diff options
| -rw-r--r-- | .gitattributes | 4 | ||||
| -rw-r--r-- | LICENSE.txt | 11 | ||||
| -rw-r--r-- | README.md | 2 | ||||
| -rw-r--r-- | old/68165-0.txt | 1865 | ||||
| -rw-r--r-- | old/68165-0.zip | bin | 26894 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h.zip | bin | 8137615 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/68165-h.htm | 2543 | ||||
| -rw-r--r-- | old/68165-h/images/fig1.jpg | bin | 86275 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig10.jpg | bin | 138784 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig10_l.jpg | bin | 410995 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig11.jpg | bin | 135530 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig11_l.jpg | bin | 455781 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig12.jpg | bin | 76918 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig12_l.jpg | bin | 252805 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig13.jpg | bin | 101494 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig13_l.jpg | bin | 241551 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig14.jpg | bin | 144188 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig14_l.jpg | bin | 436503 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig15.jpg | bin | 58217 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig15_l.jpg | bin | 528611 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig16.jpg | bin | 129387 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig16_l.jpg | bin | 149842 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig17.jpg | bin | 122754 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig17_l.jpg | bin | 353234 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig18.jpg | bin | 107173 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig18_l.jpg | bin | 316066 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig19.jpg | bin | 83781 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig19_l.jpg | bin | 407271 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig1_l.jpg | bin | 284305 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig2.jpg | bin | 83388 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig2_l.jpg | bin | 343974 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig3.jpg | bin | 93907 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig3_l.jpg | bin | 213084 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig4.jpg | bin | 128044 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig4_l.jpg | bin | 247688 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig5.jpg | bin | 126672 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig5_l.jpg | bin | 516865 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig6.jpg | bin | 154816 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig6_l.jpg | bin | 391313 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig7.jpg | bin | 93107 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig7_l.jpg | bin | 219330 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig8.jpg | bin | 87691 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig8_l.jpg | bin | 173682 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig9.jpg | bin | 193385 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/fig9_l.jpg | bin | 237924 -> 0 bytes | |||
| -rw-r--r-- | old/68165-h/images/i11.jpg | bin | 3796 -> 0 bytes |
46 files changed, 17 insertions, 4408 deletions
diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..d7b82bc --- /dev/null +++ b/.gitattributes @@ -0,0 +1,4 @@ +*.txt text eol=lf +*.htm text eol=lf +*.html text eol=lf +*.md text eol=lf diff --git a/LICENSE.txt b/LICENSE.txt new file mode 100644 index 0000000..6312041 --- /dev/null +++ b/LICENSE.txt @@ -0,0 +1,11 @@ +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. + +Procedures for determining public domain status are described in +the "Copyright How-To" at https://www.gutenberg.org. + +No investigation has been made concerning possible copyrights in +jurisdictions other than the United States. Anyone seeking to utilize +this eBook outside of the United States should confirm copyright +status under the laws that apply to them. diff --git a/README.md b/README.md new file mode 100644 index 0000000..43f7767 --- /dev/null +++ b/README.md @@ -0,0 +1,2 @@ +Project Gutenberg (https://www.gutenberg.org) public repository for +eBook #68165 (https://www.gutenberg.org/ebooks/68165) diff --git a/old/68165-0.txt b/old/68165-0.txt deleted file mode 100644 index 8661c80..0000000 --- a/old/68165-0.txt +++ /dev/null @@ -1,1865 +0,0 @@ -The Project Gutenberg eBook of Report of an autopsy on the bodies of -Chang and Eng Bunker, commonly known as the Siamese Twins, by Harrison -Allen - -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: Report of an autopsy on the bodies of Chang and Eng Bunker, - commonly known as the Siamese Twins - -Author: Harrison Allen - -Release Date: May 24, 2022 [eBook #68165] - -Language: English - -Produced by: deaurider, Guus Snijders 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 REPORT OF AN AUTOPSY ON THE -BODIES OF CHANG AND ENG BUNKER, COMMONLY KNOWN AS THE SIAMESE -TWINS *** - - - - Transcriber’s note: - - This version of the text cannot represent certain typographical - effects. Italics are delimited with the '_' character as _italic_. - The illustrations with a caption have been replaced with - [Illustration figure x: caption]. - - The few minor errors, attributable to the printer, have been - corrected. Please see the transcriber’s note at the end of this - text for details regarding the handling of any textual issues - encountered during its preparation. - - ---------------------------------------------------------------- - - - - - - REPORT - - OF - - AN AUTOPSY ON THE BODIES - - OF - - CHANG AND ENG BUNKER, - - COMMONLY KNOWN AS THE - - SIAMESE TWINS - - - BY - - HARRISON ALLEN, M.D., - PROFESSOR OF COMPARATIVE ANATOMY AND ZOÖLOGY IN THE UNIVERSITY OF - PENNSYLVANIA, SURGEON TO THE PHILADELPHIA HOSPITAL, ETC. - - - - - PHILADELPHIA: - COLLINS, PRINTER, 705 JAYNE STREET. - 1875. - - - - - AUTOPSY OF THE SIAMESE TWINS. - - - - -[Illustration Figure 1: - - Fig. 1. The twins in the acquired position (E. R., C. L.). From a - photograph taken in St. Petersburg, 1870. ] - - - - - NOTE. - - -The word “Report” used in the title of my paper is to be read as -referring to the post-mortem appearances only, and not to the -Report of the Commission as appointed by the College. The -ante-mortem history prefixed to my paper was written in -conjunction with Prof. Pancoast. - - H. ALLEN. - - - - - REPORT - - OF AN - - AUTOPSY ON THE BODIES OF CHANG AND ENG - BUNKER, COMMONLY KNOWN AS THE - SIAMESE TWINS. - - By - - HARRISON ALLEN, M.D., - PROFESSOR OF COMPARATIVE ANATOMY AND ZOÖLOGY IN THE UNIVERSITY - OF PENNSYLVANIA, SURGEON TO THE PHILADELPHIA HOSPITAL, ETC. - - [Read April 1, 1874.] - - ------- - - - - - ANTE-MORTEM HISTORY. - - -Chang and Eng Bunker were born near Bangkok, Siam, in 1811, their father -being a Chinaman, their mother a native of Siam, bred by a Chinese -father.[1] - ------ - -Footnote 1: - - For this statement see an article in Lippincott’s Magazine, March, - 1874. - ------ - -The twins were united by a band extending from the junction of the -abdominal and thoracic cavities, anteriorly, constituting the variety in -teratology known as _Omphalopagus xiphodidymus_. - -They were married in April, 1843, and raised large families; Chang -having had ten, and Eng twelve children. Chang had three boys and seven -girls; Eng had seven boys and five girls. These were in all respects -average children, excepting two, a boy and girl of Chang’s, who were -deaf-mutes. - -The twins resided in a rolling country, about four miles from Mount -Airy, Surrey Co., N. C. They were prosperous farmers, each owning his -own farm. The dwellings of the two families were a mile and a half -apart. The twins resided three days in each of the homes alternately. -They were expert in the handling of tools, in plowing, shingling, -shooting, etc. They lived much in the open air, and frequently drove in -a carriage to the neighboring village. - -The events leading to their death were as follows: About six years ago -Chang, who had always been the more excitable, became addicted to -immoderate drinking. Three years ago, while on a voyage from Liverpool -to New York, he was stricken with hemiplegia of the right side. He in -great measure recovered from this attack, but could never ascend and -descend stairs with facility. For this reason the twins occupied rooms -on the ground floors of their homes. - -On Monday evening, Jan. 12th, 1874, Chang was seized, while at his own -house, with an attack of bronchitis. He had a cough; scanty, frothy -sputa; but no pain. On Wednesday the symptoms had somewhat subsided; the -skin was acting freely. Loud bronchial râles were present over the left -side of the chest. On Thursday evening the twins insisted upon leaving -Chang’s house for Eng’s. The weather was very cold, and the journey was -undertaken in an open carriage. On their arrival, however, Chang -continued as well as before, until Friday evening, when he complained of -thoracic oppression and inability to lie down with comfort. After having -retired that evening, the twins were heard to get up, and go out on the -porch, by the side of the house, where they drank of water, and returned -to their room. They built a large wood fire, and sat down; Eng soon -complaining of being sleepy, Chang declaring that he could not breathe -if he should lie down. Finally they again retired. They both fell -asleep. Near daybreak (Jan. 17th) Eng called to one of his sons, who -slept in a room above, to come down and waken Chang. The boy soon made -his appearance, and going to the side of Chang, cried out, “Uncle Chang -is dead!” Eng at once said “Then I am going!”—It is probable that Chang -was sleeping when he died. - -Eng made no further mention of Chang other than to request that the body -be moved closer to him. Soon afterward Eng desired to have his limbs -moved. This desire continued for half an hour. He then asked for a -urinal, but did not void over a few drops of urine. He several times -repeated the endeavor to micturate, but without success. He then -complained of a choking sensation, and asked to be raised in bed. He had -continued rational. His last words were “May God have mercy on my soul!” -He gradually became fainter, fell into a syncopal state, and died -quietly a little over two hours from the announcement to him of the -death of his brother. - - - - - AUTOPSY. - - -The Autopsy was begun in the house of Eng, Sunday, February 1st, 1874, -and finished in the Mütter Museum of the College of Physicians, at -Philadelphia. - -Age of subjects, 63 years. Examination made about fifteen days and eight -hours after death. The weather had been cold. No preservative had been -employed prior to the date of the autopsy. - - - I. Post-mortem Appearances. - -The following is their description in Chang. - -Body moderately emaciated. _Rigor mortis_ none. The fingers of the right -hand were semi-flexed, a condition due doubtless to the long-standing -paralysis of the right upper extremity. Passive congestion was marked -over entire dorsal aspect of the neck, trunk, and upper extremities. It -was less marked over the corresponding surfaces of the forearm and legs. -The feet and hands were almost entirely free. The superficial veins in -the last-named localities, especially in the left foot, were distended. -The passive congestion extended over the right thoracic region as far as -the median line, and on the front of both thighs, especially the right. -Upon the head the congestion was seen behind and beneath the ears, and -was sparsely distributed over both malar prominences. The lips were -discolored. The integument of the genitals was infiltrated, the scrotum -particularly being much swollen. There was extensive greenish -discoloration on the anterior abdominal wall. The left external -abdominal ring was enlarged. Both testicles were within the scrotum. The -hair of the head was gray. That on the right side of the pubis was -black, that on the left was of an iron-gray color. - -The following is their description in Eng. - -Body moderately well nourished, spare. _Rigor mortis_ slight. Passive -congestion less marked than in Chang. It was most conspicuous on the -buttocks and infraspinous spaces. There was none in front of the body. -The testicle of left side absent from scrotum. There was moderate -greenish discoloration of anterior wall of abdomen. The hair on the -pubis was black on the right side, pure gray on left side of the median -line. - -_Measurements._—Chang was 5 ft. 2-1/2 in. in height; Eng, 5 ft. 3-1/2 -in. When the bodies were laid upon a table Chang’s left side and Eng’s -right side were drawn somewhat toward one another. This was most marked -in Chang, and gave a greater inclination of his trunk toward his -brother’s. (See Figs. 1 and 19.) - - - II. External Appearances of the Band. - -When the bodies were suspended and placed face to face, it was evident -that the congenital position had been secured. All observations were -made, as far as was possible, with the bodies in this position. With it -the details of structure, it was thought, could be easily understood; -without it the subject would be difficult and confused. - -The “band” was a massive commissure placed between the bodies at the -junction of the abdominal and thoracic regions of each. It was broader -above than below, and had a circumference of nine inches. It presented -four surfaces for examination, an upper, lower, and two lateral -surfaces. - -The _upper_ surface was somewhat flattened in both Chang and Eng. The -ensiform cartilage of each body could be felt deflected from the sternum -and prolonged into the band. The base of the cartilage in Eng presented -a rounded circular eminence, measuring one inch in diameter. There was -no corresponding eminence in Chang. The upper aspect of each process -could be well defined beneath the skin, the subcutaneous connective -tissue being more abundant in Chang than in Eng. The upper surface -measured 2-1/2 in. in width at its base towards Eng, and 2-1/3 in. at -its base towards Chang. It was 2 in. wide at its middle. - -[Illustration Figure 2: - - Fig. 2. The twins in the acquired position (E. R., C. L.), showing - band and the primary incisions, _a-b_, _c-d_. From a - photograph taken after death at Philadelphia. ] - - -The _lower_ surface was much narrower than the upper. It was marked in -the centre, but nearer the anterior than the posterior border, by a -linear scar one inch in length, which it was thought answered to the -position of the single umbilicus. The skin was adherent at this point, -but elsewhere was easily raised in folds. Behind the scar, _i. e._, -toward the posterior part of the band, the skin was somewhat corrugated. -This portion answered, in position, to Chang’s umbilical pouch. - -The _lateral_ surfaces. The terms _upper_ surface and _lower_ surface -have fixed values, no matter how they may be approached by the observer. -This is not the case, however, with the lateral surfaces, as will appear -from the following considerations. Viewing the band as a separate -form—as it was spoken of during the life of the twins—we will see that -the terms front (“anterior”) and back (“posterior”), as given to the -lateral surfaces, were derived from studying the acquired position. Thus -we were bound not to cut the “front” of the band, but allowed to make an -incision on the “back.” Now this position of selection was destroyed, -and its terms deprived of what meaning they may have had, by the -reproduction of the congenital relations of the bodies. - -There is no doubt that in infancy and early childhood there was no -acquired position, and, therefore, neither “front” nor “back” to the -band. And later, when, as we have reason to believe, the position of -selection was gradually adopted, the terms “front” and “back” were -reversible—the “front” meaning that which corresponded to the surface of -least thoracic approximation. Thus when the adult condition was fixed, -and the “front” answered to the widely separated right side of Eng’s -chest and left side of Chang’s chest, the “back” was in relation with -the closely approximated left side of Eng’s chest and right side of -Chang’s. - -To avoid awkward repetition of phrases expressing the facts of the last -sentence, the following characters will be employed in describing the -“lateral” surfaces of the band. - -E. R., C. L. (Eng’s right, Chang’s left) will designate the “anterior” -surface of the acquired position. C. R., E. L. (Chang’s right, Eng’s -left) will designate the “posterior” surface. Since the right side of -Chang’s half of the band merged into the left on Eng’s half, while the -right side of Eng’s half, after it passed the middle line, became the -left half of Chang’s, we propose using the characters E. L., E. R., and -C. R., C. L., which will be understood as signifying left side Eng, -right side Eng, etc. - -Using the above signs we found that the surface E. R., C. L. was -inclined decidedly downward and backward when seen in the congenital -position, and was 3 in. high and 2-1/2 in. wide. At E. R., the border -answering to the ensiform cartilage was marked by a large rounded -tubercle; it was much more pronounced than on the corresponding border -of C. L. When seen in the acquired position, E. R., C. L. became -“anterior,” when, at its upper margin, C. L. was longer than E. R. by -one-half inch. The tubercle on E. R., already noticed, was much more -prominent than C. L. The contour of the inferior margin was also -different, being more uneven. C. L. was not only longer, but was more -obliquely placed downward and outward to the centre of the band than E. -R. (See cast in the Mütter Museum.) - - - III. Coverings of the Band. - -In front (E. R., C. L.) the superficies could not be well examined owing -to the restrictions imposed by the families. A view of it from within -can be obtained in Figs. 8, 9, _q. v._ Permission having been granted to -make an incision “behind,” at C. R., E. L., a modified letter-H incision -was employed, thus— - - a \ / e - b >—————< d - c / \ f - - -Turning the skin flaps here indicated upwards and downwards, and the -lateral triangles outwards, there was found beneath, a layer of -superficial fatty connective tissue, with a well-defined layer of fat on -either side, but with an intermediate portion which was free from fat, -and of greater thickness. - -The skin could with some little trouble be raised over the _dorsal or -upper surface_, showing here entire absence of fat. A very delicate -artery was found running across the middle, from Eng to Chang. - -The lower portion of the surface C. R., E. L. was inseparably connected -with the umbilicus. It was also united to the superficial fascia on C. -L., about 1-1/2 inches from the umbilicus; this did not have any -connection with the deeper parts. The process of fibrous tissue which -had been felt through the skin was conspicuous on this surface of the -band, and was covered by a delicate non-fatty layer of connective -tissue. Towards the lower part of the surface were seen several -diverging lines of fibrous tissue, which were lost within the integument -about the umbilical scar, at the lower surface of the band. They were -exceedingly thin, and at one point lay directly over the posterior and -inferior wall of the umbilical pouch of Chang. - -[Illustration Figure 3: - - Fig. 3. The surface, C. R., E. L., exposed by removal of skin and - superficial fascia to display the tendons of the external - oblique muscles and adjacent parts. - - A. The superficial fascia—lost over the position of Chang’s - umbilical pouch. - - B, C. Supplemental layers of fibrous tissue of Eng not seen in - Chang; B is a continuation toward Eng of aponeurotic - fibres having a source from the linea alba of Chang; C is - independent of the former, and is continuous with the deep - pectoral fascia. - - D. The interlacing of fibres on tendon of external oblique - muscle of Chang. - - E. The linea alba of Chang, beginning at C. R. - - F. Its continuation to E. L., and insertion upon the ensiform - cartilage. ] - - -Turning down the superficial layer, the aponeurosis of the external -oblique muscle was exposed (Fig. 3). A marked contrast was exhibited in -the two sides of the band. In Chang the parts were normal so far as they -were exposed—the characteristic apertures for the escape of small -vessels being abundant and conspicuous. In turning down the superficial -fascia in Eng (Fig. 3, A), it was found to be continuous at its lower -portion with an aponeurotic layer (Fig. 3, B), which extended toward the -median line, where it was continuous with the linea alba of Chang. In -addition to this, a second layer (Fig. 3, C), analogous in position to a -deep layer of the superficial fascia, which was entirely independent of -Chang, extended over nearly the whole of Eng’s division, and was -particularly well defined over the fibres of origin of the external -oblique muscle. This was continuous with the deep layer of the -superficial fascia which passed over the entire side of Eng’s thorax. - -Toward the middle of the band this layer gradually lost its distinctive -features, and was firmly incorporated with the tendon of the external -oblique muscle. A number of fibres corresponding to it extended in -inseparable intimacy with this tendon. These were gradually lost as they -approached the linea alba of Chang, and the parts being in position -these fibres were at their lower portion covered in by the aponeurotic -extension of the linea alba already mentioned. - -On Chang’s side, as we have seen, the parts comparable to these -accessory layers were absent. There was no line of demarcation between -the tendon of the oblique and the aponeurotic attachment of the -pectoralis. The tendon of the external oblique presented a different -appearance from the normal one in a more extensive interlacing of fibres -of the linea alba with the tendon. - -The part termed above the linea alba of Chang (Fig. 3, E), has already -been indicated through skin and superficial fascia. As can be seen, this -band of fibres, having its origin from the middle line of the abdomen of -Chang, was found to be a direct continuation of the linea alba. It was -remarkable in not being inserted into the ensiform process of Chang, but -into that of Eng, and in giving off the aponeurotic outshoot B, already -noticed, as well as in having a diffused point of insertion into Eng’s -tissue as in the ensiform cartilage (F). In a word, the linea alba -approaches the surface C. R., E. L. from C. R. below, and is inserted -into E. L. above. - - - IV. Organs Of Abdomen as observed in position through the Incisions. - -Limited incisions being alone permitted, the large vessels of the -abdomen were sought for in the process of embalmment, believing, as we -did, that the procedures of securing them would enable us, by extending -the cuts from below upward, to fairly open the abdomen and examine -thereby the interior of the band. - -In each body, therefore, an incision six inches long (Fig. 2, _ab_, -_cd_) was extended from the centre of the right iliac region to the -centre of the right hypochondriac region. This was subsequently joined -by an oblique incision passing from the upper end of the first mentioned -to the lateral border of the ensiform cartilage at its base. This -incision measured 7-1/2 in. The lower end of the vertical incision was -met by a horizontal one passing to the centre of the hypogastric region, -and measuring 3-1/4 in. - - -Through these incisions were studied (1) the _umbilical ligaments_ and -(2) _the abdominal viscera_. - -1. _The umbilical ligaments._[2]—By turning forward the anterior flap in -Eng as far as possible, the peritoneal lining was exhibited, and there -was brought into view a structure beginning at the summit of the -bladder, and which, ascending the abdominal wall and passing obliquely -to the right side, could be traced clearly to the scar-like tissue -marking the remains of the umbilical structures situated upon the -anterior abdominal wall within about 1-1/2 in. of the band. This -structure was the umbilical ligament (Fig. 4, A). It was loaded with -fat, and, as it terminated at the scar, distinct lobules of fat (several -of which were pedunculated) were abundantly deposited. - -The bladder was distended and raised 5 in. above the pubis. - ------ - -Footnote 2: - - The folds of peritoneum containing remains of the hypogastric arteries - will be called throughout by the name of _the umbilical ligaments_. - ------ - -[Illustration Figure 4: - - Fig. 4. The umbilical ligament in Eng. - - A. The umbilical ligament. - - B. The lobule of fat at position of the normal umbilicus. ] - - -In Chang (Fig. 5), the same appearances were seen as those above given, -save that no fat was deposited in the umbilical ligament. On the -contrary, it resembled the omentum of an emaciated subject. When -stretched, the fold was fully an inch wide, quite transparent, and -marked by two longitudinal bands, which recalled the shapes of the -obliterated vessels. But two rather small sessile fatty appendages were -seen at the scar. - -The bladder was empty, contracted, and lay within the true pelvis. - -[Illustration Figure 5: - - Fig. 5. The umbilical ligament in Chang. - - A. The umbilical ligament. - - B. The lobule of fat at position of the normal umbilicus. ] - - -In both Chang and Eng an isolated mass of subperitoneal fat, presenting -a sub-circular form, and measuring 1 in. in diameter, was found in the -position of the normal umbilicus (Figs. 4 and 5). - -2. _The viscera._—In Eng the omentum was gathered up toward the -transverse colon. It was abundantly furnished with fat.[3] The -transverse colon extended across the abdomen, beginning on the right -side on a level with the eleventh rib. It was contracted and contained a -little flatus. The rest of the exposed region was occupied by coils of -small intestine, yielding a mesentery very rich in fat. The stomach was -not visible. By removing the small intestine, and bringing down the -transverse colon and large intestine, the pyloric extremity of the -stomach was seen. The fundus of stomach, spleen, and left kidney were -not seen. (Fig. 6.) - ------ - -Footnote 3: - - The presence of a great amount of adipose tissue throughout, in Eng, - was very noticeable as contrasted with the emaciated appearance of the - tissues in Chang. - ------ - -[Illustration Figure 6: - - Fig. 6. The abdominal organs in Eng—the small intestines removed. - - A. Left lobe of liver. - - B. Right lobe of liver. - - C. Gall-bladder. - - D. Suspensory ligament. - - E. Lobules of fat in the position of the termination of the - umbilical ligament. ] - - -_The liver._—The right lobe was alone visible. This extended entirely -across the right hypochondriac and epigastric regions. Its external free -border was not in contact with the ribs. Between it and the external -abdominal wall there was an interval of nearly an inch at its greatest -part, which was crossed by the external lateral ligament. The inferior -border of the lobe rested upon and nearly concealed the pylorus of the -stomach as well as the upper half of right kidney. Corresponding in -position to the upper portion of the right kidney was a well-defined -layer of peritoneum, presenting a sharply defined internal border. Upon -dissecting away the peritoneum from this border it was found to answer -to the inferior vena cava. The lesser omentum occupied its usual -position. The fundus of the gall-bladder was two-thirds of an inch -beyond the anterior border of the lobe, immediately to the outer side of -the caudal lobe. The position of the longitudinal fissure was well off -to the left side of the abdomen, presenting, between the right and left -lobes, a conspicuous cleft which was partially occupied by the base of -the caudal lobe. The round ligament, with its associated suspensory -ligament, had doubtless passed nearly vertically, before the relations -had been disturbed by the incision in the abdominal wall, upwards and -forwards to the anterior abdominal wall at a point lying one inch to the -outer side of the centre of the umbilicus. - -In the subject, as it lay on the table with the flap _a, b_ (Fig. 2), -turned to the left, the suspensory ligament had the appearance of being -much more obliquely inclined to the left, and could be made nearly -horizontal by a little traction. Lying beneath this ligament, but -belonging to the anterior abdominal wall, was a large mass of -subperitoneal fat about the size of a pigeon’s egg. Extending to the -extreme left, and continuous with the anterior border of the left lobe -of the liver, was a delicate prolongation of liver substance which was -lost within the connecting band. - -[Illustration Figure 7: - - Fig. 7. The abdominal organs of Chang in position—the small - intestines removed. - - A. Left lobe of liver. - - B. Right lobe of liver. - - C. Gall-bladder. - - D. Suspensory ligament. - - E. Lobules of fat in the position of the termination of the - umbilical ligament. ] - - -The upper surface of this prolongation was supported by a fold of -peritoneum, extending directly upward, apparently attached to the base -of the ensiform cartilage. Visible upon the anterior aspect of this fold -was a tortuous artery, afterwards found to be the left internal mammary. -This fold may be called _the accessory suspensory ligament_; nothing -similar to it was seen in Chang. The left lobe of the liver, save a -portion of its anterior edge, was not visible. - -In Chang (Fig. 7), by exposing the parts as in Eng, throwing the -abdominal flap, _c, d_ (Fig. 2), to the right, there was at once brought -into view the transverse colon, the greater omentum, and greater -curvature of the stomach. The latter organ was large, empty, and without -any undue traction could be so displayed as to yield its fundus and -greater curvature in position. The fundus was not visible. Lying -conspicuously within the left hypochondriac region was the spleen. Its -inferior free border, with its peritoneal attachment, was distinctly -seen; its upper portions, however, were invisible. The left lobe of the -liver held a position answering to that of the right lobe in Eng—the -external lateral ligament being stretched across the left hypochondriac -region, pursuing a similar course to the external lateral ligament of -Eng (_q. v._). The left lobe at its outer portion rested upon the -spleen, its inner portion upon the stomach. The outer portion of the -left lobe presented a thin compressed border, the inner portion was -divided by a deep sulcus into two lobes. - -The right lobe lay deep within the right hypochondriac region, the -portion about the longitudinal fissure anteriorly, alone appearing in -the dissection. The suspensory ligament held a position similar to that -in Eng. The gall-bladder held its normal position to the right lobe, and -was moderately distended with bile. - -Both Chang and Eng had the organs occupying the hypochondriac and -epigastric regions retaining, on the whole, such relations as are -usually observed. - -This statement appears pertinent, at this stage of the autopsy, in order -to explain— - - - V. Interior of Band. - -We here describe (1) _the hepatic pouches_; (2) _the umbilical pouches_; -(3) _the vascular structures of the band_; (4) _the diaphragms_; (5) -_the ensiform cartilages_. - -1. _The hepatic pouches._—The photograph (Fig. 2) indicates the position -of the right lobe of Eng’s liver in the right hypochondriac region. The -right lobe of Chang is of course not seen in the figure, since it lies -on the side of the body which is not in the field of vision. It must -follow from the rights and lefts of the two individuals being opposites -that, in drawing a line between the livers (which, as already seen, -occupy normal positions as to right and left) across the band, such a -line will be diagonal to the axes of the ensiform cartilages; Chang’s -half of the band having the line enter the band from his “right,” Eng -from his “left.” It will also follow that any pouches of peritoneum -which might accompany this line will pursue a similar direction—be on -the same plane—be right or left with respect to the axis of that plane. -Now it was actually demonstrated that such a line did extend between the -livers, and was accompanied by such peritoneal pouches. These pouches -were termed the hepatic pouches, and may be described as follows:— - -Chang.—The subject lying on the table with rights and lefts determined -as in the acquired position, the finger could be inserted behind the -suspensory ligament (Fig. 7) in a pouch lying directly beneath the -ensiform cartilages, into which passed an extension of liver-like -tissue. - -Eng.