two _cornicula laryngis_. The two
-_cuneiform cartilages_ are in the free borders of the folds of mucous
-membrane which extend from the apex of the arytenoids to the sides of
-the epiglottis. Numerous small muscles serve to bind these various
-cartilages together.
-
-At the angle of the thyroid cartilage in front are attached the
-epiglottis at the top and just below that the _superior_ or _false
-vocal cords_, two folds of mucous membrane enclosing the _superior
-thyro-arytenoid ligaments_. Lower still are found the _inferior_ or
-_true vocal cords_, which are formed by the _inferior thyro-arytenoid
-ligaments_ covered with a thin, tightly fitting mucous membrane. Both
-sets of vocal cords as well as the epiglottis may be seen by means
-of a head and a throat mirror. Between the true vocal cords is a
-narrow triangular interval called the _glottis_. It is by means of the
-vibrations of these cords that sound is produced. The false vocal cords
-cannot produce sound, though they can modify it indirectly. Quality of
-voice, as treble, base, etc., depends upon the size of the larynx and
-the length and elasticity of the vocal cords. Modulation is produced by
-changing the form of the cavity of the mouth and nose. In whispering
-the lips take the place of the vocal cords and produce sound by the
-vibration of their muscular walls.
-
-Instead of tracheotomy _laryngotomy_ is sometimes done in the
-depression between the thyroid and the cricoid, which may be felt on
-the living. _Foreign bodies_ sometimes get into the larynx and have
-to be removed, or the mucous membrane may become inflamed, causing
-_laryngitis_. _Syphilis_ attacks the larynx, and _tuberculosis_ and
-_cancer_ of the larynx occur, these last two being generally fatal.
-_Edema of the glottis_ may also occur.
-
-[Illustration: FIG. 47.--The larynx, trachea and bronchi (After
-Sobotta.)]
-
-=The Trachea.=--The trachea is a membranous tube extending down from
-the larynx for about four and a half inches to the fourth or fifth
-dorsal vertebra, where it divides into the right and left bronchi. It
-is formed of sixteen to twenty imperfect cartilaginous rings, open
-behind, enclosed in a double elastic fibrous membrane, and is lined
-with ciliated mucous membrane. The rings are for strength and in
-the interval at the back where they are wanting there is one layer
-of longitudinal and another of transverse unstriped muscle fibers.
-The passage is kept clear by the action of the cilia, which sweep up
-and out any particles of dust that become entangled in the mucus.
-_Tracheotomy_ is generally done about one inch below the cricoid, just
-above the sternal notch, incision being made through the cartilage.
-
-[Illustration: FIG. 48.--The upper thorax of a child eight years old,
-showing the thyroid and thymus glands. (Sobotta.)]
-
-Extending up on either side of the upper trachea in the neck are the
-two lobes of the _thyroid gland_, the isthmus, which connects the
-lobes, covering the trachea below anteriorly. The function of the gland
-is obscure, but it has an internal secretion of great importance in
-the metabolic processes. Its removal or disease is followed by general
-disturbances of mind and body. The injection of thyroid extract has
-proved effective as treatment. In _goiter_ the gland becomes enlarged.
-The _thymus gland_ lies below the thyroid gland at birth, in front of
-and at the sides of the trachea, and runs down behind the sternum. It
-is largest at the end of the second year, after which it atrophies,
-being almost absent at puberty. It, too, is ductless and its function
-is not well understood.
-
-=The Bronchi.=--The two bronchi, of which the right is the larger and
-shorter, resemble the trachea in structure. As they enter the root
-of the lung they divide, the right into three and the left into two
-branches, one for each lobe, after which they divide and subdivide,
-the bronchioles becoming smaller and smaller and finally ending in the
-_infundibula_, pouch-like places lined with air cells, in which cilia
-keep the air in motion. As they grow smaller the bronchioles gradually
-become wholly membranous.
-
-[Illustration: FIG. 49.--Relation of lungs to other thoracic organs.
-(Ingals.)]
-
-=The Lungs.=--The lungs themselves, two in number, lie each in a serous
-sac or _pleura_, similar in structure to the pericardium and serving
-a like purpose. The outer layer of the pleura is reflected back over
-the thoracic wall and diaphragm. There is no pleural cavity in health
-between the two layers of the pleura, the two surfaces being in close
-contact, though moistened with lymph to prevent friction during
-respiration. In inflammation of the pleuræ or pleurisy, they become
-thickened and roughened and friction results, as is shown by the sounds
-heard through the stethoscope. Friction causes effusion and fluid
-collects. This generally absorbs again, but occasionally the serous
-fluid becomes pustular and _empyema_ results.
-
-In front, between the two pleuræ, which are wholly separate, is the
-_mediastinal space_ or _mediastinum_, which extends from the sternum
-to the spinal column and contains all the thoracic viscera except the
-lungs and heart, that is, the trachea, esophagus, thoracic duct, and
-many large vessels and nerves.
-
-[Illustration: FIG. 50.--Diagrammatic representation of the termination
-of a bronchial tube in a group of infundibula: _B_, Bronchial tube;
-_LB_, bronchiole; _A_, atrium; _I_, infundibulum; _C_, alveoli. (de
-Nancrede.)]
-
-Roughly speaking, the lungs begin at the sterno-clavicular articulation
-above, the apex coming up above the level of the first rib, and extend
-downward together to the fourth cartilage, where the lower margins
-gradually separate, the lowest lung limit being the eleventh rib in
-the vertebral region. Each lung is conical. The apices extend upward
-and the bases, which are broad and concave, rest upon the diaphragm.
-The right lung is divided by a fissure into three lobes, the left into
-two. The root consists of a bronchus and pulmonary arteries, veins,
-lymphatics, and nerves. The tissue itself is composed of an aggregation
-of lobules, each consisting of a terminal bronchiole with its alveoli
-or air cells, blood-vessels, and nerves, a lung in miniature. The blind
-pouches which the air cells surround are called _infundibula_ and are
-separated by delicate membranous septa in which lie the capillaries of
-the pulmonary artery, thus exposing the blood to the air on two sides.
-The lung itself is supplied by the bronchial arteries from the thoracic
-aorta and by branches of the sympathetic and pneumogastric nerves.
-
-At birth the lungs are pinkish-white in color but in later life they
-are marked with slate-colored patches, due to the deposit in the lung
-tissue of particles of dirt breathed in. They are light, spongy, and
-highly elastic, and will float in water, crepitating upon pressure
-owing to the air in the tissue.
-
-At birth, also, the lungs are solid, so that the first air has to
-overcome adhesions between the collapsed walls of the bronchioles and
-air sacs, but after they are thus gradually unfolded, in that they are
-of extensible material and open to the air above, atmospheric pressure
-from within keeps them distended to the full extent of the chest, which
-is air tight. They never collapse afterwards unless puncture of the
-chest wall, as in stabbing, causes collapse, in which case the lung
-shrivels into a small ball.
-
-=Respiration.=--That the organic materials used by the body as food may
-give up their energy they must be broken up, and for this oxygen is
-needed. The supply of oxygen for the purpose is brought to the tissues
-by the blood, which acquires it in the lungs, and the waste product
-of combustion, carbon dioxide, is carried off in the same manner. The
-lungs are, therefore, adapted to take in large quantities of air and
-to keep up a rapid exchange of oxygen and carbon dioxide in the blood.
-This process of supplying oxygen to the tissues and of removing carbon
-dioxide and other waste is ordinarily an involuntary act, though it can
-be regulated temporarily, and is known as respiration or breathing.
-
-There are two periods to respiration: 1. _inspiration_ or the drawing
-in of air, and 2. _expiration_ or the expulsion of air from the lungs,
-the former process being a little shorter than the latter. A pause
-follows each expiration before there is another inspiration. At birth
-the normal rate of respiration is 42, but it grows slower as the child
-grows older, being 26 at the age of five or six, while in the adult it
-averages 17 to 20 times a minute. It is slower during sleep and more
-rapid during physical activity. The average amount of air taken in with
-every inspiration is 30 cubic inches and the minimum air space per
-individual should be 3000 cubic feet per hour.
-
-Breathing is of two kinds, _diaphragmatic_ or _abdominal_ and _chest_
-or _rib_ breathing, the former usually being more pronounced in men
-than in women, probably because of centuries of tight dressing on the
-part of the latter. As a rule, however, both diaphragm and ribs come
-into play; for in inspiration, which is an active movement, the thorax
-becomes enlarged from before backward, laterally, and vertically.
-The ribs are raised by the external intercostals chiefly, though the
-internal intercostals aid somewhat, and swinging out upon the vertebræ,
-widen the chest as well as deepen it. The diaphragm, which is dome-like
-when relaxed, becomes flattened in contraction and so increases the
-size of the chest from above downward. As the chest enlarges, the lungs
-expand, the air in them becomes rarefied, and more air rushes in.
-When the lungs are full they relax and the muscles relax after their
-contraction, so that expiration is a passive movement, due largely to
-the elastic relaxation of lungs and muscles, the air being driven out
-by the lessened capacity of the lungs.
-
-_Difficult Breathing._--In heart and lung troubles, where too little
-oxygen is carried to the tissues, dyspnœa or difficult breathing
-results and may even advance to _asphyxia_, a condition in which no air
-is obtained. In difficult or labored respiration the pectoral muscles
-are used in inspiration and the scaleni, which pass from the vertebræ
-of the neck to the sternum, develop and become powerful. The levatores
-of the ribs may also assist, and even the muscles of the neck and arms
-may help out, while in forced expiration the abdominal muscles are
-called into play. The glottis opens and closes rhythmically as the air
-enters and leaves the lungs, and the nostrils add their mite in the
-struggle for oxygen. Finally there may be scarcely a muscle in the body
-that is not striving to aid the respiration, and general convulsions
-may result, followed by exhaustion and death.
-
-_Air._--In ordinary breathing the lungs are not used to their full
-capacity and the air ordinarily used is known as _tidal air_. In forced
-inspiration the lungs are filled to their fullest extent and the air
-then taken in in excess of the tidal air is known as _complemental
-air_. In like manner, the difference between the air ordinarily
-breathed out and that breathed out in forced expiration is known as
-_supplemental air_. The sum of these three is the _vital capacity_ of
-the lungs, while beyond this there is probably some air that is never
-expelled, the stationary or _residual air_.
-
-_Respiratory Sounds._--The entrance and exit of the air is accompanied
-by respiratory sounds or murmurs, which vary according to their
-position in the trachea, the bronchi, or the bronchioles and are
-modified in diseases of the lungs and bronchi, when they are often
-called _râles_.
-
-_Changes in Air in Lungs._--In passing through the nose and the rest
-of the respiratory tract the air is warmed to body temperature and
-saturated with moisture. After its entrance into the lungs various
-changes take place in it through the mingling of the tidal with the
-residual air. Thus, it gives up about 4 or 5 per cent. of its oxygen
-and acquires some 4 per cent. additional carbon dioxide, while the
-amount of nitrogen remains about the same. By its giving up more oxygen
-than it receives carbon dioxide, its volume is slightly diminished.
-Exhaled air also contains traces of ammonia and certain organic
-matters, generally the results of decomposition, which give a bad odor
-to the breath and are more dangerous in a close room than the mere
-lack of oxygen or the presence of carbon dioxide. Indeed, the amount
-of oxygen may be very much diminished, being reduced even to 5 or 6
-per cent. instead of the normal 21 per cent., without being noticed
-or giving rise to any immediate bad results. Yet the importance of
-ventilation is very evident.
-
-_Effect on Blood._--Respiration causes changes also in the blood,
-the venous blood being purple and the arterial bright red. This
-difference in color is due to the absence or presence of oxygen, which
-is not absorbed or dissolved by the blood but forms a rather unstable
-compound, _oxyhemoglobin_, with the hemoglobin of the blood. As the
-oxygen is removed in the passage of the blood through the body, there
-results in venous blood reduced hemoglobin, which is of a purplish
-color. Upon exposure to the air, however, it absorbs oxygen once more
-and resumes its scarlet color. If carbon monoxide gets into the blood,
-as in cases of gas poisoning, it drives off the oxygen and forms a more
-stable compound with the hemoglobin, whence the difficulty in restoring
-a person so poisoned.
-
-_Nervous Mechanism._--Nervously, respiration is controlled in three
-ways: 1. by the phrenic nerve to the diaphragm; 2. by some fibers
-of the vagus or pneumogastric, and 3. by the respiratory center in
-the bulbous portion of the spinal cord. Injury to the respiratory
-center means the ceasing of respiration and death. Stimulation of the
-respiratory center seems to depend upon the character of the blood. If
-it is well oxygenized, the breathing is slow and quiet; if there is a
-lack of oxygen, dyspnœa results. Probably certain chemical substances
-in the blood, which are ordinarily rapidly burned up by the oxygen but
-which accumulate in its absence, serve to stimulate the respiratory
-center, thus adjusting the effort to get oxygen to the need of it.
-Respiration may be stopped by stimulating the mucous membrane of the
-nose, as with strong ammonia.
-
-_Variations._--Certain variations from the ordinary respiration might
-be mentioned here. A deep inspiration followed by a long expiration is
-known as a _sigh_ and a very deep inspiration through the mouth only
-as a _yawn_. _Hiccough_ results from a sudden inspiratory contraction
-of the diaphragm during which the glottis is suddenly closed. In
-_sobbing_ the inspirations are short and rapid with a prompt closing of
-the glottis between. Both _coughing_ and _sneezing_ consist of a deep
-inspiration followed by complete closure of the glottis and then its
-sudden opening and the forcible expulsion of air. Coughing, however,
-is generally caused by an irritation or obstruction of the larynx or
-trachea and the air is expelled through the mouth, while sneezing is
-caused by irritation of the nasal passages and the air is driven out
-through the nose. _Laughing_ and _crying_ also resemble one another in
-that each is an inspiration followed by a series of short, spasmodic
-expirations, during which the glottis is open and the vocal cords in
-characteristic vibration. They differ, however, in rhythm and in the
-facial expression that accompanies them.
-
-
-
-
-CHAPTER X.
-
-THE ABDOMEN AND THE ORGANS OF DIGESTION AND EXCRETION.
-
-
-=The Abdominal Cavity.=--Below the diaphragm and separated from the
-lowest cavity of the trunk, the pelvis, only by an invisible plane
-drawn through the brim of the true pelvis, is the abdominal cavity,
-which may be said in a general way to contain the organs of digestion
-and the kidneys. It is protected behind by the vertebræ and anteriorly
-by the lower ribs above and below by muscular walls, which make
-possible the complete bending of the body. These muscles are for the
-most part large and very strong and the greater number are inserted,
-in part at least, into a median tendinous line, the _linea alba_,
-which passes from the ensiform cartilage of the sternum above to the
-symphysis pubis below.
-
-=Muscles.=--The _external oblique muscles_ form the outermost layer of
-the abdominal wall. They rise from the external surface of the eight
-lower ribs on either side and are inserted in the anterior half of the
-iliac crest as well as by aponeurosis in the linea alba, where each
-joins its fellow from the opposite side, the fibers running downward
-and inward like the fingers in the trouser’s pocket. Along the lower
-border of the aponeurosis is a broad fold, _Poupart’s ligament_.
-The _internal oblique_ rises on either side from the outer half of
-Poupart’s ligament and the anterior part of the crest of the ilium
-and is inserted into the crest of the os pubis, the cartilages of the
-lower ribs, and the linea alba. Its fibers run at right angles to those
-of the external oblique. These oblique muscles serve to compress the
-viscera, to flex the body, and also assist in expiration.
-
-The deepest of the abdominal muscles is the _transversalis_, which
-rises from the outer third of Poupart’s ligament and the adjoining part
-of the crest of the ilium, from the six lower costal cartilages, and
-by a broad aponeurosis, the _lumbar fascia_, from the lumbar vertebræ.
-It is inserted into the pubic crest and by aponeurosis into the linea
-alba. There is one of these muscles on either side.
-
-[Illustration: FIG. 51.--Muscles of the trunk from before (left side,
-superficial; and right side, deep): 1, Pectoralis major; 2, deltoid;
-3, portion of latissimus dorsi; 4, serratus magnus; 5, subclavius; 6,
-the pectoralis, sternocostal portion; 7, serratus magnus; 12, rectus
-abdominis; 13, internal oblique; 14, external oblique; 15, abdominal
-aponeurosis and tendinous intersections of rectus abdominis; 16, over
-symphysis pubis; 17, linea semilunaris; 18, gluteus medius; 19, tensor
-vaginæ femoris; 20, rectus femoris; 21, sartorius; 22, femoral part of
-iliopsoas; 23, pectineus; 24, adductor longus; 25, gracilis. (Dorland’s
-Dictionary.)]
-
-The _rectus abdominis_ is also really two muscles and extends from the
-symphysis pubis to the cartilages of the fifth, sixth, and seventh
-ribs. At first it passes back of the oblique and transversalis
-muscles, but about a fourth of the way up it passes in front of the
-transversalis and between two layers of the internal oblique, which
-thereafter forms its sheath. Its chief duty is to flex the chest on the
-pelvis, though it also compresses the abdominal viscera.
-
-One other muscle, a small one, is found in front, the _pyramidalis_,
-which rises from the pubic crest and is inserted into the linea alba
-midway to the umbilicus.
-
-At the back the open space over the kidneys, between the lower ribs
-and the os innominatum, is closed in on either side by the _quadratus
-lumborum_, which extends from the three or four lower lumbar vertebræ
-and the adjacent iliac crest to the last rib and the upper four
-lumbar vertebræ. It flexes the trunk laterally or forward according
-as one muscle or both are used, and may aid in either expiration or
-inspiration.
-
-The _nerves_ of the abdominal muscles are chiefly the internal
-intercostals.
-
-=The Peritoneum.=--Lining the abdominal cavity is a serous membrane,
-the peritoneum, which is reflected back over the viscera within in such
-a way as to cover each one wholly or in part. Folds of peritoneum,
-the _omenta_, connect the stomach with the other viscera, the most
-important being the _great omentum_, which has one layer descending
-from the anterior and another from the posterior wall of the stomach.
-The _mesenteries_ are double layers of peritoneum which hold the
-intestines to the vertebræ and posterior wall. Between their folds run
-the blood-vessels.
-
-[Illustration: FIG. 52.--Diagram showing the nine regions of the
-abdominal cavity: 1, Right hypochondriac; 2, epigastric; 3, left
-hypochondriac; 4, right lumbar; 5, umbilical; 6, left lumbar; 7, right
-iliac; 8, hypogastric; 9, left iliac. (Ashton.)]
-
-=Abdominal Regions.=--For convenience of description the abdominal
-cavity has been divided into nine regions by means of two transverse
-parallel lines, the one through the ninth costal cartilages and the
-other just over the iliac crests, and two perpendicular parallel
-lines through the cartilage of the eighth rib and the middle of
-Poupart’s ligament on either side. These nine regions have been named
-as follows: The right and left hypochondriac regions up under the ribs
-with the epigastrium between, the right and left lumbar regions next
-below with the umbilical between, and the right and left inguinal with
-the hypogastric between. Others divide it into quadrants by one line
-drawn across and another down through the umbilicus. The contents of
-the abdomen in full are the stomach, intestines, liver, gall-bladder,
-spleen, pancreas, kidneys, suprarenal capsules, and the great vessels,
-that is, the organs of digestion and excretion. When distended the
-bladder extends up into the abdominal cavity, as does the uterus also
-when enlarged.
-
-=Salivary Digestion.=--Although most of the digestive organs are
-situated in the abdomen, the food enters the body through the mouth,
-where its prehension is a voluntary act. Here digestion also begins and
-from the first the process is a double one, mechanical and chemical,
-mechanical digestion consisting largely of muscular movements by which
-the food is ground up and carried through the digestive tract. Thorough
-mastication or grinding of the food by the teeth is necessary, while
-the tongue assists by moving the food about and by mixing it thoroughly
-with the _saliva_, a viscid fluid composed of water and salts and
-having a slightly alkaline reaction. The saliva is secreted by the
-parotid, sublingual, and submaxillary glands, and serves to soften and
-dissolve the food and by virtue of its unorganized ferment, _ptyalin_,
-to convert starch into sugar. Upon proteins and fats it has practically
-no digestive action. Moderate warmth and an alkaline medium favor its
-action, while extremes of heat or cold or an acid medium hinder it.
-There is little absorption in the mouth, though starch, nicotine, and
-alcohol may be absorbed in small quantities.
-
-=The Pharynx.=--When the food is ready for deglutition or
-swallowing, it is thrust back into the pharynx, a somewhat conical,
-musculo-membranous sac, situated, base upward, behind the nose and
-mouth and behind, but somewhat above, the larynx. The pharynx is about
-four and a half inches long and ends on a level with the cricoid
-cartilage in the esophagus or gullet. It is attached to the vertebræ
-at the back and opens in front into the mouth. The posterior nares,
-the Eustachian tubes, and the larynx also open into it, the last being
-protected by the _epiglottis_, which closes during deglutition to
-prevent food from entering the air passages, just as the soft palate
-is drawn back to prevent regurgitation of food into the nose. There
-are three coats to the pharynx: 1. a mucous coat continuous with that
-of the mouth and ciliated down to the floor of the nares; 2. a fibrous
-coat, and 3. a muscular coat containing among others the constrictor
-muscles which serve to carry the food down to the esophagus. Its
-arteries are branches of the external carotid and its nerves come from
-the spinal accessory and the sympathetic. Occasionally a _foreign
-body_ gets lodged in the pharynx just out of reach of the finger and
-threatens strangulation. _Retropharyngeal abscess_ on the posterior
-wall occurs rarely.
-
-[Illustration: FIG. 53.--Position of the thoracic and abdominal
-organs, front view. (Morrow.)]
-
-=The Esophagus.=--From the pharynx the food passes to the cardiac
-orifice of the stomach, opposite the tenth dorsal vertebra, through
-the esophagus, a muscular tube about nine inches long, which collapses
-when empty, its lumen then appearing as a transverse slit. It, too,
-has three coats: 1. an inner mucous coat; 2. an areolar coat, and 3.
-a muscular coat, the muscles being arranged in two sets, an outer
-longitudinal layer and an inner circular layer. By a series of rhythmic
-contractions, especially of the circular fibers, the food is pushed
-along, though sometimes with liquid food there is no peristaltic action
-of the esophagus, the pharyngeal muscles alone sending it to the
-stomach. At the lower end of the esophagus an especially strong band
-of circular muscle fibers form a sort of sphincter, which prevents the
-regurgitation of food. The whole act of swallowing is a reflex, not a
-voluntary act and is due to irritation set up by the stimulus of the
-foreign body, the food. _Stricture of the esophagus_ is common and
-may be of three kinds: 1. spasmodic, occurring in nervous women; 2.
-fibrous, due to scar tissue, or 3. malignant, due to cancer.
-
-=The Stomach.=--The stomach is a pear-shaped dilatation of the
-alimentary canal, lying under the liver and diaphragm in the epigastrium
-and left hypochondrium and connecting the esophagus with the small
-intestine. It lies largely behind the ribs, but the greater curvature
-is only two fingers’ breadth above the umbilicus and can be manipulated
-through the skin. The _cardiac end_, into which the esophagus enters,
-is the larger and points upward to the left. The lesser and lower end,
-known as the _pylorus_, is at the right and its opening into the small
-intestine is guarded by the _pyloric sphincter_. The lesser curvature
-is concave and on the upper surface; the greater, convex and on the
-under surface. The great omentum is attached to the latter.
-
-In _size_ the stomach varies more or less, that of a man generally
-being larger than that of a woman, but it is usually about ten inches
-long and four or five inches across. It has a capacity of about five
-pints and serves as a storehouse for food.
-
-The stomach has four _coats_: 1. a serous coat derived from the
-peritoneum; 2. a muscular coat of three layers with longitudinal fibers
-continuous with those of the esophagus, circular fibers, and oblique
-fibers; 3. an areolar coat, and 4. a mucous coat, which, when the
-stomach is empty, is thrown into longitudinal folds or _rugæ_, and
-whose surface is covered with glands, the _gastric glands_, for the
-secretion of the digestive fluids.
-
-The _arteries_ come from the celiac axis and the _nerves_ from the
-pneumogastric and the solar plexus.
-
-_Ulcer_ and _cancer_ of the stomach are both rather common. In
-the former there is apt to be _hyper_-acidity and in the latter
-_hypo_-acidity, but the rule does not always hold. In cases of ulcer
-there may be hemorrhage and even perforation. Such hemorrhage can be
-distinguished from hemorrhage from the lungs by its slightly acid odor
-and by the frothy character of hemorrhage from the lungs. There is much
-irritation at the pylorus and where there is irritation there is liable
-to be cancer.
-
-=Gastric Digestion.=--In the stomach the food is churned and thoroughly
-mixed with the gastric juices, and it is also subjected to a propulsive
-movement that drives it on to the intestine. When it comes to the
-stomach it is semi-solid and when it has become fluid or semi-fluid, in
-which state it is known as _chyme_, it is ready to pass on. Before it
-can do so, however, it must overcome the strong pyloric sphincter, and
-this it does by the muscles about the sphincter pushing it constantly
-on until the sphincter gives way. Probably most of the propulsive
-movements take place within a few inches of the pylorus.
-
-The _gastric juice_ is secreted by glands in the wall of the stomach
-and poured out through little tubules which project from the surface.
-It is a thin, almost colorless fluid with a sour taste and odor due
-to the presence of free _hydrochloric acid_, an important element in
-digestion. Probably when the stomach is empty and for some twenty
-minutes after the appearance of food there is no hydrochloric acid
-present and, the food being alkaline, salivary digestion continues.
-Then, called forth by the presence of the food, the hydrochloric acid
-appears and salivary digestion ceases in the acid medium. Little
-digestion of starches or fats takes place, the chief action being
-on proteins, which are converted into soluble peptones. For besides
-hydrochloric acid the gastric juice contains two ferments: 1. _pepsin_,
-which is particularly active in aiding the digestion of proteins, and
-2. _rennin_, which especially affects milk. Neither hydrochloric acid
-nor pepsin seems capable of digesting food alone, but each is essential
-to the other. They are secreted by different types of cells, secretion
-depending upon the nerve supply and upon the presence of food. Gastric
-digestion is favored by minute subdivision of the food and by the
-right proportion of hydrochloric acid, which should be 0.2 per cent.
-Body temperature is also advantageous. Except that proteins are put in
-solution and partly digested, little digestion goes on in the stomach,
-and though the rugæ afford a large absorbing surface, little absorption
-takes place, although more takes place than in the mouth and in time
-most foods, except fats, can be absorbed. The time of digestion varies
-with different foods and in different people, but probably three to
-five hours are necessary. The food leaves the stomach as _chyme_, a
-fluid of about the consistency of pea soup.
-
-_Vomiting_ is more or less the reverse of swallowing and is generally
-preceded by a feeling of _nausea_, which starts up _retching_, a more
-or less involuntary effort of the stomach to throw off its contents.
-To relieve the retching a long breath is taken, followed by a deep
-expiration that opens the cardiac end of the stomach and allows the
-abdominal muscles to force the food out. After much vomiting and
-prolonged retching the pyloric end of the stomach may be affected and
-bile will then appear in the vomitus. _Artificial vomiting_ may be
-produced by irritation of the gastric nerve center in the brain or by
-irritation of the stomach itself.
-
-[Illustration: FIG. 54.--The intestinal canal: 1, Stomach; 2, duodenum;
-3, jejunum; 4, ileum; 5, cecum; 6, vermiform appendix; 7, ascending
-colon; 8, transverse colon; 9, descending colon; 10, sigmoid flexure;
-11, rectum. (Leidy.)]
-
-=Intestinal Canal.=--From the stomach the food passes into the
-intestinal canal, a convoluted tube which extends from the stomach to
-the anus and in which, more particularly in the upper portion, the
-greater part of the digestion and absorption of food takes place. This
-tube, which is about six times the height of its possessor, consists of
-two parts, the small and the large intestines, the first four-fifths,
-or about 25 feet, being small intestine. It occupies the central and
-lower parts of the abdominal cavity and a small portion of the pelvic
-cavity, and is attached to the spine by the mesentery, which, however,
-allows great freedom of motion, so that there is little fixation to the
-loops of the small intestines.
-
-=The Small Intestine.=--The small intestine opens out of the stomach
-and has three divisions: 1. the _duodenum_, which is only about ten to
-twelve inches long; 2. the _jejunum_, so called because it is generally
-empty after death, which is about two-fifths of the remainder and lies
-chiefly in the umbilical region and the left iliac fossa, and 3. the
-_ileum_ or _curved intestine_, the remaining three-fifths, which gets
-its name from its numerous coils and which lies in the middle and the
-right side of the abdomen. There is no direct division between the
-jejunum and the ileum, but the first part of the former and the last
-part of the latter are quite different in character. At its entrance
-into the large intestine the ileum is guarded by the _ileo-cecal valve_.
-
-[Illustration: FIG. 55.--1, Central lacteal; 2, capillary network; 3,
-columnar cells.]
-
-The same _coats_ continue in the small intestine as were found in the
-stomach, but they are here much thinner and the inner coat is shaggy,
-like velvet, with innumerable minute processes called _villi_, which
-greatly increase the absorbing surface. In fact, the great length of
-the intestine as well as the presence of the villi is aimed to provide
-a large surface to absorb the food as it passes, an even greater
-increase of surface being provided by the fact that the intestinal wall
-is thrown into folds, the _valvulæ conniventes_. Each villus is covered
-with a layer of columnar epithelial cells and has within connective
-tissue, in which are found a fine capillary network and open lymph
-spaces from which leads a single lacteal vessel.
-
-Closely connected with the lymphatic vessels are the _solitary glands_,
-small round bodies the size of a small pin’s head. _Peyer’s glands_
-or _patches_ are patches of solitary glands opposite the mesenteric
-attachment and are largest and most numerous in the ileum. In typhoid
-fever they are involved and may become the seat of ulcers. There are
-also the _glands of Lieberkühn_ which secrete the succus entericus.
-
-The _arteries_ of the small intestine, which include the superior
-mesenteric, are from the celiac axis and the _nerves_ are from the
-superior mesenteric plexus of the sympathetic. The _veins_ empty
-chiefly into the portal system.
-
-The _movements_ of the intestine, like those of the esophagus, are
-peristaltic, but the action is complicated by the fact that the tube is
-not straight but in coils.
-
-=Intestinal Digestion.=--The food, which enters the duodenum as chyme,
-there comes in contact with the bile and the pancreatic juice, which
-together but unmixed enter the duodenum from their respective ducts
-by a common orifice. As in the stomach, the digestive juices are
-called forth by the presence of food. The _bile_ is secreted in the
-liver, from which it flows away through the hepatic duct, which joins
-the cystic duct from the gall-bladder to form the common bile duct.
-Through this it flows into the intestine during digestion, but between
-whiles it passes up into the gall-bladder, where it is stored for
-future use and whence it is expelled when needed. When pure it is a
-thick, viscid liquid, varying from a bright red to a greenish-yellow in
-color according to the pigments present, and of an alkaline reaction.
-It consists chiefly of the bile pigments, _biliverdin_, which gives
-the green color, and _bilirubin_, which gives the red color, and of
-bile salts in solution, _cholesterin_, which probably forms the basis
-of many gall stones, is also present. Bile is a disinfectant to the
-bowel and a lubricant for the feces. How much digestive action it has
-is a question, but it affords the necessary alkaline medium for the
-pancreatic juice to act in.
-
-The _pancreatic juice_ is secreted by the pancreas, from which it
-enters the intestine through the pancreatic duct, and is probably the
-most important fluid in the digestive process. It is clear, practically
-colorless, slightly viscid or gelatinous, and quite strongly alkaline
-in reaction, owing to the presence of sodium carbonate. It contains
-three ferments, _amylopsin_ for the digestion of starch, _trypsin_ for
-the digestion of proteins, and _steapsin_ for the digestion of fats.
-By it, as by the saliva, starch is turned into sugar or maltose, in
-which form it is absorbed, while proteins are converted into peptones,
-as they are in the stomach. Since, however, fats are acted on nowhere
-else, the chief function of the pancreatic juice may be considered
-to be the digestion of fats. Having broken through their albuminous
-envelope, it divides them into glycerine and fatty acids and then
-emulsifies them with the assistance of the bile.
-
-The food also comes in contact with the _succus entericus_, a juice
-secreted by the glands of Lieberkühn in the small intestine, whose
-chief action is the conversion of sugar into glucose.
-
-=Absorption.=--As the food is absorbed from the intestine it is
-liquid and entirely digested and is known as _chyle_. Practically all
-absorption takes place from the small intestine, though there is a
-little in the large intestine. It takes place in two ways: 1. through
-the portal vessels and 2. through the _lacteals_, which are the
-lymphatic vessels of the small intestine. Fats are absorbed practically
-entirely by the lacteals. They enter the cells covering the villi,
-travel thence to the lymph spaces, and so into the lacteal or main
-lymph channel, whence they are carried to the thoracic duct and the
-general circulation. From the blood they are absorbed as fat and stored
-up as adipose or fatty tissue, which is found throughout the body in
-connective tissue about the organs. Organic salts and water are for
-the most part absorbed by the portal system, which they reach through
-the capillaries of the villi and through which they go to the liver.
-Starches, in the form of sugar, pass between the cells of the villi
-into the lymph spaces, from which they are taken up by the capillaries.
-On the way to the liver maltose becomes dextrose. Proteins, in the form
-of peptones, pass through the layer of epithelial cells to the lymph
-spaces and then to the capillaries, an active part being taken by the
-cells. By the time they reach the liver the peptones have been changed
-back into proteins. In fact, peptones seem to have some poisonous
-effect upon the blood if they get into it as such.
-
-=The Large Intestine.=--The large intestine differs from the small
-in size and in fixity of position, lying curved in horseshoe shape
-above and around the small intestine. It is five or six feet long,
-large in caliber, and is thrown into crosswise folds. It has the same
-four _coats_ as the small intestine, but the mucous coat is pale and
-smooth, without villi. Its _glands_ are the crypts of Lieberkühn and
-the solitary glands. The _arteries_ are branches of the superior and
-inferior mesenteric and the _nerves_ come from sympathetic plexuses.
-
-The blind sac lying in the right iliac fossa, with which the large
-intestine begins, is called the _cecum_, and into this the ileum
-opens, the ileo-cecal valve preventing regurgitation. Just below the
-ileo-cecal opening is the _vermiform appendix_, a narrow, worm-like
-tube with a blind end, varying in length from one to nine inches, but
-generally about four and one-half inches long, which, so far as is
-known, is functionless as well as dangerous. People have been born
-without an appendix and it has in rare instances grown again after
-operation. Its base is located in the living by _McBurney’s point_, a
-point two inches from the anterior superior spine of the ilium on a
-line drawn from the spine to the umbilicus.
-
-From the cecum the intestine ascends in what is known as the _ascending
-colon_ along the abdominal wall at the right to the under surface of
-the liver, where it turns in the _hepatic flexure_ abruptly across
-the body to the left, passing below the liver, stomach, and spleen
-in the _transverse colon_. In the _splenic flexure_ it turns down
-the left abdominal wall, the _descending colon_ passing to the crest
-of the ilium, where there is another curve, the _sigmoid flexure_,
-leading to the _rectum_, which passes for six or eight inches down
-along the vertebræ, a little to the left, to the _anus_, the external
-opening. This opening is guarded by two _sphincter muscles_, about an
-inch apart, the internal and external sphincters. The coils of the
-small intestine lie below the transverse colon, covered mostly by the
-omentum. The splenic flexure is behind the stomach and below the spleen
-and is slightly higher than the hepatic flexure. The sigmoid flexure
-can be felt in the left inguinal region in thin people.
-
-The fact that the _rectum_ is somewhat to the left is of importance in
-childbirth because if the rectum is packed, it may turn the child’s
-head in the wrong direction.
-
-No digestion goes on in the large intestine, the function being to
-dry by absorbing water. The _movements_ are practically the same
-as those of the small intestine except that they are much less
-active. Fermentation makes the contents acid. By the time food
-reaches the rectum it has been thoroughly digested and has given up
-its nourishment. It is then expelled as waste matter or _feces_.
-_Defecation_ combines the involuntary movements of peristalsis and
-relaxation of the sphincters with the voluntary aid of the abdominal
-muscles. The _ano-spinal reflex_, by which movements of the bowel are
-regulated, is in the lumbar enlargement of the cord.
-
-The _hemorrhoidal veins_ in the lower rectum are connected with both
-the systemic and the portal veins and have no valves so that, as they
-are subjected to much strain, they often become varicose and dilated.
-This condition is called _hemorrhoids_ or _piles_. _Obstruction_ of
-the intestine may be caused by the growth of a constricting band, by
-_intussusception_ or telescoping of the intestine on itself, especially
-at the ileo-cecal valve, or by _volvulus_ or twisting. _Foreign bodies_
-are sometimes found in the appendix but they are not usually the cause
-of appendicitis. _Cancer of the intestine_ is common and its mass
-is apt to cause obstruction with all its attendant symptoms. It may
-necessitate an artificial anus. _Hernia_ or _rupture_ may also occur
-and the hernia may become strangulated.
-
-=Food and Metabolism.=--Anything serves as food that replaces or
-hinders the loss to which the component parts of the body are liable.
-Proteins, carbohydrates, fats, some mineral matters, as salt and
-perhaps iron, and water are needed. The energy once expended by plants
-or animals in the formation of the materials which serve as food is set
-free in the body by the breaking up of these complex substances into
-their original elements, which are then recombined into the complex
-materials needed for the body’s life and growth. This process of
-building up complex materials from simple ones is known as _anabolism_
-and that of breaking them down as _katabolism_, while the two combined
-form the complete cycle of _metabolism_. Those foods have the best
-value that give up their energy most readily. For their combustion,
-heat, oxygen, and water are needed. Hunger indicates that the supply of
-material for katabolism has been used up and that more is needed, just
-as thirst indicates the need of the system for more fluids.
-
-The proteins or nitrogenous foods include all animal foods except fats,
-fish, crustaceans, eggs, milk and its products, certain vegetables,
-especially the lentils, that is, peas and beans, and gelatine. The fats
-include various fats and oils commonly eaten. The carbohydrates are
-the starchy foods, as cereals, sugars, fruits, and most vegetables,
-in fact, practically all except the lentils. Various beverages and
-condiments have no great nutritive value but serve to stimulate the
-appetite and to excite the secretion of the digestive juices. Coffee,
-tea, and alcohol are stimulants.
-
-The different classes of foods have different functions in the
-nourishment of the body. The proteins are primarily tissue-builders
-and also help somewhat in force production. The fats are essentially
-heat-producers, though they too help in force production. The
-carbohydrates are chiefly important as force-producers, though they
-also produce heat and to a certain extent save protein oxidation. Fat
-is formed by all three but only in small amount by proteins. So no one
-food can form the whole diet but there must be variety. Carbohydrates
-and fats are not sufficient for life, some protein is necessary.
-Carbohydrates are more digestible than fats but have less potential
-energy. Gelatine saves waste of nitrogen, though it does not increase
-the supply. Water and salts are not nutritive but they aid the body
-processes, the water helping to dilute and dissolve substances for
-digestion.
-
-The end-product of the consumption of protein is _urea_, which is
-eliminated by the kidneys. Just where it is formed is unknown, but many
-think in the liver. A trifling amount of urea is also eliminated in
-the sweat and in the breath as well as in the feces. Proteins increase
-nitrogenous metabolism and also the metabolism of other foods, but the
-amount of nitrogen eliminated is just equal to that taken in. Probably
-some comes from the tissues themselves and not from the food. The
-oxidation of carbohydrates and fats is measured by the amount of carbon
-excreted. At first as much is given off as is taken in, but after a
-while the carbohydrate is stored up as glycogen in the liver and the
-fats are stored as fat.
-
-The amount of food needed varies with the person’s size and occupation,
-less being needed for a child than for an adult and more for a
-hard-working man than for one who is doing less work. In general, 100
-to 130 grams of protein, 40 to 80 grams of fat, 450 to 550 grams of
-carbohydrates, 30 grams of salts, and 28,000 grams of water is a fair
-amount.
-
-Foods are cooked to make them more digestible and to develop their
-flavor, so that they will taste better. Cooking also kills germs and
-parasites that might be harmful. Meats should be cooked rapidly on
-the outside to coagulate the surface albumen and keep in the juices.
-The heat, besides coagulating the albumen, turns the tough parts to
-gelatine. In cereals the tough envelope of cellulose is broken up
-and in vegetables the tough fibrous parts are softened and made more
-digestible.
-
-=The Liver.=--Below the diaphragm on the right and extending across
-above the stomach, resting in a way upon the transverse colon and the
-small intestine, is the liver, the largest gland in the body. It is
-dark reddish-brown in color and is larger in proportion in the child
-than in the adult. The upper surface is convex and lies in contact
-with the diaphragm, while the lower surface is concave to fit over the
-organs beneath. With a full breath it comes downward and forward, with
-the edge against the abdominal wall, and can be easily felt. Numerous
-strong ligaments, including the suspensory ligament from the diaphragm,
-hold it in place, and it is more firmly fixed than any other of the
-abdominal organs, probably on account of its large size. It is divided
-by fissures into five _lobes_, of which the most important are the
-right and left, the right one being the largest and containing the
-gall-bladder in one of its fissures.
-
-[Illustration: FIG. 56.--The liver, seen from below. 1, Inferior vena
-cava; 2, gall-bladder. (Morrow.)]
-
-The liver tissue contains a large number of _cells_ collected into
-_lobules_, in the center of each of which is a blood-vessel, the
-_intralobular vein_, from which a network of capillaries extends to
-the edge of the lobule, there being a capillary on either side of each
-row of cells. Between the cells also are the _intercellular biliary
-passages_, roots of the bile ducts which exist in the connective tissue
-between the lobules and which join to form two main ducts, one from
-the right and the other from the left lobe. By the union of these two
-ducts the _hepatic duct_ is formed, which, after a course of one or two
-inches, joins the cystic duct from the gall-bladder to form the _ductus
-communis_ or _common bile duct_.
-
-The liver has a double _blood supply_, the _hepatic artery_ from the
-celiac axis bringing nourishment to the connective tissue and the walls
-of the blood-vessels, while the capillaries between the cells come from
-the _portal vein_, which, being formed by the junction of the superior
-and inferior mesenteric, the splenic and the gastric veins, contains
-the proteins and carbohydrates absorbed during digestion. After its
-passage through the liver this blood from the portal vein is collected
-once more into the hepatic veins, which convey it to the inferior vena
-cava. During its passage, however, various changes take place, for the
-liver plays an important part in the metabolic processes of the body.
-
-The liver has two principal _functions_, the secreting of bile and
-the storing up of glycogen. The secretion of _bile_, which is a very
-important aid to digestion, is probably a reflex act, the presence of
-peptones in the portal blood after meals acting as a stimulant to the
-liver cells. For food at once increases the secretion of bile, which
-is poured from the cells into the small bile ducts and finally passes
-into the hepatic duct and so to the gall-bladder, where it is stored
-until needed. Although the flow from the liver is constant, the amount
-secreted reaches its maximum when the food gets down into the small
-intestine, that is, four or five hours after eating, there being a
-lull before that. Apart from the process of secretion, the manufacture
-of the bile pigments, _bilirubin_ and _biliverdin_, which are made from
-the hemoglobin of the blood, seems to require some special action on
-the part of the liver cells.
-
-The _glycogen_, which is manufactured and stored in the liver cells,
-is a clear hyaline substance, akin to starch and capable of being
-converted into sugar by the starch ferment. Probably there is some
-such ferment in the blood which converts the glycogen into sugar as
-soon as it passes from the liver into the blood, though what it is,
-is not known. Neither is it known just how glycogen is formed, but
-it is manufactured chiefly after a mixed meal in which carbohydrates
-predominate, proteins having little and fats no effect upon its
-formation. It is undoubtedly formed from the sugar in the portal blood
-and the process requires some work on the part of the liver cell
-itself. Probably there is always some sugar in the circulating blood
-which, as it is used up, must be made good. If there it not enough in
-the diet, the liver supplies the deficiency from its store of glycogen.
-
-Glycogen is found also in the muscles, in the placenta as food for the
-fetus, in leucocytes, and to a slight extent in cartilage. In fact, it
-is the form in which carbohydrate material is supplied to the tissues
-as needed. Normally, much of the sugar is used up by the blood and
-its cells in metabolism, giving rise to heat and energy. In muscles
-glycogen is probably digested as lactic acid, as before action muscle
-is neutral or slightly alkaline and after action acid.
-
-When the liver is deranged and allows the glycogen to pass out into the
-blood too freely, or when the glycogen is not held as such but turned
-to sugar and passed out in large quantities, _sugar in the urine_ or
-_diabetes mellitus_ results.
-
-Besides its secreting function the liver has an _eliminative function_
-and plays an important part in purifying the blood, removing from
-it many poisonous and narcotic substances. It is thought by some,
-though it has not been proved, that _urea_, the end-product of protein
-metabolism, which is brought by the blood to the kidneys and there
-excreted, is formed in the liver. At any rate, urea is formed not only
-from the nitrogenous food eaten but from the metabolism of protein
-substances in the tissues, being purely a waste product, from which
-the nutritious substances have been absorbed. The amount thrown off is
-an accurate gauge of the amount of protein metabolism going on. The
-process of its manufacture is doubtless very complex.
-
-_Ptosis_ or _dropping_ of the liver sometimes occurs and is due to the
-stretching of the ligaments. _Rupture_ is common, generally as the
-result of a fall from a height, on account of its size and friability.
-The liver is also subject to many diseases. _Cirrhosis_ occurs in
-people who drink a good deal and in its later stages is accompanied by
-_ascites_, an accumulation of fluid in the abdominal cavity. When there
-is a general accumulation of fluid throughout the body it is known as
-_anasarca_. _Syphilis_ causes enlargement of the liver. _Abscesses_
-occur, perhaps oftener in the tropics than farther north, and may break
-into the lungs, stomach, or intestine.
-
-=The Gall-bladder.=--The gall-bladder, which is simply a reservoir
-for the bile, is a pear-shaped organ three inches long and one inch
-broad. It lies in a fossa on the under side of the liver, with the
-large end or fundus touching the abdominal wall just below the ninth
-costal cartilage. Here it can be felt as a small mass in empyema of
-the gall-bladder. Normally it holds a little over one ounce, but with
-occlusion it may become stretched. Its duct is the _cystic duct_, which
-joins the hepatic duct in the common bile duct, but bile only passes
-up into the gall-bladder when the opening into the duodenum is closed,
-that is, between meals.
-
-If one of the bile ducts is stopped up by a stone or cancer or for
-any other cause, the bile backs up in the liver, the pigments are
-absorbed into the circulation, and _jaundice_ results. In this
-condition operation is dangerous, as the time of coagulation of the
-blood, normally five minutes or less, is much delayed. _Gall stones_,
-formed largely of bile pigments and cholesterin, sometimes collect in
-the gall-bladder, where they cause irritation and may give rise to
-_empyema_ of the gall-bladder. The stones vary in size from a pea to a
-hen’s egg and when small may be very numerous.
-
-[Illustration: FIG. 57.--The pancreas, spleen, gall-bladder, etc.,
-showing their relations. (After Sobotta.)]
-
-=The Pancreas.=--Another accessory organ of digestion is the pancreas,
-the _abdominal salivary gland_, as it is sometimes called on account
-of its close resemblance to the parotid gland. This is a grayish-white
-racemose gland, six and a half inches long by one and a half inches
-wide and one inch thick, lying behind the stomach on a level with the
-first and second lumbar vertebræ and shaped like a pistol with its
-handle toward the right. In an emaciated person it can be felt. The
-_pancreatic duct_ runs the whole length of the gland from left to right
-and conveys the _pancreatic juice_ from various little glands in the
-substance of the organ to the duodenum, into which it empties along
-with the common bile duct by a common orifice. The _arteries_ are from
-the celiac axis and superior mesenteric, the _veins_ belong to the
-portal system, and the _nerves_ come from the solar plexus.
-
-Surgically the pancreas is of no special importance, though _acute
-pancreatitis_ does occasionally occur and is a very serious condition
-and one hard to diagnose.
-
-=The Spleen.=--The largest and most important of the ductless glands
-is the spleen, an oblong, flattened organ lying deep in the left
-hypochondriac region between the stomach and diaphragm above the
-descending colon, and corresponding to the ninth, tenth, and eleventh
-ribs. It is soft, brittle, and very vascular. Its _artery_ is a branch
-of the celiac axis and the _vein_ belongs to the portal system. Its
-_nerves_ are the pneumogastric and branches from the solar plexus. The
-_function_ is not well understood but probably it is connected with or
-related to the vascular system in some way. Perhaps it manufactures
-blood corpuscles.
-
-The spleen varies more in size than any other organ. Normally it cannot
-be felt, but in typhoid it usually can. It is generally atrophied in
-old age and hypertrophied in almost all acute infectious diseases,
-especially in typhoid fever and malaria. In leukemia it is often
-greatly enlarged. Sometimes in violent falls it is _ruptured_ and there
-is considerable hemorrhage.
-
-=The Suprarenal Capsules.=--The other ductless glands, the suprarenal
-capsules, yellowish triangular bodies, are situated just above and
-in front of the kidneys. Their function is important but not well
-understood. Death, accompanied by great muscular weakness, follows
-the removal of both, and when they are diseased, similar weakness is
-observed and the skin becomes bronzed. Injection of the extract of
-the suprarenals stimulates the muscular system. So probably they
-secrete into the blood minute quantities of a substance or substances
-beneficial to the body, especially to the muscular system.
-
-[Illustration: FIG. 58.--Diagram of the relation of kidney to viscera,
-spine, and surface points. (American Text-Book of Surgery.)]
-
-=The Kidneys.=--The two kidneys lie on either side of the vertebræ at
-the back of the abdominal cavity and behind the peritoneum, between the
-last dorsal and the third lumbar vertebræ, their inner edge being about
-one inch from the spinous processes. They are bean-shaped, four inches
-long, two inches wide, and one inch thick, and are embedded in a mass
-of fat and loose areolar tissue. They can be felt only when misplaced
-or when enlarged, as by tuberculosis or malignant disease.
-
-The whole kidney is enveloped in a fibrous _capsule_ which normally
-may be peeled off but which in some diseases becomes adherent. On the
-internal border is a _fissure_ or _hilum_, through which pass the
-blood-vessels and the ureter. Upon entering, the ureter dilates into
-a sac, the _pelvis of the kidney_, into which project the _Malpighian
-pyramids_ of the _medullary substance_, a substance made up of the
-straight uriniferous tubules and blood-vessels. Outside the medullary
-substance and just under the capsule is the _cortex_, containing the
-_Malpighian bodies_, blood-vessels, and the _convoluted tubules_ or
-_loops of Henle_. Each Malpighian body contains within a capsule a
-plexus of capillaries, the _glomerulus_, with an afferent arteriole and
-an efferent vein. The _renal artery_ is a branch of the aorta and the
-_nerves_ are from the solar plexus.
-
-[Illustration: FIG. 59.--A longitudinal section of the kidney. (Leroy.)
-_a_, Renal artery; _c_, cortex; _m_, medulla; _u_, ureter.]
-
-[Illustration: FIG. 60.--A Malpighian body or corpuscle. (Leidy.)
-_a_, Afferent artery; _e_, efferent vessel; _c_, capillaries; _k_,
-commencement of uriniferous tubule; _h_, uriniferous tubule.]
-
-_The Urine._--As the blood passes through the glomeruli, the urine is
-filtered off as it were, probably by a process of transudation rather
-than simple filtration. The cells lining the tubules also play an
-important part in its formation, not by secreting new substances but
-by taking up those brought by the blood and discharging them into the
-convoluted tubules, from which the urine passes through the straight
-tubules of the medulla to the pelvis, to be carried thence by the
-ureter. The process of the formation of the urine, therefore, is not
-purely a process of secretion but requires some action on the part of
-the kidney, though no new substances are secreted in the kidney.
-
-The passage of the urine down through the ureters is assisted by a kind
-of peristaltic action in the walls of the ureters and it is expelled
-from the body by the act of _micturition_, which is mostly voluntary,
-though a certain amount of nervous mechanism controls it. The seat of
-this nervous mechanism is in the lumbar enlargement of the spinal cord.
-In some nervous conditions, especially where there is injury to the
-spinal cord, there is _involuntary micturition_.
-
-The urine is a watery solution containing many waste products,
-especially urea. It is generally amber in color, varying in shade with
-circumstances, with an aromatic, characteristic odor when fresh. It
-is acid in reaction and has a specific gravity of about 1020, though
-this too varies with circumstances. Besides water, which is its chief
-constituent, it contains urea, uric acid, organic acids, urates,
-inorganic salts, including sodium chloride and phosphates of calcium
-and magnesium, a certain amount of ammonia, and certain pigments. Its
-acidity is due to acid sodium phosphate in solution but varies with the
-food, and in disease the urine may become alkaline when passed. After
-standing a few hours in a warm place it decomposes and becomes alkaline.
-
-The quantity, which is normally three pints or fifteen hundred cubic
-centimeters in twenty-four hours, varies with the amount of fluid
-drunk, the amount of perspiration, etc. The amount secreted depends
-chiefly, however, upon the flow of the blood through the kidneys; the
-greater the flow of blood, the larger the amount of urine formed; and
-the blood flow is determined by blood pressure and by vasomotor action.
-Secretion also seems to be increased by the presence of urea, which
-apparently serves as a stimulant to the kidney cells.
-
-The excretion of waste materials takes place by three main channels,
-the lungs, skin, and kidneys, and the materials are of four kinds,
-_urea_, _carbon dioxide_, _salts_, and _water_. The lungs carry off
-carbon dioxide and water chiefly, the skin these and inorganic salts,
-while the kidneys eliminate practically all the urea as well as
-inorganic salts and water. When the kidneys are not working the skin
-carries off much urea. In fact, a close relationship exists between the
-kidneys and the skin in the matter of excretion. Thus, with increased
-perspiration in warm weather comes decreased urine, while in cold
-weather the blood is sent in and the urine increased in amount.
-
-To incite action of the kidneys drugs known as _diuretics_ may be used.
-These act in two ways, by stimulating the kidney cells directly and by
-acting on the general circulation or nervous system. Any emotional or
-nervous excitement increases the flow of urine.
-
-There are certain abnormal constituents of urine, of which the two most
-important are _albumen_ and _sugar_. The former is found only when
-there is some disturbance of the kidneys, ureters, or bladder, and its
-presence usually denotes some change in the cells lining the urinary
-tract. It may occur in congestion of the kidney as well as in disease.
-Sugar is found only in _diabetes_, the amount varying with the severity
-of the disease. In _jaundice_ certain bile pigments are present in the
-urine, giving it a dark brown color and to the foam a greenish-yellow
-color. Even normal urine has some sediment upon standing, consisting
-of cells from the urinary tract and mucus. In very acid urine after
-standing a heavy sediment, whitish or pinkish, _i.e._, brick dust, in
-color, is thrown down. It does not necessarily denote disease, but
-shows the urine is acid and concentrated. In _alkaline urine_ there is
-a sediment due to phosphates.
-
-_Rupture_ of the kidney occurs but is not so serious as rupture of
-the liver or spleen because the kidney is situated outside of the
-peritoneum. It necessitates the removal of the kidney, however, and
-when for any reason one kidney is removed the other increases in size
-and does double work to compensate for the loss. Removal of both
-kidneys means death. Sometimes the kidney becomes loose and moves
-about, a condition known as _floating kidney_. _Perinephritic abscess_
-is abscess in the loose fatty tissue about the kidney.
-
-[Illustration: FIG. 61.--The urinary organs viewed from behind.]
-
-=The Ureters=, one for each kidney, are tubes the size of a goose
-quill and about fourteen inches long, extending from the hilum of the
-kidney to the base of the bladder. They have three _coats_, an internal
-mucous, a muscular, and an external fibrous coat, this last being
-continuous with the cortex of the kidney and the fibrous tissue of the
-bladder. In the female the ureters may be felt through the wall of the
-vagina as they come into the bladder. In tubercular disease of one
-kidney the ureter becomes inflamed and enlarged and through the vagina
-feels almost like a lead pencil, a sure diagnostic sign.
-
-=The Bladder and Urethra.=--In their course to the bladder the ureters
-pass from the abdominal into the pelvic cavity, but before describing
-the pelvis itself it will be well to complete the account of the
-urinary organs by considering the bladder and urethra. The _bladder_ is
-the reservoir for the urine and has muscular walls lined with mucous
-membrane. A peritoneal coat covers the upper surface and is reflected
-to the walls of the abdomen and pelvis. It is situated back of the os
-pubis, the front bone of the pelvis, with its base or fundus directed
-downward and backward. Normally it is in the pelvis, but when much
-distended it mounds up into the abdominal cavity, where it can be
-felt in front as a tumor. It rests on the rectum in the male and on
-the cervix in the female and is held in place by numerous ligaments.
-When empty it may be Y-shaped, but it becomes oval when distended. Its
-capacity is about one pint.
-
-The lower abdominal wall and the anterior wall of the bladder may be
-wanting congenitally. In paralysis of the sphincter at the neck of the
-bladder distention results. _Stones_ may be found in the bladder.
-
-From the neck of the bladder the urine passes out of the body through
-the _urethra_. This in the male passes down through the penis and is
-about ten inches long. Except when urine is passing it is a transverse
-slit with the upper and under surfaces in contact, while at the end of
-the penis the slit of the meatus urinarius is vertical. When the penis
-is flaccid, the urethra describes a sharp curve before its entrance
-into the bladder, but it becomes approximately straight when the penis
-is raised at right angles to the body--an important point to remember
-in catheterization.
-
-In the female the urethra is straight and much shorter, being only
-about one and a half inches long. The _meatus urinarius_ is in the
-anterior vaginal wall about one inch behind the clitoris.
-
-Sometimes the urethra is _ruptured_ in a fall. _Stricture_ of the
-urethra occurs sometimes after gonorrhoea, owing to the formation of
-scar tissue following ulcer.
-
-
-
-
-CHAPTER XI.
-
-THE PELVIS AND THE GENITAL ORGANS.
-
-
-=The Pelvis.=--Before taking up the pelvic organs, the pelvis itself
-should be described. The name pelvis has been given to the bony ring
-which is interposed between the spine and the femurs on account of its
-resemblance to a basin. At the back of this basin or pelvis are the
-_sacrum_ and _coccyx_, already described in connection with the back,
-and at the sides and meeting in the median line in front are the two
-_ossa innominata_ or _nameless bones_, so called on account of their
-peculiar and indescribable shape. At birth each os innominatum is made
-up of three bones, the _ilium_, _ischium_, and _pubes_, but about the
-age of puberty the three become welded into one. At their point of
-junction is the cavity of the acetabulum for articulation with the head
-of the femur or thigh bone.
-
-[Illustration: FIG. 62.--Front view of the pelvis, with its ligaments.
-(Dorland.) _a_, Anterior sacro-iliac ligament; _b_, iliofemoral
-ligament; _c_, obturator membrane; _d_, symphysis pubis; _e_,
-sacro-sciatic ligament.]
-
-[Illustration: FIG. 63.--The right innominate bone. (After Toldt.)]
-
-The upper, expanded portion of the os innominatum is the _ilium_,
-whose upper border is known as the _crest_ and which has two _spinous
-processes_ front and back, a superior and an inferior, the superior
-spine being in each case the larger. These spines, especially the
-anterior superior spines, and the crest give attachment to many
-muscles, and to the outer surface of the bone the gluteal muscles are
-attached. The anterior superior spine is also important in making
-measurements to ascertain whether both legs are of equal length.
-
-Below the ilium posteriorly is the _body of the ischium_, which has on
-its lower edge a tuberosity, the prominent bone on which one sits. Near
-the upper edge is the _spine_ of the _ischium_, between which and the
-posterior inferior spine of the ilium is the greater _sacro-sciatic
-notch_ for the passage of vessels and nerves, including the sciatic
-nerves. From the tuberosity the ramus extends forward below the
-_obturator foramen_, a large opening between the ischium and the pubes,
-also for the passage of vessels and nerves, to meet the pubes, the last
-and smallest of the three bones which go to make up the os innominatum.
-
-The anterior surface of each _pubes_ presents a crest, ending
-externally in a spine, and the two pubic bones join in front in the
-_symphysis pubis_. The bone gets its name from the growth of pubic
-hairs over this region at puberty.
-
-[Illustration: FIG. 64.--Diameters of the pelvis: _d_, antero-posterior;
-_o b_, oblique; _t r_, transverse. (de Nancrede.)]
-
-Anteriorly the ossa innominata support the external organs of
-generation, while within are the internal organs of generation. On the
-inner surface of the ilium, slightly above the level of the acetabulum,
-is the _ileo-pectineal line_, above which lie the _iliac fossæ_. A
-plane drawn through the prominence of the sacrum, the ileo-pectineal
-lines, and the upper margin of the symphysis pubis serves to divide
-the upper or false pelvis from the lower or true pelvis. The _false
-pelvis_, which is the larger, serves to support the intestines and
-to take part of the weight from the abdominal walls, while the _true
-pelvis_, being more surrounded by bone and so capable of affording
-more protection, guards the internal organs of generation. The lower
-circumference of the pelvis is known as the _outlet_. In the female the
-bones are lighter, the sacrum less curved, and the diameters greater
-than in the male.
-
-On the whole, the pelvic bones are well covered in with muscles. The
-anterior superior spine, however, is easily felt in front and the whole
-crest can be felt back to the posterior superior spine. The tuberosity
-of the ischium also can be felt, especially when the thigh is flexed,
-for it is largely uncovered of muscles. The spine of the os pubis can
-always be felt, on a level with the great trochanter, and the relation
-of its position to that of a hernia shows whether the rupture is above
-or below Poupart’s ligament, that is, whether it is inguinal or femoral.
-
-Occasionally there is lack of development of the pubic bones for two
-or three inches and the bladder is exposed. _Fracture_ of the pelvis
-may occur, perhaps with injury to the viscera. The acetabulum may
-be fractured or the sacrum broken, with injury to the sacral plexus
-of nerves, causing paralysis of the lower extremities and of the
-sphincters, with resultant involuntary passage of urine and feces, and
-in childbirth the coccyx is often broken. In _rickets_ there may be
-great deformity of the pelvis, causing trouble in childbirth later in
-life. _Osteomalacia_ is a disease of adults, in which the bones are
-soft and the weight pushes the promontory of the sacrum forward and
-approximates the sides of the pelvis.
-
-=The Male Generative Organs.=--The male generative organs consist of
-the prostate gland, testes, and penis.
-
-The _prostate gland_ is shaped like a small horse-chestnut and is
-composed of numerous glands from which come a dozen or more excretory
-ducts. It surrounds the neck of the bladder and the beginning of the
-urethra and is next to the rectum, through which an examination may be
-made to determine its size. For it often enlarges in elderly men, the
-frequent passage of urine in small amounts being a symptom of enlarged
-prostate.
-
-The _procreating glands_, which secrete the spermatozoa or semen, are
-two in number, the _testes_ or _testicles_, and are homologous to the
-ovaries in the female. They are ovoid in form and are suspended by the
-_spermatic cords_ in a sac, the _scrotum_, back of the penis. During
-early fetal life they are in the back of the abdomen near the kidneys,
-but before birth they descend along the inguinal canals into the
-scrotum. The excretory duct of the testis is called the _vas deferens_.
-It passes up by the spermatic cord through the inguinal canal into
-the pelvis to the base of the bladder and at the base of the prostate
-joins the duct of the vesicula seminalis to form the _ejaculatory
-duct_. The two _vesiculæ seminales_ are small receptacles for the semen
-lying in contact with the base of the bladder and secrete a fluid with
-which they dilute the semen. The ejaculatory duct terminates near
-the prostate in the urethra by a slit-like orifice on each side, the
-spermatozoa being finally excreted through the urethra.
-
-The _penis_ is the external organ of generation in the male and is
-attached to the pubes and the anterior part of the ischium. It is
-composed of erectile tissue and encloses the urethra, the _meatus
-urinarius_ appearing at its end as a vertical slit. Toward the end the
-skin of the penis is loose and is prolonged forward in what is known
-as the _prepuce_ or _foreskin_. It is this that is clipped away in
-circumcision.
-
-=The Female Generative Organs.=--The female generative organs include
-the ovaries, Fallopian tubes, uterus, vagina, and the external
-genitalia or vulva.
-
-The _ovaries_, which are homologous to the testes in the male, are
-two flattened oval bodies, grayish pink in color, suspended from the
-lateral or broad ligaments which fasten the uterus to the walls of the
-pelvis. They are one and a quarter inches long, three-quarters of an
-inch wide, and half an inch thick and are attached at the upper end to
-one of the fimbriæ of the Fallopian tubes. They consist of numerous
-_Graafian follicles_ embedded in a fibrous stroma, each follicle
-containing an _ovum_ about ¹/₁₂₅ inch in diameter and just visible to
-the naked eye. When a follicle ruptures and discharges an ovum, an
-irregular yellow spot, the _corpus luteum_, appears at the point of
-rupture. After ordinary menstruation it is known as the _false corpus
-luteum_ and after conception as the _true_ one, this one being larger
-and lasting longer.
-
-[Illustration: FIG. 65.--View of the pelvis and its organs. (Savage.)
-_B_, Bladder; _U_, uterus (drawn down by loop _e_); _F_, Fallopian
-tubes; _O_, ovaries; _L_, round ligaments; _g_, ureter; _a_, ovarian
-vessels, often prominent under their peritoneal covering; _R_, rectum;
-_V_, vertebra.]
-
-The _Fallopian tubes_ are the oviducts and convey the ova from the
-ovaries to the uterus. They are four inches long and lie between the
-layers of the broad ligaments, opening into the uterus by an orifice
-the size of a bristle, while the end next to the ovary spreads
-out trumpet-like and is edged with _fimbriæ_ as with a fringe, the
-fimbriated extremity. There are three _coats_: a serous coat which is
-continuous with the peritoneum, a muscular coat, and, within, a mucous
-coat covered with cilia, continuous with the mucous membrane of the
-uterus. One fimbria is attached to the ovary and as the ovum is given
-off it finds its way into the tube and thence to the uterus.
-
-[Illustration: FIG. 66.--Sagittal section of the female pelvis.
-(Dickinson.)]
-
-The _uterus_ is a pear-shaped organ, about three inches long, two
-inches broad above, and one inch thick, situated in the pelvic cavity
-between the rectum and the bladder. The wide part or _fundus_ is
-above and the narrow neck or _cervix_ below, lying partly within the
-vagina. The whole is held in place by ligaments. These include the
-_broad ligaments_, which extend from the sides of the uterus to the
-lateral walls of the pelvis, and the _round ligaments_, two muscular
-cords, about four inches long, which pass out through the abdominal
-ring into the inguinal canal and so to the mons veneris and labia, thus
-corresponding to the spermatic cords in the male. The cavity of the
-body of the uterus is small and flattened and opens into the cervix by
-the _internal os uteri_, the _external os_ being at the opening of the
-cervix into the vagina. There are three _coats_: a serous coat derived
-from the peritoneum, a muscular coat of unstriped fibers which forms
-the bulk of the whole organ, and a mucous coat covered with ciliated
-epithelium.
-
-The uterus is always enlarged during menstruation and is enormously
-enlarged in pregnancy. It receives the fecundated ovum, retains and
-supports it during the development of the fetus, and is the chief agent
-of expulsion. In _tubal_ or _extra-uterine pregnancy_ the ovum becomes
-attached in the tube instead of in the uterus, and develops there,
-rupturing the tube and causing serious hemorrhage.
-
-The passage from the cervix out of the body is the _vagina_, a
-membranous canal, curved upward and backward to conform to the axis of
-the pelvis, and attached above to the cervix. Ordinarily the sides are
-in contact.
-
-The _arteries_ of the internal organs of generation are the uterine
-from the internal iliac and the ovarian from the aorta in the female,
-the pudic branches of the internal iliac and the spermatic from the
-aorta in the male. The _nerves_ are largely from the sympathetic system.
-
-_Abscess formation_ occurs frequently in the tubes and _gonorrheal
-infection_ may spread up the vagina and through the uterus to the
-tubes, and even to the abdominal cavity itself. The tubes may also be
-_tubercular_.
-
-_Salpingectomy_ or removal of the tubes is the commonest operation
-after that for appendicitis. _Cancer_ of the uterus may necessitate
-_panhysterectomy_ or removal of the uterus and all its appendages.
-
-[Illustration: FIG. 67.--Virginal vulva. (Modified from Tarnier.) 1,
-labia majora; 2, fourchette; 3, labia minora; 4, glans clitoridis; 5,
-meatus urinarius; 6, vestibule; 7, entrance to the vagina; 8, hymen;
-9, orifice of Bartholin’s gland; 10, anterior commissure of labia
-majora; 11, anus; 12, blind recess; 13, fossa navicularis; 14, body of
-clitoris.]
-
-The _external genitalia_ in the female, as in the male, are situated
-over the pubic arch. They are known as the _vulva_ and include the
-mons Veneris, the labia majora and minora, the vaginal orifice, the
-clitoris, and the meatus urinarius.
-
-The _mons Veneris_ is a rounded eminence composed of fatty tissue,
-which surmounts the pubic bones and is covered with hair at puberty.
-From it two prominent longitudinal folds of skin, covered with hair
-on the outside, the _labia majora_, extend backward, forming the
-lateral boundaries of the vulva. Within these labia again are two
-thin cutaneous folds, the _labia minora_ or _nymphæ_, which run back
-from the clitoris for about one and a half inches and enclose the
-_vaginal orifice_. The _clitoris_ corresponds to the penis and is
-just above the upper part of the labia minora. Between it and the
-vagina is the _meatus urinarius_. The orifice of the vagina is partly
-closed in the virgin by the _hymen_, a thin fold of mucous membrane,
-which occasionally closes it completely, _imperforate hymen_. The
-_fourchette_ is a small transverse fold of skin at the junction of the
-labia minora posteriorly. Between the vagina and the rectum is the
-_perineal body_, a somewhat triangular structure made up of many small
-muscles. Its surface is known as the _perineum_. It is frequently torn
-wholly or in part during childbirth and has to be sewed up.
-
-
-
-
-CHAPTER XII.
-
-THE UPPER EXTREMITIES.
-
-
-The upper extremities include the shoulders, arms, forearms, wrists,
-and hands and contain each thirty-two bones. The bones of the two
-shoulders taken together are called the _shoulder girdle_ and consist
-of the two clavicles or collar bones and the two scapulæ or shoulder
-blades, which together make an almost complete girdle of the shoulders.
-
-The =clavicle= is a long slender bone extending almost horizontally
-from the sternum to the scapula and can be felt for its whole length
-in the living. For the inner two-thirds it is convex anteriorly,
-for the outer third concave. In woman it is generally less curved,
-smoother, and more slender than in man, and as bone is rough when the
-muscles attached are powerful, the right clavicle, being used more, is
-generally rougher and thicker than the left. Among the muscles attached
-are the large neck muscle, the _sterno-cleido-mastoid_, whose tendons
-form the _presternal notch_, the _trapezius_, the _pectoralis major_,
-and the _deltoid_.
-
-Being slender and superficial the clavicle is most frequently _broken_
-of any bone in the body, generally by indirect violence, as by falling
-with the hand out, though old people in such a case are apt to get
-_Colles’ fracture_ at the wrist. The bone generally gives way at the
-juncture of the outer and middle thirds, with displacement of the
-parts inward, so that the fracture is seldom compound. Since, however,
-the main vessels of the upper arm, with their nerves, lie beneath the
-clavicle, there is danger of their being punctured. Such serious injury
-is guarded against by the presence of the _subclavius muscle_. The
-clavicle is occasionally removed for _sarcoma_.
-
-[Illustration: FIG. 68.--Bones of the upper extremity. (Toldt.)]
-
-[Illustration: FIG. 69.--Left scapula, posterior surface (after Toldt).]
-
-The =scapula= or =shoulder blade=, so called from its shape, is a
-large, flat, triangular bone with a prominent ridge, the _spine_,
-crossing its dorsum or posterior surface near its upper edge. It
-extends from the second to the seventh rib, with its posterior margin
-parallel to and about one inch from the dorsal vertebræ. The _head_,
-in which is situated the _glenoid cavity_ for articulation with the
-humerus or upper arm bone, is surrounded by a slight constriction,
-the _neck_. Above it projects the _coracoid process_, so called from
-its fancied resemblance to a crow’s beak. This can usually be felt
-about one inch from the juncture of the outer and middle thirds of
-the clavicle and from it arise the short head of the biceps and the
-coraco-brachialis muscle. The _acromion process_ at the end of the
-spine extends out beyond the glenoid cavity posteriorly and affords
-attachment to the deltoid and trapezius muscles. It forms the summit
-of the shoulder. Numerous other muscles are attached to the surface
-of the scapula, the only parts which are truly subcutaneous being the
-whole length of the spine and the acromion process, though the lower
-angle and the coracoid process can generally be felt. The muscles bulge
-so much that the spine in the living appears as a slight depression
-extending back almost to the vertebræ. The large number of the muscles
-on the shoulder and arm is due to the great flexibility and strength
-required for the various uses to which the arms are put.
-
-=Shoulder Muscles.=--The most important shoulder muscle is the
-_deltoid_, a large triangular muscle, which surrounds and protects
-the shoulder-joint and gives the shoulder its rounded form. It rises
-from the outer third of the clavicle, from the acromion process, and
-from the whole length of the spine of the scapula, and is inserted
-by a tendon into a rough prominence on the middle of the outer side
-of the humerus. It serves to raise the arm and to draw it somewhat
-forward or back, according as the anterior or posterior fibers are
-used. The _pectoralis major_ rises from the inner half of the clavicle,
-the front of the sternum, and the cartilages of the true ribs and its
-fibers converge to form a fan-shaped muscle, which is inserted by a
-flat tendon into the edge of the bicipital groove on the humerus. It
-draws the arm forward and inward and helps considerably in forced
-inspiration. The _serratus magnus_ rises from the outer surface and
-upper border of the eight upper ribs and from an aponeurosis covering
-the upper intercostal spaces, and is inserted along the whole length of
-the posterior border of the scapula. It carries the scapula forward and
-is used in pushing.
-
-The scapula is seldom _broken_ because it is quite movable and is
-covered with large muscles and because it lies on the chest, which
-serves as an elastic cushion. The acromion process is the part most
-frequently broken and occasionally the neck is fractured. _Tumors_
-occur and may necessitate the amputation of the whole upper extremity.
-
-=The Humerus.=--The bone of the upper arm, the humerus, is the largest
-bone in the upper extremity and articulates with the scapula above
-and with the ulna and radius below. At its upper end are the _head_
-and the _anatomical neck_, with the _greater tuberosity_ external to
-and the _lesser tuberosity_ in front of them. The constriction of the
-surgical neck is below the tuberosities, and extending from between
-them downward and inward along the upper third of the bone is the
-bicipital groove for the long head of the biceps. Though round above,
-below the _shaft_ becomes flattened from before backward and curves
-slightly forward, terminating in the internal and external _condyles_,
-from the former of which the flexors and the round pronator arise and
-from the latter the extensors and supinators. From the external condyle
-also there projects in front the _radial head_ or _capitellum_ for
-articulation with the radius. Internally to the capitellum in front and
-in a corresponding position on the back of the bone are the trochlear
-surfaces for articulation with the ulna, there being a depression in
-front called the _coronoid fossa_ for the reception of the _coronoid
-process_ of the ulna in flexion of the forearm, and another depression
-behind, the _olecranon fossa_, to receive the tip of the olecranon
-process during extension. On the lower half of the humerus at the back
-is the spiral groove for the _musculo-spiral nerve_ and the _superior
-profunda artery_, while the _ulnar nerve_ runs in a groove back of the
-internal condyle.
-
-The humerus is almost completely covered with muscles, the only
-part that is subcutaneous being a small portion of the external and
-internal condyles. The head can be felt under the muscles and the
-greater tuberosity forms the point of the shoulder. When the arm is
-at the side, the biceps appears at the front and inner side and the
-brachialis anticus on either side below, while on the back of the arm,
-with its largest swelling above, is the triceps.
-
-[Illustration: FIG. 70.
-
-FIG. 70.--Superficial muscles of shoulder and arm (from before): 1,
-Pectoralis major; 2, deltoid; 3, biceps brachii; 4, brachialis anticus;
-5, triceps; 6, pronator radii teres; 7, flexor carpi radialis; 8,
-palmaris longus; 9, flexor carpi ulnaris; 10, supinator longus; 11,
-extensor ossis metacarpi pollicis; 12, extensor brevis pollicis; 13,
-flexor sublimis digitorum; 14, flexor longus pollicis; 15, flexor
-profundus digitorum; 16, palmaris brevis; 17, abductor pollicis.
-(Dorland’s Dictionary.)]
-
-[Illustration: FIG. 71.
-
-FIG. 71.--Superficial muscles of shoulder and arm (from behind): 1,
-Trapezius; 2, deltoid; 3, rhomboideus major; 4, infraspinatus; 5,
-teres minor; 6, teres major; 7, latissimus dorsi; 8, triceps; 9,
-anconeus; 10, brachialis anticus; 11, supinator longus; 12, extensor
-carpi radialis longior; 13, extensor carpi radialis brevior; 14,
-extensor communis digitorum; 15, extensor carpi ulnaris; 16, flexor
-carpi ulnaris; 17, extensor ossis metacarpi pollicis; 18, extensor
-brevis pollicis; 19, tendon of extensor longus pollicis. (Dorland’s
-Dictionary.)]
-
-=Upper Arm Muscles.=--The _biceps_ is the most important arm muscle. It
-rises by a short head from the coracoid process of the scapula and by
-a long head from a tubercle on the upper margin of the glenoid cavity,
-the tendon arching over the head of the humerus and descending in the
-bicipital groove. It is inserted into the back of the tuberosity of
-the radius and by a broad aponeurosis into the fascia of the forearm.
-It flexes and supinates the forearm and renders the fascia tense. Its
-inner border forms a guide in tying the _brachial artery_, as this
-artery runs along its inner side.
-
-The _brachialis anticus_ rises from the lower half of the outer and
-inner surfaces of the humerus and is inserted into the coronoid process
-of the ulna, thus covering and projecting the elbow-joint anteriorly.
-It is a flexor of the forearm.
-
-Another smaller muscle on the anterior arm, which also aids in flexion,
-is the _coraco-brachialis_, which extends from the coracoid process of
-the scapula to the middle of the inner surface of the humerus.
-
-Extending the entire length of the posterior surface of the humerus
-is the _triceps_, similar to the quadriceps extensor in the thigh and
-direct antagonist to the biceps and brachialis anticus muscles. It
-rises by a long head from below the glenoid fossa, by the external head
-from the upper third of the posterior surface of the humerus, and by
-the internal head from the middle and lower thirds of the posterior
-surface. It is inserted in the olecranon process of the ulna and serves
-to extend the forearm and arm.
-
-The humerus is more often _fractured_ by muscular action than any
-other bone. Usually the fracture occurs in the lower half of the
-bone and sometimes the musculo-spiral nerve is involved. There is a
-great tendency to non-union, probably due to interposition of soft
-parts. Sometimes the break is across and down between the condyles,
-_T-fracture_. Involvement of the elbow-joint is more serious than
-fracture of the humerus alone. _Sarcoma_ of the humerus does occur and
-may require the removal of the clavicle and scapula as well as of the
-arm bone itself. In _amputation_ of the humerus in children a long skin
-flap is left to allow for growth of the bone, as it is liable to grow
-again.
-
-=The Ulna.=--In the forearm there are two bones, the ulna and the
-radius, of which the former is the longer. The ulna is on the inner
-side of the forearm and its upper end forms the greater part of the
-articulation with the humerus, as most of the articulation at the wrist
-is formed by the radius and the inter-articular fibro-cartilage. The
-head of the ulna is at the lower extremity of the bone and articulates
-on the outer side with the radius and below with the triangular
-fibro-cartilage. From its inner side projects the _styloid process_.
-The olecranon process forms the upper extremity and presents anteriorly
-an articular surface, the _greater sigmoid cavity_, for articulation
-with the trochlea of the humerus, where it fits into the olecranon
-fossa during extension. The same articulating surface also covers
-the _coronoid process_, a smaller projection below and in front of
-the olecranon, which fits into the coronoid fossa during flexion.
-Continuous with the greater sigmoid cavity on the outer side is the
-_lesser sigmoid cavity_ for articulation with the head of the radius.
-Under the _triceps tendon_, which is inserted into the olecranon, is a
-_bursa_ or sac of synovial membrane, such as occurs in parts where much
-force is brought to bear.
-
-=The Radius.=--The radius, or spoke of the wheel, is on the outer
-side of the forearm and gets its name from the way it turns upon
-the ulna in pronation. The _shaft_ is larger below than above and
-is slightly curved longitudinally for greater strength. The upper
-extremity or _head_ is small and has a slightly concave upper surface
-for articulation with the radial head of the humerus. It articulates by
-its sides with the lesser sigmoid cavity and is bound to the ulna by
-the _orbicular ligament_, which runs over a smooth articular surface.
-Below the head is the constriction of the _neck_ with the tuberosity
-for the biceps tendon to the inner side below. The lower extremity is
-large and forms the chief part of the wrist-joint, articulating with
-the semilunar and scaphoid bones of the wrist. From the lower extremity
-the strong conical _styloid process_ projects externally.
-
-[Illustration: FIG. 72.--Bones of the right forearm in a position of
-supination. (Toldt.)]
-
-In the living the _olecranon process_ of the ulna is always felt at
-the elbow and the posterior border of the ulna forms the prominent
-ridge down the forearm, leading to the styloid process. The head of
-the radius is felt just below the external condyle and often makes a
-dimple in the muscles of the forearm. The rest of its upper half is
-concealed with muscles, but the lower half is easily felt as there are
-only tendons over it. The styloid process is felt externally. Normally
-that of the radius is a little lower than that of the ulna, so that in
-cases of fracture their relative position is of considerable importance
-as showing the amount of deformity.
-
-The two forearm bones are more frequently _broken_ together than
-separately and generally by direct violence, the lower fragment being
-usually drawn up by the action of the flexor and extensor muscles and
-producing a swelling on the palmar surface of the forearm. Indirect
-violence usually causes fracture of the radius only. In both cases, but
-especially in fracture of both bones, there is a tendency for membrane
-to get between the fragments, so the arm is put up in splints with the
-hand midway between pronation and supination in order to separate the
-bones as far as possible. Care must be taken not to have the bandage
-too tight or gangrene of the fingers may result. In most fractures of
-the arm it is put up bent, but in _fracture of the olecranon_ it is put
-up fully extended, as the fragment is sure otherwise to be displaced by
-the pull of the triceps. In fact, the olecranon is sometimes fractured
-by the muscular force of the triceps, though usually its fracture,
-which is frequent, is due to direct violence. The ulna is also often
-fractured in the middle by direct violence or the styloid process may
-be broken. Fracture of the neck or shaft of the radius is very common,
-the most important arm fracture being that of the lower end of the
-radius or _Colles’ fracture_. This and the corresponding fracture in
-the leg, _Pott’s fracture_, are two of the commonest fractures. In
-_dislocation of the wrist_ the normal relation of the two styloid
-processes remains unchanged, but in Colles’ fracture the lower fragment
-often projects on the back of the hand, making a typical deformity
-called the _silver fork deformity_.
-
-The bones of the wrist and hand had best be described before the
-forearm muscles are taken up, as the muscles of the forearm are
-distributed largely to the fingers.
-
-=The Wrist.=--The wrist or _carpus_ is made up of eight bones arranged
-in two rows of four each. In the first row are the _scaphoid_ and
-_semilunar bones_, on the outer side, articulating with the radius, the
-_cuneiform_ articulating with the fibro-cartilage of the wrist-joint,
-and the _pisiform_. In the second row, in corresponding positions,
-are the _trapezium_, _trapezoid_, _os magnum_, and _unciform_. The
-eminence felt on the radial side of the wrist is the protuberance of
-the scaphoid, while the pisiform is generally felt on the ulnar side.
-
-[Illustration: FIG. 73.--Right carpal bones, dorsal surface. _T_,
-trapezium; _T´_, trapezoid; _7_, os magnum; _U_, unciform; _S_,
-scaphoid; _L_, semilunar; _C_, cuneiform; _P_, pisiform.]
-
-=The Hand.=--The hand contains nineteen bones, five _metacarpal bones_,
-one for each finger and the thumb, whose bases articulate with the
-lower row of wrist bones, and fourteen _phalanges_, three for each
-finger and two for the thumb, of which the first row articulate with
-the metacarpal bones. They are all long bones and are slightly concave
-anteriorly. When the hand is flexed it is the heads of the metacarpal
-bones, not the bases of the phalanges, that are so prominent, the head
-of the third metacarpal being most prominent.
-
-The metacarpals are seldom _fractured_, though bad fractures
-occasionally occur. In comminuted fracture nothing can be done but
-remove the bone. If the periosteum is left the bone will grow again.
-Two diseases sometimes affect the metacarpals and the phalanges,
-_tuberculosis_ and _syphilis_. Both cause swelling of the bones.
-
-=Muscles of the Forearm.=--The chief groups of muscles on the forearm
-are the _flexors_ and _pronators_ on the anterior surface and the
-_extensors_ and _supinators_ on the posterior surface. In general the
-flexors and pronators take their origin from on or around the internal
-condyle, while the extensors and supinators arise on or around the
-external condyle. Where not otherwise stated it will be understood that
-such is their origin. In a general way they may by grouped as follows:
-
-                    ANTERIOR SURFACE.
-                               { flexor carpi radialis
-    Flexors of wrist           { flexor carpi ulnaris
-                               { palmaris longus
-
-    Flexors of fingers         { flexor sublimis digitorum
-                               { flexor profundus digitorum
-
-    Flexor of thumb              flexor longus pollicis
-
-    Pronators of hand          { pronator radii teres
-                               { pronator quadratus
-
-                    POSTERIOR SURFACE.
-    Extensor of forearm          anconeus
-
-                               { extensor carpi radialis longior
-    Extensors of wrist         { extensor carpi radialis brevior
-                               { extensor carpi ulnaris
-
-                               { extensor ossis metacarpi pollicis
-    Extensors of thumb         { extensor primi internodii pollicis
-                               { extensor secundi internodii pollicis
-
-    Extensor of fingers          extensor communis digitorum
-
-    Extensor of index finger     extensor indicis
-
-    Extensor of little finger    extensor minimi digiti
-
-    Supinators of hand         { supinator longus
-                               { supinator brevis
-
-Of the _flexors of the wrist_ the _flexor carpi radialis_ is inserted
-into the base of the index and usually of the third metacarpal bone,
-the _flexor carpi ulnaris_ into the fifth metacarpal, the pisiform and
-the unciform bones, while the _palmaris longus_ goes to the anterior
-annular ligament of the wrist and the palmar fascia of the hand. The
-_flexor sublimis digitorum_ is inserted by four tendons into the second
-phalanges of the fingers, while the _flexor profundus digitorum_ arises
-from the upper part of the ulna and is inserted into the last phalanges
-of the fingers. The _flexor of the thumb_ arises from the middle of the
-radius and is inserted into the last phalanx of the thumb. Which joint
-is flexed by a muscle depends upon the origin and insertion of the
-muscle, all those included between being affected. Thus, the _flexor
-sublimis digitorum_, which has its origin in part at least from the
-condyle and is inserted in the second phalanges of the fingers, flexes
-the forearm, wrist, and all the finger-joints but the last, while the
-_flexor profundus digitorum_, arising from the ulna, though it flexes
-the wrist and fingers, has no power of flexing the forearm.
-
-The _pronator radii teres_, besides arising from the supra-condylar
-ridge, rises from the coronoid process of the ulna. It is inserted into
-the middle of the outer surface of the radius and serves to pronate
-the forearm. The other pronator, the _pronator quadratus_, is a small
-quadrilateral muscle extending transversely across the radius and ulna
-just above their carpal extremities. It rises from the anterior surface
-of the ulna and is inserted into the anterior external border of the
-radius.
-
-On the back of the forearm the _anconeus_ serves to extend the forearm
-only, being inserted into the upper part of the posterior surface of
-the ulna. The _extensors of the wrist_ are inserted into the bases of
-the various metacarpal bones and have some power to extend the forearm
-as well as the wrist. The _extensors of the thumb_, as their names
-imply, go one to the metacarpal bone and one to each of the phalanges,
-the longest one extending the whole thumb, the others only a part. They
-rise from the ulna and radius, not the condyle. The _extensor communis
-digitorum_ goes to all the phalanges of all the fingers, the _extensor
-minimi digiti_ to those of the little finger only, and the _extensor
-indicis_ to those of the index finger, the last two arising short of
-the condyle.
-
-Of the _supinators_ the longer one is inserted into the styloid process
-of the radius, while the shorter one, the _supinator brevis_, is
-inserted into the upper part of the same bone, both thus serving to
-turn the radius on the ulna.
-
-Where the _tendons_ of the various muscles pass over the wrist, both
-front and back, they are covered with a synovial sheath and are held
-down by a broad ligament, which some of them perforate, the annular
-ligament. The strong fibrous band of the _anterior annular ligament_
-arches over the carpal bones in front. Beneath it pass the median nerve
-and the tendons of the flexors of the fingers and thumb. The _posterior
-annular ligament_ is of less importance.
-
-The deep _palmar fascia_ forms a sheath for the muscles of the hand.
-In carpenters there sometimes occurs _Dupuytren’s contraction_ of the
-palmar fascia, which draws the fingers up. As operation is not always
-successful, it is quite a serious matter.
-
-The _muscles of the hand_ itself include various abductor, adductor,
-and short flexor muscles of the thumb and little finger. There also
-extend between the metacarpal bones the _lumbricales_, four small
-muscles that aid the deep flexor muscles; likewise seven _interossei_,
-of which four are dorsal and three palmar. The _dorsal interossei_
-arise by two heads from the adjacent sides of the metacarpal bones and
-are inserted into the bases of the first phalanges, thus abducting the
-fingers; while the _palmar interossei_, arising from the palmar surface
-of the second, fourth, and fifth metacarpals, are inserted into the
-three corresponding first phalanges and adduct the fingers toward an
-imaginary line drawn through the middle finger.
-
-=Joints of the Upper Extremity.=--The joints of the upper extremity,
-with the exception of the wrist-joint, are the most freely movable of
-any in the body, probably because the hand has the finest work to do
-and a greater number of motions are required. Even the wrist has much
-greater freedom of motion than the corresponding joint in the lower
-extremity.
-
-The _shoulder-joint_ is rather a deep joint, to allow of the varied
-motion required, and has a capsular ligament from the margin of the
-glenoid fossa above to the neck of the humerus below. The _elbow_,
-which is a hinge joint, has an anterior and a posterior ligament and
-two lateral ligaments, as is practically the case in all such joints.
-The _wrist_ has several ligaments which, taken together, are capsular
-in nature.
-
-=Blood Supply of the Upper Extremity.=--The blood supply of the upper
-extremity comes through the _subclavian artery_, which, on the right,
-springs from the innominate artery and on the left from the aortic
-arch. It remains one trunk as far as the elbow, though different names
-have been given to different parts. Thus, as it passes over the lower
-border of the first rib, it becomes the _axillary_, and at the lower
-border of the axilla, where it starts down the arm, the _brachial_. At
-the elbow it divides into the _ulnar_ and _radial arteries_.
-
-In its upper part the _brachial artery_ lies internal to the humerus
-but below it is in front of the bone. The _radial_ runs in a line from
-the middle of the elbow anteriorly to the inner side of the styloid
-process of the radius and is much exposed to injury in the lower third
-of its course, as when the hand is thrust through glass. On it at the
-wrist the pulse is counted. It is much smaller than the ulnar and winds
-around the outer side of the thumb to the palm, where, with the deep
-branch from the ulnar, it forms the _deep palmar arch_. The _ulnar
-artery_ passes obliquely inward to the middle of the forearm and thence
-along its ulnar border to the palm of the hand, where it divides into
-the deep branch and the _superficial palmar arch_ which supplies the
-four _digital arteries_.
-
-From the _axillary artery_ branches go to the chest wall and shoulder,
-the most important being the two _circumflex arteries_ to the deltoid.
-The brachial has only two branches of any importance, the _superior_
-and _inferior profunda_, both on the upper arm, of course.
-
-In case of _hemorrhage_ compression can frequently be applied with the
-fingers where the subclavian crosses the rib or in the axilla, where
-the artery can be pressed up against the humerus.
-
-=Nerves.=--The nerve supply of the shoulder comes chiefly from the
-anterior and posterior _thoracic_, the _suprascapular_, and the
-_circumflex_, these last going to the deltoid. The biceps is supplied
-by the _musculo-cutaneous_, the triceps by the _musculo-spiral_, and
-the brachialis anticus by both. Most of the flexor and pronator muscles
-are supplied by the _median_, while the _posterior interosseous_ and
-the _musculo-spiral nerves_ go to the extensors and supinators. The
-_ulnar nerve_ supplies the hand largely.
-
-
-
-
-CHAPTER XIII.
-
-THE LOWER EXTREMITIES.
-
-
-The lower extremities resemble the upper very closely in the
-arrangement of the bones, muscles, arteries, and nerves, though
-modifications occur, due to the difference in function of the lower
-limbs. There is one long bone in the upper part or thigh, the femur,
-and two in the lower part or leg, the tibia and fibula, while over the
-knee-joint is the patella or knee-cap. The ankle has seven bones and
-the foot nineteen like the hand.
-
-=The Femur.=--The femur is the longest bone in the body, being about
-one-fourth the height of the person. It inclines toward its fellow at
-the knee in order to bring the knee-joints near the center of gravity
-in walking, the amount of inclination varying with the width of the
-hips and the height of the person. On account of the greater width of
-hip the tendency to knock-knee is greater in women than in men.
-
-The _shaft_ of the femur is enlarged at the extremities and is
-slightly curved forward, the concavity being strengthened at the back
-by a longitudinal ridge, the _linea aspera_, along part of which the
-gluteus maximus muscle is attached. The _head_, which is covered with
-cartilage, except for an oval depression for the attachment of the
-ligamentum teres, one of the ligaments of the hip-joint, and which
-articulates with the hollow of the acetabulum in the os innominatum,
-projects considerably upward, inward, and forward from the shaft,
-the _neck_ varying much in length and angle. It is generally more
-horizontal in women than in men and in rickets the great weight on
-the softened bone tends to press the head down, causing the deformity
-known as “_coxa vera_”, in which the neck is almost horizontal.
-Extending upward, outward, and backward from the shaft at the base
-of the neck, about three-quarters of an inch lower than the head and
-about on a level with the acetabulum and the spine of the os pubis,
-is the _greater trochanter_. This large, irregular prominence and the
-smaller one of the _lesser trochanter_, which is at the lower part of
-the base of the neck posteriorly, are for the attachment of muscles
-and to assist in rotating the bone. The lower extremity of the femur
-is larger than the upper and is flat from before backward. Between its
-two large eminences, the external and internal _condyles_, is a smooth
-depression in front, the _trochlear surface_, for articulation with the
-patella. The external condyle is more prominent in front, the internal
-inferiorly, the latter being the longer of the two by about half an
-inch. The _epiphysis_ at the lower end of the femur is the only one in
-which ossification has begun at birth. Therefore, if ossification is
-found there, the child is known to have arrived at full term.
-
-[Illustration: FIG. 74.--Bones of the lower extremity. (Toldt.)]
-
-So many large muscles are attached to the femur that the shaft cannot
-be detected in the living unless the person is very thin and poorly
-developed. The outer surface of the greater trochanter, however, and
-the condyles can be felt.
-
-A string stretched from the anterior superior spine of the ilium to the
-tuberosity of the ischium passes in the middle just over the upper edge
-of the greater trochanter. The line thus drawn is known as _Nélaton’s
-line_ and is of considerable importance in many conditions of the
-hip. Thus, if the hip is dislocated, the trochanter will be thrown
-above _Nélaton’s line_, and in osteomalacia the pelvis sinks and the
-trochanter is again above the line.
-
-=Thigh Muscles.=--Of the thigh muscles only a few need be mentioned.
-One large muscle is the _psoas magnus_, which has its origin on the
-front of the last dorsal and all the lumbar vertebræ, passes down
-across the brim of the pelvis and under Poupart’s ligament, gradually
-diminishing in size, and terminates in a tendon that is inserted into
-the lesser trochanter. It serves to flex the thigh on the pelvis and to
-rotate it outward. The _psoas parvus_ rises from the last dorsal and
-the first lumbar vertebræ and does not go out of the pelvis.
-
-The _sartorius_ or _tailor muscle_ is flat and ribbon-like and is the
-longest muscle in the body. It rises from the anterior superior spine
-of the ilium and is inserted into the upper inner surface of the shaft
-of the tibia. By it the legs are crossed. It also forms the outer side
-of an important landmark, _Scarpa’s triangle_, whose base is formed by
-Poupart’s ligament and the inner side by the _adductor magnus muscle_,
-which passes from the ramus of the os pubis and the tuberosity of the
-ischium to the linea aspera. The _femoral artery_ bisects the triangle
-and runs into its apex.
-
-The bulk of the anterior portion of the thigh is formed by the
-_quadriceps extensor_, which is really made up of four muscles, the
-_rectus femoris_, whose origin is on the anterior inferior iliac spine
-and above the acetabulum; the _vastus externus_, which comes from
-the greater trochanter and the upper linea aspera; and the _vastus
-internus_ and _crureus_, which rise from the neck of the femur and
-the linea aspera. It is inserted into the tubercle of the tibia by
-the _ligamentum patellæ_, in which the patella lies. Its action is to
-extend the leg.
-
-At the back and forming the _buttocks_ are the three glutei muscles,
-the _gluteus maximus_, _medius_, and _minimus_. All these rise from the
-outer side of the ilium and have their insertion on or about the great
-trochanter. They serve to hold the trunk erect and to extend, abduct,
-and rotate the thigh.
-
-[Illustration: FIG. 75.]
-
-[Illustration: FIG. 76.]
-
-[Illustration: FIG. 77.
-
-FIG. 75.--Superficial muscles of hip and thigh (from behind): 1,
-Gluteus medius; 2, gluteus maximus; 3, vastus externus; 4, biceps
-flexor cruris; 5, semitendinosus; 6, semimembranosus; 7, gracilis; 8,
-sartorius; 9, adductor magnus; 10, 11, gastrocnemius; 12, origin of
-plantaris. (Dorland’s Dictionary.)
-
-FIG. 76.--Muscles of the inner side of thigh and interior of pelvis:
-1, Iliacus; 2, psoas magnus; 3, obturator internus; 4, pyriformis; 5,
-erector spinæ; 6, gluteus maximus; 7, sartorius; 8, adductor longus; 9,
-gracilis; 10, adductor magnus; 11, semimembranosus; 12, semitendinosus;
-13, rectus femoris; 14, vastus internus. (Dorland’s Dictionary.)
-
-FIG. 77.--Superficial muscles of front of thigh: 1, Insertion of
-external oblique into iliac crest; 2, aponeurosis of external oblique;
-3, external abdominal ring; 4, gluteus medius; 5, tensor vaginæ
-formoris; 6, sartorius; 7, iliopsoas; 8, pectineus; 9, adductor longus;
-10, gracilis; 11, adductor magnus; 12, vastus externus; 13, rectus
-femoris; 14, vastus internus; 15, biceps flexor cruris. (Dorland’s
-Dictionary.)]
-
-Lower down and forming the back of the thigh are the biceps and the
-semitendinosus and semimembranosus muscles. The _biceps_ rises by two
-heads from the tuberosity of the ischium and the linea aspera and is
-inserted into the head of the fibula. It is on the outer side of the
-thigh and its tendon, which embraces the external lateral ligament of
-the knee-joint, forms the _outer hamstring_. On the inner side are the
-_semitendinosus_ and the _semimembranosus muscles_. These rise from
-the tuberosity of the ischium and are inserted, the one into the upper
-inner surface of the shaft of the tibia and the other into the internal
-tuberosity of the tibia. Their tendons form the _inner hamstring_.
-Like the biceps they serve to extend the thigh and flex the leg on the
-thigh, but where the biceps rotates the leg out they, being attached to
-the inner side of the leg bones, rotate it in.
-
-=The patella=, or _small pan_, is a flat, somewhat triangular bone
-developed in the quadriceps extensor tendon. Four _muscles_ are
-attached to it as well as the ligamentum patellæ, which holds it to the
-tibia and gives increased leverage by making the quadriceps extensor
-work at a greater angle. It articulates with the condyles and serves
-to protect the joint. One bursa, the _prepatella bursa_, separates it
-from the skin and another, surrounded by adipose tissue, from the head
-of the tibia. The external surface can be seen and felt on the front of
-the knee and the bone can be moved from side to side when the leg is
-straight.
-
-=Joints of the Lower Extremity.=--The _hip-joint_ is a ball-and-socket
-joint but is not so freely movable as the shoulder-joint, the head of
-the femur being held in the acetabulum by many strong ligaments, of
-which the most important is the _capsular_ ligament.
-
-The _knee-joint_ is largely a hinge joint, but in some positions it has
-some rotation. It is formed by the condyles of the femur, the head of
-the tibia, and the patella, and has fourteen ligaments, including the
-_ligamentum patellæ_ and the _crucial ligaments_. Its synovial sac is
-the largest found in any joint. Two _semilunar cartilages_, placed on
-the head of the tibia, serve to deepen the socket for the condyles,
-changing somewhat in shape and thickness as the joint moves. The
-interval between the thigh and the leg bones can be felt at the knee.
-When the leg is extended the juncture of the bones is slightly above
-the patella, while in flexion a knife passed below the apex of the
-patella will pass into the joint.
-
-_Congenital dislocation_ of the hip occurs. _Separation of the
-epiphysis of the femur_ may occur and sometimes the neck, rarely
-the lower part of the shaft, is _fractured_. Either condyle may
-be fractured off or there may be a T-fracture, in which case the
-popliteal artery may be injured. In _dislocation_ the head may be
-behind or in front of the acetabulum. _Impacted hip_, where the neck
-of the femur has, in a fall, been driven into the head, is common
-in old people. Sometimes, especially in young children, the bone is
-infected, _osteomyelitis_. _Sarcoma_ occurs. Most tubercular disease of
-the hip originates at the upper extremity of the femur, _tuberculosis_
-generally starting in the head and then attacking the capsule and
-the soft parts of the joint. If neglected, shortening of the leg may
-result, in which case the bone has to be broken and set at an angle in
-order to enable the child to walk.
-
-[Illustration: FIG. 78.]
-
-[Illustration: FIG. 79.
-
-FIG. 78.--Right knee-joint, posterior view. (Leidy.)
-
-FIG. 79.--Right knee-joint, showing internal ligaments: 2, anterior
-crucial ligament; 3, posterior crucial ligament; 4, transverse
-ligament; 6, 7, semilunar fibro-cartilages. (Leidy.)]
-
-Occasionally a bit of cartilage gets broken off in the knee-joint and
-wedged between the bones, so that the joint cannot be straightened.
-This is _dislocation of the semilunar cartilage_ and necessitates an
-operation for removal of the piece. The cartilage will eventually
-be replaced by fibrous tissue and in a few months the leg will be
-all right. _Dislocation of the knee_ is rare, though it may occur
-in any direction. Often the bursæ of the joint are irritated, as by
-kneeling to scrub floors, and _bursitis_ or _housemaid’s knee_ results.
-_Fracture of the patella_ may be caused by muscular traction or by
-direct violence, and is generally repaired by making an incision
-and sewing the parts of the bone together. _Tumor albus_ or _white
-swelling_ is _tuberculosis of the knee_ and is fairly common in
-children. _Specific knee_ means _syphilis of the knee_ and generally
-occurs in both knees.
-
-=The Tibia.=--The tibia or _shin bone_ is next longest to the femur
-and is on the inner side of the leg, corresponding to the ulna in the
-arm. The _shaft_ is prismoid and is more slender for the lower quarter,
-where fracture is consequently most frequent. The anterior border forms
-the _crest_ or shin and can be felt for its upper two-thirds. The
-lower extremity, which is smaller than the upper, articulates with the
-astragalus bone of the ankle and with the fibula. Its _head_ or upper
-extremity is expanded into two lateral _tuberositis_ for articulation
-with the femur and for muscular attachment, both of which can easily
-be felt just below the bend of the knee. Their upper surfaces are
-smooth and concave, with a vertical bifid spine in the middle and a
-prominent tubercle for the attachment of the semilunar cartilages on
-either side. On the anterior surface of the head, below, is a rough
-eminence or tubercle, which also can be felt. The lower part of this
-is for the attachment of the ligamentum patellæ, while the upper part,
-which is smoother, is for the bursa that is placed under the tendon to
-prevent friction. On the back of the outer tuberosity is a facet for
-the head of the fibula. At the lower end there projects downward on the
-inner side, overhanging the arch of the foot, the _internal malleolus_,
-the prominent part of the ankle. It is on a higher level and somewhat
-farther forward than the _external malleolus_.
-
-=The Fibula.=--The fibula is the most slender of all the bones in
-proportion to its length and is on the outer side of the leg. Its
-_head_ is small and placed toward the back of the tibia below the
-knee-joint, from which it is excluded. The head articulates with the
-external tuberosity and has extending upward from it the styloid
-process. To it is attached the _biceps tendon_ or _outer hamstring_.
-At the lower extremity of the shaft is the _external malleolus_, which
-articulates with the astragalus and forms the outer ankle. The only
-parts of the fibula that can be felt, besides the malleolus, which is
-very prominent, are the head and the lower external surface of the
-shaft.
-
-In _fracture of the leg_ both bones are usually broken, though either
-may be broken separately. _Pott’s fracture_ is fracture of the lower
-fibula, and may be caused by stamping hard when stepping on to the
-sidewalk. In rickets the tibia becomes bowed outward and forward,
-causing _bow leg_, a condition which in very young children may be
-rectified by manipulation. Later on braces are needed and after five
-years the bones have to be broken and set straight.
-
-=The Ankle.=--The ankle or _tarsus_ has but seven bones where the
-wrist has eight. They are the _os calcis_ or _heel bone_, which is
-the largest and strongest and forms the tuberosity of the heel; the
-_astragalus_, which is next largest and helps to form the ankle-joint;
-the _cuboid_; the _navicular_ (_boat-like_) or _scaphoid_; and the
-internal, middle, and external _cuneiform bones_. The astragalus is
-above and partially in front of the os calcis, to which is attached
-the _tendo Achillis_. The _cuboid_ is on the outer side of the foot,
-in front of the os calcis and behind the metatarsals. It is noticeable
-in _congenital club-foot_, in which condition the tarsal bones may be
-distorted in shape and misplaced. The _navicular_ or _scaphoid_ is
-on the inner side of the foot, between the astragalus and the three
-cuneiform bones.
-
-=The Foot.=--There are five _metatarsal bones_ in the foot,
-corresponding to the five metacarpals in the hand, and the toes have
-the same number of _phalanges_ as the fingers, though they are shorter
-and stronger. The big toe corresponds to the thumb.
-
-[Illustration: FIG. 80.--Bones of the right foot, dorsal surface:
-1, Astragalus; 2, talus; 3, os calcis, 4, navicular; 5, internal
-cuneiform; 6, middle cuneiform; 7, external cuneiform; 8, cuboid; 9,
-metatarsus; 10-14, phalanges. (Leidy.)]
-
-_Fracture_ of the os calcis and the astragalus are most commonly caused
-by a fall from a height, while the metatarsals and phalanges are
-generally broken by something heavy falling upon them. Because of their
-delicate structure, their distance from the heart, and the differences
-of temperature to which they are subjected, the tarsal bones are
-especially liable to become _tubercular_, amputation of the feet even
-becoming necessary at times. In diabetes there may be a perforating
-ulcer on the sole of the foot and the bone may become diseased.
-
-[Illustration: FIG. 81.]
-
-[Illustration: FIG. 82.]
-
-[Illustration: FIG. 83.
-
-FIG. 81.--Superficial muscles of the leg from inner side: 1,
-Vastus internus; 2, sartorius; 3, gracilis; 4, semitendinosus; 5,
-semimembranosus; 6, inner head of gastrocnemius; 7, soleus; 8, tendon
-of plantaris; 9, tendon of tibialis posticus; 10, flexor longus
-digitorum; 11, flexor longus hallucis; 12, tibialis anticus; 13,
-abductor hallucis. (Dorland’s Dictionary.)
-
-FIG. 82.--Muscles of leg and foot (from before): 1, Tendon of rectus
-femoris; 2, vastus internus; 3, vastus externus; 4, sartorius; 5,
-iliotibial band; 6, inner head of gastrocnemius; 7, inner part of
-soleus; 8, tibialis anticus; 9, extensor proprius hallucis; 10,
-extensor longus digitorum; 11, peroneus longus; 12, peroneus brevis;
-13, peroneus tertius; 14, origin of extensor brevis digitorum.
-(Dorland’s Dictionary.)
-
-FIG. 83.--Superficial muscles of leg (from behind): 1, Vastus externus;
-2, biceps flexor cruris; 3, semitendinosus; 4, semimembranosus; 5,
-gracilis; 6, sartorius; 7, outer, and 8, inner, head of gastrocnemius;
-9, plantaris; 10, soleus; 11, peroneus longus; 12, peroneus brevis; 13,
-flexor longus digitorum; 14, tibialis posticus; 15, lower fibers of
-flexor longus hallucis. (Dorland’s Dictionary.)]
-
-=Muscles of the Leg.=--The greater part of the calf of the leg is
-formed by the _gastrocnemius_, a large bulging muscle, which rises from
-the condyles of the femur and is inserted along with the _soleus_,
-whose origin is on the back of the upper fibula, and the _plantaris_,
-which comes from the linea aspera, into the os calcis by a common
-tendon, the _tendo Achillis_, the largest and strongest tendon in
-the body. Its action is to extend the foot and to rotate it slightly
-inward. Other extensors of the foot, which also evert it, are the
-_peroneus longus_ and the _peroneus brevis_ at the upper and outer part
-of the leg, the former rising from the outer tuberosity of the tibia
-and the upper fibula and being inserted into the first metatarsal and
-the internal cuneiform, the latter arising from the lower fibula and
-being inserted into the fifth metatarsal. The foot is flexed, adducted,
-and rotated inward by means of the _tibialis anticus_, which rises from
-the outer tuberosity and the upper two-thirds of the outer surface of
-the tibia and is inserted into the internal cuneiform bone.
-
-In the foot, and corresponding to the palmar fascia in the hand, is
-the _plantar fascia_, the densest of all fibrous membranes. There are
-also various annular ligaments, and the _foot muscles_ are arranged
-similarly to those in the hand.
-
-=The Blood Supply of the Lower Extremity.=--The blood supply of the
-lower extremity comes from the _external iliac artery_, a branch of the
-_common iliac_, which passes obliquely downward and outward along the
-border of the psoas muscle to Poupart’s ligament, where it enters the
-thigh and becomes the _femoral artery_. Its only important branches are
-the _deep epigastric_, which goes up along the internal abdominal ring,
-and the _deep circumflex iliac_. As the _femoral artery_ it passes
-down the inner side of the thigh to the internal condyle of the femur,
-being very superficial at Scarpa’s triangle, where it can be compressed
-with the thumb to stop hemorrhage below. If a tourniquet is applied,
-it should be applied a little lower down. The first and most important
-branch of the femoral is the _profunda femoris_.
-
-About two-thirds of the way to the knee the artery takes the name
-_popliteal_. It lies superficially in the popliteal space back of the
-knee, but above and below it is covered with muscles. Its branches
-supply the knee-joint and nearby muscles and are unimportant. At the
-lower border of the _popliteus muscle_, a small muscle at the knee, it
-divides into the _anterior and posterior tibial arteries_. The course
-of the former of these may be marked by a line from the inner side of
-the head of the fibula to midway between the malleoli at the front of
-the ankle, where it terminates in the _dorsalis pedis artery_ for the
-back of the foot. By this last the pulse is sometimes taken and its
-pulsation is a guide in determining how high up to amputate in gangrene
-of the foot. The posterior tibial extends obliquely down the back of
-the leg to the heel, where it divides into the _internal and external
-plantar arteries_ which go to the sole of the foot. Its most important
-branch is the _peroneal_.
-
-Besides the _deep veins_ accompanying the arteries there are the
-_superficial veins_, the _internal_ or _long saphenous_ on the inner
-side of the leg and thigh and the _external_ or _short saphenous_ on
-the middle of the leg posteriorly and emptying into the popliteal vein.
-Varicosity often occurs in these veins.
-
-=Nerves.=--The nerves of the muscles about the hip are branches of the
-_lumbar nerve_. The _anterior crural_ supplies the anterior part of
-the thigh, the _gluteal_ the muscles of the same name, and the _great
-sciatic_ the large muscles of the back of the thigh. Below the knee
-the _anterior tibial_ goes to the tibialis anticus and the _internal
-popliteal_ to the muscles of the calf, while the peroneus muscles are
-supplied by the _musculo-cutaneous_.
-
-
-
-
-INDEX.
-
-
-    Abdomen, 132
-      muscles, 132, _et seq._
-      nerves, 134
-      regions, 134, 135
-      contents, 135, 136
-    Abdominal aorta, 107, 109
-    Abducens nerve, 83
-    Abscess, 34, 51, 52, 100, 137, 152, 159, 168
-    Absorbent vessels or lymphatics, 34
-    Absorption of food, 33
-      in intestines, 144
-      in mouth, 136
-      in stomach, 140
-    Accommodation of eye, 72
-    Acetabulum, 162, 187
-    Acromion process, 173
-    Adam’s apple, 121
-    Adductor magnus muscle, 190
-    Adenoids, 62
-    Adipose tissue, 16
-    Air, changes by breathing, 129, 130
-      complemental, 129
-      residual, 129
-      supplemental, 129
-      tidal, 129
-    Air cells, 27
-    Albumin in urine, 158
-    Albuminoids, 12
-    Alimentary canal, 136, _et seq._
-    Alveoli of lungs, 126
-    Amœba, 12
-    Ampullæ of mamma or breast, 100
-    Amputation, 177
-    Amylopsin, 144
-    Anabolism, 147
-    Anasarca, 152
-    Anatomy, 11
-    Anconeus muscle, 182, 183
-    Anemia, 120
-    Aneurism, 109
-    Ankle, 195
-    Annular ligaments, 184, 198
-    Ano-spinal reflex, 146
-    Antrum of Highmore, 54, 57
-    Anus, 141, 146
-    Aorta, 99, 107, 109
-    Aortic valve, 104
-    Aponeuroses, 23
-    Apoplexy, 79, 118
-    Appendages of the skin, 40
-    Appendix, vermiform, 145
-    Aqueous humor, 70
-    Arachnoid, 76
-    Areola, 100
-    Areolar tissue, 15
-    Arteries, 27, 28, 29, 107
-      nerves, 29
-      of back, 94, 95
-      of brain, 77
-      of breast, 100
-      of chest, 99
-      of heart, 107
-      of intestine, 143, 145
-      of kidney, 156
-      of lower extremity, 198, 199
-      of organs of generation, 168
-      of pancreas, 153
-      of spleen, 153
-      of stomach, 139
-      of upper extremity, 185, 186
-      structure, 27
-    Artery, axillary, 99, 100, 108, 185
-      basilar, 77, 108
-      brachial, 108, 177, 185
-      carotid, common, 107, 108
-        internal and external, 108, 137
-      celiac axis, 109, 143, 150, 153
-      cerebral, 77
-      circumflex, 186
-      coronary, 107
-      communicating, 78
-      digital, 186
-      dorsalis pedis, 199
-      epigastric, deep, 198
-      facial, 28
-      femoral, 190, 198
-      gastric, 109
-      hepatic, 109, 150
-      iliac, common, 107, 109
-        internal and external, 95, 109, 198
-        circumflex, 198
-      innominate, 107
-      intercostal, 95, 97, 100, 108
-      lumbar, 95, 109
-      mammary, internal, 99, 100, 108
-      mediastinal, 99
-      mesenteric, 109, 143, 145, 153
-      ophthalmic, 70
-      peroneal, 199
-      phrenic, 99, 109
-      plantar, internal and external, 199
-      popliteal, 198
-      profunda, superior and inferior, 175, 186
-        femoris, 198
-      pudic, 168
-      pulmonary, 106, 110
-      radial, 108, 185
-      renal, 109
-      spermatic or ovarian, 109, 168
-      splenic, 109, 153
-      subclavian, 94, 99, 107, 108, 185
-      suprarenal, 109
-      suprascapular, 94
-      thyroid axis, 108
-      tibial, 198
-      transversalis colli, 94
-      ulnar, 108, 185
-      umbilical, 107
-      uterine, 168
-      vertebral, 77
-    Arytenoid cartilages, 122
-    Ascending aorta, 107
-      colon, 145
-    Ascites, 34, 152
-    Asphyxia, 128
-    Astigmatism, 73
-    Astragalus, 195
-    Atlas, 91
-    Auditory meatus, 52
-      canal, external, 63
-             internal, 64
-      center, 81
-      nerve, 64, 65, 84
-    Auricles of heart, 103
-    Axilla, 32
-    Axillary artery, 99, 100, 108, 185
-    Axis, 91
-    Axis-cylinder process, 36, 37
-
-    Back, 88, _et seq._
-      muscles, 93, 94
-      arteries, 94, 95
-      nerves, 95
-    Basilar artery, 77, 108
-    Basilic vein, 109
-    Biceps of arm, 175, 176
-      of leg, 190, 191
-    Bicipital groove, 175
-    Bicuspid or mitral valve, 104
-      teeth, 60
-    Bile, 36, 143, 150
-    Bilirubin, 12, 143, 151
-    Biliverdin, 143, 151
-    Bladder, 160
-    Blind spot, 70
-    Blood, 27, 116, _et seq._
-      amount, 116
-      arterial and venous, 29
-      circulation of, 29, 105, _et seq._
-      coagulation, 117, 118
-      coloring matter, 119
-      composition, 116, 117
-      corpuscles, 116, 118, _et seq._
-      fibrin, 117
-      functions of, 116
-      plaques, 120
-      plasma, 33, 116, 117
-      pressure, 114, 115
-      serum, 117
-      vessels, 27, _et seq._
-    Bone, 17
-      astragalus, 195
-      atlas, 91
-      axis, 91
-      canaliculi, 17
-      cancellous or spongy, 17
-      carpal, 180, 181
-      chemical composition, 18
-      clavicle, 171
-      coccyx, 90, 161
-      compact, 17, 18
-      cuboid, 195
-      cuneiform, 181, 195
-      endosteum of, 18
-      ethmoid, 48, 53
-      femur, 187
-      fibula, 194, 195
-      formation of, 18
-      frontal, 49
-      Haversian canals of, 17
-      humerus, 175
-      hyoid, 60
-      ilium, 161, 162
-      incus, 63
-      innominate, 161, 162
-      ischium, 161, 163
-      lachrymal, 48, 54
-      lacunæ of, 17
-      lamellæ of, 17
-      malar, 48, 54
-      malleus, 63
-      marrow of, 18
-      maxillary, inferior, 48, 55
-                 superior, 48, 54
-      metacarpal, 181
-      metatarsal, 195
-      nasal, 48, 55
-      navicular, 195
-      occipital, 48, 50
-      os calcis, 195
-      os innominatum, 161, 162
-      os magnum, 181
-      palate, 48, 54
-      parietal, 48, 49
-      patella, 19, 192
-      pelvis, 161
-      periosteum of, 18
-      phalanges, of foot, 195
-                 of hand, 181
-      pisiform, 181
-      pubes, 161, 163
-      radius, 178, 179
-      ribs, 97, 98
-      sacrum, 90, 161
-      scaphoid, 181, 195
-      scapula, 173
-      semilunar, 181
-      sphenoid, 48, 52
-      stapes, 63
-      sternum, 97
-      structure of, 17
-      tarsal, 195
-      temporal, 48, 51
-      tibia, 194
-      trapezium, 181
-      trapezoid, 181
-      turbinated, 53
-        inferior, 48, 53, 54
-      ulna, 177, 178
-      unciform, 181
-      vertebræ, 88
-      vomer, 48, 55
-    Bones, classification of, 19
-      flat, 20
-      function of, 19, 20
-      long, 19
-      of back, 88
-      of chest, 97, 98
-      of cranium, 48, _et seq._
-      of face, 53, _et seq._
-      of lower extremity, 187, _et seq._
-      of upper extremity, 171, _et seq._
-      pelvic, 161, _et seq._
-      sesamoid, 19
-      short, 20
-      Wormian, 19, 49
-    Bow leg, 195
-    Brachial artery, 108, 177, 185
-      plexus, 84, 85
-    Brachialis anticus, 175, 177
-    Brain, 75, _et seq._
-      areas, 81, 82
-      arteries, 77
-      function, 80, _et seq._
-      parts, 75
-    Broad ligaments of uterus, 165, 166, 168
-    Bronchi, 123, 125
-    Buffy coat, 117
-    Bursæ, synovial, 20, 178
-    Bursitis, 194
-    Buttocks, 190
-
-    Canal, alimentary, 136, _et seq._
-      auditory, 63, 64
-      central, of cord, 81
-      Haversian, 17
-      semicircular, 64, 66
-    Canaliculi of bone, 17
-    Cancellous tissue of bone, 17
-    Cancer, 35, 58, 62, 100, 122, 139, 146, 169
-    Canine teeth, 60
-    Canthus of eye, 67, 68
-    Capillaries, 28, 29
-    Capitellum, 175
-    Capsular ligament of hip, 193
-    Carbohydrates, 12, 26, 147, 148, 151
-    Cardiac cycle, 104
-      muscle, 22, 25
-      nerve, 78
-      plexus, 87
-    Caries, 98
-    Carotids, common, 107, 108
-      internal and external, 108, 137
-    Carpal bones, 180, 181
-    Carpus or wrist, 180, 181
-    Cartilage, 16
-    Cartilages, arytenoid, 122
-      costal, 98
-      cricoid, 121
-      thyroid, 121
-      triangular, 57
-    Casein, 11
-    Cauda equina, 79, 91
-    Cecum, 145
-    Celiac axis, 109, 150, 153
-    Cells, 12, 13
-    Central canal of cord, 81
-    Cephalocele, 53
-    Cerebellum, 51, 78
-    Cerebral arteries, 77
-      veins, 78
-    Cerebro-spinal fluid, 34, 76, 79
-      meningitis, 79
-      nervous system, 75, _et seq._
-    Cerebrum or brain proper, 51, 75
-    Cervical nerves, 84
-      plexus, 84
-      vertebræ, 90, 91
-    Cervix of uterus, 168
-    Chemical composition of the body, 11
-      of bone, 18
-    Chest or thorax, 96
-      arteries, 99
-      bones, 97, 98
-      muscles, 98, 99
-      nerves, 99
-    Cholesterin, 143
-    Chordæ tendineæ, 104
-    Choroid, 68
-    Chromatic aberration, 73
-    Chyle, 32, 33, 144
-    Chyme, 139, 140
-    Cilia, 15, 27
-    Ciliary muscles, 69, 72
-      processes, 69, 72
-    Circle of Willis, 78, 108
-    Circulation of the blood, fetal, 106, 107
-      portal, 109, 110
-      pulmonary, 110
-      systemic, 105, 106, 107, _et seq._, 112, 113
-    Circumflex artery, 186
-    Circumflex nerve, 85, 186
-    Circumvallate papillæ, 61
-    Cirrhosis of liver, 152
-    Clavicle, 171
-    Cleft palate, 55
-    Clitoris, 170
-    Clotting of blood, 23, 117, 118
-      of lymph, 33
-      of muscle, 23
-    Club-foot, 195
-    Coccygeal nerve, 84
-      vertebræ, 90
-    Coccyx, 90, 161
-    Cochlea, 64, 65
-    Colles’ fracture, 171, 180
-    Color blindness, 73
-      perception, 73
-    Coloring matters, 12
-      of bile, 143, 151
-      of blood, 119
-    Colon, ascending, 145
-      descending, 145
-      transverse, 145
-    Columnæ carneæ, 104
-    Commissures of cord, 80
-    Common bile duct, 150
-    Communicating arteries, 78
-    Compact tissue of bone, 17, 18
-    Condyles, humerus, 175
-      femur, 189
-    Conjunctiva, 67
-    Conjugate focus, 71
-    Convolutions of brain, 76
-    Connective tissue, 15, _et seq._
-      areolar, 15
-      bony, 17
-      cartilaginous, 16
-      elastic, 15
-      fatty or adipose, 16
-      fibrous, 15
-    Coraco-brachialis, 177
-    Coracoid process of scapula, 173
-    Cordiform tendon, 98
-    Cornea, 27, 68, 70
-    Cornicula laryngis, 122
-    Coronary artery, 107
-      sinus, 105
-      valve, 105
-    Coronal suture, 48
-    Coronoid fossa, 175
-      process, 178
-    Corpus luteum, 166
-    Corpuscles of blood, 116, 118, _et seq._
-      tactile, 37, 39, 46
-    Corti, organ of, 65
-    Costal cartilages, 98
-    Coughing, 131
-    “Coxa vera,” 189
-    Cranial nerves, 77, 78, 83, 84
-    Craniotabes, 53
-    Cranium, bones of, 48, _et seq._
-    Cribriform plate of ethmoid bone, 53
-    Cricoid cartilage, 121
-    Crista galli, 53
-    Cross eye, 72
-    Crossed pyramidal tract, 82
-    Crucial ligaments, 193
-    Crural nerves, 85, 199
-    Crureus, 190
-    Crying, 131
-    Crypts of Lieberkühn, 143, 144, 145
-    Crystalline lens, 69, 70
-    Cuboid bone, 195
-    Cuneiform bones, ankle, 195
-                     wrist, 181
-          cartilages, 122
-    Cutaneous nerves, 46, 85
-    Cystic duct, 143, 152
-
-    Deltoid, 174
-    Dendrites, 36
-    Derma, 39
-    Descending aorta, 107
-      colon, 145
-    Diabetes mellitus, 151, 196
-    Diaphragm, 98, 99, 128
-    Diaphysis, 18
-    Diastole, 104, 106
-    Differentiation of tissues, 13
-    Digestion, in mouth, 136
-      in small intestine, 143, 144
-      in stomach, 139, 140
-      of fats, 144
-      of proteids, 140, 144
-      of starch, 136, 144
-    Digital arteries, 186
-    Diphtheria, 35
-    Diploë, 20, 48
-    Direct cerebellar tract, 82
-      pyramidal tract, 80, 82
-    Dislocation, 180, 193, 194
-    Diuretics, 158
-    Dorsal or thoracic nerves, 84, 85
-      vertebræ, 90, 91
-    Dorsalis pedis artery, 199
-    Duct, common bile, 150
-      cystic, 143, 152
-      ejaculatory, 165
-      hepatic, 143, 150
-      lachrymal, 68
-      of Rivinus, 62
-      pancreatic, 153
-      right lymphatic, 31, 32
-      Stensen’s, 62
-      Wharton’s, 62
-    Ductless glands, 36
-    Ductus arteriosus, 106, 107
-      communis choledochus or common bile duct, 150
-    Duodenum, 142
-    Dupuytren’s contraction, 184
-    Dura mater, 15, 76, 79
-    Ear, 63, _et seq._
-      external, 63
-        function of, 65
-      internal, 64
-        function of, 65
-      middle, 63
-        function of, 65
-    Edema, 33, 34, 122
-    Eighth nerve, 64, 84
-    Ejaculatory duct, 165
-    Elbow, 32
-      joint, 185
-    Elastic tissue, 15
-    Eleventh nerve, 84
-    Emmetropic eye, 72
-    Emphysema, 97
-    Empyema of gall-bladder, 152, 153
-      of lungs, 126
-    End bulbs, 37
-    Endocardium, 103
-    Endolymph, 64, 65
-    Endosteum, 18
-    Endothelium, 14, 40
-    Ensiform cartilage, 97
-    Epidermis, 27, 39
-    Epigastric artery, 198
-    Epigastrium, 135
-    Epiglottis, 60, 121, 136
-    Epiphysis, 18, 189, 193
-    Epithelium, 14, 27
-      ciliated, 15, 27
-      columnar, 14
-      glandular, 14
-      pavement, 14
-      simple, 14
-      stratified, 14
-    Erythrocytes, 118, 119
-    Esophagus, 138
-    Ethmoid bone, 53
-    Eustachian tubes, 52, 63
-      valve, 106, 107
-    Excreting glands, 35
-    Extensor carpi radialis longior, 182, 183
-                            brevior, 182, 183
-      ulnaris, 182, 183
-      communis digitorum, 182, 184
-      indicis, 182, 184
-      minimi digiti, 182, 184
-      ossis metacarpi pollicis, 182, 183
-      primi internodii pollicis, 182, 183
-      secundi internodii pollicis, 182, 183
-    Eye, 66, _et seq._
-      accommodation, 72
-      coats of, 68
-      color of, 69
-      formation of image in, 70, _et seq._
-      humors of, 70
-      muscles of, 67
-      nerves of, 67, 68
-      teeth, 60
-    Eyeball, 66
-    Eyebrows, 66
-    Eyelashes, 67
-    Eyelids, 66, 67
-
-    Face, bones of, 53, _et seq._
-    Facial artery, 28
-      nerve, 83, 84
-    Fallopian tubes, 166, 167
-    Far-sightedness, 72, 73
-    Fat or adipose tissue, 16
-    Fats, 12, 147, 148
-      absorption, 144
-      digestion, 143, 144
-    False pelvis, 163
-      ribs, 97
-    Fascia, lumbar, 133
-    Fascia, palmar, 184
-      plantar, 198
-    Fasciæ, 15, 21
-    Fasciculi, 21
-    Fauces, pillars of, 59
-    Feces, 146
-    Female generative organs, 163, 165, _et seq._
-    Femoral artery, 190, 198
-    Femur, 187
-    Fenestra ovalis, 63, 65
-      rotunda, 65
-    Ferments, 12, 136, 144
-    Fetal circulation, 106, 107
-    Fetus, 111
-    Fever, 45
-    Fibrin, 11, 23, 33, 117
-      ferment, 117
-    Fibrinogen, 117
-    Fibrous tissue, 15
-    Fibula, 194, 195
-    Fifth nerve, 83
-    Filum terminale, 78, 91
-    Fimbriæ, 167
-    First nerve, 83
-    Fissure of Rolando, 75, 82
-      of Sylvius, 75
-    Flexor carpi radialis, 182, 183
-                 ulnaris, 182, 183
-      longus pollicis, 182, 183
-      profundus digitorum, 182, 183
-      sublimis digitorum, 182, 183
-    Floating ribs, 97
-    Follicles, Graafian, 166
-    Fontanelles, 19, 49
-    Food, 147
-      amount, 148
-      classes of, 147
-      cooking, 148
-      function, 147, 148
-    Foot, bones of, 195, 196
-      muscles of, 198
-    Foramen, intervertebral, 90
-      magnum, 50
-      nutrient, 19
-      obturator, 163
-      of Majendie, 79
-      optic, 66, 70
-      ovale, 106
-    Foreign bodies, 118, 122, 137, 146
-    Fossa, coronoid, 175
-      glenoid, 51
-      iliac, 163
-      nasal, 55, 57
-      olecranon, 175
-    Fourchette, 170
-    Fourth nerve, 68, 83
-    Fovea centralis, 70
-    Fractures, 98, 164, 171, 174, 175, 177, 180, 181, 193, 194, 195, 196
-    Frenum of tongue, 60
-    Frontal bone, 48, 49
-
-    Gall-bladder 143, 152, 153
-      stones, 143
-    Ganglia, 87, 110
-    Gangrene, 180, 199
-    Gastric artery, 109
-      glands, 35
-      juice, 139
-      vein, 110, 150
-    Gastrocnemius, 196
-    Generative organs, female, 163, 165, _et seq._
-      male, 163, 164, 165
-    Genito-crural nerve, 85
-    Gladiolus 97
-    Glands, 32, 35, 36
-      ductless, 36
-      excreting, 35
-      functions, 36
-      gastric, 35
-      lachrymal, 68
-      lymphatic, 32, 34, 35
-      mammary, 99, 100
-      Meibomian, 67
-      of Lieberkühn, 143, 144, 145
-      parotid, 51, 62
-      Peyer’s, 142
-      procreating, 165
-      prostate, 164, 165
-      racemose, 35
-      salivary, 35, 61, 136
-      sebaceous, 35, 40, 41
-      secreting, 35
-      solitary, 142, 145
-      sublingual, 56, 62
-      submaxillary, 56, 62
-      sweat, 35, 42
-      thymus, 124
-      thyroid, 124
-    Glenoid cavity, 173
-            fossa, 51
-    Globulin, 11
-    Glosso-pharyngeal nerve, 61, 84
-    Glottis, 122, 129
-    Gluteal nerves, 199
-    Glutei muscles, 190
-    Glycogen, 26, 36, 150, 151
-    Goiter, 124
-    Gonorrhea, 160, 168
-    Graafian follicles, 166
-    Gray matter of brain and cord, 36, 75, 76, 78, 80, 81
-    Green-stick fracture, 19
-    Groin, glands of, 32, 35
-    Gustatory cells, 61
-
-    Hair, 27, 40
-      follicle, 40
-    Hamstring, inner, 191
-      outer, 191
-    Hard palate, 55, 59
-    Haversian canals, 17
-    Hearing, sense of, 65
-    Heart, 101, _et seq._
-      beat, 102, 104, 111, 112
-      nerves, 110, 111
-      position, 102
-      sounds, 111
-      structure, 103, 104
-    Heat center, 45
-      production, 44
-      prostration, 45
-      stroke, 45
-    Hemoglobin, 119, 130
-    Hemorrhage, 139, 186
-    Hemorrhoidal veins, 146
-    Hemorrhoids, 146
-    Henle’s loops, 156
-    Hepatic artery, 109, 150
-      duct, 143, 150
-      flexure, 145, 146
-      veins, 110
-    Hernia, 146, 164
-    Hiccough, 99, 131
-    Highmore, antrum of, 54, 57
-    Hilum of kidney, 155
-    Hip-joint, 192
-    Housemaid’s knee, 194
-    Humerus, 175
-    Humors of eye, 70
-    Humpback or Pott’s disease, 91
-    Hydrocarbons, 12
-    Hydrocephalus, 34
-    Hydrochloric acid, 139, 140
-    Hydrothorax, 34
-    Hymen, 170
-    Hyoid bone, 60
-    Hypermetropia or far-sightedness, 72, 73
-    Hypochondriac regions, 135
-    Hypogastric plexus, 87
-      region, 135
-    Hypoglossal nerve, 84
-
-    Idiocy, 53
-    Ileo-cecal valve, 142, 145
-    Ileo-pectineal line, 163
-    Ileum, 142
-    Iliac artery, common, 107, 109
-      deep circumflex, 198
-      external and internal, 95, 109, 198
-      fosssæ, 163
-    Ilio-hypogastric nerve, 85
-    Ilio-inguinal nerve, 85
-    Ilium, 161, 162
-    Impacted hip, 193
-    Incisor teeth, 60
-    Incus, 63
-    Infundibula of lung, 125, 127
-    Inguinal regions, 135
-    Innominate artery, 107
-      bone, 161, 162
-      veins, 109
-    Inorganic compounds in body, 12
-    Intercostal arteries, 95, 97, 100, 108
-      muscles, 98, 128
-      nerves, 85, 97, 99, 134
-    Intercellular substance, 14, 17
-    Interossei muscles, 184
-    Interosseous nerves, 85, 186
-    Internal secretion, 36
-    Intervertebral foramen, 90
-    Intestines, 141, _et seq._
-      large, 141, 145
-        function, 146
-        glands, 145
-        nerves, 145
-        structure, 145, 146
-      small, 141, 142, _et seq._
-        blood-vessels, 143
-        function, 143, 144
-        glands, 142, 143
-        nerves, 143
-        structure, 142
-    Intima, 27
-    Intralobular vein, 150
-    Intussusception, 146
-    Involuntary muscle, 21
-    Iris, 68, 69, 72
-    Ischium, 161, 163
-    Island of Reil, 75
-
-    Jaundice, 35, 152, 153, 158
-    Jejunum, 142
-    Joints, 15, 20
-      classes of, 20, 21
-      ankle, 195
-      elbow, 21, 185
-      hip, 21, 192
-      knee, 193
-      motion of, 20, 21
-      shoulder, 21, 185
-      wrist, 185
-    Jugular veins, 109
-    Juice, gastric, 139
-      pancreatic, 143, 144, 153
-
-    Katabolism, 147
-    Kidneys, 155, _et seq._
-      floating, 159
-      function, 156, _et seq._
-      position, 155
-      structure, 155, 156
-    Knee-jerk, 83
-    Knee-joint, 193
-
-    Labia majora, 169
-      minora or nymphæ, 170
-    Labyrinth, membranous, 64, 65
-      osseous, 64
-    Lachrymal bones, 48, 54
-      canal, 54, 57
-      duct, 68
-      gland, 68
-      sac, 54, 68
-    Lacteals, 32, 144
-    Lacunæ of bone, 17
-    Lambdoidal suture, 48
-    Lamellæ of bone, 17
-    Laminæ of vertebræ, 89
-    Large intestine, 141, 145
-    Laryngitis, 122
-    Laryngotomy, 122
-    Larynx, 121
-    Latissimus dorsi, 93
-    Laughing, 131
-    Lens, crystalline, 69, 70
-    Leucocytes, 33, 34, 119, 120
-    Levator scapulæ, 93
-    Levatores of ribs, 129
-    Lieberkühn, glands of, 143, 144, 145
-    Ligaments, 15, 20, 21
-      annular, 184, 198
-      broad, of uterus, 165, 166, 168
-      capsular, of hip, 21, 193
-      crucial, of knee, 193
-      orbicular, 178
-      Poupart’s, 132
-      round, of uterus, 168
-      suspensory, of liver, 149
-      thyro-arytenoid, 122
-    Ligamentum nuchæ, 50, 91, 93
-      patellæ, 190, 192, 193, 194
-      teres, 187
-    Line, Nélaton’s, 189
-    Linea alba, 132
-      aspera, 187
-    Liver, 36, 149, _et seq._
-      blood supply, 150
-      diseases of, 152
-      function, 150, _et seq._
-      position, 149
-      structure, 149, 150
-    Loops of Henle, 156
-    Lower extremities, 187, _et seq._
-    Lumbar artery, 95, 109
-      fascia, 133
-      nerves, 84, 85
-      plexus, 84
-      regions, 135
-      vertebræ, 90
-    Lumbricales, 184
-    Lungs, 125, _et seq._
-      function, 127, _et seq._
-      nerves, 127
-      position, 126
-      structure, 126, 127
-    Lupus, 58
-    Lymph, 30, 32
-      capillaries, 30
-      character, 32, 33
-      flow of, 33
-      function, 34
-      spaces, 30
-      transudation of, 33
-    Lymphatic glands, 32, 34, 35
-      system, 27, 29, _et seq._
-      vessels, 30, 31
-        valves of, 31, 32, 33
-
-    Macula lutea, 70
-    Malar or cheek bone, 48, 54
-    Malaria, 154
-    Male organs of generation, 163, 164, 165
-    Malleolus of fibula, 194, 195
-      of tibia, 194
-    Malleus, 63
-    Malpighian bodies, 156
-      pyramids, 156
-    Mammary artery, internal, 99, 100, 108
-      glands, 99, 100
-    Manubrium, 97
-    Marrow of bone, 18
-    Masseter, 51, 54
-    Mastoid abscess, 51, 52
-      cells, 51, 64
-      portion of temporal bone, 51
-    Maxillary bone, inferior, 48, 55
-      superior, 48, 54
-    McBurney’s point, 145
-    Meatus, auditory, 52, 65
-      nasal, 57
-      urinarius, 160, 165, 170
-    Median, cephalic vein, 109
-      nerve, 85, 186
-      vein, 109
-    Mediastinal artery, 99
-    Mediastinum, 32, 126
-    Medulla or marrow, 18
-    Medulla oblongata, 78, 79, 82
-    Medullary artery, 19
-      canal, 19
-      sheath, 37
-    Meibomian duct, 74
-      glands, 67
-    Membrana tympani or drum, 63
-    Membranous labyrinth, 64, 65
-    Mesenteric arteries, 109, 143, 145, 153
-      veins, 110, 150
-    Mesenteries, 32, 134
-    Metabolism, 45, 147, 151, 152
-    Metacarpal bones, 181
-    Metatarsal bones, 195
-    Micturition, 157
-    Milk teeth, 60
-    Mitral valve, 104
-    Molar teeth, 60
-    Monometer, 114
-    Mons Veneris, 169
-    Motor areas, 81, 82
-      center, 81, 82
-      oculi nerve, 68, 83
-      tract, 82
-    Mouth, 59, _et seq._
-    Mucous membrane, 40
-    Mucus, 40
-    Mumps, 62
-    Muscle, 21, _et seq._
-      action, 23, 24
-      cardiac, 22, 25
-      characteristics, 22, 23, 24, 25
-      classes of, 21
-      fatigue of, 26, 27
-      function of, 24
-      smooth, 21, 25
-      sounds, 25
-      striated, 21, 23, 25
-      work, 25, 26
-    Muscles of abdomen, 132, _et seq._
-      of arm, 175, 176, 177
-      of back, 93, 94
-      of chest, 98, 99, 128
-      of foot, 198
-      of forearm, 182
-      of hand, 184
-      of head, 50, 51, 54, 55, 58, 67, 69
-      of leg, 196, _et seq._
-      of neck, 51, 92, 93, 129
-      of shoulder, 174
-      of thigh, 189, _et seq._
-    Musculo-cutaneous nerve, 85, 186, 199
-    Musculo-spiral nerve, 85, 175, 186
-    Musical sounds, 65
-    Myopia or near-sightedness, 72, 73
-    Myosin, 11, 23
-    Myosinogen, 23
-
-    Nails, 27, 40
-    Nares, 57
-    Nasal bones, 55
-      duct, 68
-      fossæ, 55, 57
-      meatus, 57
-    Nasal septum, 55
-    Navicular or scaphoid bone, 195
-    Near-sightedness, 72, 73
-    Neck, glands of, 32
-      muscles of, 51, 92
-    Nélaton’s line, 189
-    Nerve, 37
-      action of, 37, 38, 83
-      cell or gray matter, 36
-      fiber or white matter, 36
-      function, 37
-      ganglia, 87, 110
-      motor, 82
-      plexus, 29, 84, _et seq._
-      sensory, 82, 83
-      terminations, 37
-    Nerves, 24, 36
-      abducens, 83
-      auditory, 64, 65, 84
-      cardiac, 78
-      cervical, 84
-      circumflex, 85, 186
-      coccygeal, 84
-      cranial, 77, 78, 83, 84
-      crural, anterior, 85, 199
-      cutaneous, 46, 85
-      dorsal or thoracic, 84, 85
-      eighth, 64, 84
-      eleventh, 84
-      facial, 83
-      fifth, 83
-      first, 83
-      fourth, 68, 83
-      genito-crural, 85
-      glosso-pharyngeal, 61, 84
-      gluteal, 199
-      hypoglossal, 84
-      ilio-hypogastric, 61, 85
-      ilio-inguinal, 85
-      intercostal, 85, 97, 99, 134
-      interosseous, 85, 186
-      lumbar, 84, 85
-      median, 85, 186
-      motor oculi, 68, 83
-      musculo-cutaneous, 85, 186, 199
-      musculo-spiral, 85, 175, 186
-      ninth, 84
-      obturator, 85
-      olfactory, 53, 58, 83
-      optic, 70, 71, 76, 83
-      patheticus, 83
-      phrenic, 85, 99, 130
-      plantar, 85
-      pneumogastric, 84, 110, 111, 127, 130, 153
-      popliteal, 85, 199
-      post-tibial, 85
-      radial, 85
-      sacral, 84
-      sciatic, 85, 163, 199
-      second, 70, 83
-      seventh, 83
-      sixth, 68, 83
-      spinal, 84, 95
-        accessory, 84, 95, 137
-      suprascapular, 186
-      sympathetic, 87, 110, 127, 137, 143, 145, 168
-      tenth, 84
-      third, 68, 72, 83
-      thoracic, 186
-        cutaneous, 100
-      tibial, 86, 87, 199
-      trifacial, 61, 83
-      twelfth, 84
-      ulnar, 85, 175, 186
-      vagus, 84, 110, 111, 127, 130, 153
-      vasoconstrictors, 115
-        dilators, 115
-        motor, 29, 78, 115
-    Nervous system, 38, 75, _et seq._
-      tissue, 13, 36
-    Neurilemma, 37
-    Ninth nerve, 84
-    Nipple, 100
-    Nose, 57, 58
-      bleed, 59
-    Nucleolus, 12
-    Nucleus, 12
-    Nutrient foramen, 19
-    Nymphæ, 170
-
-    Oblique muscles of abdomen, 132
-      of eye, 68
-    Obturator foramen, 163
-      nerve, 85
-    Occipital bone, 48, 50
-    Occipito-frontalis muscle, 51
-    Odontoid process of axis, 91
-    Olecranon fossa, 175
-      process, 178
-    Olfactory bulbs, 53, 58, 76
-      cells, 58
-      grooves, 53
-      nerves, 53, 58, 83
-      tract, 58, 76
-    Omenta, 134, 146
-    Ophthalmic artery, 70
-    Optic axis, 70
-      commissure, 76
-      foramen, 66, 70
-      nerve, 70, 71, 76, 83
-      tract, 76
-    Orbicular ligament, 178
-    Orbicularis palpebrarum, 67
-    Orbit of eye, 54, 66
-    Organ of Corti, 65
-    Organic compounds in body, 11, 12
-    Os calcis, 195
-      innominatum, 161, 162
-      magnum, 181
-      uteri, 168
-    Osseous labyrinth, 64
-    Ossicles of ear, 63, 65
-    Osteoblasts, 18
-    Osteomalacia, 164, 189
-    Osteomyelitis, 193
-    Oval window, 63, 64, 65
-    Ovaries, 165
-    Ovum, 12, 166, 168
-    Oxyhemoglobin, 130
-
-    Paget’s disease, 53
-    Pain, sensation of, 47, 81
-    Palate, bones of, 48, 54
-      cleft, 55
-      hard, 55, 59
-      soft, 59, 60, 136
-    Palmar, arch, 186
-      fascia, 184
-    Palmaris longus, 182, 183
-    Pancreas, 153
-    Pancreatic duct, 143, 153
-      juice, 143, 144, 153
-    Pancreatitis, 153
-    Panhysterectomy, 169
-    Papillæ of skin, 37, 39
-      of tongue, 61
-    Paralysis, 79
-    Parietal bone, 48, 49
-    Parotid gland, 51, 62
-    Patella or knee-cap, 19, 192
-    Patheticus nerve, 83
-    Pectoral muscles, 99, 128
-    Pectoralis major, 174
-    Pedicles of vertebræ, 89
-    Pelvis, 132, 161, _et seq._
-      false, 163
-      of kidney, 156
-      true, 163, 164
-    Penis, 160, 165
-    Pepsin, 140
-    Peptones, 12, 140, 150
-    Pericardium, 34, 101, 102
-    Perichondrium, 16
-    Perineal body, 170
-    Perineum, 170
-    Perilymph, 64, 65
-    Periosteum, 15, 18, 19, 76
-    Peripheral resistance, 112, 114
-    Peristaltic movements, 138, 143, 146
-    Peritoneum, 134
-    Permanent teeth, 60
-    Peroneal artery, 199
-    Peroneus brevis, 197
-      longus, 197
-    Petrous portion of temporal bone, 51, 52
-    Peyer’s patches or glands, 142
-    Phalanges of foot, 195
-      of hand, 181
-    Pharynx, 59, 136, 137
-    Physiology, 11
-    Phrenic artery, 99, 109
-      nerve, 85, 99, 130
-    Pia mater, 76
-    Pigeon breast, 97
-    Pillars of the fauces, 59, 60
-    Pink eye, 74
-    Pinna, 63
-    Pisiform bone, 181
-    Pituitary body, 36
-    Placenta, 106, 107
-    Plantar artery, 199
-      fascia, 198
-      nerve, 86
-    Plantaris, 197
-    Plasma of blood, 33, 116, 117
-    Platysma myoides, 92
-    Pleuræ, 34, 125
-    Plexus, 29
-      brachial, 84, 85
-      cardiac, 87
-      cervical, 84
-      hypogastric, 87
-      lumbar, 84
-      sacral, 84, 85
-      solar, 87, 153
-    Pneumogastric nerve, 84, 110, 127, 153
-    Polypi, 58
-    Pons Varolii, 78
-    Popliteal artery, 198
-      nerves, 86, 199
-      space, 32, 198
-    Popliteus muscle, 198
-    Portal circulation, 110
-      vein, 110, 150
-    Pott’s disease, 91
-      fracture, 180, 195
-    Poupart’s ligament, 132
-    Prepatella bursa, 192
-    Prepuce, 165
-    Presbyopia, 73
-    Presternal notch, 171
-    Procreating glands, 165
-    Profunda artery, 175, 186
-      femoris artery, 198
-    Promontory of the sacrum, 90
-    Pronator quadratus, 182, 183
-      radii teres, 182, 183
-    Prostate gland, 164, 165
-    Proteins, 11, 26, 33, 140, 144, 147, 148
-    Protoplasm, 12, 13
-    Psoas magnus, 189, 190
-      parvus, 190
-    Ptosis of liver, 152
-      of upper lid, 74
-    Ptyalin, 61, 136
-    Pubes, 161, 163
-    Pudic artery, 168
-    Pulmonary artery, 106, 110
-      circulation, 110
-      valves, 104
-      veins, 105, 110
-    Pulse, 112, 113, 114, 115
-    Pulse, causes, 112
-      dicrotic, 113
-      rate, 111, 113, 114
-    Pupil of eye, 69, 72
-    Pus corpuscles, 120
-    Pylorus, 138
-    Pyramidalis muscle, 134
-    Pyramids, Malpighian, 156
-
-    Quadratus lumborum, 134
-    Quadriceps extensor, 190
-
-    Radial artery, 108, 185
-      nerve, 85
-    Racemose glands, 35
-    Radius, 178, 179
-    Râles, 129
-    Receptaculum chyli, 32
-    Recti muscles of eye, 67, 72
-    Rectum, 145, 146
-    Rectus abdominis, 133, 134
-      capitis anticus major, 93
-      femoris, 190
-    Red corpuscles, 118, 119
-    Reflex action, 83
-    Regions, abdominal, 134, 135
-    Renal artery, 109
-    Rennin, 140
-    Respiration, 121, 127, _et seq._
-      center of, 78, 130
-      effect on air, 129, 130
-      effect on blood, 130, 131
-      forced, 128, 129
-      kinds of, 128
-      rate, 128
-      sounds, 129
-      variations in, 131
-    Retching, 140
-    Retina, 68, 69, 70
-    Rheumatism, 25
-    Rhomboideus muscles, 93
-    Rickets, 19, 49, 53, 97, 164, 195
-    Ribs, 97, 98
-    Right lymphatic duct, 31, 32
-    Rigor mortis, 22, 23
-    Rivinus, ducts of, 62
-    Rodent ulcer, 74
-    Rods and cones, 69, 70
-    Rolando, fissure of, 75, 82
-    Rosary, 97
-    Round ligament of uterus, 168
-    Round window, 64, 65
-    Rupture, 146, 164
-      of kidney, 158
-      of liver, 152
-      of spleen, 154
-      of urethra, 160
-
-    Sacral nerves, 84
-      plexus, 84, 85
-      vertebræ, 90
-    Sacro-sciatic notch, 163
-    Sacrum, 90, 161
-    Sagittal suture, 48
-    Saliva, 61, 136
-    Salivary glands, 35, 61, 136
-    Salpingectomy, 169
-    Saphenous veins, 109, 199
-    Sarcolemma, 21
-    Sarcoma, 173, 177, 193
-    Sartorius muscles, 23, 190
-    Scalenus muscles, 93, 128
-    Scaphoid bone, ankle, 195
-      wrist, 181
-    Scapula, 173
-    Scarlet fever, 35
-    Scarpa’s triangle, 190, 198
-    Schwann, white substance of, 37
-    Sciatic nerve, 85, 163, 199
-    Sclera or sclerotic coat, 68
-    Scrotum, 165
-    Sebaceous glands, 35, 40, 41
-    Sebum, 41
-    Second nerve, 70, 83
-    Secreting glands, 35
-    Segmentation, growth by, 12
-    Semen, 165
-    Semicircular canals, 64, 66
-    Semilunar bones, 181
-      cartilages, 193, 194
-      valves, 28, 32, 104
-    Semimembranosus muscle, 191
-    Semitendinosus muscle, 191
-    Sense, organs of, 57, _et seq._
-      of hearing, 65
-      of sight, 70, _et seq._
-      of smell, 55, 57, 58, 61
-      of taste, 55, 61
-      of touch, 45, _et seq._
-    Sensory nerves, 82, 83
-      tract, 82
-    Septum of nose, 55
-      deviation of, 58
-    Serous membrane, 40
-    Serratus magnus, 174
-    Serum albumin, 11
-      of blood, 117
-    Sesamoid bones, 19
-    Seventh nerve, 83
-    Shin, 194
-    Shoulder girdle, 171
-      joint, 185
-    Sighing, 131
-    Sight, sense of, 70, _et seq._
-    Sigmoid cavities, 178
-      flexure, 145, 146
-    Silent areas in brain, 82
-    Silver fork deformity, 180
-    Sinuses, 28, 49, 51, 52, 78, 105
-    Sixth nerve, 68, 83
-    Skin, 39, _et seq._
-    Skull, bones of, 48, _et seq._
-    Small intestine, 141, 142, _et seq._
-    Smell, sense of, 55, 57, 58, 61
-    Smooth muscle, 21, 25
-    Sneezing, 131
-    Sobbing, 131
-    Soft palate, 59, 60, 136
-    Solar plexus, 87, 153
-    Soleus, 196
-    Solitary glands, 142, 145
-    Sounds, 65, 66
-    Special senses, 57, _et seq._
-    Speech, 122
-      center, 82
-    Spermatic or ovarian artery, 109, 168
-      cords, 165
-    Spermatozoa, 165
-    Sphenoid bone, 48, 52
-    Sphincter of anus, 146
-      of pupil, 72
-      of pylorus, 138
-    Spina bifida, 91
-    Spinal accessory nerve, 84, 95, 137
-      canal, 91
-      column, 88
-      cord, 79, _et seq._
-      foramen, 89
-      nerves, 84, 95
-    Spine, 87
-    Spinous process of vertebræ, 89
-    Spleen, 153, 154
-    Splenic artery, 109, 153
-      flexure, 145, 146
-      vein, 110, 150
-    Sprain, 21
-    Squamous portion of temporal bone, 51
-    Stapes, 63
-    Starches, 12, 136, 144
-    Steapsin, 144
-    Stensen’s duct, 62
-    Sterno-cleido-mastoid muscle, 51, 92, 171
-    Sternum, 97
-    Stimuli, 24
-    Stomach, 138
-      arteries, 139
-      digestion in, 139, 140
-      glands, 139
-      position, 138
-      structure, 139
-    Stomach teeth, 60
-    Strabismus, 72
-    Striated or striped muscle, 21, 23, 25
-    Stricture of esophagus, 138
-      of urethra, 160
-    Sty, 74
-    Styloid process of fibula, 195
-      of radius, 178, 179
-      of temporal bone, 52
-      of ulna, 178, 179
-    Subarachnoid space, 76, 79
-    Subclavian arteries, 94, 99, 107, 108, 185
-      veins, 109
-    Subclavius muscle, 173
-    Subdural space, 76
-    Sublingual gland, 56, 62
-    Submaxillary gland, 56, 62
-    Succus entericus, 143, 144
-    Sugar in urine, 151, 158
-    Superciliary ridges, 49
-    Supinator brevis, 182, 184
-      longus, 182, 184
-    Supraorbital foramen or notch, 49
-      vessels and nerve, 49
-    Suprarenal artery, 109
-      capsules, 36, 154
-    Suprascapular artery, 94
-      nerve, 186
-    Suspensory ligament of lens, 70, 72
-                        of liver, 149
-    Sutures, 48, 53
-      coronal, 48
-      lambdoidal, 48
-      sagittal, 48
-    Sweat, composition, 42
-      functions, 42
-      glands, 35, 42
-      nervous control of, 42
-      quantity, 43
-    Sylvius, fissure of, 75
-    Sympathetic nerve, 87, 110, 127, 137, 143, 145, 168
-      system, 75, 87
-    Symphysis pubis, 163
-    Synovial fluid, 20, 34
-      membrane, 20
-    Syphilis, 35, 58, 122, 152, 182, 194
-    Systemic circulation, 105, 106, 107, _et seq._, 112, 113
-    Systole, 104, 106, 112
-
-    T-fracture, 177, 193
-    Tablets of skull, 20, 48
-    Tactile corpuscles, 37, 39, 46
-    Tarsus or ankle, 195
-    Taste buds, 61
-      nerves of, 61
-      sense of, 55, 61
-    Tears, 68
-    Teeth, 27, 60
-    Temperature of body, 43
-      regulation of, 43
-      sensation of, 47
-      variations in, 44
-    Temporal bone, 48, 51
-      muscle, 50, 51, 55
-    Temporary or milk teeth, 60
-    Tendo Achillis, 195, 197
-    Tendons, 15, 23
-    Tenth nerve, 84
-    Testes or testicles, 165
-    Third nerve, 68, 72, 83
-    Thoracic aorta, 99, 107, 109
-      duct, 31
-      nerves, 186
-    Thoracic cutaneous nerve, 100
-    Thorax, 96
-    Thymus gland, 36, 124
-    Thyro-arytenoid ligaments, 122
-    Thyroid axis, 108
-      cartilage, 121
-      gland, 36, 124
-    Tibia or shin bone, 194
-    Tibial artery, 198
-      nerve, 76, 87, 199
-    Tibialis anticus, 197
-    Tissues, areolar, 15
-      bony, 13, 17
-      cartilaginous, 13
-      connective, 13, 15
-      differentiation of, 13
-      elastic, 15
-      epithelial, 13
-      fibrous, 15
-      muscular, 13
-      nervous, 13, 36
-    Tongue, 46, 59, 60
-      tie, 62
-    Tonsillitis, 35, 62
-    Tonsils, 59, 62
-    Torticollis, 92
-    Touch, corpuscles, 37, 39, 46
-      sense of, 45, _et seq._
-    Trachea, 123
-    Tracheotomy, 123
-    Transudation of lymph, 33
-    Transversalis muscle, 133
-      colli artery, 94
-    Transverse colon, 145
-      processes of vertebræ, 89
-    Trapezium, 181
-    Trapezius, 93, 171
-    Trapezoid bone, 181
-    Triangular cartilage, 57
-    Triceps, 176, 177
-    Tricuspid valve, 104
-    Trifacial nerve, 61, 83
-    Trochanters, 189
-    Trochlear surface of femur, 189
-      of humerus, 175
-    True pelvis, 163, 164
-      ribs, 97
-    Trypsin, 144
-    Tuberculosis, 35, 122, 155, 159, 168, 182, 193, 194, 196
-    Tuberosities of humerus, 175
-      of tibia, 194
-    Tuberosity of ischium, 163
-      of radius, 178
-    Tubuli lactiferi, 100
-    Tumor albus, 194
-    Tumors, 100, 175
-    Tunica vaginalis oculi, 67
-    Turbinated bones, 48, 53, 54
-    Twelfth nerve, 84
-    Tympanum, 51, 63
-    Typhoid fever, 142, 154
-
-    Ulcer, 139
-    Ulna, 177, 178, 185
-    Ulnar artery, 108
-      nerve, 85, 175, 186
-    Umbilical artery, 107
-      region, 135
-      vein, 106
-    Unciform bone, 181
-    Unstriated or unstriped muscle, 21, 22, 25
-    Upper extremities, 171, _et seq._
-    Urea, 148, 152, 158
-    Ureters, 155, 156, 159
-    Urethra, 159, 160, 165
-    Urinary apparatus, 155, _et seq._
-    Urine, 156, _et seq._
-    Uterine artery, 168
-    Uterus, 167, 168
-    Uvula, 59
-
-    Vagina, 168
-    Vagus or pneumogastric nerves, 84, 110, 111, 130
-    Valves, 103
-      aortic, 104
-      bicuspid or mitral, 104
-      coronary, 105
-      Eustachian, 106, 107
-      ileo-cecal, 142, 145
-      of lymphatic vessels, 31, 32, 33
-      of veins, 28
-      pulmonary, 104
-      semilunar, 28, 32, 104
-      tricuspid, 104
-    Valvulæ conniventes, 142
-    Varicose veins, 109, 113, 199
-    Vas deferens, 165
-    Vasa nervorum, 37
-       vasorum, 29
-    Vasoconstrictor nerves, 115
-      dilator nerves, 115
-      motor nerves, 29, 78, 115
-    Vascular system, 107, et seq.
-    Vastus externus, 190
-      internus, 190
-    Veins, 27, 28, 29, 109
-      basilic, 109
-      deep, 28
-      gastric, 110, 150
-      hemorrhoidal, 146
-      hepatic, 110, 150
-      iliac, common, 109
-      inferior vena cava, 105, 109, 150
-      innominate, 109
-      intralobular, 150
-      jugular, 109
-      median, 109
-      cephalic, 109
-      mesenteric, 110, 150
-      portal, 110, 150
-      pulmonary, 105, 110
-      saphenous, 109, 199
-      splenic, 110, 150
-      subclavian, 109
-      superficial, 28
-      superior vena cava, 105, 109
-      umbilical, 106
-      valves, 28
-      varicosity, 109, 113, 199
-    Vena cava, inferior, 105, 109, 150
-      superior, 105, 109
-    Venæ comites, 27, 113
-    Ventricles of brain, 75, 79
-      of heart, 103
-    Vermiform appendix, 145
-    Vertebra prominens, 91
-    Vertebræ, 88, _et seq._
-    Vertebral arteries, 77
-    Vesiculæ seminales, 165
-    Vestibule of labyrinth, 64, 65
-    Vicarious function of glands, 35
-    Villi, 142
-    Viscera, abdominal, 135, _et seq._
-    Visual center, 81
-    Vital capacity, 129
-    Vitreous humor, 70
-    Vocal cords, 122
-    Volvulus, 146
-    Voluntary muscle, 21, 23
-    Vomer, 48, 55
-    Vomiting, 140
-    Vulva, 169
-
-    Wharton’s duct, 62
-    White corpuscles or leucocytes, 27, 33, 34, 119, 120
-    White substance of Schwann, 37
-      matter of brain and cord, 75, 76, 78, 80, 81
-    Willis, circle of, 78, 108
-    Wisdom teeth, 60
-    Wormian bones, 19, 49
-    Wrist, 180
-      joint, 185
-    Wry neck or torticollis, 92
-
-    Yawning, 131
-
-    Zygomatic process of temporal bone, 51, 54
-
-
-
-
-SAUNDERS’ BOOKS FOR NURSES
-
-
-                                                           PAGE
-    Aikens’ Clinical Studies for Nurses                       3
-    Aikens’ Hospital Management                               3
-    Aikens’ Primary Studies for Nurses                        3
-    Aikens’ Training School Methods and the Head Nurse        3
-    Beck’s Reference Handbook for Nurses                      4
-    Boyd’s State Registration for Nurses                      4
-    Davis’ Obstetric and Gynecologic Nursing                  5
-    DeLee’s Obstetrics for Nurses                             5
-    Dorland’s Medical Dictionaries                         7, 8
-    Fiske’s Anatomy and Physiology for Nurses                 4
-    Fowler’s Operating Room and the Patient                   4
-    Friedenwald and Ruhrah on Diet                            6
-    Galbraith’s Four Epoch’s of Woman’s Life                  6
-    Galbraith’s Hygiene and Physical Training for Women       6
-    Grafstrom’s Mechano-therapy (Massage)                     8
-    Griffith’s Care of the Baby                               8
-    Hoxie’s Medicine for Nurses                               8
-    Lewis’ Anatomy and Physiology for Nurses                  7
-    Macfarlane’s Gynecology for Nurses                        5
-    Manhattan Hospital Eye, Ear, Nose and Throat Nursing      6
-    McCombs’ Diseases of Children for Nurses                  7
-    McKenzie’s Exercise in Education and Medicine             5
-    Morris’ Essentials of Materia Medica                      8
-    Morrow’s Immediate Care of Injured                        8
-    Nancrede’s Essentials of Anatomy                          8
-    Paul’s Materia Medica for Nurses                          8
-    Paul’s Nursing in the Acute Infectious Fevers             8
-    Pyle’s Personal Hygiene                                   8
-    Register’s Fever Nursing                                  8
-    Stoney’s Bacteriology and Surgical Technic                2
-    Stoney’s Materia Medica for Nurses                        2
-    Stoney’s Nursing                                          2
-    Wilson’s Reference Handbook of Obstetric Nursing          7
-
-                      W. B. SAUNDERS COMPANY
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-
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-Stoney’s Nursing
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-great general usefulness. The best chapter is the one on observation
-of symptoms which is very thorough.” There are directions how to
-_improvise_ everything ordinarily needed in the sick room.
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-    =Practical Points in Nursing.= By EMILY M. A.
-    STONEY, Superintendent of the Training School for
-    Nurses in the Carney Hospital, South Boston, Mass.
-    12mo, 495 pages, illustrated.
-                                    Cloth, $1.75 net.
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-Stoney’s Materia Medica
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-Stoney’s Materia Medica was written by a head nurse who knows just
-what the nurse needs. _American Medicine_ says it contains “all the
-information in regards to drugs that a nurse should possess. * * * The
-treatment of poisoning is stated in a manner that will permit of its
-being carried out thoroughly and intelligently.”
-
-    =Materia Medica for Nurses.= By EMILY M. A.
-    STONEY, Superintendent of the Training School
-    for Nurses in the Carney Hospital, South Boston,
-    Mass. 12mo volume of 300 pages.
-                                    Cloth, $1.50 net.
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-Stoney’s Surgical Technic
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-stated in its title in a concise manner.”
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-    =Bacteriology and Surgical Technic for Nurses.= By
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-                                    Cloth, $1.50 net.
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-    Aikens’ Hospital Management                      JUST READY
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-    =Hospital Management.= Arranged and edited by
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-Aikens’ Primary Studies for Nurses
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-_Trained Nurse and Hospital Review_ says: “It is safe to say that any
-pupil who has mastered even the major portion of this work would be one
-of the best prepared first year pupils who ever stood for examination.”
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-    =Primary Studies for Nurses.= By CHARLOTTE
-    A. AIKENS, formerly Director of Sibley Memorial
-    Hospital, Washington, D. C. 12mo of 435 pages,
-    illustrated.
-                                    Cloth, $1.75 net.
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-the nurse and _how much_. The _Medical Record_ says: “This book is
-original, breezy and healthy.”
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-    =Hospital Training-School Methods and the Head
-    Nurse.= By CHARLOTTE A. AIKENS, formerly
-    Director of Sibley Memorial Hospital, Washington,
-    D. C. 12mo of 267 pages.
-                                    Cloth, $1.50 net.
-
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-Aikens’ Clinical Studies for Nurses
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-This new work is written on the same lines as the author’s successful
-work for primary students, taking up the studies the nurse must pursue
-during the second and third years.
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-    =Clinical Studies for Nurses.= By CHARLOTTE
-    A. AIKENS, formerly Director of Sibley Memorial
-    Hospital, Washington, D. C. 12mo of 512 pages,
-    illustrated.
-                                    Cloth, $2.00 net.
-
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-Fowler’s Operating Room NEW (2d) EDITION
-
-Dr. Fowler’s work contains all information of a surgical nature that a
-nurse must know in order to attain the highest efficiency. _Canadian
-Journal of Medicine and Surgery_ says: “We find compactly and clearly
-stated just those thousand and one things which when required are so
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-    =The Operating Room and the Patient.=
-    By RUSSELL S. FOWLER, M. D., Professor of
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-    Octavo of 284 pages, with original illustrations.
-                                    Cloth, $2.00 net.
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-Miss Fiske weaves the physiology in with the anatomy, and in such a way
-that both anatomy and function are readily understood and retained by
-the reader.
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-    =Anatomy and Physiology for Nurses.=
-    By ANNETTE FISKE. A. M., Graduate of the
-    Waltham Training School for Nurses, Massachusetts.
-    12mo of 250 pages, illustrated.
-
-
-Beck’s Reference Handbook NEW (2d) EDITION
-
-This book contains all the information that a nurse requires to carry
-out any directions given by the physician. The _Montreal Medical
-Journal_ says it is “cleverly systematized and shows close observation
-of the sickroom and hospital regime.”
-
-    =A Reference Handbook for Nurses.=
-    By AMANDA K. BECK, Graduate of the Illinois
-    Training School for Nurses, Chicago, Ill. 32mo
-    volume of 200 pages. Bound in flexible leather,
-                                           $1.25 net.
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-Boyd’s State Registration for Nurses
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-This book tells the nurse just what she must know in order to obtain
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-laws, requirements, fees, exceptions and restrictions, violations and
-their penalties. The work will also form a serviceable basis for the
-drafting of laws.
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-    =State Registration for Nurses.= By LOUIE
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-                                 Price, 50 cents net.
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-
-Dr. DeLee’s book really considers two subjects--obstetrics for nurses
-and actual obstetric nursing. _Trained Nurse and Hospital Review_ says
-the “book abounds with practical suggestions, and they are given with
-such clearness that they cannot fail to leave their impress.”
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-    =Obstetrics for Nurses.= By JOSEPH B.
-    DELEE, M. D., Professor of Obstetrics at the
-    Northwestern University Medical School, Chicago.
-    12mo volume of 512 pages, fully illustrated.
-                                    Cloth, $2.50 net.
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-_The Trained Nurse and Hospital Review_ says: “This is one of the most
-practical and useful books ever presented to the nursing profession.”
-The text is illustrated.
-
-    =Obstetric and Gynecologic Nursing.=
-    By EDWARD P. DAVIS, M. D., Professor of
-    Obstetrics in the Jefferson Medical College,
-    Philadelphia. 12mo volume of 436 pages,
-    illustrated. Buckram,                  $1.75 net.
-
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-
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-_Dr. A. M. Seabrook_, Woman’s Hospital of Philadelphia, says: “It is a
-most admirable little book, covering in a concise but attractive way
-the subject from the nurse’s standpoint. You certainly keep up to date
-in all these matters, and are to be complimented upon your progress and
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-    =A Reference Handbook of Gynecology for Nurses.=
-    By CATHARINE MACFARLANE, M. D., Gynecologist to
-    the Woman’s Hospital of Philadelphia. 32mo of 150
-    pages, with 70 illustrations.
-                         Flexible leather, $1.25 net.
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-McKenzie’s Exercise in Education and Medicine
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-    =Exercise in Education and Medicine.=
-    By R. TAIT MCKENZIE, B. A., M. D., Professor of
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-    University of Pennsylvania. Octavo of 406 pages,
-    with 346 illustrations.
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-            Throat.= By the Committee on Nurses of the Manhattan
-            Eye, Ear, and Throat Hospital: J. EDWARD GILES, M.
-            D., Surgeon in Eye Department; ARTHUR B. DUEL, M.
-            D., (chairman), Surgeon in Ear Department; HARMON
-            SMITH, M. D., Surgeon in Throat Department. Assisted
-            by JOHN R. SHANNON, M. D., Assistant Surgeon in
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-training school and after graduation. _American Journal of Nursing_
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-    of 395 pages.
-                                    Cloth, $1.50 net
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-Friedenwald & Ruhrah on Diet THIRD EDITION
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-    by JOHN H. MUSSER, M. D., University of
-    Pennsylvania. 12mo of 247 pages.
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-says: “Every page emphasizes the nurse’s relation to the case.”
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-American Pocket Dictionary NEW (6th) EDITION
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-The _Trained Nurse and Hospital Review_ says: “We have had many
-occasions to refer to this dictionary, and in every instance we have
-found the desired information.”
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-    =American Pocket Medical Dictionary.= Edited by
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-    University, Chicago.
-             Flexible leather, gold edges, $1.00 net;
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-    Mich. 12mo of 375 pages, 150 illustrations.
-                                    Cloth, $1.75 net.
-
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-Dorland’s Illustrated Dictionary NEW (5th) EDITION
-
-    =The American Illustrated Medical Dictionary.=
-    Edited by W. A. N. DORLAND, M. D. Large
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-    colors. Flexible leather, $4.50 net; thumb indexed,
-                                           $5.00 net.
-
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-Paul’s Materia Medica
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-    =A Text-Book of Materia Medica for Nurses.=
-    By GEORGE P. PAUL, M. D., Samaritan Hospital,
-    Troy, N. Y. 12mo of 240 pages.
-                                    Cloth, $1.50 net.
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-Paul’s Fever Nursing
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-    =Nursing in the Acute Infectious Fevers.=
-    By GEORGE P. PAUL, M. D.
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-
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-Hoxie’s Medicine for Nurses
-
-    =Practice of Medicine for Nurses.=
-    By GEORGE HOWARD HOXIE, M. D., University
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-    by PEARL L. LAPTAD. 12mo of 284 pages,
-    illustrated.
-                                    Cloth, $1.50 net.
-
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-
-    =Mechano-therapy (Massage and Medical
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-    B. Sc., M. D., 12mo, 200 pages.
-                                    Cloth, $1.25 net.
-
-
-Nancrede’s Anatomy NEW (7th) EDITION
-
-    =Essentials of Anatomy.= CHARLES B. G.
-    DENANCREDE, M. D., University of Michigan.
-    12mo, 400 pages, 180 illustrations.
-                                    Cloth, $1.00 net.
-
-
-Morrow’s Immediate Care of Injured
-
-    =Immediate Care of the Injured.= By ALBERT
-    S. MORROW, M. D., New York City Home for
-    Aged and Infirm. Octavo of 340 pages, with 238
-    illustrations.                  Cloth, $2.50 net.
-
-
-Register’s Fever Nursing
-
-    =A Text-Book on Practical Fever Nursing.=
-    By   EDWARD C. REGISTER, M. D., North Carolina
-    Medical College. Octavo of 350 pages, illustrated.
-                                    Cloth, $2.50 net.
-
-
-Pyle’s Personal Hygiene NEW (4th) EDITION
-
-    =A Manual of Personal Hygiene.= Edited by
-    WALTER L. PYLE, M. D. Wills Eye Hospital,
-    Philadelphia. 12mo, 472 pages, illus.
-                                           $1.50 net.
-
-
-Morris’ Materia Medica NEW (7th) EDITION
-
-    =Essentials of Materia Medica, Therapeutics,
-    and Prescription Writing.= By HENRY MORRIS,
-    M. D. Revised by W. A. BASTEDO, M. D.,
-    Columbia University, N. Y. 12mo of 300 pages,
-    illustrated.                    Cloth, $1.00 net.
-
-Griffith’s Care of the Baby JUST ISSUED NEW (5th) EDITION
-
-    =The Care of the Baby.= By J. P. CROZER
-    GRIFFITH, M. D., University of Pennsylvania.
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-<div style='text-align:center; font-size:1.2em; font-weight:bold'>The Project Gutenberg eBook of Structure and Functions of The Body, by Annette Fiske</div>
-
-<div style='display:block; margin:1em 0'>
-This eBook is for the use of anyone anywhere in the United States and
-most other parts of the world at no cost and with almost no restrictions
-whatsoever. You may copy it, give it away or re-use it under the terms
-of the Project Gutenberg License included with this eBook or online
-at <a href="https://www.gutenberg.org">www.gutenberg.org</a>. If you
-are not located in the United States, you will have to check the laws of the
-country where you are located before using this eBook.
-</div>
-
-<table style='min-width:0; padding:0; margin-left:0; border-collapse:collapse'>
-  <tr><td>Title:</td><td>Structure and Functions of The Body</td></tr>
-  <tr><td></td><td>A Hand-Book of Anatomy and Physiology for Nurses and others desiring a Practical knowledge of the Subject</td></tr>
-</table>
-
-<div style='display:block; margin-top:1em; margin-bottom:1em; margin-left:2em; text-indent:-2em'>Author: Annette Fiske</div>
-
-<div style='display:block; margin:1em 0'>Release Date: March 08, 2021 [eBook #64754]</div>
-
-<div style='display:block; margin:1em 0'>Language: English</div>
-
-<div style='display:block; margin:1em 0'>Character set encoding: UTF-8</div>
-
-<div style='display:block; margin-left:2em; text-indent:-2em'>Produced by: MFR and the Online Distributed Proofreading Team at https://www.pgdp.net (This file was produced from images generously made available by The Internet Archive)</div>
-
-<div style='margin-top:2em; margin-bottom:4em'>*** START OF THE PROJECT GUTENBERG EBOOK STRUCTURE AND FUNCTIONS OF THE BODY ***</div>
-<div class="figcenter">
-    <img src="images/frontispiece.jpg" alt="" width="500" height="616" />
-    <p class="f150">The human skeleton (Lewis).</p>
-</div>
-<hr class="chap" />
-
-<h1>STRUCTURE AND FUNCTIONS<br /> <small><i>of</i></small><br /> THE BODY</h1>
-
-<p class="center">A HAND-BOOK OF ANATOMY AND PHYSIOLOGY FOR<br />
-NURSES AND OTHERS DESIRING A PRACTICAL<br />
-KNOWLEDGE OF THE SUBJECT</p>
-
-<p class="center space-above2 space-below2">BY<br /><span class="bigfont150">ANNETTE FISKE, A. M.</span><br />
-GRADUATE OF THE WALTHAM TRAINING SCHOOL FOR NURSES</p>
-
-<p class="center"><i>ILLUSTRATED</i></p>
-
-<p class="center space-above2">PHILADELPHIA AND LONDON<br />W. B. SAUNDERS COMPANY<br />1911</p>
-<hr class="r5" />
-<p class="center">Copyright, 1911, by W. B. Saunders Company<br />PRINTED IN AMERICA</p>
-<hr class="r5" />
-
-<p class="center">PRESS OF<br />W. B. SAUNDERS COMPANY<br />PHILADELPHIA</p>
-<hr class="chap" />
-
-<div class="chapter">
-  <p class="center">TO MY FATHER</p>
-  <p class="f90">and</p>
-  <p class="center">TO DR. ALFRED WORCESTER</p>
-  <p class="center">as those who have perhaps most helped me in<br />
-                    the formation and realization of my ideals<br />
-                    this book is affectionately dedicated</p>
-</div>
-
-<hr class="chap" />
-<p><span class="pagenum"><a name="Page_5" id="Page_5">[Pg 5]</a></span></p>
-
-<div class="chapter"><h2 class="nobreak">PREFACE.</h2></div>
-
-<p>Although there are already in existence many books on anatomy and
-physiology for nurses, none with which I am acquainted has seemed to me
-to provide in concise form just the knowledge needed by the nurse in
-her profession. Most of them, moreover, separate the anatomy from the
-physiology and all treat the different systems of tissues separately,
-first the bones, then the muscles, and so on. These defects, as they
-seem to me, I have attempted to correct not only by weaving the
-physiology in with the anatomy, but by treating first the general
-structures found throughout the body and then describing the structure
-and function of each part in detail. Thus, the first chapter is devoted
-to a description of the general structure of all the tissues, a
-separate chapter being devoted, however, to the skin, its appendages,
-and function, including the sense of touch. Then the head with its
-bones, muscles, and organs of special sense is described, while the
-brain is treated with the rest of the nervous system, thus forming the
-connecting link between the head and the body. In the same way the
-back, chest, abdomen, pelvis, and extremities are taken up in turn and
-the bones, muscles, blood-vessels, nerves, and special organs of each,
-together with their functions, described.</p>
-
-<p>Although written more particularly for nurses I am in hopes that
-this book may prove useful to any others who may desire to acquire a
-practical knowledge of anatomy and physiology.</p>
-
-<p>Besides the usual text-books, I am much indebted for material to notes
-<span class="pagenum"><a name="Page_6" id="Page_6">[Pg 6]</a></span>
-taken in lecture courses given by Dr. Fred R. Jouett and Dr. F. J.