—This fact could not be well demonstrated in Eng in this position, -but is well seen in Fig. 8. - -It follows that the two hepatic pouches are on nearly the same plane, -and that each approaches the central point of the band diagonally from -the right side of the subject with whose abdominal cavity it is -continuous. - -2. _The umbilical pouches._—Beneath the hepatic pouches, and between -them and the inferior border of the band, were two pouches which, from -their association with the round ligament, have been termed _the -umbilical pouches_. - -When the finger was passed toward the band from the abdomen of Chang, -and following the peritoneum of the anterior wall of the abdomen, it -passed into a pouch of the band directly over the skin covering, across -the band, over the umbilicus, and was received within the folds of the -suspensory ligament of the liver of Eng. This pouch was so superficial -that while the finger was in the pouch any motion of the finger was -readily followed by the observer. - -In the same way as above, if the finger was introduced _behind_ the -suspensory ligament of Eng, it slipped into a pouch which passed across -the median line of the band, and was received within the folds of the -suspensory ligament of the liver of Chang. - -There were then two pouches communicating with the two abdominal -cavities, arranged one above another in the band, Chang’s being the -lower of the two. No remains of an umbilical vein were detected, nor was -there any communication between the pouches and the umbilicus. It has -already been noticed that the round ligament of each liver passed from -the longitudinal fissure to a scar on the anterior wall of the abdomen -near the band. It was not, therefore, within the round ligaments, but -the folds of the suspensory ligaments, that the pouches were found. - -Eng’s pouch measured 2-1/2 in. From edge of Chang’s suspensory ligament -to end of hepatic pouch measured 3 in. - -Extending across the band, about midway between the properties of the -two individuals, was a septum. It was attached above and below to the -respective boundaries of the band, and along its entire length was -incorporated with its two peritoneal cavities, so that when in the -course of the dissection of the “posterior” surface of the band the -peritoneal covering of the band was displayed, several large lobules of -fat were seen lying to Eng’s side of the septum.[4] - ------ - -Footnote 4: - - Before the septum was known to exist, the band was opened from behind - in the presence of the Fellows of the College (Feb. 18th, 1874). The - exact relations of the septum could not at that time be determined. - Figs. 8, 9, and 10 are taken from studies of the parts made the day - after the meeting. - ------ - -It will be seen that Fig. 8 represents the band opened to display the -pouches with the septum. The lower end of the septum is fixed near the -scar of the umbilicus, and holds an immobile position over the umbilical -pouches. At this point it is free from fat. But as it extends over the -hepatic pouches it is more pliant. This portion of the septum has been -carried a little to Chang’s side of the band to display the entire -length of the hepatic pouch of Eng. - -Figs. 9 and 10 are designed to exhibit the appearances presented in -securing views of the septum from its sides. Fig. 9 is the side toward -Chang, and Fig. 10 is the side toward Eng. - -[Illustration Figure 8: - - Fig. 8. The surface, C. R., E. L., showing the interior of band by - free division of the aponeuroses seen in Fig. 7, and their - underlying peritoneal attachments. - - A. The orifice of umbilical pouch of Eng. - - B. The orifice of umbilical pouch of Chang, showing connection - with suspensory ligament of Eng. - - C. The fenestrated umbilical pouch of Eng passing between the - folds of the suspensory ligament of Chang. - - D. Suspensory ligament of liver of Eng. - - E. Hepatic tract. - - F. Hepatic pouch of Eng. - - G. The septum. ] - - -The pouches and septum were now removed and the position of the hepatic -tract determined. It rested upon the incurved borders of the ensiform -cartilages (see Fig. 15), and as the subject lay on the table with the -“posterior” surfaces of the band exposed (Fig. 11) the hepatic tract was -slightly arched. It measured three inches in length, was compressed, and -measured six lines wide and three lines thick. The tract arose from the -livers at the same point—namely, directly above the longitudinal -fissure, having more fulness on the side of the right than of the left -lobe. The round ligament, as it passed out of the longitudinal fissure -of each liver, was placed beneath and a little to the left of the tract. - -[Illustration Figure 9: - - Fig. 9. The septum viewed from Chang’s side. - - A. The orifice of umbilical pouch of Chang. - - B. The orifice of the hepatic pouch of Chang. - - C. Suspensory ligament of Chang containing umbilical pouch of - Eng. ] - - -[Illustration Figure 10: - - Fig. 10. The septum viewed from Eng’s side. - - A. The orifice of the umbilical pouch of Eng. - - B. The orifice of the hepatic pouch of same. - - C. Suspensory ligament of Eng containing the umbilical pouch of - Chang. ] - - -3. _The vascular structures of the band_ were as follows:— - -The livers being united, it was found that a colored injection thrown -into the portal vein of Chang passed into the liver of Eng. A careful -dissection of the blood vessel (Fig. 11, C) proved it to be a terminal -twig of the portal system of Chang. It was of the thickness of a No. -seven catheter, French scale, gradually diminished in size, and was -lost toward the centre of the band. It did not pass as such across the -band, but appeared to break up into minute branches before reaching -the liver of Eng. At the same time there was undoubted distension of -the portal capillaries with the colored fluid under the capsule of -the dorsal surface of the right lobe of Eng’s liver, one and one-half -inches from the band. Examination of the branches of the mesenteric -veins of Eng revealed the curious fact that some of them had received -the injection. This had not been transmitted through the liver, for the -portal vein at the transverse fissure was empty, but through a distinct -extra-hepatic portal track, which was found lying under the peritoneum -beneath the position of the hepatic pouches, and in association with -the umbilical pouches. This vessel began by relatively large radicals -towards Chang’s side, became larger as these encroached on Eng’s side, -and was finally received within the portal system of Eng’s body, as a -tributary to its mesenteric vein. - -[Illustration Figure 11: - - Fig. 11. The surface, C. R., E. L., with pouches removed to display - the hepatic tract. - - A. Liver of Chang. - - B. Liver of Eng. - - C. Portal vessel of Chang. - - D, D. Minute branches of hepatic artery. - - E. Subcutaneous fat of surface, E. R., C. L. ] - - -No other vessels were met with in the band excepting a few insignificant -branches of the hepatic artery, and the terminal twigs of the right -internal mammary of Eng. The former vessels are marked D, D, Fig. 11. -The latter vessel terminated by piercing the diaphragm, and giving -ultimate filaments to the integument of the “front” of the band as shown -in Fig. 12. - -[Illustration Figure 12: - - Fig. 12. The surface, C. R., E. L., with pouches, hepatic tract, and - peritoneal attachments removed to display the diaphragms. - - A. Subcutaneous fat of surface, E. R., C. L. - - B, C. Symmetrical muscular fasciculi. - - D. Fasciculi of Eng crossing the median line of the band. ] - - -4. _The diaphragms._—The subject being in the same position as in Fig. -2, the livers were removed, the peritoneal coverings dissected from the -band, and the diaphragms exposed (Fig. 12). The point (A), marked by the -terminal twigs of the right internal mammary of Eng, indicated the -“anterior” of the band. A broad slip of fibres of Chang (B) was seen to -pass across the median line, and to be inserted into the left border of -the ensiform cartilage of Eng (Fig. 17). This arrangement would appear -to correspond to the smaller collection of fibres (C) belonging entirely -to Eng. A second arrangement of fibres was seen above those just -indicated, immediately under the cartilages (D). This appeared to arise -from the border of the cordiform tendon of Eng by two distinct narrow -slips, which crossed the median line to be inserted dispersedly on the -diaphragm of Chang. - -[Illustration Figure 13: - - Fig. 13. The peritoneal linings of the anterior walls of both - abdominal cavities. - - A, A. The summits of the bladders. - - B, B. The umbilical ligaments. - - C, C. The nodules of fat at the parietal scar. - - D, D. The isolated lobules of fat. ] - - -5. _The ensiform cartilages._—After removing the diaphragms the -cartilages were exposed. They may be described as follows:— - -Chang.—The cartilage measured 2-1/2 in. wide, and 8 in. in length along -its axis. The right border was very prominent, and projected 1/2 in. -beyond the limit of the corresponding border in Eng. It was almost in -close contact with the cartilage of the eighth rib; it was very robust, -with upper surface convex, under surface nearly plane. The left lateral -border was 2-1/2 in. in length, right lateral border 11 lines in length. -The former was marked by three tubercles of about equal size. One -situated about 1 in. from the sternal origin; the other about 2 in. from -the same point; the third at its extreme anterior border. None of these -were robust, or presented any of the thickening noticed on the right -side. The middle of these tubercles was on a line with that of the -posterior tubercle. The junction of the ensiform process with the -sternum was not marked by the eminence characterizing the similar point -in Eng. - -Eng.—The cartilage differed from that of Chang in being 2-1/3 in. wide, -11 lines in length of axis. The left lateral border was abruptly -deflected downward, and did not present the transverse smooth projection -noticed in Chang. This deflection was almost at right angles to the -dorsal surface, acuminate inferiorly, and presenting a straight surface -toward Chang, and an oblique one toward the ribs. The length of left -lateral border was 1 in. The right lateral border, 1-1/3 in. in length, -presented a smooth sub-rounded edge without tubercles, and terminated in -a free rounded border on a plane a little above that of Chang. On the -whole this border was more robust than that of Chang. On the dorsal -aspect of the process near its base was seen the rounded eminence -described in the account of the external appearances (see page 7). - -A comparison between the two ensiform cartilages shows that in Chang the -anterior border was longer than in the right in Eng. In other -proportions Eng’s was equal if not larger than Chang’s, and was more -robust. - -[Illustration Figure 14: - - Fig. 14. A section of both ensiform cartilages, C. R., E. L. - - A. Chang’s cartilage. - - B. Eng’s cartilage. - - C. The synchondrosis. - - D. The bursa-like sac covering the same. - - E. An opening in the sac. - - F. Transversalis muscle of Eng. - - G. Transversalis muscle of Chang. ] - - -The union between the cartilages was of the character of a symphysis. -The union was very intimate along the border E. L., C. R., “posterior” -(Fig. 14); the exposure of the junction by a delicate transverse cut -showed a close union between the cartilages, thus constituting this part -of the band a synchondrosis. That this, however, did not characterize -the entire line of apposition was at once seen by turning to the border -E. R., C. L. (“anterior”), where an interval, two lines in width, was -seen between the cartilages, an interval which had been evidently -susceptible of variation during life. This interval extended across -one-fourth the width of the band. The portion of the band between the -parts as above indicated, was occupied by a bursa-like sac (Fig. 14, D), -which was opened by a minute orifice (E) to display its true nature. -This sac was crossed above by a stout band of fibrous tissue (Fig. 15, -A) an inch in width. Beneath, the sac was protected by a less -well-defined band of the same width as the upper ligament, and which -crossed between the two processes, to be lost in the perichondrium. - -[Illustration Figure 15: - - Fig. 15. Upper surface of ensiform cartilages. - - A. The upper ligament uniting the cartilages. ] - - -Viewing the cartilages as the constituent parts of the band, we found -the border C. L., E. R., the “anterior,” to be longer than C. R., E. L., -the “posterior.” C. L., E. R. was a convex, nearly even border, C. L. -being larger than E. R., with a gaping interval placed nearer Eng than -Chang. C. R., E. L. was an irregular, uneven border, without interval, -C. R. being smaller than E. L., and placed to the outer side. - - - VI. Other Structures. - -1. _The spleens._—This organ in Eng was 5 in. long, 3-1/3 in. wide. The -dorsum was marked by a large sulcus, extending nearly across the organ, -continuous with the sulcus on the superior border. The hilus was -relatively shorter than that of Chang, beginning above, fully an inch -below its upper border, and terminating within a half inch of its -inferior border. - -In Chang it measured 5 in. long, 2-1/3 in. wide. It was sub-elliptical -in form, upper lip somewhat abruptly compressed. The lower border was -obtuse and rounded. The dorsum was smooth, and presented at its -posterior edge a single sulcus placed midway between the tip and the -inferior border. The hilus extended nearly the entire length of the -under surface. - -2. _The livers_ (Fig. 16).—In Eng the liver was 9 in. broad. The right -lobe was 7-1/2 in. wide, antero-posteriorly. The fundus of the -gall-bladder was seen on the anterior edge of the organ. The only -noticeable feature on the under surface of the liver, was the lobus -Spigelii. This was large, measuring 2 in. in transverse diameter, and -2-1/3 in. in antero-posterior diameter. It presented a somewhat -increased breadth of neck, which was overlapped by an anterior -prolongation of the lobe, and terminated by a rounded compressed -extremity at the transverse fissure. The quadrilateral lobe was well -developed, 2 in. long in greatest diameter, 10 lines wide. - -[Illustration Figure 16: - - Fig. 16. The livers. - - A. Right lobe of Eng. - - B. Left lobe of same. - - C. Right lobe of Chang. - - D. Left lobe of same. - - E. Hepatic tract. - - F. Round ligament of Eng. - - G. Round ligament of Chang. - - H. Accessory suspensory ligament of Eng, with termination of - the right mammary artery. - - I. Fundus of gall-bladder of Chang. - - J. Fundus of gall-bladder of Eng. ] - - -In Chang the liver was 8-1/3 in. broad. The right lobe was 5 in. wide, -antero-posteriorly. The appearance of the gall-bladder corresponded to -that seen in Eng. The under surface was normal. The lobus Spigelii -presented a narrower neck than in Eng, the anterior prolongation being -greater. The quadrilateral lobe was less developed than in Eng. Indeed -it was not raised above the under surface of the right lobe, and its -limits were so imperfectly marked that it could not well be measured. - -[Illustration Figure 17: - - Fig. 17. Kidneys of Eng. - - A. Left kidney. - - B. Right kidney. - - C. Left renal vein. - - D. Left supra-renal vein. - - E. Left spermatic vein. - - F. Descending vena cava not distended with clot. - - G. Right renal vein. - - H. Aorta distended with plaster. - - I. Primitive iliac arteries. ] - - -3. _The kidneys._—In Eng, the body lying on the table E. R., C. L., the -left kidney (Fig. 17, A) was 4 in. long, 1-1/2 wide at its hilus, and of -the usual kidney shape. It lacked 1/2 in. of reaching the crest of the -ilium. The renal vein (Fig. 17, C) of the same side measured 3 in. in -length, and was decidedly oblique in position, its termination in the -cava being below the level of the lower end of the kidney. - -The right kidney (Fig. 17, B) corresponded in position to the left -kidney of Chang, that is to say, it was in the shallower portion of the -abdomen, and in contact with the abdominal wall. It measured 4 in. in -length, and 2-1/4 in. in width. Its inferior border lacked 2 in. of -reaching the superior crest of the ilium. The renal vein ascended a -little upward to enter the cava a little below the level of the upper -end of the kidney. - -In Chang, the body lying in such a way that the great trochanter of the -right side rested on the table, the left trochanter being raised three -inches from the same plane, an obliquity was given to the trunk, and -rendered the position of the abdominal organs somewhat anomalous. - -The left kidney (Fig. 18, A) lay with its lower half clearly within the -iliac fossa, its inferior border answering to a point an inch and a half -below the termination of the aorta. The organ lay, at its inner and -inferior portion, upon the left primitive iliac vein; it measured 3-3/4 -in. in length, and 2-7/12 in. in width at its widest part. It was larger -below, where it retained the usual appearance, but was somewhat abruptly -pointed above, and was marked by the characteristic notch on its inner -side. The renal vein (Fig. 18, C) was very obliquely situated, indeed -was almost parallel with the cava, and was 3-1/2 in. long. The -termination of the renal vein answered to a line running across the -abdomen lying fully 1 in. above the upper end of the left kidney. - -[Illustration Figure 18: - - Fig. 18. Kidneys of Chang. - - A. Left kidney. - - B. Right kidney. - - C. Left renal vein. - - D. Right renal vein. - - E. Left spermatic vein. - - F. Aorta filled with plaster. - - G. Primitive iliac veins. - - H. Descending cava distended with clot. - - I. Left supra-renal vein. ] - - -The right kidney (Fig. 18, B) was normally situated. It measured 4 in. -in length, and 1-1/2 in. in width at its centre, and presented the usual -reniform appearance. Its inferior edge just reached an eminence -answering to the superior crest of the ilium. - -4. _The testicles._—The right testicle of Eng was normal. The left -testicle was not within the scrotum. Dissection from within the abdomen -showed that the organ had been retracted. It lay well concealed within -the inguinal canal, slight traction making it appear within the abdomen. - -The testicles of Chang were normal. - -5. _The hearts._—The heart in Eng was situated nearer the median line -than normal. The abdominal incision was very unfavorable for studying -its exact position in the mediastinum. It was removed through an opening -made in the diaphragm. The right side of the heart was occupied by a -soft grumous clot much smaller than was found in the same locality in -Chang, and which did not distend the cavities. The left side was normal. -It was without clot so far as could be determined in the injected -condition of the ventricle. - -The heart of Chang presented a right auricle and ventricle distended -with a dense venous clot; this extended from the right ventricle along -the pulmonary arteries. The left side of the heart was empty. - -The ductus arteriosus and foramen ovale were firmly closed in both -hearts. - -6. _The vessels._—The arteries of both subjects were, so far as -examined, in an extremely atheromatous condition. Large plates of -calcareous matter were deposited in the abdominal aortas. The injecting -matter flowed insufficiently in the left lower extremity of Chang, from -a clot plugging the femoral artery. - -The venous system of Chang was engorged, giving the appearance of these -vessels having been injected after death; that of Eng was comparatively -empty. - -7. _The lungs._—The lungs were so altered by _post-mortem_ changes prior -to embalming, their contraction by the chloride of zinc, and their -increase of weight from the plaster, that no extended examination was -made of them. But little difference was seen between the conditions of -the lungs in the two men. No hepatization was present in Chang. - -8. _The vertebral column and ribs._—There was marked lateral curvature -of the vertebral column in both bodies. This was more conspicuous in -Chang. The convexity of the curve was about half-way down the vertebral -column, and inclined in Chang to the right side. The distance from the -centre of the vertebral column to the left abdominal wall, 2 in.; to the -right abdominal wall, 5 in. The left side of the abdominal cavity, -measuring from about the level of the band to the last rib of the right -side, 7-1/2 inches. - -The ribs in both Chang and Eng were 22 in number, 7 true and 4 false. On -the right side of Eng the first, second, and third ribs were normal. The -fourth, fifth, sixth, and seventh presented diminished intercostal -spaces, owing probably to the extreme traction made on them by the -deflection of the ensiform cartilages. The intercostal space between the -third and fourth ribs was slightly contracted; that between the fourth -and fifth ribs was very much contracted, the muscle being bulged inward. -Between the fifth and sixth, and sixth and seventh ribs the space was -less contracted. The remaining intercostal spaces were about normal. The -fifth rib near its articulation with the vertebral column formed a -well-defined ridge within the thorax, carrying with it the sixth and -seventh ribs, thus forming a rounded elevation, distinguishing the -positions of these ribs from the thoracic wall above and below this -point, where the parietal surface presented the usual concave -appearance. - -On the left side of Chang a similar arrangement of ribs and intercostal -spaces was seen to the above. - -The remaining organs were not examined. - - - - - REMARKS. - - -With reference to the cause of death of the Siamese twins it may be -briefly said that, in consequence of the restrictions by which we were -bound, no examination of the brains was made. It cannot, therefore, be -proved that the cause of Chang’s death was a cerebral clot, although -such an opinion, from the suddenness of death, preceded as it was by -hemiplegia and an immediate engorgement of the left lung, is tenable. -Eng died, in all probability, in a state of syncope induced by fright—a -view which the over-distended bladder and the retraction of the right -testicle would appear to corroborate. - -The existence of lateral curvature was not unsuspected. It was known to -those who had examined the twins before death. Indeed, it must have been -a necessity of the acquired position. - -The presence of a pad of subperitoneal fat at the usual position of the -umbilicus was certainly curious. It would appear to be an example of a -localized nutritive change about the peritoneum, at the centre of the -umbilical region, anticipating the exit of the vessels of the cord at -that point. Familiar examples of this anticipation between structures -developing from different layers of the embryo are seen in malformations -of the genital organs, eye, ear, etc. In the above example it is -remarkable only from the rarity of the conditions yielding it. - -The circulation in each individual of the twins was practically -complete, since the demonstration of continuity between the portal -systems, although satisfactory, invites the conclusion that the amount -of blood which passed from one to the other side of the band must have -been, in the condition of the parts at the time of the demonstration, -very inconsiderable, and was not competent in all probability to modify -the performance of any act of the economy. - -In the fœtal and early period of extra-uterine life the vessels must -have been more capacious, and associated with a large tract of liver -tissue. It follows, all things being equal, that an attempt at division -of the band in early life would have been accompanied with more venous -hemorrhage than at any subsequent period. - -In proof that the twins were the product of a single conception, the -strict correspondence between the markings of the two spleens, as well -as the number of the ribs, may be observed. The absence of available -data bearing upon the question of symmetry between visceral organs of -twins, prevents us from drawing here too positive an inference. It is -probable, however, that the twins were individuals of a single organism, -remarkable for its complete expression of duplex bilaterality.[5] - ------ - -Footnote 5: - - I desire to return thanks to Dr. T. H. Andrews and Dr. J. W. White, - Jr., for important assistance rendered in preparing the notes of the - autopsy. - ------ - -[Illustration Figure 19: - - Fig. 19. Foreshortened view of the trunks, showing in the acquired - position the band from above and the contours of its - lateral surfaces. ] - - - - - DESCRIPTION OF FIGURES. - - FROM PHOTOGRAPHS. - - Fig. 1. Twins in acquired position (E. R., C. L.). Taken in St. - Petersburg, 1870. Page 3. - - Fig. 2. Twins in acquired position (E. R., C. L.). Taken after death - at Philadelphia. Page 8. - - - FROM SKETCHES. - - Fig. 3. The surface, C. R., E. L., exposed by removal of skin and - superficial fascia to display the tendons of the external - oblique muscles and adjacent parts. Page 12. - - A. The superficial fascia—lost over the position of Chang’s - umbilical pouch. - - B, C. Supplemental layers of fibrous tissue of Eng not seen in - Chang; B is a continuation toward Eng of aponeurotic fibres - having a source from the linea alba of Chang; - C is independent of the former, and is continuous with the - deep pectoral fascia. - - D. The interlacing of fibres on tendon of external oblique muscle - of Chang. - - E. The linea alba of Chang, beginning at C. R. - - F. Its continuation to E. L., and insertion upon the ensiform - cartilage. - - - Fig. 4. The umbilical ligament in Eng. Page 15. - - A. The umbilical ligament. - - B. The lobule of fat at position of normal umbilicus. - - - Fig. 5. The umbilical ligament in Chang. Page 16. - The letters as in Fig. 4. - - - Fig. 6. The abdominal organs of Eng—the small intestines removed. - Page 17. - - A. Left lobe of liver. - - B. Right lobe of liver. - - C. Gall-bladder. - - D. Suspensory ligament. - - E. Lobules of fat in the position of the termination of the - umbilical ligament. - - - Fig. 7. The abdominal organs in Chang—the small intestines removed. - Page 19. The letters as in Fig. 6. - - - Fig. 8. The surface, C. R., E. L., showing the interior of band by - free division of the aponeuroses seen in Fig. 7, and their - underlying peritoneal attachments. Page 24. - - A. The orifice of umbilical pouch of Eng. - - B. The orifice of umbilical pouch of Chang, showing connection - with suspensory ligament of Eng. - - C. The fenestrated umbilical pouch of Eng passing between the - folds of the suspensory ligament of Chang. - - D. Suspensory ligament of liver of Eng. - - E. Hepatic tract. - - F. Hepatic pouch of Eng. - - G. The septum. - - - Fig. 9. The septum viewed from Chang’s side. Page 25. - - A. The orifice of umbilical pouch of Chang. - - B. The orifice of hepatic pouch of Chang. - - C. Suspensory ligament of Chang, containing umbilical pouch of - Eng. - - - Fig. 10. The septum viewed from Eng’s side. Page 26. - - A. The orifice of umbilical pouch of Eng. - - B. The orifice of hepatic pouch of Eng. - - C. Suspensory ligament of Eng, containing umbilical pouch of - Chang. - - - Fig. 11. The surface, C. R., E. L., with pouches removed to display the - hepatic tract. Page 27. - - A. Liver of Chang. - - B. Liver of Eng. - - C. Portal vessel of Chang. - - D, D. Minute branches of hepatic artery. - - E. Subcutaneous fat of surface, E. R., C. L. - - - Fig. 12. The surface, C. R., E. L., with pouches, hepatic tract, and - peritoneal attachments removed to display the diaphragms. - Page 28. - - A. Subcutaneous fat of surface, E. R., C. L. - - B, C. Symmetrical muscular fasciculi. - - D. Fasciculi of Eng, crossing median line of band. - - - Fig. 13. The peritoneal linings of the anterior walls of both abdominal - cavities. Page 29. - - A, A. The summits of the bladders. - - B, B. The umbilical ligaments. - - C, C. The nodules of fat at the parietal scar. - - D, D. The isolated lobules of fat. - - - Fig. 14. A section of both ensiform cartilages, C. R., E. L. Page 31. - - A. Chang’s cartilage. - - B. Eng’s cartilage. - - C. The synchondrosis. - - D. The bursa-like sac covering the same. - - E. An opening into the sac. - - F. Transversalis muscle of Eng. - - G. Transversalis muscle of Chang. - - - Fig. 15. Upper surface of ensiform cartilages. Page 32. - - A. The upper ligament uniting the cartilages. - - - Fig. 16. The livers. Page 34. - - A. Right lobe of Eng. - - B. Left lobe of same. - - C. Right lobe of Chang. - - D. Left lobe of same. - - E. Hepatic tract. - - F. Round ligament of Eng. - - G. Round ligament of Chang. - - H. Accessory suspensory ligament of Eng, with termination of the - right mammary artery. - - I. Fundus of gall-bladder of Chang. - - J. Fundus of gall-bladder of Eng. - - - Fig. 17. Kidneys of Eng. Page 35. - - A. Left kidney. - - B. Right kidney. - - C. Left renal vein. - - D. Left supra-renal vein. - - E. Left spermatic vein. - - F. Descending vena cava not distended with clot. - - G. Right renal vein. - - H. Aorta distended with plaster. - - I. Primitive iliac arteries. - - - Fig. 18. Kidneys of Chang. Page 37. - - A. Left kidney. - - B. Right kidney. - - C. Left renal vein. - - D. Right renal vein. - - E. Left spermatic vein. - - F. Aorta filled with plaster. - - G. Primitive iliac veins. - - H. Descending cava distended with clot. - - I. Left supra-renal vein. - - - Fig. 19. Foreshortened view of the trunks, showing in the acquired - position the band from above, and the contours of its lateral - surfaces. Page 42. - - - - - ---------------------------------------------------------------- - - Transcriber’s notes: - - ● The errors deemed most likely to be the printer’s have been - corrected, and are noted here. - ● Where hyphenation occurs on a line break, the decision to retain - or remove is based on occurrences elsewhere in the text. - ● Errors in punctuation and quotes have been silently restored. - ● Illustrations have been moved to the corresponding paragraph. - ● The footnotes were moved to near the corresponding paragraph. - ● The numbers below reference the page and line in the original - book. - - - reference correction original text - 86.36 abruptly but was somewhat abruptedly pointed - 26.4 blood vessel A careful dissection of the bloodvessel - - ---------------------------------------------------------------- - -*** END OF THE PROJECT GUTENBERG EBOOK REPORT OF AN AUTOPSY ON THE -BODIES OF CHANG AND ENG BUNKER, COMMONLY KNOWN AS THE SIAMESE -TWINS *** - -Updated editions will replace the previous one--the old editions will -be renamed. - -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the -United States without permission and without paying copyright -royalties. Special rules, set forth in the General Terms of Use part -of this license, apply to copying and distributing Project -Gutenberg-tm electronic works to protect the PROJECT GUTENBERG-tm -concept and trademark. Project Gutenberg is a registered trademark, -and may not be used if you charge for an eBook, except by following -the terms of the trademark license, including paying royalties for use -of the Project Gutenberg trademark. If you do not charge anything for -copies of this eBook, complying with the trademark license is very -easy. You may use this eBook for nearly any purpose such as creation -of derivative works, reports, performances and research. Project -Gutenberg eBooks may be modified and printed and given away--you may -do practically ANYTHING in the United States with eBooks not protected -by U.S. copyright law. Redistribution is subject to the trademark -license, especially commercial redistribution. - -START: FULL LICENSE - -THE FULL PROJECT GUTENBERG LICENSE -PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK - -To protect the Project Gutenberg-tm mission of promoting the free -distribution of electronic works, by using or distributing this work -(or any other work associated in any way with the phrase "Project -Gutenberg"), you agree to comply with all the terms of the Full -Project Gutenberg-tm License available with this file or online at -www.gutenberg.org/license. - -Section 1. General Terms of Use and Redistributing Project -Gutenberg-tm electronic works - -1.A. By reading or using any part of this Project Gutenberg-tm -electronic work, you indicate that you have read, understand, agree to -and accept all the terms of this license and intellectual property -(trademark/copyright) agreement. If you do not agree to abide by all -the terms of this agreement, you must cease using and return or -destroy all copies of Project Gutenberg-tm electronic works in your -possession. If you paid a fee for obtaining a copy of or access to a -Project Gutenberg-tm electronic work and you do not agree to be bound -by the terms of this agreement, you may obtain a refund from the -person or entity to whom you paid the fee as set forth in paragraph -1.E.8. - -1.B. "Project Gutenberg" is a registered trademark. It may only be -used on or associated in any way