-Goodridge of Cambridge, Mass., at the Cambridge School of Nursing, and
-by Dr. Vivian Daniel of Watertown at the Waltham Training School for Nurses.</p>
-
-<p>I wish particularly to express my gratitude and appreciation for the
-kind and helpful criticism given me by Dr. Eugene A. Darling, Assistant
-Professor of Physiology, Harvard College.</p>
-
-<p class="author"><span class="smcap">Annette Fiske.</span></p>
-<p><i>May, 1911.</i></p>
-
-<hr class="chap" />
-<p><span class="pagenum"><a name="Page_7" id="Page_7">[Pg 7]</a></span></p>
-
-<div class="chapter"><h2 class="nobreak">CONTENTS.</h2></div>
-
-<table border="0" cellspacing="0" summary="TOC" cellpadding="0" >
-  <tbody><tr>
-      <td class="tdc" colspan="2">CHAPTER I.</td>
-   </tr><tr>
-      <td class="tdr" colspan="2"><small>PAGE</small></td>
-   </tr><tr>
-      <td class="tdl"><span class="smcap">Composition and General Structure of the Body</span></td>
-      <td class="tdr"><a href="#CHAPTER_I">11</a></td>
-   </tr><tr>
-      <td class="tdl" colspan="2"><p class="neg-indent">
-              Chemical Constitution of the Body, 11—The Cell, 12—The Fundamental
-              Tissues of the Body, 13—Epithelial Tissue, 14—Connective Tissue,
-              15—Structure of Bone, 17—Bone Formation, 18—Chemical Composition of
-              Bone, 18—Classification and Function of Bones, 19—Joints, 20—Muscle,
-              21—Action of the Muscles, 23—Physiology of Muscle, 24—Cilia, 27—The
-              Blood, 27—Arteries, 27—Veins, 28—Capillaries, 28—Lymphatic System,
-              29—Lymphatic Vessels, 31—Lymphatic Glands, 32—Lymph, 32—Glands,
-              35—Ductless Glands, 36—Nervous Tissue, 36.</p></td>
-   </tr><tr>
-      <td class="tdc_space-above1" colspan="2">CHAPTER II.</td>
-   </tr><tr>
-      <td class="tdl"><span class="smcap">The Skin, Its Appendages and Its Function</span></td>
-      <td class="tdr"><a href="#Page_39">39</a></td>
-   </tr><tr>
-      <td class="tdl" colspan="2"><p class="neg-indent">The Skin,
-             39—Appendages of the Skin: Nails, 40—Hair, 40—Sebaceous
-             Glands, 41—Sweat Glands, 42—Sweat, 42—Temperature Regulation, 43—Fever,
-             45—Sense of Touch, 45—Touch Corpuscles, 46.</p></td>
-   </tr><tr>
-      <td class="tdc_space-above1" colspan="2">CHAPTER III.</td>
-   </tr><tr>
-      <td class="tdl"><span class="smcap">The Cranium and Face</span></td>
-      <td class="tdr"><a href="#Page_48">48</a></td>
-   </tr><tr>
-      <td class="tdl" colspan="2"><p class="neg-indent">
-                      The Cranial Bones, 48—Frontal Bone, 49—Parietal Bones, 49—Occipital
-                      Bone, 50—Occipito-frontalis Muscle, 51—Temporal Bones, 51—Sphenoid
-                      or Wedge Bone, 52—Ethmoid Bone, 53—Turbinated Bones, 53—Ossification
-                      of Sutures, 53—Bones of the Face, 53—Superior Maxillary Bones,
-                      54—Antrum of Highmore, 54—Malar or Cheek Bones, 54—Lachrymal Bones,
-                      54—Palate Bones, 54—Nasal Bones, 55—Vomer, 55—Inferior Turbinated
-                      Bones, 55—Inferior Maxillary Bone or Lower Jaw, 55—Sublingual Gland,
-                      56—Submaxillary Gland, 56.</p></td>
-   </tr><tr>
-      <td class="tdc_space-above1" colspan="2">CHAPTER IV.</td>
-   </tr><tr>
-      <td class="tdl"><span class="smcap">The Organs of Special Sense</span></td>
-      <td class="tdr"><a href="#Page_57">57</a></td>
-   </tr><tr>
-      <td class="tdl" colspan="2"><p class="neg-indent">
-                The Nose, 57—The Sense of Smell, 58—The Mouth, 59—The Hyoid Bone,
-                 60—The Teeth, 60—The Sense of Taste, 61—Salivary Glands, 61—The
-                 Tonsils, 62—The Ear, 63—Eustachian Tubes, 63—Sensation of Hearing,
-                 65—The Eye, 66—Lachrymal Gland, 68—Coats of the Eye, 68—Light Rays and
-                 Sight, 70—Accommodation, 72—Color Perception, 73.</p></td>
-   </tr><tr>
-      <td class="tdc_space-above1" colspan="2">CHAPTER V.
-                   <span class="pagenum"><a name="Page_8" id="Page_8">[Pg 8]</a></span></td>
-   </tr><tr>
-      <td class="tdl"><span class="smcap">The Nervous System</span></td>
-      <td class="tdr"><a href="#Page_75">75</a></td>
-   </tr><tr>
-      <td class="tdl" colspan="2"><p class="neg-indent">
-                The Cerebrum, 75—The Cerebellum, 78—Pons Variolii, 78—Medulla
-                Oblongata, 78—Spinal Cord, 79—Brain-centers, 81—Motor Tract, 82—Sensory
-                Tract, 82—Reflex Action, 83—Cranial Nerves, 83—Spinal Nerves,
-                84—Brachial Plexus, 85—Sacral Plexus, 85—The Sympathetic System, 87—The
-                Sympathetic Nerves, 87.</p></td>
-   </tr><tr>
-      <td class="tdc_space-above1" colspan="2">CHAPTER VI.</td>
-   </tr><tr>
-      <td class="tdl"><span class="smcap">The Back</span></td>
-      <td class="tdr"><a href="#Page_88">88</a></td>
-   </tr><tr>
-      <td class="tdl" colspan="2"><p class="neg-indent">
-                             The Spine, 88—The Vertebræ, 88—Muscles of the Neck,
-                             92—Muscles of the Back, 93.</p></td>
-   </tr><tr>
-      <td class="tdc_space-above1" colspan="2">CHAPTER VII.</td>
-   </tr><tr>
-      <td class="tdl"><span class="smcap">The Chest</span></td>
-      <td class="tdr"><a href="#Page_96">96</a></td>
-   </tr><tr>
-      <td class="tdl" colspan="2"><p class="neg-indent">
-                        The Sternum, 97—The Ribs, 97—Costal Cartilages, 98—Muscles of the
-                        Chest, 98—Diaphragm, 98—Mammary Glands, 100.</p></td>
-   </tr><tr>
-      <td class="tdc_space-above1" colspan="2">CHAPTER VIII.</td>
-   </tr><tr>
-      <td class="tdl"><span class="smcap">The Heart and Circulation</span></td>
-      <td class="tdr"><a href="#Page_101">101</a></td>
-   </tr><tr>
-      <td class="tdl" colspan="2"><p class="neg-indent">
-                The Heart, 101—The Pericardium, 101—Cavities of the Heart, 103—The
-                Endocardium, 103—The Valves of the Heart, 103—Circulation,
-                105—Circulation in the Fetus, 106—Arteries, 107—Veins, 109—Portal
-                Circulation, 109—Pulmonary Circulation, 110—Nerves of the Heart,
-                110—Heart Sounds, 111—The Heart Beat, 111—Factors Affecting
-                Circulation, 112—The Pulse, 113—Blood Pressure, 114—Nerve Supply
-                of the Blood-vessels, 115—The Blood, 116—Composition of the Blood,
-                116—Coagulability of the Blood, 117—Blood-corpuscles, 118.</p></td>
-   </tr><tr>
-      <td class="tdc_space-above1" colspan="2">CHAPTER IX.</td>
-   </tr><tr>
-      <td class="tdl"><span class="smcap">The Lungs and Respiration</span></td>
-      <td class="tdr"><a href="#Page_121">121</a></td>
-   </tr><tr>
-      <td class="tdl" colspan="2"><p class="neg-indent">
-                   The Larynx, 121—The Trachea, 123—The Thyroid Gland, 124—The Thymus
-                   Gland, 124—The Bronchi, 125—The Lungs, 125—The Pleura, 125—The
-                   Mediastinum, 126—Respiration, 127—Air, 129—Respiratory Sounds,
-                   129—Changes in Air in Lungs, 129—Effect of Respiration on Blood,
-                   130—Nervous Mechanism of Respiration, 130—Variations in Respiration, 131.</p></td>
-   </tr><tr>
-      <td class="tdc_space-above1" colspan="2">CHAPTER X.
-                          <span class="pagenum"><a name="Page_9" id="Page_9">[Pg 9]</a></span></td>
-   </tr><tr>
-      <td class="tdl"><span class="smcap">The Abdomen and the Organs of Digestion and Excretion</span></td>
-      <td class="tdr"><a href="#Page_132">132</a></td>
-   </tr><tr>
-      <td class="tdl" colspan="2"><p class="neg-indent">
-                     The Abdominal Cavity, 132—Muscles of the Abdomen, 132—The Peritoneum,
-                     134—Abdominal Regions, 134—Salivary Digestion, 136—The Pharynx, 139—The
-                     Esophagus, 138—The Stomach, 138—Gastric Digestion, 139—Vomiting,
-                     140—Intestinal Canal, 141—The Small Intestine, 142—Intestinal
-                     Digestion, 143—Absorption in Intestine, 144—The Large Intestine,
-                     145—Food and Metabolism, 147—The Liver, 149—The Gall-bladder, 152—The
-                     Pancreas, 153—The Spleen, 153—The Suprarenal Capsules, 154—The Kidneys,
-                     155—The Urine, 156—The Ureters, 159—The Bladder and Urethra, 159.</p></td>
-   </tr><tr>
-      <td class="tdc_space-above1" colspan="2">CHAPTER XI.</td>
-   </tr><tr>
-      <td class="tdl"><span class="smcap">The Pelvis and the Genital Organs</span></td>
-      <td class="tdr"><a href="#Page_161">161</a></td>
-   </tr><tr>
-      <td class="tdl" colspan="2"><p class="neg-indent">
-                  The Pelvis, 161—The Male Generative Organs, 164—The Prostate Gland,
-                  164—The Testes, 165—The Penis, 165—The Female Generative Organs,
-                  165—The Ovaries, 165—The Fallopian Tubes, 166—The Uterus, 167—The
-                  Vagina, 168—The External Genitalia in the Female, 169—The Vulva,
-                  169—The Mons Veneris, 169—The Labia Majora, 169—The Labia Minora,
-                  170—The Clitoris, 170—The Meatus Urinarius, 170—The Hymen, 170—The
-                  Fourchette, 170—The Perineal Body, 170—The Perineum, 170.</p></td>
-   </tr><tr>
-      <td class="tdc_space-above1" colspan="2">CHAPTER XII.</td>
-   </tr><tr>
-      <td class="tdl"><span class="smcap">The Upper Extremities</span></td>
-      <td class="tdr"><a href="#Page_171">171</a></td>
-   </tr><tr>
-      <td class="tdl" colspan="2"><p class="neg-indent">
-                 The Shoulder Girdle, 171—The Clavicle, 171—The Scapula, 173—Shoulder
-                 Muscles, 174—The Humerus, 175—Upper Arm Muscles, 176—The Ulna, 177—The
-                 Radius, 178—The Wrist, 180—The Hand, 181—Meta-carpals, 181—Phalanges,
-                 181—Muscles of the Forearm, 182—Muscles of the Hand, 184—Joints of the
-                 Upper Extremity, 185—Blood Supply of the Upper Extremity, 185—Nerves of
-                 the Upper Extremity, 186.</p></td>
-   </tr><tr>
-      <td class="tdc_space-above1" colspan="2">CHAPTER XIII.</td>
-   </tr><tr>
-      <td class="tdl"><span class="smcap">The Lower Extremities</span></td>
-      <td class="tdr"><a href="#Page_187">187</a></td>
-   </tr><tr>
-      <td class="tdl" colspan="2"><p class="neg-indent">
-                  The Femur, 187—Thigh Muscles, 189—The Patella, 192—Joints of the
-                  Lower Extremity, 192—The Tibia, 194—The Fibula, 194—The Ankle, 195—The
-                  Foot, 195—Metatarsals, 195—Phalanges, 195—Muscles of the Leg, 196—The
-                  Blood Supply of the Lower Extremity, 198—Nerves of the Lower Extremity, 199.</p></td>
-   </tr><tr>
-      <td class="tdl_space-above1"><span class="smcap">Index</span></td>
-      <td class="tdr"><a href="#Page_201">201</a></td>
-   </tr>
- </tbody>
-</table>
-
-<p><span class="pagenum"><a name="Page_10" id="Page_10">[Pg 10]</a></span></p>
-<hr class="chap" />
-<p><span class="pagenum"><a name="Page_11" id="Page_11">[Pg 11]</a></span></p>
-
-<div class="chapter">
-<p class="f200"><b>STRUCTURE AND<br /> FUNCTIONS OF THE BODY.</b></p>
-<hr class="chap" />
-</div>
-
-<div class="chapter">
-<h2 class="nobreak"><a name="CHAPTER_I" id="CHAPTER_I">CHAPTER I.</a><br />
-<span class="h2_subtitle">COMPOSITION AND GENERAL STRUCTURE<br /> OF THE BODY.</span></h2>
-</div>
-
-<p>Anatomy is the study of the physical structure and physiology the study
-of the normal functions of the human body.</p>
-
-<p><b>Chemical Constitution of the Body.</b>—In the body only twenty
-elements have been found. These include carbon, oxygen, hydrogen,
-nitrogen, sulphur, phosphorus, calcium, magnesium, manganese, chlorin,
-potassium, and fluorin. For the most part they appear in very complex
-and highly unstable combinations, though oxygen and nitrogen may be
-said to exist uncombined in the blood, alimentary canal, and lungs.
-Hydrogen also occurs in simple form in the alimentary canal, but as the
-result of fermentation, not as an element of the body.</p>
-
-<p>Of the organic compounds some contain nitrogen and some do not. The
-most important of the former are the proteins, which are found only in
-living bodies and consist of carbon, hydrogen, oxygen, nitrogen, and
-sulphur combined in very similar proportions. The important proteins in
-the body are the serum albumen and fibrin found in the blood, myosin in
-muscle, globulin in the red blood-corpuscles, and casein in the milk.
-Similar to the proteins but capable of passing through membranes are the
-<span class="pagenum"><a name="Page_12" id="Page_12">[Pg 12]</a></span>
-peptones, the final result of protein digestion, from which the
-albuminoids differ in that they contain no sulphur. Ferments containing
-nitrogen exist in all the cells of the body, though more particularly
-in those of the digestive organs, and the coloring matters, as the
-bilirubin of the bile, are nitrogenous.</p>
-
-<p>The organic substances that do not contain nitrogen are the
-carbohydrates or starches, the hydrocarbons or fats, and the acids, of
-which the most important is carbon dioxide, given off by the lungs.</p>
-
-<p>The inorganic substances are water, which forms a large percentage
-of all the tissues and from one-fourth to one-third of the whole body
-weight, sodium chloride or common salt, which plays an important part
-in keeping substances in solution, potassium and magnesium chloride,
-and hydrochloric acid, found in the stomach.</p>
-
-<p><b>The Cell.</b>—Although the body is a very complex organism,
-the cell is its unit or foundation. In fact, the body begins life as a
-single protoplasmic cell, the ovum, which is frequently compared
-to the amœba, a microscopic animal consisting of a single cell of
-protoplasm or living substance—a substance not well understood as
-yet—but possessing practically all the functions of the human body.
-For, although it has no organs and is homogeneous in structure, the
-amœba can move by throwing out a process, and can surround and absorb
-food, which it builds up into new tissue, discarding the waste. The
-ovum, however, differs from the amœba in that it has a transparent
-limiting membrane and contains a darker spot, the nucleus. This in
-turn contains another smaller spot, the nucleolus, while through the
-protoplasm, which is semi-fluid, extends a fine network that seems to
-hold it in place.</p>
-
-<p>The <i>ovum</i> is very small, about <big>¹/₁₂₅</big> inch in diameter,
-and after fertilization grows by segmentation, the nucleus dividing in two
-and the protoplasm grouping itself anew about the two nuclei. This division
-continues, each cell dividing and forming two, or sometimes four, new
-<span class="pagenum"><a name="Page_13" id="Page_13">[Pg 13]</a></span>
-cells, all of which at first appear alike. By degrees, however,
-differentiation takes place and different groups of cells assume
-different characteristics. Thus the various tissues are gradually
-developed, each with a structure and a function of its own, and are
-distributed among the various organs, each organ consisting of several
-tissues. During the process of growth and even after full growth of the
-body is attained old cells are continually dying and being replaced by
-new ones.</p>
-
-<p>The typical cell is circular, but through being squeezed together
-in the tissues or for some other reason the cells vary in shape in
-different parts, being at times hexagonal, spindle-shaped, or columnar.
-Yet, whatever their differences in shape or other characteristics, they
-all live the same sort of life. All protoplasm absorbs oxygen when it
-comes in contact with it and in the process of combining with it is in
-part burned or oxidized, with the consequent setting free of heat and
-other forms of energy and the formation of carbon dioxide. So long as
-the body is alive, therefore, whether it is in a state of activity or
-of rest, it is the seat of constant chemical change throughout all its
-cells, and to these chemical changes are due all the forms of energy
-manifested by the body. For energy is never destroyed, though it may
-appear in a different form, and the elements of the human body are
-so combined that their energy may be liberated and manifested in the
-different functions the body exhibits.</p>
-
-<p><b>The fundamental tissues of the body</b> are the <a href="#FIG_01">epithelial tissues</a>,
-the connective tissues, including the cartilaginous and bony tissues,
-and the muscular and nervous tissues. Of these the epithelial tissues
-serve as a protection to the surface of other tissues; the connective
-tissues together form a framework for the support and general
-protection of the other tissues; while energy is expended by muscular
-and nervous tissue, the latter directing the former in its movements.
-All the tissues are inter-dependent and the organs work together.
-Besides cells every tissue contains a certain amount of lifeless matter,
-<span class="pagenum"><a name="Page_14" id="Page_14">[Pg 14]</a></span>
-the intercellular substance, which was at some time produced by the cells.</p>
-
-<div class="figcenter">
-    <img id="FIG_01" src="images/i_014.jpg" alt="" width="600" height="353" />
-    <p class="blockquot"><span class="smcap">Fig. 1.</span>—Epithelium: 1, pavement epithelium; 2,
-                  columnar epithelium; 3, ciliated epithelium; 4, stratified epithelium.</p>
-</div>
-
-<p>In <b>epithelial tissue</b> there is little intercellular substance,
-the cells being close together and arranged generally as a skin or
-membrane covering external or internal surfaces. When there are several
-layers of cells, the deepest are columnar in shape and the others
-become more and more flattened and scale-like as they approach the
-surface, where they are gradually rubbed off and replaced by the growth
-of new cells from below. This <a href="#FIG_01">stratified epithelium</a>, as it is called,
-is found wherever a surface is exposed to friction, as in the skin and
-in the mucous membrane of the mouth, pharynx, and esophagus, and in
-that of the vagina and the neck of the uterus. In simple epithelium,
-where there is only a single layer of cells, the cells may be pavement
-or hexagonal, columnar, glandular, or ciliated, according to their
-different functions. The flat <a href="#FIG_02">pavement cells</a> occur where a very smooth
-surface is required, as in the heart, lungs, blood-vessels, serous
-cavities, etc. None of these surfaces communicate directly with the
-external surface of the body and the name endothelium is substituted
-for epithelium. The columnar form of cell in the intestine facilitates
-the passage of leucocytes between the cells. In glandular epithelium
-the cells vary according to the gland in which they occur, their
-<span class="pagenum"><a name="Page_15" id="Page_15">[Pg 15]</a></span>
-protoplasm being filled with the material the gland secretes. Finally,
-<a href="#FIG_01">ciliated epithelium</a> is composed of columnar cells with cilia or little
-hair-like processes upon their free surface which serve to send
-secreted fluids and other matters along the surfaces where they occur,
-as in the air passages, parts of the generative organs, the ventricles
-of the brain, and the central canal of the spinal cord.</p>
-
-<p><b>Connective tissue</b> has a great deal of intercellular substance.
-One form, <i>areolar tissue</i>, is composed of a loose network of fine
-white fibers with a few yellow elastic fibers interspersed and with
-cells lying in the spaces between the fibers. It connects and surrounds
-the different organs and parts, holding them together, yet allowing
-free motion, and is one of the most extensively distributed of the
-tissues. It is continuous throughout.</p>
-
-<div class="figcenter">
-    <img id="FIG_02" src="images/i_015.jpg" alt="" width="600" height="244" />
-    <p class="center"><span class="smcap">Fig. 2.</span>—Section of bladder epithelium. (Hill.)</p>
-</div>
-
-<p>Closely allied to the areolar is the <a href="#FIG_03"><i>fibrous tissue</i></a>,
-in which the white fibers lie close together and run for the most part in one
-direction only. This is found in ligaments, joints and tendons, as also
-in such fibrous protective membranes as the periosteum, dura mater, the
-fasciæ of muscles, etc. Fibrous tissue is silvery white in appearance
-and is very strong and tough, yet pliant. It is not extensile.</p>
-
-<p><i>Elastic tissue</i>, on the other hand, has a large predominance of
-yellow elastic fibers and is very extensile and elastic, though not so
-strong as the fibrous. It is found in the walls of the blood-vessels,
-<span class="pagenum"><a name="Page_16" id="Page_16">[Pg 16]</a></span>
-especially the arteries, in the walls of the air tubes, in the
-ligaments of the spine, etc.</p>
-
-<p><a href="#FIG_03"><i>Fatty or adipose tissue</i></a> is formed by the deposit of
-fat in the cells of the areolar tissue and is found in most parts where the areolar
-tissue occurs, though it varies largely in amount in different parts.
-It is found pretty generally under the skin, fills in inequalities
-about various organs and about the joints, and exists in large
-quantities in the marrow of the long bones. In moderate amounts it
-gives grace to the form and constitutes an important reserve fund.</p>
-
-<div class="figcenter">
-    <img id="FIG_03" src="images/i_016.jpg" alt="" width="600" height="395" />
-    <p class="blockquot"><span class="smcap">Fig. 3.</span>—Adipose tissue (Leroy): <i>a</i>,
-                  Fibrous tissue; <i>b</i>, fat cells; <i>c</i>, nucleus of fat cells; <i>d</i>,
-                  fatty acid crystals in fat cells.</p>
-</div>
-<p><i>Cartilage</i> consists of groups of nucleated cells in intercellular
-substance. It is very firm, yet highly elastic, and serves in the
-joints to break the force of concussion of the harder and less elastic
-bones. Except when it occurs at the end of a bone, it is covered with a
-membrane called the perichondrium, which carries its blood supply. In
-the nose, ear, larynx and trachea it serves to give shape, to keep the
-<span class="pagenum"><a name="Page_17" id="Page_17">[Pg 17]</a></span>
-passages open, and to afford attachment for muscles. Most of the skeleton
-of the fetus consists of cartilage, which later develops into bone.</p>
-
-<p><i>Bone.</i>—In <a href="#FIG_04">bone</a> the intercellular tissue is rendered
-hard by the deposit of mineral salts, the resulting material being of great
-strength and rigidity. The texture may be close and dense like ivory or
-open and spongy, the difference lying merely in the fact that the one
-has fewer spaces between the solid particles than the other. There is
-usually a hard, compact layer on the exterior of the bone, as that is
-where the greatest cross-strain comes, especially in the long bones,
-while within is the cancellous or spongy tissue, which gives lightness
-to the bone and is capable of withstanding enormous pressure, though it
-can bear little cross-strain.</p>
-
-<div class="figcenter">
-    <img id="FIG_04" src="images/i_017.jpg" alt="" width="600" height="299" />
-    <p class="center"><span class="smcap">Fig. 4.</span>—Cross-section
-                of compact bone tissue. (After Sharpey.)</p>
-</div>
-
-<p><b>Structure of Bone.</b>—The hard substance in bone is always
-arranged in lamellæ or bundles of bony fibers, which in cancellous
-tissue meet to form a kind of lattice-work, while in the dense tissue
-they are generally arranged in rings about the <a href="#FIG_04">Haversian canals</a>,
-channels through which the blood-vessels pass through the bone
-longitudinally. Between the lamellæ are spaces called <a href="#FIG_04"><i>lacunæ</i></a>,
-in which lie branched cells, the spaces being connected with each other
-and with the Haversian canals by numerous tiny canals or <a href="#FIG_04">canaliculi</a>,
-<span class="pagenum"><a name="Page_18" id="Page_18">[Pg 18]</a></span>
-by which nutrient material finds its way from the Haversian canals to all
-parts of the bone.</p>
-
-<p>Within the bone is the medulla or <i>marrow</i>, which is of two varieties:
-the yellow, which is largely fat and is found in the long bones of
-adults, and the red, which is nearly three-fourths water and is found
-in most of the other adult bones and in the bones of the fetus and of
-the infant.</p>
-
-<p>Lining the medullary and cancellous cavities is a delicate connective
-tissue lining, the <i>endosteum</i>, which contains many bone-forming cells,
-while on the outside of the bone, except at the articular ends, is the
-<i>periosteum</i> with its outer protective layer and its inner vascular
-layer containing osteoblasts or bone-forming cells. The periosteum is
-essential for the growth of new bone where the old bone has died, and
-if the periosteum is removed from healthy bone the part beneath is
-liable to die, as it is by the constant growth of the osteoblasts that
-the bone grows and is renewed. In the repair of broken bones tissue is
-formed between and around the broken ends.</p>
-
-<p><b>Bone Formation.</b>—Most of the skull and face bones begin as
-membranes of connective tissue, that is, are formed in membrane.
-Bones are also formed in cartilage, the bone formation in this case
-beginning from centers of ossification, where the deposit of lime
-salts in the intercellular substance begins, the salts coming to the
-centers dissolved in the plasma. Such a center of growth in a bone
-is called the epiphysis and is separated from the main part of the
-bone or diaphysis by cartilage until full growth is attained, when
-ossification becomes complete. So in surgery, in working on the bones
-of children, part of the epiphysis should always be left for the sake
-of future growth. The outer shell of compact tissue is deposited by the
-periosteum.</p>
-
-<p><b>Chemical Composition of Bone.</b>—Chemically bone is composed
-of about one-third organic or animal matter, largely gelatine, and
-<span class="pagenum"><a name="Page_19" id="Page_19">[Pg 19]</a></span>
-two-thirds inorganic matter, including various salts of calcium,
-magnesium, and sodium. In young children the animal matter predominates
-and the bones are soft and often bend instead of breaking, only the
-outside shell on one side giving way, as in “green-stick” fracture.
-In rickets there is a deficiency of lime salts, but the increased
-brittleness of the bones in old age is due, not to increase of mineral
-matter, but to the less spongy texture of old bones.</p>
-
-<p><b>Classification and Function of Bones.</b>—There are in the body
-some two hundred bones, which may be classified as long, short, flat,
-and irregular. Occasionally an irregular bone develops in a fontanelle,
-the membranous opening at the juncture of the sutures of the skull.
-This is known as a Wormian bone. It is not, however, included in the
-two hundred, as are not the sesamoid bones or bones developed in
-tendons, with the exception of the patella or knee-cap.</p>
-
-<p>Long bones are developed in cartilage and consist of a shaft, two
-extremities, and various processes. They are more or less curved to
-give them strength and grace. They serve as supports and act as levers
-for purposes of motion and the exercise of power. Since a hollow
-cylinder is just as strong as a solid one of the same size, the weight
-coming only on the outer shell, the great bones which are accountable
-for weight and which need to be light themselves have hollow shafts,
-composed chiefly of compact tissue with a central medullary canal. The
-ends, however, are expanded in order to make better connection at the
-joints and to afford broad surfaces for muscular attachment, cancellous
-tissue being used in them for lightness and strength. The large spongy
-ends also give elasticity and lessen jar, and by bringing the tendons
-to the bone at a greater angle increase their effectiveness. Blood is
-brought to the long bones not only by the vessels of the periosteum but
-by the medullary artery, which penetrates the compact tissue by the
-nutrient foramen and divides into an ascending and a descending branch.
-<span class="pagenum"><a name="Page_20" id="Page_20">[Pg 20]</a></span></p>
-
-<p>Short bones are spongy throughout. They are used for strength and where
-little motion is required.</p>
-
-<p>Flat bones are composed of two thin layers of compact tissue with a
-varying amount of cancellous tissue between, and are for protection and
-muscular attachment. The cancellous material between the two layers or
-tablets of the skull is called the diploë.</p>
-
-<p>Eminences and depressions occur on bones and when they are not
-articular are for the attachment of ligaments and muscles. If they are
-articular, they help to form joints.</p>
-
-<p>As a whole the bony framework serves to keep the soft parts in place,
-to support and protect them, and to aid in locomotion. The bones of the
-head and trunk support and protect organs; those of the arms are for
-tact and prehension; those of the lower extremities are for support and
-locomotion.</p>
-
-<p>Normally bones have little sensibility, but when inflamed they are
-extremely sensitive and painful.</p>
-
-<p><b>Joints.</b>—The bones are connected with and move upon one another
-by means of joints. These joints are of three kinds: 1. Immovable,
-where the adjacent margins of the bones are closely applied, with
-little fibrous tissue between, as in the sutures of the head; 2. those
-with limited motion, which are very strong, the parts being connected
-with tough fibro-cartilage; and 3. freely movable. In this last group
-the articulating surfaces are covered with cartilage, which again is
-lined with a delicate synovial membrane which secretes a small amount
-of lubricating fluid, the synovial fluid, to reduce friction. Their
-surfaces are also sometimes deepened by the presence of inter-articular
-fibro-cartilages. Bursæ or sacs of synovial membrane occur outside the
-joints under tendons and ligaments to reduce friction.</p>
-
-<p>The nature and extent of the motion of a joint is defined and the bones
-are held together by strong bands of fibrous tissue or ligaments, these
-ligaments being more fully developed in joints where there is great
-<span class="pagenum"><a name="Page_21" id="Page_21">[Pg 21]</a></span>
-freedom of motion or where there is great weight to be supported. In a
-ball-and-socket joint, such as the hip, there is a ligament in the form
-of a strong capsule which surrounds the joint on all sides and limits
-its motion, while hinge joints, like the elbow, and pivot joints, such
-as that formed by the atlas on the axis, have lateral ligaments that
-allow of freer motion. In the shoulder-joint, which is the most freely
-movable joint in the body, the capsular ligament is very lax.</p>
-
-<p>In general the kinds of motion possible in joints may be said to be
-flexion, extension, abduction, adduction, circumduction, and rotation.</p>
-
-<p>When much violence is applied to a joint and no dislocation results, as
-in a sprain, there is often much stretching and even laceration of the ligaments.</p>
-
-<p><b>Muscle.</b>—The flesh, which forms a large proportion of the
-weight of the body, consists of muscular tissue. Of this two kinds
-are found: 1. The striated or striped muscle of animal life, which is
-under the control of the will and so is known as <a href="#FIG_05">voluntary muscle</a>,
-and 2. the unstriped or smooth muscle of organic life over which we have
-no control, that is, the involuntary muscle. Each fiber of striped
-muscle has an elastic, membranous sheath, the sarcolemma, and consists
-of rod-shaped cells with a nucleus along the edge, set end to end and
-having <a href="#FIG_05">crosswise striations</a>. In unstriated muscle the
-fibers, which have no sarcolemma, consist of oval or spindle-shaped cells,
-with a nucleus much smaller than that of striped muscle and situated in the
-middle. In both kinds of muscle the fibers are bound together with
-connective tissue and blood-vessels into fasciculi or bundles, and many
-bundles go to make up a muscle. The muscle in turn has a connective
-tissue envelope or sheath, the fascia. These fasciæ are found
-throughout the body, the superficial ones being just beneath the skin,
-while the deep ones not only form sheaths for the various muscles but
-form partitions between them and serve to strengthen their attachments.
-<span class="pagenum"><a name="Page_22" id="Page_22">[Pg 22]</a></span>
-The striped muscles are those of motion, while the unstriped occur in
-the hollow organs, surrounding the cavity and in some cases lessening
-its capacity by their contraction.</p>
-
-<p>An intermediate form of muscle known as cardiac muscle occurs in the
-heart. Here the fibers have striations but the nucleus is generally in
-the middle of the cell and the fibers branch and run together.</p>
-
-<div class="figcenter">
-    <img id="FIG_05" src="images/i_022a.jpg" alt="" width="600" height="158" />
-    <img src="images/i_022b.jpg" alt="" width="600" height="285" />
-    <p class="blockquot"><span class="smcap">Fig. 5.</span>—Voluntary muscle (Leroy). <i>A</i>,
-          Three voluntary fibers in long sections: <i>a</i>, three voluntary muscle
-          fibers; <i>b</i>, nuclei of same; <i>c</i>, fibrous tissue between the fibers
-          (endomysium); <i>d</i>, fibers separated into sarcostyles. <i>B</i>, Fiber
-          (diagrammatic): <i>a</i>, dark band; <i>b</i>, light band; <i>c</i>, median line of
-           Hensen; <i>d</i>, membrane of Krause; <i>e</i>, sarcolemma; <i>f</i>, nucleus. <i>C</i>:
-           <i>a</i>, Light band; <i>b</i>, dark band; <i>c</i>, contracting elements; <i>d</i>, row
-           of dots composing the membrane of Krause; <i>e</i>, slight narrowing of
-           contracting element aiding in production of median line of Hensen.</p>
-</div>
-
-<p>In life muscle appears more or less translucent and is contractile and
-alkaline, but in death it loses its translucency and becomes rigid, at
-the same time giving off in decomposition much carbon dioxide, so that
-its reaction is acid. This phenomenon of the muscles becoming rigid in
-death is called rigor mortis and occurs generally a few hours after
-<span class="pagenum"><a name="Page_23" id="Page_23">[Pg 23]</a></span>
-death, though it may come at once or be considerably delayed. It
-may last anywhere from a few moments to several days but generally
-lasts from twenty-four to thirty-six hours. It is probably due to the
-formation in the muscle of myosin, a substance which probably comes
-from myosinogen in the living muscle and which is closely akin to
-the fibrin of blood. Probably the myosin or what precedes it causes
-clotting of the muscle just as fibrin or what precedes it causes
-clotting of the blood.</p>
-
-<div class="figcenter">
-    <img id="FIG_06" src="images/i_023.jpg" alt="" width="600" height="295" />
-    <p class="blockquot"><span class="smcap">Fig. 6.</span>—Three voluntary muscle
-          fibers from an injected muscle, showing network of blood capillaries. (Hill.)</p>
-</div>
-
-<p>The muscles vary in shape in different parts of the body, being long
-and slender in the limbs and broad and flat in the trunk. They are
-attached chiefly to bones but also to cartilages, ligaments, and skin,
-either by means of tendons, which are cords or bands of white inelastic
-fibrous tissue, or by means of aponeuroses, membranous expansions of
-the same nature. Most voluntary muscles consist of a belly and two ends
-or tendons. The origin is the fixed point from which it acts while the
-movable point upon which it acts is known as its insertion.</p>
-
-<p><b>Action of the Muscles.</b>—When attached to bones, muscles are
-distributed in three ways: 1. When it is necessary to produce much
-motion rapidly, a short muscle is used. 2. When a part needs to be
-moved far and much contraction on the part of the muscle is, therefore,
-needed, the muscle is very long, as in the case of the sartorius
-<span class="pagenum"><a name="Page_24" id="Page_24">[Pg 24]</a></span>
-muscle, which shortens half its length. 3. Finally, where less distance
-has to be covered but greater power is required, tendons are used, as
-in this case the contraction is powerful but does not carry the part far.</p>
-
-<p>In performing the mechanical work of the body the muscles are aided by
-the fact that the bones, to which they are largely attached, are set
-together loosely and form a set of levers, on which the muscles act
-to perform certain definite acts. All three classes of levers occur:
-1. where the fulcrum is between the weight and the power, as in the
-case of the head, which is balanced by the muscles of the neck on the
-vertebræ; 2. where the weight is between the fulcrum and the power, as
-when a person raises himself upon his toes; and 3. where the power is
-between the fulcrum and the weight, as when the biceps is used to raise
-a weight held in the hand. The erect position of the body is difficult
-to maintain because the center of gravity is high up, and it is by the
-contraction of many muscles in the legs, thighs, back, abdomen, and
-neck that the body is balanced upright upon the feet.</p>
-
-<p><b>Physiology of Muscle.</b>—<i>Irritability</i> or sensitiveness to
-stimulation and <i>contractility</i> or the power to contract are the two
-most important functions of muscle. Contraction occurs in response to
-nervous energy brought by the nerves, a nerve filament going to each
-muscle fiber, into which it plunges, its substance being lost and its
-sheath becoming continuous with that of the muscle fiber. Any irritant,
-as heat, electricity, etc., when applied to the nerve, causes the
-muscle to contract. Moreover, muscle has an irritability of its own
-and can contract independently of the nervous system. In contracting
-it shortens and thickens, bringing the two ends closer together, and
-becomes firm and rigid. The amount of contraction depends upon the
-strength of the stimulus and the irritability of the muscle. The
-minimal stimulus is the least stimulus that will cause a contraction
-<span class="pagenum"><a name="Page_25" id="Page_25">[Pg 25]</a></span>
-and the maximal is one that will cause the greatest contraction. The
-work done depends in like manner upon the strength of the stimulus.
-During contraction certain sounds are given off called muscle
-sounds, which can be heard with the stethoscope but have no special
-significance.</p>
-
-<p>The muscles which have the greatest power of rapid contraction are
-generally attached to levers. Indeed, striated muscle is characterized
-by the rapidity and strength with which it works, though its rhythmic
-motion is slight. Smooth muscle, on the other hand, is characterized
-by its great force, considerable rhythm, considerable tone, and slight
-rapidity, that is, its contraction is slower and lasts longer than that
-of striated muscle. Cardiac muscle is characterized by great rhythm and
-force, fair rapidity, and slight tonicity, tonicity being the amount of
-tone or readiness to work. For even in sleep muscle is always in tone,
-that is, ready to do its work. It is this that makes the difference in
-appearance between a living and a dead person and enables one to spring
-to his feet at night if he hears a noise, a thing he could not do if
-his muscles were wholly relaxed. Thus, rapidity is the great function
-of striated, tonicity of smooth, and rhythm of cardiac muscle. In
-paralysis the muscles droop and lose their tone. Muscles are frequently
-the seat of rheumatic disorders.</p>
-
-<p>When set free, potential energy accomplishes work. In muscle there is
-a good deal of potential energy, which is set free as heat and as work
-accomplished. Even when the muscles are at rest, chemical changes are
-going on and heat is being produced, though more heat is produced when
-they are functioning. If the body depended upon its gross motions for
-all its heat it would grow cold while a person rested. The respiratory
-organs, however, and the heart are always working and chemical changes
-are constantly taking place.</p>
-
-<p>Ordinarily a muscle has some object in contracting, such as the raising
-of a load, and it contracts voluntarily more or less according to the
-<span class="pagenum"><a name="Page_26" id="Page_26">[Pg 26]</a></span>
-weight of the load. The amount of work done is calculated in
-foot-pounds or gram-meters, that is, the energy required to raise one
-pound one foot or one gram one meter. As a rule the muscles with the
-longest fibers, as the biceps, do the most work and those with a large
-number of fibers do more than those with less. It has been calculated
-that whereas an engine gives back one-twelfth of the energy of the coal
-consumed, muscle liberates one-fourth of the energy brought to it in
-the form of food. During activity the glycogen or sugar in the muscle
-is used up and the muscle becomes more acid, owing to the lactic acid
-that is formed. The carbon is taken in and carbon dioxide given off.
-Nitrogen puts the muscle in condition to do its work but is not so
-much used up in the work as is the carbohydrate material. So it is the
-non-nitrogenous matter that does the work and any increase in urea, the
-end-product of protein metabolism, is mere wear and tear.</p>
-
-<p>Sudden heat or cold causes muscular contraction and moderate heat
-favors both muscular and nervous irritability. Moderate cold, however,
-lessens the force of contraction and below zero muscle very largely
-loses its irritability without necessarily becoming rigid.</p>
-
-<p>While well supplied with blood, muscle will contract without fatigue,
-but if the blood supply is shut off, it soon loses its irritability
-and becomes rigid. The more a muscle is used in moderation the more it
-develops, but after it has done a certain amount of work it becomes
-exhausted, losing its irritability or power to respond to stimuli and
-later becoming rigid. Such fatigue is due to the production of certain
-poisonous waste products which have a paralyzing effect on the nerves
-and which are ordinarily gradually carried away in the blood, but which
-sometimes, if produced to excess, accumulate too fast for the blood
-wholly to remove them. Usually the nerve becomes exhausted first and
-the muscle substance later. So long as it is connected with the nervous
-<span class="pagenum"><a name="Page_27" id="Page_27">[Pg 27]</a></span>
-system a muscle will respond to stimuli, but when the nerve becomes
-tired, degeneration is more rapid. In fact, the degree of exhaustion is
-determined by several factors, as by relation to the central nervous
-system, variations in temperature, blood supply, and functional activity,
-the process being more rapid in warm than in cold blooded animals.</p>
-
-<p><b>Cilia.</b>—A few motions are accomplished by tissue that is not
-muscular, as in the case of the cilia attached to the cells of the
-respiratory tract, which lie flat on the free surface and then lash
-forward, serving in the air cells to keep the air in motion and in the
-tubes to send secretions from below upward and outward and to keep out
-foreign bodies. Cilia are also found in the female genital tract, where
-they aid the passage of the ovum from the ovary to the womb. They act
-together, though apparently not governed by the nervous system. As in
-the white corpuscles of the blood, whose motion also is not muscular,
-the changes that take place in ciliated epithelium are probably about
-the same as those in muscular tissue, that is, contractile.</p>
-
-<p><b>The Blood.</b>—To most of the tissues just described nourishment
-is brought in the blood, which circulates through the body in a system
-of hollow tubes, the arteries and veins, whence it is distributed
-through the agency of the lymphatic system. There are no blood-vessels,
-however, in the epidermis, epithelium, nails, hair, teeth, nor in the
-cornea of the eye. The vessels that carry the blood from the heart
-are called arteries, those that return it veins. The former begin as
-large vessels and gradually decrease in size; the latter begin as small
-vessels and form larger and larger trunks as they approach the heart.</p>
-
-<p>The <i>arteries</i> have three coats: 1. a thin, serous coat, the internal
-or intima; 2. a middle or muscular coat, and 3. an external coat of
-connective tissue. The middle coat is the thickest and is the one that
-prevents the walls from collapsing when cut across. Except in the
-<span class="pagenum"><a name="Page_28" id="Page_28">[Pg 28]</a></span>
-cranium, each artery is enclosed in a sheath with its vein or veins,
-the venæ comites. Usually the arteries occupy protected situations and
-are straight in their course. Where a vessel has to accommodate itself
-to the movements of a part, however, it may be curved, as in the case
-of the facial artery which is curled on itself to allow for movements
-of the jaw. They anastomose or communicate freely with one another,
-thus promoting equality of distribution and pressure and making good
-circulation possible even after the obliteration of a large vessel.</p>
-
-<p>The <i>veins</i> have three coats like the arteries, but they are not
-so thick and the muscular coat is not so highly developed, so that the
-walls collapse when cut and have no elasticity. There are constrictions
-on the surface of many of the veins due to the presence of valves.
-These valves are formed of semilunar folds of the lining membrane
-and are arranged in pairs. They serve to prevent the blood, whose
-circulation in the veins is sluggish, from flowing back.</p>
-
-<p>There are two sets of veins, the superficial and the deep, which
-communicate with each other. In fact, all the veins, large and small,
-anastomose very freely, especially in the skull and neck, where
-obstruction would result in serious trouble, throughout the spinal
-cord, and in the abdomen and pelvis. The deep veins accompany the
-arteries in their sheath, while the superficial ones have thicker walls
-and run between the layers of the superficial fascia under the skin,
-terminating in the deep veins. In the skull the venous channels take
-the form of sinuses, formed by a separating of the layers of the dura
-mater, with an endothelial lining that is continuous with that of the
-veins.</p>
-
-<p>The <a href="#FIG_06"><i>capillaries</i></a> are intermediate between the arteries
-and the veins, the final division of the arteries and the first source of the veins.
-They are tiny vessels with but a single coat, continuous with the
-innermost coat of both arteries and veins and consisting practically of
-one layer of cells with a small amount of connective tissue between.
-<span class="pagenum"><a name="Page_29" id="Page_29">[Pg 29]</a></span>
-They spread in a great network throughout the tissues, forming plexuses
-and being especially abundant where the blood is needed for other
-purposes than local nutrition, as in the secreting glands. Their
-diameter is so small that the red corpuscles have to pass in single
-file and may even then be squeezed out of shape. As they have no
-muscular tissue in their walls, they have no power of contracting.
-Their walls, however, like those of the smaller arteries and veins, are
-porous and by virtue of this quality they play an important part in the
-economy, since in them the exchange takes place between the tissues and
-the blood.</p>
-
-<p>The arteries in general carry freshly oxidized blood and the veins
-blood from which the oxygen has been largely used up and which contains
-waste material. In the pulmonary system, however, the case is reversed,
-the pulmonary arteries conveying venous blood, as it is called, from
-the heart to the lungs to be oxidized and the veins returning the blood
-after it has received its new supply of oxygen.</p>
-
-<p>The pumping of the blood through the arteries is assisted by the
-contractions of the muscular coat, while the elastic tissue, of which
-it contains a certain amount, gives elasticity to the walls and enables
-them to stretch and so to accommodate the larger blood supply forced
-into them at each beat by the heart. The walls of the veins have not
-the power of contracting and the blood is pushed through more by
-gravity and the action of the arteries than by any action of their own.</p>
-
-<p>The walls of all the vessels are nourished by tiny blood-vessels in
-the outer coat, known as <i>vasa vasorum</i>, and the nerves that regulate
-the action of the arteries are the vasomotor nerves from the vasomotor
-center in the medulla. Sufficient impulse goes from this center to the
-blood-vessels all the time to keep them somewhat contracted, in a state
-of tone, that is, which is increased or diminished as the blood supply
-is to be diminished or increased.
-<span class="pagenum"><a name="Page_30" id="Page_30">[Pg 30]</a></span></p>
-
-<p><b>Lymphatic System.</b>—The <a href="#FIG_07">lymphatic system</a> also extends
-throughout the body and consists of a system of channels, spaces, and glands
-very closely related to the circulatory system and containing a fluid
-called lymph. There are three principal parts to the system: 1. the
-lymph spaces, which are open spaces, with no definite walls, in the
-connective tissue framework of the body, more frequent near arteries
-and veins and especially so among the capillaries; 2. the lymph
-capillaries or small vessels which connect the lymph spaces; and 3. the
-lymphatic vessels, of which there is a deep and a superficial set, the
-latter accompanying the superficial veins on the surface of the body,
-the former accompanying the deep blood-vessels.
-<span class="pagenum"><a name="Page_31" id="Page_31">[Pg 31]</a></span></p>
-
-<div class="figcenter">
-    <img id="FIG_07" src="images/i_030.jpg" alt="" width="600" height="446" />
-    <p class="blockquot"><span class="smcap">Fig.</span> 7.—Diagram showing the course
-           of the main trunks of the absorbent system: the lymphatics of lower
-           extremities (<span class="smcap">D</span>) meet the lacteals of the
-           intestines (<span class="smcap">LAC</span>) at the receptaculum chyli
-           (<span class="smcap">R.C.</span>), where the thoracic duct begins. The
-           superficial vessels are shown in the diagram on the right arm and leg
-           (<span class="smcap">S</span>), and the deeper ones on the left arm
-           (<span class="smcap">D</span>). The glands are here and there shown in
-           groups. The small right duct opens into the veins on the right side.
-           The thoracic duct opens into the union of the great veins of the left
-           side of the neck (<span class="smcap">T</span>). (Yeo.)</p>
-</div>
-
-<p class="space-above1">The <i>lymph spaces</i> are generally small, though
-there are some large serous cavities, such as the abdomen, that may be
-considered as extended lymph spaces.</p>
-
-<div class="figcenter">
-    <img id="FIG_08" src="images/i_031.jpg" alt="" width="600" height="474" />
-    <p class="blockquot"><span class="smcap">Fig.</span> 8.—Diagram of a lymphatic gland,
-          showing afferent (<i>a. l.</i>) and efferent (<i>e. l.</i>) lymphatic vessels;
-          cortical substance (<i>C</i>); medullary substance (<i>M</i>); fibrous coat
-          (<i>c</i>); sending trabeculæ (<i>tr</i>) into the substance of the gland, where
-           they branch, and in the medullary part form a reticulum; the trabeculæ
-           are surrounded by the lymph path or sinus (<i>l. s.</i>), which separates
-           them from the adenoid tissue (<i>l. h.</i>). (Sharpey.)</p>
-</div>
-
-<p>The <i>lymphatic vessels</i> have delicate, transparent walls, with three
-coats like the arteries, though much thinner, and anastomose even
-more freely than the veins. They have a beaded appearance due to the
-presence of numerous valves, which form constrictions on their surface.
-The right lymphatic duct, which is only about an inch long, drains all
-the lymphatics of the right half of the upper part of the trunk, the
-head, and the neck approximately, while the thoracic duct drains those
-of the rest of the body. The latter, which is the largest vessel of the
-<span class="pagenum"><a name="Page_32" id="Page_32">[Pg 32]</a></span>
-system, begins opposite the second lumbar vertebra with a bulb-like
-reservoir for the lymph or chyle, the receptaculum chyli, and extends
-up along the spinal column for a distance of about eighteen inches to
-the seventh cervical vertebra, where, with the right lymphatic duct, it
-empties into the left subclavian vein at its junction with the internal
-jugular, thus establishing direct communication between the lymph
-spaces and the venous system. The orifices of both vessels are guarded
-by semilunar valves to prevent regurgitation of the blood.</p>
-
-<div class="figcenter">
-    <img id="FIG_09" src="images/i_032.jpg" alt="" width="600" height="325" />
-    <p class="center"><span class="smcap">Fig.</span> 9.—Central (superficial)
-                  lymphatic glands of the axilla. (After Leaf.)</p>
-</div>
-
-<p>The <a href="#FIG_08"><i>lymphatic glands</i></a> are small oval glandular bodies
-and occur here and there along the course of the lymphatics. Before entering one of
-them the vessel breaks up into several afferent vessels which form
-a plexus within and then emerge again as several efferent vessels
-which soon unite to form one trunk. These glands occur chiefly in the
-mesentery, along the great vessels, and in the mediastinum, <a href="#FIG_09">axilla</a>,
-neck, elbow, groin, and popliteal space.</p>
-
-<p>The <i>lymph</i> varies in character with the locality, being a little
-thicker and more opalescent in the lacteals, as the lymphatics of the
-<span class="pagenum"><a name="Page_33" id="Page_33">[Pg 33]</a></span>
-small intestine are called, especially during digestion, when fat is
-present. Here it is called chyle. Otherwise it is generally a clear,
-transparent and slightly opalescent fluid, which, owing to the presence
-of fibrin, clots when drawn from the body and allowed to stand. In
-fact, it resembles blood plasma very closely in composition and, as it
-also contains a certain number of corpuscles or leucocytes that just
-correspond to the white corpuscles of the blood, it is practically
-blood without the red corpuscles. These leucocytes have considerable
-power of amœboid movement and are thought by some to play an important
-part in the absorption of food.</p>
-
-<p>Owing to intracapillary pressure, the lymph transudes into the
-lymph spaces and bathes the tissues, being carried away again by
-the lymphatics. The amount of transudation is determined by the
-blood pressure—the greater the pressure, the greater the amount of
-transudation—and is increased by some organic action of the cells in
-the walls of the vessels. In the process of transudation a certain
-amount of solid matter goes through the wall of the vessel and it is
-probable that certain protein elements can be carried thus from the
-blood-vessels to the lymphatics, though they do not pass through the
-capillary wall as readily as other substances. Some lymph is also
-probably formed by the action of the tissues themselves, though the
-process is not understood.</p>
-
-<p>All muscular movements, active or passive, including the respiratory
-movements, tend to drive the lymph on its way by pressure, the valves
-of the vessels keeping it from flowing back. Moreover, its flow is
-from the capillaries to the veins or from a region of high pressure to
-one of less pressure. There is probably also some contraction in the
-walls of the vessels themselves, and the continual formation of lymph
-helps to drive it along. If an obstruction to the circulation occurs,
-however, back-pressure results and causes too great transudation. In
-that event a limb becomes swollen, pale, and generally cool. It pits on
-<span class="pagenum"><a name="Page_34" id="Page_34">[Pg 34]</a></span>
-pressure, the pressure driving the lymph out and there being no
-circulation to bring it back. This condition is called œdema and occurs
-in liver, kidney, and heart troubles, being generally first observed at
-the ankles. In ascites, hydrothorax, hydrocephalus, and pericardial and
-pleural effusions the fluid corresponds to lymph in its composition and
-the large amount is due to excessive formation of the fluid, which is
-normally present in small quantities.</p>
-
-<p>Lymph gives the tissues substances from the blood that they need and
-carries off those they do not, whether waste or substances of use to
-other tissues. Because they thus absorb certain materials not needed
-by the tissues and convey them to the circulation, the lymphatics have
-also been called absorbents. Indeed, lymph may be spoken of as the
-middleman between the blood and the tissues.</p>
-
-<p>Another function of the lymph is to lubricate. Thus, the synovial fluid
-of the joints is lymph and the pleuræ and the pericardium contain lymph
-or serum to reduce the friction between the adjoining surfaces as much
-as possible. The brain and spinal cord do not quite fill the cavities
-of the cranium and the spinal column but float on a cushion of lymph,
-the cerebro-spinal fluid. When the brain, which is subject to increase
-and diminution in size, increases in size, it drives the lymph out, and
-when it diminishes, the lymph returns.</p>
-
-<p>The lymph glands serve as a protection to adjacent parts and when it
-leaves the gland the lymph is purer and richer in leucocytes than
-when it entered. In fact, they filter harmful matter from the lymph
-and apparently also form white corpuscles. Normally they can with
-difficulty be felt, but in disease, if the leucocytes are unable to
-destroy or carry off the poison, the lymph carries it along to the
-glands, which swell and become tender. If the infection is not severe
-the swelling goes down and the tenderness passes after a short time,
-but if it is severe, there may be suppuration and abscess formation and
-<span class="pagenum"><a name="Page_35" id="Page_35">[Pg 35]</a></span>
-the gland even perhaps be destroyed, giving its life for the health of
-the part. Thus a wound in the foot, if infected, may cause irritation
-and enlargement of the glands at the knee and in the groin.</p>
-
-<p>The lymphatic glands are frequently the seat of tubercular infection,
-especially in the neck, and are enlarged in scarlet fever, tonsillitis,
-and diphtheria. In syphilis there is general glandular enlargement, and
-the glands in the groin become enlarged in all diseases of the genital
-organs. In malignant growths, such as cancer, the extension of the
-disease is often along the lines of the lymphatics.</p>
-
-<p><b>Glands.</b>—Of glands in general a word might now be spoken. They
-are of two kinds, excreting and secreting, and, when simple, are formed
-by the folding in of a free surface, as in the case of the salivary,
-gastric, and sebaceous glands, the cells at the gland becoming so
-modified as to be able to perform the function of excreting or
-secreting. In racemose glands the gland is broken up into many pockets.
-Excreting glands take from an organ or from a part substances which
-have outlived their usefulness and are to be cast out of the body,
-while the secreting glands form from the blood substances that did not
-exist in it before, but which are of use to the body, as the ptyalin
-of the saliva. A strict line cannot, however, be drawn between the two
-kinds of glands, most glands partaking more or less of both functions,
-though the sebaceous and sweat glands are probably purely excreting
-glands and the salivary glands are almost purely secreting. The glands,
-moreover, are more or less interchangeable in their functions, that
-is, they have vicarious function, and one gland can take up and do for
-another what that other is for some reason unable to do. In jaundice,
-where there is stoppage of the bile duct, the kidneys help out the
-liver by excreting the bile. If one <a href="#FIG_58">kidney</a> is removed the
-other does work for both, and the glands of the skin may help out the kidneys or
-<i>vice versa</i>. Hemorrhage from the lungs sometimes occurs in suppression
-of the menses.
-<span class="pagenum"><a name="Page_36" id="Page_36">[Pg 36]</a></span></p>
-
-<p>In a general way the <i>function of glands</i> is chemical. They filter
-out by osmosis, selecting the useful parts for secretion and the useless
-for excretion. In the chemical action that goes on considerable energy
-is given off, as is shown by the amount of pressure in the glands and
-by the fact that their temperature is higher than that of the blood.
-They all work in a reflex manner, being under the control of the
-central nervous system. Thus, what is eaten affects the nerve terminals
-in the mouth, the sensation passes to the nervous system, and an
-impulse is carried by the motor nerves to the salivary glands.</p>
-
-<p>Most of the glands have ducts to convey away their secretion to other
-parts of the body or to send excretions out of the body, but there are
-also <i>ductless glands</i>, which, though they seem to have some important
-function in the process of metabolism, are not well understood. Most
-of them seem to manufacture some substance that is absorbed by the
-tissues and that plays an important part in the bodily metabolism,
-though nothing is secreted by them externally. They are said to have
-an internal secretion, whereas the glands with ducts have an external
-secretion. The liver has both forms of secretion, the bile which is
-sent out and the glycogen that is stored. The ductless glands are the
-thymus and thyroid glands, the suprarenal capsules, and the pituitary
-body in the brain.</p>
-
-<p><b>Nervous Tissue.</b>—Presiding over all the organs, muscles, and
-blood-vessels, as the source of all action and all sensation, are the
-nerves. Nervous tissue is of two kinds: 1. the gray or vesicular, which
-originates impulses and receives impressions, and 2. the white or
-<a href="#FIG_10">fibrous</a>, which conveys impressions. The gray matter
-consists of large granular cells of protoplasm containing nuclei, which give
-off many branches or dendrites. From the under surface there usually comes one
-main branch, the <a href="#FIG_10">axis-cylinder</a> process. These processes sometimes
-<span class="pagenum"><a name="Page_37" id="Page_37">[Pg 37]</a></span>
-give off branches and sometimes not, but they form the nerve fibers and
-carry impulses away from the nerve cells. The cells of the processes
-are elongated in shape, have a nucleus, and are placed end to end, with
-a definite constriction between them.</p>
-
-<p>Each axis-cylinder process is surrounded by a sheath called the
-<a href="#FIG_10">medullary sheath</a>, while each nerve fiber consists of
-a central axis-cylinder process surrounded by the white substance of Schwann
-and enclosed in a sheath. A bundle of these fibers invested in a
-fibro-areolar membrane called the <a href="#FIG_10">neurilemma</a> constitutes
-a nerve, and of these the white matter is formed. The blood supply is brought by
-minute vessels, the <i>vasa nervorum</i>.</p>
-
-<div class="figcenter">
-    <img id="FIG_10" src="images/i_037.jpg" alt="" width="600" height="159" />
-    <p class="blockquot"><span class="smcap">Fig. 10.</span>—Longitudinal nerve fiber
-         (diagrammatic): <i>a</i>, Axis-cylinder; <i>b</i>, medullary sheath; <i>c</i>,
-          neurilemma; <i>d</i>, nucleus; <i>e</i>, node of Ranvier. (Leroy.)</p>
-</div>
-
-<p>The nerves of the cerebro-spinal system preside over animal life and
-have to do with voluntary acts, while those from the sympathetic
-system regulate organic life and are quite independent of the will.
-Both sensory and motor nerves extend all over the body, accompanying
-the arteries in a general way. The sensory nerves end on the surface
-in plexuses, in end bulbs situated in the papillæ of the skin, or
-in tactile corpuscles, these last occurring more especially where
-there is no hair. The motor nerves end peripherally in plexuses or
-by end plates. The central terminations of the motor nerves and the
-terminations of sensory nerves in special organs, except where they end
-in a cell, are not well understood.</p>
-
-<p>Like muscles, nerves are probably never at rest, for through them the
-muscles get their tone. When a nerve acts, no heat is produced and
-there is no change in the nerve afterward, as there is in muscle.
-Probably nerve impulse is the transmission of physical rather than
-<span class="pagenum"><a name="Page_38" id="Page_38">[Pg 38]</a></span>
-chemical changes along the fiber, the atoms of the nerve being set
-in vibration and the vibrations being transmitted along its length.
-Stimulation is produced by physical injury, by chemical influence, by
-electricity, by heat, and the message is always referred to the nerve
-termination. Thus, if the nerve at the elbow, over the “crazy bone,” is
-touched, a tingling is felt in the fingers rather than at the point of
-pressure. A person who has had an arm or leg amputated will frequently
-speak of his fingers or toes on that side being cold, or complain of
-pain in them, because the scar below the point of amputation tightens
-around the nerves and pinches them.</p>
-
-<p>It is through the nerves that people get in touch with the outer world
-and that they judge of size, weight, etc. All careful adjustment of the
-muscles is under the control of the nervous system.</p>
-
-<hr class="chap" />
-<div class="chapter">
-<p><span class="pagenum"><a name="Page_39" id="Page_39">[Pg 39]</a></span></p>
-<h2 class="nobreak">CHAPTER II.<br />
-<span class="h2_subtitle">THE SKIN, ITS APPENDAGES<br /> AND ITS FUNCTION.</span></h2></div>
-
-<p>The whole exterior surface of the body is covered by the skin, an
-excreting and absorbing organ, which serves as a protection to the
-parts beneath and is also the organ of touch. It has two layers,
-a superficial and a deep. The superficial layer, the <a href="#FIG_11">epidermis</a>
-or cuticle, is composed wholly of epithelial cells, of which the deepest
-layer is columnar and moulded upon the papillary layer of the <a href="#FIG_11">derma</a>,
-while the intermediate layers are more rounded and the surface ones
-flat. The deepest layer also contains the skin pigment, which causes
-the variation in shade between the Indian, the negro, and the white
-man. Below the epidermis, which is chiefly protective, is the tough,
-elastic, and flexible tissue of the derma or true skin, in which are
-vested most of the activities of the skin. Its surface is covered
-with papillæ, which are more numerous in the more sensitive parts.
-Each papilla contains one or more capillary loops and one or more
-nerve fibers, while some terminate in an oval body known as a tactile
-corpuscle. Beneath the papillæ is the reticular layer, composed of
-interlacing bands of fibrous tissue and containing blood-vessels,
-lymphatics, and nerves, as well as unstriped muscle fibers where
-hair is present.</p>
-
-<div class="figcenter">
-    <img id="FIG_11" src="images/i_039.jpg" alt="" width="600" height="208" />
-    <p class="center"><span class="smcap">Fig. 11.</span>—Vertical section of skin.</p>
-</div>
-
-<p><span class="pagenum"><a name="Page_40" id="Page_40">[Pg 40]</a></span>
-At the apertures of the body the skin stops and is replaced by <i>mucous
-membrane</i>, an integument of greater delicacy but which consists
-fundamentally of the same two layers, a superficial, bloodless
-epithelium and a deep fibrous derma. It is continuous with the skin,
-but is much redder and more sensitive and bleeds more easily. The
-passages and cavities that it lines, unlike those lined by serous
-membranes, communicate with the exterior of the body and are for that
-reason protected against contact with foreign substances by mucus,
-which is thicker and more sticky than the lymph that moistens the
-endothelium found on serous surfaces. Mucous membrane is found in the
-alimentary canal, the respiratory tract, and the genito-urinary tract.
-In cavities, like the stomach and intestines, which are subject to
-variations in capacity, it is thrown into folds or rugæ. The mucus is
-secreted by small glands in the membrane.</p>
-
-<p><b>Appendages of the Skin.</b>—The skin has various appendages. On
-the dorsal surface of the last phalanges of the fingers and toes are
-flattened and horny modifications of epithelium, the <i>nails</i>. They have
-a root embedded in a groove of skin by which they grow in length and a
-vascular matrix of derma beneath them which gives growth in thickness.
-To their growth in length there seems to be no limit.</p>
-
-<p>The <a href="#FIG_12"><i>hairs</i></a> also, which occur all over the body,
-except on the palms of the hands and the soles of the feet, are a modification
-of the epithelium. Each hair has a bulbous root springing from an involution
-in the epidermis and derma called the <a href="#FIG_11"><i>hair follicle</i></a>,
-into which one or two <a href="#FIG_11">sebaceous glands</a> empty. It is raised
-by involuntary muscle fibers and grows by constant additions to the surface by which
-it is attached. This growth seems, however, to be limited, and when its term
-<span class="pagenum"><a name="Page_41" id="Page_41">[Pg 41]</a></span>
-is reached the hair falls out and is replaced by another. The horny
-epithelial cells that go to form the hair contain the pigment that
-gives it its color.</p>
-
-<div class="figcenter">
-    <img id="FIG_12" src="images/i_041.jpg" alt="" width="400" height="376" />
-    <p class="blockquot"><span class="smcap">Fig. 12.</span>—Skin and longitudinal section of
-       hair: <i>a</i>, Epidermis; <i>b</i>, corium; <i>c</i>, sebaceous gland; <i>d</i>, fibrous
-       root-sheath; <i>e</i>, glassy membrane; <i>f</i>, outer root-sheath; <i>g</i>, inner
-       root-sheath; <i>h</i>, expanded bulbous end of hair; <i>i</i>, papilla of hair;
-       <i>j</i>, arrector pili; <i>k</i>, adipose tissue. (Leroy)</p>
-</div>
-
-<p>Like the hairs, the <a href="#FIG_12"><i>sebaceous glands</i></a> are situated
-in all parts of the body except the palms of the hands and the soles of the feet.
-They lie in the papillary layer and empty into the hair follicles, except
-occasionally, when they empty directly upon the surface of the skin.
-They secrete an oily substance, <i>sebum</i>, the débris resulting from the
-degeneration of the epithelial cells of the gland itself, which serves
-to keep the hair glossy and the skin soft and flexible.
-<span class="pagenum"><a name="Page_42" id="Page_42">[Pg 42]</a></span></p>
-
-<p>The <a href="#FIG_11"><i>sweat glands</i></a>, on the other hand, are more frequent
-on the palms and soles and though sometimes found in the derma are usually situated
-lower down in the subcutaneous cellular tissue. They are least numerous
-on the back and neck. Coiled up in the lower layers of the skin, they
-discharge the sweat through a spiral excretory duct upon its free surface.</p>
-
-<p>The <i>sweat</i> is a clear, colorless, watery fluid with a salty taste,
-an alkaline reaction, and a characteristic odor that varies with
-the individual. If very scanty, it may be acid in reaction. Besides
-water it contains a small percentage of solids, as inorganic salts,
-especially sodium chloride, fatty acids, neutral fats, and at times,
-especially in some diseases of the kidneys, urea, that is, the
-end-products of the metabolism of starches and fats chiefly. There
-is usually also some carbon dioxide, whence the expression cutaneous
-respiration.</p>
-
-<p>The sweat serves to keep the skin moist and in good condition, to
-remove outworn and poisonous or irritating matters, and to regulate
-the temperature. As a rule it evaporates upon reaching the surface, in
-which case it is known as invisible or insensible perspiration, but if
-conditions of the atmosphere are not favorable to prompt evaporation,
-as when the air is damp, the skin becomes damp and there is visible
-perspiration.</p>
-
-<p>Though an abundant supply of blood increases the action of the sweat
-glands, they are regulated by definite secretory nerves rather than
-by the vasomotor nerves. In a cold sweat the action is probably due
-to some disturbance of the nerve supply without increase of the blood
-supply. Ordinarily perspiring is a reflex act due to the stimulation
-of the afferent cutaneous nerves, as by the application of heat, but
-sometimes, as in cases of strong emotions, involuntary impulses are
-sent from the brain to the spinal centers and so arouse the action of
-the glands. Atropin has the power of preventing the secretion of sweat
-<span class="pagenum"><a name="Page_43" id="Page_43">[Pg 43]</a></span>
-by paralyzing the terminations of the secretory nerves, while
-pilocarpin produces an opposite effect in a similar way.</p>
-
-<p>On account of these sweat glands the skin becomes next in importance
-after the kidneys in the excretion of waste products. The quantity of
-sweat excreted varies greatly and is hard to measure. It is influenced
-by the temperature and humidity of the surrounding air, by the nature
-and quantity of food and drink consumed, by the amount of exercise,
-the relative activity of other organs, especially the <a href="#FIG_58">kidneys</a>,
-and by certain mental conditions. The hotter it is, the greater the amount of
-perspiration. In damp weather there may be less perspiration, but it
-does not evaporate and is therefore more in evidence.</p>
-
-<p>Ordinarily man has a temperature of 98.6°. The source of this body heat
-or temperature is the general body metabolism, muscular activity, and
-activity of the glands, especially of the liver, which is constantly
-active, the blood in the hepatic vein being warmer than that in any
-other part of the body. The tissue of the brain also is said to be
-warmer than the surrounding blood, and the heart and respiratory
-muscles, which are in constant activity, are responsible for much of
-the body heat. The amount of heat generated in the body, therefore,
-varies at different times, according as a person is awake or asleep,
-quiet or active.</p>
-
-<p><b>Temperature Regulation.</b>—The temperature is regulated by
-variations in the production and loss of heat, less being known of its
-production than of its loss. It has been calculated that four-fifths of
-the energy of the body is converted into heat, one-fifth into work. As
-the minimum amount of heat produced in twenty-four hours is sufficient
-to raise 10 gallons of water from 0° to boiling-point, it is evident
-that if there were not some way for the escape of much of this heat the
-body would become hotter and hotter and finally destroy itself. The
-temperature, however, except on the surface, is uniform, heat being
-<span class="pagenum"><a name="Page_44" id="Page_44">[Pg 44]</a></span>
-lost as fast as it is produced. For, although oxidation at any point
-raises the heat of the blood at the point, this heat is carried by the
-blood to other parts, to which the surplus is given up, while blood
-cooled in the skin goes to the hotter inward parts to cool them and be
-warmed itself. In fact, heat is expended by conduction and radiation,
-through respiration, perspiration, and heat given to the urine and
-fæces. It is, therefore, largely, 75 to 80 per cent., carried off
-through the skin and the lungs; 60 to 70 per cent. is lost by radiation
-to the air and other bodies with which the body comes in contact;
-20 to 30 per cent. is lost by the evaporation of sweat, 4 to 8 per
-cent. by the warming of expired air, urine and feces, and 1 to 2 per
-cent. by cold food that is taken in. Radiation acts more favorably
-where the surroundings are cool and the air in motion, as on a breezy
-day. Conduction is carried on best where the surrounding air is cool,
-especially if it is moist, for moist air is a better conductor of heat
-than dry air. Evaporation is very important in hot weather or where men
-work in hot air.</p>
-
-<p>Even in health the temperature may range from 98.6° to 99.5°, and a
-degree or two below or above is not dangerous. When a person first
-gets up in the morning his temperature is apt to be subnormal, but
-after food and exercise have been taken it becomes normal and stays
-so till the end of the day, when, if the person is tired, it may go
-up a little. If a person is tired out, the temperature is apt to be
-subnormal. There is also in the body what is called the vital tide,
-which is highest afternoon and evening and lowest in the morning.</p>
-
-<p>The rate of production of heat varies greatly in different people. One
-person uses a certain amount of tissue more quickly than another, that
-is, he lives faster. Moreover, size makes a difference in that a small
-body has more surface to its weight than a large one and so has to
-produce the same amount of heat at a faster rate in order to maintain
-the right temperature. Taking food increases heat, probably because of
-<span class="pagenum"><a name="Page_45" id="Page_45">[Pg 45]</a></span>
-the muscular effort needed to eat it. Muscular work is another factor.
-And finally the whole matter of heat production seems to be under
-the control of the nervous system. Not much is known on this point
-except that there is a heat center in the medulla which plays an
-important part in heat production and whose influence is seen where
-the temperature shoots way up in disease just before death. It is now
-thought that fever is due to a disturbance of this nervous mechanism,
-though just what the disturbance is is not known.</p>
-
-<p><i>Fever</i> is a condition of increased bodily temperature, due to
-increased production or to decreased loss of heat. As a rule, in all
-fevers the metabolic changes in the body are increased. Hence the
-patient becomes emaciated in a long fever. The frequent increase in the
-amount of urea during fever shows an increase in protein metabolism.
-The temperature in fevers rises as high as 106° and in sunstroke
-sometimes to 110°. Except in sunstroke a higher temperature than 106°
-generally means death. Subnormal temperature is due to a decrease in
-the bodily metabolism and so to lessened heat production. As a rule,
-if the functions are all active, especially that of the sweat glands,
-a person can be exposed to severe heat without the temperature being
-affected, though sometimes on a hot summer day it may be up half to one
-degree. The cause of heat-stroke with its high fever is unknown, but
-probably it is due to some effect on the heat center in the brain. Heat
-prostration is also due to prolonged exposure to heat, but is generally
-accompanied by a subnormal temperature. The effect of cold, as in
-freezing, is to diminish all the metabolic activities of the body. The
-temperature can be artificially regulated more or less by variations of
-food, varying amounts of exercise, by drugs, etc.</p>
-
-<p><b>Sense of Touch.</b>—Before passing on to a discussion of the
-individual parts, a few words might well be said of the sense of touch,
-since that is general and resides largely in the skin, whose other
-<span class="pagenum"><a name="Page_46" id="Page_46">[Pg 46]</a></span>
-functions have just been described. It may be regarded as the form from
-which all the other special senses have developed, certain portions
-of the body having become more sensitive than others to certain
-vibrations, as the eye to those of light. The internal organs probably
-have little sense of touch.</p>
-
-<div class="figcontainer">
-  <div class="figsub">
-   <img id="FIG_13" src="images/i_046a.jpg" alt="" width="300" height="390" />
-  </div>
-  <div class="figsub">
-   <img src="images/i_046b.jpg" alt="" width="250" height="409" />
-   </div>
-   <p class="center"><span class="smcap">Figs. 13, 14.</span>—Meissner’s corpuscle from man; ×750.<br />
-           (Böhm, Davidoff, and Huber.)</p>
-</div>
-
-<p>Touch is useful only within arm’s reach but there gives one a sense of
-space that sight does not give. It is practically determined by the
-<a href="#FIG_13"><i>touch corpuscles</i></a>, which are found in the skin over
-almost the entire body, though they are more numerous in some places than in others,
-the distribution of the corpuscles determining the sensitiveness of the
-skin. These touch corpuscles are protoplasmic bodies containing nuclei,
-about which are entwined filaments from the cutaneous nerves. Where the
-corpuscles are absent the filaments of the cutaneous nerves themselves
-play an important part. The finger tips have a very delicate sense of
-touch and the tip of the tongue is the most sensitive part of the body.
-<span class="pagenum"><a name="Page_47" id="Page_47">[Pg 47]</a></span>
-Hence spaces in the mouth seem larger than elsewhere. By the
-transmission of sensations of touch to the brain the sensation is
-localized and the tactile sensation becomes a tactile perception.</p>
-
-<p>There are three main divisions of the sense of touch: 1. sensations of
-touch proper or tactile sensation; 2. sensations of temperature, and
-3. sensations of pain. The temperature sense is the transmission by
-the skin of sensations not so much of a certain degree of heat or cold
-as of the difference between the temperature of an object and that of
-the skin. The longer an object is in contact with the skin, the less
-conscious the person is of it, not only because it becomes of the
-same temperature, but also because he becomes accustomed to it. There
-also seem to be in the skin, besides the touch corpuscles, two other
-terminal organs with separate nerve fibers, the one for detecting heat,
-the other cold; for there are places on the body where heat can be
-detected and cold cannot, and <i>vice versa</i>.</p>
-
-<p>Sensations of pain may be merely an exaggeration of tactile sensation,
-as in too hard pressure or too great heat, but there seems to be also
-a sensation of pain in the skin. All organs are said to have common
-sensibility to pain and any exaggeration of this sensibility causes a
-sensation of pain. All the special senses require a certain amount of
-judgment in the interpretation of the sensations they convey.</p>
-
-<hr class="chap" />
-<div class="chapter">
-<p><span class="pagenum"><a name="Page_48" id="Page_48">[Pg 48]</a></span></p>
-<h2 class="nobreak">CHAPTER III.<br /> <span class="h2_subtitle">THE CRANIUM AND FACE.</span></h2></div>
-
-<p>The intelligence and all the special senses, except the sense of touch
-already spoken of, are gathered together compactly in the head, where
-they are carefully protected with bony tissue. Covering the brain is
-the skull or cranium, which is made up of eight bones, the frontal, the
-occipital, two parietal, two temporal, the sphenoid, and the ethmoid,
-while the bones of the face are fourteen in number, two nasal, two
-superior maxillary, two lachrymal, two malar, two palate, two inferior
-turbinated, the vomer, and the inferior maxillary. For the most part
-the bones are arranged in pairs, one on either side.</p>
-
-<p><b>The Cranial Bones.</b>—The cranium or skull is especially adapted
-for the protection of the brain and the bones are flat and closely
-fitted to its surface. They have two layers of bone, the outer and the
-inner tables, of which the outer is the thicker, and between these is
-a tissue filled with blood-vessels, the <i>diploë</i>. In the infant, whose
-brain has not yet attained its full size, opportunity must be left
-for growth and the skull therefore consists of a number of bones with
-interlocking notched edges, where growth takes place, but in the adult
-it forms one solid covering of bone.</p>
-
-<p>The line where the edges of two cranial bones come together is called
-a <i>suture</i>. The suture between the frontal bone and the forward edges
-of the two parietal bones is called the <a href="#FIG_15A"><i>coronal suture</i></a>,
-that between the two parietal bones at the vertex of the skull is known as the
-<i>longitudinal</i> or <a href="#FIG_15B"><i>sagittal suture</i></a>, and that between
-the occipital bone and the back edges of the parietal bones as the <i>lambdoidal suture</i>.
-<span class="pagenum"><a name="Page_49" id="Page_49">[Pg 49]</a></span></p>
-
-<p>Where the coronal and sagittal sutures meet is a membranous interval
-known as the <i>anterior fontanelle</i>, while the <i>posterior fontanelle</i>
-is at the juncture of the sagittal with the lambdoidal suture. These
-<a href="#FIG_15B">fontanelles</a>—so called from the pulsations of the brain
-that can be seen in them—close after birth either by the extension of the
-surrounding bones or by the development in them of small bones known
-as <i>Wormian bones</i>, the posterior one closing within a few months,
-the anterior by the end of the second year. In rickets, however, the anterior
-fontanelle remains open a long time, sometimes into the fourth year.</p>
-
-<div class="figcontainer">
-  <div class="figsub">
-   <img id="FIG_15A" src="images/i_049a.jpg" alt="" width="200" height="183" />
-  </div>
-  <div class="figsub">
-   <img id="FIG_15B" src="images/i_049b.jpg" alt="" width="300" height="222" />
-   </div>
-   <p class="center"><span class="smcap">Fig. 15.</span>—Cranium at birth,
-            showing sutures and fontanelles.</p>
-</div>
-
-<p>The <a href="#FIG_16"><b>frontal bone</b></a>, as its name implies, forms the
-fore part of the head or forehead. It joins the parietal bones above and the
-temporal bones on either side. At the lower edge are the supra-orbital
-arches, each with a supra-orbital notch or foramen on its inner margin
-for the passage of the supra-orbital vessels and nerve, the nerve most
-affected in neuralgia. Just above the arches on either side are the
-superciliary ridges, behind which, between the two tables of the skull,
-lie the frontal sinuses. On the inner surface the frontal sulcus for
-the longitudinal sinus runs along the median line.</p>
-
-<p>The <b>parietal bones</b> are the side bones of the skull. They meet
-<span class="pagenum"><a name="Page_50" id="Page_50">[Pg 50]</a></span>
-each other in the sagittal suture at the median line above and join
-the frontal and occipital bones at either end, while below they touch
-upon the temporal bones, the temporal muscles being attached in part
-along their lower surface. These muscles are inserted into the coronoid
-process of the lower jaw, which they thus help to raise and to retract.</p>
-
-<div class="figcenter">
-    <img id="FIG_16" src="images/i_050.jpg" alt="" width="600" height="461" />
-    <p class="center"><span class="smcap">Fig. 16.</span>—Front view
-             of the skull.<br /> (After Sobotta.)</p>
-</div>
-
-<p>The <a href="#FIG_17"><b>occipital bone</b></a> is at the base of the skull
-and at birth consists of four pieces. In the lower, anterior part is the foramen
-magnum, an oval opening through which the spinal cord passes from
-the skull down into the spinal canal. Half way between the foramen
-and the top of the bone is the external occipital protuberance for
-the attachment of the ligamentum nuchæ which holds the head erect.
-The inner side of the bone is deeply concave and is divided by a
-cross-shaped grooved ridge into four fossæ, the internal occipital
-<span class="pagenum"><a name="Page_51" id="Page_51">[Pg 51]</a></span>
-protuberance being situated where the arms of the cross meet. The
-occipital lobes of the cerebrum lie in the two upper fossæ and the
-hemispheres of the cerebellum in the two lower ones. In the grooves
-upon the ridge are the sinuses which collect the blood from the brain.</p>
-
-<p>The occipital and frontal muscles, united by a thin aponeurosis, cover
-the whole upper cranium and are known as the <i>occipito-frontalis
-muscle</i>. At the back this is attached to the occipital bone, while
-in front it interlaces with various face muscles. It is a powerful
-muscle and raises the brows, wrinkles the forehead, and draws the scalp
-forward. Long hair grows on the skin over it as a further protection
-against blows upon the skull and sudden variations in temperature.</p>
-
-<p>The <a href="#FIG_17"><b>temporal bones</b></a>—said to be so named because the
-hair over them is the first to turn with age—are situated at the sides and base
-of the skull and are in three portions: the squamous or scale-like, the
-mastoid or nipple-like, and the petrous or stony portion. The squamous
-is the upper portion and has projecting from its lower part the long
-arched zygomatic process, which articulates with the <a href="#FIG_16">malar bone</a>
-of the face and from which arises the <i>masseter muscle</i>, one of the chief
-muscles of mastication, which has its insertion in the ramus and angle
-of the lower jaw. Just above the zygomatic process the <i>temporal
-muscle</i> has its origin in part, while below is the <i>glenoid fossa</i>
-for articulation with the condyle of the lower jaw, the posterior portion
-of the fossa being occupied by part of the parotid gland.</p>
-
-<p>The rough mastoid portion of the temporal bone is toward the back and
-affords attachment to various muscles, of which the most important are
-the occipito-frontalis and the sterno-cleido-mastoid. Within it are the
-mastoid cells, which communicate with the inner ear and are lined with
-mucous membrane continuous with that of the tympanum. They probably
-have something to do with the hearing. In children they often become
-<span class="pagenum"><a name="Page_52" id="Page_52">[Pg 52]</a></span>
-the seat of inflammation (mastoid abscess) in infectious diseases and
-the mastoid bone has to be cut to let out pus that has collected.
-As the lateral sinus is directly behind the mastoid bone, there is
-very great danger of going through into the sinus and causing a fatal
-hemorrhage.</p>
-
-<div class="figcenter">
-    <img id="FIG_17" src="images/i_052.jpg" alt="" width="600" height="438" />
-    <p class="center"><span class="smcap">Fig. 17.</span>—Side view of the skull.<br />
-            (After Sobotta.)</p>
-</div>
-
-<p>The petrous portion, which contains the organ of hearing, is between
-and somewhat behind the other two portions, at the lower edge of the
-temporal bone, wedged between the sphenoid and the occipital bones. On
-its outer surface is the <i>external auditory meatus</i>, and from below
-projects a long sharp spine called the <i>styloid process</i>, to which
-several minor muscles are attached. In the same angle between the
-petrous and squamous portions lies the bony Eustachian tube.</p>
-
-<p>The <b>sphenoid</b> or <b>wedge bone</b>, so called because in the
-process of development it serves as a wedge, lies at the base of the
-cranium, forming as it were the anterior part of the floor of the
-<span class="pagenum"><a name="Page_53" id="Page_53">[Pg 53]</a></span>
-cavity containing the brain. It is a large, bat-shaped bone and
-articulates with all the cranial and many of the facial bones, binding
-them all together. It has a body, two large wings, and two lesser wings
-and, appears on the outside of the skull between the frontal and the
-temporal bones behind the zygomatic process. In the adult the body of
-the sphenoid is hollowed out into the sphenoid sinuses, in which pus
-sometimes forms.</p>
-
-<p><b>The Ethmoid Bone.</b>—In front of and below the sphenoid and
-extending forward to the frontal bone is the ethmoid, the last of the
-cranial bones. It consists of a horizontal cribriform or sieve-like
-plate, from either side of which depend lateral masses of ethmoid
-cells. To the inner side of these masses are attached the thin curved
-<i>turbinated bones</i>, superior and middle, while between them is a
-vertical plate that forms the bony septum of the nose. Rising from
-the upper surface of the cribriform plate is another vertical plate,
-the <i>crista galli</i>, with the olfactory grooves on either side for
-the reception of the olfactory bulbs, filaments of the olfactory nerve
-passing down through the perforations of the cribriform plate to the
-nose. For the brain, which fills almost the entire cavity of the
-cranium, is supported by the sphenoid and ethmoid bones internally, as
-it is protected externally by the other cranial bones.</p>
-
-<p><b>Ossification of Sutures.</b>—If premature ossification of all the
-sutures occurs, <i>idiocy</i> results, while in <i>cephalocele</i> there
-is a gap in the ossifying of the bones so that the membranes or brain protrude.
-In <i>rickets</i> the forehead is high and square and the face bones
-poorly developed, so that the head looks larger than it really is. In
-<i>Paget’s disease</i> the bones enlarge and soften. This affects the head
-but not the face and often the first thing noticed is that the hat is
-too small. <i>Craniotabes</i> is thinning of the bone in places, the bone
-becoming like parchment and being easily bent. It is generally caused
-by pressure of the pillow or the nurse’s arm.</p>
-
-<p><b>Bones of the Face.</b>—The facial bones serve to form the various
-<span class="pagenum"><a name="Page_54" id="Page_54">[Pg 54]</a></span>
-features of the face, which after all are merely organs of special
-sense. Many delicate muscles control the facial expression which,
-consciously or unconsciously, reflects the character of their owner.</p>
-
-<p>Surgically the most important of the facial bones are the two <a href="#FIG_17"><i>superior
-maxillary bones</i></a>, because of the number of diseases to which they
-are liable. They meet in front, together forming the upper jaw, and
-with the malar bone help form the lower part of the orbit of the eye.
-They are cuboid in shape and are hollowed out into a pyramidal cavity
-called the <i>antrum of Highmore</i>, which opens by a small orifice into
-the middle nasal meatus and which sometimes becomes infected and has
-to be tapped. The nasal process for articulation with the frontal and
-nasal bones has, at its lower edge, a crest for the inferior turbinated
-bone, and close beside this on the inside, extending down from the
-upper edge, is a deep groove which, with the lachrymal and inferior
-turbinated bones, helps to form the lachrymal canal for the nasal tear
-duct. The bones give attachment to many small muscles, connected for
-the most part with the nose and mouth, of which the masseter is the
-only important one.</p>
-
-<p>The two <a href="#FIG_16"><i>malar</i></a> or <i>cheek bones</i> are small quadrangular
-bones, which form the prominences of the cheeks and help form the orbits of the
-eyes. Projecting backward from each is a zygomatic process for
-articulation with the zygomatic process of the temporal bone, while a
-maxillary process extends downward for articulation with the superior
-maxillary. Here again the most important muscle attached is the
-masseter. If the malar bone is crushed great deformity results.</p>
-
-<p>The <i>lachrymal bones</i> are two small bones, about the size and shape
-of a finger-nail, situated at the front of the inner wall of the orbit. At
-the external edge is a groove which lodges the lachrymal sac above and
-forms part of the lachrymal canal below.</p>
-
-<p>The two <i>palate bones</i> are at the back of the nasal fossæ and help to
-form the floor of the nose, the roof of the mouth, and the orbit. Each
-<span class="pagenum"><a name="Page_55" id="Page_55">[Pg 55]</a></span>
-has a vertical and a horizontal plate, and it is these last that by
-their juncture form the <i>hard palate</i>. Oftentimes in cases of hare-lip
-<i>cleft palate</i> also occurs, the result of incomplete development. To
-remedy the consequent opening in the roof of the mouth, which makes
-articulation difficult, operation is generally resorted to, though
-sometimes a plate is fitted over the opening by a dentist.</p>
-
-<p>The <a href="#FIG_16"><i>nasal bones</i></a> are two small oblong bones which
-articulate with the frontal and superior maxillary bones and with each other.
-They form the bridge of the nose, the rest of the nose being wholly of cartilage,
-except for the <i>vomer</i>, a bone shaped like a plough-share, which forms
-part of the nasal septum, articulating along its anterior edge with the
-ethmoid and the triangular cartilage.</p>
-
-<p>The two <i>inferior turbinated bones</i> lie along the outer walls of the
-nasal fossæ. They are thin scroll-like bones covered with mucous
-membrane and serve to heat the air as it passes in. Sometimes when one
-has a cold, the membrane and the bone too swell up and close the nares.
-Loss of the sense of smell in a bad cold may be due to such swelling
-and the consequent impeding of the entrance of odoriferous particles—a
-condition that would likewise interfere with the sense of taste. Part
-of the bone is sometimes removed, to enlarge the passage, enough being
-left to warm the air.</p>
-
-<p>Lastly, there is the <a href="#FIG_17"><i>inferior maxillary bone</i></a> or
-<i>lower jaw</i>. This has a horseshoe-shaped body and two <i>rami</i>, one at either
-end. Each ramus has a pointed process in front called the <i>coronoid process</i>,
-into which is inserted the temporal muscle. At the back, and separated
-from the coronoid process by the sigmoid notch, is the <i>condyle</i>, which
-articulates with the glenoid fossa on the temporal bone. The rami also
-give attachment to the masseter muscle at its point of insertion. In
-adult age the ramus is almost vertical but in old age the portion of
-the jaw hollowed out into alveoli for the teeth becomes absorbed and
-<span class="pagenum"><a name="Page_56" id="Page_56">[Pg 56]</a></span>
-the angle of the jaw becomes very obtuse. On the inner side of the jaw
-near the middle on either side is the fossa for the <i>sublingual gland</i>,
-while the <i>submaxillary gland</i> lies in a fossa farther back on either
-side.</p>
-
-<p>Sometimes the lower jaw is dislocated and when once this has occurred
-it is liable to occur again, the ligaments becoming stretched.</p>
-
-<hr class="chap" />
-<div class="chapter">
-<p><span class="pagenum"><a name="Page_57" id="Page_57">[Pg 57]</a></span></p>
-<h2 class="nobreak">CHAPTER IV.<br /> <span class="h2_subtitle">THE ORGANS OF SPECIAL SENSE.</span></h2></div>
-
-<p><b>The Nose.</b>—The nose, the organ of the sense of smell, is
-composed of a framework of bones and cartilages, the bridge being
-formed by the two nasal bones, and the septum by the vomer and the
-triangular cartilage. It consists of two parts, the <i>external nose</i>
-and the internal or <i>nasal fossæ</i>, which open to the face by the
-anterior nares or nostrils and into the pharynx by the posterior nares.
-Externally it is covered with skin, internally with ciliated mucous
-membrane. The <i>fossæ</i> have the inferior turbinated bones along their
-outer walls and are divided into three parts known as the <a href="#FIG_18"><i>superior</i>,
-the <i>middle</i>, and the <i>inferior meatus</i></a>, the middle one connecting with
-the antrum of Highmore, while into the inferior meatus the lachrymal
-canal empties. There are many small muscles of which little use is
-<span class="pagenum"><a name="Page_58" id="Page_58">[Pg 58]</a></span>
-made, although in forced respiration, as in pneumonia, where every aid
-to breathing is called into play, even the alæ nasi or nostrils are made
-to exert what muscular power they possess in order to supply more air.</p>
-
-<div class="figcenter">
-    <img id="FIG_18" src="images/i_057.jpg" alt="" width="600" height="401" />
-    <p class="center"><span class="smcap">Fig. 18.</span>—The nasal cavity.<br />
-             (After Sobotta.)</p>
-</div>
-
-<p>Not only is most of the air breathed in through the nose and warmed in
-its passage through, but the nose is the organ of smell and by means
-of the peculiar property of its nerves protects the lungs against
-deleterious gases and helps the taste discriminate. The <i>olfactory</i>
-or <i>first cranial nerves</i>, after emerging from the brain, lie on the
-under surface of the frontal lobe and rest on the ethmoid bone in what
-is known as the <i>olfactory tract</i>. Each nerve ends in a bulb-like
-termination called an <i>olfactory bulb</i>, which rests on the cribriform
-plate and sends little terminal fibers down through to be distributed
-to the nasal cavities, especially to the upper half of the septum of
-the nose, the roof of the nose, and the anterior and middle turbinated
-bones. For in the mucous membrane of the upper nasal cavity are
-specially modified epithelial cells called <a href="#FIG_18"><i>olfactory cells</i></a>,
-which play an important part in the conduction of smell. Hence when one
-wishes to smell anything especially well he sniffs it up.</p>
-
-<p>Probably the <i>sensation of smell</i> is caused by odoriferous particles
-in the atmosphere being breathed into the nose, where they affect the
-olfactory cells, which transmit the impulses to the olfactory nerve
-and so to the brain. Whereas a certain amount of moisture in the nasal
-cavity seems to be essential for accuracy of smell, the presence of
-too much or too little interferes with it. The mucous membrane has a
-certain power also of distinguishing different smells at the same time,
-though this power varies greatly in different people, one smell often
-wholly overpowering all others.</p>
-
-<p>The cartilage below the bridge of the nose is sometimes attacked
-in <i>syphilis</i> and <i>cancer</i>, and <i>lupus</i> often begins on the nose.
-<i>Deviation of the septum</i> may occlude all air from one side of the
-nose, an effect also produced by <i>polypi</i>, generally of the turbinated
-<span class="pagenum"><a name="Page_59" id="Page_59">[Pg 59]</a></span>
-bone. Either condition is easily remedied. <i>Nosebleed</i>, though
-generally unimportant, may be serious in adults.</p>
-
-<p><b>The Mouth.</b>—The mouth is of great importance as an entrance
-for fresh air to the lungs when the nasal passages are for any reason
-impeded and as the resonant chamber from which proceeds the voice,
-man’s chief means of communication with his fellows. Its chief value
-may be said, however, to reside in the fact that it is the vestibule
-of the alimentary canal. It is an ovoid cavity lined with mucous
-membrane and is bounded in front by the <i>lips</i>, at the sides by the
-<i>cheeks</i>, below by the floor and tongue, and above by the <i>hard palate</i>
-anteriorly and by the <i>soft palate</i> posteriorly, the <i>uvula</i> depending
-from the latter like a curtain between the mouth and the pharynx. Shape
-is given to the mouth by the bones of the upper and lower jaw and its
-size is altered by the lowering and raising of the latter, which is
-quite freely movable.</p>
-
-<div class="figcenter">
-    <img id="FIG_19" src="images/i_059.jpg" alt="" width="400" height="282" />
-    <p class="center"><span class="smcap">Fig. 19.</span>—The hyoid bone. (Toldt.)</p>
-</div>
-
-<p>At the back of the mouth, at the entrance to the pharynx, are the
-<i>anterior</i> and <i>posterior pillars</i> of the fauces, which contain
-muscular tissue, and between which on either side are thick masses
-of lymphoid tissue, the <i>tonsils</i>. The floor of the mouth is formed
-largely by the <i>tongue</i>, which completely fills the space within the
-<span class="pagenum"><a name="Page_60" id="Page_60">[Pg 60]</a></span>
-lower teeth. Its base or root is directed backward and downward and is
-attached by muscles to the hyoid bone and the lower jaw, the <a href="#FIG_19"><i>hyoid
-bone</i></a> being a horseshoe-shaped bone lying just below and as it were
-within the inferior maxillary. The base of the tongue is attached also
-to the epiglottis and at the sides to the soft palate by the anterior
-pillars. Except at its base and the posterior part of its under surface
-the tongue is free, but a fold of mucous membrane, the <i>frenum</i>, holds
-it somewhat in front. Thus it possesses great versatility of motion and
-serves as an auxiliary in articulation, mastication, and deglutition.</p>
-
-<p><b>The Teeth.</b>—Securely embedded in either jaw are the teeth,
-nature’s instrument for the first preparation of the food for digestion
-through tearing and grinding. The <i>incisors</i>, which are in front, have
-wide sharp edges for cutting the food. Next come the <i>canine</i> teeth
-with a sharp point for tearing it, while at the back are the <i>molars</i>
-with a broad flat top for grinding.</p>
-
-<p>There are two sets of teeth: 1. the <i>temporary</i> or <i>milk teeth</i>,
-twenty in number—four incisors, two canines, and four molars in
-each jaw—which appear at from six months to two years, and 2. the
-<i>permanent teeth</i>, thirty-two in number—four incisors, two canines,
-known as <i>eye teeth</i> in the upper jaw and as <i>stomach teeth</i> in
-the lower jaw, four bicuspids, so called because they have two cusps where
-the molars have four or five, and six molars in each jaw—which come
-from the sixth to the twenty-first years. The first to appear are the
-two lower middle incisors, which come at the age of six months. The
-last to appear are the <i>wisdom teeth</i>, the farthest back of the molars,
-which come at the age of twenty-one years or thereabouts.</p>
-
-<p>Each tooth consists of a crown or body above the gum, a neck, and a
-fang or root within the gum. The body is of dentine or ivory with a
-thin crust of enamel and contains the <i>pulp</i>, a vascular connective
-tissue containing many nerves. Beginning at the neck and covering the
-fang is a layer of cement or true bone.
-<span class="pagenum"><a name="Page_61" id="Page_61">[Pg 61]</a></span></p>
-
-<p><b>The Sense of Taste.</b>—The sense of taste lies chiefly in the
-<i>taste buds</i> as they are called which are filled with <i>gustatory
-cells</i> and are found in the papillæ of the tongue, principally in
-the <i>circumvallate papillæ</i> at the back of the tongue, which are few
-in number and arranged in a V-shape. There is also a certain power
-of taste in the tip and sides of the tongue but little in the upper
-surface or dorsum. Only five special tastes can be distinguished:
-bitter, sweet, acid, sour, and salt, but sometimes more than one
-can be distinguished at a time, as bitter and sweet. Every one can
-distinguish between different tastes but the power varies in different
-people and with different conditions. Certain tastes seem to be better
-distinguished in certain places, as sweet at the tip and bitter at the
-back of the tongue. Moreover, the sense of taste is very dependent
-upon the sense of smell, especially in the case of aromatic and savory
-substances, which one really does not taste but smell. If one held his
-nose and closed his eyes he would not know from the taste whether he
-was eating onion or apple. This leads to the habit of pinching the nose
-when taking nauseous medicines.</p>
-
-<p>To be tasted a substance must be in solution. Friction against the
-tongue, lips or cheek increase the sense of taste. A temperature of
-100° Fahrenheit favors taste, while both great heat and great cold
-impair it.</p>
-
-<p>There are probably at least two nerves of taste, the lingual branch
-of the trifacial or fifth cranial and the gustatory branch of the
-glosso-pharyngeal.</p>
-
-<p>Along with the sense of taste there are other senses in the mouth which
-play an important part, such as <i>pressure</i> and the <i>sense of heat and
-cold</i>, and it is often hard to distinguish them from the pure sensation
-of taste, which indeed is always accompanied by them.</p>
-
-<p><b>Salivary Glands.</b>—On either side of the mouth are three
-racemose glands for the secretion of the <i>saliva</i>, which serves to
-soften and lubricate the food and partially to digest starches by means of its
- <span class="pagenum"><a name="Page_62" id="Page_62">[Pg 62]</a></span>
-ferment, <i>ptyalin</i>. The <a href="#FIG_20"><i>parotid
-gland</i></a> is the largest and is below and in front of the ear, opening
-by <i>Stensen’s duct</i>. The <a href="#FIG_20"><i>submaxillary gland</i></a> is
-below the jaw toward the back on either side and its duct is <i>Wharton’s
-duct</i>. The <a href="#FIG_20"><i>sublingual gland</i></a> lies beneath the
-mucous membrane of the floor of the mouth and opens by eight to twenty
-tiny ducts beside the frenum, the <i>ducts of Rivinus</i>. The activity of
-the glands depends upon the blood supply; the more blood the greater
-their activity.</p>
-
-<div class="figcenter">
-    <img id="FIG_20" src="images/i_062.jpg" alt="" width="500" height="321" />
-    <p class="blockquot"><span class="smcap">Fig. 20.</span>—Dissection of the side of the
-     face, showing the salivary glands: <i>a</i>, Sublingual gland; <i>b</i>, submaxillary
-     gland, with its duct opening on the floor of the mouth beneath the tongue at
-     <i>d</i>; <i>c</i>, parotid gland and its duct, which opens on the inner side
-     of the cheek. (After Yeo.)</p>
-</div>
-
-<p><b>The Tonsils.</b>—The tonsils vary in size and in <i>tonsillitis</i>
-swell and may even meet in the median line. They are frequently
-removed. When they are enlarged one often gets a <i>third tonsil</i> or
-<i>adenoids</i>, a lymphoid growth at the back of the pharynx which causes
-mouth-breathing by day and snoring by night. A child with adenoids is
-starved for air and what air is breathed in is not warmed. The growth
-should be removed.</p>
-
-<p>A short frenum produces <i>tongue-tie</i>, which may be remedied by
-snipping. Cancer of the tongue is fairly common and necessitates a
-radical operation. In mumps the parotid glands are inflamed and enlarged.
-<span class="pagenum"><a name="Page_63" id="Page_63">[Pg 63]</a></span></p>
-
-<p><b>The Ear.</b>—The special organ of hearing is the ear, to which
-there are three parts, the external, the middle, and the internal ear.</p>
-
-<p>The <i>external ear</i> consists of the <i>pinna</i> or expanded cartilaginous
-portion, for the concentration and direction of sound waves, and the
-<i>external auditory canal</i>, partly cartilage, partly bone, which is
-directed forward, inward, and downward and conveys sound to the middle ear.</p>
-
-<div class="figcenter">
-    <img id="FIG_21" src="images/i_063.jpg" alt="" width="500" height="399" />
-    <p class="center"><span class="smcap">Fig. 21.</span>—The small bones of
-         the ear; external view (enlarged).<br /> (After Gray.)</p>
-</div>
-
-<p>The <i>middle ear</i> or <i>tympanum</i> is an irregular cavity in the petrous
-portion of the temporal bone. Its outer wall is formed by the <i>membrana
-tympani</i> or <i>drum</i>, an oval translucent membrane placed obliquely at
-the bottom of the external auditory canal. The middle ear communicates
-with the inner ear through the <i>fenestra ovalis</i> or oval window and
-contains the <i>ossicles</i>, the <a href="#FIG_21"><i>malleus</i></a> or hammer,
-the <a href="#FIG_21"><i>incus</i></a> or anvil, and the
-<a href="#FIG_21"><i>stapes</i></a> or stirrup, which are arranged in a movable chain
-from the drum to the oval window. The <i>malleus</i>, which is connected with
-the membrana tympani, articulates by its head with the body of the
-incus, while the stapes articulates with the <i>incus</i> by its head and is
-connected by its base with the margin of the oval window. Connection
-is made between the middle ear and the pharynx and the pressure of the
-air upon the drum made equal on either side by means of the <a href="#FIG_18"><i>Eustachian
-tubes</i></a>. These tubes are about an inch and a half long, have cilia, and
-<span class="pagenum"><a name="Page_64" id="Page_64">[Pg 64]</a></span>
-convey wax and other matter from the ear to the pharynx. Occasionally
-in a cold or for some other reason they become stopped up and trouble
-results in the middle ear. Some of the <i>mastoid cells</i> also connect
-with the middle ear and may become infected, causing mastoid disease.</p>
-
-<div class="figcenter">
-    <img id="FIG_22" src="images/i_064.jpg" alt="" width="600" height="344" />
-    <p class="blockquot"><span class="smcap">Fig. 22.</span>—Interior view of left bony
-         labyrinth after removal of the superior and external walls: 1, 2, 3, the
-         superior, posterior, and external or horizontal semicircular canals; 4,
-         fovea hemi-elliptica; 5, fovea hemispherica; 6, common opening of the
-         superior and posterior semicircular canals; 7, opening of the aqueduct
-         of the vestibule; 8, opening of the aqueduct of the cochlea; 9, the
-         scala vestibuli; 10, scala tympani; the lamina spiralis separating 9
-         and 10. (From Quain, after Sömmerring.)</p>
-</div>
-
-<p>The <i>internal ear</i> consists of various chambers hollowed out in
-the petrous portion of the temporal bone. There is an <i>osseous
-labyrinth</i>, consisting of a central cavity known as the <i>vestibule</i>,
-three <a href="#FIG_22">semicircular canals</a>, and the <a href="#FIG_22"><i>cochlea</i></a>
-and within the osseous labyrinth, surrounded by <i>perilymph</i>, is the
-<i>membranous labyrinth</i>, of like form, filled with the <i>endolymph</i>.
-Communication exists externally with the middle ear by the <i>round</i> and
-<i>oval windows</i> and internally with the <a href="#FIG_22"><i>internal
-auditory canal</i></a>, through which passes the eighth cranial or
-auditory nerve, the special nerve of hearing, which is distributed to
-the inner ear only. When the auditory nerve enters the ear through this
-internal auditory meatus it divides into two branches,
-<span class="pagenum"><a name="Page_65" id="Page_65">[Pg 65]</a></span>
-of which one goes to the vestibule and the other to the <i>organ of
-Corti</i>, a group of specially modified epithelial cells in the cochlea
-of the membranous labyrinth, which is very important in transmitting
-the impulses to the brain. The nerve also breaks up into very small
-branches and is distributed practically throughout the wall of the labyrinth.</p>
-
-<p>The <i>sensation of hearing</i> is the result of impulses transmitted to
-the auditory nerve and so conveyed to the auditory center in the brain.
-It is caused by sound waves which travel through the air from their
-point of origin and enter the external ear. This collects and selects
-the waves of sound and helps one to a certain extent to determine the
-direction from which the sound comes. As they pass through the external
-meatus the sound waves are collected into a comparatively small area
-for transmission to the middle ear, where, by means of the drum, they
-set in vibration the chain of ossicles. Through these the vibrations
-are in turn transmitted to the oval window, being intensified in the
-process. Here again they are taken up by the perilymph, from which they
-pass through the wall of the membranous labyrinth to the endolymph,
-affecting the epithelial lining of the labyrinth in such a way that the
-impulses are transmitted to the auditory nerve, more particularly in
-the vestibule, from which the vibrations enter the cochlea. They also
-affect the cells of the organ of Corti in like manner as they pass from
-the perilymph to the endolymph. The membrane that covers the fenestra
-rotunda or round window relaxes and expands as the vibrations strike
-it, thus serving to eliminate the shock of impact.</p>
-
-<p><i>Musical sounds</i> are caused by rhythmical or regularly repeated
-vibrations, while irregular vibrations give rise to noises. In musical
-sounds loudness is determined by the height or amplitude of the
-vibrations, pitch by the length of the wave, and quality by the number
-of so called partial tones. A sensation of sound cannot be produced by
-<span class="pagenum"><a name="Page_66" id="Page_66">[Pg 66]</a></span>
-less than 30 vibrations a second and the ordinary person cannot
-hear more than 16,000 vibrations a second. Different sounds can
-be distinguished when they follow each other as closely as by one
-one-hundredth of a second.</p>
-
-<p>All sound does not come through the canal of the ear. The bones of the
-head vibrate and carry sound. So there are instruments for the deaf
-which are put in the ear and others which are placed between the teeth.</p>
-
-<p>The <a href="#FIG_22"><i>semicircular canals</i></a> are not essential to
-hearing but have something to do with a person’s power of maintaining
-his equilibrium. Injury to them may cause dizziness and loss of equilibrium.</p>
-
-<p><b>The Eye.</b>—One more feature, perhaps the most expressive,
-remains to be described, the eye. The senses are all modifications
-of the original cutaneous sensibility and the nerve of sight is no
-more sensitive to light than any other nerve. It therefore needs an
-end organ that is sensitive to the motions of the ether in order to
-give impressions of light. This organ is provided in the eye, which
-is not only itself capable of being moved in every direction, but is
-placed in the most movable part of the body, the head, which can be
-turned in almost a complete circle. The <i>eyeball</i> is spherical and
-lies in the cavity of the orbit upon a cushion of fat, where it has a
-large range of sight but is securely protected from injury by its bony
-surroundings. The sunken eyes following protracted illness are due to
-the using by the system of the fat on which the eyeball ordinarily rests.</p>
-
-<p>Each <i>orbital cavity</i> is formed by the juncture of some seven bones and
-communicates with the cavity of the brain through the <i>optic foramen</i>
-and through the sphenoidal fissure. Above the orbits are arched
-eminences of skin, the <i>eye-brows</i>, from which several rows of short
-hairs grow longitudinally and which serve to protect the eyes and to
-limit the amount of light to a certain extent, as in frowning.
-<span class="pagenum"><a name="Page_67" id="Page_67">[Pg 67]</a></span></p>
-
-<p>Still further protection is afforded by the <i>eyelids</i>, longitudinal
-folds of skin, the one above, the other below, which close like
-curtains over the eye. Beneath the external layer of skin in the lids
-is fatty tissue and then the orbicularis palpebrarum muscle by means
-of which they are closed. They are kept in shape by the tarsal plates
-or cartilages, in whose ocular surface are embedded the <i>Meibomian
-glands</i>, whose secretion prevents the free edges of the lids from
-sticking together. Along these edges grows a double or triple row
-of stiff hairs, the <i>eye-lashes</i>, which curve outward so as not to
-interfere with each other and also to prevent the entrance into the eye
-of foreign bodies. Lining the inner surface of the lids and reflected
-thence over the anterior surface of the sclerotic coat of the eye is
-a mucous membrane, the <i>conjunctiva</i>, which is thick, opaque, and
-vascular on the lids but thin and transparent on the eyeball. The angles
-between the lids are known as the <i>internal</i> and the <i>external canthus</i>.</p>
-
-<div class="figcenter">
-    <img id="FIG_23" src="images/i_067.jpg" alt="" width="600" height="281" />
-    <p class="center"><span class="smcap">Fig. 23.</span>—The external ocular muscles. (Pyle.)</p>
-</div>
-
-<p><i>Muscles</i> and <i>Nerves</i>.—The eyeball is held in position by the
-ocular muscles, the conjunctiva, and the lids, while surrounding it,
-yet allowing free movement, is a thin membranous sac, the <i>tunica
-vaginalis oculi</i>. The <a href="#FIG_23">superior and inferior recti
-muscles</a> at the upper and lower edges of the ball turn the eye up
-<span class="pagenum"><a name="Page_68" id="Page_68">[Pg 68]</a></span>
-and down; the internal and external recti at the inner and outer edges
-turn the eye inward and outward; and the <a href="#FIG_23">superior and
-inferior</a> oblique rotate the eye. The nerves supplying these muscles
-are the third or motor oculi, the fourth and the sixth.</p>
-
-<p>The <a href="#FIG_24"><i>lachrymal gland</i></a>, which is about the size and
-shape of an almond, is situated at the upper and outer part of the orbit. It secretes
-a fluid which keeps the anterior surface of the eye bathed in moisture
-and is ordinarily drained away through the lachrymal sac in the inner
-canthus, whence it passes by the lachrymal ducts into the nose. When
-the amount secreted is excessive, it overflows the lower lid as <i>tears</i>.</p>
-
-<div class="figcenter">
-    <img id="FIG_24" src="images/i_068.jpg" alt="" width="600" height="264" />
-    <p class="center"><span class="smcap">Fig. 24.</span>—Diagram of
-           the lacrimal apparatus. (Pyle.)</p>
-</div>
-
-<p><i>Coats of Eye.</i>—The membranes or coats of the eye are three in number:
-an outer or sclerotic, a middle or vascular, and an inner or sensitive.</p>
-
-<p>The <i>sclerotic coat</i> is a rather thick, fibrous, protective membrane.
-Where it passes in front of the iris, however, it is thinner and
-transparent and is known as the <a href="#FIG_25"><i>cornea</i></a>. The cornea
-projects somewhat and, as it were, resembles a segment of a smaller sphere set
-into the rest of the sclerotic.</p>
-
-<p>The middle or vascular coat, known as the <a href="#FIG_25"><i>choroid</i></a>,
-carries blood-vessels for the <a href="#FIG_25">retina</a> or sensitive coat in its
-inner layer and has an outer layer of pigment cells that excludes light and darkens
-the inner chamber of the eye. The folds of the choroid at its anterior
-<span class="pagenum"><a name="Page_69" id="Page_69">[Pg 69]</a></span>
-margin contain the <a href="#FIG_25">ciliary muscles</a> and are known as the <i>ciliary
-processes</i>, while the name <a href="#FIG_25"><i>iris</i></a> is given to the little
-round pigmented, perforated, curtain-like muscle just in front of the
-crystalline lens. The posterior surface of the iris is covered with a
-thick layer of pigment cells to prevent the entrance of light except
-through the central opening or <i>pupil</i>, and its anterior surface also
-has pigment cells that give it its color, though the difference in the
-color of people’s eyes is due rather to the amount of pigment present
-than to its color, a small amount of pigment being present in blue eyes
-and a large amount in brown and black eyes. Variations in the size
-of the pupil are brought about by contractions of the circular and
-radiating fibers of the iris, contraction of the circular fibers making
-it smaller and those of the radiating larger. The pupil is constricted
-for near objects and during sleep, and is dilated for distant objects.
-In a dull light also it dilates to let in more light, and in a bright
-light it contracts. The appearance of the pupil is often important as a
-means of diagnosis and in etherization.</p>
-
-<div class="figcenter">
-    <img id="FIG_25" src="images/i_069.jpg" alt="" width="600" height="299" />
-    <p class="center"><span class="smcap">Fig. 25.</span>—Vertical section
-          through the eyeball and eyelids. (Pyle.)</p>
-</div>
-
-<p>Lastly there is the innermost <i>sensitive coat</i> or <i>retina</i>, which
-has eight layers, the outer one containing some pigment cells and the next
-<span class="pagenum"><a name="Page_70" id="Page_70">[Pg 70]</a></span>
-the rods and cones, in which the power of perception is supposed to
-lie, branches of the optic nerve being distributed over it in all
-directions. In fact, the retina is formed by a membranous expansion of
-the optic or second cranial nerve, the special nerve of sight, which
-passes into the orbit through the optic foramen at the back and enters
-the eyeball close to the <i>macula lutea</i> or <i>yellow spot</i>. The exact
-spot where the <a href="#FIG_25">optic nerve</a> enters the retina is not sensitive
-and is known as the <i>blind spot</i>. In the center of the macula lutea, however,
-which is in the middle of the retina posteriorly, is a tiny pit, the
-<i>fovea centralis</i>, in which all the layers of the retina except the
-rods and cones are absent, and at this point vision is most perfect.
-It is, therefore, always turned toward the object looked at, and when
-one wishes to see an object distinctly, he must keep moving his eyes
-over it that the rays from each part may fall in turn upon the fovea
-centralis.</p>
-
-<p>Directly behind the pupil is the <a href="#FIG_25"><i>crystalline lens</i></a>,
-a rather firm gelatinous body enclosed in a capsule, which is transparent in life
-but opaque in death. The lens is doubly convex and is held in place
-by the suspensory ligaments, which arise from the ciliary processes.
-In front of it is the anterior chamber of the eye, filled with a thin
-watery fluid called the <a href="#FIG_25"><i>aqueous humor</i></a>, while
-the larger space back of it, occupying about four-fifths of the entire
-globe, is filled with a jelly-like substance known as the <i>vitreous humor</i>.</p>
-
-<p>The chief artery of the eye is the <i>ophthalmic</i>.</p>
-
-<p><i>Light Rays.</i>—The eye is practically a camera and its principal
-function is to reflect images. Although there are several refracting
-surfaces and media, for practical purposes the cornea alone need be
-considered. Except for those rays which enter the eye perpendicularly
-to the cornea, whose line of entrance is called the <i>optic axis</i>, all
-rays are refracted when they enter the eye and the point at which they
-meet and cross each other behind the cornea is called the <i>principal
-focus of the eye</i>. To focus properly, all the rays from any one point
-<span class="pagenum"><a name="Page_71" id="Page_71">[Pg 71]</a></span>
-on an object must meet again in a common point upon the retina, their
-<i>conjugate focus</i>. In the normal eye all the rays from an object are
-focused on the retina and form upon it an image of the object which, as
-in the camera, is inverted, because of the crossing of the rays behind
-the cornea. Once focused on the retina the light traverses the various
-layers to the layer of rods and cones, where chemical action takes
-place and affects the little filaments of the optic nerve, by which the
-message is carried to the brain.</p>
-
-<div class="figcenter">
-    <img id="FIG_26A" src="images/i_071a.jpg" alt="" width="600" height="194" />
-    <img id="FIG_26B" src="images/i_071b.jpg" alt="" width="600" height="190" />
-    <img id="FIG_26C" src="images/i_071c.jpg" alt="" width="600" height="180" />
-    <p class="blockquot"><span class="smcap">Fig. 26.</span>—Diagram showing the difference
-         between (<i>A</i>) emmetropic, (<i>B</i>) myopic and (<i>C</i>) hypermetropic eyes.
-        (American Text-book of Physiology.)</p>
-</div>
-
-<p>When the eye is at rest the pupil and lens are in their normal
-<span class="pagenum"><a name="Page_72" id="Page_72">[Pg 72]</a></span>
-condition and at such times the eye sees only distant objects. The
-ability of the eye to focus upon objects at different distances is
-called <i>accommodation</i> and to accomplish it three things are necessary:
-1. change in the shape of the lens; 2. convergence of the axes of the
-eyes, and 3. narrowing of the pupils.</p>
-
-<p>When the eye is directed toward distant objects, the muscle fibers
-in the ciliary processes relax, causing tightening of the suspensory
-ligaments and consequent flattening of the surface of the lens.
-Otherwise an image would be formed in front of the retina; for the
-greater the convexity of the lens, the greater the angle of refraction.
-Such accommodation is passive and so not fatiguing. To look at nearby
-objects, on the contrary, the ciliary muscles contract, drawing the
-choroid forward and allowing the suspensory ligaments to relax, so that
-the lens bulges in front. This is an exertion.</p>
-
-<p>In order to accommodate properly, moreover, both eyes must work
-together and the axes of both eyes must be directed toward the object.
-Therefore, in looking at nearby objects the axes of the eyes converge,
-drawn by the internal recti muscles. In <i>strabismus</i> or <i>cross eye</i>,
-where the axes of both eyes cannot be directed toward the object at the
-same time, the rays fall upon one part of one eye and upon a different
-part of the other eye and two separate images are seen.</p>
-
-<p>Finally there is concentric narrowing of the pupil by contraction of
-the circular fibers of the iris, by which means various side rays that
-would come to a focus outside the retina are excluded.</p>
-
-<p>All the muscles of accommodation, the ciliary muscles, the internal
-recti, and the sphincter pupillæ, are under the control of the third nerve.</p>
-
-<p>Connected with this power of accommodation and dependent on it are the
-two conditions of <i>near-sightedness</i> or <a href="#FIG_26B"><i>myopia</i></a>
-and <i>far-sightedness</i> or <a href="#FIG_26C"><i>hypermetropia</i></a>.</p>
-
-<p>The normal eye is <a href="#FIG_26A">emmetropic</a> and is almost perfectly spherical, but in
-<span class="pagenum"><a name="Page_73" id="Page_73">[Pg 73]</a></span>
-the near-sighted or myopic eye the ball, instead of being round, is
-flattened from above down and so bulges in front. Consequently, owing
-to the greater distance from the lens to the retina, images are formed
-in front of the retina. Only nearby objects can be seen clearly,
-because the farther the object from the eye the farther in front of
-the retina the image is formed. Concave glasses are worn to enable
-near-sighted people to see at a distance. Hypermetropic or far-sighted
-eyes are flattened from before backward and can see only objects at a
-distance clearly, as those nearby form images behind the retina. For
-such eyes convex glasses are worn.</p>
-
-<p>As the ordinary person approaches middle life, he becomes able to see
-better at a distance than near to. This <i>presbyopia</i>, as it is called,
-which is practically far-sightedness, is due to a partial loss of the
-power of accommodation in the lens, the result of a general loss of
-elasticity in the parts.</p>
-
-<p>Another very common defect is <i>astigmatism</i>, a failure of the rays
-to focus upon a point, owing generally to a flattening in the surface of
-the cornea.</p>
-
-<p><i>Color perception</i> is also an important function of the eye. The
-waves of hyperluminous ether when of a certain rate of vibration give the
-sensation of heat and when their vibrations are more rapid they give
-the sensation of light. Each of the primary colors of the spectrum
-gives off a pretty definite number of light rays which travel through
-the air and enter the eye, the number of rays determining the color
-thrown upon the retina and the velocity determining the intensity of
-the color. Occasionally when light is passing through into the eye it
-is broken up as in a prism and the person gets a sensation as of all
-sorts of colors, <i>chromatic aberration</i>. Total or partial absence of
-sensitiveness to color is called <i>color blindness</i>. It is commonest
-in the form of inability to distinguish between red and green and is
-probably due to a defect in the retina.
-<span class="pagenum"><a name="Page_74" id="Page_74">[Pg 74]</a></span></p>
-
-<p>Sometimes a hair follicle on the lid becomes infected and a <i>sty</i>
-is formed. <i>Pink eye</i> is conjunctivitis or inflammation of the
-conjunctiva. A Meibomian duct may become stopped and cause bulging, or
-there may be a sagging down or <i>ptosis of the upper lid</i> in certain
-diseases, as meningitis, apoplexy, and more especially syphilis.
-<i>Rodent ulcer</i> often begins by the eye or on the cheek.</p>
-
-<hr class="chap" />
-<div class="chapter">
-<p><span class="pagenum"><a name="Page_75" id="Page_75">[Pg 75]</a></span></p>
-<h2 class="nobreak">CHAPTER V.<br /> <span class="h2_subtitle">THE NERVOUS SYSTEM.</span></h2></div>
-
-<p>The nervous system, which regulates all the vital processes of the
-body, physical and chemical, and which is situated partly in the head
-and partly in the trunk, may well form the connecting link between the
-description of the head and that of the trunk. It has two divisions,
-the cerebro-spinal system and the sympathetic system. The former
-consists of the cerebrum or brain proper, the cerebellum or little
-brain, the pons Varolii, the medulla oblongata, the spinal cord, and
-the cranial and spinal nerves; the latter of a series of ganglia or
-aggregations of nerve centers. The brain, which includes the cerebrum,
-cerebellum, pons, and medulla, occupies the cranium and the spinal cord
-is contained within the bony framework of the spinal column. In the
-male the brain weighs about 49 ounces and in the female 44, while in an
-idiot it seldom weighs more than 23 ounces.</p>
-
-<p>The <a href="#FIG_27"><b>cerebrum</b></a> or brain proper has two parts or
-hemispheres, roughly oval in shape, each of which has five lobes separated by
-fissures, the frontal, parietal, occipital, and temporo-sphenoidal
-lobes, and the central lobe or <i>island of Reil</i> at the base of the
-brain. The chief fissures are the <a href="#FIG_27"><i>longitudinal fissure</i></a>,
-the <i>fissure of Sylvius</i> at the base of the brain, and the <i>fissure of Rolando</i>
-between the frontal and parietal lobes. There are also five serous
-cavities called <i>ventricles</i>, the two lateral and the third, fourth,
-and fifth ventricles, of which the first two, one in either hemisphere,
-are the most important. Around these cavities is the <i>brain substance</i>,
-which is made up of two tissues, the white and the gray, the latter
-<span class="pagenum"><a name="Page_76" id="Page_76">[Pg 76]</a></span>
-forming the outer part of the brain to the depth of perhaps half an
-inch, and the white matter forming the rest. The outer or gray part is
-called the <i>cortex</i> and is largely made up of nerve cells. It might be
-called the active part of the brain. The white part consists largely of
-nerve fibers which are given off from the nerve cells and are carried
-down into the spinal cord.</p>
-
-<p>The surface of the brain is convoluted, the ridges being separated by
-deep furrows or sulci, by which means a great extent of gray matter
-is secured. The furrows contain fluid from the subarachnoid spaces
-and vary in number and depth according to intelligence. While the
-convolutions are not uniform in all brains, the principal ones are
-constant.</p>
-
-<p>Both the brain and the spinal cord are covered by three membranes, the
-dura mater, the arachnoid, and the pia mater. The <i>dura mater</i> is dense
-and fibrous and lines the interior of the skull, being firmly adherent
-to it at many points. In fact, it constitutes the internal periosteum
-of the cranial bones. The <i>arachnoid</i> is a delicate serous membrane,
-with two layers, lubricated to prevent friction, which divides the
-space between the dura mater and the pia mater, bridging over the
-convolutions and enclosing the subdural and subarachnoid spaces which
-are connected with lymphatics and contain a serous secretion, the
-<i>cerebro-spinal fluid</i>. This fluid forms an elastic water cushion, on
-which the brain rests, and prevents concussion. The <i>pia mater</i> is
-vascular, containing blood-vessels, lymphatics, and nerves, and is closely
-attached to the surface of the brain, dipping down into all the sulci.</p>
-
-<p>At the base or under surface of the brain are some very important
-structures. The <a href="#FIG_27"><i>olfactory bulbs</i></a> lie beneath the frontal
-lobe and projecting back is the <i>olfactory tract</i>, through which the olfactory
-nerves come from the brain. Back of the olfactory tract is the <a href="#FIG_27"><i>optic
-commissure</i></a> where the optic nerves coming from the brain cross each
-other. And back of the commissure again is the <i>optic tract</i>, where the
-<span class="pagenum"><a name="Page_77" id="Page_77">[Pg 77]</a></span>
-optic nerves emerge from the brain. At the base of the brain are also
-the exits of the twelve cranial nerves.</p>
-
-<div class="figcenter">
-    <img id="FIG_27" src="images/i_077.jpg" alt="" width="600" height="613" />
-    <p class="blockquot"><span class="smcap">Fig. 27.</span>—Base of brain. (Leidy.) 1, 2, 3,
-         cerebrum; 4 and 5, longitudinal fissure; 6, fissure of Sylvius; 7,
-         anterior perforated spaces; 8, infundibulum; 9, corpora albicantia; 10,
-         posterior perforated space; 11, crura cerebri; 12, pons Varolii; 13,
-         junction of spinal cord and medulla oblongata; 14, anterior pyramid;
-         14ˣ, decussation of anterior pyramid; 15, olivary body; 16, restiform
-         body; 17, cerebellum; 19, crura cerebelli; 21, olfactory sulcus; 22,
-         olfactory tract; 23, olfactory bulbs; 24, optic commissure; 25, motor
-         oculi nerve; 26, patheticus nerve; 27, trigeminus nerve; 28, abducens
-         nerve; 29, facial nerve; 30, auditory nerve; 31, glosso-pharyngeal
-         nerve; 32, pneumogastric nerve; 33, spinal accessory nerve; 34,
-         hypoglossal nerve.</p>
-</div>
-
-<p>Upon entering the brain the <i>arteries</i> run a tortuous course, the
-tortuosity breaking the force of the blood stream in the small vessels
-where congestion would be with difficulty relieved. The basilar artery,
-which is formed by the juncture of the two vertebrals, divides into the
-<span class="pagenum"><a name="Page_78" id="Page_78">[Pg 78]</a></span>
-two posterior cerebrals, each of which joins one of the anterior
-cerebrals by a posterior communicating artery. The two anterior
-cerebrals also are joined by an anterior communicating artery, thus
-completing the circle. The circle thus formed at the base of the brain
-is called the <i>circle of Willis</i> and provides for a good supply of
-blood in event of an accident to any vessel. The blood is returned to
-the general circulation through the cerebral veins and sinuses formed
-by the separation of the dura mater into two layers.</p>
-
-<p>The <a href="#FIG_27"><b>cerebellum</b></a> is about one-seventh the size of
-the cerebrum and weighs about 5 ounces. It lies in the lower occipital fossæ of
-the skull and is oblong in shape and divided into two lateral hemispheres
-by a transverse fissure. It is made up of both white and gray matter,
-of which the former predominates, the gray being external as in the
-cerebrum. The cells are about the same as in the cortex and its surface
-is traversed by queer furrows. Of its function little is known but it
-probably plays a most important part in the coördination of the nervous
-and muscular acts by which the movements of the body are carried on.</p>
-
-<p>At the back of the cerebrum and below the cerebellum is the <a href="#FIG_27"><b>pons
-Varolii</b></a>, which forms a connecting link with the medulla oblongata
-or bulging part of the cord. It is made up essentially of white matter
-or nerve fibers, though there is a small amount of gray matter in which
-are found the nuclei of some of the cranial nerves.</p>
-
-<p>In the <a href="#FIG_27"><b>medulla oblongata</b></a>, which is about 1 inch
-long and extends from the pons Varolii to the upper border of the atlas or
-first cervical vertebra, the gray matter is not necessarily external
-to the white but is found in patches in the white. The gray matter
-here corresponds more or less to that of the spinal cord and the white
-matter is continuous with that of the cord. From the medulla arise the
-fifth to twelfth cranial nerves and the vasomotor nerves. The cardiac
-nerve has its center here and here too are the centers of respiration,
-<span class="pagenum"><a name="Page_79" id="Page_79">[Pg 79]</a></span>
-phonation, deglutition, mastication, and expression. In the medulla the
-nerves that arise in the cerebrum cross over from one side of the body
-to the other on the crossed pyramidal tracts. The importance of this
-crossing of the nerve fibers is seen in apoplexy, when a blood-vessel
-is ruptured in the brain and hemorrhage causes pressure, generally on
-the motor tract. Paralysis of the nerves and of the muscles to which
-they go results. The paralysis is generally of one side of the body,
-the opposite side from that on which the injury occurred. The seat
-of injury in the brain or cord can frequently be determined by the
-situation and extent of the paralysis.</p>
-
-<p><a href="#FIG_28"><b>Spinal Cord.</b></a>—Extending down from the medulla through
-the spinal column is the cord. Its length from the foramen magnum, where
-it begins, down through the vertebræ to the lower border of the first
-lumbar vertebra, where it ends in a very fine thread-like process with
-no special function, called the <i>filum terminale</i>, is 17 to 18 inches.
-Just before it ends a number of nerves are given off in a tail-like
-expansion known as the <i>cauda equina</i> or horse’s tail. It is not
-uniform throughout its length but presents two enlargements, a cervical
-enlargement in the lower cervical region, and a lumbar enlargement in
-the lower dorsal region, where the nerves are given off to the arms and
-legs respectively. The membranes are the same as those of the brain
-and are continuous with them, but here the dura mater is not attached
-to the bony walls enclosing it. For the cord does not fit closely
-into the canal but is as it were suspended in it. The <i>subarachnoid
-space</i> communicates with the ventricles of the brain by the <i>foramen of
-Majendie</i> and is filled with <i>cerebro-spinal fluid</i> for the protection
-of the cord. In cerebro-spinal meningitis or spotted fever this fluid
-is infected and for diagnosis lumbar puncture is performed.
-<span class="pagenum"><a name="Page_80" id="Page_80">[Pg 80]</a></span></p>
-
-<div class="figcenter">
-    <img id="FIG_28" src="images/i_080.jpg" alt="" width="600" height="601" />
-    <p class="blockquot"><span class="smcap">Fig. 28.</span>—Different views of a portion
-           of the spinal cord from the cervical region, with the roots of the nerves. In
-           <i>A</i> the anterior surface of the specimen is shown, the anterior nerve
-           root of its right side being divided; in <i>B</i> a view of the right side
-           is given; in <i>C</i> the upper surface is shown; in <i>D</i> the nerve roots
-           and ganglion are shown from below: 1, the anterior median fissure; 2,
-           posterior median fissure; 3, anterior lateral depression, over which
-           the anterior nerve roots are seen to spread; 4, posterior lateral
-           groove, into which the posterior roots are seen to sink; 5, anterior
-           roots passing the ganglion; 5´, in <i>A</i>, the anterior root divided; 6,
-           the posterior roots, the fibers of which pass into the ganglion, 6; 7,
-           the united or compound nerve; 7´, the posterior primary branch seen in
-           <i>A</i> and <i>D</i> to be derived in part from the anterior and in part from
-           the posterior root. (Allen Thomson.)</p>
-</div>
-
-<p>If a cross-section of the cord is made, it is found to have a pretty
-definite structure. It is roughly circular and is divided by certain
-fissures, of which the most important are the anterior and posterior
-median, the latter being rather a dividing line or septum. By them
-it is divided into halves connected by a small band in the middle
-called the <i>commissure</i>. The white matter is exterior to the gray
-and is divided by it into four columns, which again are divided into
-tracts according to certain groups of nerves that travel through
-them. The most important tract is the direct pyramidal tract in the
-anterior column. The gray matter is arranged in the form of a letter H
-practically, consisting of two lateral halves, more or less crescentic
-in outline, connected by a narrow band, the <i>gray commissure</i>. Each
-half is divided into two <i>horns</i>, the anterior, toward the front of the
-cord, and the posterior, toward the back, the former being generally
-much thicker and heavier than the latter. The structure of the gray and
-<span class="pagenum"><a name="Page_81" id="Page_81">[Pg 81]</a></span>
-of the white matter is essentially the same as in the brain, but
-the proportion varies in different parts of the cord, the white
-predominating in the cervical region and the gray being much better
-developed in the lumbar region, where the nerve cells for control of
-the lower extremities occur. The gray is least well developed in the
-dorsal region. Through the center of the cord runs a small hole or
-canal filled with cerebro-spinal fluid, the <i>central canal of the cord</i>.</p>
-
-<div class="figcenter">
-    <img id="FIG_29" src="images/i_081.jpg" alt="" width="600" height="364" />
-    <p class="center"><span class="smcap">Fig. 29.</span>—Functional areas
-           of the cerebral cortex, left hemisphere. (A. A. Stevens.)</p>
-</div>
-
-<p>The brain is the seat of intelligence and will, the center of all
-voluntary action. Molecular change in some part of the cerebral
-substance is the indispensable accompaniment of every phenomenon of
-consciousness. Indeed, the brain is never in a state of complete
-repose, there being dreams even during sleep. The brain is not
-sensitive to injury in the sense of pain. It can be lacerated without
-much pain.</p>
-
-<p>Various centers exist in the brain, of which the most important perhaps
-is the <i>motor center</i>. The <i>visual center</i> is in the occipital lobe,
-<span class="pagenum"><a name="Page_82" id="Page_82">[Pg 82]</a></span>
-the <i>auditory center</i> in the temporal lobe, the <a href="#FIG_29"><i>speech center</i></a>
-in the third left frontal convolution. Thus the impulses of the senses have
-been located, though the function of many parts, the so called <i>silent
-areas</i>, are still in obscurity.</p>
-
-<p>The <a href="#FIG_29"><i>motor center</i></a>, that is, the center for motion of
-the skeletal muscles, is situated about the fissure of Rolando and is divided into
-three parts, one for the legs, one for the face, and one for the arms,
-the one for the legs being uppermost and the others below in the order
-mentioned. Fibers from these cells extend down through the brain and
-cord to the muscles, the fibers being collected into well-recognized
-bundles and the whole known as the <i>motor tract</i>. There may be one long
-fiber from a cell in the brain down through most of the cord or there
-may be a succession of shorter fibers that are not actually connected
-but are in close contact with each other. In the upper pons the fibers
-for the face cross to the opposite side, while the rest keep on down
-through the medulla, and as they emerge from the medulla they too cross
-to the other side and keep on down in the crossed pyramidal tract.
-A few fibers do not cross but come down the direct pyramidal tract,
-which, however, disappears part way down. The <i>crossed pyramidal tract</i>
-is the true motor tract and in it the fibers are continually sending
-branches to the cells in the gray matter, where they connect with the
-anterior horn.</p>
-
-<p>The anatomy of the <i>sensory tract</i> is not so well understood. By
-it impulses are sent to the brain by the peripheral organs, practically
-the surface of the body. The sensory fibers connect with the sensory
-cells in the posterior horn, from which fibers are sent to the brain,
-practically the reverse of motor action. There are three chief sensory
-tracts, which are supposed to transmit different sensations, one pain,
-one muscular sensations, and the third sensations of touch. All these
-tracts, of which the chief is the <i>direct cerebellar tract</i>, in passing
-up the cord pass to the opposite side at different levels and then go
-on to the cortex of the brain.
-<span class="pagenum"><a name="Page_83" id="Page_83">[Pg 83]</a></span></p>
-
-<p>The action of the nerves is similar to reflex action, only that an
-effort of will is needed to send an impulse from the brain. It is by
-the help of the brain along this line that an infinity of artificial
-reflexes or habits is acquired, for which volition is needed in the
-beginning but which are later done unconsciously. Herein lie the
-possibilities of all education.</p>
-
-<p>The brain and spinal cord work together, the cord acting as a medium
-between the brain, in which all the higher psychical processes, such as
-will, thought, etc., originate, and the muscular apparatus. The cord,
-however, has some action entirely independent of the brain, as is seen
-in <i>reflex action</i>. This action is entirely involuntary, so that the
-cord is sometimes spoken of as the seat of involuntary action, commonly
-called reflex action. All unconscious acts are reflex acts, as when the
-hand is drawn away from a hot iron. If an impulse is sent along one
-of the sensory fibers, it enters the cord through the posterior horn,
-where its nerve cell is found. Then, through some connection between
-the nerve cell of the sensory fiber and that of the motor fiber the
-impulse is transmitted to the motor cell and another impulse is sent
-out of the cord along the motor fiber of the nerve to the muscle.
-One of the commonest reflexes is the <i>knee-jerk</i>. Reflex action is
-important because the reflexes are interfered with, delayed, destroyed,
-or increased in different diseases. The time normally required for a
-reflex act is very brief, that for the knee-jerk being about three
-one-hundredths of a second.</p>
-
-<p>The nerves of the head, known as the <i>cranial nerves</i>, arise from
-the brain, while the rest of the body is supplied by the spinal nerves,
-which come off at intervals from the spinal cord. The cranial nerves
-consist of twelve pairs: (1) The olfactory or nerve of smell, (2) the
-optic or nerve of sight, (3) the motor oculi, (4) the patheticus, which
-controls the eye, (5) the trigeminus or trifacial, a nerve of general
-sensation, motion, and taste, (6) the abducens, a motor nerve, (7) the
-<span class="pagenum"><a name="Page_84" id="Page_84">[Pg 84]</a></span>
-facial nerve of the face, ear, palate, and tongue, (8) the auditory or
-nerve of hearing, (9) the glosso-pharyngeal, nerve of sensation and
-taste, (10) the pneumogastric or vagus, which is both motor and sensory
-and governs respiration, the heart, and the stomach, (11) the spinal
-accessory, to the muscles of the soft palate, and (12) the hypoglossal,
-the motor nerve to the tongue.</p>
-
-<p>The <i>spinal nerves</i> also are arranged in pairs: Eight cervical pairs,
-twelve dorsal or thoracic, five lumbar, five sacral, and one coccygeal,
-these titles denoting their point of origin near the vertebra of the
-same name. Each of these nerves arises by two roots, an anterior motor
-root from the anterior horn of gray matter and a posterior sensory root
-from the posterior horn, the latter having a ganglion upon it. After
-emerging from the cord the two roots unite to form the nerve, that the
-nerve may contain both motor and sensory fibers. The motor fibers are
-called efferent because they carry impulses <i>from</i> the cord, while the
-sensory are called afferent because they carry impulses back <i>to</i> the
-cord. After leaving the cord the nerves unite to form plexuses, which
-again divide into various nerve trunks and are distributed to the muscles.</p>
-
-<p>The first <i>cervical nerves</i> pass out of the spinal column above
-the first cervical vertebra and the other cervical nerves below that
-and the succeeding vertebræ, while the other spinal nerves emerge
-each below the corresponding vertebra, as the first dorsal below
-the first dorsal vertebra, etc. After emerging they break up into a
-large anterior division and a small posterior division, the posterior
-branches supplying the spine and the dorsal muscles and skin, the
-anterior the rest of the trunk and the limbs. The <i>cervical plexus</i> is
-formed by the anterior divisions of the first four cervical nerves, the
-<i>brachial plexus</i> by the last four cervical and the first dorsal or
-thoracic nerves, the <i>lumbar plexus</i> by the four upper lumbar, and the
-<i>sacral plexus</i> by the last lumbar and the four upper sacral nerves.
-<span class="pagenum"><a name="Page_85" id="Page_85">[Pg 85]</a></span></p>
-
-<p>The only important branch of any of the four upper cervical nerves,
-which in general supply the neck and shoulders, is the <i>phrenic</i>, which
-is distributed to the pericardium, the pleuræ, and the under surface of
-the diaphragm.</p>
-
-<p>The <i>brachial plexus</i>, as its name implies, supplies the arms and
-has a number of important branches, as the circumflex to the shoulder, the
-musculo-cutaneous to the upper arm, the elbow-joint, and the outer
-surface of the forearm, the internal cutaneous to the inner side of
-the arm, the median to the pronators and flexors and the fingers on
-the radial side, and the ulnar to the elbow and wrist-joint. The
-musculo-spiral runs down the spiral groove to the external condyle of
-the humerus or upper arm bone, where it divides into the radial and the
-posterior interosseous, the former going to the thumb and two adjacent
-fingers and the latter to the wrist-joint and the muscles on the back
-of the forearm. Sometimes, in fracture of the humerus the callus thrown
-out pinches the musculo-spiral and causes pain.</p>
-
-<p>The dorsal or <i>thoracic nerves</i> supply the back with their posterior
-divisions and their anterior divisions are the <i>intercostal nerves</i>.</p>
-
-<p>The <i>lumbar nerves</i> supply the abdomen, pelvis, and thigh, the chief
-branches being the ilio-hypogastric to the abdomen and gluteal region,
-the ilio-inguinal to the inguinal region and scrotum, the external
-cutaneous and genito-crural to the thigh, and the obturator to the
-thigh and the hip and knee-joints. The anterior crural descends beneath
-Poupart’s ligament and divides into an anterior and a posterior division
-which supply the thigh muscles, its branches going to the pelvis.</p>
-
-<div class="figcenter">
-    <img id="FIG_30" src="images/i_086.jpg" alt="" width="500" height="632" />
-    <p class="blockquot"><span class="smcap">Fig. 30.</span>—Diagrammatic view of the
-       sympathetic cord of the right side, showing its connections with the principal
-       cerebro-spinal nerves and the main preaortic plexuses. (Reduced from
-       Quain’s anatomy.)</p>
-</div>
-
-<p>The <i>sacral plexus</i> supplies the organs of the pelvis, the thigh, and
-the leg. Its chief branches are the great sciatic, the largest nerve in
-the body, and the small sciatic, which go to the buttocks and thigh.
-The great sciatic runs down the back of the thigh and divides at the
-<span class="pagenum"><a name="Page_86" id="Page_86">[Pg 86]</a></span>
-lower third of the thigh into the internal and external popliteal
-nerves, the former of which passes along the back of the thigh to the
-knee, where it becomes the posterior tibial, which in turn divides at
-the ankle into the internal and external plantar. The external popliteal
-<span class="pagenum"><a name="Page_87" id="Page_87">[Pg 87]</a></span>
-descends along the outer side of the popliteal space and divides
-an inch below the head of the fibula into the anterior tibial,
-which supplies the flexors and skin of the ankle-joint, and the
-musculo-cutaneous, which sends branches to the skin of the lower leg
-and the dorsum of the foot.</p>
-
-<p><b>The Sympathetic System.</b>—Joined to the cerebro-spinal system
-by intervening cords is the sympathetic system. This is made up of two
-series of ganglia, one on either side of the spinal column, connected
-by longitudinal bands and extending from the base of the skull to the
-coccyx. They do not form an independent nervous system, each ganglion,
-which seems to resemble the motor cells of the spinal cord, being
-connected by motor and sensory fibers with the cerebral system.</p>
-
-<p>The <a href="#FIG_30"><i>sympathetic nerves</i></a> are mostly gray, non-medullated
-fibers and are distributed to viscera, secreting glands, and blood-vessels, whose
-movements are involuntary and feelings obtuse. They form networks upon
-the heart and other viscera and send branches to the cranium to the
-organs of special sense. There are three main plexuses: The <i>solar
-plexus</i> behind the stomach, which supplies the abdominal viscera; the
-<a href="#FIG_30"><i>hypogastric plexus</i></a> in front of the prominence of the
-sacrum, whose nerves go to the pelvic organs; and the <i>cardiac plexus</i> behind
-the aortic arch for the thoracic viscera.</p>
-
-<p>Over these nerves one has no control. A blow in the region between the
-costal cartilages and below the sternum is a solar plexus blow and is
-very upsetting.</p>
-
-<p>The sympathetic system serves to maintain vitality in all the important
-portions of the system and one of its important functions is to keep up
-communication between one part and another, so that when any organ is
-affected the others will act accordingly and help out to the best of
-their ability.</p>
-
-<hr class="chap" />
-<div class="chapter">
-<p><span class="pagenum"><a name="Page_88" id="Page_88">[Pg 88]</a></span></p>
-<h2 class="nobreak">CHAPTER VI.<br /> <span class="h2_subtitle">THE BACK.</span></h2></div>
-
-<div class="figleft">
-    <img src="images/i_088.jpg" alt="" width="150" height="728" />
-    <p class="center"><span class="smcap">Fig. 31.</span>—<br />The spinal
-                  column.<br /> (Church and Peterson.)</p>
-</div>
-
-<p><b>The Spine.</b>—The trunk may be roughly divided into the back, the
-chest or thorax, the abdomen, and the pelvis. By the back is denoted
-the spinal column with its muscles, blood-vessels, etc., and the spinal
-cord already described. The spine or vertebral column, which serves the
-double purpose of holding the body erect and of protecting the cord, is
-usually about two feet, two inches in length. In its course there occur
-several curves, which serve to give springiness and strength and, with
-the intervertebral cartilages, to mitigate the force of concussion from
-blows and falls. The curve is convex forward in the cervical region,
-convex backward in the dorsal, forward in the lumbar, and backward
-again in the sacral region. There is most freedom of motion in the
-cervical region.</p>
-
-<p>As is the case with the other bones, the <i>vertebræ</i> are specially
-adapted in shape and size to the needs they are called upon to fill.
-Strength and flexibility, with a minimum bulk, a channel for the cord,
-and passages for the numerous nerves and blood-vessels are some of the
-requirements which, in combination, they meet to an astonishing degree.
-They are thirty-three in all, and are divided into groups according
-to the region in which they occur: seven cervical in the neck, twelve
-dorsal or thoracic, five lumbar, five sacral, and four coccygeal.
-<span class="pagenum"><a name="Page_89" id="Page_89">[Pg 89]</a></span></p>
-
-<p>Although the vertebræ of the different groups differ more or less
-in size and shape in accordance with the various demands of their
-positions, they all have certain general characteristics. Each has
-a body, two laminæ, two pedicles, two transverse processes, and one
-spinous process. The <i>pedicles</i> extend back from the body on either
-side and support two broad plates of bone, the <i>laminæ</i>, whose juncture
-at the back completes the <i>spinal foramen</i> for the passage of the cord.
-At their juncture is the <i>spinous process</i>, which can be felt beneath
-the skin, while the <i>transverse processes</i> project from the juncture of
-the laminæ with the pedicles. All the processes are for the attachment
-of muscles that move the spine. The <i>body</i> is formed of cancellous bone
-with a compact layer outside. Transversely it is slightly oval, while
-its upper and lower surfaces are flat, except in the cervical region,
-where the upper surface is concave laterally and the under convex
-laterally and concave from before back. Between the bodies are disks of
-fibro-cartilage, which increases motion and springiness. The <i>spinous
-process</i> or <i>spine</i> is short in the cervical region, long and directed
-downward in the dorsal region, thick and projecting almost straight out
-in the lumbar region. The pedicles are notched above and below so that
-<span class="pagenum"><a name="Page_90" id="Page_90">[Pg 90]</a></span>
-when articulated the notches of two vertebræ join to form the
-<i>intervertebral foramen</i> for the outward passage of nerves and the
-inward passage of blood-vessels.</p>
-
-<p>The distinguishing mark of the <i>cervical vertebræ</i> is the foramen in
-each transverse process, through which the vertebral arteries run to
-the skull. They are also smaller than the dorsal and lumbar vertebræ.
-The <i>dorsal vertebræ</i> are distinguished by having on the transverse
-processes and on the body smooth articular surfaces called facets and
-demi-facets for articulation with the ribs. The <i>lumbar vertebræ</i> are
-the largest and heaviest and have the thickest spine. By the time the
-sacral region is reached, however, the vertebræ have only a rudimentary
-spinous process. Moreover, in adult age the sacral bones grow together
-and form one triangular bone, the <a href="#FIG_33"><i>sacrum</i></a>, which has a
-broad base called the <i>promontory of the sacrum</i> and a blunt apex. It is concave
-in front and convex behind and has an articulating surface for joining
-the pelvic bones. In the case of the <i>coccyx</i> also the four original
-bones, all rudimentary in character and supposed to be the survival of
-a tail, grow together to form one bone. Together the sacrum and coccyx
-form the posterior wall of the true pelvis.</p>
-
-<div class="figcenter">
-    <img id="FIG_32" src="images/i_089.jpg" alt="" width="600" height="282" />
-    <p class="blockquot"><span class="smcap">Fig. 32.</span>—A type of vertebra. (Leidy.)
-        1, Body; 2, pedicle; 3, lamina; 4, spinal foramen; 5, spinous process; 6,
-        transverse process; 7, articular process.</p>
-
-    <img id="FIG_33" src="images/i_090.jpg" alt="" width="600" height="339" />
-    <p class="center"><span class="smcap">Fig. 33.</span>—The sacrum, from before.<br />
-                (Drawn by D. Gunn.)</p>
-</div>
-
-<p><span class="pagenum"><a name="Page_91" id="Page_91">[Pg 91]</a></span>
-Some of the dorsal vertebræ are peculiar in the arrangement of their
-facets and demi-facets, while among the <i>cervical vertebræ</i> are several
-whose peculiarities should be more carefully noted. Thus, the first
-cervical vertebra or <i>atlas</i> supports the head and has practically no
-body, the place of the body being taken by a narrow anterior arch of
-bone and an opening, continuous with the spinal foramen, into which
-the <i>odontoid process of the axis</i> fits, being held in place by
-ligaments. At either side on top is a facet for articulation with the
-occipital bone. There is almost no spine. The second vertebra or <i>axis</i>
-has surmounting the body the odontoid process, with a facet in front
-for articulation with the atlas and one behind for the transverse
-ligament to move over. The seventh cervical vertebra or <i>vertebra
-prominens</i> has a very long spinous process—hence name—to which is attached
-the <i>ligamentum nuchæ</i>. It can be felt very distinctly on the living.</p>
-
-<p>Running from the skull down through the spinal column into the sacral
-vertebræ and formed by the joining of the <a href="#FIG_32">spinal foramina</a>
-of the individual vertebræ is an opening called the <i>spinal canal</i>, which
-holds the cord. The cord, however, stops practically at the first
-lumbar vertebra, where it splits up into the <i>cauda equina</i>,
-only the <i>filum terminate</i> extending farther down.</p>
-
-<p>Occasionally the laminæ do not form completely and the membranes of the
-cord may bulge out and form a tumor, or the cord itself may come out
-also. This generally occurs in the lumbar region, where it is known as
-<i>spina bifida</i>. If in case of fracture of a vertebra there is paralysis
-of the parts below due simply to the pressure of a fragment of bone
-upon the cord, it may be completely cured by removal of the fragment.
-If, however, the cord suffers injury, the paralysis will remain.
-<i>Humpback</i> or <i>Pott’s disease</i> is caused by the tubercle bacillus,
-which eats away the bodies of the vertebræ so that the column caves in
-and the spinous processes are thrown out in a hump or kyphos.
-<span class="pagenum"><a name="Page_92" id="Page_92">[Pg 92]</a></span></p>
-
-<div class="figcenter">
-    <img id="FIG_34" src="images/i_092.jpg" alt="" width="600" height="598" />
-    <p class="blockquot"><span class="smcap">Fig. 34.</span>—Muscles of the right side
-       of the head and neck: 1, Frontalis; 2, superior auricular; 3, posterior auricular;
-       4, orbicularis palpebrarum; 5, pyramidalis nasi; 6, compressor naris;
-       7, levator labii superioris alæque nasi; 8, levator labii superioris;
-       9, zygomaticus major; 10, orbicularis oris; 11, depressor labii
-       inferioris; 12, depressor anguli oris; 13, anterior belly of digastric;
-       14, mylohyoid; 15, hyoglossus; 16, stylohyoid; 17, posterior belly of
-       digastric; 18, the masseter; 19, sternohyoid; 20, anterior belly of
-       omohyoid; 21, thyrohyoid; 22, 23, lower and middle constrictors of
-       pharynx; 24, sternomastoid; 25, 26, splenius; 27, levator scapulæ; 28,
-       anterior scalenus; 29, posterior belly of omohyoid; 30, middle and
-       posterior scalenus; 31, trapezius. (Dorland’s Dictionary.)</p>
-</div>
-
-<p><b>Muscles of the Neck.</b>—Before speaking of the muscles of the back
-a few of those of the neck had best be taken up. They are numerous
-but mostly of minor importance. Largest and most important is the
-<i>sterno-cleido-mastoid muscle</i>, which has its origin on the upper part
-of the sternum and the inner third of the clavicle and is inserted
-into the mastoid process of the temporal bone. It passes obliquely
-across the side of the neck and serves to flex the head to the side
-and to draw the face in the opposite direction. When both muscles
-contract the head is flexed on the neck and the neck on the chest. In
-<i>wry neck</i> or <i>torticollis</i> this muscle is constantly contracted. The
-<i>platysma myoides</i> arises from the fascia over the pectoral, deltoid,
-and trapezius muscles and is inserted into the lower jaw, the angle of
-the mouth, and the loose tissue in the lower part of the face. It
-<span class="pagenum"><a name="Page_93" id="Page_93">[Pg 93]</a></span>
-wrinkles the skin of the neck and depresses the lower jaw. In the
-cow and horse it is so highly developed that by it the skin can be
-contracted all over the body to drive off flies. The <i>rectus capitis
-anticus major</i> arises from the third to the sixth cervical vertebræ
-and is inserted into the occipital bone, serving to flex the head. The
-<a href="#FIG_34"><i>scalenus muscles</i></a> have their origin on the lower cervical
-vertebræ and are inserted into the first and second ribs, thus aiding in the
-elevation of the ribs as well as in lateral flexion of the neck. The
-head is held upright by the <i>ligamentum nuchæ</i>, which rises from the
-external occipital protuberance and is inserted into the spinous
-processes of all the cervical vertebræ except the first.</p>
-
-<p><b>Muscles of the Back.</b>—The chief back muscles are the trapezius
-and the latissimus dorsi, which together cover in the back pretty
-thoroughly. The <a href="#FIG_35"><i>trapezius</i></a> arises from the occipital
-bone, the ligamentum nuchæ, and the spinous processes of the seventh cervical
-and all the dorsal vertebræ and is inserted into the outer third of
-the clavicle or collar bone and the acromion process and spine of the
-scapula or shoulder blade. It is thus triangular in shape and covers in
-the neck and shoulders, serving to draw the head back and to the side.
-It overlaps the latissimus dorsi.</p>
-
-<p>The <a href="#FIG_35"><i>latissimus dorsi</i></a> has its origin by aponeurosis
-from the spinous processes of the six lower dorsal and all the lumbar and sacral
-vertebræ, from the crest of the ilium or hip bone, and from the three
-or four lower ribs, swings across the side, dwindling in size, and is
-inserted by a small tendon into the bicipital groove of the humerus or
-upper arm bone, thus covering in the part of the back not covered by
-the trapezius. It draws the arm down and back, raises the lower ribs,
-and draws the trunk forward, as in climbing. The flat muscles of the
-back and abdomen have a tendency to flatten out into aponeuroses, such
-as occurs in the origin of the latissimus dorsi.</p>
-
-<p>The <a href="#FIG_35"><i>levator scapulæ</i></a>, from the transverse processes
-of the upper <span class="pagenum"><a name="Page_94" id="Page_94">[Pg 94]</a></span>
-cervical vertebræ to the posterior border of the scapula, serves
-to raise the angle of the scapula, and the <a href="#FIG_35"><i>rhomboideus major</i>
-and <i>minor</i></a>, from the ligamentum nuchæ, the seventh cervical, and the upper
-dorsal vertebræ to the root of the spine of the scapula, draw the
-inferior angle back and up.</p>
-
-<div class="figcenter">
-    <img id="FIG_35" src="images/i_094.jpg" alt="" width="600" height="718" />
-    <p class="blockquot"><span class="smcap">Fig. 35.</span>—Muscles of the trunk from
-        behind (left side, superficial; right side, deep): 1, Sternomastoid; 2,
-        splenius; 3, trapezius; 4, latissimus dorsi; 5, infraspinatus; 6, teres
-        minor; 7, teres major; 8, deltoid; 9, external oblique of abdomen;
-        10, gluteus medius; 11, gluteus maximus; 12, levator anguliscapulæ;
-        13, rhomboideus minor; 14, rhomboideus major; 15, part of longissimus
-        dorsi; 16, tendons of insertion of iliocostalis; 17, supraspinatus; 18,
-        infraspinatus; 19, teres minor; 20, teres major; 21, serratus magnus;
-        22, upper, and 22´, lower part of serratus posticus inferior; 23,
-        internal oblique; 24, gluteus medius; 25, pyriformis and superior and
-        inferior gemelli; 26, 26´, portions of obturator internus; 27, tendon
-        of obturator internus; 28, quadratus femoris. (Dorland’s Dictionary.)</p>
-</div>
-
-<p>The <i>blood supply</i> in the cervical region and about the shoulders comes
-from branches of the subclavian artery, such as the suprascapular and
-<span class="pagenum"><a name="Page_95" id="Page_95">[Pg 95]</a></span>
-the transversalis colli. Lower down the supply comes from the posterior
-branches of the intercostals, dorsal branches of the lumbar, and
-branches of the internal iliac.</p>
-
-<p>The muscles of the back are supplied by the <i>spinal nerves</i>, the spinal
-accessory also going to the trapezius muscle.</p>
-
-<hr class="chap" />
-<div class="chapter">
-<p><span class="pagenum"><a name="Page_96" id="Page_96">[Pg 96]</a></span></p>
-<h2 class="nobreak">CHAPTER VII.<br /> <span class="h2_subtitle">THE CHEST.</span></h2></div>
-
-<p>The chest or thorax occupies the upper part of the trunk in front and
-is a dome-shaped cavity containing and protecting the heart and lungs.
-Its walls are formed by the dorsal vertebræ at the back, the ribs at
-either side, and the sternum and costal cartilages in front, all well
-covered with muscles. The floor is formed by the <a href="#FIG_38">diaphragm</a>.
-Through the upper opening of the chest pass the trachea, the esophagus, and many
-important vessels and nerves.</p>
-
-<div class="figcenter">
-    <img id="FIG_36" src="images/i_096.jpg" alt="" width="600" height="487" />
-    <p class="center"><span class="smcap">Fig. 36.</span>—Thorax
-               (anterior view.)<br /> (Ingals.)</p>
-</div>
-
-<p><span class="pagenum"><a name="Page_97" id="Page_97">[Pg 97]</a></span>
-The shape of the chest may vary in disease. Thus, in rickets there is
-the prominent “pigeon” breast and the rosary, that is, a bead at the
-juncture of each rib with the costal cartilage, while in emphysema the
-chest is enlarged in all directions and barrel-shaped. In severe cases
-of lateral curvature it is distorted but may be improved by exercises.</p>
-
-<p><b>The Sternum.</b>—The sternum or breast-bone is a long narrow bone
-and has three parts, the <a href="#FIG_36"><i>manubrium</i></a> or handle above,
-the <a href="#FIG_36"><i>gladiolus</i></a> or sword, and the
-<a href="#FIG_36"><i>ensiform cartilage</i></a> at the lower end. On either
-side are notches for the <a href="#FIG_36">costal cartilages</a>; for the first
-seven ribs as well as the clavicle articulate with it. Except for some muscles
-along the edges it lies directly under the skin and the ridge between
-the manubrium and the gladiolus can be felt in the living, a fact which
-assists in determining the position of the different ribs in cases of
-fracture, as the second rib articulates at this point.</p>
-
-<div class="figcenter">
-    <img id="FIG_37" src="images/i_097.jpg" alt="" width="600" height="260" />
-    <p class="blockquot"><span class="smcap">Fig. 37.</span>—A and B, typical ribs;
-         C, first rib; D, twelfth rib. 1, head; 2, neck; 3, tuberosity;
-         4, grooved edge; 5, shaft; 6, oval depression for costa cartilage.</p>
-</div>
-
-<p><b>The Ribs.</b>—The ribs are twenty-four in number, <a href="#FIG_36">twelve
-on each side</a>, of which the upper seven, which articulate with the sternum by
-individual cartilages, are called <i>true ribs</i>, the other five <i>false
-ribs</i>. Of the false ribs the upper three articulate indirectly with
-the sternum through the seventh cartilage, with which their cartilages
-unite, while the other two have their anterior extremities free and are
-<span class="pagenum"><a name="Page_98" id="Page_98">[Pg 98]</a></span>
-called <i>floating ribs</i>. All the ribs slope down toward the front
-and are by nature more freely movable in women than in men. Most of
-the ribs have a <a href="#FIG_37">head divided by a little ridge</a> into two
-facets for articulation with the dorsal vertebræ, a flattened neck, a tuberosity
-at the base of the neck with a facet for articulation with the
-transverse process of the vertebra below, an angle, and a shaft,
-which is externally convex and is grooved on its lower edge for the
-intercostal vessels and nerve. The first and second, eleventh and
-twelfth ribs, however, are somewhat peculiar, the first two being
-shorter, flatter and rather broader than the rest and the first having
-only one facet on the head, while the last two have only one facet on
-the head and no neck or tuberosity.</p>
-
-<p>The <a href="#FIG_36"><i>costal cartilages</i></a> serve to prolong the ribs and
-greatly increase the elasticity of the chest wall. They grow longer down to the seventh
-and then decrease again in length.</p>
-
-<p>The ribs, except the first and second, which are protected by the
-clavicle, are frequently <i>broken</i>. Such a break causes pain in
-breathing and sometimes the end of a rib pierces the lung tissue
-and swelling all over the body results, due to the presence of air.
-<i>Caries</i> or death of the rib is also frequent. <i>Fracture of the
-sternum</i> occurs occasionally, generally from direct force, as from a
-blow with the knee in foot-ball, and there may be dislocation between
-the manubrium and gladiolus.</p>
-
-<p><b>Muscles of the Chest.</b>—The spaces between the ribs, from the
-tubercle of the rib behind to the cartilage in front, are filled by
-the <i>external intercostal muscles</i>, which pass downward and forward
-from the lower border of one rib to the upper border of the one below.
-There are, therefore, eleven pairs of these muscles. There are also
-eleven pairs of the <i>internal intercostals</i>, which commence at the
-sternum and extend back to the angle of the rib. These extend downward
-and backward. The external intercostals raise and evert the ribs in
-inspiration, the internal depress and invert them in expiration.
-<span class="pagenum"><a name="Page_99" id="Page_99">[Pg 99]</a></span></p>
-
-<p>The chief respiratory muscle, however, is the <a href="#FIG_38"><i>diaphragm</i></a>,
-a somewhat fan-shaped muscle that forms the floor of the chest cavity. It takes
-its origin from the ensiform cartilage, the six or seven lower ribs and
-their cartilages, and from the upper three or four lumbar vertebræ,
-that is, from the whole of the internal circumference of the thorax,
-and is inserted into the central cordiform tendon. It has several large
-and several small openings for the aorta, the esophagus, the venæ cavæ,
-the thoracic duct, and various nerves, and its surfaces are covered by
-serous membranes, by the two pleuræ and the pericardium above and by
-the peritoneum below. It partially supports the heart and lungs. Convex
-toward the chest, it becomes flattened in contraction and so increases
-the capacity of the chest. It aids in all expulsive acts, as sneezing,
-coughing, laughing, urinating, defecating, vomiting, and childbirth.
-<i>Hiccough</i> is spasm of the diaphragm.</p>
-
-<div class="figcenter">
-    <img id="FIG_38" src="images/i_099.jpg" alt="" width="600" height="405" />
-    <p class="blockquot"><span class="smcap">Fig. 38.</span>—Interior view of the
-         diaphragm. (Leidy.) 1-3, The three lobes of the central tendon, surrounded by
-         the fleshy fasciculi derived from the inferior margin of the thorax;
-         4, 5, the crura; 6, 7, the arcuate ligaments; 8, aortic orifice;
-         9, esophageal orifice; 10, quadrate foramen; 11, psoas muscle; 12,
-         quadrate lumbar muscle.</p>
-</div>
-
-<p><span class="pagenum"><a name="Page_100" id="Page_100">[Pg 100]</a></span>
-The <i>arteries</i> of the chest are the intercostal branches of the
-subclavian and the thoracic aorta, the phrenic, mediastinal, and
-intercostal branches of the internal mammary, and the thoracic branches
-of the axillary.</p>
-
-<p>The <i>nerves</i> are the intercostals and phrenics.</p>
-
-<p><b>Mammary Glands.</b>—On the outside of the chest walls, lodged in
-the fascia of the pectoral muscles, are the mammary glands, accessory
-organs of the generative system. They exist in both sexes but are
-only rudimentary in the male. In the female they are small before
-puberty but enlarge as the generative organs become more completely
-developed, forming two hemispherical eminences, one on either side,
-between the third and seventh ribs. During pregnancy they increase once
-more in size preparatory to the secretion of the milk, and in old age
-they atrophy. From the middle projects a small pinkish-brown conical
-eminence, the <i>nipple</i>, surrounded by a paler area, the <i>areola</i>.
-After the second month of pregnancy both nipple and areola become darker
-in color, a point of great diagnostic value in early pregnancy.</p>
-
-<p>The mammary glands themselves consist of lobules of gland tissue with
-a central lactiferous tubule, the lobules being gathered into lobes
-with fatty tissue between. From the juncture of these tubules result
-fifteen or twenty excretory ducts, the <i>tubuli lactiferi</i>, which
-converge toward the areola. Beneath the nipple they dilate, forming the
-<i>ampullæ</i>, and then contract again to pass out through the nipple as
-straight tubes.</p>
-
-<p><i>Breast abscess</i> occurs most commonly in nursing mothers, as where
-a part is most active there is most danger of abscess. Many benign
-<i>tumors</i> of the breast, as the fibrous tumors, occur and are especially
-common in young women. If a fibrous tumor is allowed to develop it may
-become cancerous. <i>Cancer</i>, however, generally occurs after the age of
-forty and is usually due to some irritation, as to a blow from a ball.</p>
-
-<p>The <i>arteries</i> of the breasts are the thoracic branches of the
-axillary, the intercostal, and the internal mammary.</p>
-
-<p>The <i>nerves</i> are from the thoracic cutaneous.</p>
-
-<hr class="chap" />
-<div class="chapter">
-<p><span class="pagenum"><a name="Page_101" id="Page_101">[Pg 101]</a></span></p>
-<h2 class="nobreak">CHAPTER VIII.<br /><span class="h2_subtitle">THE HEART AND CIRCULATION.</span></h2></div>
-
-<p><b>The Heart.</b>—Shielded within the chest are, as has been said, the
-heart and lungs. The heart lies on the left side behind the sternum
-and the cartilages of the fourth to seventh ribs in a closed, conical,
-membranous sac, the <i>pericardium</i>, which is attached by its base to the
-central tendon of the diaphragm, and whose point extends up between
-the pleuræ of the lungs. This sac has an external fibrous layer and an
-internal serous layer that is reflected back over the heart itself,
-<span class="pagenum"><a name="Page_102" id="Page_102">[Pg 102]</a></span>
-forming a closed sac, within which a thin fluid is secreted that serves
-to reduce friction during the movements of the heart, the two inner
-surfaces sliding over each other with every beat.</p>
-
-<div class="figcenter">
-    <img id="FIG_39" src="images/i_101.jpg" alt="" width="600" height="482" />
-    <p class="center"><span class="smcap">Fig. 39.</span>—The heart.<br />
-            (Stoney.)</p>
-
-    <img id="FIG_40" src="images/i_102.jpg" alt="" width="600" height="551" />
-    <p class="blockquot"><span class="smcap">Fig. 40.</span>—Left auricle and ventricle,
-       opened and part of their walls removed to show their cavities: 1, Right
-       pulmonary vein cut short; 1´, cavity of left auricle; 3, 3´, thick wall
-       of left ventricle; 4, portion of same with papillary muscle attached;
-       5, the other papillary muscles; 6, 6´, the segments of the mitral
-       valve; 7, in aorta is placed over the semilunar valves; 8, pulmonary
-       artery; 10, aorta and its branches. (Allen Thomson.)</p>
-</div>
-
-<p>The heart itself is a hollow conical organ composed of cardiac muscle,
-a combination of smooth and striated fibers found nowhere else in the
-body. It lies obliquely, base up, between the lungs, suspended by the
-great blood-vessels and with the apex directed downward, forward, and to
-the left, the apex beat being normally felt in the fifth intercostal
-space, one inch inside and two inches below the left nipple. In size it
-varies in different people and is generally smaller in women than in
-<span class="pagenum"><a name="Page_103" id="Page_103">[Pg 103]</a></span>
-men. On the average it is five inches long, three and a half inches
-broad, and two inches thick. A man’s heart usually weighs about eleven
-ounces and that of a woman nine ounces. It never leaks except from
-disease and such leakage is fatal.</p>
-
-<p><i>The Cavities.</i>—The heart contains four cavities, two <a href="#FIG_39"><i>auricles</i></a>
-above and two <a href="#FIG_40"><i>ventricles</i></a> below, with a longitudinal septum between the
-auricle and ventricle on the right and those on the left. The posterior
-surface is largely made up of the left ventricle and the anterior of
-the right ventricle. The right auricle, which receives the blood from
-the general circulation, has a capacity of about two fluid ounces and
-is larger than the left, which receives the blood returning from the
-lungs, though its walls are thinner. Of the ventricles the left is the
-larger and its walls are about three times as thick as those of the
-right, for it has to send the blood all over the body. All the cavities
-are lined with smooth, transparent, serous membrane, the <i>endocardium</i>,
-which is continuous with the intima of the great vessels.</p>
-
-<div class="figcenter">
-    <img id="FIG_41" src="images/i_103.jpg" alt="" width="600" height="304" />
-    <p class="blockquot"><span class="smcap">Fig. 41.</span>—Orifices of the heart,
-       seen from above, both the auricles and the great vessels being removed: <i>PA</i>,
-       Pulmonary artery and its semilunar valves; <i>Ao</i>, aorta and its valves;
-       <i>RAV</i>, tricuspid, and <i>LAV</i>, bicuspid valves; <i>mv</i>, segments of mitral
-       valve; <i>lv</i>, segment of tricuspid valve. (Huxley.)</p>
-</div>
-
-<p><i>The Valves.</i>—The opening from the auricle into the ventricle on
-either side is guarded on the ventral side by a valve formed of folds
-of endocardium. The valve on the right side has three flaps or cusps
-<span class="pagenum"><a name="Page_104" id="Page_104">[Pg 104]</a></span>
-and is called the <a href="#FIG_41"><i>tricuspid valve</i></a>, while that on the
-left has two flaps, larger and thicker than those of the tricuspid, and is known as
-the <a href="#FIG_41"><i>bicuspid</i> or <i>mitral valve</i></a>. The flaps of either
-valve are kept from being forced into the auricle in closing by fine tendinous cords,
-the <i>chordæ tendineæ</i>, which are attached to the <i>columnæ carneæ</i>,
-muscular bands or columns projecting from the walls of the ventricle,
-which contract and hold the chordæ tendineæ taut. The opening into the
-pulmonary artery is from the posterior part of the right ventricle
-and is guarded by the <a href="#FIG_41"><i>semilunar</i> or <i>pulmonary valve</i></a>,
-while the aortic opening from the left ventricle is guarded by a similar valve,
-the <i>aortic valve</i>, the most important valve in the body. All these
-valves are planned primarily to prevent regurgitation of the blood
-during contraction of the heart muscle. Pressure in the ventricle must
-exceed that in the arteries before the semilunar valves will open and
-the blood can be driven out, just as the auriculo-ventricular valves
-remain closed until the pressure in the auricles exceeds that in the
-ventricles.</p>
-
-<p>The <i>heart beat</i> is caused by the twisting of the heart upon its
-axis during contraction of the muscle. Normally it beats rhythmically and
-regularly, whatever a person does, at a rate of about seventy-two
-contractions to the minute in the adult. To the regular <i>cardiac
-cycle</i>, as it is called, there are two periods, the <i>systole</i> and the
-<i>diastole</i>, the former representing the period of contraction of the
-ventricles, when the blood is sent to the lungs and over the body,
-and the latter representing the period of rest following the emptying
-of the ventricles, during which they are refilled. Contraction of
-the heart occupies one-fifth of the time of one beat, dilatation
-two-fifths, and the pause two-fifths. There are really two systoles,
-one of the auricles and one of the ventricles, but they come so close
-together that they are practically simultaneous so far as sound is
-concerned, though they can be distinguished by sight. During systole
-the tricuspid and mitral valves close sharply to prevent regurgitation
-<span class="pagenum"><a name="Page_105" id="Page_105">[Pg 105]</a></span>
-into the auricles, while the semilunar valves open to let the blood
-out. The cardiac cycle is, therefore, as follows:</p>
-
-<div class="figcenter">
-    <img id="FIG_42" src="images/i_105.jpg" alt="" width="600" height="557" />
-    <p class="center"><span class="smcap">Fig. 42.</span>—Diagram of the circulation.<br />
-         (After Kirke.)</p>
-</div>
-
-<p><b>Circulation.</b>—The blood, after it has given off its oxygen
-and collected carbon dioxide, returns to the heart through two main
-channels, the <i>superior</i> and <i>inferior venæ cavæ</i>, the former bringing
-the blood from the upper part of the body, including the head, neck,
-and arms, and the latter from the lower part below the diaphragm. The
-two vessels empty along with the <i>coronary sinus</i>, which is guarded by
-the <i>coronary valve</i>, into the right auricle. At the same time that
-they empty into this auricle the four <a href="#FIG_42"><i>pulmonary veins</i></a>,
-the only veins that carry arterial or oxygenated blood, are emptying the fresh blood
-<span class="pagenum"><a name="Page_106" id="Page_106">[Pg 106]</a></span>
-from the lungs into the left auricle. When both auricles are full,
-they contract and send the blood into the ventricles, the <i>auricular
-systole</i>. As the blood comes through into the ventricles it probably
-comes around by the walls and closes the auriculo-ventricular valves,
-though just how the valves close is not certain. When the two
-ventricles are full they in turn contract, the <i>ventricular systole</i>,
-and the blood is forced out, that in the right ventricle passing to the
-lungs for its new supply of oxygen through the <a href="#FIG_42"><i>pulmonary artery</i></a>,
-the only artery to carry venous blood, and that from the left ventricle
-entering the aorta for general distribution through the body. Following
-the systole is a pause, the <i>diastole</i>, while the heart fills again.</p>
-
-<div class="figcenter">
-    <img id="FIG_43" src="images/i_106.jpg" alt="" width="400" height="477" />
-    <p class="center"><span class="smcap">Fig. 43.</span>—The fetal circulation.</p>
-</div>
-
-<p><i>Circulation in Fetus.</i>—In the fetus there is <a href="#FIG_43">direct communication
-between the two auricles</a> through the <i>foramen ovale</i>, which normally
-closes at birth, though occasionally it remains open. There is also
-communication between the pulmonary artery and the arch of the aorta
-through the <a href="#FIG_43"><i>ductus arteriosus</i></a>. The freshly oxidized
-blood comes to the fetus through the placenta, from which it is brought along
-the umbilical cord in the umbilical vein to the liver and thence to
-the inferior vena cava, where it mixes with the blood from the lower
-extremities. By the inferior vena cava it is carried to the right
-auricle, where the <i>Eustachian valve</i>—a valve between the inferior
-vena cava and the auriculo-ventricular opening, larger in the fetus
-than in later life where it serves no special purpose—guides it across
-the auricle and through the foramen ovale to the left auricle. From
-this auricle, together with a small amount of blood from the lungs,
-it goes to the left ventricle and is distributed by the aorta almost
-<span class="pagenum"><a name="Page_107" id="Page_107">[Pg 107]</a></span>
-entirely to the head and upper extremities. Hence their large size and
-perfect development at birth. Returned from the upper extremities by
-the superior vena cava, the blood enters the right auricle again and,
-passing over the Eustachian valve this time, descends to the right
-ventricle, from which the greater part passes by the pulmonary artery
-and the ductus arteriosus to the descending aorta, though a small
-amount keeps on through the pulmonary artery to the lungs. In the aorta
-it mixes with the blood from the left ventricle and part goes to supply
-the lower extremities, though the greater part is carried back to the
-placenta through the two umbilical arteries. The fact that the greater
-part of the blood traverses the liver accounts for its large size at
-birth, while the lower extremities, which receive for the most part
-blood that has already circulated through the upper extremities, are of
-small size and imperfectly developed.</p>
-
-<p><b>Arteries.</b>—After birth the arterial blood for the general
-circulation leaves the heart by the <a href="#FIG_44">aorta</a>, the main
-distributing artery of the body. Through this and its branches it is carried
-throughout the body in what, with the return of the venous blood by the venæ cavæ
-and other smaller veins, is known as the <i>systemic circulation</i>. The
-<i>aorta</i> ascends from the left ventricle and arches backward to the left
-over the root of the left lung to descend along the spinal column at
-the left to the fourth lumbar vertebra, about opposite the umbilicus,
-where, considerably diminished in size by the branches it has given
-off, it divides into the two <i>common iliacs</i>. For convenience its
-different parts are named, according to their position, the <i>ascending
-aorta</i>, the <i>arch of the aorta</i>, and the <i>descending aorta</i>, the last
-being subdivided into the <i>thoracic</i> and the <i>abdominal aorta</i>.</p>
-
-<div class="figcenter">
-    <img id="FIG_44" src="images/i_108.jpg" alt="" width="600" height="220" />
-    <p class="center"><span class="smcap">Fig. 44.</span>—The aortæ and
-                their branches.<br /> (Leidy.)</p>
-</div>
-
-<p>From the ascending aorta come off the <i>coronary arteries</i> which supply
-the heart muscle itself, as the coronary sinuses carry off the venous
-blood from the heart. From the arch are given off the <i>left common
-<span class="pagenum"><a name="Page_108" id="Page_108">[Pg 108]</a></span>
-carotid</i> and <i>left subclavian</i> and the <i>innominate</i>, which divides into
-the <i>right common carotid</i> and <i>right subclavian</i>.</p>
-
-<p>The <i>common carotids</i> pass up the neck behind the sterno-cleido-mastoid
-muscles in a line from the sterno-clavicular joint to a point midway
-between the mastoid process and the angle of the lower jaw and divide
-opposite the upper border of the thyroid cartilage into the <i>internal</i>
-and <i>external carotids</i>, of which the former with its branches supplies
-the anterior part of the brain, the eye and forehead, and the latter
-the neck and face.</p>
-
-<p>The <i>subclavian</i> is the artery of the upper extremity but its vertebral
-branch goes to the brain, where with its fellow it forms the <i>basilar
-artery</i>, whose branches together with the branches of the internal
-carotid form the <i>circle of Willis</i> at the base of the brain. Other
-branches of the subclavian are the <i>thyroid axis</i>, with branches to
-the neck and shoulders; the <i>internal mammary</i>, with branches to the
-chest walls, mediastinum, and diaphragm, such as the musculo-phrenic and
-superior epigastric; and the <i>superior intercostal</i>. At the lower
-border of the first rib, over which it passes, the name <i>axillary</i> is
-substituted for <i>subclavian</i>, while at the lower border of the axilla,
-where it starts down the arm, it is called the <i>brachial artery</i>. At
-the elbow the brachial divides into the <i>radial</i> and <i>ulnar arteries</i>.