with an electronic work by people who -agree to be bound by the terms of this agreement. There are a few -things that you can do with most Project Gutenberg-tm electronic works -even without complying with the full terms of this agreement. See -paragraph 1.C below. There are a lot of things you can do with Project -Gutenberg-tm electronic works if you follow the terms of this -agreement and help preserve free future access to Project Gutenberg-tm -electronic works. See paragraph 1.E below. - -1.C. The Project Gutenberg Literary Archive Foundation ("the -Foundation" or PGLAF), owns a compilation copyright in the collection -of Project Gutenberg-tm electronic works. Nearly all the individual -works in the collection are in the public domain in the United -States. If an individual work is unprotected by copyright law in the -United States and you are located in the United States, we do not -claim a right to prevent you from copying, distributing, performing, -displaying or creating derivative works based on the work as long as -all references to Project Gutenberg are removed. Of course, we hope -that you will support the Project Gutenberg-tm mission of promoting -free access to electronic works by freely sharing Project Gutenberg-tm -works in compliance with the terms of this agreement for keeping the -Project Gutenberg-tm name associated with the work. You can easily -comply with the terms of this agreement by keeping this work in the -same format with its attached full Project Gutenberg-tm License when -you share it without charge with others. - -1.D. The copyright laws of the place where you are located also govern -what you can do with this work. Copyright laws in most countries are -in a constant state of change. If you are outside the United States, -check the laws of your country in addition to the terms of this -agreement before downloading, copying, displaying, performing, -distributing or creating derivative works based on this work or any -other Project Gutenberg-tm work. The Foundation makes no -representations concerning the copyright status of any work in any -country other than the United States. - -1.E. Unless you have removed all references to Project Gutenberg: - -1.E.1. The following sentence, with active links to, or other -immediate access to, the full Project Gutenberg-tm License must appear -prominently whenever any copy of a Project Gutenberg-tm work (any work -on which the phrase "Project Gutenberg" appears, or with which the -phrase "Project Gutenberg" is associated) is accessed, displayed, -performed, viewed, copied or distributed: - - 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. - -1.E.2. If an individual Project Gutenberg-tm electronic work is -derived from texts not protected by U.S. copyright law (does not -contain a notice indicating that it is posted with permission of the -copyright holder), the work can be copied and distributed to anyone in -the United States without paying any fees or charges. If you are -redistributing or providing access to a work with the phrase "Project -Gutenberg" associated with or appearing on the work, you must comply -either with the requirements of paragraphs 1.E.1 through 1.E.7 or -obtain permission for the use of the work and the Project Gutenberg-tm -trademark as set forth in paragraphs 1.E.8 or 1.E.9. - -1.E.3. If an individual Project Gutenberg-tm electronic work is posted -with the permission of the copyright holder, your use and distribution -must comply with both paragraphs 1.E.1 through 1.E.7 and any -additional terms imposed by the copyright holder. Additional terms -will be linked to the Project Gutenberg-tm License for all works -posted with the permission of the copyright holder found at the -beginning of this work. - -1.E.4. Do not unlink or detach or remove the full Project Gutenberg-tm -License terms from this work, or any files containing a part of this -work or any other work associated with Project Gutenberg-tm. - -1.E.5. Do not copy, display, perform, distribute or redistribute this -electronic work, or any part of this electronic work, without -prominently displaying the sentence set forth in paragraph 1.E.1 with -active links or immediate access to the full terms of the Project -Gutenberg-tm License. - -1.E.6. You may convert to and distribute this work in any binary, -compressed, marked up, nonproprietary or proprietary form, including -any word processing or hypertext form. However, if you provide access -to or distribute copies of a Project Gutenberg-tm work in a format -other than "Plain Vanilla ASCII" or other format used in the official -version posted on the official Project Gutenberg-tm website -(www.gutenberg.org), you must, at no additional cost, fee or expense -to the user, provide a copy, a means of exporting a copy, or a means -of obtaining a copy upon request, of the work in its original "Plain -Vanilla ASCII" or other form. Any alternate format must include the -full Project Gutenberg-tm License as specified in paragraph 1.E.1. - -1.E.7. Do not charge a fee for access to, viewing, displaying, -performing, copying or distributing any Project Gutenberg-tm works -unless you comply with paragraph 1.E.8 or 1.E.9. - -1.E.8. You may charge a reasonable fee for copies of or providing -access to or distributing Project Gutenberg-tm electronic works -provided that: - -* You pay a royalty fee of 20% of the gross profits you derive from - the use of Project Gutenberg-tm works calculated using the method - you already use to calculate your applicable taxes. The fee is owed - to the owner of the Project Gutenberg-tm trademark, but he has - agreed to donate royalties under this paragraph to the Project - Gutenberg Literary Archive Foundation. Royalty payments must be paid - within 60 days following each date on which you prepare (or are - legally required to prepare) your periodic tax returns. Royalty - payments should be clearly marked as such and sent to the Project - Gutenberg Literary Archive Foundation at the address specified in - Section 4, "Information about donations to the Project Gutenberg - Literary Archive Foundation." - -* You provide a full refund of any money paid by a user who notifies - you in writing (or by e-mail) within 30 days of receipt that s/he - does not agree to the terms of the full Project Gutenberg-tm - License. You must require such a user to return or destroy all - copies of the works possessed in a physical medium and discontinue - all use of and all access to other copies of Project Gutenberg-tm - works. - -* You provide, in accordance with paragraph 1.F.3, a full refund of - any money paid for a work or a replacement copy, if a defect in the - electronic work is discovered and reported to you within 90 days of - receipt of the work. - -* You comply with all other terms of this agreement for free - distribution of Project Gutenberg-tm works. - -1.E.9. If you wish to charge a fee or distribute a Project -Gutenberg-tm electronic work or group of works on different terms than -are set forth in this agreement, you must obtain permission in writing -from the Project Gutenberg Literary Archive Foundation, the manager of -the Project Gutenberg-tm trademark. Contact the Foundation as set -forth in Section 3 below. - -1.F. - -1.F.1. Project Gutenberg volunteers and employees expend considerable -effort to identify, do copyright research on, transcribe and proofread -works not protected by U.S. copyright law in creating the Project -Gutenberg-tm collection. Despite these efforts, Project Gutenberg-tm -electronic works, and the medium on which they may be stored, may -contain "Defects," such as, but not limited to, incomplete, inaccurate -or corrupt data, transcription errors, a copyright or other -intellectual property infringement, a defective or damaged disk or -other medium, a computer virus, or computer codes that damage or -cannot be read by your equipment. - -1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the "Right -of Replacement or Refund" described in paragraph 1.F.3, the Project -Gutenberg Literary Archive Foundation, the owner of the Project -Gutenberg-tm trademark, and any other party distributing a Project -Gutenberg-tm electronic work under this agreement, disclaim all -liability to you for damages, costs and expenses, including legal -fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT -LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE -PROVIDED IN PARAGRAPH 1.F.3. YOU AGREE THAT THE FOUNDATION, THE -TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE -LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR -INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH -DAMAGE. - -1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a -defect in this electronic work within 90 days of receiving it, you can -receive a refund of the money (if any) you paid for it by sending a -written explanation to the person you received the work from. If you -received the work on a physical medium, you must return the medium -with your written explanation. The person or entity that provided you -with the defective work may elect to provide a replacement copy in -lieu of a refund. If you received the work electronically, the person -or entity providing it to you may choose to give you a second -opportunity to receive the work electronically in lieu of a refund. If -the second copy is also defective, you may demand a refund in writing -without further opportunities to fix the problem. - -1.F.4. Except for the limited right of replacement or refund set forth -in paragraph 1.F.3, this work is provided to you 'AS-IS', WITH NO -OTHER WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT -LIMITED TO WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PURPOSE. - -1.F.5. Some states do not allow disclaimers of certain implied -warranties or the exclusion or limitation of certain types of -damages. If any disclaimer or limitation set forth in this agreement -violates the law of the state applicable to this agreement, the -agreement shall be interpreted to make the maximum disclaimer or -limitation permitted by the applicable state law. The invalidity or -unenforceability of any provision of this agreement shall not void the -remaining provisions. - -1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the -trademark owner, any agent or employee of the Foundation, anyone -providing copies of Project Gutenberg-tm electronic works in -accordance with this agreement, and any volunteers associated with the -production, promotion and distribution of Project Gutenberg-tm -electronic works, harmless from all liability, costs and expenses, -including legal fees, that arise directly or indirectly from any of -the following which you do or cause to occur: (a) distribution of this -or any Project Gutenberg-tm work, (b) alteration, modification, or -additions or deletions to any Project Gutenberg-tm work, and (c) any -Defect you cause. - -Section 2. Information about the Mission of Project Gutenberg-tm - -Project Gutenberg-tm is synonymous with the free distribution of -electronic works in formats readable by the widest variety of -computers including obsolete, old, middle-aged and new computers. It -exists because of the efforts of hundreds of volunteers and donations -from people in all walks of life. - -Volunteers and financial support to provide volunteers with the -assistance they need are critical to reaching Project Gutenberg-tm's -goals and ensuring that the Project Gutenberg-tm collection will -remain freely available for generations to come. In 2001, the Project -Gutenberg Literary Archive Foundation was created to provide a secure -and permanent future for Project Gutenberg-tm and future -generations. To learn more about the Project Gutenberg Literary -Archive Foundation and how your efforts and donations can help, see -Sections 3 and 4 and the Foundation information page at -www.gutenberg.org - -Section 3. Information about the Project Gutenberg Literary -Archive Foundation - -The Project Gutenberg Literary Archive Foundation is a non-profit -501(c)(3) educational corporation organized under the laws of the -state of Mississippi and granted tax exempt status by the Internal -Revenue Service. The Foundation's EIN or federal tax identification -number is 64-6221541. Contributions to the Project Gutenberg Literary -Archive Foundation are tax deductible to the full extent permitted by -U.S. federal laws and your state's laws. - -The Foundation's business office is located at 809 North 1500 West, -Salt Lake City, UT 84116, (801) 596-1887. Email contact links and up -to date contact information can be found at the Foundation's website -and official page at www.gutenberg.org/contact - -Section 4. Information about Donations to the Project Gutenberg -Literary Archive Foundation - -Project Gutenberg-tm depends upon and cannot survive without -widespread public support and donations to carry out its mission of -increasing the number of public domain and licensed works that can be -freely distributed in machine-readable form accessible by the widest -array of equipment including outdated equipment. Many small donations -($1 to $5,000) are particularly important to maintaining tax exempt -status with the IRS. - -The Foundation is committed to complying with the laws regulating -charities and charitable donations in all 50 states of the United -States. Compliance requirements are not uniform and it takes a -considerable effort, much paperwork and many fees to meet and keep up -with these requirements. We do not solicit donations in locations -where we have not received written confirmation of compliance. To SEND -DONATIONS or determine the status of compliance for any particular -state visit www.gutenberg.org/donate - -While we cannot and do not solicit contributions from states where we -have not met the solicitation requirements, we know of no prohibition -against accepting unsolicited donations from donors in such states who -approach us with offers to donate. - -International donations are gratefully accepted, but we cannot make -any statements concerning tax treatment of donations received from -outside the United States. U.S. laws alone swamp our small staff. - -Please check the Project Gutenberg web pages for current donation -methods and addresses. Donations are accepted in a number of other -ways including checks, online payments and credit card donations. To -donate, please visit: www.gutenberg.org/donate - -Section 5. General Information About Project Gutenberg-tm electronic works - -Professor Michael S. Hart was the originator of the Project -Gutenberg-tm concept of a library of electronic works that could be -freely shared with anyone. For forty years, he produced and -distributed Project Gutenberg-tm eBooks with only a loose network of -volunteer support. - -Project Gutenberg-tm eBooks are often created from several printed -editions, all of which are confirmed as not protected by copyright in -the U.S. unless a copyright notice is included. Thus, we do not -necessarily keep eBooks in compliance with any particular paper -edition. - -Most people start at our website which has the main PG search -facility: www.gutenberg.org - -This website includes information about Project Gutenberg-tm, -including how to make donations to the Project Gutenberg Literary -Archive Foundation, how to help produce our new eBooks, and how to -subscribe to our email newsletter to hear about new eBooks. diff --git a/old/68165-0.zip b/old/68165-0.zip Binary files differdeleted file mode 100644 index f802744..0000000 --- a/old/68165-0.zip +++ /dev/null diff --git a/old/68165-h.zip b/old/68165-h.zip Binary files differdeleted file mode 100644 index 886536d..0000000 --- a/old/68165-h.zip +++ /dev/null diff --git a/old/68165-h/68165-h.htm b/old/68165-h/68165-h.htm deleted file mode 100644 index 1948a1f..0000000 --- a/old/68165-h/68165-h.htm +++ /dev/null @@ -1,2543 +0,0 @@ -<!DOCTYPE html> -<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> - <head> - <meta charset="utf-8" /> - <title>Report of an autopsy on the bodies of Change and Eng Bunker--A Project Gutenberg eBook.