-<span class="pagenum"><a name="Page_109" id="Page_109">[Pg 109]</a></span>
-The <i>axillary artery</i> sends branches to the chest and shoulder and is
-more frequently injured than any other artery except the popliteal. <i>Aneurism</i>
-may occur in it and is very likely to occur in the thoracic aorta.</p>
-
-<p>From the <i>thoracic aorta</i> branches go to various of the chest contents,
-while the <i>abdominal aorta</i> supplies the abdominal viscera. Among the
-branches of the abdominal aorta are: the <i>celiac axis</i>, which has a
-gastric, an hepatic, and a splenic branch; the <i>superior</i> and <i>inferior
-mesenteric</i> to the intestines; the <i>renal</i>; the <i>suprarenal</i>; the
-<i>spermatic</i> or <i>ovarian</i>; the <i>inferior phrenic</i>; and the <i>lumbar</i>.</p>
-
-<p>The <i>common iliacs</i> divide at the upper edge of the sacrum into the
-<i>external</i> and <i>internal iliacs</i>, of which the latter with its branches
-supplies the walls and viscera of the pelvis and the inner part of the
-thigh. The external iliac and its branches go to the thigh, leg, and foot.</p>
-
-<p><b>Veins.</b>—Of the veins few need be mentioned by name. The deep
-veins have the same names as the arteries they accompany, though there
-are two <i>innominate veins</i> where there is only one innominate artery,
-the <i>subclavian</i> and <i>internal jugular</i> veins on either side joining
-to form an innominate vein and the two innominates in turn forming
-the <i>superior vena cava</i>. Of the superficial veins the <i>external</i>
-and <i>internal jugular</i> correspond to the common carotid arteries and
-return the blood from the head and face. The external jugular vein is
-important because it is the largest superficial vein in the neck and
-is often cut in suicide. The <i>median vein</i> is found at the bend of
-the elbow and is used in letting blood and in giving salt solution,
-while the <i>basilic</i> is on the inner side and the <i>median cephalic</i>
-on the outer side of the upper arm. <i>Varicosity</i> often occurs in the
-<i>internal</i> or <i>long saphenous</i> and the <i>external</i> or <i>short
-saphenous</i> in the leg. The <i>inferior vena cava</i> is formed by the
-juncture of the two <i>common iliac veins</i>.</p>
-
-<p><b>Portal Circulation.</b>—The portal system of veins includes four
-<span class="pagenum"><a name="Page_110" id="Page_110">[Pg 110]</a></span>
-large trunks which collect the blood from the viscera of digestion, the
-<i>superior</i> and <i>inferior mesenteric veins</i> from the intestines, the
-<i>splenic vein</i> from the spleen, and the <i>gastric</i> from the stomach.
-These join together to form the <i>portal vein</i>, the only vein that
-breaks up into capillaries. This divides and ramifies through the liver,
-whence it emerges as the <i>hepatic veins</i>. The whole is known as the
-portal circulation.</p>
-
-<p><b>Pulmonary Circulation.</b>—Of the pulmonary circulation and its
-vessels a few words might also be said. The <i>pulmonary artery</i>,
-which carries the blood from the right ventricle to the lungs, is only
-about two inches long and divides into a right and a left pulmonary
-artery, which pierce the pericardium and go to their respective lungs.
-The right one is the larger and longer, for it has farther to go and
-gives off a branch to supply the third lobe of the right lung. The
-vessels finally divide and subdivide, terminating in the <i>pulmonary
-capillaries</i>. The venous capillaries then gather together to form a
-main vein in each lobule, these veins uniting into two trunks for each
-lung, the <i>pulmonary veins</i>, which empty into the left auricle.</p>
-
-<p><b>Nerves of Heart.</b>—The muscular fibers of the heart have the
-power of rhythmical contraction. Independent nerve centers or ganglia
-are also found in the muscular walls and influence the mechanism of
-the heart, especially the acceleratory mechanism. Thus, in some of the
-lower animals the heart can be removed from the body, and if placed in
-normal salt solution will go on beating for some time. The heart is
-controlled, however, by two nerves, the <i>vagus</i> or <i>pneumogastric</i>
-and the <i>sympathetic</i>. Of these the vagus is the inhibitory mechanism.
-It acts as a check and makes the heart’s action regular and rhythmic. If
-it is cut, the action of the heart becomes very rapid and irregular.
-The sympathetic is the acceleratory mechanism. When the vagus alone is
-stimulated, it first slows, then stops the heart, for it weakens the
-systole and prolongs diastole. Acceleration follows stimulation of the
-<span class="pagenum"><a name="Page_111" id="Page_111">[Pg 111]</a></span>
-sympathetic, both the rapidity and the force of the beat being
-increased. When a person faints from a blow in the abdomen, it is
-because the pneumogastric is affected and inhibits the action of
-the heart. The work of the heart is very dependent upon its nervous
-condition and functional diseases of the heart are practically wholly
-due to nervous derangement.</p>
-
-<p><b>Heart Sounds.</b>—Through the stethoscope two heart sounds may
-be heard. They are known as the first and second sounds. The first
-is a soft, rushing sound, stronger and louder than the other, and is
-caused in part by the contraction of the muscle itself when the blood
-is forced out and in part by the closure of the auriculo-ventricular
-valves. The second sound is shorter and sharper, a snap, and is
-caused by the closure of the semilunar valves when the contraction of
-the ventricles ceases and they begin to refill. In certain diseased
-conditions, where the edges of the valves are roughened, they do not
-snap properly and the sound varies from the normal.</p>
-
-<p><b>The Heart Beat.</b>—The rate of the heart beat is proportionate
-to the size of the person and increases in rapidity as the size
-diminishes. If the ear is placed over the abdomen of a pregnant woman,
-the heart of the fetus can be heard beating very rapidly. In prolonged
-labor it may become more rapid or very faint and warn the doctor that
-something should be done. The usual rate of the pulse in the fetus
-is 140 to 150 times a minute, though it varies with size and sex. At
-birth it drops to 140 to 130; for the first year it is 130 to 115; for
-the second year 115 to 105; for the third year 105 to 95; from the
-seventh to the fourteenth years 80 to 90; from the fourteenth to the
-twenty-first years 75 to 80; from twenty-one to sixty 60 to 75. In
-old age it rises a little and is 75 to 80. The rate is higher in the
-average woman than in the average man and increases with exercise, with
-increase of temperature, and in high altitudes, where the atmospheric
-pressure is less.</p>
-
-<p>At each beat of the heart from four to six ounces of blood are expelled
-<span class="pagenum"><a name="Page_112" id="Page_112">[Pg 112]</a></span>
-into the pulmonary artery and the aorta, and in 22 or 23 beats all the
-blood in the body passes through the heart. The power exerted by the
-heart every minute in thus driving the blood upon its course has been
-estimated as sufficient to raise its own weight, three-quarters of a
-pound, the height of the Washington monument or 150 meters; for the
-ventricles have to force the blood into vessels already full.</p>
-
-<p><b>Factors Affecting Circulation.</b>—There are three main factors
-in the circulation: 1. the systole, which gives the blood its first
-impulse; 2. the peripheral resistance in the capillaries, which serves
-to hold it in check, slowing the circulation and doing away with its
-rhythmic character, and 3. the elasticity of the walls of the arteries.</p>
-
-<p>If a ligature is tied about an artery, there is a swelling on the side
-toward the heart, while in the case of a vein, the swelling is on the
-side away from the heart, that is, the swelling is in either case on
-the side from which the blood comes. When an artery is cut, however,
-the blood comes out rhythmically in spurts, though from a cut vein it
-oozes slowly and regularly. For the blood is pumped out by the heart
-rhythmically and its rhythmic beating against the walls of the artery
-is felt in the <i>pulse</i>, which follows slightly after the beat of the
-heart itself. The pulse is due to the fact that the vessels into which
-the blood is forced are already full. This causes a local dilation at
-the beginning of the artery which passes with diminishing force along
-its entire length, the distention being due to the fact that more force
-is needed to drive the blood through the small arteries and capillaries
-than to stretch the elastic walls of the aorta and the large arteries.
-It is this elastic character of the arteries that makes the blood flow
-constant, for otherwise the blood would come intermittently in jets, as
-it is pumped from the heart. The elastic walls of the vessels, however,
-offer a certain resistance to the pumping of the fluid through them and
-at the same time, by relaxing between whiles, allow a certain amount of
-fluid to be retained in them, so that they continue full and the flow
-<span class="pagenum"><a name="Page_113" id="Page_113">[Pg 113]</a></span>
-is more or less constant. The insufficient outlet also helps to make
-the flow constant.</p>
-
-<p>By the time the blood reaches the veins its rhythmic character has
-been done away with, but though there are no elastic walls in the
-veins, it still has force enough after the slowing in the capillaries
-to return to the heart. In this it is aided to a certain extent by
-the valves and by the action of the skeletal muscles as they contract
-and expand, especially in the arms and legs, where the blood runs
-perpendicularly and there is a high column to be supported. There are
-also more veins than arteries, each large artery having two large
-veins, the venæ comites, to help get the blood back to the heart, and
-the veins anastomose freely. Thus, if the blood cannot get back by one
-channel it does by another. In parts like the brain, where it is very
-important that there should be no compression, since any disturbance
-of circulation would lead to serious results, the vessels are enclosed
-in thick walls, and in the liver, through which all the blood passes
-and where compression is sure to cause trouble, the veins are simply
-caverns carved out in the organ and have no walls. They lie open when
-the organ is opened. <i>Varicose veins</i> are the result of valves giving
-way through inherited weakness or disease so that others have an unduly
-large weight to support.</p>
-
-<p><b>The Pulse.</b>—The <i>pulse wave</i> is characterized by a quick
-rise and a slow fall, though this cannot ordinarily be distinguished by
-the finger. In some slow fevers, however, the fall is very long and
-distinct ripples can be felt. This is known as the <i>dicrotic pulse</i>.
-With age the arterial walls grow stiffer and more rigid and less
-adapted to their work. In certain cases of heart disease the heart does
-not transmit all the beats to the pulse and to get the true rate the
-heart must be listened to.</p>
-
-<p>The rate at which the pulse wave travels varies with the size of the
-artery and the force of the heart beat but is about 15 to 20 feet a
-second. The flow is most rapid in the arteries because they are nearest
-<span class="pagenum"><a name="Page_114" id="Page_114">[Pg 114]</a></span>
-the heart, where the pressure is greatest, and slowest in the
-capillaries, where the area is greatest, the sectional area of the
-capillaries, known as the <i>peripheral area</i> because it is farthest from
-the heart, being larger than that of the large arteries. Thus rapidity
-of flow varies with pressure and with area.</p>
-
-<p><b>Blood Pressure.</b>—Liquids, moreover, are incompressible and
-exert pressure on the walls of the tubes through which they pass. The
-amount of pressure depends upon the inflow and outflow, increasing
-directly with the inflow and inversely with the outflow, that is, the
-smaller the outlet the greater the pressure, and <i>vice versa</i>. The
-pressure is also greatest nearest to the inflow and gradually decreases
-with distance until at the point of outflow there is practically no
-pressure. So, in the arteries the blood pressure is greatest in the
-large vessels nearer the heart and gradually decreases as they branch
-into smaller and smaller vessels. In passing through the capillaries,
-owing to their small size and resultant increased friction, the
-blood meets with more resistance, the peripheral resistance, and
-this resistance usually regulates the pressure in the arteries. The
-greater the peripheral resistance, as a rule, the greater the arterial
-pressure. The pressure in the capillaries is very slight and in the
-veins there is practically no pressure. In fact, in the large veins
-near the heart the pressure is negative and the blood is almost sucked
-into the heart.</p>
-
-<p>Pressure, then, is greatest in the arteries and least in the veins,
-while the rate of flow is fastest in the arteries—300 to 500
-millimeters a second—and slowest in the capillaries—75 millimeters
-a second—being a little faster again in the veins—200 millimeters a
-second.</p>
-
-<p>Blood pressure is gauged by opening a vessel and inserting a
-<i>manometer</i>, the pressure being determined by the height to which the
-mercury is raised. In man the pressure in the arteries is 120 to 160
-<span class="pagenum"><a name="Page_115" id="Page_115">[Pg 115]</a></span>
-millimeters. It is considerably heightened during inspiration by the
-increased pressure of the lungs on the heart and great vessels. In
-pericarditis the opposite is true.</p>
-
-<p>When the blood pressure is high, the <i>pulse</i> is small and travels
-fast, because the wall of the artery is already highly stretched. Such a
-pulse is hard and incompressible. A large pulse occurs where the heart
-is strong and the pressure is low, owing to peripheral dilatation. A
-low-pressure pulse is soft and compressible if the heart beat is weak.
-A slow pulse is generally stronger than a rapid one.</p>
-
-<p>The <i>nerve supply of the blood-vessels</i> comes from the spinal cord
-through the vasomotor nerves, which are connected with the sympathetic
-system and are distributed to the smooth muscle fibers of the vessels.
-They are of two classes, the <i>vasoconstrictors</i>, which diminish the
-lumen of the vessels, and the <i>vasodilators</i>, which increase the size
-of the vessels. By these nerves the general tone of the arteries is
-kept up. They are distributed chiefly to vessels in the skin and
-in the abdominal organs and the constrictors are probably the more
-important. When the constrictors are stimulated, three phenomena occur:
-1. diminished flow through the vessel, due to its diminished size; 2.
-increased general arterial pressure, and 3. increased flow through
-the other arteries. When the dilators are stimulated the opposite
-effect is produced: 1. the flow through the vessel is increased; 2.
-there is decreased arterial pressure, and 3. there is decreased flow
-through the other arteries. The palor of fright is due to the action
-of the vasoconstrictor nerves of the face and blushing to the action
-of the vasodilators. Heat stimulates the vasodilators so that more
-blood goes to the skin, perspiration begins, and the body is cooled by
-evaporation. Cold stimulates the vasoconstrictors and the blood is kept
-within the body, where it cannot cool. If a part has too much blood, an
-impulse passes by the vasoconstrictors to lessen the supply, while if
-<span class="pagenum"><a name="Page_116" id="Page_116">[Pg 116]</a></span>
-more blood is needed a message goes to the central nervous system and
-an impulse passes by the vasodilators to flush the organ. The more
-active a part is in functioning the greater the number of capillaries,
-except in the brain, which has only large vessels. The vessels of the
-intestines contain much blood and are capable of containing all the
-blood in the body.</p>
-
-<p><b>The Blood.</b>—The blood itself, which thus circulates through
-the body, carrying nutrition to the tissues and removing waste, is a
-complex fluid of a bright red color. Its amount has been calculated
-to be about one-thirteenth of the body weight. One-fourth of it is
-generally in the heart, lungs, and large arteries and veins, one-fourth
-in the liver, one-fourth in the skeletal muscles, and one-fourth
-variously distributed through the other organs. If there is too little
-blood, the vital processes cannot go on as they should, while too great
-a supply causes weakness rather than strength. So the tendency is to
-keep the amount constant and any blood added is disposed of and any
-blood lost is replaced. In starvation it is the last tissue to be used
-up, for on it the life of the other tissues depends.</p>
-
-<p><i>Composition.</i>—In composition the blood is practically the same
-in all arteries and fundamentally the same everywhere, but in passing
-through certain organs certain substances are added to or taken from
-it, so that its character changes more or less. Thus it varies somewhat
-in composition in different parts of the body, as in the liver and
-kidneys. It has five main functions: 1. the conveying of fuel from the
-digestive tract to the tissues, or force production; 2. the carrying of
-oxygen to the tissues; 3. the carrying of tissue-building materials,
-or tissue building; 4. the distribution of heat; and 5. the removal of
-waste products.</p>
-
-<p>The blood is slightly alkaline in reaction, of a saltish taste, and has
-a specific gravity of 1055. Its temperature is about 100° Fahrenheit
-or 37.8° Centigrade. It is made up of two parts, the <i>plasma</i> or fluid
-<span class="pagenum"><a name="Page_117" id="Page_117">[Pg 117]</a></span>
-portion and the <a href="#FIG_45"><i>corpuscles</i></a> or solid portion. The plasma,
-again, which is transparent and almost colorless, consists of two materials, the
-<i>blood serum</i> and <i>fibrin</i>. Fibrin does not exist as such in the body
-nor in freshly shed blood, but there is a substance named <i>fibrinogen</i>
-which is worked on by another substance, the <i>fibrin ferment</i>, to form
-fibrin. Both fibrin ferment and fibrinogen can be isolated from the blood.</p>
-
-<p><i>Coagulability.</i>—In the body the blood is perfectly fluid and under
-normal conditions does not coagulate. But, though fluid when first
-shed, upon standing it gradually becomes viscid, that is, in two or
-three minutes, then jelly-like, in five to ten minutes, and grows
-firmer and firmer until there finally appears around this jelly-like
-mass or clot a yellowish fluid, the <i>serum</i>. The <i>clot</i> is made
-up of the corpuscles and fibrin. If some blood is drawn and set on ice until
-the corpuscles settle, the plasma can then be drawn off, and after it
-has stood a while in a warm place coagulation will take place, a mass
-of fibrin forming in the middle. It takes from one to two hours for
-clotting to be complete. In very slow clotting at a low temperature the
-white corpuscles appear in a layer on top of the clot, the buffy coat.</p>
-
-<p>Of <i>fibrin</i> little is known, but its formation is the most important
-step in clotting, as its presence is absolutely essential. If it
-is removed by whipping, the blood will not clot. It is a delicate,
-stringy material, elastic and contractile, and contains certain salts
-of lime and magnesium, upon whose presence its power of coagulation
-depends. The coagulability of blood differs in different people and is
-occasionally so little as to make operation dangerous.</p>
-
-<p>The most favorable temperature for clotting is that of the body,
-extreme heat preventing it and cold delaying it. That the blood does
-not clot in the body must be due to some relation between the blood
-and the walls of the arteries and veins that prevents it, just as the
-walls of the stomach are not digested by the juices secreted. Though
-<span class="pagenum"><a name="Page_118" id="Page_118">[Pg 118]</a></span>
-coagulation does not normally take place in the body, it does take
-place when a blood-vessel is injured or when the blood comes in contact
-with the air, a wise provision of nature, as otherwise the tendency
-would be for bleeding to go on indefinitely after injury. The greater
-the surface with which the blood comes in contact the more quickly it
-clots. Injury to the vessel wall itself is necessary; the endothelium
-must be cracked. Under extreme injury the muscular coat of the vessel
-undergoes spasmodic contraction and partially closes it. Hence a wound
-caused by tearing is less likely to bleed than one due to cutting.</p>
-
-<p>The valves of the heart, which are covered with endothelium, are
-frequently the seat of fibrin coagulation, bits of the fibrin thus
-formed giving rise to conditions in various kinds of heart trouble. Or
-the bits of fibrin float in the blood and perhaps lodge in the small
-vessels of the brain and cause apoplexy. Pus in various parts of the
-body will set up coagulation in nearby arteries. In fact, the presence
-of any foreign substance in the blood causes clotting.</p>
-
-<div class="figcenter">
-    <img id="FIG_45" src="images/i_118.jpg" alt="" width="600" height="278" />
-    <p class="blockquot"><span class="smcap">Fig. 45.</span>—Cells of blood: <i>a</i>,
-         Colored blood-corpuscles seen on the flat; <i>b</i>, on edge; <i>c</i>,
-         in rouleau; <i>d</i>, blood platelets. (Leroy.)</p>
-</div>
-
-<p><b>Blood-corpuscles.</b>—The solid parts of the blood are the red
-corpuscles, the white corpuscles, and the blood plaques or plates.
-It is to the <a href="#FIG_45"><i>red corpuscles</i></a>, or <i>erythrocytes</i> which
-number about 5,000,000 to the cubic millimeter of blood, that the color of the blood
-is due. Under the microscope they appear as small, spherical, biconcave
-<span class="pagenum"><a name="Page_119" id="Page_119">[Pg 119]</a></span>
-discs with a slightly greenish-yellow color, which have a tendency to
-form in rouleaux. They are homogeneous, with no limiting membrane,
-and are made up of a fine network of tissue, the <i>stroma</i>, in which
-is embedded the hemoglobin or coloring matter. This hemoglobin is a
-crystalline body and the most complex substance known to chemists. The
-corpuscles are very flexible and can squeeze through small apertures,
-as in the tiny capillaries, and regain their shape. They are probably
-formed chiefly in the red bone marrow at the ends of the bones, which
-under the microscope shows red corpuscles in various stages of growth,
-and also in the spleen, for which no other use is known. Their function
-is to carry oxygen, which forms a chemical combination, though an
-extremely loose one, with the hemoglobin. As the tissues are more
-greedy of oxygen than is the hemoglobin, they rob the corpuscles of it.</p>
-
-<div class="figcenter">
-    <img id="FIG_46" src="images/i_119.jpg" alt="" width="600" height="168" />
-    <p class="blockquot"><span class="smcap">Fig. 46.</span>—Various forms of
-         leucocytes: <i>a</i>, Small lymphocyte; <i>b</i>, large lymphocyte;
-         <i>c</i>, polymorphonuclear neutrophile; <i>d</i>, eosinophile. (Leroy.)</p>
-</div>
-
-<p>The <i>white corpuscles</i> or <a href="#FIG_46"><i>leucocytes</i></a> are much
-fewer in number, about one to from 300 to 700 of the red, the average number being
-5,000 to 10,000 to the cubic millimeter. They are larger than the red
-corpuscles, colorless, and spherical when at rest. Their structure is
-more definite, there being a definite cell substance or protoplasm
-and one or more nuclei, which vary more or less in shape and size.
-The corpuscles are classed in accordance with these variations in the
-nuclei. They are most numerous during digestion and are probably formed
-in the lymphatic system, constantly passing from the lymphatics to the
-<span class="pagenum"><a name="Page_120" id="Page_120">[Pg 120]</a></span>
-arteries and veins. For they have the function of amœboid movement by
-which they not only wander from place to place in the blood, keeping
-close to the sides of the vessels, but pass through the walls of the
-capillaries, probably between the cells which form their lining, into
-the lymph spaces. This is known as <i>migration of the white corpuscles</i>.
-In inflammation they collect in the inflamed area to assist in allaying
-the inflammation by absorbing and carrying off its products. For they
-carry waste products and destroy poisons, acting as scavengers and
-protectors of the body. When they are unsuccessful and the inflammation
-gets the better of them, they become <i>pus corpuscles</i>.</p>
-
-<p>Besides the corpuscles there are seen floating in the blood small
-disk-like substances with no special characteristics, the <i>blood
-plaques</i> or <a href="#FIG_45"><i>plates</i></a>, whose function is unknown.</p>
-
-<p>In <i>anemia</i> the red corpuscles are diminished and the white corpuscles
-and blood plaques increased in number. After excessive bleeding normal
-salt solution is injected, subcutaneously or by rectum, as being nearly
-equivalent to blood serum in composition, and the renewal of the
-solid elements is left to time. The length of time needed for their
-restoration is about a week, except in the case of the hemoglobin,
-which takes longer.</p>
-
-<hr class="chap" />
-<div class="chapter">
-<p><span class="pagenum"><a name="Page_121" id="Page_121">[Pg 121]</a></span></p>
-<h2 class="nobreak">CHAPTER IX.<br /><span class="h2_subtitle">THE LUNGS AND RESPIRATION.</span></h2></div>
-
-<p>Besides the heart and the great vessels the chest contains the lungs,
-the chief organ of respiration, which, with the rest of the respiratory
-system, will now be treated. The nose and mouth, through which the air
-first enters the body, have already been spoken of. From them the air
-passes through the larynx to the trachea, thence to the bronchi, and so
-to the lungs, where the supply of oxygen for the tissues is taken from
-the air by the hemoglobin of the blood.</p>
-
-<p><b>The Larynx.</b>—<a href="#FIG_47">The larynx</a> lies in front of the pharynx
-at the upper and fore part of the neck, where it causes a considerable
-projection, known as <i>Adam’s apple</i>. It is a triangular box, base
-up, flattened at the back, in front, and at the sides, but becoming
-cylindrical below. Above it opens into the bottom of the pharynx and
-below into the trachea. It is lined with mucous membrane. Its opening
-at the base of the tongue is closed during swallowing by a little
-door-like valve of fibro-cartilage, the <i>epiglottis</i>, to prevent the
-entrance of food.</p>
-
-<p>Nine <i>cartilages</i> go to make up the larynx, of which the most important
-are the thyroid and cricoid cartilages and the epiglottis already
-mentioned. The <a href="#FIG_47"><i>thyroid</i></a> is the largest and is open behind,
-its two alæ or wings meeting in an acute angle in front and forming the Adam’s
-apple, always more prominent in the male than in the female. It is
-attached above to the hyoid bone and has cornua or horns on either
-side, top and bottom. The <i>cricoid</i> or ring-like cartilage resembles
-a seal ring with the stone placed posteriorly. It is stronger than the
-<span class="pagenum"><a name="Page_122" id="Page_122">[Pg 122]</a></span>
-thyroid and forms the lower part of the cavity of the larynx.
-Inside and resting on the upper border of the cricoid are the two
-smaller <i>arytenoid</i> or pitcher-like cartilages, pyramidal in shape,
-and surmounting these again the two <i>cornicula laryngis</i>. The two
-<i>cuneiform cartilages</i> are in the free borders of the folds of mucous
-membrane which extend from the apex of the arytenoids to the sides of
-the epiglottis. Numerous small muscles serve to bind these various
-cartilages together.</p>
-
-<p>At the angle of the thyroid cartilage in front are attached the
-<a href="#FIG_47">epiglottis</a> at the top and just below that the <i>superior</i>
-or <i>false vocal cords</i>, two folds of mucous membrane enclosing the <i>superior
-thyro-arytenoid ligaments</i>. Lower still are found the <i>inferior</i> or
-<i>true vocal cords</i>, which are formed by the <i>inferior thyro-arytenoid
-ligaments</i> covered with a thin, tightly fitting mucous membrane. Both
-sets of vocal cords as well as the epiglottis may be seen by means
-of a head and a throat mirror. Between the true vocal cords is a
-narrow triangular interval called the <i>glottis</i>. It is by means of the
-vibrations of these cords that sound is produced. The false vocal cords
-cannot produce sound, though they can modify it indirectly. Quality of
-voice, as treble, base, etc., depends upon the size of the larynx and
-the length and elasticity of the vocal cords. Modulation is produced by
-changing the form of the cavity of the mouth and nose. In whispering
-the lips take the place of the vocal cords and produce sound by the
-vibration of their muscular walls.</p>
-
-<p>Instead of tracheotomy <i>laryngotomy</i> is sometimes done in the
-depression between the thyroid and the cricoid, which may be felt on
-the living. <i>Foreign bodies</i> sometimes get into the larynx and have
-to be removed, or the mucous membrane may become inflamed, causing
-<i>laryngitis</i>. <i>Syphilis</i> attacks the larynx, and <i>tuberculosis</i>
-and <i>cancer</i> of the larynx occur, these last two being generally fatal.
-<i>Edema of the glottis</i> may also occur.
-<span class="pagenum"><a name="Page_123" id="Page_123">[Pg 123]</a></span></p>
-
-<div class="figcenter">
-    <img id="FIG_47" src="images/i_123.jpg" alt="" width="400" height="509" />
-    <p class="center"><span class="smcap">Fig. 47.</span>—The larynx,
-           trachea and bronchi<br /> (After Sobotta.)</p>
-</div>
-
-<p><b>The Trachea.</b>—<a href="#FIG_48">The trachea</a> is a membranous tube
-extending down from the larynx for about four and a half inches to the fourth
-or fifth dorsal vertebra, where it divides into the right and left bronchi. It
-is formed of sixteen to twenty imperfect cartilaginous rings, open
-behind, enclosed in a double elastic fibrous membrane, and is lined
-with ciliated mucous membrane. The rings are for strength and in
-the interval at the back where they are wanting there is one layer
-of longitudinal and another of transverse unstriped muscle fibers.
-The passage is kept clear by the action of the cilia, which sweep up
-and out any particles of dust that become entangled in the mucus.
-<i>Tracheotomy</i> is generally done about one inch below the cricoid,
-<span class="pagenum"><a name="Page_124" id="Page_124">[Pg 124]</a></span>
-just above the sternal notch, incision being made through the cartilage.</p>
-
-<div class="figcenter">
-    <img id="FIG_48" src="images/i_124.jpg" alt="" width="600" height="465" />
-    <p class="blockquot"><span class="smcap">Fig. 48.</span>—The upper thorax
-        of a child eight years old, showing the thyroid and thymus glands. (Sobotta.)</p>
-</div>
-
-<p>Extending up on either side of the <a href="#FIG_47">upper trachea</a> in the
-neck are the two lobes of the <a href="#FIG_48"><i>thyroid gland</i></a>, the isthmus,
-which connects the lobes, covering the trachea below anteriorly. The function of the gland
-is obscure, but it has an internal secretion of great importance in
-the metabolic processes. Its removal or disease is followed by general
-disturbances of mind and body. The injection of thyroid extract has
-proved effective as treatment. In <i>goiter</i> the gland becomes enlarged.
-The <i>thymus gland</i> lies below the thyroid gland at birth, in front of
-and at the sides of the trachea, and runs down behind the sternum. It
-is largest at the end of the second year, after which it atrophies,
-being almost absent at puberty. It, too, is ductless and its function
-is not well understood.
-<span class="pagenum"><a name="Page_125" id="Page_125">[Pg 125]</a></span></p>
-
-<p><b>The Bronchi.</b>—<a href="#FIG_47">The two bronchi</a>, of which the right
-is the larger and shorter, resemble the trachea in structure. As they enter the root
-of the lung they divide, the right into three and the left into two
-branches, one for each lobe, after which they divide and subdivide,
-the bronchioles becoming smaller and smaller and finally ending in the
-<i>infundibula</i>, pouch-like places lined with air cells, in which cilia
-keep the air in motion. As they grow smaller the bronchioles gradually
-become wholly membranous.</p>
-
-<div class="figcenter">
-    <img id="FIG_49" src="images/i_125.jpg" alt="" width="600" height="469" />
-    <p class="center"><span class="smcap">Fig. 49.</span>—Relation of lungs
-           to other thoracic organs.<br /> (Ingals.)</p>
-</div>
-
-<p><b>The Lungs.</b>—<a href="#FIG_49">The lungs</a> themselves, two in number, lie
-each in a serous sac or <i>pleura</i>, similar in structure to the pericardium and
-serving a like purpose. The outer layer of the pleura is reflected back
-over the thoracic wall and diaphragm. There is no pleural cavity in
-health between the two layers of the pleura, the two surfaces being in
-close contact, though moistened with lymph to prevent friction during
-<span class="pagenum"><a name="Page_126" id="Page_126">[Pg 126]</a></span>
-respiration. In inflammation of the pleuræ or pleurisy, they become
-thickened and roughened and friction results, as is shown by the sounds
-heard through the stethoscope. Friction causes effusion and fluid
-collects. This generally absorbs again, but occasionally the serous
-fluid becomes pustular and <i>empyema</i> results.</p>
-
-<p>In front, between the two pleuræ, which are wholly separate, is the
-<i>mediastinal space</i> or <i>mediastinum</i>, which extends from the sternum
-to the spinal column and contains all the thoracic viscera except the
-lungs and heart, that is, the trachea, esophagus, thoracic duct, and
-many large vessels and nerves.</p>
-
-<div class="figcenter">
-    <img src="images/i_126.jpg" alt="" width="600" height="267" />
-    <p class="blockquot"><span class="smcap">Fig. 50.</span>—Diagrammatic
-         representation of the termination of a bronchial tube in a group
-         of infundibula: <i>B</i>, Bronchial tube; <i>LB</i>, bronchiole;
-         <i>A</i>, atrium; <i>I</i>, infundibulum; <i>C</i>, alveoli.
-        (de Nancrede.)</p>
-</div>
-
-<p>Roughly speaking, the lungs begin at the sterno-clavicular articulation
-above, the apex coming up above the level of the first rib, and extend
-downward together to the fourth cartilage, where the lower margins
-gradually separate, the lowest lung limit being the eleventh rib in
-the vertebral region. Each lung is conical. The apices extend upward
-and the bases, which are broad and concave, rest upon the diaphragm.
-The right lung is divided by a fissure into three lobes, the left into
-two. The root consists of a bronchus and pulmonary arteries, veins,
-lymphatics, and nerves. The tissue itself is composed of an aggregation
-of lobules, each consisting of a terminal bronchiole with its alveoli
-<span class="pagenum"><a name="Page_127" id="Page_127">[Pg 127]</a></span>
-or air cells, blood-vessels, and nerves, a lung in miniature. The blind
-pouches which the air cells surround are called <i>infundibula</i> and are
-separated by delicate membranous septa in which lie the capillaries of
-the pulmonary artery, thus exposing the blood to the air on two sides.
-The lung itself is supplied by the bronchial arteries from the thoracic
-aorta and by branches of the sympathetic and pneumogastric nerves.</p>
-
-<p>At birth the lungs are pinkish-white in color but in later life they
-are marked with slate-colored patches, due to the deposit in the lung
-tissue of particles of dirt breathed in. They are light, spongy, and
-highly elastic, and will float in water, crepitating upon pressure
-owing to the air in the tissue.</p>
-
-<p>At birth, also, the lungs are solid, so that the first air has to
-overcome adhesions between the collapsed walls of the bronchioles and
-air sacs, but after they are thus gradually unfolded, in that they are
-of extensible material and open to the air above, atmospheric pressure
-from within keeps them distended to the full extent of the chest, which
-is air tight. They never collapse afterwards unless puncture of the
-chest wall, as in stabbing, causes collapse, in which case the lung
-shrivels into a small ball.</p>
-
-<p><b>Respiration.</b>—That the organic materials used by the body as
-food may give up their energy they must be broken up, and for this
-oxygen is needed. The supply of oxygen for the purpose is brought
-to the tissues by the blood, which acquires it in the lungs, and
-the waste product of combustion, carbon dioxide, is carried off in
-the same manner. The lungs are, therefore, adapted to take in large
-quantities of air and to keep up a rapid exchange of oxygen and carbon
-dioxide in the blood. This process of supplying oxygen to the tissues
-and of removing carbon dioxide and other waste is ordinarily an
-involuntary act, though it can be regulated temporarily, and is known
-as respiration or breathing.</p>
-
-<p>There are two periods to respiration: 1. <i>inspiration</i> or the drawing
-<span class="pagenum"><a name="Page_128" id="Page_128">[Pg 128]</a></span>
-in of air, and 2. <i>expiration</i> or the expulsion of air from the lungs,
-the former process being a little shorter than the latter. A pause
-follows each expiration before there is another inspiration. At birth
-the normal rate of respiration is 42, but it grows slower as the child
-grows older, being 26 at the age of five or six, while in the adult it
-averages 17 to 20 times a minute. It is slower during sleep and more
-rapid during physical activity. The average amount of air taken in with
-every inspiration is 30 cubic inches and the minimum air space per
-individual should be 3000 cubic feet per hour.</p>
-
-<p>Breathing is of two kinds, <i>diaphragmatic</i> or <i>abdominal</i> and <i>chest</i>
-or <i>rib</i> breathing, the former usually being more pronounced in men
-than in women, probably because of centuries of tight dressing on the
-part of the latter. As a rule, however, both diaphragm and ribs come
-into play; for in inspiration, which is an active movement, the thorax
-becomes enlarged from before backward, laterally, and vertically.
-The ribs are raised by the external intercostals chiefly, though the
-internal intercostals aid somewhat, and swinging out upon the vertebræ,
-widen the chest as well as deepen it. The diaphragm, which is dome-like
-when relaxed, becomes flattened in contraction and so increases the
-size of the chest from above downward. As the chest enlarges, the lungs
-expand, the air in them becomes rarefied, and more air rushes in.
-When the lungs are full they relax and the muscles relax after their
-contraction, so that expiration is a passive movement, due largely to
-the elastic relaxation of lungs and muscles, the air being driven out
-by the lessened capacity of the lungs.</p>
-
-<p><i>Difficult Breathing.</i>—In heart and lung troubles, where too
-little oxygen is carried to the tissues, dyspnœa or difficult breathing
-results and may even advance to <i>asphyxia</i>, a condition in which no
-air is obtained. In difficult or labored respiration the pectoral muscles
-are used in inspiration and the scaleni, which pass from the vertebræ
-<span class="pagenum"><a name="Page_129" id="Page_129">[Pg 129]</a></span>
-of the neck to the sternum, develop and become powerful. The levatores
-of the ribs may also assist, and even the muscles of the neck and arms
-may help out, while in forced expiration the abdominal muscles are
-called into play. The glottis opens and closes rhythmically as the air
-enters and leaves the lungs, and the nostrils add their mite in the
-struggle for oxygen. Finally there may be scarcely a muscle in the body
-that is not striving to aid the respiration, and general convulsions
-may result, followed by exhaustion and death.</p>
-
-<p><i>Air.</i>—In ordinary breathing the lungs are not used to their full
-capacity and the air ordinarily used is known as <i>tidal air</i>. In forced
-inspiration the lungs are filled to their fullest extent and the air
-then taken in in excess of the tidal air is known as <i>complemental
-air</i>. In like manner, the difference between the air ordinarily
-breathed out and that breathed out in forced expiration is known as
-<i>supplemental air</i>. The sum of these three is the <i>vital capacity</i>
-of the lungs, while beyond this there is probably some air that is never
-expelled, the stationary or <i>residual air</i>.</p>
-
-<p><i>Respiratory Sounds.</i>—The entrance and exit of the air is accompanied
-by respiratory sounds or murmurs, which vary according to their
-position in the trachea, the bronchi, or the bronchioles and are
-modified in diseases of the lungs and bronchi, when they are often
-called <i>râles</i>.</p>
-
-<p><i>Changes in Air in Lungs.</i>—In passing through the nose and the
-rest of the respiratory tract the air is warmed to body temperature and
-saturated with moisture. After its entrance into the lungs various
-changes take place in it through the mingling of the tidal with the
-residual air. Thus, it gives up about 4 or 5 per cent. of its oxygen
-and acquires some 4 per cent. additional carbon dioxide, while the
-amount of nitrogen remains about the same. By its giving up more oxygen
-than it receives carbon dioxide, its volume is slightly diminished.
-<span class="pagenum"><a name="Page_130" id="Page_130">[Pg 130]</a></span>
-Exhaled air also contains traces of ammonia and certain organic
-matters, generally the results of decomposition, which give a bad odor
-to the breath and are more dangerous in a close room than the mere
-lack of oxygen or the presence of carbon dioxide. Indeed, the amount
-of oxygen may be very much diminished, being reduced even to 5 or 6
-per cent. instead of the normal 21 per cent., without being noticed
-or giving rise to any immediate bad results. Yet the importance of
-ventilation is very evident.</p>
-
-<p><i>Effect on Blood.</i>—Respiration causes changes also in the blood,
-the venous blood being purple and the arterial bright red. This
-difference in color is due to the absence or presence of oxygen, which
-is not absorbed or dissolved by the blood but forms a rather unstable
-compound, <i>oxyhemoglobin</i>, with the hemoglobin of the blood. As the
-oxygen is removed in the passage of the blood through the body, there
-results in venous blood reduced hemoglobin, which is of a purplish
-color. Upon exposure to the air, however, it absorbs oxygen once more
-and resumes its scarlet color. If carbon monoxide gets into the blood,
-as in cases of gas poisoning, it drives off the oxygen and forms a more
-stable compound with the hemoglobin, whence the difficulty in restoring
-a person so poisoned.</p>
-
-<p><i>Nervous Mechanism.</i>—Nervously, respiration is controlled in
-three ways: 1. by the phrenic nerve to the diaphragm; 2. by some fibers
-of the vagus or pneumogastric, and 3. by the respiratory center in
-the bulbous portion of the spinal cord. Injury to the respiratory
-center means the ceasing of respiration and death. Stimulation of the
-respiratory center seems to depend upon the character of the blood. If
-it is well oxygenized, the breathing is slow and quiet; if there is a
-lack of oxygen, dyspnœa results. Probably certain chemical substances
-in the blood, which are ordinarily rapidly burned up by the oxygen but
-<span class="pagenum"><a name="Page_131" id="Page_131">[Pg 131]</a></span>
-which accumulate in its absence, serve to stimulate the respiratory
-center, thus adjusting the effort to get oxygen to the need of it.
-Respiration may be stopped by stimulating the mucous membrane of the
-nose, as with strong ammonia.</p>
-
-<p><i>Variations.</i>—Certain variations from the ordinary respiration might
-be mentioned here. A deep inspiration followed by a long expiration is
-known as a <i>sigh</i> and a very deep inspiration through the mouth only
-as a <i>yawn</i>. <i>Hiccough</i> results from a sudden inspiratory contraction
-of the diaphragm during which the glottis is suddenly closed. In
-<i>sobbing</i> the inspirations are short and rapid with a prompt closing of
-the glottis between. Both <i>coughing</i> and <i>sneezing</i> consist of a
-deep inspiration followed by complete closure of the glottis and then its
-sudden opening and the forcible expulsion of air. Coughing, however,
-is generally caused by an irritation or obstruction of the larynx or
-trachea and the air is expelled through the mouth, while sneezing is
-caused by irritation of the nasal passages and the air is driven out
-through the nose. <i>Laughing</i> and <i>crying</i> also resemble one another
-in that each is an inspiration followed by a series of short, spasmodic
-expirations, during which the glottis is open and the vocal cords in
-characteristic vibration. They differ, however, in rhythm and in the
-facial expression that accompanies them.</p>
-
-<hr class="chap" />
-<div class="chapter">
-<p><span class="pagenum"><a name="Page_132" id="Page_132">[Pg 132]</a></span></p>
-<h2 class="nobreak">CHAPTER X.<br /><span class="h2_subtitle">THE ABDOMEN AND THE ORGANS<br />
-OF DIGESTION AND EXCRETION.</span></h2></div>
-
-<p><b>The Abdominal Cavity.</b>—Below the diaphragm and separated from
-the lowest cavity of the trunk, the pelvis, only by an invisible plane
-drawn through the brim of the true pelvis, is the abdominal cavity,
-which may be said in a general way to contain the organs of digestion
-and the kidneys. It is protected behind by the vertebræ and anteriorly
-by the lower ribs above and below by muscular walls, which make
-possible the complete bending of the body. These muscles are for the
-most part large and very strong and the greater number are inserted,
-in part at least, into a median tendinous line, the <i>linea alba</i>,
-which passes from the ensiform cartilage of the sternum above to the
-symphysis pubis below.</p>
-
-<p><b>Muscles.</b>—The <a href="#FIG_51"><i>external oblique muscles</i></a> form
-the outermost layer of the abdominal wall. They rise from the external surface of
-the eight lower ribs on either side and are inserted in the anterior
-half of the iliac crest as well as by aponeurosis in the linea alba,
-where each joins its fellow from the opposite side, the fibers running
-downward and inward like the fingers in the trouser’s pocket. Along the
-lower border of the aponeurosis is a broad fold, <i>Poupart’s ligament</i>.
-The <a href="#FIG_51"><i>internal oblique</i></a> rises on either side from the
-outer half of Poupart’s ligament and the anterior part of the crest of the ilium
-and is inserted into the crest of the os pubis, the cartilages of the
-lower ribs, and the linea alba. Its fibers run at right angles to those
-of the external oblique. These oblique muscles serve to compress the
-viscera, to flex the body, and also assist in expiration.
-<span class="pagenum"><a name="Page_133" id="Page_133">[Pg 133]</a></span></p>
-
-<p>The deepest of the abdominal muscles is the <i>transversalis</i>, which
-rises from the outer third of Poupart’s ligament and the adjoining part
-of the crest of the ilium, from the six lower costal cartilages, and
-by a broad aponeurosis, the <i>lumbar fascia</i>, from the lumbar vertebræ.
-It is inserted into the pubic crest and by aponeurosis into the linea
-alba. There is one of these muscles on either side.</p>
-
-<div class="figcenter">
-    <img id="FIG_51" src="images/i_133.jpg" alt="" width="600" height="638" />
-    <p class="blockquot"><span class="smcap">Fig. 51.</span>—Muscles of the trunk
-          from before (left side, superficial; and right side, deep): 1, Pectoralis
-          major; 2, deltoid; 3, portion of latissimus dorsi; 4, serratus magnus; 5,
-          subclavius; 6, the pectoralis, sternocostal portion; 7, serratus
-          magnus; 12, rectus abdominis; 13, internal oblique; 14, external
-          oblique; 15, abdominal aponeurosis and tendinous intersections of
-          rectus abdominis; 16, over symphysis pubis; 17, linea semilunaris; 18,
-          gluteus medius; 19, tensor vaginæ femoris; 20, rectus femoris; 21,
-          sartorius; 22, femoral part of iliopsoas; 23, pectineus; 24, adductor
-          longus; 25, gracilis. (Dorland’s Dictionary.)</p>
-</div>
-
-<p><span class="pagenum"><a name="Page_134" id="Page_134">[Pg 134]</a></span>
-The <a href="#FIG_51"><i>rectus abdominis</i></a> is also really two muscles and extends
-from the symphysis pubis to the cartilages of the fifth, sixth, and seventh
-ribs. At first it passes back of the oblique and transversalis
-muscles, but about a fourth of the way up it passes in front of the
-transversalis and between two layers of the internal oblique, which
-thereafter forms its sheath. Its chief duty is to flex the chest on the
-pelvis, though it also compresses the abdominal viscera.</p>
-
-<p>One other muscle, a small one, is found in front, the <i>pyramidalis</i>,
-which rises from the pubic crest and is inserted into the linea alba
-midway to the umbilicus.</p>
-
-<p>At the back the open space over the kidneys, between the lower ribs
-and the os innominatum, is closed in on either side by the <i>quadratus
-lumborum</i>, which extends from the three or four lower lumbar vertebræ
-and the adjacent iliac crest to the last rib and the upper four lumbar
-vertebræ. It flexes the trunk laterally or forward according as one muscle
-or both are used, and may aid in either expiration or inspiration.</p>
-
-<p>The <i>nerves</i> of the abdominal muscles are chiefly the internal
-intercostals.</p>
-
-<p><b>The Peritoneum.</b>—Lining the abdominal cavity is a serous
-membrane, the peritoneum, which is reflected back over the viscera
-within in such a way as to cover each one wholly or in part. Folds of
-peritoneum, the <i>omenta</i>, connect the stomach with the other viscera,
-the most important being the <i>great omentum</i>, which has one layer
-descending from the anterior and another from the posterior wall of the
-stomach. The <i>mesenteries</i> are double layers of peritoneum which hold
-the intestines to the vertebræ and posterior wall. Between their folds
-run the blood-vessels.</p>
-
-<div class="figcenter">
-    <img id="FIG_52" src="images/i_135.jpg" alt="" width="600" height="549" />
-    <p class="blockquot"><span class="smcap">Fig. 52.</span>—Diagram showing the
-            nine regions of the abdominal cavity: 1, Right hypochondriac;
-            2, epigastric; 3, left hypochondriac; 4, right lumbar; 5, umbilical;
-            6, left lumbar; 7, right iliac; 8, hypogastric; 9, left iliac. (Ashton.)</p>
-</div>
-
-<p><b>Abdominal Regions.</b>—For convenience of description the abdominal
-cavity has been divided into nine regions by means of two transverse
-parallel lines, the one through the ninth costal cartilages and the
-other just over the iliac crests, and two perpendicular parallel lines
-<span class="pagenum"><a name="Page_135" id="Page_135">[Pg 135]</a></span>
-through the cartilage of the eighth rib and the middle of Poupart’s
-ligament on either side. These nine regions have been named as follows:
-The right and left <a href="#FIG_52">hypochondriac regions</a> up under the ribs with the
-epigastrium between, the right and left <a href="#FIG_52">lumbar regions</a> next below
-with the <a href="#FIG_52">umbilical</a> between, and the right and left
-<a href="#FIG_52">inguinal</a> with the <a href="#FIG_52">hypogastric</a>
-between. Others divide it into quadrants by one line drawn
-across and another down through the umbilicus. The contents of the
-abdomen in full are the stomach, intestines, liver, gall-bladder,
-spleen, pancreas, kidneys, suprarenal capsules, and the great vessels,
-<span class="pagenum"><a name="Page_136" id="Page_136">[Pg 136]</a></span>
-that is, the organs of digestion and excretion. When distended the
-bladder extends up into the abdominal cavity, as does the uterus also
-when enlarged.</p>
-
-<p><b>Salivary Digestion.</b>—Although most of the digestive organs are
-situated in the abdomen, the food enters the body through the mouth,
-where its prehension is a voluntary act. Here digestion also begins and
-from the first the process is a double one, mechanical and chemical,
-mechanical digestion consisting largely of muscular movements by which
-the food is ground up and carried through the digestive tract. Thorough
-mastication or grinding of the food by the teeth is necessary, while
-the tongue assists by moving the food about and by mixing it thoroughly
-with the <i>saliva</i>, a viscid fluid composed of water and salts and
-having a slightly alkaline reaction. The saliva is secreted by the
-parotid, sublingual, and submaxillary glands, and serves to soften and
-dissolve the food and by virtue of its unorganized ferment, <i>ptyalin</i>,
-to convert starch into sugar. Upon proteins and fats it has practically
-no digestive action. Moderate warmth and an alkaline medium favor its
-action, while extremes of heat or cold or an acid medium hinder it.
-There is little absorption in the mouth, though starch, nicotine, and
-alcohol may be absorbed in small quantities.</p>
-
-<p><b>The Pharynx.</b>—When the food is ready for deglutition or
-swallowing, it is thrust back into the pharynx, a somewhat conical,
-musculo-membranous sac, situated, base upward, behind the nose and
-mouth and behind, but somewhat above, the larynx. The pharynx is about
-four and a half inches long and ends on a level with the cricoid
-cartilage in the esophagus or gullet. It is attached to the vertebræ
-at the back and opens in front into the mouth. The posterior nares,
-the Eustachian tubes, and the larynx also open into it, the last being
-protected by the <i>epiglottis</i>, which closes during deglutition to
-prevent food from entering the air passages, just as the soft palate is
-drawn back to prevent regurgitation of food into the nose. There are
-<span class="pagenum"><a name="Page_137" id="Page_137">[Pg 137]</a></span>
-three coats to the pharynx: 1. a mucous coat continuous with that of
-the mouth and ciliated down to the floor of the nares; 2. a fibrous
-coat, and 3. a muscular coat containing among others the constrictor
-muscles which serve to carry the food down to the esophagus. Its
-arteries are branches of the external carotid and its nerves come from
-the spinal accessory and the sympathetic. Occasionally a <i>foreign
-body</i> gets lodged in the pharynx just out of reach of the finger and
-threatens strangulation. <i>Retropharyngeal abscess</i> on the posterior
-wall occurs rarely.</p>
-
-<div class="figcenter">
-    <img id="FIG_53" src="images/i_137.jpg" alt="" width="500" height="658" />
-    <p class="center"><span class="smcap">Fig. 53.</span>—Position of the
-         thoracic and abdominal organs,<br /> front view. (Morrow.)</p>
-</div>
-
-<p><span class="pagenum"><a name="Page_138" id="Page_138">[Pg 138]</a></span>
-<b>The Esophagus.</b>—From the pharynx the food passes to the cardiac
-orifice of the stomach, opposite the tenth dorsal vertebra, through
-the esophagus, a muscular tube about nine inches long, which collapses
-when empty, its lumen then appearing as a transverse slit. It, too,
-has three coats: 1. an inner mucous coat; 2. an areolar coat, and 3.
-a muscular coat, the muscles being arranged in two sets, an outer
-longitudinal layer and an inner circular layer. By a series of rhythmic
-contractions, especially of the circular fibers, the food is pushed
-along, though sometimes with liquid food there is no peristaltic action
-of the esophagus, the pharyngeal muscles alone sending it to the
-stomach. At the lower end of the esophagus an especially strong band
-of circular muscle fibers form a sort of sphincter, which prevents the
-regurgitation of food. The whole act of swallowing is a reflex, not a
-voluntary act and is due to irritation set up by the stimulus of the
-foreign body, the food. <i>Stricture of the esophagus</i> is common and
-may be of three kinds: 1. spasmodic, occurring in nervous women; 2.
-fibrous, due to scar tissue, or 3. malignant, due to cancer.</p>
-
-<p><b>The Stomach.</b>—<a href="#FIG_53">The stomach</a> is a pear-shaped dilatation of
-the alimentary canal, lying under the <a href="#FIG_53">liver</a> and diaphragm in the
-epigastrium and left hypochondrium and connecting the esophagus with
-the small intestine. It lies largely behind the ribs, but the greater
-curvature is only two fingers’ breadth above the umbilicus and can
-be manipulated through the skin. The <i>cardiac end</i>, into which the
-esophagus enters, is the larger and points upward to the left. The
-lesser and lower end, known as the <i>pylorus</i>, is at the right and its
-opening into the small intestine is guarded by the <i>pyloric sphincter</i>.
-The lesser curvature is concave and on the upper surface; the greater,
-convex and on the under surface. The great omentum is attached to the latter.</p>
-
-<p>In <i>size</i> the stomach varies more or less, that of a man generally
-being larger than that of a woman, but it is usually about ten inches
-<span class="pagenum"><a name="Page_139" id="Page_139">[Pg 139]</a></span>
-long and four or five inches across. It has a capacity of about five
-pints and serves as a storehouse for food.</p>
-
-<p>The stomach has four <i>coats</i>: 1. a serous coat derived from the
-peritoneum; 2. a muscular coat of three layers with longitudinal fibers
-continuous with those of the esophagus, circular fibers, and oblique
-fibers; 3. an areolar coat, and 4. a mucous coat, which, when the
-stomach is empty, is thrown into longitudinal folds or <i>rugæ</i>, and
-whose surface is covered with glands, the <i>gastric glands</i>, for the
-secretion of the digestive fluids.</p>
-
-<p>The <i>arteries</i> come from the celiac axis and the <i>nerves</i>
-from the pneumogastric and the solar plexus.</p>
-
-<p><i>Ulcer</i> and <i>cancer</i> of the stomach are both rather common. In
-the former there is apt to be <i>hyper</i>-acidity and in the latter
-<i>hypo</i>-acidity, but the rule does not always hold. In cases of ulcer
-there may be hemorrhage and even perforation. Such hemorrhage can be
-distinguished from hemorrhage from the lungs by its slightly acid odor
-and by the frothy character of hemorrhage from the lungs. There is much
-irritation at the pylorus and where there is irritation there is liable
-to be cancer.</p>
-
-<p><b>Gastric Digestion.</b>—In the stomach the food is churned and
-thoroughly mixed with the gastric juices, and it is also subjected
-to a propulsive movement that drives it on to the intestine. When it
-comes to the stomach it is semi-solid and when it has become fluid or
-semi-fluid, in which state it is known as <i>chyme</i>, it is ready to pass
-on. Before it can do so, however, it must overcome the strong pyloric
-sphincter, and this it does by the muscles about the sphincter pushing
-it constantly on until the sphincter gives way. Probably most of the
-propulsive movements take place within a few inches of the pylorus.</p>
-
-<p>The <i>gastric juice</i> is secreted by glands in the wall of the stomach
-and poured out through little tubules which project from the surface.
-It is a thin, almost colorless fluid with a sour taste and odor due
-to the presence of free <i>hydrochloric acid</i>, an important element in
-digestion. Probably when the stomach is empty and for some twenty
-<span class="pagenum"><a name="Page_140" id="Page_140">[Pg 140]</a></span>
-minutes after the appearance of food there is no hydrochloric acid
-present and, the food being alkaline, salivary digestion continues.
-Then, called forth by the presence of the food, the hydrochloric acid
-appears and salivary digestion ceases in the acid medium. Little
-digestion of starches or fats takes place, the chief action being
-on proteins, which are converted into soluble peptones. For besides
-hydrochloric acid the gastric juice contains two ferments: 1. <i>pepsin</i>,
-which is particularly active in aiding the digestion of proteins, and
-2. <i>rennin</i>, which especially affects milk. Neither hydrochloric acid
-nor pepsin seems capable of digesting food alone, but each is essential
-to the other. They are secreted by different types of cells, secretion
-depending upon the nerve supply and upon the presence of food. Gastric
-digestion is favored by minute subdivision of the food and by the
-right proportion of hydrochloric acid, which should be 0.2 per cent.
-Body temperature is also advantageous. Except that proteins are put in
-solution and partly digested, little digestion goes on in the stomach,
-and though the rugæ afford a large absorbing surface, little absorption
-takes place, although more takes place than in the mouth and in time
-most foods, except fats, can be absorbed. The time of digestion varies
-with different foods and in different people, but probably three to
-five hours are necessary. The food leaves the stomach as <i>chyme</i>, a
-fluid of about the consistency of pea soup.</p>
-
-<p><i>Vomiting</i> is more or less the reverse of swallowing and is generally
-preceded by a feeling of <i>nausea</i>, which starts up <i>retching</i>, a more
-or less involuntary effort of the stomach to throw off its contents.
-To relieve the retching a long breath is taken, followed by a deep
-expiration that opens the cardiac end of the stomach and allows the
-abdominal muscles to force the food out. After much vomiting and
-prolonged retching the pyloric end of the stomach may be affected and
-bile will then appear in the vomitus. <i>Artificial vomiting</i> may be
-<span class="pagenum"><a name="Page_141" id="Page_141">[Pg 141]</a></span>
-produced by irritation of the gastric nerve center in the brain or by
-irritation of the stomach itself.</p>
-
-<div class="figcenter">
-    <img id="FIG_54" src="images/i_141.jpg" alt="" width="500" height="635" />
-    <p class="blockquot"><span class="smcap">Fig. 54.</span>—The intestinal canal:
-         1, Stomach; 2, duodenum; 3, jejunum; 4, ileum; 5, cecum; 6, vermiform appendix; 7,
-         ascending colon; 8, transverse colon; 9, descending colon; 10, sigmoid
-         flexure; 11, rectum. (Leidy.)</p>
-</div>
-
-<p><b>Intestinal Canal.</b>—From the stomach the food passes into the
-<a href="#FIG_54">intestinal canal</a>, a convoluted tube which extends from the
-stomach to the anus and in which, more particularly in the upper portion, the
-greater part of the digestion and absorption of food takes place. This
-tube, which is about six times the height of its possessor, consists of
-two parts, the small and the large intestines, the first four-fifths,
-or about 25 feet, being small intestine. It occupies the central and
-lower parts of the abdominal cavity and a small portion of the pelvic
-cavity, and is attached to the spine by the mesentery, which, however,
-<span class="pagenum"><a name="Page_142" id="Page_142">[Pg 142]</a></span>
-allows great freedom of motion, so that there is little fixation to the
-loops of the small intestines.</p>
-
-<p><b>The Small Intestine.</b>—The small intestine opens out of the
-stomach and has three divisions: 1. the <a href="#FIG_54"><i>duodenum</i></a>, which is only about
-ten to twelve inches long; 2. the <a href="#FIG_54"><i>jejunum</i></a>, so called because it is
-generally empty after death, which is about two-fifths of the remainder
-and lies chiefly in the umbilical region and the left iliac fossa, and
-3. the <a href="#FIG_54"><i>ileum</i></a> or <i>curved intestine</i>, the remaining
-three-fifths, which gets its name from its numerous coils and which lies in the middle
-and the right side of the abdomen. There is no direct division between the
-jejunum and the ileum, but the first part of the former and the last
-part of the latter are quite different in character. At its entrance
-into the large intestine the ileum is guarded by the <i>ileo-cecal valve</i>.</p>
-
-<div class="figleft">
-    <img id="FIG_55" src="images/i_142.jpg" alt="" width="200" height="238" />
-    <p class="center"><span class="smcap">Fig. 55.</span>—<br />1, Central lacteal;&emsp;&nbsp;<br />
-            2, capillary network;<br /> 3, columnar cells.&emsp;&nbsp;</p>
-</div>
-
-<p>The same <i>coats</i> continue in the small intestine as were found in the
-stomach, but they are here much thinner and the inner coat is shaggy,
-like velvet, with innumerable minute processes called <i>villi</i>, which
-greatly increase the absorbing surface. In fact, the great length of
-the intestine as well as the presence of the villi is aimed to provide
-a large surface to absorb the food as it passes, an even greater
-increase of surface being provided by the fact that the intestinal wall
-is thrown into folds, the <i>valvulæ conniventes</i>. Each villus is covered
-with a layer of columnar epithelial cells and has within connective
-tissue, in which are found a fine capillary network and open lymph
-spaces from which leads a single lacteal vessel.</p>
-
-<p>Closely connected with the lymphatic vessels are the <i>solitary glands</i>,
-small round bodies the size of a small pin’s head. <i>Peyer’s glands</i>
-or <i>patches</i> are patches of solitary glands opposite the mesenteric
-attachment and are largest and most numerous in the ileum. In typhoid
-<span class="pagenum"><a name="Page_143" id="Page_143">[Pg 143]</a></span>
-fever they are involved and may become the seat of ulcers. There are
-also the <i>glands of Lieberkühn</i> which secrete the succus entericus.</p>
-
-<p>The <i>arteries</i> of the small intestine, which include the superior
-mesenteric, are from the celiac axis and the <i>nerves</i> are from the
-superior mesenteric plexus of the sympathetic. The <i>veins</i> empty
-chiefly into the portal system.</p>
-
-<p>The <i>movements</i> of the intestine, like those of the esophagus, are
-peristaltic, but the action is complicated by the fact that the tube is
-not straight but in coils.</p>
-
-<p><b>Intestinal Digestion.</b>—The food, which enters the <a href="#FIG_54">duodenum</a>
-as chyme, there comes in contact with the bile and the pancreatic juice,
-which together but unmixed enter the duodenum from their respective
-ducts by a common orifice. As in the stomach, the digestive juices
-are called forth by the presence of food. The <i>bile</i> is secreted in
-the liver, from which it flows away through the hepatic duct, which
-joins the cystic duct from the gall-bladder to form the common bile
-duct. Through this it flows into the intestine during digestion, but
-between whiles it passes up into the gall-bladder, where it is stored
-for future use and whence it is expelled when needed. When pure it is a
-thick, viscid liquid, varying from a bright red to a greenish-yellow in
-color according to the pigments present, and of an alkaline reaction.
-It consists chiefly of the bile pigments, <i>biliverdin</i>, which gives
-the green color, and <i>bilirubin</i>, which gives the red color, and of
-bile salts in solution, <i>cholesterin</i>, which probably forms the basis
-of many gall stones, is also present. Bile is a disinfectant to the
-bowel and a lubricant for the feces. How much digestive action it has
-is a question, but it affords the necessary alkaline medium for the
-pancreatic juice to act in.</p>
-
-<p>The <i>pancreatic juice</i> is secreted by the <a href="#FIG_57">pancreas</a>,
-from which it enters the intestine through the pancreatic duct, and is probably
-the most important fluid in the digestive process. It is clear, practically
-colorless, slightly viscid or gelatinous, and quite strongly alkaline
-in reaction, owing to the presence of sodium carbonate. It contains
-<span class="pagenum"><a name="Page_144" id="Page_144">[Pg 144]</a></span>
-three ferments, <i>amylopsin</i> for the digestion of starch, <i>trypsin</i>
-for the digestion of proteins, and <i>steapsin</i> for the digestion of fats.
-By it, as by the saliva, starch is turned into sugar or maltose, in
-which form it is absorbed, while proteins are converted into peptones,
-as they are in the stomach. Since, however, fats are acted on nowhere
-else, the chief function of the pancreatic juice may be considered
-to be the digestion of fats. Having broken through their albuminous
-envelope, it divides them into glycerine and fatty acids and then
-emulsifies them with the assistance of the bile.</p>
-
-<p>The food also comes in contact with the <i>succus entericus</i>, a juice
-secreted by the glands of Lieberkühn in the small intestine, whose
-chief action is the conversion of sugar into glucose.</p>
-
-<p><b>Absorption.</b>—As the food is absorbed from the intestine it is
-liquid and entirely digested and is known as <i>chyle</i>. Practically
-all absorption takes place from the small intestine, though there is a
-little in the large intestine. It takes place in two ways: 1. through
-the portal vessels and 2. through the <i>lacteals</i>, which are the
-lymphatic vessels of the small intestine. Fats are absorbed practically
-entirely by the lacteals. They enter the cells covering the villi,
-travel thence to the lymph spaces, and so into the lacteal or main
-lymph channel, whence they are carried to the thoracic duct and the
-general circulation. From the blood they are absorbed as fat and stored
-up as adipose or fatty tissue, which is found throughout the body in
-connective tissue about the organs. Organic salts and water are for
-the most part absorbed by the portal system, which they reach through
-the <a href="#FIG_55">capillaries</a> of the villi and through which they go to
-the <a href="#FIG_53">liver</a>. Starches, in the form of sugar, pass between the
-cells of the villi into the lymph spaces, from which they are taken up by the capillaries.
-On the way to the liver maltose becomes dextrose. Proteins, in the form
-of peptones, pass through the layer of epithelial cells to the lymph
-<span class="pagenum"><a name="Page_145" id="Page_145">[Pg 145]</a></span>
-spaces and then to the capillaries, an active part being taken by the
-cells. By the time they reach the liver the peptones have been changed
-back into proteins. In fact, peptones seem to have some poisonous
-effect upon the blood if they get into it as such.</p>
-
-<p><b>The Large Intestine.</b>—The large intestine differs from the small
-in size and in fixity of position, lying curved in horseshoe shape
-above and around the small intestine. It is five or six feet long,
-large in caliber, and is thrown into crosswise folds. It has the same
-four <i>coats</i> as the small intestine, but the mucous coat is pale and
-smooth, without villi. Its <i>glands</i> are the crypts of Lieberkühn and
-the solitary glands. The <i>arteries</i> are branches of the superior and
-inferior mesenteric and the <i>nerves</i> come from sympathetic plexuses.</p>
-
-<p>The blind sac lying in the right iliac fossa, with which the large
-intestine begins, is called the <a href="#FIG_54"><i>cecum</i></a>, and into this
-the ileum opens, the ileo-cecal valve preventing regurgitation. Just below the
-ileo-cecal opening is the <i>vermiform appendix</i>, a narrow, worm-like
-tube with a blind end, varying in length from one to nine inches, but
-generally about four and one-half inches long, which, so far as is
-known, is functionless as well as dangerous. People have been born
-without an appendix and it has in rare instances grown again after
-operation. Its base is located in the living by <i>McBurney’s point</i>, a
-point two inches from the anterior superior spine of the ilium on a
-line drawn from the spine to the umbilicus.</p>
-
-<p>From the cecum the intestine ascends in what is known as the <a href="#FIG_54"><i>ascending
-colon</i></a> along the abdominal wall at the right to the under surface of
-the liver, where it turns in the <i>hepatic flexure</i> abruptly across the
-body to the left, passing below the liver, stomach, and spleen in the
-<a href="#FIG_54"><i>transverse colon</i></a>. In the <i>splenic flexure</i> it turns down the left
-abdominal wall, the <a href="#FIG_54"><i>descending colon</i></a> passing to the crest of the
-ilium, where there is another curve, the <a href="#FIG_54"><i>sigmoid flexure</i></a>, leading
-to the <a href="#FIG_54"><i>rectum</i></a>, which passes for six or eight inches down along the
-<span class="pagenum"><a name="Page_146" id="Page_146">[Pg 146]</a></span>
-vertebræ, a little to the left, to the <i>anus</i>, the external opening.
-This opening is guarded by two <i>sphincter muscles</i>, about an inch
-apart, the internal and external sphincters. The coils of the small
-intestine lie below the transverse colon, covered mostly by the
-omentum. The splenic flexure is behind the stomach and below the spleen
-and is slightly higher than the hepatic flexure. The sigmoid flexure
-can be felt in the <a href="#FIG_52">left inguinal region</a> in thin people.</p>
-
-<p>The fact that the <i>rectum</i> is somewhat to the left is of importance
-in childbirth because if the rectum is packed, it may turn the child’s
-head in the wrong direction.</p>
-
-<p>No digestion goes on in the large intestine, the function being to
-dry by absorbing water. The <i>movements</i> are practically the same
-as those of the small intestine except that they are much less
-active. Fermentation makes the contents acid. By the time food
-reaches the rectum it has been thoroughly digested and has given up
-its nourishment. It is then expelled as waste matter or <i>feces</i>.
-<i>Defecation</i> combines the involuntary movements of peristalsis and
-relaxation of the sphincters with the voluntary aid of the abdominal
-muscles. The <i>ano-spinal reflex</i>, by which movements of the bowel are
-regulated, is in the lumbar enlargement of the cord.</p>
-
-<p>The <i>hemorrhoidal veins</i> in the lower rectum are connected with both
-the systemic and the portal veins and have no valves so that, as they
-are subjected to much strain, they often become varicose and dilated.
-This condition is called <i>hemorrhoids</i> or <i>piles</i>. <i>Obstruction</i>
-of the intestine may be caused by the growth of a constricting band, by
-<i>intussusception</i> or telescoping of the intestine on itself, especially
-at the ileo-cecal valve, or by <i>volvulus</i> or twisting. <i>Foreign bodies</i>
-are sometimes found in the appendix but they are not usually the cause
-of appendicitis. <i>Cancer of the intestine</i> is common and its mass
-is apt to cause obstruction with all its attendant symptoms. It may
-necessitate an artificial anus. <i>Hernia</i> or <i>rupture</i> may also
-occur and the hernia may become strangulated.
-<span class="pagenum"><a name="Page_147" id="Page_147">[Pg 147]</a></span></p>
-
-<p><b>Food and Metabolism.</b>—Anything serves as food that replaces or
-hinders the loss to which the component parts of the body are liable.
-Proteins, carbohydrates, fats, some mineral matters, as salt and
-perhaps iron, and water are needed. The energy once expended by plants
-or animals in the formation of the materials which serve as food is set
-free in the body by the breaking up of these complex substances into
-their original elements, which are then recombined into the complex
-materials needed for the body’s life and growth. This process of
-building up complex materials from simple ones is known as <i>anabolism</i>
-and that of breaking them down as <i>katabolism</i>, while the two combined
-form the complete cycle of <i>metabolism</i>. Those foods have the best
-value that give up their energy most readily. For their combustion,
-heat, oxygen, and water are needed. Hunger indicates that the supply of
-material for katabolism has been used up and that more is needed, just
-as thirst indicates the need of the system for more fluids.</p>
-
-<p>The proteins or nitrogenous foods include all animal foods except fats,
-fish, crustaceans, eggs, milk and its products, certain vegetables,
-especially the lentils, that is, peas and beans, and gelatine. The fats
-include various fats and oils commonly eaten. The carbohydrates are
-the starchy foods, as cereals, sugars, fruits, and most vegetables,
-in fact, practically all except the lentils. Various beverages and
-condiments have no great nutritive value but serve to stimulate the
-appetite and to excite the secretion of the digestive juices. Coffee,
-tea, and alcohol are stimulants.</p>
-
-<p>The different classes of foods have different functions in the
-nourishment of the body. The proteins are primarily tissue-builders
-and also help somewhat in force production. The fats are essentially
-heat-producers, though they too help in force production. The
-carbohydrates are chiefly important as force-producers, though they
-also produce heat and to a certain extent save protein oxidation. Fat
-<span class="pagenum"><a name="Page_148" id="Page_148">[Pg 148]</a></span>
-is formed by all three but only in small amount by proteins. So no one
-food can form the whole diet but there must be variety. Carbohydrates
-and fats are not sufficient for life, some protein is necessary.
-Carbohydrates are more digestible than fats but have less potential
-energy. Gelatine saves waste of nitrogen, though it does not increase
-the supply. Water and salts are not nutritive but they aid the body
-processes, the water helping to dilute and dissolve substances for
-digestion.</p>
-
-<p>The end-product of the consumption of protein is <i>urea</i>, which is
-eliminated by the <a href="#FIG_58">kidneys</a>. Just where it is formed is unknown,
-but many think in the liver. A trifling amount of urea is also eliminated in
-the sweat and in the breath as well as in the feces. Proteins increase
-nitrogenous metabolism and also the metabolism of other foods, but the
-amount of nitrogen eliminated is just equal to that taken in. Probably
-some comes from the tissues themselves and not from the food. The
-oxidation of carbohydrates and fats is measured by the amount of carbon
-excreted. At first as much is given off as is taken in, but after a
-while the carbohydrate is stored up as glycogen in the liver and the
-fats are stored as fat.</p>
-
-<p>The amount of food needed varies with the person’s size and occupation,
-less being needed for a child than for an adult and more for a
-hard-working man than for one who is doing less work. In general, 100
-to 130 grams of protein, 40 to 80 grams of fat, 450 to 550 grams of
-carbohydrates, 30 grams of salts, and 28,000 grams of water is a fair
-amount.</p>
-
-<p>Foods are cooked to make them more digestible and to develop their
-flavor, so that they will taste better. Cooking also kills germs and
-parasites that might be harmful. Meats should be cooked rapidly on
-the outside to coagulate the surface albumen and keep in the juices.
-The heat, besides coagulating the albumen, turns the tough parts to
-gelatine. In cereals the tough envelope of cellulose is broken up and
-in vegetables the tough fibrous parts are softened and made more digestible.
-<span class="pagenum"><a name="Page_149" id="Page_149">[Pg 149]</a></span></p>
-
-<p><b>The Liver.</b>—Below the diaphragm on the right and extending
-across above the stomach, resting in a way upon the transverse colon
-and the small intestine, is <a href="#FIG_56">the liver</a>, the largest gland
-in the body. It is dark reddish-brown in color and is larger in proportion in the
-child than in the adult. The upper surface is convex and lies in
-contact with the diaphragm, while the lower surface is concave to fit
-over the organs beneath. With a full breath it comes downward and
-forward, with the edge against the abdominal wall, and can be easily
-felt. Numerous strong ligaments, including the suspensory ligament
-from the diaphragm, hold it in place, and it is more firmly fixed than
-any other of the abdominal organs, probably on account of its large
-size. It is divided by fissures into five <i>lobes</i>, of which the most
-important are the right and left, the right one being the largest and
-containing the gall-bladder in one of its fissures.</p>
-
-<div class="figcenter">
-    <img id="FIG_56" src="images/i_149.jpg" alt="" width="600" height="403" />
-    <p class="blockquot"><span class="smcap">Fig. 56.</span>—The liver,
-           seen from below. 1, Inferior vena cava; 2, gall-bladder. (Morrow.)</p>
-</div>
-
-<p><span class="pagenum"><a name="Page_150" id="Page_150">[Pg 150]</a></span>
-The liver tissue contains a large number of <i>cells</i> collected into
-<i>lobules</i>, in the center of each of which is a blood-vessel, the
-<i>intralobular vein</i>, from which a network of capillaries extends to
-the edge of the lobule, there being a capillary on either side of each
-row of cells. Between the cells also are the <i>intercellular biliary
-passages</i>, roots of the bile ducts which exist in the connective tissue
-between the lobules and which join to form two main ducts, one from
-the right and the other from the left lobe. By the union of these two
-ducts the <i>hepatic duct</i> is formed, which, after a course of one or two
-inches, joins the cystic duct from the gall-bladder to form the <i>ductus
-communis</i> or <i>common bile duct</i>.</p>
-
-<p>The liver has a double <i>blood supply</i>, the <i>hepatic artery</i> from
-the celiac axis bringing nourishment to the connective tissue and the walls
-of the blood-vessels, while the capillaries between the cells come from
-the <i>portal vein</i>, which, being formed by the junction of the superior
-and inferior mesenteric, the splenic and the gastric veins, contains
-the proteins and carbohydrates absorbed during digestion. After its
-passage through the liver this blood from the portal vein is collected
-once more into the hepatic veins, which convey it to the inferior vena
-cava. During its passage, however, various changes take place, for the
-liver plays an important part in the metabolic processes of the body.</p>
-
-<p>The liver has two principal <i>functions</i>, the secreting of bile and
-the storing up of glycogen. The secretion of <i>bile</i>, which is a very
-important aid to digestion, is probably a reflex act, the presence of
-peptones in the portal blood after meals acting as a stimulant to the
-liver cells. For food at once increases the secretion of bile, which
-is poured from the cells into the small bile ducts and finally passes
-into the hepatic duct and so to the gall-bladder, where it is stored
-until needed. Although the flow from the liver is constant, the amount
-secreted reaches its maximum when the food gets down into the small
-intestine, that is, four or five hours after eating, there being a lull
-<span class="pagenum"><a name="Page_151" id="Page_151">[Pg 151]</a></span>
-before that. Apart from the process of secretion, the manufacture of
-the bile pigments, <i>bilirubin</i> and <i>biliverdin</i>, which are made
-from the hemoglobin of the blood, seems to require some special action on
-the part of the liver cells.</p>
-
-<p>The <i>glycogen</i>, which is manufactured and stored in the liver cells,
-is a clear hyaline substance, akin to starch and capable of being
-converted into sugar by the starch ferment. Probably there is some
-such ferment in the blood which converts the glycogen into sugar as
-soon as it passes from the liver into the blood, though what it is,
-is not known. Neither is it known just how glycogen is formed, but
-it is manufactured chiefly after a mixed meal in which carbohydrates
-predominate, proteins having little and fats no effect upon its
-formation. It is undoubtedly formed from the sugar in the portal blood
-and the process requires some work on the part of the liver cell
-itself. Probably there is always some sugar in the circulating blood
-which, as it is used up, must be made good. If there it not enough in
-the diet, the liver supplies the deficiency from its store of glycogen.</p>
-
-<p>Glycogen is found also in the muscles, in the placenta as food for the
-fetus, in leucocytes, and to a slight extent in cartilage. In fact, it
-is the form in which carbohydrate material is supplied to the tissues
-as needed. Normally, much of the sugar is used up by the blood and
-its cells in metabolism, giving rise to heat and energy. In muscles
-glycogen is probably digested as lactic acid, as before action muscle
-is neutral or slightly alkaline and after action acid.</p>
-
-<p>When the liver is deranged and allows the glycogen to pass out into the
-blood too freely, or when the glycogen is not held as such but turned
-to sugar and passed out in large quantities, <i>sugar in the urine</i> or
-<i>diabetes mellitus</i> results.</p>
-
-<p>Besides its secreting function the liver has an <i>eliminative function</i>
-and plays an important part in purifying the blood, removing from it
-many poisonous and narcotic substances. It is thought by some, though
-<span class="pagenum"><a name="Page_152" id="Page_152">[Pg 152]</a></span>
-it has not been proved, that <i>urea</i>, the end-product of protein
-metabolism, which is brought by the blood to the kidneys and there
-excreted, is formed in the liver. At any rate, urea is formed not only
-from the nitrogenous food eaten but from the metabolism of protein
-substances in the tissues, being purely a waste product, from which
-the nutritious substances have been absorbed. The amount thrown off is
-an accurate gauge of the amount of protein metabolism going on. The
-process of its manufacture is doubtless very complex.</p>
-
-<p><i>Ptosis</i> or <i>dropping</i> of the liver sometimes occurs and is due
-to the stretching of the ligaments. <i>Rupture</i> is common, generally as the
-result of a fall from a height, on account of its size and friability.
-The liver is also subject to many diseases. <i>Cirrhosis</i> occurs in
-people who drink a good deal and in its later stages is accompanied by
-<i>ascites</i>, an accumulation of fluid in the abdominal cavity. When there
-is a general accumulation of fluid throughout the body it is known as
-<i>anasarca</i>. <i>Syphilis</i> causes enlargement of the liver. <i>Abscesses</i>
-occur, perhaps oftener in the tropics than farther north, and may break
-into the lungs, stomach, or intestine.</p>
-
-<p><b>The Gall-bladder.</b>—The <a href="#FIG_57">gall-bladder</a>, which is simply
-a reservoir for the bile, is a pear-shaped organ three inches long and one inch
-broad. It lies in a fossa on the <a href="#FIG_56">under side of the liver</a>,
-with the large end or fundus touching the abdominal wall just below the ninth
-costal cartilage. Here it can be felt as a small mass in empyema of
-the gall-bladder. Normally it holds a little over one ounce, but with
-occlusion it may become stretched. Its duct is the <i>cystic duct</i>, which
-joins the hepatic duct in the common bile duct, but bile only passes
-up into the gall-bladder when the opening into the duodenum is closed,
-that is, between meals.</p>
-
-<p>If one of the bile ducts is stopped up by a stone or cancer or for any
-other cause, the bile backs up in the liver, the pigments are absorbed
-<span class="pagenum"><a name="Page_153" id="Page_153">[Pg 153]</a></span>
-into the circulation, and <i>jaundice</i> results. In this condition
-operation is dangerous, as the time of coagulation of the blood,
-normally five minutes or less, is much delayed. <i>Gall stones</i>, formed
-largely of bile pigments and cholesterin, sometimes collect in the
-gall-bladder, where they cause irritation and may give rise to
-<i>empyema</i> of the gall-bladder. The stones vary in size from a pea
-to a hen’s egg and when small may be very numerous.</p>
-
-<div class="figcenter">
-    <img id="FIG_57" src="images/i_153.jpg" alt="" width="600" height="452" />
-    <p class="center"><span class="smcap">Fig. 57.</span>—The pancreas, spleen,
-         gall-bladder, etc., showing their relations.<br /> (After Sobotta.)</p>
-</div>
-
-<p><b>The Pancreas.</b>—Another accessory organ of digestion is <a href="#FIG_57">the
-pancreas</a>, the <i>abdominal salivary gland</i>, as it is sometimes called
-on account of its close resemblance to the parotid gland. This is a
-grayish-white racemose gland, six and a half inches long by one and
-a half inches wide and one inch thick, lying behind the stomach on
-a level with the first and second lumbar vertebræ and shaped like a
-pistol with its handle toward the right. In an emaciated person it can
-<span class="pagenum"><a name="Page_154" id="Page_154">[Pg 154]</a></span>
-be felt. The <i>pancreatic duct</i> runs the whole length of the gland
-from left to right and conveys the <i>pancreatic juice</i> from various
-little glands in the substance of the organ to the duodenum, into
-which it empties along with the common bile duct by a common orifice.
-The <i>arteries</i> are from the celiac axis and superior mesenteric, the
-<i>veins</i> belong to the portal system, and the <i>nerves</i> come from
-the solar plexus.</p>
-
-<p>Surgically the pancreas is of no special importance, though <i>acute
-pancreatitis</i> does occasionally occur and is a very serious condition
-and one hard to diagnose.</p>
-
-<p><b>The Spleen.</b>—The largest and most important of the ductless
-glands is <a href="#FIG_57">the spleen</a>, an oblong, flattened organ lying deep
-in the left <a href="#FIG_52">hypochondriac region</a> between the stomach and diaphragm above the
-<a href="#FIG_53">descending colon</a>, and corresponding to the ninth, tenth, and eleventh
-ribs. It is soft, brittle, and very vascular. Its <i>artery</i> is a branch
-of the celiac axis and the <i>vein</i> belongs to the portal system. Its
-<i>nerves</i> are the pneumogastric and branches from the solar plexus. The
-<i>function</i> is not well understood but probably it is connected with or
-related to the vascular system in some way. Perhaps it manufactures
-blood corpuscles.</p>
-
-<p>The spleen varies more in size than any other organ. Normally it cannot
-be felt, but in typhoid it usually can. It is generally atrophied in
-old age and hypertrophied in almost all acute infectious diseases,
-especially in typhoid fever and malaria. In leukemia it is often
-greatly enlarged. Sometimes in violent falls it is <i>ruptured</i>
-and there is considerable hemorrhage.</p>
-
-<p><b>The Suprarenal Capsules.</b>—The other ductless glands, the
-suprarenal capsules, yellowish triangular bodies, are situated just
-above and in front of the kidneys. Their function is important but not
-well understood. Death, accompanied by great muscular weakness, follows
-the removal of both, and when they are diseased, similar weakness is
-observed and the skin becomes bronzed. Injection of the extract of the
-<span class="pagenum"><a name="Page_155" id="Page_155">[Pg 155]</a></span>
-suprarenals stimulates the muscular system. So probably they secrete
-into the blood minute quantities of a substance or substances
-beneficial to the body, especially to the muscular system.</p>
-
-<div class="figcenter">
-    <img id="FIG_58" src="images/i_155.jpg" alt="" width="500" height="447" />
-    <p class="center"><span class="smcap">Fig. 58.</span>—Diagram of the relation of kidney to
-       viscera, spine, and surface points.<br /> (American Text-Book of Surgery.)</p>
-</div>
-
-<p><b>The Kidneys.</b>—The <a href="#FIG_58">two kidneys</a> lie on either side of the vertebræ
-at the back of the abdominal cavity and behind the peritoneum, between
-the last dorsal and the third lumbar vertebræ, their inner edge being
-about one inch from the spinous processes. They are bean-shaped, four
-inches long, two inches wide, and one inch thick, and are embedded in
-a mass of fat and loose areolar tissue. They can be felt only when
-misplaced or when enlarged, as by tuberculosis or malignant disease.</p>
-
-<p>The <a href="#FIG_59">whole kidney</a> is enveloped in a fibrous <i>capsule</i> which
-normally may be peeled off but which in some diseases becomes adherent. On the
-internal border is a <i>fissure</i> or <i>hilum</i>, through which pass the
-blood-vessels and the <a href="#FIG_59">ureter</a>. Upon entering, the ureter dilates
-into a sac, the <i>pelvis of the kidney</i>, into which project the <i>Malpighian
-pyramids</i> of the <i>medullary substance</i>, a substance made up of the
-<span class="pagenum"><a name="Page_156" id="Page_156">[Pg 156]</a></span>
-straight uriniferous tubules and blood-vessels. Outside the medullary
-substance and just under the capsule is the <i>cortex</i>, containing the
-<a href="#FIG_60"><i>Malpighian bodies</i></a>, blood-vessels, and the <i>convoluted
-tubules</i> or <i>loops of Henle</i>. Each Malpighian body contains within a capsule a
-plexus of capillaries, the <i>glomerulus</i>, with an afferent arteriole and
-an efferent vein. The <i>renal artery</i> is a branch of the aorta and the
-<i>nerves</i> are from the solar plexus.</p>
-
-<div class="figcontainer">
-  <div class="figsub">
-   <img id="FIG_59" src="images/i_156a.jpg" alt="" width="300" height="389" />
-   <p class="center"><span class="smcap">Fig. 59.</span>—A longitudinal
-            section<br /> of the kidney. (Leroy.)<br /> <i>a</i>, Renal artery; <i>c</i>,
-            cortex;<br /> <i>m</i>, medulla; <i>u</i>, ureter.</p>
-  </div>
-  <div class="figsub">
-   <img  id="FIG_60" src="images/i_156b.jpg" alt="" width="270" height="354" />
-   <p class="center"><span class="smcap">Fig. 60.</span>—A Malpighian body<br />
-          or corpuscle. (Leidy.)<br /> <i>a</i>, Afferent artery;<br /> <i>e</i>, efferent
-          vessel;<br /> <i>c</i>, capillaries;<br /> <i>k</i>, commencement of<br /> uriniferous
-          tubule;<br /> <i>h</i>, uriniferous tubule.</p>
-   </div>
-</div>
-
-<p><i>The Urine.</i>—As the blood passes through the glomeruli, the urine
-is filtered off as it were, probably by a process of transudation rather
-than simple filtration. The cells lining the tubules also play an
-important part in its formation, not by secreting new substances but
-by taking up those brought by the blood and discharging them into the
-convoluted tubules, from which the urine passes through the straight
-tubules of the medulla to the pelvis, to be carried thence by the
-<span class="pagenum"><a name="Page_157" id="Page_157">[Pg 157]</a></span>
-ureter. The process of the formation of the urine, therefore, is not
-purely a process of secretion but requires some action on the part of
-the kidney, though no new substances are secreted in the kidney.</p>
-
-<p>The passage of the urine <a href="#FIG_61">down through the ureters</a> is assisted
-by a kind of peristaltic action in the walls of the ureters and it is expelled
-from the body by the act of <i>micturition</i>, which is mostly voluntary,
-though a certain amount of nervous mechanism controls it. The seat of
-this nervous mechanism is in the lumbar enlargement of the spinal cord.
-In some nervous conditions, especially where there is injury to the
-spinal cord, there is <i>involuntary micturition</i>.</p>
-
-<p>The urine is a watery solution containing many waste products,
-especially urea. It is generally amber in color, varying in shade with
-circumstances, with an aromatic, characteristic odor when fresh. It
-is acid in reaction and has a specific gravity of about 1020, though
-this too varies with circumstances. Besides water, which is its chief
-constituent, it contains urea, uric acid, organic acids, urates,
-inorganic salts, including sodium chloride and phosphates of calcium
-and magnesium, a certain amount of ammonia, and certain pigments. Its
-acidity is due to acid sodium phosphate in solution but varies with the
-food, and in disease the urine may become alkaline when passed. After
-standing a few hours in a warm place it decomposes and becomes alkaline.</p>
-
-<p>The quantity, which is normally three pints or fifteen hundred cubic
-centimeters in twenty-four hours, varies with the amount of fluid
-drunk, the amount of perspiration, etc. The amount secreted depends
-chiefly, however, upon the flow of the blood through the kidneys; the
-greater the flow of blood, the larger the amount of urine formed; and
-the blood flow is determined by blood pressure and by vasomotor action.
-Secretion also seems to be increased by the presence of urea, which
-apparently serves as a stimulant to the kidney cells.
-<span class="pagenum"><a name="Page_158" id="Page_158">[Pg 158]</a></span></p>
-
-<p>The excretion of waste materials takes place by three main channels,
-the lungs, skin, and kidneys, and the materials are of four kinds,
-<i>urea</i>, <i>carbon dioxide</i>, <i>salts</i>, and <i>water</i>. The lungs
-carry off carbon dioxide and water chiefly, the skin these and inorganic salts,
-while the kidneys eliminate practically all the urea as well as
-inorganic salts and water. When the kidneys are not working the skin
-carries off much urea. In fact, a close relationship exists between the
-kidneys and the skin in the matter of excretion. Thus, with increased
-perspiration in warm weather comes decreased urine, while in cold
-weather the blood is sent in and the urine increased in amount.</p>
-
-<p>To incite action of the kidneys drugs known as <i>diuretics</i> may be used.
-These act in two ways, by stimulating the kidney cells directly and by
-acting on the general circulation or nervous system. Any emotional or
-nervous excitement increases the flow of urine.</p>
-
-<p>There are certain abnormal constituents of urine, of which the two most
-important are <i>albumen</i> and <i>sugar</i>. The former is found only when
-there is some disturbance of the kidneys, ureters, or bladder, and its
-presence usually denotes some change in the cells lining the urinary
-tract. It may occur in congestion of the kidney as well as in disease.
-Sugar is found only in <i>diabetes</i>, the amount varying with the severity
-of the disease. In <i>jaundice</i> certain bile pigments are present in the
-urine, giving it a dark brown color and to the foam a greenish-yellow
-color. Even normal urine has some sediment upon standing, consisting
-of cells from the urinary tract and mucus. In very acid urine after
-standing a heavy sediment, whitish or pinkish, <i>i.e.</i>, brick dust,
-in color, is thrown down. It does not necessarily denote disease, but
-shows the urine is acid and concentrated. In <i>alkaline urine</i> there
-is a sediment due to phosphates.</p>
-
-<p><i>Rupture</i> of the kidney occurs but is not so serious as rupture of the
-<span class="pagenum"><a name="Page_159" id="Page_159">[Pg 159]</a></span>
-liver or spleen because the kidney is situated outside of the
-peritoneum. It necessitates the removal of the kidney, however, and
-when for any reason one kidney is removed the other increases in size
-and does double work to compensate for the loss. Removal of both
-kidneys means death. Sometimes the kidney becomes loose and moves
-about, a condition known as <i>floating kidney</i>. <i>Perinephritic abscess</i>
-is abscess in the loose fatty tissue about the kidney.</p>
-
-<div class="figcenter">
-    <img id="FIG_61" src="images/i_159.jpg" alt="" width="400" height="391" />
-    <p class="center"><span class="smcap">Fig. 61.</span>—The urinary
-              organs<br /> viewed from behind.</p>
-</div>
-
-<p><b>The Ureters</b>, one for each kidney, are tubes the size of a goose
-quill and about fourteen inches long, extending from the hilum of the
-kidney to the base of the bladder. They have three <i>coats</i>, an internal
-mucous, a muscular, and an external fibrous coat, this last being
-continuous with the cortex of the kidney and the fibrous tissue of the
-bladder. In the female the ureters may be felt through the wall of the
-vagina as they come into the bladder. In tubercular disease of one
-kidney the ureter becomes inflamed and enlarged and through the vagina
-feels almost like a lead pencil, a sure diagnostic sign.</p>
-
-<p><b>The Bladder and Urethra.</b>—In their course to <a href="#FIG_61">the bladder</a>
-<span class="pagenum"><a name="Page_160" id="Page_160">[Pg 160]</a></span>
-the ureters pass from the abdominal into the pelvic cavity, but before
-describing the pelvis itself it will be well to complete the account
-of the urinary organs by considering the bladder and urethra. The
-<i>bladder</i> is the reservoir for the urine and has muscular walls lined
-with mucous membrane. A peritoneal coat covers the upper surface and is
-reflected to the walls of the abdomen and pelvis. It is situated back
-of the os pubis, the front bone of the pelvis, with its base or fundus
-directed downward and backward. Normally it is in the pelvis, but when
-much distended it mounds up into the abdominal cavity, where it can be
-felt in front as a tumor. It rests on the rectum in the male and on
-the cervix in the female and is held in place by numerous ligaments.
-When empty it may be Y-shaped, but it becomes oval when distended. Its
-capacity is about one pint.</p>
-
-<p>The lower abdominal wall and the anterior wall of the bladder may be
-wanting congenitally. In paralysis of the sphincter at the neck of the
-bladder distention results. <i>Stones</i> may be found in the bladder.</p>
-
-<p>From the neck of the bladder the urine passes out of the body through
-the <a href="#FIG_61"><i>urethra</i></a>. This in the male passes down through the
-penis and is about ten inches long. Except when urine is passing it is a transverse
-slit with the upper and under surfaces in contact, while at the end of
-the penis the slit of the meatus urinarius is vertical. When the penis
-is flaccid, the urethra describes a sharp curve before its entrance
-into the bladder, but it becomes approximately straight when the penis
-is raised at right angles to the body—an important point to remember
-in catheterization.</p>
-
-<p>In the female the urethra is straight and much shorter, being only
-about one and a half inches long. The <i>meatus urinarius</i> is in the
-anterior vaginal wall about one inch behind the clitoris.</p>
-
-<p>Sometimes the urethra is <i>ruptured</i> in a fall. <i>Stricture</i>
-of the urethra occurs sometimes after gonorrhoea, owing to the formation
-of scar tissue following ulcer.</p>
-
-<hr class="chap" />
-<div class="chapter">
-<p><span class="pagenum"><a name="Page_161" id="Page_161">[Pg 161]</a></span></p>
-<h2 class="nobreak">CHAPTER XI.<br /><span class="h2_subtitle">THE PELVIS AND THE<br />
-GENITAL ORGANS.</span></h2></div>
-
-<p><b>The Pelvis.</b>—Before taking up the pelvic organs, <a href="#FIG_62">the pelvis</a>
-itself should be described. The name pelvis has been given to the bony
-ring which is interposed between the spine and the femurs on account of
-its resemblance to a basin. At the back of this basin or pelvis are the
-<a href="#FIG_33"><i>sacrum</i></a> and <i>coccyx</i>, already described in connection
-with the back, and at the sides and meeting in the median line in front are the two
-<a href="#FIG_63"><i>ossa innominata</i></a> or <i>nameless bones</i>, so called on account
-of their peculiar and indescribable shape. At birth each os innominatum is made
-up of three bones, the <i>ilium</i>, <i>ischium</i>, and <i>pubes</i>, but about
-<span class="pagenum"><a name="Page_162" id="Page_162">[Pg 162]</a></span>
-the age of puberty the three become welded into one. At their point of
-junction is the cavity of the acetabulum for articulation with the head
-of the femur or thigh bone.</p>
-
-<div class="figcenter">
-    <img id="FIG_62" src="images/i_161.jpg" alt="" width="600" height="399" />
-    <p class="blockquot"><span class="smcap">Fig. 62.</span>—Front view
-          of the pelvis, with its ligaments. (Dorland.) <i>a</i>, Anterior
-          sacro-iliac ligament; <i>b</i>, iliofemoral ligament; <i>c</i>,
-          obturator membrane; <i>d</i>, symphysis pubis; <i>e</i>,
-          sacro-sciatic ligament.</p>
-
-    <img id="FIG_63" src="images/i_162.jpg" alt="" width="500" height="445" />
-    <p class="center"><span class="smcap">Fig. 63.</span>—The right
-            innominate bone.<br /> (After Toldt.)</p>
-</div>
-
-<p>The upper, expanded portion of the os innominatum is the <a href="#FIG_63"><i>ilium</i></a>,
-whose upper border is known as the <i>crest</i> and which has two <i>spinous
-processes</i> front and back, a superior and an inferior, the superior
-spine being in each case the larger. These spines, especially the
-anterior superior spines, and the crest give attachment to many
-muscles, and to the outer surface of the bone the gluteal muscles are
-attached. The anterior superior spine is also important in making
-measurements to ascertain whether both legs are of equal length.
-<span class="pagenum"><a name="Page_163" id="Page_163">[Pg 163]</a></span></p>
-
-<p>Below the ilium posteriorly is the <a href="#FIG_63"><i>body of the ischium</i></a>,
-which has on its lower edge a tuberosity, the prominent bone on which one sits. Near
-the upper edge is the <i>spine</i> of the <i>ischium</i>, between which and
-the posterior inferior spine of the ilium is the greater <i>sacro-sciatic
-notch</i> for the passage of vessels and nerves, including the sciatic
-nerves. From the tuberosity the ramus extends forward below the
-<i>obturator foramen</i>, a large opening between the ischium and the pubes,
-also for the passage of vessels and nerves, to meet the pubes, the last
-and smallest of the three bones which go to make up the os innominatum.</p>
-
-<p>The anterior surface of each <i>pubes</i> presents a crest, ending
-externally in a spine, and the two pubic bones join in front in the
-<i>symphysis pubis</i>. The bone gets its name from the growth of pubic
-hairs over this region at puberty.</p>
-
-<div class="figcenter">
-    <img src="images/i_163.jpg" alt="" width="600" height="284" />
-    <p class="blockquot"><span class="smcap">Fig. 64.</span>—Diameters
-         of the pelvis: <i>d</i>, antero-posterior; <i>o b</i>, oblique;
-         <i>t r</i>, transverse. (de Nancrede.)</p>
-</div>
-
-<p>Anteriorly the ossa innominata support the external organs of
-generation, while within are the internal organs of generation. On the
-inner surface of the ilium, slightly above the level of the acetabulum,
-is the <i>ileo-pectineal line</i>, above which lie the <i>iliac fossæ</i>.
-A plane drawn through the prominence of the sacrum, the ileo-pectineal
-lines, and the upper margin of the symphysis pubis serves to divide
-the upper or false pelvis from the lower or true pelvis. The <i>false
-<span class="pagenum"><a name="Page_164" id="Page_164">[Pg 164]</a></span>
-pelvis</i>, which is the larger, serves to support the intestines and
-to take part of the weight from the abdominal walls, while the <i>true
-pelvis</i>, being more surrounded by bone and so capable of affording
-more protection, guards the internal organs of generation. The lower
-circumference of the pelvis is known as the <i>outlet</i>. In the female
-the bones are lighter, the sacrum less curved, and the diameters greater
-than in the male.</p>
-
-<p>On the whole, the pelvic bones are well covered in with muscles. The
-anterior superior spine, however, is easily felt in front and the whole
-crest can be felt back to the posterior superior spine. The tuberosity
-of the ischium also can be felt, especially when the thigh is flexed,
-for it is largely uncovered of muscles. The spine of the os pubis can
-always be felt, on a level with the great trochanter, and the relation
-of its position to that of a hernia shows whether the rupture is above
-or below Poupart’s ligament, that is, whether it is inguinal or femoral.</p>
-
-<p>Occasionally there is lack of development of the pubic bones for two
-or three inches and the bladder is exposed. <i>Fracture</i> of the pelvis
-may occur, perhaps with injury to the viscera. The acetabulum may
-be fractured or the sacrum broken, with injury to the sacral plexus
-of nerves, causing paralysis of the lower extremities and of the
-sphincters, with resultant involuntary passage of urine and feces, and
-in childbirth the coccyx is often broken. In <i>rickets</i> there may be
-great deformity of the pelvis, causing trouble in childbirth later in
-life. <i>Osteomalacia</i> is a disease of adults, in which the bones are
-soft and the weight pushes the promontory of the sacrum forward and
-approximates the sides of the pelvis.</p>
-
-<p><b>The Male Generative Organs.</b>—The male generative organs consist
-of the prostate gland, testes, and penis.</p>
-
-<p>The <i>prostate gland</i> is shaped like a small horse-chestnut and is
-composed of numerous glands from which come a dozen or more excretory
-ducts. It surrounds the neck of the bladder and the beginning of the
-<span class="pagenum"><a name="Page_165" id="Page_165">[Pg 165]</a></span>
-urethra and is next to the rectum, through which an examination may be
-made to determine its size. For it often enlarges in elderly men, the
-frequent passage of urine in small amounts being a symptom of enlarged
-prostate.</p>
-
-<p>The <i>procreating glands</i>, which secrete the spermatozoa or semen, are
-two in number, the <i>testes</i> or <i>testicles</i>, and are homologous to the
-ovaries in the female. They are ovoid in form and are suspended by the
-<i>spermatic cords</i> in a sac, the <i>scrotum</i>, back of the penis. During
-early fetal life they are in the back of the abdomen near the kidneys,
-but before birth they descend along the inguinal canals into the
-scrotum. The excretory duct of the testis is called the <i>vas deferens</i>.
-It passes up by the spermatic cord through the inguinal canal into
-the pelvis to the base of the bladder and at the base of the prostate
-joins the duct of the vesicula seminalis to form the <i>ejaculatory
-duct</i>. The two <i>vesiculæ seminales</i> are small receptacles for the semen
-lying in contact with the base of the bladder and secrete a fluid with
-which they dilute the semen. The ejaculatory duct terminates near
-the prostate in the urethra by a slit-like orifice on each side, the
-spermatozoa being finally excreted through the urethra.</p>
-
-<p>The <i>penis</i> is the external organ of generation in the male and is
-attached to the pubes and the anterior part of the ischium. It is
-composed of erectile tissue and encloses the urethra, the <i>meatus
-urinarius</i> appearing at its end as a vertical slit. Toward the end the
-skin of the penis is loose and is prolonged forward in what is known
-as the <i>prepuce</i> or <i>foreskin</i>. It is this that is clipped away in
-circumcision.</p>
-
-<p><b>The Female Generative Organs.</b>—The female generative organs
-include the ovaries, Fallopian tubes, uterus, vagina, and the external
-genitalia or vulva.</p>
-
-<p>The <a href="#FIG_65"><i>ovaries</i></a>, which are homologous to the testes in
-the male, are two flattened oval bodies, grayish pink in color, suspended from the
-<span class="pagenum"><a name="Page_166" id="Page_166">[Pg 166]</a></span>
-lateral or broad ligaments which fasten the uterus to the walls of the
-pelvis. They are one and a quarter inches long, three-quarters of an
-inch wide, and half an inch thick and are attached at the upper end to
-one of the fimbriæ of the <a href="#FIG_65">Fallopian tubes</a>. They consist of
-numerous <i>Graafian follicles</i> embedded in a fibrous stroma, each follicle
-containing an <i>ovum</i> about ¹/₁₂₅ inch in diameter and just visible to
-the naked eye. When a follicle ruptures and discharges an ovum, an
-irregular yellow spot, the <i>corpus luteum</i>, appears at the point of
-rupture. After ordinary menstruation it is known as the <i>false corpus
-luteum</i> and after conception as the <i>true</i> one, this one being larger
-and lasting longer.</p>
-
-<div class="figcenter">
-    <img id="FIG_65" src="images/i_166.jpg" alt="" width="600" height="432" />
-    <p class="blockquot"><span class="smcap">Fig. 65.</span>—View of the pelvis
-           and its organs. (Savage.) <i>B</i>, Bladder; <i>U</i>, uterus (drawn
-           down by loop <i>e</i>); <i>F</i>, Fallopian tubes; <i>O</i>, ovaries;
-           <i>L</i>, round ligaments; <i>g</i>, ureter; <i>a</i>, ovarian vessels,
-           often prominent under their peritoneal covering; <i>R</i>, rectum;
-           <i>V</i>, vertebra.</p>
-</div>
-
-<p>The <a href="#FIG_65"><i>Fallopian tubes</i></a> are the oviducts and convey the
-ova from the ovaries to the uterus. They are four inches long and lie between the
-layers of the broad ligaments, opening into the uterus by an orifice the
-<span class="pagenum"><a name="Page_167" id="Page_167">[Pg 167]</a></span>
-size of a bristle, while the end next to the ovary spreads out
-trumpet-like and is edged with <i>fimbriæ</i> as with a fringe, the
-fimbriated extremity. There are three <i>coats</i>: a serous coat which is
-continuous with the peritoneum, a muscular coat, and, within, a mucous
-coat covered with cilia, continuous with the mucous membrane of the
-uterus. One fimbria is attached to the ovary and as the ovum is given
-off it finds its way into the tube and thence to the uterus.</p>
-
-<div class="figcenter">
-    <img src="images/i_167.jpg" alt="" width="600" height="585" />
-    <p class="center"><span class="smcap">Fig. 66.</span>—Sagittal
-             section of the female pelvis.<br /> (Dickinson.)</p>
-</div>
-
-<p>The <a href="#FIG_65"><i>uterus</i></a> is a pear-shaped organ, about three inches
-long, two inches broad above, and one inch thick, situated in the pelvic cavity
-between the rectum and the bladder. The wide part or <i>fundus</i> is above
-<span class="pagenum"><a name="Page_168" id="Page_168">[Pg 168]</a></span>
-and the narrow neck or <i>cervix</i> below, lying partly within the vagina.
-The whole is held in place by ligaments. These include the <i>broad
-ligaments</i>, which extend from the sides of the uterus to the lateral
-walls of the pelvis, and the <i>round ligaments</i>, two muscular cords,
-about four inches long, which pass out through the abdominal ring
-into the inguinal canal and so to the mons veneris and labia, thus
-corresponding to the spermatic cords in the male. The cavity of the
-body of the uterus is small and flattened and opens into the cervix by
-the <i>internal os uteri</i>, the <i>external os</i> being at the opening of the
-cervix into the vagina. There are three <i>coats</i>: a serous coat derived
-from the peritoneum, a muscular coat of unstriped fibers which forms
-the bulk of the whole organ, and a mucous coat covered with ciliated
-epithelium.</p>
-
-<p>The uterus is always enlarged during menstruation and is enormously
-enlarged in pregnancy. It receives the fecundated ovum, retains and
-supports it during the development of the fetus, and is the chief agent
-of expulsion. In <i>tubal</i> or <i>extra-uterine pregnancy</i> the ovum
-becomes attached in the tube instead of in the uterus, and develops there,
-rupturing the tube and causing serious hemorrhage.</p>
-
-<p>The passage from the cervix out of the body is the <a href="#FIG_67"><i>vagina</i></a>,
-a membranous canal, curved upward and backward to conform to the axis of
-the pelvis, and attached above to the cervix. Ordinarily the sides are
-in contact.</p>
-
-<p>The <i>arteries</i> of the internal organs of generation are the uterine
-from the internal iliac and the ovarian from the aorta in the female,
-the pudic branches of the internal iliac and the spermatic from the
-aorta in the male. The <i>nerves</i> are largely from the sympathetic system.</p>
-
-<p><i>Abscess formation</i> occurs frequently in the tubes and <i>gonorrheal
-infection</i> may spread up the vagina and through the uterus to the tubes,
-and even to the abdominal cavity itself. The tubes may also be <i>tubercular</i>.
-<span class="pagenum"><a name="Page_169" id="Page_169">[Pg 169]</a></span></p>
-
-<p><i>Salpingectomy</i> or removal of the tubes is the commonest operation
-after that for appendicitis. <i>Cancer</i> of the uterus may necessitate
-<i>panhysterectomy</i> or removal of the uterus and all its appendages.</p>
-
-<div class="figcenter">
-    <img id="FIG_67" src="images/i_169.jpg" alt="" width="600" height="589" />
-    <p class="blockquot"><span class="smcap">Fig. 67.</span>—Virginal vulva.
-         (Modified from Tarnier.) 1, labia majora; 2, fourchette;
-         3, labia minora; 4, glans clitoridis; 5, meatus urinarius;
-         6, vestibule; 7, entrance to the vagina; 8, hymen; 9, orifice
-         of Bartholin’s gland; 10, anterior commissure of labia majora;
-         11, anus; 12, blind recess; 13, fossa navicularis; 14, body of clitoris.</p>
-</div>
-
-<p>The <i>external genitalia</i> in the female, as in the male, are situated
-over the pubic arch. They are known as the <a href="#FIG_67"><i>vulva</i></a>
-and include the mons Veneris, the labia majora and minora, the vaginal orifice,
-the clitoris, and the meatus urinarius.</p>
-
-<p>The <i>mons Veneris</i> is a rounded eminence composed of fatty tissue,
-which surmounts the pubic bones and is covered with hair at puberty.
-From it two prominent longitudinal folds of skin, covered with hair on
-the outside, the <a href="#FIG_67"><i>labia majora</i></a>, extend backward, forming the
-<span class="pagenum"><a name="Page_170" id="Page_170">[Pg 170]</a></span>
-lateral boundaries of the vulva. Within these labia again are two
-thin cutaneous folds, the <a href="#FIG_67"><i>labia minora</i></a> or <i>nymphæ</i>,
-which run back from the clitoris for about one and a half inches and enclose the
-<i>vaginal orifice</i>. The <a href="#FIG_67"><i>clitoris</i></a> corresponds to the
-penis and is just above the upper part of the labia minora. Between it and the
-vagina is the <a href="#FIG_67"><i>meatus urinarius</i></a>. The orifice of the vagina is partly
-closed in the virgin by the <a href="#FIG_67"><i>hymen</i></a>, a thin fold of mucous membrane,
-which occasionally closes it completely, <i>imperforate hymen</i>. The
-<a href="#FIG_67"><i>fourchette</i></a> is a small transverse fold of skin at the junction
-of the labia minora posteriorly. Between the vagina and the rectum is the
-<i>perineal body</i>, a somewhat triangular structure made up of many small
-muscles. Its surface is known as the <i>perineum</i>. It is frequently torn
-wholly or in part during childbirth and has to be sewed up.</p>
-
-<hr class="chap" />
-<div class="chapter">
-<p><span class="pagenum"><a name="Page_171" id="Page_171">[Pg 171]</a></span></p>
-<h2 class="nobreak">CHAPTER XII.<br /><span class="h2_subtitle">THE UPPER EXTREMITIES.</span></h2></div>
-
-<p>The upper extremities include the shoulders, arms, forearms, wrists,
-and hands and contain each thirty-two bones. The bones of the two
-shoulders taken together are called the <i>shoulder girdle</i> and consist
-of the two clavicles or collar bones and the two scapulæ or shoulder
-blades, which together make an almost complete girdle of the shoulders.</p>
-
-<p>The <a href="#FIG_68"><b>clavicle</b></a> is a long slender bone extending
-almost horizontally from the sternum to the scapula and can be felt for its
-whole length in the living. For the inner two-thirds it is convex
-anteriorly, for the outer third concave. In woman it is generally less
-curved, smoother, and more slender than in man, and as bone is rough
-when the muscles attached are powerful, the right clavicle, being used
-more, is generally rougher and thicker than the left. Among the muscles
-attached are the large neck muscle, the <i>sterno-cleido-mastoid</i>, whose
-tendons form the <i>presternal notch</i>, the <a href="#FIG_35"><i>trapezius</i></a>,
-the <a href="#FIG_51"><i>pectoralis major</i></a>, and the
-<a href="#FIG_35"><i>deltoid</i></a>.</p>
-
-<p>Being slender and superficial the clavicle is most frequently <i>broken</i>
-of any bone in the body, generally by indirect violence, as by falling
-with the hand out, though old people in such a case are apt to get
-<i>Colles’ fracture</i> at the wrist. The bone generally gives way at the
-juncture of the outer and middle thirds, with displacement of the
-parts inward, so that the fracture is seldom compound. Since, however,
-the main vessels of the upper arm, with their nerves, lie beneath the
-clavicle, there is danger of their being punctured. Such serious injury
-is guarded against by the presence of the <i>subclavius muscle</i>. The
-clavicle is occasionally removed for <i>sarcoma</i>.
-<span class="pagenum"><a name="Page_172" id="Page_172">[Pg 172]</a></span></p>
-
-<div class="figcenter">
-    <img id="FIG_68" src="images/i_172.jpg" alt="" width="300" height="554" />
-    <p class="center"><span class="smcap">Fig. 68.</span>—Bones of
-           the upper extremity.<br /> (Toldt.)</p>
-</div>
-<p><span class="pagenum"><a name="Page_173" id="Page_173">[Pg 173]</a></span></p>
-<div class="figcenter">
-    <img id="FIG_69" src="images/i_173.jpg" alt="" width="600" height="439" />
-    <p class="center"><span class="smcap">Fig. 69.</span>—Left scapula,
-           posterior surface<br /> (after Toldt).</p>
-</div>
-
-<p>The <a href="#FIG_69"><b>scapula</b></a> or <b>shoulder blade</b>, so called from
-its shape, is a large, flat, triangular bone with a prominent ridge, the <i>spine</i>,
-crossing its dorsum or posterior surface near its upper edge. It
-extends from the second to the seventh rib, with its posterior margin
-parallel to and about one inch from the dorsal vertebræ. The <i>head</i>,
-in which is situated the <i>glenoid cavity</i> for articulation with the
-humerus or upper arm bone, is surrounded by a slight constriction,
-the <i>neck</i>. Above it projects the <a href="#FIG_69"><i>coracoid process</i></a>,
-so called from its fancied resemblance to a crow’s beak. This can usually be felt
-about one inch from the juncture of the outer and middle thirds of
-the clavicle and from it arise the short head of the biceps and the
-coraco-brachialis muscle. The <a href="#FIG_69"><i>acromion process</i></a> at the
-end of the spine extends out beyond the glenoid cavity posteriorly and affords
-<span class="pagenum"><a name="Page_174" id="Page_174">[Pg 174]</a></span>
-attachment to the deltoid and trapezius muscles. It forms the summit
-of the shoulder. Numerous other muscles are attached to the surface
-of the scapula, the only parts which are truly subcutaneous being the
-whole length of the spine and the acromion process, though the lower
-angle and the coracoid process can generally be felt. The muscles bulge
-so much that the spine in the living appears as a slight depression
-extending back almost to the vertebræ. The large number of the muscles
-on the shoulder and arm is due to the great flexibility and strength
-required for the various uses to which the arms are put.</p>
-
-<p><b>Shoulder Muscles.</b>—The most important shoulder muscle is the
-<a href="#FIG_71"><i>deltoid</i></a>, a large triangular muscle, which surrounds
-and protects the shoulder-joint and gives the shoulder its rounded form. It rises
-from the outer third of the <a href="#FIG_68">clavicle</a>, from the acromion process,
-and from the whole length of the spine of the scapula, and is inserted
-by a tendon into a rough prominence on the middle of the outer side
-of the humerus. It serves to raise the arm and to draw it somewhat
-forward or back, according as the anterior or posterior fibers are
-used. The <a href="#FIG_70"><i>pectoralis major</i></a> rises from the inner
-half of the clavicle, the front of the sternum, and the cartilages of the true
-ribs and its fibers converge to form a fan-shaped muscle, which is inserted by a
-flat tendon into the edge of the bicipital groove on the humerus. It
-draws the arm forward and inward and helps considerably in forced
-inspiration. The <a href="#FIG_35"><i>serratus magnus</i></a> rises from the
-outer surface and upper border of the eight upper ribs and from an aponeurosis
-covering the upper intercostal spaces, and is inserted along the whole length of
-the posterior border of the scapula. It carries the scapula forward and
-is used in pushing.</p>
-
-<p>The scapula is seldom <i>broken</i> because it is quite movable and is
-covered with large muscles and because it lies on the chest, which
-serves as an elastic cushion. The acromion process is the part most
-<span class="pagenum"><a name="Page_175" id="Page_175">[Pg 175]</a></span>
-frequently broken and occasionally the neck is fractured. <i>Tumors</i>
-occur and may necessitate the amputation of the whole upper extremity.</p>
-
-<p><b>The Humerus.</b>—The bone of the upper arm, the humerus, is the
-largest bone in the upper extremity and articulates with the scapula
-above and with the ulna and radius below. At its upper end are the
-<i>head</i> and the <i>anatomical neck</i>, with the <i>greater tuberosity</i>
-external to and the <i>lesser tuberosity</i> in front of them. The
-constriction of the surgical neck is below the tuberosities, and
-extending from between them downward and inward along the upper third
-of the bone is the bicipital groove for the long head of the biceps.
-Though round above, below the <i>shaft</i> becomes flattened from before
-backward and curves slightly forward, terminating in the internal and
-external <i>condyles</i>, from the former of which the flexors and the
-round pronator arise and from the latter the extensors and supinators.
-From the external condyle also there projects in front the <i>radial
-head</i> or <i>capitellum</i> for articulation with the radius. Internally
-to the capitellum in front and in a corresponding position on the
-back of the bone are the trochlear surfaces for articulation with the
-ulna, there being a depression in front called the <i>coronoid fossa</i>
-for the reception of the <i>coronoid process</i> of the ulna in flexion of
-the forearm, and another depression behind, the <i>olecranon fossa</i>,
-to receive the tip of the olecranon process during extension. On the
-lower half of the humerus at the back is the spiral groove for the
-<i>musculo-spiral nerve</i> and the <i>superior profunda artery</i>, while
-the <i>ulnar nerve</i> runs in a groove back of the internal condyle.</p>
-
-<p>The humerus is almost completely covered with muscles, the only part
-that is subcutaneous being a small portion of the external and internal
-condyles. The head can be felt under the muscles and the greater
-tuberosity forms the point of the shoulder. When the arm is at the
-side, the biceps appears at the front and inner side and the brachialis
-<span class="pagenum"><a name="Page_176" id="Page_176">[Pg 176]</a></span>
-anticus on either side below, while on the back of the arm, with its
-largest swelling above, is the triceps.</p>
-
-<div class="figcenter">
-    <img id="FIG_70" src="images/i_176a.jpg" alt="" width="600" height="183" />
-    <p class="center"><span class="smcap">Fig. 70.</span></p>
-    <p class="blockquot"><span class="smcap">Fig. 70.</span>—Superficial muscles
-        of shoulder and arm (from before): 1, Pectoralis major; 2, deltoid;
-        3, biceps brachii; 4, brachialis anticus; 5, triceps; 6, pronator radii teres;
-        7, flexor carpi radialis; 8, palmaris longus; 9, flexor carpi ulnaris;
-       10, supinator longus; 11, extensor ossis metacarpi pollicis;
-       12, extensor brevis pollicis; 13, flexor sublimis digitorum;
-       14, flexor longus pollicis; 15, flexor profundus digitorum;
-       16, palmaris brevis; 17, abductor pollicis. (Dorland’s Dictionary.)</p>
-
-    <img id="FIG_71" src="images/i_176b.jpg" alt="" width="600" height="179" />
-    <p class="center"><span class="smcap">Fig. 71.</span></p>
-    <p class="blockquot"><span class="smcap">Fig. 71.</span>—Superficial muscles
-        of shoulder and arm (from behind): 1, Trapezius; 2, deltoid; 3,
-        rhomboideus major; 4, infraspinatus; 5, teres minor; 6, teres major;
-        7, latissimus dorsi; 8, triceps; 9, anconeus; 10, brachialis anticus;
-       11, supinator longus; 12, extensor carpi radialis longior; 13, extensor
-       carpi radialis brevior; 14, extensor communis digitorum; 15, extensor carpi
-       ulnaris; 16, flexor carpi ulnaris; 17, extensor ossis metacarpi pollicis;
-       18, extensor brevis pollicis; 19, tendon of extensor longus pollicis.
-      (Dorland’s Dictionary.)</p>
-</div>
-
-<p><b>Upper Arm Muscles.</b>—The <a href="#FIG_70"><i>biceps</i></a> is the most
-important arm muscle. It rises by a short head from the coracoid process of the
-scapula and by a long head from a tubercle on the upper margin of the
-glenoid cavity, the tendon arching over the head of the humerus and
-descending in the bicipital groove. It is inserted into the back of the
-tuberosity of the radius and by a broad aponeurosis into the fascia of
-the forearm. It flexes and supinates the forearm and renders the fascia
-<span class="pagenum"><a name="Page_177" id="Page_177">[Pg 177]</a></span>
-tense. Its inner border forms a guide in tying the <i>brachial artery</i>,
-as this artery runs along its inner side.</p>
-
-<p>The <a href="#FIG_71"><i>brachialis anticus</i></a> rises from the lower half of
-the outer and inner surfaces of the humerus and is inserted into the coronoid process
-of the ulna, thus covering and projecting the elbow-joint anteriorly.
-It is a flexor of the forearm.</p>
-
-<p>Another smaller muscle on the anterior arm, which also aids in flexion,
-is the <i>coraco-brachialis</i>, which extends from the coracoid process of
-the scapula to the middle of the inner surface of the humerus.</p>
-
-<p>Extending the entire length of the posterior surface of the humerus
-is the <a href="#FIG_71"><i>triceps</i></a>, similar to the quadriceps extensor in
-the thigh and direct antagonist to the biceps and brachialis anticus muscles. It
-rises by a long head from below the glenoid fossa, by the external head
-from the upper third of the posterior surface of the humerus, and by
-the internal head from the middle and lower thirds of the posterior
-surface. It is inserted in the olecranon process of the ulna and serves
-to extend the forearm and arm.</p>
-
-<p>The humerus is more often <i>fractured</i> by muscular action than any
-other bone. Usually the fracture occurs in the lower half of the
-bone and sometimes the musculo-spiral nerve is involved. There is a
-great tendency to non-union, probably due to interposition of soft
-parts. Sometimes the break is across and down between the condyles,
-<i>T-fracture</i>. Involvement of the elbow-joint is more serious than
-fracture of the humerus alone. <i>Sarcoma</i> of the humerus does occur and
-may require the removal of the clavicle and scapula as well as of the
-arm bone itself. In <i>amputation</i> of the humerus in children a long skin
-flap is left to allow for growth of the bone, as it is liable to grow again.</p>
-
-<p><b>The Ulna.</b>—In the forearm there are two bones, the ulna and the
-radius, of which the former is the longer. <a href="#FIG_72">The ulna</a> is on
-the inner side of the forearm and its upper end forms the greater part of the
-<span class="pagenum"><a name="Page_178" id="Page_178">[Pg 178]</a></span>
-articulation with the humerus, as most of the articulation at the wrist
-is formed by the radius and the inter-articular fibro-cartilage. The
-head of the ulna is at the lower extremity of the bone and articulates
-on the outer side with the radius and below with the triangular
-fibro-cartilage. From its inner side projects the <i>styloid process</i>.
-The olecranon process forms the upper extremity and presents anteriorly
-an articular surface, the <i>greater sigmoid cavity</i>, for articulation
-with the trochlea of the humerus, where it fits into the olecranon
-fossa during extension. The same articulating surface also covers
-the <i>coronoid process</i>, a smaller projection below and in front
-of the olecranon, which fits into the coronoid fossa during flexion.
-Continuous with the greater sigmoid cavity on the outer side is the
-<i>lesser sigmoid cavity</i> for articulation with the head of the radius.
-Under the <i>triceps tendon</i>, which is inserted into the olecranon, is a
-<i>bursa</i> or sac of synovial membrane, such as occurs in parts where much
-force is brought to bear.</p>
-
-<p><b>The Radius.</b>—<a href="#FIG_72">The radius</a>, or spoke of the wheel,
-is on the outer side of the forearm and gets its name from the way it turns
-upon the ulna in pronation. The <i>shaft</i> is larger below than above
-and is slightly curved longitudinally for greater strength. The upper
-extremity or <i>head</i> is small and has a slightly concave upper surface
-for articulation with the radial head of the humerus. It articulates by
-its sides with the lesser sigmoid cavity and is bound to the ulna by
-the <i>orbicular ligament</i>, which runs over a smooth articular surface.
-Below the head is the constriction of the <i>neck</i> with the <a href="#FIG_72">tuberosity</a>
-for the biceps tendon to the inner side below. The lower extremity is
-large and forms the chief part of the wrist-joint, articulating with
-the semilunar and scaphoid bones of the wrist. From the lower extremity
-the strong conical <i>styloid process</i> projects externally.
-<span class="pagenum"><a name="Page_179" id="Page_179">[Pg 179]</a></span></p>
-
-<div class="figcenter">
-    <img id="FIG_72" src="images/i_179.jpg" alt="" width="350" height="496" />
-    <p class="center"><span class="smcap">Fig. 72.</span>—Bones of the right forearm<br />
-             in a position of supination. (Toldt.)</p>
-</div>
-
-<p>In the living the <i>olecranon process</i> of the ulna is always felt
-at the elbow and the posterior border of the ulna forms the prominent
-ridge down the forearm, leading to the styloid process. The head of the
-radius is felt just below the external condyle and often makes a dimple
-in the muscles of the forearm. The rest of its upper half is concealed
-with muscles, but the lower half is easily felt as there are only
-tendons over it. The styloid process is felt externally. Normally that
-<span class="pagenum"><a name="Page_180" id="Page_180">[Pg 180]</a></span>
-of the radius is a little lower than that of the ulna, so that in cases
-of fracture their relative position is of considerable importance as
-showing the amount of deformity.</p>
-
-<p>The two forearm bones are more frequently <i>broken</i> together than
-separately and generally by direct violence, the lower fragment being
-usually drawn up by the action of the flexor and extensor muscles and
-producing a swelling on the palmar surface of the forearm. Indirect
-violence usually causes fracture of the radius only. In both cases, but
-especially in fracture of both bones, there is a tendency for membrane
-to get between the fragments, so the arm is put up in splints with the
-hand midway between pronation and supination in order to separate the
-bones as far as possible. Care must be taken not to have the bandage
-too tight or gangrene of the fingers may result. In most fractures of
-the arm it is put up bent, but in <i>fracture of the olecranon</i> it is put
-up fully extended, as the fragment is sure otherwise to be displaced by
-the pull of the triceps. In fact, the olecranon is sometimes fractured
-by the muscular force of the triceps, though usually its fracture,
-which is frequent, is due to direct violence. The ulna is also often
-fractured in the middle by direct violence or the styloid process may
-be broken. Fracture of the neck or shaft of the radius is very common,
-the most important arm fracture being that of the lower end of the
-radius or <i>Colles’ fracture</i>. This and the corresponding fracture in
-the leg, <i>Pott’s fracture</i>, are two of the commonest fractures. In
-<i>dislocation of the wrist</i> the normal relation of the two styloid
-processes remains unchanged, but in Colles’ fracture the lower fragment
-often projects on the back of the hand, making a typical deformity
-called the <i>silver fork deformity</i>.</p>
-
-<p>The bones of the wrist and hand had best be described before the
-forearm muscles are taken up, as the muscles of the forearm are
-distributed largely to the fingers.</p>
-
-<p><b>The Wrist.</b>—The wrist or <a href="#FIG_73"><i>carpus</i></a> is made up of
-<span class="pagenum"><a name="Page_181" id="Page_181">[Pg 181]</a></span>
-eight bones  arranged in two rows of four each. In the first row are the <a href="#FIG_73"><i>scaphoid</i>
-and <i>semilunar bones</i></a>, on the outer side, articulating with the
-radius, the <a href="#FIG_73"><i>cuneiform</i></a> articulating with the fibro-cartilage of the
-wrist-joint, and the <a href="#FIG_73"><i>pisiform</i></a>. In the second row, in corresponding
-positions, are the <a href="#FIG_73"><i>trapezium</i>, <i>trapezoid</i>, <i>os magnum</i></a>, and
-<i>unciform</i>. The eminence felt on the radial side of the wrist is the
-protuberance of the scaphoid, while the pisiform is generally felt on
-the ulnar side.</p>
-
-<div class="figcenter">
-    <img id="FIG_73" src="images/i_181.jpg" alt="" width="400" height="387" />
-    <p class="blockquot"><span class="smcap">Fig. 73.</span>—Right carpal
-        bones, dorsal surface. <i>T</i>, trapezium; <i>T´</i>, trapezoid;
-        <i>7</i>, os magnum; <i>U</i>, unciform; <i>S</i>, scaphoid;
-        <i>L</i>, semilunar; <i>C</i>, cuneiform; <i>P</i>, pisiform.</p>
-</div>
-
-<p><b>The Hand.</b>—The hand contains nineteen bones, five <i>metacarpal
-bones</i>, one for each finger and the thumb, whose bases articulate with
-the lower row of wrist bones, and fourteen <i>phalanges</i>, three for each
-finger and two for the thumb, of which the first row articulate with
-the metacarpal bones. They are all long bones and are slightly concave
-anteriorly. When the hand is flexed it is the heads of the metacarpal
-bones, not the bases of the phalanges, that are so prominent, the head
-of the third metacarpal being most prominent.</p>
-
-<p>The metacarpals are seldom <i>fractured</i>, though bad fractures
-occasionally occur. In comminuted fracture nothing can be done but
-remove the bone. If the periosteum is left the bone will grow again.
-<span class="pagenum"><a name="Page_182" id="Page_182">[Pg 182]</a></span>
-Two diseases sometimes affect the metacarpals and the phalanges,
-<i>tuberculosis</i> and <i>syphilis</i>. Both cause swelling of the bones.</p>
-
-<p class="space-below1"><b>Muscles of the Forearm.</b>—The chief groups
-of muscles on the forearm are the <i>flexors</i> and <i>pronators</i> on the
-anterior surface and the <i>extensors</i> and <i>supinators</i> on the posterior
-surface. In general the flexors and pronators take their origin from
-on or around the internal condyle, while the extensors and supinators
-arise on or around the external condyle. Where not otherwise stated it
-will be understood that such is their origin. In a general way they may
-by grouped as follows:</p>
-
-<table border="0" cellspacing="0" summary="Forearm muscles." cellpadding="0" >
-  <tbody><tr>
-      <td class="tdc" colspan="3"><big><b><span class="smcap">Anterior Surface.</span></b></big></td>
-   </tr><tr>
-      <td class="tdl" rowspan="3">Flexors of wrist</td>
-      <td class="tdc" rowspan="3"><img src="images/cbl-3.jpg" alt="" width="16" height="57" /></td>
-      <td class="tdl_ws1">flexor carpi radialis</td>
-   </tr><tr>
-      <td class="tdl_ws1">flexor carpi ulnaris</td>
-   </tr><tr>
-      <td class="tdl_ws1 bb">palmaris longus</td>
-   </tr><tr>
-      <td class="tdl" rowspan="2">Flexors of fingers</td>
-      <td class="tdc" rowspan="2"><img src="images/cbl-2.jpg" alt="" width="9" height="32" /></td>
-      <td class="tdl_ws1">flexor sublimis digitorum</td>
-   </tr><tr>
-      <td class="tdl_ws1 bb">flexor profundus digitorum</td>
-   </tr><tr>
-      <td class="tdl">Flexor of thumb</td>
-      <td class="tdc">&nbsp;</td>
-      <td class="tdl_ws1 bb">flexor longus pollicis</td>
-   </tr><tr>
-      <td class="tdl" rowspan="2">Pronators of hand</td>
-      <td class="tdc" rowspan="2"><img src="images/cbl-2.jpg" alt="" width="9" height="32" /></td>
-      <td class="tdl_ws1">pronator radii teres</td>
-   </tr><tr>
-      <td class="tdl_ws1 bb">pronator quadratus</td>
-   </tr><tr>
-      <td class="tdc" colspan="3"><br /><big><b><span class="smcap">Posterior Surface.</span></b></big></td>
-   </tr><tr>
-      <td class="tdl">Extensor of forearm</td>
-      <td class="tdc">&nbsp;</td>
-      <td class="tdl_ws1 bb">anconeus</td>
-   </tr><tr>
-      <td class="tdl" rowspan="3">Extensors of wrist</td>
-      <td class="tdc" rowspan="3"><img src="images/cbl-3.jpg" alt="" width="16" height="57" /></td>
-      <td class="tdl_ws1">extensor carpi radialis longior</td>
-   </tr><tr>
-      <td class="tdl_ws1">extensor carpi radialis brevior</td>
-   </tr><tr>
-      <td class="tdl_ws1 bb">extensor carpi ulnaris</td>
-   </tr><tr>
-      <td class="tdl" rowspan="3">Extensors of thumb</td>
-      <td class="tdc" rowspan="3"><img src="images/cbl-3.jpg" alt="" width="16" height="57" /></td>
-      <td class="tdl_ws1">extensor ossis metacarpi pollicis</td>
-   </tr><tr>
-      <td class="tdl_ws1">extensor primi internodii pollicis</td>
-   </tr><tr>
-      <td class="tdl_ws1 bb">extensor&nbsp;secundi&nbsp;internodii&nbsp;pollicis</td>
-   </tr><tr>
-      <td class="tdl">Extensor of fingers</td>
-      <td class="tdc">&nbsp;</td>
-      <td class="tdl_ws1 bb">extensor communis digitorum</td>
-   </tr><tr>
-      <td class="tdl">Extensor of index finger</td>
-      <td class="tdc">&nbsp;</td>
-      <td class="tdl_ws1 bb">extensor indicis</td>
-   </tr><tr>
-      <td class="tdl">Extensor of little finger</td>
-      <td class="tdc">&nbsp;</td>
-      <td class="tdl_ws1 bb">extensor minimi digiti</td>
-   </tr><tr>
-      <td class="tdl" rowspan="2">Supinators of hand</td>
-      <td class="tdc" rowspan="2"><img src="images/cbl-2.jpg" alt="" width="9" height="32" /></td>
-      <td class="tdl_ws1">supinator longus</td>
-   </tr><tr>
-      <td class="tdl_ws1 bb">supinator brevis</td>
-   </tr>
- </tbody>
-</table>
-
-<p class="space-above1"><span class="pagenum"><a name="Page_183" id="Page_183">[Pg 183]</a></span>
-Of the <i>flexors of the wrist</i> the <i>flexor carpi radialis</i> is inserted
-into the base of the index and usually of the third metacarpal bone,
-the <i>flexor carpi ulnaris</i> into the fifth metacarpal, the pisiform and
-the unciform bones, while the <i>palmaris longus</i> goes to the anterior
-annular ligament of the wrist and the palmar fascia of the hand. The
-<i>flexor sublimis digitorum</i> is inserted by four tendons into the second
-phalanges of the fingers, while the <i>flexor profundus digitorum</i> arises
-from the upper part of the ulna and is inserted into the last phalanges
-of the fingers. The <i>flexor of the thumb</i> arises from the middle of the
-radius and is inserted into the last phalanx of the thumb. Which joint
-is flexed by a muscle depends upon the origin and insertion of the
-muscle, all those included between being affected. Thus, the <i>flexor
-sublimis digitorum</i>, which has its origin in part at least from the
-condyle and is inserted in the second phalanges of the fingers, flexes
-the forearm, wrist, and all the finger-joints but the last, while the
-<i>flexor profundus digitorum</i>, arising from the ulna, though it flexes
-the wrist and fingers, has no power of flexing the forearm.</p>
-
-<p>The <i>pronator radii teres</i>, besides arising from the supra-condylar
-ridge, rises from the coronoid process of the ulna. It is inserted into
-the middle of the outer surface of the radius and serves to pronate
-the forearm. The other pronator, the <i>pronator quadratus</i>, is a small
-quadrilateral muscle extending transversely across the radius and ulna
-just above their carpal extremities. It rises from the anterior surface
-of the ulna and is inserted into the anterior external border of the radius.</p>
-
-<p>On the back of the forearm the <i>anconeus</i> serves to extend the forearm
-only, being inserted into the upper part of the posterior surface of
-the ulna. The <i>extensors of the wrist</i> are inserted into the bases of
-the various metacarpal bones and have some power to extend the forearm
-as well as the wrist. The <i>extensors of the thumb</i>, as their names
-imply, go one to the metacarpal bone and one to each of the phalanges,
-<span class="pagenum"><a name="Page_184" id="Page_184">[Pg 184]</a></span>
-the longest one extending the whole thumb, the others only a part. They
-rise from the ulna and radius, not the condyle. The <i>extensor communis
-digitorum</i> goes to all the phalanges of all the fingers, the <i>extensor
-minimi digiti</i> to those of the little finger only, and the <i>extensor
-indicis</i> to those of the index finger, the last two arising short of
-the condyle.</p>
-
-<p>Of the <i>supinators</i> the longer one is inserted into the styloid process
-of the radius, while the shorter one, the <i>supinator brevis</i>, is
-inserted into the upper part of the same bone, both thus serving to
-turn the radius on the ulna.</p>
-
-<p>Where the <i>tendons</i> of the various muscles pass over the wrist, both
-front and back, they are covered with a synovial sheath and are held
-down by a broad ligament, which some of them perforate, the annular
-ligament. The strong fibrous band of the <i>anterior annular ligament</i>
-arches over the carpal bones in front. Beneath it pass the median nerve
-and the tendons of the flexors of the fingers and thumb. The <i>posterior
-annular ligament</i> is of less importance.</p>
-
-<p>The deep <i>palmar fascia</i> forms a sheath for the muscles of the hand.
-In carpenters there sometimes occurs <i>Dupuytren’s contraction</i> of the
-palmar fascia, which draws the fingers up. As operation is not always
-successful, it is quite a serious matter.</p>
-
-<p>The <i>muscles of the hand</i> itself include various abductor, adductor,
-and short flexor muscles of the thumb and little finger. There also
-extend between the metacarpal bones the <i>lumbricales</i>, four small
-muscles that aid the deep flexor muscles; likewise seven <i>interossei</i>,
-of which four are dorsal and three palmar. The <i>dorsal interossei</i>
-arise by two heads from the adjacent sides of the metacarpal bones and
-are inserted into the bases of the first phalanges, thus abducting the
-fingers; while the <i>palmar interossei</i>, arising from the palmar surface
-of the second, fourth, and fifth metacarpals, are inserted into the
-<span class="pagenum"><a name="Page_185" id="Page_185">[Pg 185]</a></span>
-three corresponding first phalanges and adduct the fingers toward an
-imaginary line drawn through the middle finger.</p>
-
-<p><b>Joints of the Upper Extremity.</b>—The joints of the upper
-extremity, with the exception of the wrist-joint, are the most freely
-movable of any in the body, probably because the hand has the finest
-work to do and a greater number of motions are required. Even the wrist
-has much greater freedom of motion than the corresponding joint in the
-lower extremity.</p>
-
-<p>The <i>shoulder-joint</i> is rather a deep joint, to allow of the varied
-motion required, and has a capsular ligament from the margin of the
-glenoid fossa above to the neck of the humerus below. The <i>elbow</i>,
-which is a hinge joint, has an anterior and a posterior ligament and
-two lateral ligaments, as is practically the case in all such joints.
-The <i>wrist</i> has several ligaments which, taken together, are capsular
-in nature.</p>
-
-<p><b>Blood Supply of the Upper Extremity.</b>—The blood supply of the
-upper extremity comes through the <i>subclavian artery</i>, which, on
-the right, springs from the innominate artery and on the left from
-the aortic arch. It remains one trunk as far as the elbow, though
-different names have been given to different parts. Thus, as it passes
-over the lower border of the first rib, it becomes the <i>axillary</i>,
-and at the lower border of the axilla, where it starts down the arm,
-the <i>brachial</i>. At the elbow it divides into the <i>ulnar</i> and
-<i>radial arteries</i>.</p>
-
-<p>In its upper part the <i>brachial artery</i> lies internal to the humerus
-but below it is in front of the bone. The <i>radial</i> runs in a line from
-the middle of the elbow anteriorly to the inner side of the styloid
-process of the radius and is much exposed to injury in the lower third
-of its course, as when the hand is thrust through glass. On it at the
-wrist the pulse is counted. It is much smaller than the ulnar and winds
-around the outer side of the thumb to the palm, where, with the deep
-branch from the ulnar, it forms the <i>deep palmar arch</i>. The
-<span class="pagenum"><a name="Page_186" id="Page_186">[Pg 186]</a></span>
-<i>ulnar artery</i> passes obliquely inward to the middle of the forearm and
-thence along its ulnar border to the palm of the hand, where it divides
-into the deep branch and the <i>superficial palmar arch</i> which supplies
-the four <i>digital arteries</i>.</p>
-
-<p>From the <i>axillary artery</i> branches go to the chest wall and shoulder,
-the most important being the two <i>circumflex arteries</i> to the deltoid.
-The brachial has only two branches of any importance, the <i>superior</i>
-and <i>inferior profunda</i>, both on the upper arm, of course.</p>
-
-<p>In case of <i>hemorrhage</i> compression can frequently be applied with
-the fingers where the subclavian crosses the rib or in the axilla, where
-the artery can be pressed up against the humerus.</p>
-
-<p><b>Nerves.</b>—The nerve supply of the shoulder comes chiefly from
-the anterior and posterior <i>thoracic</i>, the <i>suprascapular</i>, and the
-<i>circumflex</i>, these last going to the deltoid. The biceps is supplied
-by the <i>musculo-cutaneous</i>, the triceps by the <i>musculo-spiral</i>,
-and the brachialis anticus by both. Most of the flexor and pronator muscles
-are supplied by the <i>median</i>, while the <i>posterior interosseous</i>
-and the <i>musculo-spiral nerves</i> go to the extensors and supinators. The
-<i>ulnar nerve</i> supplies the hand largely.</p>
-
-<hr class="chap" />
-<div class="chapter">
-<p><span class="pagenum"><a name="Page_187" id="Page_187">[Pg 187]</a></span></p>
-<h2 class="nobreak">CHAPTER XIII.<br /><span class="h2_subtitle">THE LOWER EXTREMITIES.</span></h2></div>
-
-<p>The lower extremities resemble the upper very closely in the
-arrangement of the bones, muscles, arteries, and nerves, though
-modifications occur, due to the difference in function of the lower
-limbs. There is one long bone in the upper part or thigh, the femur,
-and two in the lower part or leg, the tibia and fibula, while over the
-knee-joint is the patella or knee-cap. The ankle has seven bones and
-the foot nineteen like the hand.</p>
-
-<p><b>The Femur.</b>—<a href="#FIG_74">The femur</a> is the longest bone in the body,
-being about one-fourth the height of the person. It inclines toward its
-fellow at the knee in order to bring the knee-joints near the center of
-gravity in walking, the amount of inclination varying with the width of
-the hips and the height of the person. On account of the greater width
-of hip the tendency to knock-knee is greater in women than in men.</p>
-
-<p>The <i>shaft</i> of the femur is enlarged at the extremities and is
-slightly curved forward, the concavity being strengthened at the back
-by a longitudinal ridge, the <i>linea aspera</i>, along part of which the
-gluteus maximus muscle is attached. The <i>head</i>, which is covered with
-cartilage, except for an oval depression for the attachment of the
-ligamentum teres, one of the ligaments of the hip-joint, and which
-articulates with the hollow of the acetabulum in the os innominatum,
-projects considerably upward, inward, and forward from the shaft,
-the <i>neck</i> varying much in length and angle. It is generally more
-<span class="pagenum"><a name="Page_188" id="Page_188">[Pg 188]</a></span>
-horizontal in women than in men and in rickets the great weight on the
-softened bone tends to press the head down, causing the deformity known
-as “<i>coxa vera</i>”, in which the neck is almost horizontal. Extending
-upward, outward, and backward from the shaft at the base of the neck,
-about three-quarters of an inch lower than the head and about on a
-<span class="pagenum"><a name="Page_189" id="Page_189">[Pg 189]</a></span>
-level with the acetabulum and the spine of the os pubis, is the
-<i>greater trochanter</i>. This large, irregular prominence and the smaller
-one of the <i>lesser trochanter</i>, which is at the lower part of the
-base of the neck posteriorly, are for the attachment of muscles and
-to assist in rotating the bone. The lower extremity of the femur is
-larger than the upper and is flat from before backward. Between its
-two large eminences, the external and internal <i>condyles</i>, is a smooth
-depression in front, the <i>trochlear surface</i>, for articulation with
-the patella. The external condyle is more prominent in front, the internal
-inferiorly, the latter being the longer of the two by about half an
-inch. The <i>epiphysis</i> at the lower end of the femur is the only one
-in which ossification has begun at birth. Therefore, if ossification is
-found there, the child is known to have arrived at full term.</p>
-
-<div class="figcenter">
-    <img id="FIG_74" src="images/i_188.jpg" alt="" width="300" height="680" />
-    <p class="center"><span class="smcap">Fig. 74.</span>—Bones of
-               the lower extremity.<br /> (Toldt.)</p>
-</div>
-
-<p>So many large muscles are attached to the femur that the shaft cannot
-be detected in the living unless the person is very thin and poorly
-developed. The outer surface of the greater trochanter, however, and
-the condyles can be felt.</p>
-
-<p>A string stretched from the anterior superior spine of the ilium to the
-tuberosity of the ischium passes in the middle just over the upper edge
-of the greater trochanter. The line thus drawn is known as <i>Nélaton’s
-line</i> and is of considerable importance in many conditions of the
-hip. Thus, if the hip is dislocated, the trochanter will be thrown
-above <i>Nélaton’s line</i>, and in osteomalacia the pelvis sinks and the
-trochanter is again above the line.</p>
-
-<p><b>Thigh Muscles.</b>—Of the thigh muscles only a few need be
-mentioned. One large muscle is the <a href="#FIG_76"><i>psoas magnus</i></a>, which has its origin
-on the front of the last dorsal and all the lumbar vertebræ, passes
-<span class="pagenum"><a name="Page_190" id="Page_190">[Pg 190]</a></span>
-down across the brim of the pelvis and under Poupart’s ligament,
-gradually diminishing in size, and terminates in a tendon that is
-inserted into the lesser trochanter. It serves to flex the thigh on the
-pelvis and to rotate it outward. The <i>psoas parvus</i> rises from the last
-dorsal and the first lumbar vertebræ and does not go out of the pelvis.</p>
-
-<p>The <a href="#FIG_75"><i>sartorius</i> or <i>tailor muscle</i></a> is flat and ribbon-like
-and is the longest muscle in the body. It rises from the anterior superior spine
-of the ilium and is inserted into the upper inner surface of the shaft
-of the <a href="#FIG_74">tibia</a>. By it the legs are crossed. It also forms the outer side
-of an important landmark, <i>Scarpa’s triangle</i>, whose base is formed by
-Poupart’s ligament and the inner side by the <a href="#FIG_75"><i>adductor magnus muscle</i></a>,
-which passes from the ramus of the os pubis and the tuberosity of the
-ischium to the linea aspera. The <i>femoral artery</i> bisects the triangle
-and runs into its apex.</p>
-
-<p>The bulk of the anterior portion of the thigh is formed by the
-<i>quadriceps extensor</i>, which is really made up of four muscles, the
-<a href="#FIG_76"><i>rectus femoris</i></a>, whose origin is on the anterior inferior iliac spine
-and above the acetabulum; the <a href="#FIG_75"><i>vastus externus</i></a>, which comes from
-the greater trochanter and the upper linea aspera; and the <a href="#FIG_77"><i>vastus
-internus</i></a> and <i>crureus</i>, which rise from the neck of the <a href="#FIG_74">femur</a>
-and the linea aspera. It is inserted into the tubercle of the tibia by
-the <i>ligamentum patellæ</i>, in which the <a href="#FIG_74">patella</a> lies. Its action is
-to extend the leg.</p>
-
-<p>At the back and forming the <i>buttocks</i> are the three glutei muscles,
-the <a href="#FIG_75"><i>gluteus maximus</i>, <i>medius</i>, and <i>minimus</i></a>. All these rise
-from the outer side of the ilium and have their insertion on or about the great
-trochanter. They serve to hold the trunk erect and to extend, abduct,
-and rotate the thigh.
-<span class="pagenum"><a name="Page_191" id="Page_191">[Pg 191]</a></span></p>
-
-<div class="figcontainer">
-  <div class="figsub">
-   <img id="FIG_75" src="images/i_191a.jpg" alt="" width="200" height="536" />
-   <p class="center"><span class="smcap">Fig. 75.</span></p>
-  </div>
-  <div class="figsub">
-   <p class="center">&nbsp;</p>
-   <img  id="FIG_76" src="images/i_191b.jpg" alt="" width="200" height="441" />
-   <p class="center"><span class="smcap">Fig. 76.</span></p>
-   </div>
-  <div class="figsub">
-   <img  id="FIG_77" src="images/i_191c.jpg" alt="" width="200" height="486" />
-   <p class="center"><span class="smcap">Fig. 77.</span></p>
-   </div>
-   <p class="blockquot"><span class="smcap">Fig. 75.</span>—Superficial muscles of hip and
-          thigh (from behind): 1, Gluteus medius; 2, gluteus maximus; 3,
-          vastus externus; 4, biceps flexor cruris; 5, semitendinosus; 6,
-          semimembranosus; 7, gracilis; 8, sartorius; 9, adductor magnus; 10, 11,
-          gastrocnemius; 12, origin of plantaris. (Dorland’s Dictionary.)</p>
-   <p class="blockquot"><span class="smcap">Fig. 76.</span>—Muscles of the inner side of thigh and
-          interior of pelvis: 1, Iliacus; 2, psoas magnus; 3, obturator internus; 4,
-          pyriformis; 5, erector spinæ; 6, gluteus maximus; 7, sartorius; 8,
-          adductor longus; 9, gracilis; 10, adductor magnus; 11, semimembranosus;
-          12, semitendinosus; 13, rectus femoris; 14, vastus internus. (Dorland’s Dictionary.)</p>
-   <p class="blockquot"><span class="smcap">Fig. 77.</span>—Superficial muscles of front of thigh: 1,
-          Insertion of external oblique into iliac crest; 2, aponeurosis of external
-          oblique; 3, external abdominal ring; 4, gluteus medius; 5, tensor
-          vaginæ formoris; 6, sartorius; 7, iliopsoas; 8, pectineus; 9, adductor
-          longus; 10, gracilis; 11, adductor magnus; 12, vastus externus;
-          13, rectus femoris; 14, vastus internus; 15, biceps flexor cruris.
-          (Dorland’s Dictionary.)</p>
-</div>
-
-<p>Lower down and forming the back of the thigh are the biceps and the
-semitendinosus and semimembranosus muscles. The <i>biceps</i> rises by two
-heads from the tuberosity of the ischium and the linea aspera and is
-inserted into the head of the fibula. It is on the outer side of the
-thigh and its tendon, which embraces the external lateral ligament of
-the knee-joint, forms the <i>outer hamstring</i>. On the inner side are the
-<i>semitendinosus</i> and the <i>semimembranosus muscles</i>. These rise from
-the tuberosity of the ischium and are inserted, the one into the upper
-inner surface of the shaft of the tibia and the other into the internal
-tuberosity of the tibia. Their tendons form the <i>inner hamstring</i>. Like
-<span class="pagenum"><a name="Page_192" id="Page_192">[Pg 192]</a></span>
-the biceps they serve to extend the thigh and flex the leg on the
-thigh, but where the biceps rotates the leg out they, being attached to
-the inner side of the leg bones, rotate it in.</p>
-
-<p><a href="#FIG_74"><b>The patella</b></a>, or <i>small pan</i>, is a flat, somewhat
-triangular bone developed in the quadriceps extensor tendon. Four <i>muscles</i> are
-attached to it as well as the ligamentum patellæ, which holds it to the
-tibia and gives increased leverage by making the quadriceps extensor
-work at a greater angle. It articulates with the condyles and serves
-to protect the joint. One bursa, the <i>prepatella bursa</i>, separates it
-from the skin and another, surrounded by adipose tissue, from the head
-of the tibia. The external surface can be seen and felt on the front of
-the knee and the bone can be moved from side to side when the leg is straight.</p>
-
-<p><b>Joints of the Lower Extremity.</b>—The <i>hip-joint</i> is a
-ball-and-socket joint but is not so freely movable as the shoulder-joint,
-the head of the femur being held in the acetabulum by many strong ligaments,
-of which the most important is the <i>capsular</i> ligament.</p>
-
-<p>The <a href="#FIG_78"><i>knee-joint</i></a> is largely a hinge joint, but in some
-positions it has some rotation. It is formed by the condyles of the femur, the head of
-the tibia, and the patella, and has fourteen ligaments, including the
-<a href="#FIG_79"><i>ligamentum patellæ</i></a> and the <i>crucial ligaments</i>. Its synovial sac
-is the largest found in any joint. Two <a href="#FIG_79"><i>semilunar cartilages</i></a>, placed on
-the head of the tibia, serve to deepen the socket for the condyles,
-changing somewhat in shape and thickness as the joint moves. The
-interval between the thigh and the leg bones can be felt at the knee.
-When the leg is extended the juncture of the bones is slightly above
-the patella, while in flexion a knife passed below the apex of the
-patella will pass into the joint.</p>
-
-<p><i>Congenital dislocation</i> of the hip occurs. <i>Separation of the
-epiphysis of the femur</i> may occur and sometimes the neck, rarely
-the lower part of the shaft, is <i>fractured</i>. Either condyle may be
-fractured off or there may be a T-fracture, in which case the popliteal
-<span class="pagenum"><a name="Page_193" id="Page_193">[Pg 193]</a></span>
-artery may be injured. In <i>dislocation</i> the head may be behind or
-in front of the acetabulum. <i>Impacted hip</i>, where the neck of the
-femur has, in a fall, been driven into the head, is common in old
-people. Sometimes, especially in young children, the bone is infected,
-<i>osteomyelitis</i>. <i>Sarcoma</i> occurs. Most tubercular disease of the
-hip originates at the upper extremity of the femur, <i>tuberculosis</i>
-generally starting in the head and then attacking the capsule and
-the soft parts of the joint. If neglected, shortening of the leg may
-result, in which case the bone has to be broken and set at an angle in
-order to enable the child to walk.</p>
-
-<div class="figcontainer">
-  <div class="figsub">
-   <img id="FIG_78" src="images/i_193a.jpg" alt="" width="250" height="398" />
-   <p class="center"><span class="smcap">Fig. 78.</span></p>
-  </div>
-  <div class="figsub">
-   <img  id="FIG_79" src="images/i_193b.jpg" alt="" width="250" height="418" />
-   <p class="center"><span class="smcap">Fig. 79.</span></p>
-   </div>
-   <p class="blockquot"><span class="smcap">Fig. 78.</span>—Right knee-joint, posterior view. (Leidy.)</p>
-   <p class="blockquot"><span class="smcap">Fig. 79.</span>—Right knee-joint, showing internal ligaments: 2,
-          anterior crucial ligament; 3, posterior crucial ligament; 4, transverse
-          ligament; 6, 7, semilunar fibro-cartilages. (Leidy.)</p>
-</div>
-
-<p>Occasionally a bit of cartilage gets broken off in the knee-joint and
-wedged between the bones, so that the joint cannot be straightened.
-This is <a href="#FIG_79"><i>dislocation of the semilunar cartilage</i></a> and necessitates an
-operation for removal of the piece. The cartilage will eventually be
-<span class="pagenum"><a name="Page_194" id="Page_194">[Pg 194]</a></span>
-replaced by fibrous tissue and in a few months the leg will be all
-right. <i>Dislocation of the knee</i> is rare, though it may occur in any
-direction. Often the bursæ of the joint are irritated, as by kneeling
-to scrub floors, and <i>bursitis</i> or <i>housemaid’s knee</i> results.
-<i>Fracture of the patella</i> may be caused by muscular traction or by
-direct violence, and is generally repaired by making an incision
-and sewing the parts of the bone together. <i>Tumor albus</i> or <i>white
-swelling</i> is <i>tuberculosis of the knee</i> and is fairly common in
-children. <i>Specific knee</i> means <i>syphilis of the knee</i> and generally
-occurs in both knees.</p>
-
-<p><b>The Tibia.</b>—<a href="#FIG_74">The tibia or <i>shin bone</i></a> is next longest to
-the femur and is on the inner side of the leg, corresponding to the
-ulna in the arm. The <i>shaft</i> is prismoid and is more slender for
-the lower quarter, where fracture is consequently most frequent.
-The anterior border forms the <i>crest</i> or shin and can be felt for
-its upper two-thirds. The lower extremity, which is smaller than
-the upper, articulates with the astragalus bone of the ankle and
-with the fibula. Its <i>head</i> or upper extremity is expanded into two
-lateral <i>tuberositis</i> for articulation with the femur and for muscular
-attachment, both of which can easily be felt just below the bend of
-the knee. Their upper surfaces are smooth and concave, with a vertical
-bifid spine in the middle and a prominent tubercle for the attachment
-of the semilunar cartilages on either side. On the anterior surface of
-the head, below, is a rough eminence or tubercle, which also can be
-felt. The lower part of this is for the attachment of the ligamentum
-patellæ, while the upper part, which is smoother, is for the bursa that
-is placed under the tendon to prevent friction. On the back of the
-outer tuberosity is a facet for the head of the fibula. At the lower
-end there projects downward on the inner side, overhanging the arch of
-the foot, the <i>internal malleolus</i>, the prominent part of the ankle.
-It is on a higher level and somewhat farther forward than the <i>external
-malleolus</i>.</p>
-
-<p><b>The Fibula.</b>—<a href="#FIG_74">The fibula</a> is the most slender of all the bones in
-<span class="pagenum"><a name="Page_195" id="Page_195">[Pg 195]</a></span>
-proportion to its length and is on the outer side of the leg. Its
-<i>head</i> is small and placed toward the back of the tibia below the
-knee-joint, from which it is excluded. The head articulates with the
-external tuberosity and has extending upward from it the styloid
-process. To it is attached the <i>biceps tendon</i> or <i>outer hamstring</i>.
-At the lower extremity of the shaft is the <i>external malleolus</i>, which
-articulates with the astragalus and forms the outer ankle. The only
-parts of the fibula that can be felt, besides the malleolus, which is
-very prominent, are the head and the lower external surface of the shaft.</p>
-
-<p>In <i>fracture of the leg</i> both bones are usually broken, though either
-may be broken separately. <i>Pott’s fracture</i> is fracture of the lower
-fibula, and may be caused by stamping hard when stepping on to the
-sidewalk. In rickets the tibia becomes bowed outward and forward,
-causing <i>bow leg</i>, a condition which in very young children may be
-rectified by manipulation. Later on braces are needed and after five
-years the bones have to be broken and set straight.</p>
-
-<p><b>The Ankle.</b>—The ankle or <a href="#FIG_74"><i>tarsus</i></a> has but seven bones where the
-wrist has eight. They are the <i>os calcis</i> or <i>heel bone</i>, which is
-the largest and strongest and forms the tuberosity of the heel; the
-<i>astragalus</i>, which is next largest and helps to form the ankle-joint;
-the <a href="#FIG_80"><i>cuboid</i></a>; the <a href="#FIG_80"><i>navicular</i></a>
-(<i>boat-like</i>) or <i>scaphoid</i>; and the internal, middle, and external
-<a href="#FIG_80"><i>cuneiform bones</i></a>. The astragalus
-is above and partially in front of the os calcis, to which is attached
-the <i>tendo Achillis</i>. The <a href="#FIG_80"><i>cuboid</i></a> is on the outer
-side of the foot, in front of the os calcis and behind the metatarsals. It is noticeable
-in <i>congenital club-foot</i>, in which condition the tarsal bones may be
-distorted in shape and misplaced. The <i>navicular</i> or <i>scaphoid</i>
-is on the inner side of the foot, between the astragalus and the three
-cuneiform bones.</p>
-
-<p><b>The Foot.</b>—There are five <a href="#FIG_74"><i>metatarsal bones</i></a> in
-the foot, corresponding to the five metacarpals in the hand, and the toes have
-<span class="pagenum"><a name="Page_196" id="Page_196">[Pg 196]</a></span>
-the same number of <a href="#FIG_80"><i>phalanges</i></a> as the fingers, though
-they are shorter and stronger. The big toe corresponds to the thumb.</p>
-
-<div class="figcenter">
-    <img id="FIG_80" src="images/i_196.jpg" alt="" width="450" height="530" />
-    <p class="blockquot"><span class="smcap">Fig. 80.</span>—Bones of the
-           right foot, dorsal surface: 1, Astragalus; 2, talus; 3, os calcis,
-           4, navicular; 5, internal cuneiform; 6, middle cuneiform;
-           7, external cuneiform; 8, cuboid; 9, metatarsus; 10-14,
-           phalanges. (Leidy.)</p>
-</div>
-
-<p><i>Fracture</i> of the os calcis and the astragalus are most commonly
-caused by a fall from a height, while the metatarsals and phalanges are
-generally broken by something heavy falling upon them. Because of their
-delicate structure, their distance from the heart, and the differences
-of temperature to which they are subjected, the tarsal bones are
-especially liable to become <i>tubercular</i>, amputation of the feet even
-becoming necessary at times. In diabetes there may be a perforating
-ulcer on the sole of the foot and the bone may become diseased.
-<span class="pagenum"><a name="Page_197" id="Page_197">[Pg 197]</a></span></p>
-
-<div class="figcontainer">
-  <div class="figsub">
-   <img id="FIG_81" src="images/i_197a.jpg" alt="" width="200" height="442" />
-   <p class="center"><span class="smcap">Fig. 81.</span></p>
-  </div>
-  <div class="figsub">
-   <p class="center">&nbsp;</p>
-   <img  id="FIG_82" src="images/i_197b.jpg" alt="" width="150" height="447" />
-   <p class="center"><span class="smcap">Fig. 82.</span></p>
-   </div>
-  <div class="figsub">
-   <img  id="FIG_83" src="images/i_197c.jpg" alt="" width="150" height="451" />
-   <p class="center"><span class="smcap">Fig. 83.</span></p>
-   </div>
-   <p class="blockquot"><span class="smcap">Fig. 81.</span>—Superficial muscles of
-           the leg from inner side: 1, Vastus internus; 2, sartorius; 3, gracilis;
-           4, semitendinosus; 5, semimembranosus; 6, inner head of gastrocnemius;
-           7, soleus; 8, tendon of plantaris; 9, tendon of tibialis posticus;
-           10, flexor longus digitorum; 11, flexor longus hallucis; 12, tibialis
-           anticus; 13, abductor hallucis. (Dorland’s Dictionary.)</p>
-   <p class="blockquot"><span class="smcap">Fig. 82.</span>—Muscles of leg and foot
-           (from before): 1, Tendon of rectus femoris; 2, vastus internus; 3, vastus
-           externus; 4, sartorius; 5, iliotibial band; 6, inner head of gastrocnemius;
-           7, inner part of soleus; 8, tibialis anticus; 9, extensor proprius hallucis;
-           10, extensor longus digitorum; 11, peroneus longus; 12, peroneus brevis;
-           13, peroneus tertius; 14, origin of extensor brevis digitorum.
-          (Dorland’s Dictionary.)</p>
-   <p class="blockquot"><span class="smcap">Fig. 83.</span>—Superficial muscles of leg
-          (from behind): 1, Vastus externus; 2, biceps flexor cruris; 3, semitendinosus;
-          4, semimembranosus; 5, gracilis; 6, sartorius; 7, outer, and 8, inner, head of
-          gastrocnemius; 9, plantaris; 10, soleus; 11, peroneus longus; 12, peroneus brevis;
-          13, flexor longus digitorum; 14, tibialis posticus; 15, lower fibers of flexor
-          longus hallucis. (Dorland’s Dictionary.)</p>
-</div>
-
-<p><b>Muscles of the Leg.</b>—The greater part of the calf of the leg
-is formed by the <a href="#FIG_81"><i>gastrocnemius</i></a>, a large bulging muscle, which rises
-from the condyles of the femur and is inserted along with the <a href="#FIG_81"><i>soleus</i></a>,
-whose origin is on the back of the upper fibula, and the <a href="#FIG_81"><i>plantaris</i></a>,
-which comes from the linea aspera, into the os calcis by a common
-tendon, the <i>tendo Achillis</i>, the largest and strongest tendon in
-the body. Its action is to extend the foot and to rotate it slightly
-inward. Other extensors of the foot, which also evert it, are the
-<a href="#FIG_83"><i>peroneus longus</i></a> and the <a href="#FIG_82"><i>peroneus brevis</i></a>
-at the upper and outer part of the leg, the former rising from the outer tuberosity of the tibia and
-<span class="pagenum"><a name="Page_198" id="Page_198">[Pg 198]</a></span>
-the upper fibula and being inserted into the first metatarsal and the
-internal cuneiform, the latter arising from the lower fibula and being
-inserted into the fifth metatarsal. The foot is flexed, adducted, and
-rotated inward by means of the <a href="#FIG_81"><i>tibialis anticus</i></a>, which
-rises from the outer tuberosity and the upper two-thirds of the outer surface of the
-tibia and is inserted into the internal cuneiform bone.</p>
-
-<p>In the foot, and corresponding to the palmar fascia in the hand, is
-the <i>plantar fascia</i>, the densest of all fibrous membranes. There are
-also various annular ligaments, and the <i>foot muscles</i> are arranged
-similarly to those in the hand.</p>
-
-<p><b>The Blood Supply of the Lower Extremity.</b>—The blood supply of
-the lower extremity comes from the <i>external iliac artery</i>, a branch of
-the <i>common iliac</i>, which passes obliquely downward and outward along
-the border of the psoas muscle to Poupart’s ligament, where it enters
-the thigh and becomes the <i>femoral artery</i>. Its only important branches
-are the <i>deep epigastric</i>, which goes up along the internal abdominal
-ring, and the <i>deep circumflex iliac</i>. As the <i>femoral artery</i> it
-passes down the inner side of the thigh to the internal condyle of the
-femur, being very superficial at Scarpa’s triangle, where it can be
-compressed with the thumb to stop hemorrhage below. If a tourniquet is
-applied, it should be applied a little lower down. The first and most
-important branch of the femoral is the <i>profunda femoris</i>.</p>
-
-<p>About two-thirds of the way to the knee the artery takes the name
-<i>popliteal</i>. It lies superficially in the popliteal space back of
-the knee, but above and below it is covered with muscles. Its branches
-supply the knee-joint and nearby muscles and are unimportant. At the
-lower border of the <i>popliteus muscle</i>, a small muscle at the knee, it
-divides into the <i>anterior and posterior tibial arteries</i>. The course
-of the former of these may be marked by a line from the inner side of
-the head of the fibula to midway between the malleoli at the front of
-<span class="pagenum"><a name="Page_199" id="Page_199">[Pg 199]</a></span>
-the ankle, where it terminates in the <i>dorsalis pedis artery</i> for the
-back of the foot. By this last the pulse is sometimes taken and its
-pulsation is a guide in determining how high up to amputate in gangrene
-of the foot. The posterior tibial extends obliquely down the back of
-the leg to the heel, where it divides into the <i>internal and external
-plantar arteries</i> which go to the sole of the foot. Its most important
-branch is the <i>peroneal</i>.</p>
-
-<p>Besides the <i>deep veins</i> accompanying the arteries there are the
-<i>superficial veins</i>, the <i>internal</i> or <i>long saphenous</i> on the
-inner side of the leg and thigh and the <i>external</i> or <i>short saphenous</i>
-on the middle of the leg posteriorly and emptying into the popliteal vein.
-Varicosity often occurs in these veins.</p>
-
-<p><b>Nerves.</b>—The nerves of the muscles about the hip are branches of
-the <i>lumbar nerve</i>. The <i>anterior crural</i> supplies the anterior part
-of the thigh, the <i>gluteal</i> the muscles of the same name, and the <i>great
-sciatic</i> the large muscles of the back of the thigh. Below the knee
-the <i>anterior tibial</i> goes to the tibialis anticus and the <i>internal
-popliteal</i> to the muscles of the calf, while the peroneus muscles are
-supplied by the <i>musculo-cutaneous</i>.