</title> - <style> /* <![CDATA[ */ - body { margin-left: 8%; margin-right: 10%; } - h1 { text-align: center; font-weight: normal; font-size: 1.4em; } - h2 { text-align: center; font-weight: normal; font-size: 1.2em; } - h3 { text-align: center; font-weight: normal; font-size: 1.2em; } - .pageno { right: 1%; font-size: x-small; background-color: inherit; color: silver; - text-indent: 0em; text-align: right; position: absolute; - border: thin solid silver; padding: .1em .2em; font-style: normal; - font-variant: normal; font-weight: normal; text-decoration: none; } - p { text-indent: 0; margin-top: 0.5em; margin-bottom: 0.5em; text-align: justify; } - sup { vertical-align: top; font-size: 0.6em; } - .fss { font-size: 75%; } - .sc { font-variant: small-caps; } - .large { font-size: large; } - .xlarge { font-size: x-large; } - .small { font-size: small; } - .xsmall { font-size: x-small; } - .dl_1 dd { text-align: left; padding-top: .5em; padding-left: .5em; - margin-left: 5.0em; } - .dl_1 dt { float: left; clear: left; text-align: right; width: 4.0em; - padding-top: .5em; padding-right: .5em; } - .dl_2 dd { text-align: left; padding-top: .5em; padding-left: .5em; - margin-left: 4.2em; } - .dl_2 dt { float: left; clear: left; text-align: right; width: 4.0em; - padding-top: .5em; padding-right: .5em; } - @media handheld { .dl_1 dt { float: left; clear: left; text-align: right; - width: 4.0em; padding-top: .5em; padding-right: .5em; } } - @media handheld { .dl_2 dt { float: left; clear: left; text-align: right; - width: 4.0em; padding-top: .5em; padding-right: .5em; } } - dl.dl_1 { margin-top: .5em; margin-bottom: .5em; } - dl.dl_2 { margin-top: .5em; margin-bottom: .5em; } - ul.ul_1 {padding-left: 0; margin-left: 2.78%; margin-top: .5em; - margin-bottom: .5em; list-style-type: disc; } - div.footnote > :first-child { margin-top: 1em; } - div.footnote p { text-indent: 1em; margin-top: 0.0em; margin-bottom: 0.0em; } - .chapter { clear: both; page-break-before: always; } - .figcenter { clear: both; max-width: 100%; margin: 2em auto; text-align: center; } - .figcenter img { max-width: 100%; height: auto; } - .id001 { width:100%; } - .id002 { width:150px; } - @media handheld { .id001 { margin-left:0%; width:100%; } } - @media handheld { .id002 { margin-left:41%; width:18%; } } - .ig001 { width:100%; } - .table0 { margin: auto; margin-top: 2em; width: 90%; } - .nf-center { text-align: center; } - .nf-center-c0 { text-align: left; margin: 0.5em 0; } - .nf-center-c1 { text-align: left; margin: 1em 0; } - .c000 { margin-top: 2em; } - .c001 { margin-left: 5.56%; margin-right: 2.78%; margin-top: 0.5em; - margin-bottom: 0.5em; } - .c002 { margin-top: 4em; } - .c003 { margin-top: 1em; } - .c004 { page-break-before: always; margin-top: 4em; } - .c005 { margin-right: 9.72%; margin-top: 2em; margin-bottom: 0.5em; } - .c006 { margin-right: 9.72%; text-align: right; } - .c007 { border: none; border-bottom: thin solid; margin-top: 1em; - margin-bottom: 1em; margin-left: 45%; width: 10%; margin-right: 45%; } - .c008 { page-break-before:auto; margin-top: 4em; } - .c009 { margin-top: 2em; text-indent: 1em; margin-bottom: 0.0em; } - .c010 { text-decoration: none; } - .c011 { text-indent: 1em; margin-top: 0.0em; margin-bottom: 0.0em; } - .c012 { page-break-before: always; margin-top: 2em; } - .c013 { margin-top: 1em; text-indent: 1em; margin-bottom: 0.0em; } - .c014 { page-break-before: auto; margin-top: 2em; } - .c015 { border: none; border-bottom: thin solid; width: 10%; margin-left: 0; - margin-top: 4em; text-align: left; } - .c016 { margin-top: 4em; text-indent: 1em; margin-bottom: 0.0em; } - .c017 { vertical-align: top; text-align: left; padding-right: 1em; } - .c018 { vertical-align: top; text-align: left; } - .epubonly {visibility: hidden; display: none; } - @media handheld { .epubonly { visibility: visible; display: inline; } } - .htmlonly {visibility: visible; display: inline; } - @media handheld { .htmlonly { visibility: hidden; display: none; } } - ins.correction { text-decoration:none; border-bottom: thin dotted gray; } - div.tnotes { padding-left:1em;padding-right:1em;background-color:#E3E4FA; - border:1px solid silver; margin:1em 5% 0 5%; text-align: justify; } - div.tnotes {page-break-before: always; page-break-after: always; } - .div-fig { width:75%; max-width:45em; margin:0 auto; margin-bottom: 2em; - text-align:center; } - .div-fig1 { width:60%; max-width:45em; margin:0 auto; margin-bottom: 2em; - text-align:center; } - .div-note { width: 75%; margin:0 auto; font-size:smaller; } - .figcenter.id001 { margin-bottom:-0.5em; } - .dl_1 dt { padding-top: 0.1em; } - .dl_1 dd { padding-top: 0.1em; } - .dl_2 dt { padding-top: 0.2em; } - .dl_2 dd { padding-top: 0.2em; } - .dl_2 dt.c002 { margin-top: 1.1em; } - .dl_2 dd.c002 { margin-top: 1.1em; } - .figure_list a { font-size:smaller; } - .pglink {padding-left: 0.5em; } - .shortline { border: none; border-bottom: thin solid; width: 10%; - margin-left: 0; margin-bottom: 4em; text-align: left; } - .nowrap { white-space: nowrap; } - sub { vertical-align: bottom; font-size: 0.6em; } - /* ]]> */ </style> - </head> - <body> -<p style='text-align:center; font-size:1.2em; font-weight:bold'>The Project Gutenberg eBook of Report of an autopsy on the bodies of Chang and Eng Bunker, commonly known as the Siamese Twins, by Harrison Allen</p> -<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> - -<p style='display:block; margin-top:1em; margin-bottom:1em; margin-left:2em; text-indent:-2em'>Title: Report of an autopsy on the bodies of Chang and Eng Bunker, commonly known as the Siamese Twins</p> -<p style='display:block; margin-top:1em; margin-bottom:0; margin-left:2em; text-indent:-2em'>Author: Harrison Allen</p> -<p style='display:block; text-indent:0; margin:1em 0'>Release Date: May 24, 2022 [eBook #68165]</p> -<p style='display:block; text-indent:0; margin:1em 0'>Language: English</p> - <p style='display:block; margin-top:1em; margin-bottom:0; margin-left:2em; text-indent:-2em; text-align:left'>Produced by: deaurider, Guus Snijders and the Online Distributed Proofreading Team at https://www.pgdp.net (This file was produced from images generously made available by The Internet Archive)</p> -<div style='margin-top:2em; margin-bottom:4em'>*** START OF THE PROJECT GUTENBERG EBOOK REPORT OF AN AUTOPSY ON THE BODIES OF CHANG AND ENG BUNKER, COMMONLY KNOWN AS THE SIAMESE TWINS ***</div> - -<div class='tnotes'> - -<div class='nf-center-c1'> -<div class='nf-center c000'> - <div>Transcriber’s note:</div> - </div> -</div> - -<p class='c001'>The few minor errors, attributable to the printer, have been corrected. Please -see the <a href='#endnote'>transcriber’s note</a> at the end of this text -for details regarding the handling of any textual issues encountered -during its preparation.</p> - -<div class='htmlonly'> - -<p class='c001'>Corrections in spelling are indicated using an <ins class='correction' title='original spelling'>underline</ins> -highlight. Placing the cursor over the correction will produce the -original text in a small popup.</p> - -</div> -<div class='epubonly'> - -<p class='c001'>Corrections in spelling are indicated as hyperlinks, which will navigate the -reader to the corresponding entry in the corrections table in the -note at the end of the text.</p> - -</div> - -</div> - -<div class='nf-center-c1'> -<div class='nf-center c002'> - <div class='c003'><span class='xlarge'><b>REPORT</b></span></div> - <div class='c003'><span class='xsmall'>OF</span></div> - <div class='c003'>AN AUTOPSY ON THE BODIES</div> - <div class='c003'><span class='xsmall'>OF</span></div> - <div class='c003'><span class='large'>CHANG AND ENG BUNKER,</span></div> - <div class='c003'><span class='small'>COMMONLY KNOWN AS THE</span></div> - <div class='c003'><span class='large'>SIAMESE TWINS</span></div> - <div class='c000'><span class='small'>BY</span></div> - <div class='c003'>HARRISON ALLEN, M.D.,</div> - <div><span class='xsmall'>PROFESSOR OF COMPARATIVE ANATOMY AND ZOÖLOGY IN THE UNIVERSITY OF</span></div> - <div><span class='xsmall'>PENNSYLVANIA, SURGEON TO THE PHILADELPHIA HOSPITAL, ETC.</span></div> - <div class='c002'>PHILADELPHIA:</div> - <div>COLLINS, PRINTER, 705 JAYNE STREET.</div> - <div>1875.</div> - </div> -</div> - -<div> - <h1 class='c004'>AUTOPSY OF THE SIAMESE TWINS.</h1> -</div> - -<div class='div-fig1'> - -<div id='fig1' class='figcenter id001'> -<a href='images/fig1_l.jpg'><img src='images/fig1.jpg' alt='' class='ig001' /></a> -</div> - <dl class='dl_1 c002'> - <dt><span class='sc'>Fig. 1.</span></dt> - <dd>The twins in the acquired position <span class="nowrap">(E. R., C. L.).</span> From a - photograph taken in St. Petersburg, 1870. - </dd> - </dl> - -</div> - -<div class='div-note'> - -<h3 class='c004'>NOTE.</h3> - -<p class='c005'>The word “<span class='sc'>Report</span>” used in the title of my paper is to be read as -referring to the post-mortem appearances only, and not to the Report of -the Commission as appointed by the College. The ante-mortem history -prefixed to my paper was written in conjunction with Prof. Pancoast.</p> - -<div class='c006'>H. ALLEN.</div> - -</div> - -<div class='nf-center-c1'> -<div class='nf-center c002'> - <div><span class='pageno' id='Page_3'>3</span><span class='large'>REPORT</span></div> - <div class='c003'><span class='small'>OF AN</span></div> - <div class='c003'><span class='large'>AUTOPSY ON THE BODIES OF CHANG AND ENG</span></div> - <div><span class='large'>BUNKER, COMMONLY KNOWN AS THE</span></div> - <div><span class='large'>SIAMESE TWINS.</span></div> - <div class='c003'><span class='sc'>By</span></div> - <div class='c003'>HARRISON ALLEN, M.D.,</div> - <div>PROFESSOR OF COMPARATIVE ANATOMY AND ZOÖLOGY IN THE UNIVERSITY</div> - <div>OF PENNSYLVANIA, SURGEON TO THE PHILADELPHIA HOSPITAL, ETC.</div> - <div class='c003'>[Read April 1, 1874.]</div> - </div> -</div> - -<hr class='c007' /> - -<div class='chapter'> - <h2 class='c008'>ANTE-MORTEM HISTORY.</h2> -</div> - -<p class='c009'><span class='sc'>Chang and Eng Bunker</span> were born near Bangkok, -Siam, in 1811, their father being a Chinaman, their -mother a native of Siam, bred by a Chinese <span class="nowrap">father.<a id='r1'></a><a href='#f1' class='c010'><sup>[1]</sup></a></span></p> - -<p class='c011'>The twins were united by a band extending from -the junction of the abdominal and thoracic cavities, -anteriorly, constituting the variety in teratology known -as <i>Omphalopagus xiphodidymus</i>.</p> - -<p class='c011'>They were married in April, 1843, and raised large -families; Chang having had ten, and Eng twelve children. -Chang had three boys and seven girls; Eng -had seven boys and five girls. These were in all respects -average children, excepting two, a boy and girl -of Chang’s, who were deaf-mutes.</p> - -<p class='c011'>The twins resided in a rolling country, about four -miles from Mount Airy, Surrey Co., N. C. They were -prosperous farmers, each owning his own farm. The -<span class='pageno' id='Page_4'>4</span>dwellings of the two families were a mile and a half -apart. The twins resided three days in each of the -homes alternately. They were expert in the handling -of tools, in plowing, shingling, shooting, etc. They -lived much in the open air, and frequently drove in a -carriage to the neighboring village.</p> - -<p class='c011'>The events leading to their death were as follows: -About six years ago Chang, who had always been the -more excitable, became addicted to immoderate drinking. -Three years ago, while on a voyage from Liverpool -to New York, he was stricken with hemiplegia of -the right side. He in great measure recovered from -this attack, but could never ascend and descend stairs -with facility. For this reason the twins occupied rooms -on the ground floors of their homes.</p> - -<p class='c011'>On Monday evening, Jan. 12th, 1874, Chang was -seized, while at his own house, with an attack of bronchitis. -He had a cough; scanty, frothy sputa; but no -pain. On Wednesday the symptoms had somewhat -subsided; the skin was acting freely. Loud bronchial -râles were present over the left side of the chest. On -Thursday evening the twins insisted upon leaving -Chang’s house for Eng’s. The weather was very cold, -and the journey was undertaken in an open carriage. -On their arrival, however, Chang continued as well as -before, until Friday evening, when he complained of thoracic -oppression and inability to lie down with comfort. -After having retired that evening, the twins were heard -to get up, and go out on the porch, by the side of the -house, where they drank of water, and returned to their -room. They built a large wood fire, and sat down; Eng -soon complaining of being sleepy, Chang declaring -that he could not breathe if he should lie down. Finally -<span class='pageno' id='Page_5'>5</span>they again retired. They both fell asleep. Near daybreak -(Jan. 17th) Eng called to one of his sons, who -slept in a room above, to come down and waken Chang. -The boy soon made his appearance, and going to the -side of Chang, cried out, “Uncle Chang is dead!” -Eng at once said “Then I am going!”—It is probable -that Chang was sleeping when he died.</p> - -<p class='c011'>Eng made no further mention of Chang other than -to request that the body be moved closer to him. Soon -afterward Eng desired to have his limbs moved. This -desire continued for half an hour. He then asked for -a urinal, but did not void over a few drops of urine. -He several times repeated the endeavor to micturate, -but without success. He then complained of a choking -sensation, and asked to be raised in bed. He had -continued rational. His last words were “May God -have mercy on my soul!” He gradually became -fainter, fell into a syncopal state, and died quietly a -little over two hours from the announcement to him of -the death of his brother.</p> - -<div class='chapter'> - <h2 class='c008'>AUTOPSY.</h2> -</div> - -<p class='c009'>The <span class='sc'>Autopsy</span> was begun in the house of Eng, Sunday, -February 1st, 1874, and finished in the Mütter -Museum of the College of Physicians, at Philadelphia.</p> - -<p class='c011'>Age of subjects, 63 years. Examination made about -fifteen days and eight hours after death. The weather -had been cold. No preservative had been employed -prior to the date of the autopsy.</p> - -<div> - <span class='pageno' id='Page_6'>6</span> - <h3 class='c012'>I. <span class='sc'>Post-mortem Appearances.</span></h3> -</div> - -<p class='c013'>The following is their description in Chang.</p> - -<p class='c011'>Body moderately emaciated. <i>Rigor mortis</i> none. -The fingers of the right hand were semi-flexed, a condition -due doubtless to the long-standing paralysis of -the right upper extremity. Passive congestion was -marked over entire dorsal aspect of the neck, trunk, -and upper extremities. It was less marked over the -corresponding surfaces of the forearm and legs. The -feet and hands were almost entirely free. The superficial -veins in the last-named localities, especially in -the left foot, were distended. The passive congestion -extended over the right thoracic region as far as the -median line, and on the front of both thighs, especially -the right. Upon the head the congestion was seen -behind and beneath the ears, and was sparsely distributed -over both malar prominences. The lips were -discolored. The integument of the genitals was infiltrated, -the scrotum particularly being much swollen. -There was extensive greenish discoloration on the anterior -abdominal wall. The left external abdominal -ring was enlarged. Both testicles were within the -scrotum. The hair of the head was gray. That on -the right side of the pubis was black, that on the left -was of an iron-gray color.</p> - -<p class='c011'>The following is their description in Eng.</p> - -<p class='c011'>Body moderately well nourished, spare. <i>Rigor mortis</i> -slight. Passive congestion less marked than in -Chang. It was most conspicuous on the buttocks and -infraspinous spaces. There was none in front of the -body. The testicle of left side absent from scrotum. -There was moderate greenish discoloration of anterior -<span class='pageno' id='Page_7'>7</span>wall of abdomen. The hair on the pubis was black on -the right side, pure gray on left side of the median line.</p> - -<p class='c013'><i>Measurements.</i>—Chang was 5 ft. <span class="nowrap">2-<sup>1</sup>/<sub>2</sub> in.</span> in height; -Eng, 5 ft. <span class="nowrap">3-<sup>1</sup>/<sub>2</sub> in.</span> When the bodies were laid upon a -table Chang’s left side and Eng’s right side were drawn -somewhat toward one another. This was most marked -in Chang, and gave a greater inclination of his trunk -toward his brother’s. (See Figs. <a href='#fig1'>1</a> and <a href='#fig19'>19</a>.)</p> - -<h3 class='c012'>II. <span class='sc'>External Appearances of the Band.