-<span class="pagenum"><a name="Page_200" id="Page_200">[Pg 200]</a></span></p>
-
-<hr class="chap" />
-<p><span class="pagenum"><a name="Page_201" id="Page_201">[Pg 201]</a></span></p>
-
-<div class="chapter">
-   <h2 class="nobreak"><a name="INDEX" id="INDEX">INDEX.</a></h2>
-</div>
-
-<ul class="index">
-<li class="isub1">Abdomen, <a href="#Page_132">132</a></li>
-<li class="isub3">muscles, <a href="#Page_132">132</a>, <i>et seq.</i></li>
-<li class="isub3">nerves, <a href="#Page_134">134</a></li>
-<li class="isub3">regions, <a href="#Page_134">134</a>, <a href="#Page_135">135</a></li>
-<li class="isub3">contents, <a href="#Page_135">135</a>, <a href="#Page_136">136</a></li>
-<li class="isub1">Abdominal aorta, <a href="#Page_107">107</a>, <a href="#Page_109">109</a></li>
-<li class="isub1">Abducens nerve, <a href="#Page_83">83</a></li>
-<li class="isub1">Abscess, <a href="#Page_34">34</a>, <a href="#Page_51">51</a>, <a href="#Page_52">52</a>, <a href="#Page_100">100</a>,
-                  <a href="#Page_137">137</a>, <a href="#Page_152">152</a>, <a href="#Page_159">159</a>, <a href="#Page_168">168</a></li>
-<li class="isub1">Absorbent vessels or lymphatics, <a href="#Page_34">34</a></li>
-<li class="isub1">Absorption of food, <a href="#Page_33">33</a></li>
-<li class="isub3">in intestines, <a href="#Page_144">144</a></li>
-<li class="isub3">in mouth, <a href="#Page_136">136</a></li>
-<li class="isub3">in stomach, <a href="#Page_140">140</a></li>
-<li class="isub1">Accommodation of eye, <a href="#Page_72">72</a></li>
-<li class="isub1">Acetabulum, <a href="#Page_162">162</a>, <a href="#Page_187">187</a></li>
-<li class="isub1">Acromion process, <a href="#Page_173">173</a></li>
-<li class="isub1">Adam’s apple, <a href="#Page_121">121</a></li>
-<li class="isub1">Adductor magnus muscle, <a href="#Page_190">190</a></li>
-<li class="isub1">Adenoids, <a href="#Page_62">62</a></li>
-<li class="isub1">Adipose tissue, <a href="#Page_16">16</a></li>
-<li class="isub1">Air, changes by breathing, <a href="#Page_129">129</a>, <a href="#Page_130">130</a></li>
-<li class="isub3">complemental, <a href="#Page_129">129</a></li>
-<li class="isub3">residual, <a href="#Page_129">129</a></li>
-<li class="isub3">supplemental, <a href="#Page_129">129</a></li>
-<li class="isub3">tidal, <a href="#Page_129">129</a></li>
-<li class="isub1">Air cells, <a href="#Page_27">27</a></li>
-<li class="isub1">Albumin in urine, <a href="#Page_158">158</a></li>
-<li class="isub1">Albuminoids, <a href="#Page_12">12</a></li>
-<li class="isub1">Alimentary canal, <a href="#Page_136">136</a>, <i>et seq.</i></li>
-<li class="isub1">Alveoli of lungs, <a href="#Page_126">126</a></li>
-<li class="isub1">Amœba, <a href="#Page_12">12</a></li>
-<li class="isub1">Ampullæ of mamma or breast, <a href="#Page_100">100</a></li>
-<li class="isub1">Amputation, <a href="#Page_177">177</a></li>
-<li class="isub1">Amylopsin, <a href="#Page_144">144</a></li>
-<li class="isub1">Anabolism, <a href="#Page_147">147</a></li>
-<li class="isub1">Anasarca, <a href="#Page_152">152</a></li>
-<li class="isub1">Anatomy, <a href="#Page_11">11</a></li>
-<li class="isub1">Anconeus muscle, <a href="#Page_182">182</a>, <a href="#Page_183">183</a></li>
-<li class="isub1">Anemia, <a href="#Page_120">120</a></li>
-<li class="isub1">Aneurism, <a href="#Page_109">109</a></li>
-<li class="isub1">Ankle, <a href="#Page_195">195</a></li>
-<li class="isub1">Annular ligaments, <a href="#Page_184">184</a>, <a href="#Page_198">198</a></li>
-<li class="isub1">Ano-spinal reflex, <a href="#Page_146">146</a></li>
-<li class="isub1">Antrum of Highmore, <a href="#Page_54">54</a>, <a href="#Page_57">57</a></li>
-<li class="isub1">Anus, <a href="#Page_141">141</a>, <a href="#Page_146">146</a></li>
-<li class="isub1">Aorta, <a href="#Page_99">99</a>, <a href="#Page_107">107</a>, <a href="#Page_109">109</a></li>
-<li class="isub1">Aortic valve, <a href="#Page_104">104</a></li>
-<li class="isub1">Aponeuroses, <a href="#Page_23">23</a></li>
-<li class="isub1">Apoplexy, <a href="#Page_79">79</a>, <a href="#Page_118">118</a></li>
-<li class="isub1">Appendages of the skin, <a href="#Page_40">40</a></li>
-<li class="isub1">Appendix, vermiform, <a href="#Page_145">145</a></li>
-<li class="isub1">Aqueous humor, <a href="#Page_70">70</a></li>
-<li class="isub1">Arachnoid, <a href="#Page_76">76</a></li>
-<li class="isub1">Areola, <a href="#Page_100">100</a></li>
-<li class="isub1">Areolar tissue, <a href="#Page_15">15</a></li>
-<li class="isub1">Arteries, <a href="#Page_27">27</a>, <a href="#Page_28">28</a>, <a href="#Page_29">29</a>
-              , <a href="#Page_107">107</a></li>
-<li class="isub3">nerves, <a href="#Page_29">29</a></li>
-<li class="isub3">of back, <a href="#Page_94">94</a>, <a href="#Page_95">95</a></li>
-<li class="isub3">of brain, <a href="#Page_77">77</a></li>
-<li class="isub3">of breast, <a href="#Page_100">100</a></li>
-<li class="isub3">of chest, <a href="#Page_99">99</a>
-<span class="pagenum"><a name="Page_202" id="Page_202">[Pg 202]</a></span></li>
-<li class="isub3">of heart, <a href="#Page_107">107</a></li>
-<li class="isub3">of intestine, <a href="#Page_143">143</a>, <a href="#Page_145">145</a></li>
-<li class="isub3">of kidney, <a href="#Page_156">156</a></li>
-<li class="isub3">of lower extremity, <a href="#Page_198">198</a>, <a href="#Page_199">199</a></li>
-<li class="isub3">of organs of generation, <a href="#Page_168">168</a></li>
-<li class="isub3">of pancreas, <a href="#Page_153">153</a></li>
-<li class="isub3">of spleen, <a href="#Page_153">153</a></li>
-<li class="isub3">of stomach, <a href="#Page_139">139</a></li>
-<li class="isub3">of upper extremity, <a href="#Page_185">185</a>, <a href="#Page_186">186</a></li>
-<li class="isub3">structure, <a href="#Page_27">27</a></li>
-<li class="isub1">Artery, axillary, <a href="#Page_99">99</a>, <a href="#Page_100">100</a>, <a href="#Page_108">108</a>,
-                     <a href="#Page_185">185</a></li>
-<li class="isub3">basilar, <a href="#Page_77">77</a>, <a href="#Page_108">108</a></li>
-<li class="isub3">brachial, <a href="#Page_108">108</a>, <a href="#Page_177">177</a>, <a href="#Page_185">185</a></li>
-<li class="isub3">carotid, common, <a href="#Page_107">107</a>, <a href="#Page_108">108</a></li>
-<li class="isub6">internal and external, <a href="#Page_108">108</a>, <a href="#Page_137">137</a></li>
-<li class="isub3">celiac axis, <a href="#Page_109">109</a>, <a href="#Page_143">143</a>, <a href="#Page_150">150</a>,
-                   <a href="#Page_153">153</a></li>
-<li class="isub3">cerebral, <a href="#Page_77">77</a></li>
-<li class="isub3">circumflex, <a href="#Page_186">186</a></li>
-<li class="isub3">coronary, <a href="#Page_107">107</a></li>
-<li class="isub3">communicating, <a href="#Page_78">78</a></li>
-<li class="isub3">digital, <a href="#Page_186">186</a></li>
-<li class="isub3">dorsalis pedis, <a href="#Page_199">199</a></li>
-<li class="isub3">epigastric, deep, <a href="#Page_198">198</a></li>
-<li class="isub3">facial, <a href="#Page_28">28</a></li>
-<li class="isub3">femoral, <a href="#Page_190">190</a>, <a href="#Page_198">198</a></li>
-<li class="isub3">gastric, <a href="#Page_109">109</a></li>
-<li class="isub3">hepatic, <a href="#Page_109">109</a>, <a href="#Page_150">150</a></li>
-<li class="isub3">iliac, common, <a href="#Page_107">107</a>, <a href="#Page_109">109</a></li>
-<li class="isub5">internal and external, <a href="#Page_95">95</a>, <a href="#Page_109">109</a>, <a href="#Page_198">198</a></li>
-<li class="isub5">circumflex, <a href="#Page_198">198</a></li>
-<li class="isub3">innominate, <a href="#Page_107">107</a></li>
-<li class="isub3">intercostal, <a href="#Page_95">95</a>, <a href="#Page_97">97</a>, <a href="#Page_100">100</a>,
-                   <a href="#Page_108">108</a></li>
-<li class="isub3">lumbar, <a href="#Page_95">95</a>, <a href="#Page_109">109</a></li>
-<li class="isub3">mammary, internal, <a href="#Page_99">99</a>, <a href="#Page_100">100</a>, <a href="#Page_108">108</a></li>
-<li class="isub3">mediastinal, <a href="#Page_99">99</a></li>
-<li class="isub3">mesenteric, <a href="#Page_109">109</a>, <a href="#Page_143">143</a>, <a href="#Page_145">145</a>,
-                <a href="#Page_153">153</a></li>
-<li class="isub3">ophthalmic, <a href="#Page_70">70</a></li>
-<li class="isub3">peroneal, <a href="#Page_199">199</a></li>
-<li class="isub3">phrenic, <a href="#Page_99">99</a>, <a href="#Page_109">109</a></li>
-<li class="isub3">plantar, internal and external, <a href="#Page_199">199</a></li>
-<li class="isub3">popliteal, <a href="#Page_198">198</a></li>
-<li class="isub3">profunda, superior and inferior, <a href="#Page_175">175</a>, <a href="#Page_186">186</a></li>
-<li class="isub7">femoris, <a href="#Page_198">198</a></li>
-<li class="isub3">pudic, <a href="#Page_168">168</a></li>
-<li class="isub3">pulmonary, <a href="#Page_106">106</a>, <a href="#Page_110">110</a></li>
-<li class="isub3">radial, <a href="#Page_108">108</a>, <a href="#Page_185">185</a></li>
-<li class="isub3">renal, <a href="#Page_109">109</a></li>
-<li class="isub3">spermatic or ovarian, <a href="#Page_109">109</a>, <a href="#Page_168">168</a></li>
-<li class="isub3">splenic, <a href="#Page_109">109</a>, <a href="#Page_153">153</a></li>
-<li class="isub3">subclavian, <a href="#Page_94">94</a>, <a href="#Page_99">99</a>, <a href="#Page_107">107</a>, <a href="#Page_108">108</a>,
-                          <a href="#Page_185">185</a></li>
-<li class="isub3">suprarenal, <a href="#Page_109">109</a></li>
-<li class="isub3">suprascapular, <a href="#Page_94">94</a></li>
-<li class="isub3">thyroid axis, <a href="#Page_108">108</a></li>
-<li class="isub3">tibial, <a href="#Page_198">198</a></li>
-<li class="isub3">transversalis colli, <a href="#Page_94">94</a></li>
-<li class="isub3">ulnar, <a href="#Page_108">108</a>, <a href="#Page_185">185</a></li>
-<li class="isub3">umbilical, <a href="#Page_107">107</a></li>
-<li class="isub3">uterine, <a href="#Page_168">168</a></li>
-<li class="isub3">vertebral, <a href="#Page_77">77</a></li>
-<li class="isub1">Arytenoid cartilages, <a href="#Page_122">122</a></li>
-<li class="isub1">Ascending aorta, <a href="#Page_107">107</a></li>
-<li class="isub3">colon, <a href="#Page_145">145</a></li>
-<li class="isub1">Ascites, <a href="#Page_34">34</a>, <a href="#Page_152">152</a></li>
-<li class="isub1">Asphyxia, <a href="#Page_128">128</a></li>
-<li class="isub1">Astigmatism, <a href="#Page_73">73</a></li>
-<li class="isub1">Astragalus, <a href="#Page_195">195</a></li>
-<li class="isub1">Atlas, <a href="#Page_91">91</a></li>
-<li class="isub1">Auditory meatus, <a href="#Page_52">52</a></li>
-<li class="isub3">canal, external, <a href="#Page_63">63</a></li>
-<li class="isub6">internal, <a href="#Page_64">64</a></li>
-<li class="isub3">center, <a href="#Page_81">81</a></li>
-<li class="isub3">nerve, <a href="#Page_64">64</a>, <a href="#Page_65">65</a>, <a href="#Page_84">84</a></li>
-<li class="isub1">Auricles of heart, <a href="#Page_103">103</a></li>
-<li class="isub1">Axilla, <a href="#Page_32">32</a></li>
-<li class="isub1">Axillary artery, <a href="#Page_99">99</a>, <a href="#Page_100">100</a>, <a href="#Page_108">108</a>,
-                 <a href="#Page_185">185</a></li>
-<li class="isub1">Axis, <a href="#Page_91">91</a></li>
-<li class="isub1">Axis-cylinder process, <a href="#Page_36">36</a>, <a href="#Page_37">37</a>
-<span class="pagenum"><a name="Page_203" id="Page_203">[Pg 203]</a></span></li>
-
-<li class="ifrst">Back, <a href="#Page_88">88</a>, <i>et seq.</i></li>
-<li class="isub3">muscles, <a href="#Page_93">93</a>, <a href="#Page_94">94</a></li>
-<li class="isub3">arteries, <a href="#Page_94">94</a>, <a href="#Page_95">95</a></li>
-<li class="isub3">nerves, <a href="#Page_95">95</a></li>
-<li class="isub1">Basilar artery, <a href="#Page_77">77</a>, <a href="#Page_108">108</a></li>
-<li class="isub1">Basilic vein, <a href="#Page_109">109</a></li>
-<li class="isub1">Biceps of arm, <a href="#Page_175">175</a>, <a href="#Page_176">176</a></li>
-<li class="isub3">of leg, <a href="#Page_190">190</a>, <a href="#Page_191">191</a></li>
-<li class="isub1">Bicipital groove, <a href="#Page_175">175</a></li>
-<li class="isub1">Bicuspid or mitral valve, <a href="#Page_104">104</a></li>
-<li class="isub3">teeth, <a href="#Page_60">60</a></li>
-<li class="isub1">Bile, <a href="#Page_36">36</a>, <a href="#Page_143">143</a>, <a href="#Page_150">150</a></li>
-<li class="isub1">Bilirubin, <a href="#Page_12">12</a>, <a href="#Page_143">143</a>, <a href="#Page_151">151</a></li>
-<li class="isub1">Biliverdin, <a href="#Page_143">143</a>, <a href="#Page_151">151</a></li>
-<li class="isub1">Bladder, <a href="#Page_160">160</a></li>
-<li class="isub1">Blind spot, <a href="#Page_70">70</a></li>
-<li class="isub1">Blood, <a href="#Page_27">27</a>, <a href="#Page_116">116</a>, <i>et seq.</i></li>
-<li class="isub3">amount, <a href="#Page_116">116</a></li>
-<li class="isub3">arterial and venous, <a href="#Page_29">29</a></li>
-<li class="isub3">circulation of, <a href="#Page_29">29</a>, <a href="#Page_105">105</a>, <i>et seq.</i></li>
-<li class="isub3">coagulation, <a href="#Page_117">117</a>, <a href="#Page_118">118</a></li>
-<li class="isub3">coloring matter, <a href="#Page_119">119</a></li>
-<li class="isub3">composition, <a href="#Page_116">116</a>, <a href="#Page_117">117</a></li>
-<li class="isub3">corpuscles, <a href="#Page_116">116</a>, <a href="#Page_118">118</a>, <i>et seq.</i></li>
-<li class="isub3">fibrin, <a href="#Page_117">117</a></li>
-<li class="isub3">functions of, <a href="#Page_116">116</a></li>
-<li class="isub3">plaques, <a href="#Page_120">120</a></li>
-<li class="isub3">plasma, <a href="#Page_33">33</a>, <a href="#Page_116">116</a>, <a href="#Page_117">117</a></li>
-<li class="isub3">pressure, <a href="#Page_114">114</a>, <a href="#Page_115">115</a></li>
-<li class="isub3">serum, <a href="#Page_117">117</a></li>
-<li class="isub3">vessels, <a href="#Page_27">27</a>, <i>et seq.</i></li>
-<li class="isub1">Bone, <a href="#Page_17">17</a></li>
-<li class="isub3">astragalus, <a href="#Page_195">195</a></li>
-<li class="isub3">atlas, <a href="#Page_91">91</a></li>
-<li class="isub3">axis, <a href="#Page_91">91</a></li>
-<li class="isub3">canaliculi, <a href="#Page_17">17</a></li>
-<li class="isub3">cancellous or spongy, <a href="#Page_17">17</a></li>
-<li class="isub3">carpal, <a href="#Page_180">180</a>, <a href="#Page_181">181</a></li>
-<li class="isub3">chemical composition, <a href="#Page_18">18</a></li>
-<li class="isub3">clavicle, <a href="#Page_171">171</a></li>
-<li class="isub3">coccyx, <a href="#Page_90">90</a>, <a href="#Page_161">161</a></li>
-<li class="isub3">compact, <a href="#Page_17">17</a>, <a href="#Page_18">18</a></li>
-<li class="isub3">cuboid, <a href="#Page_195">195</a></li>
-<li class="isub3">cuneiform, <a href="#Page_181">181</a>, <a href="#Page_195">195</a></li>
-<li class="isub3">endosteum of, <a href="#Page_18">18</a></li>
-<li class="isub3">ethmoid, <a href="#Page_48">48</a>, <a href="#Page_53">53</a></li>
-<li class="isub3">femur, <a href="#Page_187">187</a></li>
-<li class="isub3">fibula, <a href="#Page_194">194</a>, <a href="#Page_195">195</a></li>
-<li class="isub3">formation of, <a href="#Page_18">18</a></li>
-<li class="isub3">frontal, <a href="#Page_49">49</a></li>
-<li class="isub3">Haversian canals of, <a href="#Page_17">17</a></li>
-<li class="isub3">humerus, <a href="#Page_175">175</a></li>
-<li class="isub3">hyoid, <a href="#Page_60">60</a></li>
-<li class="isub3">ilium, <a href="#Page_161">161</a>, <a href="#Page_162">162</a></li>
-<li class="isub3">incus, <a href="#Page_63">63</a></li>
-<li class="isub3">innominate, <a href="#Page_161">161</a>, <a href="#Page_162">162</a></li>
-<li class="isub3">ischium, <a href="#Page_161">161</a>, <a href="#Page_163">163</a></li>
-<li class="isub3">lachrymal, <a href="#Page_48">48</a>, <a href="#Page_54">54</a></li>
-<li class="isub3">lacunæ of, <a href="#Page_17">17</a></li>
-<li class="isub3">lamellæ of, <a href="#Page_17">17</a></li>
-<li class="isub3">malar, <a href="#Page_48">48</a>, <a href="#Page_54">54</a></li>
-<li class="isub3">malleus, <a href="#Page_63">63</a></li>
-<li class="isub3">marrow of, <a href="#Page_18">18</a></li>
-<li class="isub3">maxillary, inferior, <a href="#Page_48">48</a>, <a href="#Page_55">55</a></li>
-<li class="isub7">superior, <a href="#Page_48">48</a>, <a href="#Page_54">54</a></li>
-<li class="isub3">metacarpal, <a href="#Page_181">181</a></li>
-<li class="isub3">metatarsal, <a href="#Page_195">195</a></li>
-<li class="isub3">nasal, <a href="#Page_48">48</a>, <a href="#Page_55">55</a></li>
-<li class="isub3">navicular, <a href="#Page_195">195</a></li>
-<li class="isub3">occipital, <a href="#Page_48">48</a>, <a href="#Page_50">50</a></li>
-<li class="isub3">os calcis, <a href="#Page_195">195</a></li>
-<li class="isub3">os innominatum, <a href="#Page_161">161</a>, <a href="#Page_162">162</a></li>
-<li class="isub3">os magnum, <a href="#Page_181">181</a></li>
-<li class="isub3">palate, <a href="#Page_48">48</a>, <a href="#Page_54">54</a></li>
-<li class="isub3">parietal, <a href="#Page_48">48</a>, <a href="#Page_49">49</a></li>
-<li class="isub3">patella, <a href="#Page_19">19</a>, <a href="#Page_192">192</a></li>
-<li class="isub3">pelvis, <a href="#Page_161">161</a></li>
-<li class="isub3">periosteum of, <a href="#Page_18">18</a></li>
-<li class="isub3">phalanges, of foot, <a href="#Page_195">195</a></li>
-<li class="isub7">of hand, <a href="#Page_181">181</a></li>
-<li class="isub3">pisiform, <a href="#Page_181">181</a></li>
-<li class="isub3">pubes, <a href="#Page_161">161</a>, <a href="#Page_163">163</a></li>
-<li class="isub3">radius, <a href="#Page_178">178</a>, <a href="#Page_179">179</a>
-<span class="pagenum"><a name="Page_204" id="Page_204">[Pg 204]</a></span></li>
-<li class="isub3">ribs, <a href="#Page_97">97</a>, <a href="#Page_98">98</a></li>
-<li class="isub3">sacrum, <a href="#Page_90">90</a>, <a href="#Page_161">161</a></li>
-<li class="isub3">scaphoid, <a href="#Page_181">181</a>, <a href="#Page_195">195</a></li>
-<li class="isub3">scapula, <a href="#Page_173">173</a></li>
-<li class="isub3">semilunar, <a href="#Page_181">181</a></li>
-<li class="isub3">sphenoid, <a href="#Page_48">48</a>, <a href="#Page_52">52</a></li>
-<li class="isub3">stapes, <a href="#Page_63">63</a></li>
-<li class="isub3">sternum, <a href="#Page_97">97</a></li>
-<li class="isub3">structure of, <a href="#Page_17">17</a></li>
-<li class="isub3">tarsal, <a href="#Page_195">195</a></li>
-<li class="isub3">temporal, <a href="#Page_48">48</a>, <a href="#Page_51">51</a></li>
-<li class="isub3">tibia, <a href="#Page_194">194</a></li>
-<li class="isub3">trapezium, <a href="#Page_181">181</a></li>
-<li class="isub3">trapezoid, <a href="#Page_181">181</a></li>
-<li class="isub3">turbinated, <a href="#Page_53">53</a></li>
-<li class="isub5">inferior, <a href="#Page_48">48</a>, <a href="#Page_53">53</a>, <a href="#Page_54">54</a></li>
-<li class="isub3">ulna, <a href="#Page_177">177</a>, <a href="#Page_178">178</a></li>
-<li class="isub3">unciform, <a href="#Page_181">181</a></li>
-<li class="isub3">vertebræ, <a href="#Page_88">88</a></li>
-<li class="isub3">vomer, <a href="#Page_48">48</a>, <a href="#Page_55">55</a></li>
-<li class="isub1">Bones, classification of, <a href="#Page_19">19</a></li>
-<li class="isub3">flat, <a href="#Page_20">20</a></li>
-<li class="isub3">function of, <a href="#Page_19">19</a>, <a href="#Page_20">20</a></li>
-<li class="isub3">long, <a href="#Page_19">19</a></li>
-<li class="isub3">of back, <a href="#Page_88">88</a></li>
-<li class="isub3">of chest, <a href="#Page_97">97</a>, <a href="#Page_98">98</a></li>
-<li class="isub3">of cranium, <a href="#Page_48">48</a>, <i>et seq.</i></li>
-<li class="isub3">of face, <a href="#Page_53">53</a>, <i>et seq.</i></li>
-<li class="isub3">of lower extremity, <a href="#Page_187">187</a>, <i>et seq.</i></li>
-<li class="isub3">of upper extremity, <a href="#Page_171">171</a>, <i>et seq.</i></li>
-<li class="isub3">pelvic, <a href="#Page_161">161</a>, <i>et seq.</i></li>
-<li class="isub3">sesamoid, <a href="#Page_19">19</a></li>
-<li class="isub3">short, <a href="#Page_20">20</a></li>
-<li class="isub3">Wormian, <a href="#Page_19">19</a>, <a href="#Page_49">49</a></li>
-<li class="isub1">Bow leg, <a href="#Page_195">195</a></li>
-<li class="isub1">Brachial artery, <a href="#Page_108">108</a>, <a href="#Page_177">177</a>, <a href="#Page_185">185</a></li>
-<li class="isub3">plexus, <a href="#Page_84">84</a>, <a href="#Page_85">85</a></li>
-<li class="isub1">Brachialis anticus, <a href="#Page_175">175</a>, <a href="#Page_177">177</a></li>
-<li class="isub1">Brain, <a href="#Page_75">75</a>, <i>et seq.</i></li>
-<li class="isub3">areas, <a href="#Page_81">81</a>, <a href="#Page_82">82</a></li>
-<li class="isub3">arteries, <a href="#Page_77">77</a></li>
-<li class="isub3">function, <a href="#Page_80">80</a>, <i>et seq.</i></li>
-<li class="isub3">parts, <a href="#Page_75">75</a></li>
-<li class="isub1">Broad ligaments of uterus, <a href="#Page_165">165</a>, <a href="#Page_166">166</a>, <a href="#Page_168">168</a></li>
-<li class="isub1">Bronchi, <a href="#Page_123">123</a>, <a href="#Page_125">125</a></li>
-<li class="isub1">Buffy coat, <a href="#Page_117">117</a></li>
-<li class="isub1">Bursæ, synovial, <a href="#Page_20">20</a>, <a href="#Page_178">178</a></li>
-<li class="isub1">Bursitis, <a href="#Page_194">194</a></li>
-<li class="isub1">Buttocks, <a href="#Page_190">190</a></li>
-
-<li class="ifrst">Canal, alimentary, <a href="#Page_136">136</a>, <i>et seq.</i></li>
-<li class="isub3">auditory, <a href="#Page_63">63</a>, <a href="#Page_64">64</a></li>
-<li class="isub3">central, of cord, <a href="#Page_81">81</a></li>
-<li class="isub3">Haversian, <a href="#Page_17">17</a></li>
-<li class="isub3">semicircular, <a href="#Page_64">64</a>, <a href="#Page_66">66</a></li>
-<li class="isub1">Canaliculi of bone, <a href="#Page_17">17</a></li>
-<li class="isub1">Cancellous tissue of bone, <a href="#Page_17">17</a></li>
-<li class="isub1">Cancer, <a href="#Page_35">35</a>, <a href="#Page_58">58</a>, <a href="#Page_62">62</a>, <a href="#Page_100">100</a>,
-                <a href="#Page_122">122</a>, <a href="#Page_139">139</a>, <a href="#Page_146">146</a>, <a href="#Page_169">169</a></li>
-<li class="isub1">Canine teeth, <a href="#Page_60">60</a></li>
-<li class="isub1">Canthus of eye, <a href="#Page_67">67</a>, <a href="#Page_68">68</a></li>
-<li class="isub1">Capillaries, <a href="#Page_28">28</a>, <a href="#Page_29">29</a></li>
-<li class="isub1">Capitellum, <a href="#Page_175">175</a></li>
-<li class="isub1">Capsular ligament of hip, <a href="#Page_193">193</a></li>
-<li class="isub1">Carbohydrates, <a href="#Page_12">12</a>, <a href="#Page_26">26</a>, <a href="#Page_147">147</a>,
-                        <a href="#Page_148">148</a>, <a href="#Page_151">151</a></li>
-<li class="isub1">Cardiac cycle, <a href="#Page_104">104</a></li>
-<li class="isub3">muscle, <a href="#Page_22">22</a>, <a href="#Page_25">25</a></li>
-<li class="isub3">nerve, <a href="#Page_78">78</a></li>
-<li class="isub3">plexus, <a href="#Page_87">87</a></li>
-<li class="isub1">Caries, <a href="#Page_98">98</a></li>
-<li class="isub1">Carotids, common, <a href="#Page_107">107</a>, <a href="#Page_108">108</a></li>
-<li class="isub5">internal and external, <a href="#Page_108">108</a>, <a href="#Page_137">137</a></li>
-<li class="isub1">Carpal bones, <a href="#Page_180">180</a>, <a href="#Page_181">181</a></li>
-<li class="isub1">Carpus or wrist, <a href="#Page_180">180</a>, <a href="#Page_181">181</a></li>
-<li class="isub1">Cartilage, <a href="#Page_16">16</a></li>
-<li class="isub1">Cartilages, arytenoid, <a href="#Page_122">122</a></li>
-<li class="isub3">costal, <a href="#Page_98">98</a></li>
-<li class="isub3">cricoid, <a href="#Page_121">121</a></li>
-<li class="isub3">thyroid, <a href="#Page_121">121</a></li>
-<li class="isub3">triangular, <a href="#Page_57">57</a></li>
-<li class="isub1">Casein, <a href="#Page_11">11</a>
-<span class="pagenum"><a name="Page_205" id="Page_205">[Pg 205]</a></span></li>
-<li class="isub1">Cauda equina, <a href="#Page_79">79</a>, <a href="#Page_91">91</a></li>
-<li class="isub1">Cecum, <a href="#Page_145">145</a></li>
-<li class="isub1">Celiac axis, <a href="#Page_109">109</a>, <a href="#Page_150">150</a>, <a href="#Page_153">153</a></li>
-<li class="isub1">Cells, <a href="#Page_12">12</a>, <a href="#Page_13">13</a></li>
-<li class="isub1">Central canal of cord, <a href="#Page_81">81</a></li>
-<li class="isub1">Cephalocele, <a href="#Page_53">53</a></li>
-<li class="isub1">Cerebellum, <a href="#Page_51">51</a>, <a href="#Page_78">78</a></li>
-<li class="isub1">Cerebral arteries, <a href="#Page_77">77</a></li>
-<li class="isub3">veins, <a href="#Page_78">78</a></li>
-<li class="isub1">Cerebro-spinal fluid, <a href="#Page_34">34</a>, <a href="#Page_76">76</a>, <a href="#Page_79">79</a></li>
-<li class="isub3">meningitis, <a href="#Page_79">79</a></li>
-<li class="isub3">nervous system, <a href="#Page_75">75</a>, <i>et seq.</i></li>
-<li class="isub1">Cerebrum or brain proper, <a href="#Page_51">51</a>, <a href="#Page_75">75</a></li>
-<li class="isub1">Cervical nerves, <a href="#Page_84">84</a></li>
-<li class="isub3">plexus, <a href="#Page_84">84</a></li>
-<li class="isub3">vertebræ, <a href="#Page_90">90</a>, <a href="#Page_91">91</a></li>
-<li class="isub1">Cervix of uterus, <a href="#Page_168">168</a></li>
-<li class="isub1">Chemical composition of the body, <a href="#Page_11">11</a></li>
-<li class="isub3">of bone, <a href="#Page_18">18</a></li>
-<li class="isub1">Chest or thorax, <a href="#Page_96">96</a></li>
-<li class="isub3">arteries, <a href="#Page_99">99</a></li>
-<li class="isub3">bones, <a href="#Page_97">97</a>, <a href="#Page_98">98</a></li>
-<li class="isub3">muscles, <a href="#Page_98">98</a>, <a href="#Page_99">99</a></li>
-<li class="isub3">nerves, <a href="#Page_99">99</a></li>
-<li class="isub1">Cholesterin, <a href="#Page_143">143</a></li>
-<li class="isub1">Chordæ tendineæ, <a href="#Page_104">104</a></li>
-<li class="isub1">Choroid, <a href="#Page_68">68</a></li>
-<li class="isub1">Chromatic aberration, <a href="#Page_73">73</a></li>
-<li class="isub1">Chyle, <a href="#Page_32">32</a>, <a href="#Page_33">33</a>, <a href="#Page_144">144</a></li>
-<li class="isub1">Chyme, <a href="#Page_139">139</a>, <a href="#Page_140">140</a></li>
-<li class="isub1">Cilia, <a href="#Page_15">15</a>, <a href="#Page_27">27</a></li>
-<li class="isub1">Ciliary muscles, <a href="#Page_69">69</a>, <a href="#Page_72">72</a></li>
-<li class="isub3">processes, <a href="#Page_69">69</a>, <a href="#Page_72">72</a></li>
-<li class="isub1">Circle of Willis, <a href="#Page_78">78</a>, <a href="#Page_108">108</a></li>
-<li class="isub1">Circulation of the blood, fetal, <a href="#Page_106">106</a>, <a href="#Page_107">107</a></li>
-<li class="isub3">portal, <a href="#Page_109">109</a>, <a href="#Page_110">110</a></li>
-<li class="isub3">pulmonary, <a href="#Page_110">110</a></li>
-<li class="isub3">systemic, <a href="#Page_105">105</a>, <a href="#Page_106">106</a>, <a href="#Page_107">107</a>,
-                                      <i>et seq.</i>, <a href="#Page_112">112</a>, <a href="#Page_113">113</a></li>
-<li class="isub1">Circumflex artery, <a href="#Page_186">186</a></li>
-<li class="isub1">Circumflex nerve, <a href="#Page_85">85</a>, <a href="#Page_186">186</a></li>
-<li class="isub1">Circumvallate papillæ, <a href="#Page_61">61</a></li>
-<li class="isub1">Cirrhosis of liver, <a href="#Page_152">152</a></li>
-<li class="isub1">Clavicle, <a href="#Page_171">171</a></li>
-<li class="isub1">Cleft palate, <a href="#Page_55">55</a></li>
-<li class="isub1">Clitoris, <a href="#Page_170">170</a></li>
-<li class="isub1">Clotting of blood, <a href="#Page_23">23</a>, <a href="#Page_117">117</a>, <a href="#Page_118">118</a></li>
-<li class="isub3">of lymph, <a href="#Page_33">33</a></li>
-<li class="isub3">of muscle, <a href="#Page_23">23</a></li>
-<li class="isub1">Club-foot, <a href="#Page_195">195</a></li>
-<li class="isub1">Coccygeal nerve, <a href="#Page_84">84</a></li>
-<li class="isub3">vertebræ, <a href="#Page_90">90</a></li>
-<li class="isub1">Coccyx, <a href="#Page_90">90</a>, <a href="#Page_161">161</a></li>
-<li class="isub1">Cochlea, <a href="#Page_64">64</a>, <a href="#Page_65">65</a></li>
-<li class="isub1">Colles’ fracture, <a href="#Page_171">171</a>, <a href="#Page_180">180</a></li>
-<li class="isub1">Color blindness, <a href="#Page_73">73</a></li>
-<li class="isub3">perception, <a href="#Page_73">73</a></li>
-<li class="isub1">Coloring matters, <a href="#Page_12">12</a></li>
-<li class="isub3">of bile, <a href="#Page_143">143</a>, <a href="#Page_151">151</a></li>
-<li class="isub3">of blood, <a href="#Page_119">119</a></li>
-<li class="isub1">Colon, ascending, <a href="#Page_145">145</a></li>
-<li class="isub3">descending, <a href="#Page_145">145</a></li>
-<li class="isub3">transverse, <a href="#Page_145">145</a></li>
-<li class="isub1">Columnæ carneæ, <a href="#Page_104">104</a></li>
-<li class="isub1">Commissures of cord, <a href="#Page_80">80</a></li>
-<li class="isub1">Common bile duct, <a href="#Page_150">150</a></li>
-<li class="isub1">Communicating arteries, <a href="#Page_78">78</a></li>
-<li class="isub1">Compact tissue of bone, <a href="#Page_17">17</a>, <a href="#Page_18">18</a></li>
-<li class="isub1">Condyles, humerus, <a href="#Page_175">175</a></li>
-<li class="isub3">femur, <a href="#Page_189">189</a></li>
-<li class="isub1">Conjunctiva, <a href="#Page_67">67</a></li>
-<li class="isub1">Conjugate focus, <a href="#Page_71">71</a></li>
-<li class="isub1">Convolutions of brain, <a href="#Page_76">76</a></li>
-<li class="isub1">Connective tissue, <a href="#Page_15">15</a>, <i>et seq.</i></li>
-<li class="isub3">areolar, <a href="#Page_15">15</a></li>
-<li class="isub3">bony, <a href="#Page_17">17</a></li>
-<li class="isub3">cartilaginous, <a href="#Page_16">16</a></li>
-<li class="isub3">elastic, <a href="#Page_15">15</a></li>
-<li class="isub3">fatty or adipose, <a href="#Page_16">16</a></li>
-<li class="isub3">fibrous, <a href="#Page_15">15</a></li>
-<li class="isub1">Coraco-brachialis, <a href="#Page_177">177</a>
-<span class="pagenum"><a name="Page_206" id="Page_206">[Pg 206]</a></span></li>
-<li class="isub1">Coracoid process of scapula, <a href="#Page_173">173</a></li>
-<li class="isub1">Cordiform tendon, <a href="#Page_98">98</a></li>
-<li class="isub1">Cornea, <a href="#Page_27">27</a>, <a href="#Page_68">68</a>, <a href="#Page_70">70</a></li>
-<li class="isub1">Cornicula laryngis, <a href="#Page_122">122</a></li>
-<li class="isub1">Coronary artery, <a href="#Page_107">107</a></li>
-<li class="isub3">sinus, <a href="#Page_105">105</a></li>
-<li class="isub3">valve, <a href="#Page_105">105</a></li>
-<li class="isub1">Coronal suture, <a href="#Page_48">48</a></li>
-<li class="isub1">Coronoid fossa, <a href="#Page_175">175</a></li>
-<li class="isub3">process, <a href="#Page_178">178</a></li>
-<li class="isub1">Corpus luteum, <a href="#Page_166">166</a></li>
-<li class="isub1">Corpuscles of blood, <a href="#Page_116">116</a>, <a href="#Page_118">118</a>, <i>et seq.</i></li>
-<li class="isub3">tactile, <a href="#Page_37">37</a>, <a href="#Page_39">39</a>, <a href="#Page_46">46</a></li>
-<li class="isub1">Corti, organ of, <a href="#Page_65">65</a></li>
-<li class="isub1">Costal cartilages, <a href="#Page_98">98</a></li>
-<li class="isub1">Coughing, <a href="#Page_131">131</a></li>
-<li class="isub1">“Coxa vera,” <a href="#Page_189">189</a></li>
-<li class="isub1">Cranial nerves, <a href="#Page_77">77</a>, <a href="#Page_78">78</a>, <a href="#Page_83">83</a>,
-                      <a href="#Page_84">84</a></li>
-<li class="isub1">Craniotabes, <a href="#Page_53">53</a></li>
-<li class="isub1">Cranium, bones of, <a href="#Page_48">48</a>, <i>et seq.</i></li>
-<li class="isub1">Cribriform plate of ethmoid bone, <a href="#Page_53">53</a></li>
-<li class="isub1">Cricoid cartilage, <a href="#Page_121">121</a></li>
-<li class="isub1">Crista galli, <a href="#Page_53">53</a></li>
-<li class="isub1">Cross eye, <a href="#Page_72">72</a></li>
-<li class="isub1">Crossed pyramidal tract, <a href="#Page_82">82</a></li>
-<li class="isub1">Crucial ligaments, <a href="#Page_193">193</a></li>
-<li class="isub1">Crural nerves, <a href="#Page_85">85</a>, <a href="#Page_199">199</a></li>
-<li class="isub1">Crureus, <a href="#Page_190">190</a></li>
-<li class="isub1">Crying, <a href="#Page_131">131</a></li>
-<li class="isub1">Crypts of Lieberkühn, <a href="#Page_143">143</a>, <a href="#Page_144">144</a>, <a href="#Page_145">145</a></li>
-<li class="isub1">Crystalline lens, <a href="#Page_69">69</a>, <a href="#Page_70">70</a></li>
-<li class="isub1">Cuboid bone, <a href="#Page_195">195</a></li>
-<li class="isub1">Cuneiform bones, ankle, <a href="#Page_195">195</a></li>
-<li class="isub5">wrist, <a href="#Page_181">181</a></li>
-<li class="isub5">cartilages, <a href="#Page_122">122</a></li>
-<li class="isub1">Cutaneous nerves, <a href="#Page_46">46</a>, <a href="#Page_85">85</a></li>
-<li class="isub1">Cystic duct, <a href="#Page_143">143</a>, <a href="#Page_152">152</a></li>
-
-<li class="ifrst">Deltoid, <a href="#Page_174">174</a></li>
-<li class="isub1">Dendrites, <a href="#Page_36">36</a></li>
-<li class="isub1">Derma, <a href="#Page_39">39</a></li>
-<li class="isub1">Descending aorta, <a href="#Page_107">107</a></li>
-<li class="isub3">colon, <a href="#Page_145">145</a></li>
-<li class="isub1">Diabetes mellitus, <a href="#Page_151">151</a>, <a href="#Page_196">196</a></li>
-<li class="isub1">Diaphragm, <a href="#Page_98">98</a>, <a href="#Page_99">99</a>, <a href="#Page_128">128</a></li>
-<li class="isub1">Diaphysis, <a href="#Page_18">18</a></li>
-<li class="isub1">Diastole, <a href="#Page_104">104</a>, <a href="#Page_106">106</a></li>
-<li class="isub1">Differentiation of tissues, <a href="#Page_13">13</a></li>
-<li class="isub1">Digestion, in mouth, <a href="#Page_136">136</a></li>
-<li class="isub3">in small intestine, <a href="#Page_143">143</a>, <a href="#Page_144">144</a></li>
-<li class="isub3">in stomach, <a href="#Page_139">139</a>, <a href="#Page_140">140</a></li>
-<li class="isub3">of fats, <a href="#Page_144">144</a></li>
-<li class="isub3">of proteids, <a href="#Page_140">140</a>, <a href="#Page_144">144</a></li>
-<li class="isub3">of starch, <a href="#Page_136">136</a>, <a href="#Page_144">144</a></li>
-<li class="isub1">Digital arteries, <a href="#Page_186">186</a></li>
-<li class="isub1">Diphtheria, <a href="#Page_35">35</a></li>
-<li class="isub1">Diploë, <a href="#Page_20">20</a>, <a href="#Page_48">48</a></li>
-<li class="isub1">Direct cerebellar tract, <a href="#Page_82">82</a></li>
-<li class="isub3">pyramidal tract, <a href="#Page_80">80</a>, <a href="#Page_82">82</a></li>
-<li class="isub1">Dislocation, <a href="#Page_180">180</a>, <a href="#Page_193">193</a>, <a href="#Page_194">194</a></li>
-<li class="isub1">Diuretics, <a href="#Page_158">158</a></li>
-<li class="isub1">Dorsal or thoracic nerves, <a href="#Page_84">84</a>, <a href="#Page_85">85</a></li>
-<li class="isub3">vertebræ, <a href="#Page_90">90</a>, <a href="#Page_91">91</a></li>
-<li class="isub1">Dorsalis pedis artery, <a href="#Page_199">199</a></li>
-<li class="isub1">Duct, common bile, <a href="#Page_150">150</a></li>
-<li class="isub3">cystic, <a href="#Page_143">143</a>, <a href="#Page_152">152</a></li>
-<li class="isub3">ejaculatory, <a href="#Page_165">165</a></li>
-<li class="isub3">hepatic, <a href="#Page_143">143</a>, <a href="#Page_150">150</a></li>
-<li class="isub3">lachrymal, <a href="#Page_68">68</a></li>
-<li class="isub3">of Rivinus, <a href="#Page_62">62</a></li>
-<li class="isub3">pancreatic, <a href="#Page_153">153</a></li>
-<li class="isub3">right lymphatic, <a href="#Page_31">31</a>, <a href="#Page_32">32</a></li>
-<li class="isub3">Stensen’s, <a href="#Page_62">62</a></li>
-<li class="isub3">Wharton’s, <a href="#Page_62">62</a></li>
-<li class="isub1">Ductless glands, <a href="#Page_36">36</a></li>
-<li class="isub1">Ductus arteriosus, <a href="#Page_106">106</a>, <a href="#Page_107">107</a></li>
-<li class="isub3">communis choledochus or common bile duct, <a href="#Page_150">150</a></li>
-<li class="isub1">Duodenum, <a href="#Page_142">142</a></li>
-<li class="isub1">Dupuytren’s contraction, <a href="#Page_184">184</a></li>
-<li class="isub1">Dura mater, <a href="#Page_15">15</a>, <a href="#Page_76">76</a>, <a href="#Page_79">79</a>
-<span class="pagenum"><a name="Page_207" id="Page_207">[Pg 207]</a></span></li>
-
-<li class="ifrst">Ear, <a href="#Page_63">63</a>, <i>et seq.</i></li>
-<li class="isub3">external, <a href="#Page_63">63</a></li>
-<li class="isub4">function of, <a href="#Page_65">65</a></li>
-<li class="isub3">internal, <a href="#Page_64">64</a></li>
-<li class="isub4">function of, <a href="#Page_65">65</a></li>
-<li class="isub3">middle, <a href="#Page_63">63</a></li>
-<li class="isub4">function of, <a href="#Page_65">65</a></li>
-<li class="isub1">Edema, <a href="#Page_33">33</a>, <a href="#Page_34">34</a>, <a href="#Page_122">122</a></li>
-<li class="isub1">Eighth nerve, <a href="#Page_64">64</a>, <a href="#Page_84">84</a></li>
-<li class="isub1">Ejaculatory duct, <a href="#Page_165">165</a></li>
-<li class="isub1">Elbow, <a href="#Page_32">32</a></li>
-<li class="isub3">joint, <a href="#Page_185">185</a></li>
-<li class="isub1">Elastic tissue, <a href="#Page_15">15</a></li>
-<li class="isub1">Eleventh nerve, <a href="#Page_84">84</a></li>
-<li class="isub1">Emmetropic eye, <a href="#Page_72">72</a></li>
-<li class="isub1">Emphysema, <a href="#Page_97">97</a></li>
-<li class="isub1">Empyema of gall-bladder, <a href="#Page_152">152</a>, <a href="#Page_153">153</a></li>
-<li class="isub3">of lungs, <a href="#Page_126">126</a></li>
-<li class="isub1">End bulbs, <a href="#Page_37">37</a></li>
-<li class="isub1">Endocardium, <a href="#Page_103">103</a></li>
-<li class="isub1">Endolymph, <a href="#Page_64">64</a>, <a href="#Page_65">65</a></li>
-<li class="isub1">Endosteum, <a href="#Page_18">18</a></li>
-<li class="isub1">Endothelium, <a href="#Page_14">14</a>, <a href="#Page_40">40</a></li>
-<li class="isub1">Ensiform cartilage, <a href="#Page_97">97</a></li>
-<li class="isub1">Epidermis, <a href="#Page_27">27</a>, <a href="#Page_39">39</a></li>
-<li class="isub1">Epigastric artery, <a href="#Page_198">198</a></li>
-<li class="isub1">Epigastrium, <a href="#Page_135">135</a></li>
-<li class="isub1">Epiglottis, <a href="#Page_60">60</a>, <a href="#Page_121">121</a>, <a href="#Page_136">136</a></li>
-<li class="isub1">Epiphysis, <a href="#Page_18">18</a>, <a href="#Page_189">189</a>, <a href="#Page_193">193</a></li>
-<li class="isub1">Epithelium, <a href="#Page_14">14</a>, <a href="#Page_27">27</a></li>
-<li class="isub3">ciliated, <a href="#Page_15">15</a>, <a href="#Page_27">27</a></li>
-<li class="isub3">columnar, <a href="#Page_14">14</a></li>
-<li class="isub3">glandular, <a href="#Page_14">14</a></li>
-<li class="isub3">pavement, <a href="#Page_14">14</a></li>
-<li class="isub3">simple, <a href="#Page_14">14</a></li>
-<li class="isub3">stratified, <a href="#Page_14">14</a></li>
-<li class="isub1">Erythrocytes, <a href="#Page_118">118</a>, <a href="#Page_119">119</a></li>
-<li class="isub1">Esophagus, <a href="#Page_138">138</a></li>
-<li class="isub1">Ethmoid bone, <a href="#Page_53">53</a></li>
-<li class="isub1">Eustachian tubes, <a href="#Page_52">52</a>, <a href="#Page_63">63</a></li>
-<li class="isub3">valve, <a href="#Page_106">106</a>, <a href="#Page_107">107</a></li>
-<li class="isub1">Excreting glands, <a href="#Page_35">35</a></li>
-<li class="isub1">Extensor carpi radialis longior, <a href="#Page_182">182</a>, <a href="#Page_183">183</a></li>
-<li class="isub3">brevior, <a href="#Page_182">182</a>, <a href="#Page_183">183</a></li>
-<li class="isub3">ulnaris, <a href="#Page_182">182</a>, <a href="#Page_183">183</a></li>
-<li class="isub3">communis digitorum, <a href="#Page_182">182</a>, <a href="#Page_184">184</a></li>
-<li class="isub3">indicis, <a href="#Page_182">182</a>, <a href="#Page_184">184</a></li>
-<li class="isub3">minimi digiti, <a href="#Page_182">182</a>, <a href="#Page_184">184</a></li>
-<li class="isub3">ossis metacarpi pollicis, <a href="#Page_182">182</a>, <a href="#Page_183">183</a></li>
-<li class="isub3">primi internodii pollicis, <a href="#Page_182">182</a>, <a href="#Page_183">183</a></li>
-<li class="isub3">secundi internodii pollicis, <a href="#Page_182">182</a>, <a href="#Page_183">183</a></li>
-<li class="isub1">Eye, <a href="#Page_66">66</a>, <i>et seq.</i></li>
-<li class="isub3">accommodation, <a href="#Page_72">72</a></li>
-<li class="isub3">coats of, <a href="#Page_68">68</a></li>
-<li class="isub3">color of, <a href="#Page_69">69</a></li>
-<li class="isub3">formation of image in, <a href="#Page_70">70</a>, <i>et seq.</i></li>
-<li class="isub3">humors of, <a href="#Page_70">70</a></li>
-<li class="isub3">muscles of, <a href="#Page_67">67</a></li>
-<li class="isub3">nerves of, <a href="#Page_67">67</a>, <a href="#Page_68">68</a></li>
-<li class="isub3">teeth, <a href="#Page_60">60</a></li>
-<li class="isub1">Eyeball, <a href="#Page_66">66</a></li>
-<li class="isub1">Eyebrows, <a href="#Page_66">66</a></li>
-<li class="isub1">Eyelashes, <a href="#Page_67">67</a></li>
-<li class="isub1">Eyelids, <a href="#Page_66">66</a>, <a href="#Page_67">67</a></li>
-
-<li class="ifrst">Face, bones of, <a href="#Page_53">53</a>, <i>et seq.</i></li>
-<li class="isub1">Facial artery, <a href="#Page_28">28</a></li>
-<li class="isub4">nerve, <a href="#Page_83">83</a>, <a href="#Page_84">84</a></li>
-<li class="isub1">Fallopian tubes, <a href="#Page_166">166</a>, <a href="#Page_167">167</a></li>
-<li class="isub1">Far-sightedness, <a href="#Page_72">72</a>, <a href="#Page_73">73</a></li>
-<li class="isub1">Fat or adipose tissue, <a href="#Page_16">16</a></li>
-<li class="isub1">Fats, <a href="#Page_12">12</a>, <a href="#Page_147">147</a>, <a href="#Page_148">148</a></li>
-<li class="isub3">absorption, <a href="#Page_144">144</a></li>
-<li class="isub3">digestion, <a href="#Page_143">143</a>, <a href="#Page_144">144</a></li>
-<li class="isub1">False pelvis, <a href="#Page_163">163</a></li>
-<li class="isub3">ribs, <a href="#Page_97">97</a>
-<span class="pagenum"><a name="Page_208" id="Page_208">[Pg 208]</a></span></li>
-<li class="isub1">Fascia, lumbar, <a href="#Page_133">133</a></li>
-<li class="isub1">Fascia, palmar, <a href="#Page_184">184</a></li>
-<li class="isub4">plantar, <a href="#Page_198">198</a></li>
-<li class="isub1">Fasciæ, <a href="#Page_15">15</a>, <a href="#Page_21">21</a></li>
-<li class="isub1">Fasciculi, <a href="#Page_21">21</a></li>
-<li class="isub1">Fauces, pillars of, <a href="#Page_59">59</a></li>
-<li class="isub1">Feces, <a href="#Page_146">146</a></li>
-<li class="isub1">Female generative organs, <a href="#Page_163">163</a>, <a href="#Page_165">165</a>, <i>et seq.</i></li>
-<li class="isub1">Femoral artery, <a href="#Page_190">190</a>, <a href="#Page_198">198</a></li>
-<li class="isub1">Femur, <a href="#Page_187">187</a></li>
-<li class="isub1">Fenestra ovalis, <a href="#Page_63">63</a>, <a href="#Page_65">65</a></li>
-<li class="isub4">rotunda, <a href="#Page_65">65</a></li>
-<li class="isub1">Ferments, <a href="#Page_12">12</a>, <a href="#Page_136">136</a>, <a href="#Page_144">144</a></li>
-<li class="isub1">Fetal circulation, <a href="#Page_106">106</a>, <a href="#Page_107">107</a></li>
-<li class="isub1">Fetus, <a href="#Page_111">111</a></li>
-<li class="isub1">Fever, <a href="#Page_45">45</a></li>
-<li class="isub1">Fibrin, <a href="#Page_11">11</a>, <a href="#Page_23">23</a>, <a href="#Page_33">33</a>, <a href="#Page_117">117</a></li>
-<li class="isub3">ferment, <a href="#Page_117">117</a></li>
-<li class="isub1">Fibrinogen, <a href="#Page_117">117</a></li>
-<li class="isub1">Fibrous tissue, <a href="#Page_15">15</a></li>
-<li class="isub1">Fibula, <a href="#Page_194">194</a>, <a href="#Page_195">195</a></li>
-<li class="isub1">Fifth nerve, <a href="#Page_83">83</a></li>
-<li class="isub1">Filum terminale, <a href="#Page_78">78</a>, <a href="#Page_91">91</a></li>
-<li class="isub1">Fimbriæ, <a href="#Page_167">167</a></li>
-<li class="isub1">First nerve, <a href="#Page_83">83</a></li>
-<li class="isub1">Fissure of Rolando, <a href="#Page_75">75</a>, <a href="#Page_82">82</a></li>
-<li class="isub3">of Sylvius, <a href="#Page_75">75</a></li>
-<li class="isub1">Flexor carpi radialis, <a href="#Page_182">182</a>, <a href="#Page_183">183</a></li>
-<li class="isub6">ulnaris, <a href="#Page_182">182</a>, <a href="#Page_183">183</a></li>
-<li class="isub3">longus pollicis, <a href="#Page_182">182</a>, <a href="#Page_183">183</a></li>
-<li class="isub3">profundus digitorum, <a href="#Page_182">182</a>, <a href="#Page_183">183</a></li>
-<li class="isub3">sublimis digitorum, <a href="#Page_182">182</a>, <a href="#Page_183">183</a></li>
-<li class="isub1">Floating ribs, <a href="#Page_97">97</a></li>
-<li class="isub1">Follicles, Graafian, <a href="#Page_166">166</a></li>
-<li class="isub1">Fontanelles, <a href="#Page_19">19</a>, <a href="#Page_49">49</a></li>
-<li class="isub1">Food, <a href="#Page_147">147</a></li>
-<li class="isub3">amount, <a href="#Page_148">148</a></li>
-<li class="isub3">classes of, <a href="#Page_147">147</a></li>
-<li class="isub3">cooking, <a href="#Page_148">148</a></li>
-<li class="isub3">function, <a href="#Page_147">147</a>, <a href="#Page_148">148</a></li>
-<li class="isub1">Foot, bones of, <a href="#Page_195">195</a>, <a href="#Page_196">196</a></li>
-<li class="isub3">muscles of, <a href="#Page_198">198</a></li>
-<li class="isub1">Foramen, intervertebral, <a href="#Page_90">90</a></li>
-<li class="isub3">magnum, <a href="#Page_50">50</a></li>
-<li class="isub3">nutrient, <a href="#Page_19">19</a></li>
-<li class="isub3">obturator, <a href="#Page_163">163</a></li>
-<li class="isub3">of Majendie, <a href="#Page_79">79</a></li>
-<li class="isub3">optic, <a href="#Page_66">66</a>, <a href="#Page_70">70</a></li>
-<li class="isub3">ovale, <a href="#Page_106">106</a></li>
-<li class="isub1">Foreign bodies, <a href="#Page_118">118</a>, <a href="#Page_122">122</a>, <a href="#Page_137">137</a>,
-                         <a href="#Page_146">146</a></li>
-<li class="isub1">Fossa, coronoid, <a href="#Page_175">175</a></li>
-<li class="isub3">glenoid, <a href="#Page_51">51</a></li>
-<li class="isub3">iliac, <a href="#Page_163">163</a></li>
-<li class="isub3">nasal, <a href="#Page_55">55</a>, <a href="#Page_57">57</a></li>
-<li class="isub3">olecranon, <a href="#Page_175">175</a></li>
-<li class="isub1">Fourchette, <a href="#Page_170">170</a></li>
-<li class="isub1">Fourth nerve, <a href="#Page_68">68</a>, <a href="#Page_83">83</a></li>
-<li class="isub1">Fovea centralis, <a href="#Page_70">70</a></li>
-<li class="isub1">Fractures, <a href="#Page_98">98</a>, <a href="#Page_164">164</a>, <a href="#Page_171">171</a>,
-           <a href="#Page_174">174</a>, <a href="#Page_175">175</a>, <a href="#Page_177">177</a>, <a href="#Page_180">180</a>,
-           <a href="#Page_181">181</a>, <a href="#Page_193">193</a>, <a href="#Page_194">194</a>, <a href="#Page_195">195</a>,
-           <a href="#Page_196">196</a></li>
-<li class="isub1">Frenum of tongue, <a href="#Page_60">60</a></li>
-<li class="isub1">Frontal bone, <a href="#Page_48">48</a>, <a href="#Page_49">49</a></li>
-
-<li class="ifrst">Gall-bladder <a href="#Page_143">143</a>, <a href="#Page_152">152</a>, <a href="#Page_153">153</a></li>
-<li class="isub3">stones, <a href="#Page_143">143</a></li>
-<li class="isub1">Ganglia, <a href="#Page_87">87</a>, <a href="#Page_110">110</a></li>
-<li class="isub1">Gangrene, <a href="#Page_180">180</a>, <a href="#Page_199">199</a></li>
-<li class="isub1">Gastric artery, <a href="#Page_109">109</a></li>
-<li class="isub3">glands, <a href="#Page_35">35</a></li>
-<li class="isub3">juice, <a href="#Page_139">139</a></li>
-<li class="isub3">vein, <a href="#Page_110">110</a>, <a href="#Page_150">150</a></li>
-<li class="isub1">Gastrocnemius, <a href="#Page_196">196</a></li>
-<li class="isub1">Generative organs, female, <a href="#Page_163">163</a>, <a href="#Page_165">165</a>, <i>et seq.</i></li>
-<li class="isub3">male, <a href="#Page_163">163</a>, <a href="#Page_164">164</a>, <a href="#Page_165">165</a></li>
-<li class="isub1">Genito-crural nerve, <a href="#Page_85">85</a></li>
-<li class="isub1">Gladiolus <a href="#Page_97">97</a></li>
-<li class="isub1">Glands, <a href="#Page_32">32</a>, <a href="#Page_35">35</a>, <a href="#Page_36">36</a></li>
-<li class="isub3">ductless, <a href="#Page_36">36</a></li>
-<li class="isub3">excreting, <a href="#Page_35">35</a></li>
-<li class="isub3">functions, <a href="#Page_36">36</a>
-<span class="pagenum"><a name="Page_209" id="Page_209">[Pg 209]</a></span></li>
-<li class="isub3">gastric, <a href="#Page_35">35</a></li>
-<li class="isub3">lachrymal, <a href="#Page_68">68</a></li>
-<li class="isub3">lymphatic, <a href="#Page_32">32</a>, <a href="#Page_34">34</a>, <a href="#Page_35">35</a></li>
-<li class="isub3">mammary, <a href="#Page_99">99</a>, <a href="#Page_100">100</a></li>
-<li class="isub3">Meibomian, <a href="#Page_67">67</a></li>
-<li class="isub3">of Lieberkühn, <a href="#Page_143">143</a>, <a href="#Page_144">144</a>, <a href="#Page_145">145</a></li>
-<li class="isub3">parotid, <a href="#Page_51">51</a>, <a href="#Page_62">62</a></li>
-<li class="isub3">Peyer’s, <a href="#Page_142">142</a></li>
-<li class="isub3">procreating, <a href="#Page_165">165</a></li>
-<li class="isub3">prostate, <a href="#Page_164">164</a>, <a href="#Page_165">165</a></li>
-<li class="isub3">racemose, <a href="#Page_35">35</a></li>
-<li class="isub3">salivary, <a href="#Page_35">35</a>, <a href="#Page_61">61</a>, <a href="#Page_136">136</a></li>
-<li class="isub3">sebaceous, <a href="#Page_35">35</a>, <a href="#Page_40">40</a>, <a href="#Page_41">41</a></li>
-<li class="isub3">secreting, <a href="#Page_35">35</a></li>
-<li class="isub3">solitary, <a href="#Page_142">142</a>, <a href="#Page_145">145</a></li>
-<li class="isub3">sublingual, <a href="#Page_56">56</a>, <a href="#Page_62">62</a></li>
-<li class="isub3">submaxillary, <a href="#Page_56">56</a>, <a href="#Page_62">62</a></li>
-<li class="isub3">sweat, <a href="#Page_35">35</a>, <a href="#Page_42">42</a></li>
-<li class="isub3">thymus, <a href="#Page_124">124</a></li>
-<li class="isub3">thyroid, <a href="#Page_124">124</a></li>
-<li class="isub1">Glenoid cavity, <a href="#Page_173">173</a></li>
-<li class="isub4">fossa, <a href="#Page_51">51</a></li>
-<li class="isub1">Globulin, <a href="#Page_11">11</a></li>
-<li class="isub1">Glosso-pharyngeal nerve, <a href="#Page_61">61</a>, <a href="#Page_84">84</a></li>
-<li class="isub1">Glottis, <a href="#Page_122">122</a>, <a href="#Page_129">129</a></li>
-<li class="isub1">Gluteal nerves, <a href="#Page_199">199</a></li>
-<li class="isub1">Glutei muscles, <a href="#Page_190">190</a></li>
-<li class="isub1">Glycogen, <a href="#Page_26">26</a>, <a href="#Page_36">36</a>, <a href="#Page_150">150</a>, <a href="#Page_151">151</a></li>
-<li class="isub1">Goiter, <a href="#Page_124">124</a></li>
-<li class="isub1">Gonorrhea, <a href="#Page_160">160</a>, <a href="#Page_168">168</a></li>
-<li class="isub1">Graafian follicles, <a href="#Page_166">166</a></li>
-<li class="isub1">Gray matter of brain and cord, <a href="#Page_36">36</a>, <a href="#Page_75">75</a>,
-          <a href="#Page_76">76</a>, <a href="#Page_78">78</a>, <a href="#Page_80">80</a>, <a href="#Page_81">81</a></li>
-<li class="isub1">Green-stick fracture, <a href="#Page_19">19</a></li>
-<li class="isub1">Groin, glands of, <a href="#Page_32">32</a>, <a href="#Page_35">35</a></li>
-<li class="isub1">Gustatory cells, <a href="#Page_61">61</a></li>
-
-<li class="ifrst">Hair, <a href="#Page_27">27</a>, <a href="#Page_40">40</a></li>
-<li class="isub3">follicle, <a href="#Page_40">40</a></li>
-<li class="isub1">Hamstring, inner, <a href="#Page_191">191</a></li>
-<li class="isub3">outer, <a href="#Page_191">191</a></li>
-<li class="isub1">Hard palate, <a href="#Page_55">55</a>, <a href="#Page_59">59</a></li>
-<li class="isub1">Haversian canals, <a href="#Page_17">17</a></li>
-<li class="isub1">Hearing, sense of, <a href="#Page_65">65</a></li>
-<li class="isub1">Heart, <a href="#Page_101">101</a>, <i>et seq.</i></li>
-<li class="isub3">beat, <a href="#Page_102">102</a>, <a href="#Page_104">104</a>, <a href="#Page_111">111</a>, <a href="#Page_112">112</a></li>
-<li class="isub3">nerves, <a href="#Page_110">110</a>, <a href="#Page_111">111</a></li>
-<li class="isub3">position, <a href="#Page_102">102</a></li>
-<li class="isub3">sounds, <a href="#Page_111">111</a></li>
-<li class="isub3">structure, <a href="#Page_103">103</a>, <a href="#Page_104">104</a></li>
-<li class="isub1">Heat center, <a href="#Page_45">45</a></li>
-<li class="isub3">production, <a href="#Page_44">44</a></li>
-<li class="isub3">prostration, <a href="#Page_45">45</a></li>
-<li class="isub3">stroke, <a href="#Page_45">45</a></li>
-<li class="isub1">Hemoglobin, <a href="#Page_119">119</a>, <a href="#Page_130">130</a></li>
-<li class="isub1">Hemorrhage, <a href="#Page_139">139</a>, <a href="#Page_186">186</a></li>
-<li class="isub1">Hemorrhoidal veins, <a href="#Page_146">146</a></li>
-<li class="isub1">Hemorrhoids, <a href="#Page_146">146</a></li>
-<li class="isub1">Henle’s loops, <a href="#Page_156">156</a></li>
-<li class="isub1">Hepatic artery, <a href="#Page_109">109</a>, <a href="#Page_150">150</a></li>
-<li class="isub3">duct, <a href="#Page_143">143</a>, <a href="#Page_150">150</a></li>
-<li class="isub3">flexure, <a href="#Page_145">145</a>, <a href="#Page_146">146</a></li>
-<li class="isub3">veins, <a href="#Page_110">110</a></li>
-<li class="isub1">Hernia, <a href="#Page_146">146</a>, <a href="#Page_164">164</a></li>
-<li class="isub1">Hiccough, <a href="#Page_99">99</a>, <a href="#Page_131">131</a></li>
-<li class="isub1">Highmore, antrum of, <a href="#Page_54">54</a>, <a href="#Page_57">57</a></li>
-<li class="isub1">Hilum of kidney, <a href="#Page_155">155</a></li>
-<li class="isub1">Hip-joint, <a href="#Page_192">192</a></li>
-<li class="isub1">Housemaid’s knee, <a href="#Page_194">194</a></li>
-<li class="isub1">Humerus, <a href="#Page_175">175</a></li>
-<li class="isub1">Humors of eye, <a href="#Page_70">70</a></li>
-<li class="isub1">Humpback or Pott’s disease, <a href="#Page_91">91</a></li>
-<li class="isub1">Hydrocarbons, <a href="#Page_12">12</a></li>
-<li class="isub1">Hydrocephalus, <a href="#Page_34">34</a></li>
-<li class="isub1">Hydrochloric acid, <a href="#Page_139">139</a>, <a href="#Page_140">140</a></li>
-<li class="isub1">Hydrothorax, <a href="#Page_34">34</a></li>
-<li class="isub1">Hymen, <a href="#Page_170">170</a></li>
-<li class="isub1">Hyoid bone, <a href="#Page_60">60</a></li>
-<li class="isub1">Hypermetropia or far-sightedness, <a href="#Page_72">72</a>, <a href="#Page_73">73</a></li>
-<li class="isub1">Hypochondriac regions, <a href="#Page_135">135</a></li>
-<li class="isub1">Hypogastric plexus, <a href="#Page_87">87</a></li>
-<li class="isub3">region, <a href="#Page_135">135</a></li>
-<li class="isub1">Hypoglossal nerve, <a href="#Page_84">84</a>
-<span class="pagenum"><a name="Page_210" id="Page_210">[Pg 210]</a></span></li>
-
-<li class="ifrst">Idiocy, <a href="#Page_53">53</a></li>
-<li class="isub1">Ileo-cecal valve, <a href="#Page_142">142</a>, <a href="#Page_145">145</a></li>
-<li class="isub1">Ileo-pectineal line, <a href="#Page_163">163</a></li>
-<li class="isub1">Ileum, <a href="#Page_142">142</a></li>
-<li class="isub1">Iliac artery, common, <a href="#Page_107">107</a>, <a href="#Page_109">109</a></li>
-<li class="isub3">deep circumflex, <a href="#Page_198">198</a></li>
-<li class="isub3">external and internal, <a href="#Page_95">95</a>, <a href="#Page_109">109</a>, <a href="#Page_198">198</a></li>
-<li class="isub3">fosssæ, <a href="#Page_163">163</a></li>
-<li class="isub1">Ilio-hypogastric nerve, <a href="#Page_85">85</a></li>
-<li class="isub1">Ilio-inguinal nerve, <a href="#Page_85">85</a></li>
-<li class="isub1">Ilium, <a href="#Page_161">161</a>, <a href="#Page_162">162</a></li>
-<li class="isub1">Impacted hip, <a href="#Page_193">193</a></li>
-<li class="isub1">Incisor teeth, <a href="#Page_60">60</a></li>
-<li class="isub1">Incus, <a href="#Page_63">63</a></li>
-<li class="isub1">Infundibula of lung, <a href="#Page_125">125</a>, <a href="#Page_127">127</a></li>
-<li class="isub1">Inguinal regions, <a href="#Page_135">135</a></li>
-<li class="isub1">Innominate artery, <a href="#Page_107">107</a></li>
-<li class="isub3">bone, <a href="#Page_161">161</a>, <a href="#Page_162">162</a></li>
-<li class="isub3">veins, <a href="#Page_109">109</a></li>
-<li class="isub1">Inorganic compounds in body, <a href="#Page_12">12</a></li>
-<li class="isub1">Intercostal arteries, <a href="#Page_95">95</a>, <a href="#Page_97">97</a>, <a href="#Page_100">100</a>,
-                   <a href="#Page_108">108</a></li>
-<li class="isub3">muscles, <a href="#Page_98">98</a>, <a href="#Page_128">128</a></li>
-<li class="isub3">nerves, <a href="#Page_85">85</a>, <a href="#Page_97">97</a>, <a href="#Page_99">99</a>, <a href="#Page_134">134</a></li>
-<li class="isub1">Intercellular substance, <a href="#Page_14">14</a>, <a href="#Page_17">17</a></li>
-<li class="isub1">Interossei muscles, <a href="#Page_184">184</a></li>
-<li class="isub1">Interosseous nerves, <a href="#Page_85">85</a>, <a href="#Page_186">186</a></li>
-<li class="isub1">Internal secretion, <a href="#Page_36">36</a></li>
-<li class="isub1">Intervertebral foramen, <a href="#Page_90">90</a></li>
-<li class="isub1">Intestines, <a href="#Page_141">141</a>, <i>et seq.</i></li>
-<li class="isub3">large, <a href="#Page_141">141</a>, <a href="#Page_145">145</a></li>
-<li class="isub5">function, <a href="#Page_146">146</a></li>
-<li class="isub5">glands, <a href="#Page_145">145</a></li>
-<li class="isub5">nerves, <a href="#Page_145">145</a></li>
-<li class="isub5">structure, <a href="#Page_145">145</a>, <a href="#Page_146">146</a></li>
-<li class="isub3">small, <a href="#Page_141">141</a>, <a href="#Page_142">142</a>, <i>et seq.</i></li>
-<li class="isub5">blood-vessels, <a href="#Page_143">143</a></li>
-<li class="isub5">function, <a href="#Page_143">143</a>, <a href="#Page_144">144</a></li>
-<li class="isub5">glands, <a href="#Page_142">142</a>, <a href="#Page_143">143</a></li>
-<li class="isub5">nerves, <a href="#Page_143">143</a></li>
-<li class="isub5">structure, <a href="#Page_142">142</a></li>
-<li class="isub1">Intima, <a href="#Page_27">27</a></li>
-<li class="isub1">Intralobular vein, <a href="#Page_150">150</a></li>
-<li class="isub1">Intussusception, <a href="#Page_146">146</a></li>
-<li class="isub1">Involuntary muscle, <a href="#Page_21">21</a></li>
-<li class="isub1">Iris, <a href="#Page_68">68</a>, <a href="#Page_69">69</a>, <a href="#Page_72">72</a></li>
-<li class="isub1">Ischium, <a href="#Page_161">161</a>, <a href="#Page_163">163</a></li>
-<li class="isub1">Island of Reil, <a href="#Page_75">75</a></li>
-
-<li class="ifrst">Jaundice, <a href="#Page_35">35</a>, <a href="#Page_152">152</a>, <a href="#Page_153">153</a>,
-                         <a href="#Page_158">158</a></li>
-<li class="isub1">Jejunum, <a href="#Page_142">142</a></li>
-<li class="isub1">Joints, <a href="#Page_15">15</a>, <a href="#Page_20">20</a></li>
-<li class="isub3">classes of, <a href="#Page_20">20</a>, <a href="#Page_21">21</a></li>
-<li class="isub3">ankle, <a href="#Page_195">195</a></li>
-<li class="isub3">elbow, <a href="#Page_21">21</a>, <a href="#Page_185">185</a></li>
-<li class="isub3">hip, <a href="#Page_21">21</a>, <a href="#Page_192">192</a></li>
-<li class="isub3">knee, <a href="#Page_193">193</a></li>
-<li class="isub3">motion of, <a href="#Page_20">20</a>, <a href="#Page_21">21</a></li>
-<li class="isub3">shoulder, <a href="#Page_21">21</a>, <a href="#Page_185">185</a></li>
-<li class="isub3">wrist, <a href="#Page_185">185</a></li>
-<li class="isub1">Jugular veins, <a href="#Page_109">109</a></li>
-<li class="isub1">Juice, gastric, <a href="#Page_139">139</a></li>
-<li class="isub3">pancreatic, <a href="#Page_143">143</a>, <a href="#Page_144">144</a>, <a href="#Page_153">153</a></li>
-
-<li class="ifrst">Katabolism, <a href="#Page_147">147</a></li>
-<li class="isub1">Kidneys, <a href="#Page_155">155</a>, <i>et seq.</i></li>
-<li class="isub3">floating, <a href="#Page_159">159</a></li>
-<li class="isub3">function, <a href="#Page_156">156</a>, <i>et seq.</i></li>
-<li class="isub3">position, <a href="#Page_155">155</a></li>
-<li class="isub3">structure, <a href="#Page_155">155</a>, <a href="#Page_156">156</a></li>
-<li class="isub1">Knee-jerk, <a href="#Page_83">83</a></li>
-<li class="isub1">Knee-joint, <a href="#Page_193">193</a></li>
-
-<li class="ifrst">Labia majora, <a href="#Page_169">169</a></li>
-<li class="isub3">minora or nymphæ, <a href="#Page_170">170</a></li>
-<li class="isub1">Labyrinth, membranous, <a href="#Page_64">64</a>, <a href="#Page_65">65</a></li>
-<li class="isub3">osseous, <a href="#Page_64">64</a></li>
-<li class="isub1">Lachrymal bones, <a href="#Page_48">48</a>, <a href="#Page_54">54</a></li>
-<li class="isub3">canal, <a href="#Page_54">54</a>, <a href="#Page_57">57</a></li>
-<li class="isub3">duct, <a href="#Page_68">68</a></li>
-<li class="isub3">gland, <a href="#Page_68">68</a>
-<span class="pagenum"><a name="Page_211" id="Page_211">[Pg 211]</a></span></li>
-<li class="isub3">sac, <a href="#Page_54">54</a>, <a href="#Page_68">68</a></li>
-<li class="isub1">Lacteals, <a href="#Page_32">32</a>, <a href="#Page_144">144</a></li>
-<li class="isub1">Lacunæ of bone, <a href="#Page_17">17</a></li>
-<li class="isub1">Lambdoidal suture, <a href="#Page_48">48</a></li>
-<li class="isub1">Lamellæ of bone, <a href="#Page_17">17</a></li>
-<li class="isub1">Laminæ of vertebræ, <a href="#Page_89">89</a></li>
-<li class="isub1">Large intestine, <a href="#Page_141">141</a>, <a href="#Page_145">145</a></li>
-<li class="isub1">Laryngitis, <a href="#Page_122">122</a></li>
-<li class="isub1">Laryngotomy, <a href="#Page_122">122</a></li>
-<li class="isub1">Larynx, <a href="#Page_121">121</a></li>
-<li class="isub1">Latissimus dorsi, <a href="#Page_93">93</a></li>
-<li class="isub1">Laughing, <a href="#Page_131">131</a></li>
-<li class="isub1">Lens, crystalline, <a href="#Page_69">69</a>, <a href="#Page_70">70</a></li>
-<li class="isub1">Leucocytes, <a href="#Page_33">33</a>, <a href="#Page_34">34</a>, <a href="#Page_119">119</a>,
-                                 <a href="#Page_120">120</a></li>
-<li class="isub1">Levator scapulæ, <a href="#Page_93">93</a></li>
-<li class="isub1">Levatores of ribs, <a href="#Page_129">129</a></li>
-<li class="isub1">Lieberkühn, glands of, <a href="#Page_143">143</a>, <a href="#Page_144">144</a>, <a href="#Page_145">145</a></li>
-<li class="isub1">Ligaments, <a href="#Page_15">15</a>, <a href="#Page_20">20</a>, <a href="#Page_21">21</a></li>
-<li class="isub3">annular, <a href="#Page_184">184</a>, <a href="#Page_198">198</a></li>
-<li class="isub3">broad, of uterus, <a href="#Page_165">165</a>, <a href="#Page_166">166</a>, <a href="#Page_168">168</a></li>
-<li class="isub3">capsular, of hip, <a href="#Page_21">21</a>, <a href="#Page_193">193</a></li>
-<li class="isub3">crucial, of knee, <a href="#Page_193">193</a></li>
-<li class="isub3">orbicular, <a href="#Page_178">178</a></li>
-<li class="isub3">Poupart’s, <a href="#Page_132">132</a></li>
-<li class="isub3">round, of uterus, <a href="#Page_168">168</a></li>
-<li class="isub3">suspensory, of liver, <a href="#Page_149">149</a></li>
-<li class="isub3">thyro-arytenoid, <a href="#Page_122">122</a></li>
-<li class="isub1">Ligamentum nuchæ, <a href="#Page_50">50</a>, <a href="#Page_91">91</a>, <a href="#Page_93">93</a></li>
-<li class="isub3">patellæ, <a href="#Page_190">190</a>, <a href="#Page_192">192</a>, <a href="#Page_193">193</a>,
-               <a href="#Page_194">194</a></li>
-<li class="isub3">teres, <a href="#Page_187">187</a></li>
-<li class="isub1">Line, Nélaton’s, <a href="#Page_189">189</a></li>
-<li class="isub1">Linea alba, <a href="#Page_132">132</a></li>
-<li class="isub4">aspera, <a href="#Page_187">187</a></li>
-<li class="isub1">Liver, <a href="#Page_36">36</a>, <a href="#Page_149">149</a>, <i>et seq.</i></li>
-<li class="isub3">blood supply, <a href="#Page_150">150</a></li>
-<li class="isub3">diseases of, <a href="#Page_152">152</a></li>
-<li class="isub3">function, <a href="#Page_150">150</a>, <i>et seq.</i></li>
-<li class="isub3">position, <a href="#Page_149">149</a></li>
-<li class="isub3">structure, <a href="#Page_149">149</a>, <a href="#Page_150">150</a></li>
-<li class="isub1">Loops of Henle, <a href="#Page_156">156</a></li>
-<li class="isub1">Lower extremities, <a href="#Page_187">187</a>, <i>et seq.</i></li>
-<li class="isub1">Lumbar artery, <a href="#Page_95">95</a>, <a href="#Page_109">109</a></li>
-<li class="isub3">fascia, <a href="#Page_133">133</a></li>
-<li class="isub3">nerves, <a href="#Page_84">84</a>, <a href="#Page_85">85</a></li>
-<li class="isub3">plexus, <a href="#Page_84">84</a></li>
-<li class="isub3">regions, <a href="#Page_135">135</a></li>
-<li class="isub3">vertebræ, <a href="#Page_90">90</a></li>
-<li class="isub1">Lumbricales, <a href="#Page_184">184</a></li>
-<li class="isub1">Lungs, <a href="#Page_125">125</a>, <i>et seq.</i></li>
-<li class="isub3">function, <a href="#Page_127">127</a>, <i>et seq.</i></li>
-<li class="isub3">nerves, <a href="#Page_127">127</a></li>
-<li class="isub3">position, <a href="#Page_126">126</a></li>
-<li class="isub3">structure, <a href="#Page_126">126</a>, <a href="#Page_127">127</a></li>
-<li class="isub1">Lupus, <a href="#Page_58">58</a></li>
-<li class="isub1">Lymph, <a href="#Page_30">30</a>, <a href="#Page_32">32</a></li>
-<li class="isub3">capillaries, <a href="#Page_30">30</a></li>
-<li class="isub3">character, <a href="#Page_32">32</a>, <a href="#Page_33">33</a></li>
-<li class="isub3">flow of, <a href="#Page_33">33</a></li>
-<li class="isub3">function, <a href="#Page_34">34</a></li>
-<li class="isub3">spaces, <a href="#Page_30">30</a></li>
-<li class="isub3">transudation of, <a href="#Page_33">33</a></li>
-<li class="isub1">Lymphatic glands, <a href="#Page_32">32</a>, <a href="#Page_34">34</a>, <a href="#Page_35">35</a></li>
-<li class="isub3">system, <a href="#Page_27">27</a>, <a href="#Page_29">29</a>, <i>et seq.</i></li>
-<li class="isub3">vessels, <a href="#Page_30">30</a>, <a href="#Page_31">31</a></li>
-<li class="isub4">valves of, <a href="#Page_31">31</a>, <a href="#Page_32">32</a>, <a href="#Page_33">33</a></li>
-
-<li class="ifrst">Macula lutea, <a href="#Page_70">70</a></li>
-<li class="isub1">Malar or cheek bone, <a href="#Page_48">48</a>, <a href="#Page_54">54</a></li>
-<li class="isub1">Malaria, <a href="#Page_154">154</a></li>
-<li class="isub1">Male organs of generation, <a href="#Page_163">163</a>, <a href="#Page_164">164</a>, <a href="#Page_165">165</a></li>
-<li class="isub1">Malleolus of fibula, <a href="#Page_194">194</a>, <a href="#Page_195">195</a></li>
-<li class="isub3">of tibia, <a href="#Page_194">194</a></li>
-<li class="isub1">Malleus, <a href="#Page_63">63</a></li>
-<li class="isub1">Malpighian bodies, <a href="#Page_156">156</a></li>
-<li class="isub3">pyramids, <a href="#Page_156">156</a></li>
-<li class="isub1">Mammary artery, internal, <a href="#Page_99">99</a>, <a href="#Page_100">100</a>, <a href="#Page_108">108</a></li>
-<li class="isub3">glands, <a href="#Page_99">99</a>, <a href="#Page_100">100</a></li>
-<li class="isub1">Manubrium, <a href="#Page_97">97</a></li>
-<li class="isub1">Marrow of bone, <a href="#Page_18">18</a>
-<span class="pagenum"><a name="Page_212" id="Page_212">[Pg 212]</a></span></li>
-<li class="isub1">Masseter, <a href="#Page_51">51</a>, <a href="#Page_54">54</a></li>
-<li class="isub1">Mastoid abscess, <a href="#Page_51">51</a>, <a href="#Page_52">52</a></li>
-<li class="isub3">cells, <a href="#Page_51">51</a>, <a href="#Page_64">64</a></li>
-<li class="isub3">portion of temporal bone, <a href="#Page_51">51</a></li>
-<li class="isub1">Maxillary bone, inferior, <a href="#Page_48">48</a>, <a href="#Page_55">55</a></li>
-<li class="isub3">superior, <a href="#Page_48">48</a>, <a href="#Page_54">54</a></li>
-<li class="isub1">McBurney’s point, <a href="#Page_145">145</a></li>
-<li class="isub1">Meatus, auditory, <a href="#Page_52">52</a>, <a href="#Page_65">65</a></li>
-<li class="isub3">nasal, <a href="#Page_57">57</a></li>
-<li class="isub3">urinarius, <a href="#Page_160">160</a>, <a href="#Page_165">165</a>, <a href="#Page_170">170</a></li>
-<li class="isub1">Median, cephalic vein, <a href="#Page_109">109</a></li>
-<li class="isub3">nerve, <a href="#Page_85">85</a>, <a href="#Page_186">186</a></li>
-<li class="isub3">vein, <a href="#Page_109">109</a></li>
-<li class="isub1">Mediastinal artery, <a href="#Page_99">99</a></li>
-<li class="isub1">Mediastinum, <a href="#Page_32">32</a>, <a href="#Page_126">126</a></li>
-<li class="isub1">Medulla or marrow, <a href="#Page_18">18</a></li>
-<li class="isub1">Medulla oblongata, <a href="#Page_78">78</a>, <a href="#Page_79">79</a>, <a href="#Page_82">82</a></li>
-<li class="isub1">Medullary artery, <a href="#Page_19">19</a></li>
-<li class="isub3">canal, <a href="#Page_19">19</a></li>
-<li class="isub3">sheath, <a href="#Page_37">37</a></li>
-<li class="isub1">Meibomian duct, <a href="#Page_74">74</a></li>
-<li class="isub3">glands, <a href="#Page_67">67</a></li>
-<li class="isub1">Membrana tympani or drum, <a href="#Page_63">63</a></li>
-<li class="isub1">Membranous labyrinth, <a href="#Page_64">64</a>, <a href="#Page_65">65</a></li>
-<li class="isub1">Mesenteric arteries, <a href="#Page_109">109</a>, <a href="#Page_143">143</a>, <a href="#Page_145">145</a>,
-                    <a href="#Page_153">153</a></li>
-<li class="isub3">veins, <a href="#Page_110">110</a>, <a href="#Page_150">150</a></li>
-<li class="isub1">Mesenteries, <a href="#Page_32">32</a>, <a href="#Page_134">134</a></li>
-<li class="isub1">Metabolism, <a href="#Page_45">45</a>, <a href="#Page_147">147</a>, <a href="#Page_151">151</a>,
-                       <a href="#Page_152">152</a></li>
-<li class="isub1">Metacarpal bones, <a href="#Page_181">181</a></li>
-<li class="isub1">Metatarsal bones, <a href="#Page_195">195</a></li>
-<li class="isub1">Micturition, <a href="#Page_157">157</a></li>
-<li class="isub1">Milk teeth, <a href="#Page_60">60</a></li>
-<li class="isub1">Mitral valve, <a href="#Page_104">104</a></li>
-<li class="isub1">Molar teeth, <a href="#Page_60">60</a></li>
-<li class="isub1">Monometer, <a href="#Page_114">114</a></li>
-<li class="isub1">Mons Veneris, <a href="#Page_169">169</a></li>
-<li class="isub1">Motor areas, <a href="#Page_81">81</a>, <a href="#Page_82">82</a></li>
-<li class="isub3">center, <a href="#Page_81">81</a>, <a href="#Page_82">82</a></li>
-<li class="isub3">oculi nerve, <a href="#Page_68">68</a>, <a href="#Page_83">83</a></li>
-<li class="isub3">tract, <a href="#Page_82">82</a></li>
-<li class="isub1">Mouth, <a href="#Page_59">59</a>, <i>et seq.</i></li>
-<li class="isub1">Mucous membrane, <a href="#Page_40">40</a></li>
-<li class="isub1">Mucus, <a href="#Page_40">40</a></li>
-<li class="isub1">Mumps, <a href="#Page_62">62</a></li>
-<li class="isub1">Muscle, <a href="#Page_21">21</a>, <i>et seq.</i></li>
-<li class="isub3">action, <a href="#Page_23">23</a>, <a href="#Page_24">24</a></li>
-<li class="isub3">cardiac, <a href="#Page_22">22</a>, <a href="#Page_25">25</a></li>
-<li class="isub3">characteristics, <a href="#Page_22">22</a>, <a href="#Page_23">23</a>, <a href="#Page_24">24</a>,
-                           <a href="#Page_25">25</a></li>
-<li class="isub3">classes of, <a href="#Page_21">21</a></li>
-<li class="isub3">fatigue of, <a href="#Page_26">26</a>, <a href="#Page_27">27</a></li>
-<li class="isub3">function of, <a href="#Page_24">24</a></li>
-<li class="isub3">smooth, <a href="#Page_21">21</a>, <a href="#Page_25">25</a></li>
-<li class="isub3">sounds, <a href="#Page_25">25</a></li>
-<li class="isub3">striated, <a href="#Page_21">21</a>, <a href="#Page_23">23</a>, <a href="#Page_25">25</a></li>
-<li class="isub3">work, <a href="#Page_25">25</a>, <a href="#Page_26">26</a></li>
-<li class="isub1">Muscles of abdomen, <a href="#Page_132">132</a>, <i>et seq.</i></li>
-<li class="isub3">of arm, <a href="#Page_175">175</a>, <a href="#Page_176">176</a>, <a href="#Page_177">177</a></li>
-<li class="isub3">of back, <a href="#Page_93">93</a>, <a href="#Page_94">94</a></li>
-<li class="isub3">of chest, <a href="#Page_98">98</a>, <a href="#Page_99">99</a>, <a href="#Page_128">128</a></li>
-<li class="isub3">of foot, <a href="#Page_198">198</a></li>
-<li class="isub3">of forearm, <a href="#Page_182">182</a></li>
-<li class="isub3">of hand, <a href="#Page_184">184</a></li>
-<li class="isub3">of head, <a href="#Page_50">50</a>, <a href="#Page_51">51</a>, <a href="#Page_54">54</a>, <a href="#Page_55">55</a>,
-                <a href="#Page_58">58</a>, <a href="#Page_67">67</a>, <a href="#Page_69">69</a></li>
-<li class="isub3">of leg, <a href="#Page_196">196</a>, <i>et seq.</i></li>
-<li class="isub3">of neck, <a href="#Page_51">51</a>, <a href="#Page_92">92</a>, <a href="#Page_93">93</a>, <a href="#Page_129">129</a></li>
-<li class="isub3">of shoulder, <a href="#Page_174">174</a></li>
-<li class="isub3">of thigh, <a href="#Page_189">189</a>, <i>et seq.</i></li>
-<li class="isub1">Musculo-cutaneous nerve, <a href="#Page_85">85</a>, <a href="#Page_186">186</a>, <a href="#Page_199">199</a></li>
-<li class="isub1">Musculo-spiral nerve, <a href="#Page_85">85</a>, <a href="#Page_175">175</a>, <a href="#Page_186">186</a></li>
-<li class="isub1">Musical sounds, <a href="#Page_65">65</a></li>
-<li class="isub1">Myopia or near-sightedness, <a href="#Page_72">72</a>, <a href="#Page_73">73</a></li>
-<li class="isub1">Myosin, <a href="#Page_11">11</a>, <a href="#Page_23">23</a></li>
-<li class="isub1">Myosinogen, <a href="#Page_23">23</a></li>
-
-<li class="ifrst">Nails, <a href="#Page_27">27</a>, <a href="#Page_40">40</a></li>
-<li class="isub1">Nares, <a href="#Page_57">57</a></li>
-<li class="isub1">Nasal bones, <a href="#Page_55">55</a></li>
-<li class="isub3">duct, <a href="#Page_68">68</a></li>
-<li class="isub3">fossæ, <a href="#Page_55">55</a>, <a href="#Page_57">57</a>
-<span class="pagenum"><a name="Page_213" id="Page_213">[Pg 213]</a></span></li>
-<li class="isub3">meatus, <a href="#Page_57">57</a></li>
-<li class="isub1">Nasal septum, <a href="#Page_55">55</a></li>
-<li class="isub1">Navicular or scaphoid bone, <a href="#Page_195">195</a></li>
-<li class="isub1">Near-sightedness, <a href="#Page_72">72</a>, <a href="#Page_73">73</a></li>
-<li class="isub1">Neck, glands of, <a href="#Page_32">32</a></li>
-<li class="isub3">muscles of, <a href="#Page_51">51</a>, <a href="#Page_92">92</a></li>
-<li class="isub1">Nélaton’s line, <a href="#Page_189">189</a></li>
-<li class="isub1">Nerve, <a href="#Page_37">37</a></li>
-<li class="isub3">action of, <a href="#Page_37">37</a>, <a href="#Page_38">38</a>, <a href="#Page_83">83</a></li>
-<li class="isub3">cell or gray matter, <a href="#Page_36">36</a></li>
-<li class="isub3">fiber or white matter, <a href="#Page_36">36</a></li>
-<li class="isub3">function, <a href="#Page_37">37</a></li>
-<li class="isub3">ganglia, <a href="#Page_87">87</a>, <a href="#Page_110">110</a></li>
-<li class="isub3">motor, <a href="#Page_82">82</a></li>
-<li class="isub3">plexus, <a href="#Page_29">29</a>, <a href="#Page_84">84</a>, <i>et seq.</i></li>
-<li class="isub3">sensory, <a href="#Page_82">82</a>, <a href="#Page_83">83</a></li>
-<li class="isub3">terminations, <a href="#Page_37">37</a></li>