</span></h3> - -<p class='c013'>When the bodies were suspended and placed face to -face, it was evident that the congenital position had -been secured. All observations were made, as far as -was possible, with the bodies in this position. With it -the details of structure, it was thought, could be easily -understood; without it the subject would be difficult -and confused.</p> - -<p class='c011'>The “band” was a massive commissure placed between -the bodies at the junction of the abdominal and -thoracic regions of each. It was broader above than -below, and had a circumference of nine inches. It -presented four surfaces for examination, an upper, -lower, and two lateral surfaces.</p> - -<p class='c011'>The <i>upper</i> surface was somewhat flattened in both -Chang and Eng. The ensiform cartilage of each -body could be felt deflected from the sternum and -prolonged into the band. The base of the cartilage -in Eng presented a rounded circular eminence, measuring -one inch in diameter. There was no corresponding -eminence in Chang. The upper aspect of -each process could be well defined beneath the skin, -the subcutaneous connective tissue being more -<span class='pageno' id='Page_8'>8</span>abundant in Chang than in Eng. The upper surface measured -<span class="nowrap">2-<sup>1</sup>/<sub>2</sub> in.</span> in width at its base towards Eng, and <span class="nowrap">2-<sup>1</sup>/<sub>3</sub></span> -in. at its base towards Chang. It was 2 in. wide at its -middle.</p> - -<div class='div-fig'> - -<div id='fig2' class='figcenter id001'> -<a href='images/fig2_l.jpg'><img src='images/fig2.jpg' alt='' class='ig001' /></a> -</div> - <dl class='dl_1'> - <dt><span class='sc'>Fig. 2.</span></dt> - <dd>The twins in the acquired position <span class="nowrap">(E. R., C. L.),</span> showing - band and the primary incisions, <i>a-b</i>, <i>c-d</i>. From a photograph taken after - death at Philadelphia. - </dd> - </dl> - -</div> - -<p class='c011'>The <i>lower</i> surface was much narrower than the upper. -It was marked in the centre, but nearer the anterior than -the posterior border, by a linear scar one inch in length, -which it was thought answered to the position of the -single umbilicus. The skin was adherent at this point, -but elsewhere was easily raised in folds. Behind the -scar, <i>i. e.</i>, toward the posterior part of the band, the -<span class='pageno' id='Page_9'>9</span>skin was somewhat corrugated. This portion answered, -in position, to Chang’s umbilical pouch.</p> - -<p class='c011'>The <i>lateral</i> surfaces. The terms <i>upper</i> surface and -<i>lower</i> surface have fixed values, no matter how they -may be approached by the observer. This is not the -case, however, with the lateral surfaces, as will appear -from the following considerations. Viewing the band -as a separate form—as it was spoken of during the life -of the twins—we will see that the terms front (“anterior”) -and back (“posterior”), as given to the lateral -surfaces, were derived from studying the acquired -position. Thus we were bound not to cut the “front” -of the band, but allowed to make an incision on the -“back.” Now this position of selection was destroyed, -and its terms deprived of what meaning they may have -had, by the reproduction of the congenital relations of -the bodies.</p> - -<p class='c011'>There is no doubt that in infancy and early childhood -there was no acquired position, and, therefore, -neither “front” nor “back” to the band. And later, -when, as we have reason to believe, the position of selection -was gradually adopted, the terms “front” and -“back” were reversible—the “front” meaning that -which corresponded to the surface of least thoracic -approximation. Thus when the adult condition was -fixed, and the “front” answered to the widely separated -right side of Eng’s chest and left side of Chang’s -chest, the “back” was in relation with the closely approximated -left side of Eng’s chest and right side of -Chang’s.</p> - -<p class='c011'>To avoid awkward repetition of phrases expressing -the facts of the last sentence, the following characters -<span class='pageno' id='Page_10'>10</span>will be employed in describing the “lateral” surfaces of -the band.</p> - -<p class='c011'><span class="nowrap">E. R.</span>, <span class="nowrap">C. L.</span> (Eng’s right, Chang’s left) will designate -the “anterior” surface of the acquired position. -<span class="nowrap">C. R.</span>, <span class="nowrap">E. L.</span> (Chang’s right, Eng’s left) will designate -the “posterior” surface. Since the right side of -Chang’s half of the band merged into the left on Eng’s -half, while the right side of Eng’s half, after it passed -the middle line, became the left half of Chang’s, we -propose using the characters <span class="nowrap">E. L.</span>, <span class="nowrap">E. R.</span>, and <span class="nowrap">C. R.</span>, -<span class="nowrap">C. L.</span>, which will be understood as signifying left side -Eng, right side Eng, etc.</p> - -<p class='c011'>Using the above signs we found that the surface -<span class="nowrap">E. R.</span>, <span class="nowrap">C. L.</span> was inclined decidedly downward and -backward when seen in the congenital position, and was -3 in. high and <span class="nowrap">2-<sup>1</sup>/<sub>2</sub> in.</span> wide. At <span class="nowrap">E. R.</span>, the border answering -to the ensiform cartilage was marked by a large -rounded tubercle; it was much more pronounced than -on the corresponding border of <span class="nowrap">C. L.</span> When seen in -the acquired position, <span class="nowrap">E. R.</span>, <span class="nowrap">C. L.</span> became “anterior,” -when, at its upper margin, <span class="nowrap">C. L.</span> was longer than <span class="nowrap">E. R.</span> -by one-half inch. The tubercle on <span class="nowrap">E. R.</span>, already -noticed, was much more prominent than <span class="nowrap">C. L.</span> The -contour of the inferior margin was also different, being -more uneven. <span class="nowrap">C. L.</span> was not only longer, but was -more obliquely placed downward and outward to the -centre of the band than <span class="nowrap">E. R.</span> (See cast in the Mütter -Museum.)</p> - -<h3 class='c012'>III. <span class='sc'>Coverings of the Band.</span></h3> - -<p class='c013'>In front (<span class="nowrap">E. R.</span>, <span class="nowrap">C. L.)</span> the superficies could not be -well examined owing to the restrictions imposed by the -families. A view of it from within can be obtained in -<span class='pageno' id='Page_11'>11</span>Figs. <a href='#fig8'>8</a>, <a href='#fig9'>9</a>, <i>q. v.</i> Permission having been granted to -make an incision “behind,” at <span class="nowrap">C. R.</span>, <span class="nowrap">E. L.,</span> a modified -letter-H incision was employed, thus—</p> - -<div class='figcenter id002'> -<img src='images/i11.jpg' alt='' class='ig001' /> -</div> - -<p class='c011'>Turning the skin flaps here indicated upwards and -downwards, and the lateral triangles outwards, there -was found beneath, a layer of superficial fatty connective -tissue, with a well-defined layer of fat on either -side, but with an intermediate portion which was free -from fat, and of greater thickness.</p> - -<p class='c011'>The skin could with some little trouble be raised -over the <i>dorsal or upper surface</i>, showing here entire -absence of fat. A very delicate artery was found -running across the middle, from Eng to Chang.</p> - -<p class='c011'>The lower portion of the surface <span class="nowrap">C. R.,</span> <span class="nowrap">E. L.</span> was -inseparably connected with the umbilicus. It was -also united to the superficial fascia on <span class="nowrap">C. L.,</span> about <span class="nowrap">1-<sup>1</sup>/<sub>2</sub></span> -inches from the umbilicus; this did not have any connection -with the deeper parts. The process of fibrous -tissue which had been felt through the skin was conspicuous -on this surface of the band, and was covered -by a delicate non-fatty layer of connective tissue. -Towards the lower part of the surface were seen -several diverging lines of fibrous tissue, which were -lost within the integument about the umbilical scar, at -the lower surface of the band. They were exceedingly -thin, and at one point lay directly over the posterior -and inferior wall of the umbilical pouch of Chang.</p> - -<div><span class='pageno' id='Page_12'>12</span></div> -<div class='div-fig'> - -<div id='fig3' class='figcenter id001'> -<a href='images/fig3_l.jpg'><img src='images/fig3.jpg' alt='' class='ig001' /></a> -</div> - <dl class='dl_1'> - <dt><span class='sc'>Fig. 3.</span></dt> - <dd>The surface, <span class="nowrap">C. R.,</span> <span class="nowrap">E. L.,</span> - exposed by removal of skin and superficial fascia to display the tendons of the external - oblique muscles and adjacent parts. - </dd> - <dt><span class='fss'>A.</span></dt> - <dd>The superficial fascia—lost over the position of Chang’s umbilical pouch. - </dd> - <dt><span class='fss'>B, C.</span></dt> - <dd>Supplemental layers of fibrous tissue of Eng not seen in Chang; <span - class='fss'>B</span> is a continuation toward Eng of aponeurotic fibres having a source - from the linea alba of Chang; <span class='fss'>C</span> is independent of the former, - and is continuous with the deep pectoral fascia. - </dd> - <dt><span class='fss'>D.</span></dt> - <dd>The interlacing of fibres on tendon of external oblique muscle of Chang. - </dd> - <dt><span class='fss'>E.</span></dt> - <dd>The linea alba of Chang, beginning at <span class="nowrap">C. R.</span> - </dd> - <dt><span class='fss'>F.</span></dt> - <dd>Its continuation to <span class="nowrap">E. L.,</span> and insertion upon the ensiform - cartilage. - </dd> - </dl> - -</div> - -<p class='c011'>Turning down the superficial layer, the aponeurosis -of the external oblique muscle was exposed (Fig. <a href='#fig3'>3</a>). -A marked contrast was exhibited in the two sides of -the band. In Chang the parts were normal so far as -they were exposed—the characteristic apertures for -the escape of small vessels being abundant and conspicuous. -In turning down the superficial fascia in -Eng (Fig. <a href='#fig3'>3</a>, <span class='fss'>A</span>), it was found to be continuous at its -lower portion with an aponeurotic layer (Fig. <a href='#fig3'>3</a>, <span class='fss'>B</span>), -which extended toward the median line, where it was -continuous with the linea alba of Chang. In addition -to this, a second layer (Fig. <a href='#fig3'>3</a>, <span class='fss'>C</span>), analogous in position -to a deep layer of the superficial fascia, which was -<span class='pageno' id='Page_13'>13</span>entirely independent of Chang, extended over nearly -the whole of Eng’s division, and was particularly well -defined over the fibres of origin of the external oblique -muscle. This was continuous with the deep layer of -the superficial fascia which passed over the entire side -of Eng’s thorax.</p> - -<p class='c011'>Toward the middle of the band this layer gradually -lost its distinctive features, and was firmly incorporated -with the tendon of the external oblique muscle. A -number of fibres corresponding to it extended in -inseparable intimacy with this tendon. These were -gradually lost as they approached the linea alba of -Chang, and the parts being in position these fibres -were at their lower portion covered in by the aponeurotic -extension of the linea alba already mentioned.</p> - -<p class='c011'>On Chang’s side, as we have seen, the parts comparable -to these accessory layers were absent. There -was no line of demarcation between the tendon of -the oblique and the aponeurotic attachment of the -pectoralis. The tendon of the external oblique presented -a different appearance from the normal one in a -more extensive interlacing of fibres of the linea alba -with the tendon.</p> - -<p class='c011'>The part termed above the linea alba of Chang -(Fig. <a href='#fig3'>3</a>, <span class='fss'>E</span>), has already been indicated through skin -and superficial fascia. As can be seen, this band of -fibres, having its origin from the middle line of the -abdomen of Chang, was found to be a direct continuation -of the linea alba. It was remarkable in not being -inserted into the ensiform process of Chang, but into -that of Eng, and in giving off the aponeurotic outshoot -<span class='fss'>B</span>, already noticed, as well as in having a diffused point -of insertion into Eng’s tissue as in the ensiform -<span class='pageno' id='Page_14'>14</span>cartilage (<span class='fss'>F</span>). In a word, the linea alba approaches the -surface <span class="nowrap">C. R.,</span> <span class="nowrap">E. L.</span> from <span class="nowrap">C. R.</span> below, and is inserted -into <span class="nowrap">E. L.</span> above.</p> - -<h3 class='c012'>IV. <span class='sc'>Organs Of Abdomen as observed in position through the Incisions.</span></h3> - -<p class='c013'>Limited incisions being alone permitted, the large -vessels of the abdomen were sought for in the process -of embalmment, believing, as we did, that the procedures -of securing them would enable us, by extending -the cuts from below upward, to fairly open the -abdomen and examine thereby the interior of the band.</p> - -<p class='c011'>In each body, therefore, an incision six inches long -(Fig. <a href='#fig2'>2</a>, <i>ab</i>, <i>cd</i>) was extended from the centre of -the right iliac region to the centre of the right hypochondriac -region. This was subsequently joined -by an oblique incision passing from the upper end of -the first mentioned to the lateral border of the ensiform -cartilage at its base. This incision measured -<span class="nowrap">7-<sup>1</sup>/<sub>2</sub> in.</span> The lower end of the vertical incision was met -by a horizontal one passing to the centre of the hypogastric -region, and measuring <span class="nowrap">3-<sup>1</sup>/<sub>4</sub> in.</span></p> - -<p class='c009'>Through these incisions were studied (1) the <i>umbilical -ligaments</i> and (2) <i>the abdominal viscera</i>.</p> - -<p class='c011'>1. <i>The umbilical ligaments.</i><a id='r2'></a><a href='#f2' class='c010'><sup>[2]</sup></a>—By turning forward -the anterior flap in Eng as far as possible, the peritoneal -lining was exhibited, and there was brought into -view a structure beginning at the summit of the -bladder, and which, ascending the abdominal wall and -passing obliquely to the right side, could be traced -<span class='pageno' id='Page_15'>15</span>clearly to the scar-like tissue marking the remains of -the umbilical structures situated upon the anterior -abdominal wall within about <span class="nowrap">1-<sup>1</sup>/<sub>2</sub> in.</span> of the band. This -structure was the umbilical ligament (Fig. <a href='#fig4'>4</a>, <span class='fss'>A</span>). It -was loaded with fat, and, as it terminated at the scar, -distinct lobules of fat (several of which were pedunculated) -were abundantly deposited.</p> - -<p class='c011'>The bladder was distended and raised 5 in. above -the pubis.</p> - -<div class='div-fig'> - -<div id='fig4' class='figcenter id001'> -<a href='images/fig4_l.jpg'><img src='images/fig4.jpg' alt='' class='ig001' /></a> -</div> - <dl class='dl_1'> - <dt><span class='sc'>Fig. 4.</span></dt> - <dd>The umbilical ligament in Eng. - </dd> - <dt><span class='fss'>A.</span></dt> - <dd>The umbilical ligament. - </dd> - <dt><span class='fss'>B.</span></dt> - <dd>The lobule of fat at position of the normal umbilicus. - </dd> - </dl> - -</div> - -<p class='c011'>In Chang (Fig. <a href='#fig5'>5</a>), the same appearances were seen -as those above given, save that no fat was deposited -in the umbilical ligament. On the contrary, it resembled -the omentum of an emaciated subject. When -stretched, the fold was fully an inch wide, quite transparent, -and marked by two longitudinal bands, which -<span class='pageno' id='Page_16'>16</span>recalled the shapes of the obliterated vessels. But two -rather small sessile fatty appendages were seen at the -scar.</p> - -<p class='c011'>The bladder was empty, contracted, and lay within -the true pelvis.</p> - -<div class='div-fig'> - -<div id='fig5' class='figcenter id001'> -<a href='images/fig5_l.jpg'><img src='images/fig5.jpg' alt='' class='ig001' /></a> -</div> - <dl class='dl_1'> - <dt><span class='sc'>Fig. 5.</span></dt> - <dd>The umbilical ligament in Chang. - </dd> - <dt><span class='fss'>A.</span></dt> - <dd>The umbilical ligament. - </dd> - <dt><span class='fss'>B.