-<li class="isub1">Nerves, <a href="#Page_24">24</a>, <a href="#Page_36">36</a></li>
-<li class="isub3">abducens, <a href="#Page_83">83</a></li>
-<li class="isub3">auditory, <a href="#Page_64">64</a>, <a href="#Page_65">65</a>, <a href="#Page_84">84</a></li>
-<li class="isub3">cardiac, <a href="#Page_78">78</a></li>
-<li class="isub3">cervical, <a href="#Page_84">84</a></li>
-<li class="isub3">circumflex, <a href="#Page_85">85</a>, <a href="#Page_186">186</a></li>
-<li class="isub3">coccygeal, <a href="#Page_84">84</a></li>
-<li class="isub3">cranial, <a href="#Page_77">77</a>, <a href="#Page_78">78</a>, <a href="#Page_83">83</a>, <a href="#Page_84">84</a></li>
-<li class="isub3">crural, anterior, <a href="#Page_85">85</a>, <a href="#Page_199">199</a></li>
-<li class="isub3">cutaneous, <a href="#Page_46">46</a>, <a href="#Page_85">85</a></li>
-<li class="isub3">dorsal or thoracic, <a href="#Page_84">84</a>, <a href="#Page_85">85</a></li>
-<li class="isub3">eighth, <a href="#Page_64">64</a>, <a href="#Page_84">84</a></li>
-<li class="isub3">eleventh, <a href="#Page_84">84</a></li>
-<li class="isub3">facial, <a href="#Page_83">83</a></li>
-<li class="isub3">fifth, <a href="#Page_83">83</a></li>
-<li class="isub3">first, <a href="#Page_83">83</a></li>
-<li class="isub3">fourth, <a href="#Page_68">68</a>, <a href="#Page_83">83</a></li>
-<li class="isub3">genito-crural, <a href="#Page_85">85</a></li>
-<li class="isub3">glosso-pharyngeal, <a href="#Page_61">61</a>, <a href="#Page_84">84</a></li>
-<li class="isub3">gluteal, <a href="#Page_199">199</a></li>
-<li class="isub3">hypoglossal, <a href="#Page_84">84</a></li>
-<li class="isub3">ilio-hypogastric, <a href="#Page_61">61</a>, <a href="#Page_85">85</a></li>
-<li class="isub3">ilio-inguinal, <a href="#Page_85">85</a></li>
-<li class="isub3">intercostal, <a href="#Page_85">85</a>, <a href="#Page_97">97</a>, <a href="#Page_99">99</a>, <a href="#Page_134">134</a></li>
-<li class="isub3">interosseous, <a href="#Page_85">85</a>, <a href="#Page_186">186</a></li>
-<li class="isub3">lumbar, <a href="#Page_84">84</a>, <a href="#Page_85">85</a></li>
-<li class="isub3">median, <a href="#Page_85">85</a>, <a href="#Page_186">186</a></li>
-<li class="isub3">motor oculi, <a href="#Page_68">68</a>, <a href="#Page_83">83</a></li>
-<li class="isub3">musculo-cutaneous, <a href="#Page_85">85</a>, <a href="#Page_186">186</a>, <a href="#Page_199">199</a></li>
-<li class="isub3">musculo-spiral, <a href="#Page_85">85</a>, <a href="#Page_175">175</a>, <a href="#Page_186">186</a></li>
-<li class="isub3">ninth, <a href="#Page_84">84</a></li>
-<li class="isub3">obturator, <a href="#Page_85">85</a></li>
-<li class="isub3">olfactory, <a href="#Page_53">53</a>, <a href="#Page_58">58</a>, <a href="#Page_83">83</a></li>
-<li class="isub3">optic, <a href="#Page_70">70</a>, <a href="#Page_71">71</a>, <a href="#Page_76">76</a>, <a href="#Page_83">83</a></li>
-<li class="isub3">patheticus, <a href="#Page_83">83</a></li>
-<li class="isub3">phrenic, <a href="#Page_85">85</a>, <a href="#Page_99">99</a>, <a href="#Page_130">130</a></li>
-<li class="isub3">plantar, <a href="#Page_85">85</a></li>
-<li class="isub3">pneumogastric, <a href="#Page_84">84</a>, <a href="#Page_110">110</a>, <a href="#Page_111">111</a>,
-                      <a href="#Page_127">127</a>, <a href="#Page_130">130</a>, <a href="#Page_153">153</a></li>
-<li class="isub3">popliteal, <a href="#Page_85">85</a>, <a href="#Page_199">199</a></li>
-<li class="isub3">post-tibial, <a href="#Page_85">85</a></li>
-<li class="isub3">radial, <a href="#Page_85">85</a></li>
-<li class="isub3">sacral, <a href="#Page_84">84</a></li>
-<li class="isub3">sciatic, <a href="#Page_85">85</a>, <a href="#Page_163">163</a>, <a href="#Page_199">199</a></li>
-<li class="isub3">second, <a href="#Page_70">70</a>, <a href="#Page_83">83</a></li>
-<li class="isub3">seventh, <a href="#Page_83">83</a></li>
-<li class="isub3">sixth, <a href="#Page_68">68</a>, <a href="#Page_83">83</a></li>
-<li class="isub3">spinal, <a href="#Page_84">84</a>, <a href="#Page_95">95</a></li>
-<li class="isub5">accessory, <a href="#Page_84">84</a>, <a href="#Page_95">95</a>, <a href="#Page_137">137</a></li>
-<li class="isub3">suprascapular, <a href="#Page_186">186</a></li>
-<li class="isub3">sympathetic, <a href="#Page_87">87</a>, <a href="#Page_110">110</a>, <a href="#Page_127">127</a>, <a href="#Page_137">137</a>,
-                        <a href="#Page_143">143</a>, <a href="#Page_145">145</a>, <a href="#Page_168">168</a></li>
-<li class="isub3">tenth, <a href="#Page_84">84</a></li>
-<li class="isub3">third, <a href="#Page_68">68</a>, <a href="#Page_72">72</a>, <a href="#Page_83">83</a></li>
-<li class="isub3">thoracic, <a href="#Page_186">186</a></li>
-<li class="isub5">cutaneous, <a href="#Page_100">100</a></li>
-<li class="isub3">tibial, <a href="#Page_86">86</a>, <a href="#Page_87">87</a>, <a href="#Page_199">199</a></li>
-<li class="isub3">trifacial, <a href="#Page_61">61</a>, <a href="#Page_83">83</a></li>
-<li class="isub3">twelfth, <a href="#Page_84">84</a></li>
-<li class="isub3">ulnar, <a href="#Page_85">85</a>, <a href="#Page_175">175</a>, <a href="#Page_186">186</a></li>
-<li class="isub3">vagus, <a href="#Page_84">84</a>, <a href="#Page_110">110</a>, <a href="#Page_111">111</a>, <a href="#Page_127">127</a>,
-                      <a href="#Page_130">130</a>, <a href="#Page_153">153</a></li>
-<li class="isub3">vasoconstrictors, <a href="#Page_115">115</a></li>
-<li class="isub5">dilators, <a href="#Page_115">115</a></li>
-<li class="isub5">motor, <a href="#Page_29">29</a>, <a href="#Page_78">78</a>, <a href="#Page_115">115</a></li>
-<li class="isub1">Nervous system, <a href="#Page_38">38</a>, <a href="#Page_75">75</a>, <i>et seq.</i>
-<span class="pagenum"><a name="Page_214" id="Page_214">[Pg 214]</a></span></li>
-<li class="isub3">tissue, <a href="#Page_13">13</a>, <a href="#Page_36">36</a></li>
-<li class="isub1">Neurilemma, <a href="#Page_37">37</a></li>
-<li class="isub1">Ninth nerve, <a href="#Page_84">84</a></li>
-<li class="isub1">Nipple, <a href="#Page_100">100</a></li>
-<li class="isub1">Nose, <a href="#Page_57">57</a>, <a href="#Page_58">58</a></li>
-<li class="isub3">bleed, <a href="#Page_59">59</a></li>
-<li class="isub1">Nucleolus, <a href="#Page_12">12</a></li>
-<li class="isub1">Nucleus, <a href="#Page_12">12</a></li>
-<li class="isub1">Nutrient foramen, <a href="#Page_19">19</a></li>
-<li class="isub1">Nymphæ, <a href="#Page_170">170</a></li>
-
-<li class="ifrst">Oblique muscles of abdomen, <a href="#Page_132">132</a></li>
-<li class="isub3">of eye, <a href="#Page_68">68</a></li>
-<li class="isub1">Obturator foramen, <a href="#Page_163">163</a></li>
-<li class="isub3">nerve, <a href="#Page_85">85</a></li>
-<li class="isub1">Occipital bone, <a href="#Page_48">48</a>, <a href="#Page_50">50</a></li>
-<li class="isub1">Occipito-frontalis muscle, <a href="#Page_51">51</a></li>
-<li class="isub1">Odontoid process of axis, <a href="#Page_91">91</a></li>
-<li class="isub1">Olecranon fossa, <a href="#Page_175">175</a></li>
-<li class="isub3">process, <a href="#Page_178">178</a></li>
-<li class="isub1">Olfactory bulbs, <a href="#Page_53">53</a>, <a href="#Page_58">58</a>, <a href="#Page_76">76</a></li>
-<li class="isub3">cells, <a href="#Page_58">58</a></li>
-<li class="isub3">grooves, <a href="#Page_53">53</a></li>
-<li class="isub3">nerves, <a href="#Page_53">53</a>, <a href="#Page_58">58</a>, <a href="#Page_83">83</a></li>
-<li class="isub3">tract, <a href="#Page_58">58</a>, <a href="#Page_76">76</a></li>
-<li class="isub1">Omenta, <a href="#Page_134">134</a>, <a href="#Page_146">146</a></li>
-<li class="isub1">Ophthalmic artery, <a href="#Page_70">70</a></li>
-<li class="isub1">Optic axis, <a href="#Page_70">70</a></li>
-<li class="isub3">commissure, <a href="#Page_76">76</a></li>
-<li class="isub3">foramen, <a href="#Page_66">66</a>, <a href="#Page_70">70</a></li>
-<li class="isub3">nerve, <a href="#Page_70">70</a>, <a href="#Page_71">71</a>, <a href="#Page_76">76</a>, <a href="#Page_83">83</a></li>
-<li class="isub3">tract, <a href="#Page_76">76</a></li>
-<li class="isub1">Orbicular ligament, <a href="#Page_178">178</a></li>
-<li class="isub1">Orbicularis palpebrarum, <a href="#Page_67">67</a></li>
-<li class="isub1">Orbit of eye, <a href="#Page_54">54</a>, <a href="#Page_66">66</a></li>
-<li class="isub1">Organ of Corti, <a href="#Page_65">65</a></li>
-<li class="isub1">Organic compounds in body, <a href="#Page_11">11</a>, <a href="#Page_12">12</a></li>
-<li class="isub1">Os calcis, <a href="#Page_195">195</a></li>
-<li class="isub3">innominatum, <a href="#Page_161">161</a>, <a href="#Page_162">162</a></li>
-<li class="isub3">magnum, <a href="#Page_181">181</a></li>
-<li class="isub3">uteri, <a href="#Page_168">168</a></li>
-<li class="isub1">Osseous labyrinth, <a href="#Page_64">64</a></li>
-<li class="isub1">Ossicles of ear, <a href="#Page_63">63</a>, <a href="#Page_65">65</a></li>
-<li class="isub1">Osteoblasts, <a href="#Page_18">18</a></li>
-<li class="isub1">Osteomalacia, <a href="#Page_164">164</a>, <a href="#Page_189">189</a></li>
-<li class="isub1">Osteomyelitis, <a href="#Page_193">193</a></li>
-<li class="isub1">Oval window, <a href="#Page_63">63</a>, <a href="#Page_64">64</a>, <a href="#Page_65">65</a></li>
-<li class="isub1">Ovaries, <a href="#Page_165">165</a></li>
-<li class="isub1">Ovum, <a href="#Page_12">12</a>, <a href="#Page_166">166</a>, <a href="#Page_168">168</a></li>
-<li class="isub1">Oxyhemoglobin, <a href="#Page_130">130</a></li>
-
-<li class="ifrst">Paget’s disease, <a href="#Page_53">53</a></li>
-<li class="isub1">Pain, sensation of, <a href="#Page_47">47</a>, <a href="#Page_81">81</a></li>
-<li class="isub1">Palate, bones of, <a href="#Page_48">48</a>, <a href="#Page_54">54</a></li>
-<li class="isub3">cleft, <a href="#Page_55">55</a></li>
-<li class="isub3">hard, <a href="#Page_55">55</a>, <a href="#Page_59">59</a></li>
-<li class="isub3">soft, <a href="#Page_59">59</a>, <a href="#Page_60">60</a>, <a href="#Page_136">136</a></li>
-<li class="isub1">Palmar, arch, <a href="#Page_186">186</a></li>
-<li class="isub3">fascia, <a href="#Page_184">184</a></li>
-<li class="isub1">Palmaris longus, <a href="#Page_182">182</a>, <a href="#Page_183">183</a></li>
-<li class="isub1">Pancreas, <a href="#Page_153">153</a></li>
-<li class="isub1">Pancreatic duct, <a href="#Page_143">143</a>, <a href="#Page_153">153</a></li>
-<li class="isub3">juice, <a href="#Page_143">143</a>, <a href="#Page_144">144</a>, <a href="#Page_153">153</a></li>
-<li class="isub1">Pancreatitis, <a href="#Page_153">153</a></li>
-<li class="isub1">Panhysterectomy, <a href="#Page_169">169</a></li>
-<li class="isub1">Papillæ of skin, <a href="#Page_37">37</a>, <a href="#Page_39">39</a></li>
-<li class="isub3">of tongue, <a href="#Page_61">61</a></li>
-<li class="isub1">Paralysis, <a href="#Page_79">79</a></li>
-<li class="isub1">Parietal bone, <a href="#Page_48">48</a>, <a href="#Page_49">49</a></li>
-<li class="isub1">Parotid gland, <a href="#Page_51">51</a>, <a href="#Page_62">62</a></li>
-<li class="isub1">Patella or knee-cap, <a href="#Page_19">19</a>, <a href="#Page_192">192</a></li>
-<li class="isub1">Patheticus nerve, <a href="#Page_83">83</a></li>
-<li class="isub1">Pectoral muscles, <a href="#Page_99">99</a>, <a href="#Page_128">128</a></li>
-<li class="isub1">Pectoralis major, <a href="#Page_174">174</a></li>
-<li class="isub1">Pedicles of vertebræ, <a href="#Page_89">89</a></li>
-<li class="isub1">Pelvis, <a href="#Page_132">132</a>, <a href="#Page_161">161</a>, <i>et seq.</i></li>
-<li class="isub3">false, <a href="#Page_163">163</a></li>
-<li class="isub3">of kidney, <a href="#Page_156">156</a></li>
-<li class="isub3">true, <a href="#Page_163">163</a>, <a href="#Page_164">164</a></li>
-<li class="isub1">Penis, <a href="#Page_160">160</a>, <a href="#Page_165">165</a></li>
-<li class="isub1">Pepsin, <a href="#Page_140">140</a></li>
-<li class="isub1">Peptones, <a href="#Page_12">12</a>, <a href="#Page_140">140</a>, <a href="#Page_150">150</a>
-<span class="pagenum"><a name="Page_215" id="Page_215">[Pg 215]</a></span></li>
-<li class="isub1">Pericardium, <a href="#Page_34">34</a>, <a href="#Page_101">101</a>, <a href="#Page_102">102</a></li>
-<li class="isub1">Perichondrium, <a href="#Page_16">16</a></li>
-<li class="isub1">Perineal body, <a href="#Page_170">170</a></li>
-<li class="isub1">Perineum, <a href="#Page_170">170</a></li>
-<li class="isub1">Perilymph, <a href="#Page_64">64</a>, <a href="#Page_65">65</a></li>
-<li class="isub1">Periosteum, <a href="#Page_15">15</a>, <a href="#Page_18">18</a>, <a href="#Page_19">19</a>, <a href="#Page_76">76</a></li>
-<li class="isub1">Peripheral resistance, <a href="#Page_112">112</a>, <a href="#Page_114">114</a></li>
-<li class="isub1">Peristaltic movements, <a href="#Page_138">138</a>, <a href="#Page_143">143</a>, <a href="#Page_146">146</a></li>
-<li class="isub1">Peritoneum, <a href="#Page_134">134</a></li>
-<li class="isub1">Permanent teeth, <a href="#Page_60">60</a></li>
-<li class="isub1">Peroneal artery, <a href="#Page_199">199</a></li>
-<li class="isub1">Peroneus brevis, <a href="#Page_197">197</a></li>
-<li class="isub3">longus, <a href="#Page_197">197</a></li>
-<li class="isub1">Petrous portion of temporal bone, <a href="#Page_51">51</a>, <a href="#Page_52">52</a></li>
-<li class="isub1">Peyer’s patches or glands, <a href="#Page_142">142</a></li>
-<li class="isub1">Phalanges of foot, <a href="#Page_195">195</a></li>
-<li class="isub3">of hand, <a href="#Page_181">181</a></li>
-<li class="isub1">Pharynx, <a href="#Page_59">59</a>, <a href="#Page_136">136</a>, <a href="#Page_137">137</a></li>
-<li class="isub1">Physiology, <a href="#Page_11">11</a></li>
-<li class="isub1">Phrenic artery, <a href="#Page_99">99</a>, <a href="#Page_109">109</a></li>
-<li class="isub3">nerve, <a href="#Page_85">85</a>, <a href="#Page_99">99</a>, <a href="#Page_130">130</a></li>
-<li class="isub1">Pia mater, <a href="#Page_76">76</a></li>
-<li class="isub1">Pigeon breast, <a href="#Page_97">97</a></li>
-<li class="isub1">Pillars of the fauces, <a href="#Page_59">59</a>, <a href="#Page_60">60</a></li>
-<li class="isub1">Pink eye, <a href="#Page_74">74</a></li>
-<li class="isub1">Pinna, <a href="#Page_63">63</a></li>
-<li class="isub1">Pisiform bone, <a href="#Page_181">181</a></li>
-<li class="isub1">Pituitary body, <a href="#Page_36">36</a></li>
-<li class="isub1">Placenta, <a href="#Page_106">106</a>, <a href="#Page_107">107</a></li>
-<li class="isub1">Plantar artery, <a href="#Page_199">199</a></li>
-<li class="isub3">fascia, <a href="#Page_198">198</a></li>
-<li class="isub3">nerve, <a href="#Page_86">86</a></li>
-<li class="isub1">Plantaris, <a href="#Page_197">197</a></li>
-<li class="isub1">Plasma of blood, <a href="#Page_33">33</a>, <a href="#Page_116">116</a>, <a href="#Page_117">117</a></li>
-<li class="isub1">Platysma myoides, <a href="#Page_92">92</a></li>
-<li class="isub1">Pleuræ, <a href="#Page_34">34</a>, <a href="#Page_125">125</a></li>
-<li class="isub1">Plexus, <a href="#Page_29">29</a></li>
-<li class="isub3">brachial, <a href="#Page_84">84</a>, <a href="#Page_85">85</a></li>
-<li class="isub3">cardiac, <a href="#Page_87">87</a></li>
-<li class="isub3">cervical, <a href="#Page_84">84</a></li>
-<li class="isub3">hypogastric, <a href="#Page_87">87</a></li>
-<li class="isub3">lumbar, <a href="#Page_84">84</a></li>
-<li class="isub3">sacral, <a href="#Page_84">84</a>, <a href="#Page_85">85</a></li>
-<li class="isub3">solar, <a href="#Page_87">87</a>, <a href="#Page_153">153</a></li>
-<li class="isub1">Pneumogastric nerve, <a href="#Page_84">84</a>, <a href="#Page_110">110</a>, <a href="#Page_127">127</a>,
-                <a href="#Page_153">153</a></li>
-<li class="isub1">Polypi, <a href="#Page_58">58</a></li>
-<li class="isub1">Pons Varolii, <a href="#Page_78">78</a></li>
-<li class="isub1">Popliteal artery, <a href="#Page_198">198</a></li>
-<li class="isub3">nerves, <a href="#Page_86">86</a>, <a href="#Page_199">199</a></li>
-<li class="isub3">space, <a href="#Page_32">32</a>, <a href="#Page_198">198</a></li>
-<li class="isub1">Popliteus muscle, <a href="#Page_198">198</a></li>
-<li class="isub1">Portal circulation, <a href="#Page_110">110</a></li>
-<li class="isub3">vein, <a href="#Page_110">110</a>, <a href="#Page_150">150</a></li>
-<li class="isub1">Pott’s disease, <a href="#Page_91">91</a></li>
-<li class="isub3">fracture, <a href="#Page_180">180</a>, <a href="#Page_195">195</a></li>
-<li class="isub1">Poupart’s ligament, <a href="#Page_132">132</a></li>
-<li class="isub1">Prepatella bursa, <a href="#Page_192">192</a></li>
-<li class="isub1">Prepuce, <a href="#Page_165">165</a></li>
-<li class="isub1">Presbyopia, <a href="#Page_73">73</a></li>
-<li class="isub1">Presternal notch, <a href="#Page_171">171</a></li>
-<li class="isub1">Procreating glands, <a href="#Page_165">165</a></li>
-<li class="isub1">Profunda artery, <a href="#Page_175">175</a>, <a href="#Page_186">186</a></li>
-<li class="isub3">femoris artery, <a href="#Page_198">198</a></li>
-<li class="isub1">Promontory of the sacrum, <a href="#Page_90">90</a></li>
-<li class="isub1">Pronator quadratus, <a href="#Page_182">182</a>, <a href="#Page_183">183</a></li>
-<li class="isub3">radii teres, <a href="#Page_182">182</a>, <a href="#Page_183">183</a></li>
-<li class="isub1">Prostate gland, <a href="#Page_164">164</a>, <a href="#Page_165">165</a></li>
-<li class="isub1">Proteins, <a href="#Page_11">11</a>, <a href="#Page_26">26</a>, <a href="#Page_33">33</a>, <a href="#Page_140">140</a>,
-                      <a href="#Page_144">144</a>, <a href="#Page_147">147</a>, <a href="#Page_148">148</a></li>
-<li class="isub1">Protoplasm, <a href="#Page_12">12</a>, <a href="#Page_13">13</a></li>
-<li class="isub1">Psoas magnus, <a href="#Page_189">189</a>, <a href="#Page_190">190</a></li>
-<li class="isub3">parvus, <a href="#Page_190">190</a></li>
-<li class="isub1">Ptosis of liver, <a href="#Page_152">152</a></li>
-<li class="isub3">of upper lid, <a href="#Page_74">74</a></li>
-<li class="isub1">Ptyalin, <a href="#Page_61">61</a>, <a href="#Page_136">136</a></li>
-<li class="isub1">Pubes, <a href="#Page_161">161</a>, <a href="#Page_163">163</a></li>
-<li class="isub1">Pudic artery, <a href="#Page_168">168</a></li>
-<li class="isub1">Pulmonary artery, <a href="#Page_106">106</a>, <a href="#Page_110">110</a></li>
-<li class="isub3">circulation, <a href="#Page_110">110</a></li>
-<li class="isub3">valves, <a href="#Page_104">104</a></li>
-<li class="isub3">veins, <a href="#Page_105">105</a>, <a href="#Page_110">110</a>
-<span class="pagenum"><a name="Page_216" id="Page_216">[Pg 216]</a></span></li>
-<li class="isub1">Pulse, <a href="#Page_112">112</a>, <a href="#Page_113">113</a>, <a href="#Page_114">114</a>, <a href="#Page_115">115</a></li>
-<li class="isub1">Pulse, causes, <a href="#Page_112">112</a></li>
-<li class="isub3">dicrotic, <a href="#Page_113">113</a></li>
-<li class="isub3">rate, <a href="#Page_111">111</a>, <a href="#Page_113">113</a>, <a href="#Page_114">114</a></li>
-<li class="isub1">Pupil of eye, <a href="#Page_69">69</a>, <a href="#Page_72">72</a></li>
-<li class="isub1">Pus corpuscles, <a href="#Page_120">120</a></li>
-<li class="isub1">Pylorus, <a href="#Page_138">138</a></li>
-<li class="isub1">Pyramidalis muscle, <a href="#Page_134">134</a></li>
-<li class="isub1">Pyramids, Malpighian, <a href="#Page_156">156</a></li>
-
-<li class="ifrst">Quadratus lumborum, <a href="#Page_134">134</a></li>
-<li class="isub1">Quadriceps extensor, <a href="#Page_190">190</a></li>
-
-<li class="ifrst">Radial artery, <a href="#Page_108">108</a>, <a href="#Page_185">185</a></li>
-<li class="isub4">nerve, <a href="#Page_85">85</a></li>
-<li class="isub1">Racemose glands, <a href="#Page_35">35</a></li>
-<li class="isub1">Radius, <a href="#Page_178">178</a>, <a href="#Page_179">179</a></li>
-<li class="isub1">Râles, <a href="#Page_129">129</a></li>
-<li class="isub1">Receptaculum chyli, <a href="#Page_32">32</a></li>
-<li class="isub1">Recti muscles of eye, <a href="#Page_67">67</a>, <a href="#Page_72">72</a></li>
-<li class="isub1">Rectum, <a href="#Page_145">145</a>, <a href="#Page_146">146</a></li>
-<li class="isub1">Rectus abdominis, <a href="#Page_133">133</a>, <a href="#Page_134">134</a></li>
-<li class="isub4">capitis anticus major, <a href="#Page_93">93</a></li>
-<li class="isub4">femoris, <a href="#Page_190">190</a></li>
-<li class="isub1">Red corpuscles, <a href="#Page_118">118</a>, <a href="#Page_119">119</a></li>
-<li class="isub1">Reflex action, <a href="#Page_83">83</a></li>
-<li class="isub1">Regions, abdominal, <a href="#Page_134">134</a>, <a href="#Page_135">135</a></li>
-<li class="isub1">Renal artery, <a href="#Page_109">109</a></li>
-<li class="isub1">Rennin, <a href="#Page_140">140</a></li>
-<li class="isub1">Respiration, <a href="#Page_121">121</a>, <a href="#Page_127">127</a>, <i>et seq.</i></li>
-<li class="isub3">center of, <a href="#Page_78">78</a>, <a href="#Page_130">130</a></li>
-<li class="isub3">effect on air, <a href="#Page_129">129</a>, <a href="#Page_130">130</a></li>
-<li class="isub3">effect on blood, <a href="#Page_130">130</a>, <a href="#Page_131">131</a></li>
-<li class="isub3">forced, <a href="#Page_128">128</a>, <a href="#Page_129">129</a></li>
-<li class="isub3">kinds of, <a href="#Page_128">128</a></li>
-<li class="isub3">rate, <a href="#Page_128">128</a></li>
-<li class="isub3">sounds, <a href="#Page_129">129</a></li>
-<li class="isub3">variations in, <a href="#Page_131">131</a></li>
-<li class="isub1">Retching, <a href="#Page_140">140</a></li>
-<li class="isub1">Retina, <a href="#Page_68">68</a>, <a href="#Page_69">69</a>, <a href="#Page_70">70</a></li>
-<li class="isub1">Rheumatism, <a href="#Page_25">25</a></li>
-<li class="isub1">Rhomboideus muscles, <a href="#Page_93">93</a></li>
-<li class="isub1">Rickets, <a href="#Page_19">19</a>, <a href="#Page_49">49</a>, <a href="#Page_53">53</a>, <a href="#Page_97">97</a>,
-                                 <a href="#Page_164">164</a>, <a href="#Page_195">195</a></li>
-<li class="isub1">Ribs, <a href="#Page_97">97</a>, <a href="#Page_98">98</a></li>
-<li class="isub1">Right lymphatic duct, <a href="#Page_31">31</a>, <a href="#Page_32">32</a></li>
-<li class="isub1">Rigor mortis, <a href="#Page_22">22</a>, <a href="#Page_23">23</a></li>
-<li class="isub1">Rivinus, ducts of, <a href="#Page_62">62</a></li>
-<li class="isub1">Rodent ulcer, <a href="#Page_74">74</a></li>
-<li class="isub1">Rods and cones, <a href="#Page_69">69</a>, <a href="#Page_70">70</a></li>
-<li class="isub1">Rolando, fissure of, <a href="#Page_75">75</a>, <a href="#Page_82">82</a></li>
-<li class="isub1">Rosary, <a href="#Page_97">97</a></li>
-<li class="isub1">Round ligament of uterus, <a href="#Page_168">168</a></li>
-<li class="isub1">Round window, <a href="#Page_64">64</a>, <a href="#Page_65">65</a></li>
-<li class="isub1">Rupture, <a href="#Page_146">146</a>, <a href="#Page_164">164</a></li>
-<li class="isub3">of kidney, <a href="#Page_158">158</a></li>
-<li class="isub3">of liver, <a href="#Page_152">152</a></li>
-<li class="isub3">of spleen, <a href="#Page_154">154</a></li>
-<li class="isub3">of urethra, <a href="#Page_160">160</a></li>
-
-<li class="ifrst">Sacral nerves, <a href="#Page_84">84</a></li>
-<li class="isub3">plexus, <a href="#Page_84">84</a>, <a href="#Page_85">85</a></li>
-<li class="isub3">vertebræ, <a href="#Page_90">90</a></li>
-<li class="isub1">Sacro-sciatic notch, <a href="#Page_163">163</a></li>
-<li class="isub1">Sacrum, <a href="#Page_90">90</a>, <a href="#Page_161">161</a></li>
-<li class="isub1">Sagittal suture, <a href="#Page_48">48</a></li>
-<li class="isub1">Saliva, <a href="#Page_61">61</a>, <a href="#Page_136">136</a></li>
-<li class="isub1">Salivary glands, <a href="#Page_35">35</a>, <a href="#Page_61">61</a>, <a href="#Page_136">136</a></li>
-<li class="isub1">Salpingectomy, <a href="#Page_169">169</a></li>
-<li class="isub1">Saphenous veins, <a href="#Page_109">109</a>, <a href="#Page_199">199</a></li>
-<li class="isub1">Sarcolemma, <a href="#Page_21">21</a></li>
-<li class="isub1">Sarcoma, <a href="#Page_173">173</a>, <a href="#Page_177">177</a>, <a href="#Page_193">193</a></li>
-<li class="isub1">Sartorius muscles, <a href="#Page_23">23</a>, <a href="#Page_190">190</a></li>
-<li class="isub1">Scalenus muscles, <a href="#Page_93">93</a>, <a href="#Page_128">128</a></li>
-<li class="isub1">Scaphoid bone, ankle, <a href="#Page_195">195</a></li>
-<li class="isub3">wrist, <a href="#Page_181">181</a></li>
-<li class="isub1">Scapula, <a href="#Page_173">173</a></li>
-<li class="isub1">Scarlet fever, <a href="#Page_35">35</a></li>
-<li class="isub1">Scarpa’s triangle, <a href="#Page_190">190</a>, <a href="#Page_198">198</a></li>
-<li class="isub1">Schwann, white substance of, <a href="#Page_37">37</a></li>
-<li class="isub1">Sciatic nerve, <a href="#Page_85">85</a>, <a href="#Page_163">163</a>, <a href="#Page_199">199</a></li>
-<li class="isub1">Sclera or sclerotic coat, <a href="#Page_68">68</a></li>
-<li class="isub1">Scrotum, <a href="#Page_165">165</a></li>
-<li class="isub1">Sebaceous glands, <a href="#Page_35">35</a>, <a href="#Page_40">40</a>, <a href="#Page_41">41</a>
-<span class="pagenum"><a name="Page_217" id="Page_217">[Pg 217]</a></span></li>
-<li class="isub1">Sebum, <a href="#Page_41">41</a></li>
-<li class="isub1">Second nerve, <a href="#Page_70">70</a>, <a href="#Page_83">83</a></li>
-<li class="isub1">Secreting glands, <a href="#Page_35">35</a></li>
-<li class="isub1">Segmentation, growth by, <a href="#Page_12">12</a></li>
-<li class="isub1">Semen, <a href="#Page_165">165</a></li>
-<li class="isub1">Semicircular canals, <a href="#Page_64">64</a>, <a href="#Page_66">66</a></li>
-<li class="isub1">Semilunar bones, <a href="#Page_181">181</a></li>
-<li class="isub3">cartilages, <a href="#Page_193">193</a>, <a href="#Page_194">194</a></li>
-<li class="isub3">valves, <a href="#Page_28">28</a>, <a href="#Page_32">32</a>, <a href="#Page_104">104</a></li>
-<li class="isub1">Semimembranosus muscle, <a href="#Page_191">191</a></li>
-<li class="isub1">Semitendinosus muscle, <a href="#Page_191">191</a></li>
-<li class="isub1">Sense, organs of, <a href="#Page_57">57</a>, <i>et seq.</i></li>
-<li class="isub4">of hearing, <a href="#Page_65">65</a></li>
-<li class="isub4">of sight, <a href="#Page_70">70</a>, <i>et seq.</i></li>
-<li class="isub4">of smell, <a href="#Page_55">55</a>, <a href="#Page_57">57</a>, <a href="#Page_58">58</a>, <a href="#Page_61">61</a></li>
-<li class="isub4">of taste, <a href="#Page_55">55</a>, <a href="#Page_61">61</a></li>
-<li class="isub4">of touch, <a href="#Page_45">45</a>, <i>et seq.</i></li>
-<li class="isub1">Sensory nerves, <a href="#Page_82">82</a>, <a href="#Page_83">83</a></li>
-<li class="isub3">tract, <a href="#Page_82">82</a></li>
-<li class="isub1">Septum of nose, <a href="#Page_55">55</a></li>
-<li class="isub3">deviation of, <a href="#Page_58">58</a></li>
-<li class="isub1">Serous membrane, <a href="#Page_40">40</a></li>
-<li class="isub1">Serratus magnus, <a href="#Page_174">174</a></li>
-<li class="isub1">Serum albumin, <a href="#Page_11">11</a></li>
-<li class="isub3">of blood, <a href="#Page_117">117</a></li>
-<li class="isub1">Sesamoid bones, <a href="#Page_19">19</a></li>
-<li class="isub1">Seventh nerve, <a href="#Page_83">83</a></li>
-<li class="isub1">Shin, <a href="#Page_194">194</a></li>
-<li class="isub1">Shoulder girdle, <a href="#Page_171">171</a></li>
-<li class="isub3">joint, <a href="#Page_185">185</a></li>
-<li class="isub1">Sighing, <a href="#Page_131">131</a></li>
-<li class="isub1">Sight, sense of, <a href="#Page_70">70</a>, <i>et seq.</i></li>
-<li class="isub1">Sigmoid cavities, <a href="#Page_178">178</a></li>
-<li class="isub3">flexure, <a href="#Page_145">145</a>, <a href="#Page_146">146</a></li>
-<li class="isub1">Silent areas in brain, <a href="#Page_82">82</a></li>
-<li class="isub1">Silver fork deformity, <a href="#Page_180">180</a></li>
-<li class="isub1">Sinuses, <a href="#Page_28">28</a>, <a href="#Page_49">49</a>, <a href="#Page_51">51</a>, <a href="#Page_52">52</a>,
-                <a href="#Page_78">78</a>, <a href="#Page_105">105</a></li>
-<li class="isub1">Sixth nerve, <a href="#Page_68">68</a>, <a href="#Page_83">83</a></li>
-<li class="isub1">Skin, <a href="#Page_39">39</a>, <i>et seq.</i></li>
-<li class="isub1">Skull, bones of, <a href="#Page_48">48</a>, <i>et seq.</i></li>
-<li class="isub1">Small intestine, <a href="#Page_141">141</a>, <a href="#Page_142">142</a>, <i>et seq.</i></li>
-<li class="isub1">Smell, sense of, <a href="#Page_55">55</a>, <a href="#Page_57">57</a>, <a href="#Page_58">58</a>,
-                <a href="#Page_61">61</a></li>
-<li class="isub1">Smooth muscle, <a href="#Page_21">21</a>, <a href="#Page_25">25</a></li>
-<li class="isub1">Sneezing, <a href="#Page_131">131</a></li>
-<li class="isub1">Sobbing, <a href="#Page_131">131</a></li>
-<li class="isub1">Soft palate, <a href="#Page_59">59</a>, <a href="#Page_60">60</a>, <a href="#Page_136">136</a></li>
-<li class="isub1">Solar plexus, <a href="#Page_87">87</a>, <a href="#Page_153">153</a></li>
-<li class="isub1">Soleus, <a href="#Page_196">196</a></li>
-<li class="isub1">Solitary glands, <a href="#Page_142">142</a>, <a href="#Page_145">145</a></li>
-<li class="isub1">Sounds, <a href="#Page_65">65</a>, <a href="#Page_66">66</a></li>
-<li class="isub1">Special senses, <a href="#Page_57">57</a>, <i>et seq.</i></li>
-<li class="isub1">Speech, <a href="#Page_122">122</a></li>
-<li class="isub3">center, <a href="#Page_82">82</a></li>
-<li class="isub1">Spermatic or ovarian artery, <a href="#Page_109">109</a>, <a href="#Page_168">168</a></li>
-<li class="isub3">cords, <a href="#Page_165">165</a></li>
-<li class="isub1">Spermatozoa, <a href="#Page_165">165</a></li>
-<li class="isub1">Sphenoid bone, <a href="#Page_48">48</a>, <a href="#Page_52">52</a></li>
-<li class="isub1">Sphincter of anus, <a href="#Page_146">146</a></li>
-<li class="isub5">of pupil, <a href="#Page_72">72</a></li>
-<li class="isub5">of pylorus, <a href="#Page_138">138</a></li>
-<li class="isub1">Spina bifida, <a href="#Page_91">91</a></li>
-<li class="isub1">Spinal accessory nerve, <a href="#Page_84">84</a>, <a href="#Page_95">95</a>, <a href="#Page_137">137</a></li>
-<li class="isub3">canal, <a href="#Page_91">91</a></li>
-<li class="isub3">column, <a href="#Page_88">88</a></li>
-<li class="isub3">cord, <a href="#Page_79">79</a>, <i>et seq.</i></li>
-<li class="isub3">foramen, <a href="#Page_89">89</a></li>
-<li class="isub3">nerves, <a href="#Page_84">84</a>, <a href="#Page_95">95</a></li>
-<li class="isub1">Spine, <a href="#Page_87">87</a></li>
-<li class="isub1">Spinous process of vertebræ, <a href="#Page_89">89</a></li>
-<li class="isub1">Spleen, <a href="#Page_153">153</a>, <a href="#Page_154">154</a></li>
-<li class="isub1">Splenic artery, <a href="#Page_109">109</a>, <a href="#Page_153">153</a></li>
-<li class="isub3">flexure, <a href="#Page_145">145</a>, <a href="#Page_146">146</a></li>
-<li class="isub3">vein, <a href="#Page_110">110</a>, <a href="#Page_150">150</a></li>
-<li class="isub1">Sprain, <a href="#Page_21">21</a></li>
-<li class="isub1">Squamous portion of temporal bone, <a href="#Page_51">51</a></li>
-<li class="isub1">Stapes, <a href="#Page_63">63</a></li>
-<li class="isub1">Starches, <a href="#Page_12">12</a>, <a href="#Page_136">136</a>, <a href="#Page_144">144</a></li>
-<li class="isub1">Steapsin, <a href="#Page_144">144</a></li>
-<li class="isub1">Stensen’s duct, <a href="#Page_62">62</a>
-<span class="pagenum"><a name="Page_218" id="Page_218">[Pg 218]</a></span></li>
-<li class="isub1">Sterno-cleido-mastoid muscle, <a href="#Page_51">51</a>, <a href="#Page_92">92</a>, <a href="#Page_171">171</a></li>
-<li class="isub1">Sternum, <a href="#Page_97">97</a></li>
-<li class="isub1">Stimuli, <a href="#Page_24">24</a></li>
-<li class="isub1">Stomach, <a href="#Page_138">138</a></li>
-<li class="isub3">arteries, <a href="#Page_139">139</a></li>
-<li class="isub3">digestion in, <a href="#Page_139">139</a>, <a href="#Page_140">140</a></li>
-<li class="isub3">glands, <a href="#Page_139">139</a></li>
-<li class="isub3">position, <a href="#Page_138">138</a></li>
-<li class="isub3">structure, <a href="#Page_139">139</a></li>
-<li class="isub1">Stomach teeth, <a href="#Page_60">60</a></li>
-<li class="isub1">Strabismus, <a href="#Page_72">72</a></li>
-<li class="isub1">Striated or striped muscle, <a href="#Page_21">21</a>, <a href="#Page_23">23</a>, <a href="#Page_25">25</a></li>
-<li class="isub1">Stricture of esophagus, <a href="#Page_138">138</a></li>
-<li class="isub5">of urethra, <a href="#Page_160">160</a></li>
-<li class="isub1">Sty, <a href="#Page_74">74</a></li>
-<li class="isub1">Styloid process of fibula, <a href="#Page_195">195</a></li>
-<li class="isub3">of radius, <a href="#Page_178">178</a>, <a href="#Page_179">179</a></li>
-<li class="isub3">of temporal bone, <a href="#Page_52">52</a></li>
-<li class="isub3">of ulna, <a href="#Page_178">178</a>, <a href="#Page_179">179</a></li>
-<li class="isub1">Subarachnoid space, <a href="#Page_76">76</a>, <a href="#Page_79">79</a></li>
-<li class="isub1">Subclavian arteries, <a href="#Page_94">94</a>, <a href="#Page_99">99</a>, <a href="#Page_107">107</a>,
-                     <a href="#Page_108">108</a>, <a href="#Page_185">185</a></li>
-<li class="isub3">veins, <a href="#Page_109">109</a></li>
-<li class="isub1">Subclavius muscle, <a href="#Page_173">173</a></li>
-<li class="isub1">Subdural space, <a href="#Page_76">76</a></li>
-<li class="isub1">Sublingual gland, <a href="#Page_56">56</a>, <a href="#Page_62">62</a></li>
-<li class="isub1">Submaxillary gland, <a href="#Page_56">56</a>, <a href="#Page_62">62</a></li>
-<li class="isub1">Succus entericus, <a href="#Page_143">143</a>, <a href="#Page_144">144</a></li>
-<li class="isub1">Sugar in urine, <a href="#Page_151">151</a>, <a href="#Page_158">158</a></li>
-<li class="isub1">Superciliary ridges, <a href="#Page_49">49</a></li>
-<li class="isub1">Supinator brevis, <a href="#Page_182">182</a>, <a href="#Page_184">184</a></li>
-<li class="isub5">longus, <a href="#Page_182">182</a>, <a href="#Page_184">184</a></li>
-<li class="isub1">Supraorbital foramen or notch, <a href="#Page_49">49</a></li>
-<li class="isub3">vessels and nerve, <a href="#Page_49">49</a></li>
-<li class="isub1">Suprarenal artery, <a href="#Page_109">109</a></li>
-<li class="isub5">capsules, <a href="#Page_36">36</a>, <a href="#Page_154">154</a></li>
-<li class="isub1">Suprascapular artery, <a href="#Page_94">94</a></li>
-<li class="isub7">nerve, <a href="#Page_186">186</a></li>
-<li class="isub1">Suspensory ligament of lens, <a href="#Page_70">70</a>, <a href="#Page_72">72</a></li>
-<li class="isub9">of liver, <a href="#Page_149">149</a></li>
-<li class="isub1">Sutures, <a href="#Page_48">48</a>, <a href="#Page_53">53</a></li>
-<li class="isub3">coronal, <a href="#Page_48">48</a></li>
-<li class="isub3">lambdoidal, <a href="#Page_48">48</a></li>
-<li class="isub3">sagittal, <a href="#Page_48">48</a></li>
-<li class="isub1">Sweat, composition, <a href="#Page_42">42</a></li>
-<li class="isub3">functions, <a href="#Page_42">42</a></li>
-<li class="isub3">glands, <a href="#Page_35">35</a>, <a href="#Page_42">42</a></li>
-<li class="isub3">nervous control of, <a href="#Page_42">42</a></li>
-<li class="isub3">quantity, <a href="#Page_43">43</a></li>
-<li class="isub1">Sylvius, fissure of, <a href="#Page_75">75</a></li>
-<li class="isub1">Sympathetic nerve, <a href="#Page_87">87</a>, <a href="#Page_110">110</a>, <a href="#Page_127">127</a>,
-             <a href="#Page_137">137</a>, <a href="#Page_143">143</a>, <a href="#Page_145">145</a>, <a href="#Page_168">168</a></li>
-<li class="isub3">system, <a href="#Page_75">75</a>, <a href="#Page_87">87</a></li>
-<li class="isub1">Symphysis pubis, <a href="#Page_163">163</a></li>
-<li class="isub1">Synovial fluid, <a href="#Page_20">20</a>, <a href="#Page_34">34</a></li>
-<li class="isub3">membrane, <a href="#Page_20">20</a></li>
-<li class="isub1">Syphilis, <a href="#Page_35">35</a>, <a href="#Page_58">58</a>, <a href="#Page_122">122</a>,
-                    <a href="#Page_152">152</a>, <a href="#Page_182">182</a>, <a href="#Page_194">194</a></li>
-<li class="isub1">Systemic circulation, <a href="#Page_105">105</a>, <a href="#Page_106">106</a>, <a href="#Page_107">107</a>,
-               <i>et seq.</i>, <a href="#Page_112">112</a>, <a href="#Page_113">113</a></li>
-<li class="isub1">Systole, <a href="#Page_104">104</a>, <a href="#Page_106">106</a>, <a href="#Page_112">112</a></li>
-
-<li class="ifrst">T-fracture, <a href="#Page_177">177</a>, <a href="#Page_193">193</a></li>
-<li class="isub1">Tablets of skull, <a href="#Page_20">20</a>, <a href="#Page_48">48</a></li>
-<li class="isub1">Tactile corpuscles, <a href="#Page_37">37</a>, <a href="#Page_39">39</a>, <a href="#Page_46">46</a></li>
-<li class="isub1">Tarsus or ankle, <a href="#Page_195">195</a></li>
-<li class="isub1">Taste buds, <a href="#Page_61">61</a></li>
-<li class="isub3">nerves of, <a href="#Page_61">61</a></li>
-<li class="isub3">sense of, <a href="#Page_55">55</a>, <a href="#Page_61">61</a></li>
-<li class="isub1">Tears, <a href="#Page_68">68</a></li>
-<li class="isub1">Teeth, <a href="#Page_27">27</a>, <a href="#Page_60">60</a></li>
-<li class="isub1">Temperature of body, <a href="#Page_43">43</a></li>
-<li class="isub3">regulation of, <a href="#Page_43">43</a></li>
-<li class="isub3">sensation of, <a href="#Page_47">47</a></li>
-<li class="isub3">variations in, <a href="#Page_44">44</a></li>
-<li class="isub1">Temporal bone, <a href="#Page_48">48</a>, <a href="#Page_51">51</a></li>
-<li class="isub3">muscle, <a href="#Page_50">50</a>, <a href="#Page_51">51</a>, <a href="#Page_55">55</a></li>
-<li class="isub1">Temporary or milk teeth, <a href="#Page_60">60</a></li>
-<li class="isub1">Tendo Achillis, <a href="#Page_195">195</a>, <a href="#Page_197">197</a></li>
-<li class="isub1">Tendons, <a href="#Page_15">15</a>, <a href="#Page_23">23</a></li>
-<li class="isub1">Tenth nerve, <a href="#Page_84">84</a>
-<span class="pagenum"><a name="Page_219" id="Page_219">[Pg 219]</a></span></li>
-<li class="isub1">Testes or testicles, <a href="#Page_165">165</a></li>
-<li class="isub1">Third nerve, <a href="#Page_68">68</a>, <a href="#Page_72">72</a>, <a href="#Page_83">83</a></li>
-<li class="isub1">Thoracic aorta, <a href="#Page_99">99</a>, <a href="#Page_107">107</a>, <a href="#Page_109">109</a></li>
-<li class="isub5">duct, <a href="#Page_31">31</a></li>
-<li class="isub5">nerves, <a href="#Page_186">186</a></li>
-<li class="isub1">Thoracic cutaneous nerve, <a href="#Page_100">100</a></li>
-<li class="isub1">Thorax, <a href="#Page_96">96</a></li>
-<li class="isub1">Thymus gland, <a href="#Page_36">36</a>, <a href="#Page_124">124</a></li>
-<li class="isub1">Thyro-arytenoid ligaments, <a href="#Page_122">122</a></li>
-<li class="isub1">Thyroid axis, <a href="#Page_108">108</a></li>
-<li class="isub3">cartilage, <a href="#Page_121">121</a></li>
-<li class="isub3">gland, <a href="#Page_36">36</a>, <a href="#Page_124">124</a></li>
-<li class="isub1">Tibia or shin bone, <a href="#Page_194">194</a></li>
-<li class="isub1">Tibial artery, <a href="#Page_198">198</a></li>
-<li class="isub3">nerve, <a href="#Page_76">76</a>, <a href="#Page_87">87</a>, <a href="#Page_199">199</a></li>
-<li class="isub1">Tibialis anticus, <a href="#Page_197">197</a></li>
-<li class="isub1">Tissues, areolar, <a href="#Page_15">15</a></li>
-<li class="isub3">bony, <a href="#Page_13">13</a>, <a href="#Page_17">17</a></li>
-<li class="isub3">cartilaginous, <a href="#Page_13">13</a></li>
-<li class="isub3">connective, <a href="#Page_13">13</a>, <a href="#Page_15">15</a></li>
-<li class="isub3">differentiation of, <a href="#Page_13">13</a></li>
-<li class="isub3">elastic, <a href="#Page_15">15</a></li>
-<li class="isub3">epithelial, <a href="#Page_13">13</a></li>
-<li class="isub3">fibrous, <a href="#Page_15">15</a></li>
-<li class="isub3">muscular, <a href="#Page_13">13</a></li>
-<li class="isub3">nervous, <a href="#Page_13">13</a>, <a href="#Page_36">36</a></li>
-<li class="isub1">Tongue, <a href="#Page_46">46</a>, <a href="#Page_59">59</a>, <a href="#Page_60">60</a></li>
-<li class="isub3">tie, <a href="#Page_62">62</a></li>
-<li class="isub1">Tonsillitis, <a href="#Page_35">35</a>, <a href="#Page_62">62</a></li>
-<li class="isub1">Tonsils, <a href="#Page_59">59</a>, <a href="#Page_62">62</a></li>
-<li class="isub1">Torticollis, <a href="#Page_92">92</a></li>
-<li class="isub1">Touch, corpuscles, <a href="#Page_37">37</a>, <a href="#Page_39">39</a>, <a href="#Page_46">46</a></li>
-<li class="isub3">sense of, <a href="#Page_45">45</a>, <i>et seq.</i></li>
-<li class="isub1">Trachea, <a href="#Page_123">123</a></li>
-<li class="isub1">Tracheotomy, <a href="#Page_123">123</a></li>
-<li class="isub1">Transudation of lymph, <a href="#Page_33">33</a></li>
-<li class="isub1">Transversalis muscle, <a href="#Page_133">133</a></li>
-<li class="isub3">colli artery, <a href="#Page_94">94</a></li>
-<li class="isub1">Transverse colon, <a href="#Page_145">145</a></li>
-<li class="isub3">processes of vertebræ, <a href="#Page_89">89</a></li>
-<li class="isub1">Trapezium, <a href="#Page_181">181</a></li>
-<li class="isub1">Trapezius, <a href="#Page_93">93</a>, <a href="#Page_171">171</a></li>
-<li class="isub1">Trapezoid bone, <a href="#Page_181">181</a></li>
-<li class="isub1">Triangular cartilage, <a href="#Page_57">57</a></li>
-<li class="isub1">Triceps, <a href="#Page_176">176</a>, <a href="#Page_177">177</a></li>
-<li class="isub1">Tricuspid valve, <a href="#Page_104">104</a></li>
-<li class="isub1">Trifacial nerve, <a href="#Page_61">61</a>, <a href="#Page_83">83</a></li>
-<li class="isub1">Trochanters, <a href="#Page_189">189</a></li>
-<li class="isub1">Trochlear surface of femur, <a href="#Page_189">189</a></li>
-<li class="isub3">of humerus, <a href="#Page_175">175</a></li>
-<li class="isub1">True pelvis, <a href="#Page_163">163</a>, <a href="#Page_164">164</a></li>
-<li class="isub3">ribs, <a href="#Page_97">97</a></li>
-<li class="isub1">Trypsin, <a href="#Page_144">144</a></li>
-<li class="isub1">Tuberculosis, <a href="#Page_35">35</a>, <a href="#Page_122">122</a>, <a href="#Page_155">155</a>,
-   <a href="#Page_159">159</a>, <a href="#Page_168">168</a>, <a href="#Page_182">182</a>, <a href="#Page_193">193</a>,
-   <a href="#Page_194">194</a>, <a href="#Page_196">196</a></li>
-<li class="isub1">Tuberosities of humerus, <a href="#Page_175">175</a></li>
-<li class="isub3">of tibia, <a href="#Page_194">194</a></li>
-<li class="isub1">Tuberosity of ischium, <a href="#Page_163">163</a></li>
-<li class="isub3">of radius, <a href="#Page_178">178</a></li>
-<li class="isub1">Tubuli lactiferi, <a href="#Page_100">100</a></li>
-<li class="isub1">Tumor albus, <a href="#Page_194">194</a></li>
-<li class="isub1">Tumors, <a href="#Page_100">100</a>, <a href="#Page_175">175</a></li>
-<li class="isub1">Tunica vaginalis oculi, <a href="#Page_67">67</a></li>
-<li class="isub1">Turbinated bones, <a href="#Page_48">48</a>, <a href="#Page_53">53</a>, <a href="#Page_54">54</a></li>
-<li class="isub1">Twelfth nerve, <a href="#Page_84">84</a></li>
-<li class="isub1">Tympanum, <a href="#Page_51">51</a>, <a href="#Page_63">63</a></li>
-<li class="isub1">Typhoid fever, <a href="#Page_142">142</a>, <a href="#Page_154">154</a></li>
-
-<li class="ifrst">Ulcer, <a href="#Page_139">139</a></li>
-<li class="isub1">Ulna, <a href="#Page_177">177</a>, <a href="#Page_178">178</a>, <a href="#Page_185">185</a></li>
-<li class="isub1">Ulnar artery, <a href="#Page_108">108</a></li>
-<li class="isub3">nerve, <a href="#Page_85">85</a>, <a href="#Page_175">175</a>, <a href="#Page_186">186</a></li>
-<li class="isub1">Umbilical artery, <a href="#Page_107">107</a></li>
-<li class="isub3">region, <a href="#Page_135">135</a></li>
-<li class="isub3">vein, <a href="#Page_106">106</a></li>
-<li class="isub1">Unciform bone, <a href="#Page_181">181</a></li>
-<li class="isub1">Unstriated or unstriped muscle, <a href="#Page_21">21</a>, <a href="#Page_22">22</a>, <a href="#Page_25">25</a></li>
-<li class="isub1">Upper extremities, <a href="#Page_171">171</a>, <i>et seq.</i></li>
-<li class="isub1">Urea, <a href="#Page_148">148</a>, <a href="#Page_152">152</a>, <a href="#Page_158">158</a></li>
-<li class="isub1">Ureters, <a href="#Page_155">155</a>, <a href="#Page_156">156</a>, <a href="#Page_159">159</a></li>
-<li class="isub1">Urethra, <a href="#Page_159">159</a>, <a href="#Page_160">160</a>, <a href="#Page_165">165</a></li>
-<li class="isub1">Urinary apparatus, <a href="#Page_155">155</a>, <i>et seq.</i>
-<span class="pagenum"><a name="Page_220" id="Page_220">[Pg 220]</a></span></li>
-<li class="isub1">Urine, <a href="#Page_156">156</a>, <i>et seq.</i></li>
-<li class="isub1">Uterine artery, <a href="#Page_168">168</a></li>
-<li class="isub1">Uterus, <a href="#Page_167">167</a>, <a href="#Page_168">168</a></li>
-<li class="isub1">Uvula, <a href="#Page_59">59</a></li>
-
-<li class="ifrst">Vagina, <a href="#Page_168">168</a></li>
-<li class="isub1">Vagus or pneumogastric nerves, <a href="#Page_84">84</a>, <a href="#Page_110">110</a>,
-                      <a href="#Page_111">111</a>, <a href="#Page_130">130</a></li>
-<li class="isub1">Valves, <a href="#Page_103">103</a></li>
-<li class="isub3">aortic, <a href="#Page_104">104</a></li>
-<li class="isub3">bicuspid or mitral, <a href="#Page_104">104</a></li>
-<li class="isub3">coronary, <a href="#Page_105">105</a></li>
-<li class="isub3">Eustachian, <a href="#Page_106">106</a>, <a href="#Page_107">107</a></li>
-<li class="isub3">ileo-cecal, <a href="#Page_142">142</a>, <a href="#Page_145">145</a></li>
-<li class="isub3">of lymphatic vessels, <a href="#Page_31">31</a>, <a href="#Page_32">32</a>, <a href="#Page_33">33</a></li>
-<li class="isub3">of veins, <a href="#Page_28">28</a></li>
-<li class="isub3">pulmonary, <a href="#Page_104">104</a></li>
-<li class="isub3">semilunar, <a href="#Page_28">28</a>, <a href="#Page_32">32</a>, <a href="#Page_104">104</a></li>
-<li class="isub3">tricuspid, <a href="#Page_104">104</a></li>
-<li class="isub1">Valvulæ conniventes, <a href="#Page_142">142</a></li>
-<li class="isub1">Varicose veins, <a href="#Page_109">109</a>, <a href="#Page_113">113</a>, <a href="#Page_199">199</a></li>
-<li class="isub1">Vas deferens, <a href="#Page_165">165</a></li>
-<li class="isub1">Vasa nervorum, <a href="#Page_37">37</a></li>
-<li class="isub3">vasorum, <a href="#Page_29">29</a></li>
-<li class="isub1">Vasoconstrictor nerves, <a href="#Page_115">115</a></li>
-<li class="isub3">dilator nerves, <a href="#Page_115">115</a></li>
-<li class="isub3">motor nerves, <a href="#Page_29">29</a>, <a href="#Page_78">78</a>, <a href="#Page_115">115</a></li>
-<li class="isub1">Vascular system, <a href="#Page_107">107</a>, et seq.</li>
-<li class="isub1">Vastus externus, <a href="#Page_190">190</a></li>
-<li class="isub3">internus, <a href="#Page_190">190</a></li>
-<li class="isub1">Veins, <a href="#Page_27">27</a>, <a href="#Page_28">28</a>, <a href="#Page_29">29</a>,
-                       <a href="#Page_109">109</a></li>
-<li class="isub3">basilic, <a href="#Page_109">109</a></li>
-<li class="isub3">deep, <a href="#Page_28">28</a></li>
-<li class="isub3">gastric, <a href="#Page_110">110</a>, <a href="#Page_150">150</a></li>
-<li class="isub3">hemorrhoidal, <a href="#Page_146">146</a></li>
-<li class="isub3">hepatic, <a href="#Page_110">110</a>, <a href="#Page_150">150</a></li>
-<li class="isub3">iliac, common, <a href="#Page_109">109</a></li>
-<li class="isub3">inferior vena cava, <a href="#Page_105">105</a>, <a href="#Page_109">109</a>,
-                <a href="#Page_150">150</a></li>
-<li class="isub3">innominate, <a href="#Page_109">109</a></li>
-<li class="isub3">intralobular, <a href="#Page_150">150</a></li>
-<li class="isub3">jugular, <a href="#Page_109">109</a></li>
-<li class="isub3">median, <a href="#Page_109">109</a></li>
-<li class="isub3">cephalic, <a href="#Page_109">109</a></li>
-<li class="isub3">mesenteric, <a href="#Page_110">110</a>, <a href="#Page_150">150</a></li>
-<li class="isub3">portal, <a href="#Page_110">110</a>, <a href="#Page_150">150</a></li>
-<li class="isub3">pulmonary, <a href="#Page_105">105</a>, <a href="#Page_110">110</a></li>
-<li class="isub3">saphenous, <a href="#Page_109">109</a>, <a href="#Page_199">199</a></li>
-<li class="isub3">splenic, <a href="#Page_110">110</a>, <a href="#Page_150">150</a></li>
-<li class="isub3">subclavian, <a href="#Page_109">109</a></li>
-<li class="isub3">superficial, <a href="#Page_28">28</a></li>
-<li class="isub3">superior vena cava, <a href="#Page_105">105</a>, <a href="#Page_109">109</a></li>
-<li class="isub3">umbilical, <a href="#Page_106">106</a></li>
-<li class="isub3">valves, <a href="#Page_28">28</a></li>
-<li class="isub3">varicosity, <a href="#Page_109">109</a>, <a href="#Page_113">113</a>, <a href="#Page_199">199</a></li>
-<li class="isub1">Vena cava, inferior, <a href="#Page_105">105</a>, <a href="#Page_109">109</a>,
-               <a href="#Page_150">150</a></li>
-<li class="isub3">superior, <a href="#Page_105">105</a>, <a href="#Page_109">109</a></li>
-<li class="isub1">Venæ comites, <a href="#Page_27">27</a>, <a href="#Page_113">113</a></li>
-<li class="isub1">Ventricles of brain, <a href="#Page_75">75</a>, <a href="#Page_79">79</a></li>
-<li class="isub3">of heart, <a href="#Page_103">103</a></li>
-<li class="isub1">Vermiform appendix, <a href="#Page_145">145</a></li>
-<li class="isub1">Vertebra prominens, <a href="#Page_91">91</a></li>
-<li class="isub1">Vertebræ, <a href="#Page_88">88</a>, <i>et seq.</i></li>
-<li class="isub1">Vertebral arteries, <a href="#Page_77">77</a></li>
-<li class="isub1">Vesiculæ seminales, <a href="#Page_165">165</a></li>
-<li class="isub1">Vestibule of labyrinth, <a href="#Page_64">64</a>, <a href="#Page_65">65</a></li>
-<li class="isub1">Vicarious function of glands, <a href="#Page_35">35</a></li>
-<li class="isub1">Villi, <a href="#Page_142">142</a></li>
-<li class="isub1">Viscera, abdominal, <a href="#Page_135">135</a>, <i>et seq.</i></li>
-<li class="isub1">Visual center, <a href="#Page_81">81</a></li>
-<li class="isub1">Vital capacity, <a href="#Page_129">129</a></li>
-<li class="isub1">Vitreous humor, <a href="#Page_70">70</a></li>
-<li class="isub1">Vocal cords, <a href="#Page_122">122</a></li>
-<li class="isub1">Volvulus, <a href="#Page_146">146</a></li>
-<li class="isub1">Voluntary muscle, <a href="#Page_21">21</a>, <a href="#Page_23">23</a></li>
-<li class="isub1">Vomer, <a href="#Page_48">48</a>, <a href="#Page_55">55</a></li>
-<li class="isub1">Vomiting, <a href="#Page_140">140</a></li>
-<li class="isub1">Vulva, <a href="#Page_169">169</a>
-<span class="pagenum"><a name="Page_221" id="Page_221">[Pg 221]</a></span></li>
-
-<li class="ifrst">Wharton’s duct, <a href="#Page_62">62</a></li>
-<li class="isub1">White corpuscles or leucocytes, <a href="#Page_27">27</a>, <a href="#Page_33">33</a>,
-               <a href="#Page_34">34</a>, <a href="#Page_119">119</a>, <a href="#Page_120">120</a></li>
-<li class="isub1">White substance of Schwann, <a href="#Page_37">37</a></li>
-<li class="isub4">matter of brain and cord, <a href="#Page_75">75</a>, <a href="#Page_76">76</a>,
-              <a href="#Page_78">78</a>, <a href="#Page_80">80</a>, <a href="#Page_81">81</a></li>
-<li class="isub1">Willis, circle of, <a href="#Page_78">78</a>, <a href="#Page_108">108</a></li>
-<li class="isub1">Wisdom teeth, <a href="#Page_60">60</a></li>
-<li class="isub1">Wormian bones, <a href="#Page_19">19</a>, <a href="#Page_49">49</a></li>
-<li class="isub1">Wrist, <a href="#Page_180">180</a></li>
-<li class="isub3">joint, <a href="#Page_185">185</a></li>
-<li class="isub1">Wry neck or torticollis, <a href="#Page_92">92</a></li>
-
-<li class="ifrst">Yawning, <a href="#Page_131">131</a></li>
-
-<li class="ifrst">Zygomatic process of temporal bone, <a href="#Page_51">51</a>, <a href="#Page_54">54</a></li>
-</ul>
-
-<hr class="chap" />
-<div class="chapter">
-    <p class="f150"><b>SAUNDERS’ BOOKS FOR NURSES</b></p>
-</div>
-<table border="0" cellspacing="0" summary="SAUNDERS’ BOOKS FOR NURSES" cellpadding="0" >
-  <tbody><tr>
-      <td class="tdr" colspan="2"><small>PAGE</small></td>
-   </tr><tr>
-      <td class="tdl">Aikens’ Clinical Studies for Nurses</td>
-      <td class="tdr">3</td>
-   </tr><tr>
-      <td class="tdl">Aikens’ Hospital Management</td>
-      <td class="tdr">3</td>
-   </tr><tr>
-      <td class="tdl">Aikens’ Primary Studies for Nurses</td>
-      <td class="tdr">3</td>
-   </tr><tr>
-      <td class="tdl">Aikens’ Training School Methods and the Head Nurse</td>
-      <td class="tdr">3</td>
-   </tr><tr>
-      <td class="tdl">Beck’s Reference Handbook for Nurses</td>
-      <td class="tdr">4</td>
-   </tr><tr>
-      <td class="tdl">Boyd’s State Registration for Nurses</td>
-      <td class="tdr">4</td>
-   </tr><tr>
-      <td class="tdl">Davis’ Obstetric and Gynecologic Nursing</td>
-      <td class="tdr">5</td>
-   </tr><tr>
-      <td class="tdl">DeLee’s Obstetrics for Nurses</td>
-      <td class="tdr">5</td>
-   </tr><tr>
-      <td class="tdl">Dorland’s Medical Dictionaries</td>
-      <td class="tdr">7, 8</td>
-   </tr><tr>
-      <td class="tdl">Fiske’s Anatomy and Physiology for Nurses</td>
-      <td class="tdr">4</td>
-   </tr><tr>
-      <td class="tdl">Fowler’s Operating Room and the Patient</td>
-      <td class="tdr">4</td>
-   </tr><tr>
-      <td class="tdl">Friedenwald and Ruhrah on Diet</td>
-      <td class="tdr">6</td>
-   </tr><tr>
-      <td class="tdl">Galbraith’s Four Epoch’s of Woman’s Life</td>
-      <td class="tdr">6</td>
-   </tr><tr>
-      <td class="tdl">Galbraith’s Hygiene and Physical Training for Women</td>
-      <td class="tdr">6</td>
-   </tr><tr>
-      <td class="tdl">Grafstrom’s Mechano-therapy (Massage)</td>
-      <td class="tdr">8</td>
-   </tr><tr>
-      <td class="tdl">Griffith’s Care of the Baby</td>
-      <td class="tdr">8</td>
-   </tr><tr>
-      <td class="tdl">Hoxie’s Medicine for Nurses</td>
-      <td class="tdr">8</td>
-   </tr><tr>
-      <td class="tdl">Lewis’ Anatomy and Physiology for Nurses</td>
-      <td class="tdr">7</td>
-   </tr><tr>
-      <td class="tdl">Macfarlane’s Gynecology for Nurses</td>
-      <td class="tdr">5</td>
-   </tr><tr>
-      <td class="tdl">Manhattan Hospital Eye, Ear, Nose and Throat Nursing</td>
-      <td class="tdr">6</td>
-   </tr><tr>
-      <td class="tdl">McCombs’ Diseases of Children for Nurses</td>
-      <td class="tdr">7</td>
-   </tr><tr>
-      <td class="tdl">McKenzie’s Exercise in Education and Medicine</td>
-      <td class="tdr">5</td>
-   </tr><tr>
-      <td class="tdl">Morris’ Essentials of Materia Medica</td>
-      <td class="tdr">8</td>
-   </tr><tr>
-      <td class="tdl">Morrow’s Immediate Care of Injured</td>
-      <td class="tdr">8</td>
-   </tr><tr>
-      <td class="tdl">Nancrede’s Essentials of Anatomy</td>
-      <td class="tdr">8</td>
-   </tr><tr>
-      <td class="tdl">Paul’s Materia Medica for Nurses</td>
-      <td class="tdr">8</td>
-   </tr><tr>
-      <td class="tdl">Paul’s Nursing in the Acute Infectious Fevers</td>
-      <td class="tdr">8</td>
-   </tr><tr>
-      <td class="tdl">Pyle’s Personal Hygiene</td>
-      <td class="tdr">8</td>
-   </tr><tr>
-      <td class="tdl">Register’s Fever Nursing</td>
-      <td class="tdr">8</td>
-   </tr><tr>
-      <td class="tdl">Stoney’s Bacteriology and Surgical Technic</td>
-      <td class="tdr">2</td>
-   </tr><tr>
-      <td class="tdl">Stoney’s Nursing</td>
-      <td class="tdr">2</td>
-   </tr><tr>
-      <td class="tdl">Wilson’s Reference Handbook of Obstetric Nursing</td>
-      <td class="tdr">7</td>
-   </tr>
- </tbody>
-</table>
-
-<p class="f150 space-above1"><b>W. B. SAUNDERS COMPANY</b></p>
-<p class="center">925 Walnut Street <span class="ws3">Philadelphia</span><br />
-London: 9, Henrietta Street, Covent Garden</p>
-<hr class="chap" />
-
-<div class="chapter">
-<p class="f150_left"><b>Stoney’s Nursing</b></p>
-<p class="author">NEW (4th) EDITION</p></div>
-
-<p class="no-indent">In this excellent volume the author explains the
-entire range of <i>private</i> nursing as distinguished from <i>hospital</i>
-nursing; and the nurse is given definite directions how best to meet
-the various emergencies. <i>The American Journal of Nursing</i> says it
-“is the fullest and most complete” and “may well be recommended as being
-of great general usefulness. The best chapter is the one on observation
-of symptoms which is very thorough.” There are directions how to
-<i>improvise</i> everything ordinarily needed in the sick room.</p>
-
-<p class="blockquot no-indent"><b>Practical Points in Nursing.</b> By
-<span class="smcap">Emily M. A. Stoney</span>, Superintendent of the Training
-School for Nurses in the Carney Hospital, South Boston, Mass. 12mo, 495
-pages, illustrated. Cloth, $1.75 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Stoney’s Materia Medica</b></p>
-<p class="author">NEW (3d) EDITION</p>
-
-<p class="no-indent">Stoney’s Materia Medica was written by a head
-nurse who knows just what the nurse needs. <i>American Medicine</i> says
-it contains “all the information in regards to drugs that a nurse should
-possess. * * * The treatment of poisoning is stated in a manner that
-will permit of its being carried out thoroughly and intelligently.”</p>
-
-<p class="blockquot no-indent"><b>Materia Medica for Nurses.</b> By
-<span class="smcap">Emily M. A. Stoney</span>, Superintendent of the
-Training School for Nurses in the Carney Hospital, South Boston, Mass.
-12mo volume of 300 pages. Cloth, $1.50 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Stoney’s Surgical Technic</b></p>
-<p class="author">NEW (3d) EDITION</p>
-
-<p class="no-indent">The first part of the book is devoted to
-Bacteriology and Antiseptics; the second part to Surgical Technic,
-Signs of Death, Autopsies, Bandaging and Dressings, Obstetric Nursing,
-Care of Infants, etc., Hygiene and Personal Conduct of the Nurse, etc.
-The New York <i>Medical Record</i> says it “is a very practical book which
-presents the subjects stated in its title in a concise manner.”</p>
-
-<p class="blockquot no-indent"><b>Bacteriology and Surgical Technic for
-Nurses.</b> By <span class="smcap">Emily M. A. Stoney</span>. Revised
-by <span class="smcap">Frederic R. Griffith</span>, M. D., New York
-12mo volume of 300 pages, fully illustrated. Cloth, $1.50 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Aikens’ Hospital Management</b></p>
-<p class="author">JUST READY</p>
-
-<p class="no-indent">This is just the work for hospital
-superintendents, training-school principals, physicians, and all who
-are actively interested in hospital administration. Each chapter has
-been written by one specially fitted to write upon that particular
-phase of the subject; and Miss Aikens has brought the various chapters
-into a harmonious whole.</p>
-
-<p class="blockquot no-indent"><b>Hospital Management.</b> Arranged
-and edited by <span class="smcap">Charlotte A. Aikens</span>, formerly
-Director of Sibley Memorial Hospital, Washington, D. C. 12mo of 488
-pages, illustrated. Cloth, $3.00 net</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Aikens’ Primary Studies for Nurses</b></p>
-
-<p class="no-indent"><i>Trained Nurse and Hospital Review</i> says: “It is
-safe to say that any pupil who has mastered even the major portion of
-this work would be one of the best prepared first year pupils who ever
-stood for examination.”</p>
-
-<p class="blockquot no-indent"><b>Primary Studies for Nurses.</b> By
-<span class="smcap">Charlotte A. Aikens</span>, formerly Director
-of Sibley Memorial Hospital, Washington, D. C. 12mo of 435 pages,
-illustrated. Cloth, $1.75 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Aikens’ Training-School Methods and the Head Nurse</b></p>
-
-<p class="no-indent">This work not only tells how to teach, but also
-what should be taught the nurse and <i>how much</i>. The <i>Medical Record</i>
-says: “This book is original, breezy and healthy.”</p>
-
-<p class="blockquot no-indent"><b>Hospital Training-School Methods and
-the Head Nurse.</b> By <span class="smcap">Charlotte A. Aikens</span>,
-formerly Director of Sibley Memorial Hospital, Washington, D. C. 12mo
-of 267 pages. Cloth, $1.50 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Aikens’ Clinical Studies for Nurses</b></p>
-<p class="center">ILLUSTRATED</p>
-
-<p class="no-indent">This new work is written on the same lines as the
-author’s successful work for primary students, taking up the studies
-the nurse must pursue during the second and third years.</p>
-
-<p class="blockquot no-indent"><b>Clinical Studies for Nurses.</b>
-By <span class="smcap">Charlotte A. Aikens</span>, formerly Director
-of Sibley Memorial Hospital, Washington, D. C. 12mo of 512 pages,
-illustrated. Cloth, $2.00 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Fowler’s Operating Room</b></p>
-<p class="author">NEW (2d) EDITION</p>
-
-<p class="no-indent">Dr. Fowler’s work contains all information of a
-surgical nature that a nurse must know in order to attain the highest
-efficiency. <i>Canadian Journal of Medicine and Surgery</i> says: “We find
-compactly and clearly stated just those thousand and one things which
-when required are so hard to locate.”</p>
-
-<p class="blockquot no-indent"><b>The Operating Room and the
-Patient.</b> By <span class="smcap">Russell S. Fowler</span>, M. D.,
-Professor of Surgery, Brooklyn Postgraduate Medical School. Octavo of
-284 pages, with original illustrations. Cloth, $2.00 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Fiske’s Anatomy and Physiology</b></p>
-<p class="author">JUST READY</p>
-
-<p class="no-indent">Miss Fiske weaves the physiology in with the
-anatomy, and in such a way that both anatomy and function are readily
-understood and retained by the reader.</p>
-
-<p class="blockquot no-indent"><b>Anatomy and Physiology for
-Nurses.</b> By <span class="smcap">Annette Fiske</span>. A. M.,
-Graduate of the Waltham Training School for Nurses, Massachusetts. 12mo
-of 250 pages, illustrated.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Beck’s Reference Handbook</b></p>
-<p class="author">NEW (2d) EDITION</p>
-
-<p class="no-indent">This book contains all the information that a
-nurse requires to carry out any directions given by the physician. The
-<i>Montreal Medical Journal</i> says it is “cleverly systematized and shows
-close observation of the sickroom and hospital regime.”</p>
-
-<p class="blockquot no-indent"><b>A Reference Handbook for Nurses.</b>
-By <span class="smcap">Amanda K. Beck</span>, Graduate of the Illinois
-Training School for Nurses, Chicago, Ill. 32mo volume of 200 pages.
-Bound in flexible leather, $1.25 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Boyd’s State Registration for Nurses</b></p>
-
-<p class="no-indent">This book tells the nurse just what she must know
-in order to obtain a certificate in any State. It presents comparative
-summaries of the laws, requirements, fees, exceptions and restrictions,
-violations and their penalties. The work will also form a serviceable
-basis for the drafting of laws.</p>
-
-<p class="blockquot no-indent"><b>State Registration for Nurses.</b> By
-<span class="smcap">Louie Croft Boyd</span>, R. N., Graduate Colorado
-Training School for Nurses. Price, 50 cents net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>DeLee’s Obstetrics for Nurses</b></p>
-<p class="author">THIRD EDITION</p>
-
-<p class="no-indent">Dr. DeLee’s book really considers two
-subjects—obstetrics for nurses and actual obstetric nursing. <i>Trained
-Nurse and Hospital Review</i> says the “book abounds with practical
-suggestions, and they are given with such clearness that they cannot
-fail to leave their impress.”</p>
-
-<p class="blockquot no-indent"><b>Obstetrics for Nurses.</b> By <span
-class="smcap">Joseph B. DeLee</span>, M. D., Professor of Obstetrics at
-the Northwestern University Medical School, Chicago. 12mo volume of 512
-pages, fully illustrated. Cloth, $2.50 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Davis’ Obstetric &amp; Gynecologic Nursing</b></p>
-<p class="author">THE NEW (3d) EDITION</p>
-
-<p class="no-indent"><i>The Trained Nurse and Hospital Review</i> says: “This is one of the most
-practical and useful books ever presented to the nursing profession.”
-The text is illustrated.</p>
-
-<p class="blockquot no-indent"><b>Obstetric and Gynecologic Nursing.</b> By
-<span class="smcap">Edward P. Davis</span>, M. D., Professor of
-Obstetrics in the Jefferson Medical College,
-Philadelphia. 12mo volume of 436 pages, illustrated.
-Buckram, $1.75 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Macfarlane’s Gynecology for Nurses</b></p>
-<p class="center">ILLUSTRATED</p>
-
-<p class="no-indent"><i>Dr. A. M. Seabrook</i>, Woman’s Hospital of
-Philadelphia, says: “It is a most admirable little book, covering in
-a concise but attractive way the subject from the nurse’s standpoint.
-You certainly keep up to date in all these matters, and are to be
-complimented upon your progress and enterprise.”</p>
-
-<p class="blockquot no-indent"><b>A Reference Handbook of Gynecology
-for Nurses.</b> By <span class="smcap">Catharine MacFarlane</span>, M.
-D., Gynecologist to the Woman’s Hospital of Philadelphia. 32mo of 150
-pages, with 70 illustrations. Flexible leather, $1.25 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>McKenzie’s Exercise in Education and Medicine</b></p>
-
-<p class="blockquot no-indent"><b>Exercise in Education and
-Medicine.</b> By <span class="smcap">R. Tait McKenzie</span>, B.
-A., M. D., Professor of Physical Education, and Director of the
-Department, University of Pennsylvania. Octavo of 406 pages, with 346
-illustrations. Cloth, $3.50 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Manhattan Hospital Eye, Ear, Nose, and Throat Nursing</b></p>
-
-<p class="center">ILLUSTRATED</p>
-
-<p class="no-indent">This is a practical book, prepared by surgeons
-who, from their experience in the operating amphitheatre and at the
-bedside, have realized the shortcomings of present nursing books in
-regard to eye, ear, nose, and throat nursing.</p>
-
-<p class="blockquot no-indent"><b>Nursing in Diseases of the Eye, Ear,
-Nose and Throat.</b> By the Committee on Nurses of the Manhattan Eye,
-Ear, and Throat Hospital: <span class="smcap">J. Edward Giles</span>,
-M. D., Surgeon in Eye Department; <span class="smcap">Arthur B.
-Duel</span>, M. D., (chairman), Surgeon in Ear Department; <span
-class="smcap">Harmon Smith</span>, M. D., Surgeon in Throat Department.
-Assisted by <span class="smcap">John R. Shannon</span>, M. D.,
-Assistant Surgeon in Eye Department; and <span class="smcap">John R.
-Page</span>, M. D., Assistant Surgeon in Ear Department. With chapters
-by <span class="smcap">Herbert B. Wilcox</span>, M. D., Attending
-Physician to the Hospital; and Miss <span class="smcap">Eugenia D.
-Ayers</span>, Superintendent of Nurses. 12mo of 260 pages, illustrated.
-Cloth, $1.50 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Friedenwald and Ruhrah’s Dietetics for Nurses</b></p>
-<p class="author">NEW (2d) EDITION</p>
-
-<p class="no-indent">This work has been prepared to meet the needs of
-the nurse, both in training school and after graduation. <i>American
-Journal of Nursing</i> says it “is exactly the book for which nurses and
-others have long and vainly sought.”</p>
-
-<p class="blockquot no-indent"><b>Dietetics for Nurses.</b> By <span
-class="smcap">Julius Friedenwald</span>, M. D., Professor of Diseases
-of the Stomach, and <span class="smcap">John Ruhrah</span>, M. D.,
-Professor of Diseases of Children, College of Physicians and Surgeons,
-Baltimore. 12mo volume of 395 pages. Cloth, $1.50 net</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Friedenwald &amp; Ruhrah on Diet</b></p>
-<p class="author">THIRD EDITION</p>
-
-<p class="blockquot no-indent"><b>Diet in Health and Disease.</b>
-By <span class="smcap">Julius Friedenwald</span>, M. D., and
-<span class="smcap">John Ruhrah</span>, M. D. Octavo volume of
-764 pages. Cloth, $4.00 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Galbraith’s Personal Hygiene and Physical Training for Women</b></p>
-<p class="author">JUST ISSUED</p>
-
-    <p class="blockquot no-indent"><b>Personal Hygiene and Physical
-    Training for Women.</b> By <span class="smcap">Anna M.
-    Galbraith</span>, M. D., Fellow New York Academy of Medicine. 12mo
-    of 371 pages, illustrated. Cloth, $2.00 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Galbraith’s Four Epochs of Woman’s Life</b></p>
-<p class="author">THE NEW (2d) EDITION</p>
-
-<p class="blockquot no-indent"><b>The Four Epochs of Woman’s Life.</b>
-By <span class="smcap">Anna M. Galbraith</span>, M. D. With an
-Introductory Note by <span class="smcap">John H. Musser</span>, M. D.,
-University of Pennsylvania. 12mo of 247 pages. Cloth, $1.50 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>McCombs’ Diseases of Children for Nurses</b></p>
-<p class="center">JUST ISSUED—NEW (2d) EDITION</p>
-
-<p class="no-indent">Dr. McCombs’ experience in lecturing to nurses
-has enabled him to emphasize <i>just those points that nurses most need
-to know. National Hospital Record</i> says: “We have needed a good book
-on children’s diseases and this volume admirably fills the want.” The
-nurse’s side has been written by head nurses, very valuable being the
-work of Miss Jennie Manly.</p>
-
-<p class="blockquot no-indent"><b>Diseases of Children for Nurses.</b>
-By <span class="smcap">Robert S. McCombs</span>, M. D., Instructor of
-Nurses at the Children’s Hospital of Philadelphia. 12mo of 470 pages,
-illustrated. Cloth, $2.00 net</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Wilson’s Obstetric Nursing</b></p>
-
-<p class="no-indent">In Dr. Wilson’s work the entire subject is covered
-from the beginning of pregnancy, its course, signs, labor, its actual
-accomplishment, the puerperium and care of the infant. <i>American
-Journal of Obstetrics</i> says: “Every page emphasizes the nurse’s
-relation to the case.”</p>
-
-<p class="blockquot no-indent"><b>A Reference Handbook of Obstetric
-Nursing.</b> By <span class="smcap">W. Reynolds Wilson</span>, M. D.,
-Visiting Physician to the Philadelphia Lying-in Charity. 32mo of 355
-pages, illustrated. Flexible leather, $1.25 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>American Pocket Dictionary</b></p>
-<p class="author">NEW (6th) EDITION</p>
-
-<p class="no-indent">The <i>Trained Nurse and Hospital Review</i> says:
-“We have had many occasions to refer to this dictionary, and in every
-instance we have found the desired information.”</p>
-
-<p class="blockquot no-indent"><b>American Pocket Medical
-Dictionary.</b> Edited by <span class="smcap">W. A. Newman
-Dorland</span>, A. M., M. D., Loyola University, Chicago. Flexible
-leather, gold edges, $1.00 net; with patent thumb index, $1.25 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Lewis’ Anatomy and Physiology</b></p>
-<p class="author">SECOND EDITION</p>
-
-<p class="no-indent"><i>Nurses Journal of Pacific Coast</i> says “it is not
-in any sense rudimentary, but comprehensive in its treatment of the
-subjects.” The low price makes this book particularly attractive.</p>
-
-<p class="blockquot no-indent"><b>Anatomy and Physiology for
-Nurses.</b> By <span class="smcap">LeRoy Lewis</span>, M. D., Lecturer
-on Anatomy and Physiology for Nurses, Lewis Hospital, Bay City, Mich.
-12mo of 375 pages, 150 illustrations. Cloth, $1.75 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Dorland’s Illustrated Dictionary</b></p>
-<p class="author">NEW (5th) EDITION</p>
-
-<p class="blockquot no-indent"><b>The American Illustrated Medical
-Dictionary.</b> Edited by <span class="smcap">W. A. N. Dorland</span>,
-M. D. Large octavo of 876 pages, 293 illustrations, 119 in colors.
-Flexible leather, $4.50 net; thumb indexed, $5.00 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Paul’s Materia Medica</b></p>
-
-<p class="blockquot no-indent"><b>A Text-Book of Materia Medica for
-Nurses.</b> By <span class="smcap">George P. Paul</span>, M. D.,
-Samaritan Hospital, Troy, N. Y. 12mo of 240 pages. Cloth, $1.50 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Paul’s Fever Nursing</b></p>
-
-<p class="blockquot no-indent"><b>Nursing in the Acute Infectious
-Fevers.</b> By <span class="smcap">George P. Paul</span>, M. D. Cloth,
-$1.00 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Hoxie’s Medicine for Nurses</b></p>
-
-<p class="blockquot no-indent"><b>Practice of Medicine for
-Nurses.</b> By <span class="smcap">George Howard Hoxie</span>, M. D.,
-University of Kansas. With a chapter on Technic of Nursing by <span
-class="smcap">Pearl L. Laptad</span>. 12mo of 284 pages, illustrated.
-Cloth, $1.50 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Grafstrom’s Mechano-therapy</b></p>
-<p class="author">SECOND EDITION</p>
-
-<p class="blockquot no-indent"><b>Mechano-therapy (Massage and Medical
-Gymnastics).</b> By <span class="smcap">Axel V. Grafstrom</span>,
-B. Sc., M. D., 12mo, 200 pages. Cloth, $1.25 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Nancrede’s Anatomy</b></p>
-<p class="author">NEW (7th) EDITION</p>
-
-<p class="blockquot no-indent"><b>Essentials of Anatomy.</b> <span
-class="smcap">Charles B. G. DeNancrede</span>, M. D., University of
-Michigan. 12mo, 400 pages, 180 illustrations. Cloth, $1.00 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Morrow’s Immediate Care of Injured</b></p>
-
-<p class="blockquot no-indent"><b>Immediate Care of the Injured.</b>
-By <span class="smcap">Albert S. Morrow</span>, M. D., New York City
-Home for Aged and Infirm. Octavo of 340 pages, with 238 illustrations.
-Cloth, $2.50 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Register’s Fever Nursing</b></p>
-
-<p class="blockquot no-indent"><b>A Text-Book on Practical Fever
-Nursing.</b> By <span class="smcap">Edward C. Register</span>, M. D.,
-North Carolina Medical College. Octavo of 350 pages, illustrated.
-Cloth, $2.50 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Pyle’s Personal Hygiene</b></p>
-<p class="author">NEW (4th) EDITION</p>
-
-<p class="blockquot no-indent"><b>A Manual of Personal Hygiene.</b>
-Edited by <span class="smcap">Walter L. Pyle</span>, M. D. Wills Eye
-Hospital, Philadelphia. 12mo, 472 pages, illus. $1.50 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Morris’ Materia Medica</b></p>
-<p class="author">NEW (7th) EDITION</p>
-
-<p class="blockquot no-indent"><b>Essentials of Materia
-Medica, Therapeutics, and Prescription Writing.</b> By
-<span class="smcap">Henry Morris</span>, M. D. Revised by
-<span class="smcap">W. A. Bastedo</span>, M. D., Columbia University, N. Y.
-12mo of 300 pages, illustrated. Cloth, $1.00 net.</p>
-<hr class="r25" />
-
-<p class="f150_left"><b>Griffith’s Care of the Baby</b></p>
-<p class="center">JUST ISSUED NEW (5th) EDITION</p>
-
-<p class="blockquot no-indent"><b>The Care of the Baby.</b> By <span
-class="smcap">J. P. Crozer Griffith</span>, M. D., University of
-Pennsylvania. 12mo of 455 pages, illustrated. Cloth, $1.50 net.</p>
-
-<hr class="chap" />
-
-<div class="transnote bbox space-above2">
-<p class="f120 space-above1">Transcriber’s Notes:</p>
-<hr class="r5" />
-<p class="indent">The cover image was created by the transcriber, and is in the public domain.</p>
-<p class="indent">The illustrations have been moved so that they do not break up
-                  paragraphs and so that they are next to the text they illustrate.</p>
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-Most people start at our website which has the main PG search
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