</span></dt> - <dd>The lobule of fat at position of the normal umbilicus. - </dd> - </dl> - -</div> - -<p class='c011'>In both Chang and Eng an isolated mass of subperitoneal -fat, presenting a sub-circular form, and -measuring 1 in. in diameter, was found in the position -of the normal umbilicus (Figs. <a href='#fig4'>4</a> and <a href='#fig5'>5</a>).</p> - -<p class='c011'>2. <i>The viscera.</i>—In Eng the omentum was gathered -up toward the transverse colon. It was abundantly -furnished with <span class="nowrap">fat.<a id='r3'></a><a href='#f3' class='c010'><sup>[3]</sup></a></span> The transverse colon extended -<span class='pageno' id='Page_17'>17</span>across the abdomen, beginning on the right side on a -level with the eleventh rib. It was contracted and -contained a little flatus. The rest of the exposed -region was occupied by coils of small intestine, yielding -a mesentery very rich in fat. The stomach was -not visible. By removing the small intestine, and -bringing down the transverse colon and large intestine, -the pyloric extremity of the stomach was seen. The -fundus of stomach, spleen, and left kidney were not -seen. (Fig. <a href='#fig6'>6</a>.)</p> - -<div class='div-fig'> - -<div id='fig6' class='figcenter id001'> -<a href='images/fig6_l.jpg'><img src='images/fig6.jpg' alt='' class='ig001' /></a> -</div> - <dl class='dl_1'> - <dt><span class='sc'>Fig. 6.</span></dt> - <dd>The abdominal organs in Eng—the small intestines removed. - </dd> - <dt><span class='fss'>A.</span></dt> - <dd>Left lobe of liver. - </dd> - <dt><span class='fss'>B.</span></dt> - <dd>Right lobe of liver. - </dd> - <dt><span class='fss'>C.</span></dt> - <dd>Gall-bladder. - </dd> - <dt><span class='fss'>D.</span></dt> - <dd>Suspensory ligament. - </dd> - <dt><span class='fss'>E.</span></dt> - <dd>Lobules of fat in the position of the termination of the umbilical ligament. - </dd> - </dl> - -</div> -<p class='c013'><span class='pageno' id='Page_18'>18</span><i>The liver.</i>—The right lobe was alone visible. This -extended entirely across the right hypochondriac and -epigastric regions. Its external free border was not in -contact with the ribs. Between it and the external -abdominal wall there was an interval of nearly an inch -at its greatest part, which was crossed by the external -lateral ligament. The inferior border of the lobe rested -upon and nearly concealed the pylorus of the stomach -as well as the upper half of right kidney. Corresponding -in position to the upper portion of the right -kidney was a well-defined layer of peritoneum, presenting -a sharply defined internal border. Upon dissecting -away the peritoneum from this border it was -found to answer to the inferior vena cava. The lesser -omentum occupied its usual position. The fundus of -the gall-bladder was two-thirds of an inch beyond the -anterior border of the lobe, immediately to the outer side -of the caudal lobe. The position of the longitudinal -fissure was well off to the left side of the abdomen, -presenting, between the right and left lobes, a conspicuous -cleft which was partially occupied by the base of -the caudal lobe. The round ligament, with its associated -suspensory ligament, had doubtless passed -nearly vertically, before the relations had been disturbed -by the incision in the abdominal wall, upwards -and forwards to the anterior abdominal wall at a point -lying one inch to the outer side of the centre of the -umbilicus.</p> - -<p class='c011'>In the subject, as it lay on the table with the flap -<i>a, b</i> (Fig. <a href='#fig2'>2</a>), turned to the left, the suspensory ligament -had the appearance of being much more obliquely -inclined to the left, and could be made nearly -horizontal by a little traction. Lying beneath this -<span class='pageno' id='Page_19'>19</span>ligament, but belonging to the anterior abdominal -wall, was a large mass of subperitoneal fat about the -size of a pigeon’s egg. Extending to the extreme left, -and continuous with the anterior border of the left -lobe of the liver, was a delicate prolongation of liver -substance which was lost within the connecting band.</p> - -<div class='div-fig'> - -<div id='fig7' class='figcenter id001'> -<a href='images/fig7_l.jpg'><img src='images/fig7.jpg' alt='' class='ig001' /></a> -</div> - <dl class='dl_1'> - <dt><span class='sc'>Fig. 7.</span></dt> - <dd>The abdominal organs of Chang in position—the small intestines removed. - </dd> - <dt><span class='fss'>A.</span></dt> - <dd>Left lobe of liver. - </dd> - <dt><span class='fss'>B.</span></dt> - <dd>Right lobe of liver. - </dd> - <dt><span class='fss'>C.</span></dt> - <dd>Gall-bladder. - </dd> - <dt><span class='fss'>D.</span></dt> - <dd>Suspensory ligament. - </dd> - <dt><span class='fss'>E.</span></dt> - <dd>Lobules of fat in the position of the termination of the umbilical ligament. - </dd> - </dl> - -</div> - -<p class='c011'>The upper surface of this prolongation was supported -by a fold of peritoneum, extending directly upward, -apparently attached to the base of the ensiform -<span class='pageno' id='Page_20'>20</span>cartilage. Visible upon the anterior aspect of this fold -was a tortuous artery, afterwards found to be the left -internal mammary. This fold may be called <i>the accessory -suspensory ligament</i>; nothing similar to it was -seen in Chang. The left lobe of the liver, save a portion -of its anterior edge, was not visible.</p> - -<p class='c013'>In Chang (Fig. <a href='#fig7'>7</a>), by exposing the parts as in Eng, -throwing the abdominal flap, <i>c, d</i> (Fig. <a href='#fig2'>2</a>), to the right, -there was at once brought into view the transverse -colon, the greater omentum, and greater curvature of -the stomach. The latter organ was large, empty, and -without any undue traction could be so displayed as to -yield its fundus and greater curvature in position. The -fundus was not visible. Lying conspicuously within -the left hypochondriac region was the spleen. Its inferior -free border, with its peritoneal attachment, was -distinctly seen; its upper portions, however, were invisible. -The left lobe of the liver held a position answering -to that of the right lobe in Eng—the external -lateral ligament being stretched across the left hypochondriac -region, pursuing a similar course to the external -lateral ligament of Eng (<i>q. v.</i>). The left lobe at -its outer portion rested upon the spleen, its inner portion -upon the stomach. The outer portion of the left -lobe presented a thin compressed border, the inner portion -was divided by a deep sulcus into two lobes.</p> - -<p class='c011'>The right lobe lay deep within the right hypochondriac -region, the portion about the longitudinal fissure -anteriorly, alone appearing in the dissection. The suspensory -ligament held a position similar to that in Eng. -The gall-bladder held its normal position to the right -lobe, and was moderately distended with bile.</p> - -<p class='c011'><span class='pageno' id='Page_21'>21</span>Both Chang and Eng had the organs occupying the -hypochondriac and epigastric regions retaining, on the -whole, such relations as are usually observed.</p> - -<p class='c011'>This statement appears pertinent, at this stage of -the autopsy, in order to explain—</p> - -<h3 class='c012'>V. <span class='sc'>Interior of Band.</span></h3> - -<p class='c013'>We here describe (1) <i>the hepatic pouches</i>; (2) <i>the -umbilical pouches</i>; (3) <i>the vascular structures of the -band</i>; (4) <i>the diaphragms</i>; (5) <i>the ensiform cartilages</i>.</p> - -<p class='c011'>1. <i>The hepatic pouches.</i>—The photograph (Fig. <a href='#fig2'>2</a>) -indicates the position of the right lobe of Eng’s liver in -the right hypochondriac region. The right lobe of -Chang is of course not seen in the figure, since it lies -on the side of the body which is not in the field of vision. -It must follow from the rights and lefts of the two individuals -being opposites that, in drawing a line between -the livers (which, as already seen, occupy normal -positions as to right and left) across the band, such -a line will be diagonal to the axes of the ensiform cartilages; -Chang’s half of the band having the line enter -the band from his “right,” Eng from his “left.” It will -also follow that any pouches of peritoneum which might -accompany this line will pursue a similar direction—be -on the same plane—be right or left with respect to -the axis of that plane. Now it was actually demonstrated -that such a line did extend between the livers, -and was accompanied by such peritoneal pouches. -These pouches were termed the hepatic pouches, and -may be described as follows:—</p> - -<p class='c011'><span class='sc'>Chang.</span>—The subject lying on the table with rights -and lefts determined as in the acquired position, the -finger could be inserted behind the suspensory -<span class='pageno' id='Page_22'>22</span>ligament (Fig. <a href='#fig7'>7</a>) in a pouch lying directly beneath the -ensiform cartilages, into which passed an extension of -liver-like tissue.</p> - -<p class='c011'><span class='sc'>Eng.</span>—This fact could not be well demonstrated in -Eng in this position, but is well seen in Fig. <a href='#fig8'>8</a>.</p> - -<p class='c011'>It follows that the two hepatic pouches are on nearly -the same plane, and that each approaches the central -point of the band diagonally from the right side of the -subject with whose abdominal cavity it is continuous.</p> - -<p class='c013'>2. <i>The umbilical pouches.</i>—Beneath the hepatic -pouches, and between them and the inferior border of -the band, were two pouches which, from their association -with the round ligament, have been termed <i>the umbilical -pouches</i>.</p> - -<p class='c011'>When the finger was passed toward the band from -the abdomen of Chang, and following the peritoneum -of the anterior wall of the abdomen, it passed into a -pouch of the band directly over the skin covering, -across the band, over the umbilicus, and was received -within the folds of the suspensory ligament of the -liver of Eng. This pouch was so superficial that while -the finger was in the pouch any motion of the finger -was readily followed by the observer.</p> - -<p class='c011'>In the same way as above, if the finger was introduced -<i>behind</i> the suspensory ligament of Eng, it slipped -into a pouch which passed across the median line of -the band, and was received within the folds of the suspensory -ligament of the liver of Chang.</p> - -<p class='c011'>There were then two pouches communicating with -the two abdominal cavities, arranged one above another -in the band, Chang’s being the lower of the two. No -remains of an umbilical vein were detected, nor was -<span class='pageno' id='Page_23'>23</span>there any communication between the pouches and the -umbilicus. It has already been noticed that the round -ligament of each liver passed from the longitudinal -fissure to a scar on the anterior wall of the abdomen -near the band. It was not, therefore, within the round -ligaments, but the folds of the suspensory ligaments, -that the pouches were found.</p> - -<p class='c011'>Eng’s pouch measured <span class="nowrap">2-<sup>1</sup>/<sub>2</sub> in.</span> From edge of Chang’s -suspensory ligament to end of hepatic pouch measured -3 in.</p> - -<p class='c011'>Extending across the band, about midway between -the properties of the two individuals, was a septum. -It was attached above and below to the respective -boundaries of the band, and along its entire length -was incorporated with its two peritoneal cavities, so -that when in the course of the dissection of the “posterior” -surface of the band the peritoneal covering of -the band was displayed, several large lobules of fat -were seen lying to Eng’s side of the <span class="nowrap">septum.<a id='r4'></a><a href='#f4' class='c010'><sup>[4]</sup></a></span></p> - -<p class='c011'>It will be seen that Fig. <a href='#fig8'>8</a> represents the band opened -to display the pouches with the septum. The lower -end of the septum is fixed near the scar of the umbilicus, -and holds an immobile position over the umbilical -pouches. At this point it is free from fat. But as -it extends over the hepatic pouches it is more pliant. -This portion of the septum has been carried a little to -Chang’s side of the band to display the entire length -of the hepatic pouch of Eng.</p> - -<p class='c011'><span class='pageno' id='Page_24'>24</span>Figs. <a href='#fig9'>9</a> and <a href='#fig10'>10</a> are designed to exhibit the appearances -presented in securing views of the septum from -its sides. Fig. <a href='#fig9'>9</a> is the side toward Chang, and Fig. -<a href='#fig10'>10</a> is the side toward Eng.</p> - -<div class='div-fig'> - -<div id='fig8' class='figcenter id001'> -<a href='images/fig8_l.jpg'><img src='images/fig8.jpg' alt='' class='ig001' /></a> -</div> - <dl class='dl_1'> - <dt><span class='sc'>Fig. 8.</span></dt> - <dd>The surface, <span class="nowrap">C. R.,</span> <span class="nowrap">E. L.,</span> - showing the interior of band by free division of the aponeuroses seen in Fig. <a href='#fig7'>7</a>, - and their underlying peritoneal attachments. - </dd> - <dt><span class='fss'>A.</span></dt> - <dd>The orifice of umbilical pouch of Eng. - </dd> - <dt><span class='fss'>B.</span></dt> - <dd>The orifice of umbilical pouch of Chang, showing connection with suspensory ligament of - Eng. - </dd> - <dt><span class='fss'>C.</span></dt> - <dd>The fenestrated umbilical pouch of Eng passing between the folds of the suspensory - ligament of Chang. - </dd> - <dt><span class='fss'>D.</span></dt> - <dd>Suspensory ligament of liver of Eng. - </dd> - <dt><span class='fss'>E.</span></dt> - <dd>Hepatic tract. - </dd> - <dt><span class='fss'>F.</span></dt> - <dd>Hepatic pouch of Eng. - </dd> - <dt><span class='fss'>G.</span></dt> - <dd>The septum. - </dd> - </dl> - -</div> - -<p class='c011'>The pouches and septum were now removed and the -position of the hepatic tract determined. It rested -<span class='pageno' id='Page_25'>25</span>upon the incurved borders of the ensiform cartilages -(see Fig. <a href='#fig15'>15</a>), and as the subject lay on the table with -the “posterior” surfaces of the band exposed (Fig. <a href='#fig11'>11</a>) -the hepatic tract was slightly arched. It measured -three inches in length, was compressed, and measured -six lines wide and three lines thick. The tract arose -from the livers at the same point—namely, directly -above the longitudinal fissure, having more fulness on -the side of the right than of the left lobe. The round -ligament, as it passed out of the longitudinal fissure of -each liver, was placed beneath and a little to the left -of the tract.</p> - -<div class='div-fig'> - -<div id='fig9' class='figcenter id001'> -<a href='images/fig9_l.jpg'><img src='images/fig9.jpg' alt='' class='ig001' /></a> -</div> - <dl class='dl_1'> - <dt><span class='sc'>Fig. 9.</span></dt> - <dd>The septum viewed from Chang’s side. - </dd> - <dt><span class='fss'>A.</span></dt> - <dd>The orifice of umbilical pouch of Chang. - </dd> - <dt><span class='fss'>B.</span></dt> - <dd>The orifice of the hepatic pouch of Chang. - </dd> - <dt><span class='fss'>C.</span></dt> - <dd>Suspensory ligament of Chang containing umbilical pouch of Eng. - </dd> - </dl> - -</div> - -<div><span class='pageno' id='Page_26'>26</span></div> -<div class='div-fig'> - -<div id='fig10' class='figcenter id001'> -<a href='images/fig10_l.jpg'><img src='images/fig10.jpg' alt='' class='ig001' /></a> -</div> - <dl class='dl_1'> - <dt><span class='sc'>Fig. 10.</span></dt> - <dd>The septum viewed from Eng’s side. - </dd> - <dt><span class='fss'>A.</span></dt> - <dd>The orifice of the umbilical pouch of Eng. - </dd> - <dt><span class='fss'>B.</span></dt> - <dd>The orifice of the hepatic pouch of same. - </dd> - <dt><span class='fss'>C.</span></dt> - <dd>Suspensory ligament of Eng containing the umbilical pouch of Chang. - </dd> - </dl> - -</div> - -<p class='c011'>3. <i>The vascular structures of the band</i> were as follows:—</p> - -<p class='c011'>The livers being united, it was found that a colored -injection thrown into the portal vein of Chang passed -into the liver of Eng. A careful dissection of the -<a id='corr26.4'></a><span class='htmlonly'><ins class='correction' title='original: bloodvessel'>blood vessel</ins></span><span class='epubonly'><a href='#c_26.4'>blood vessel</a></span> (Fig. <a href='#fig11'>11</a>, <span class='fss'>C</span>) proved it to be a terminal twig -of the portal system of Chang. It was of the thickness -of a No. seven catheter, French scale, gradually -diminished in size, and was lost toward the centre of -the band. It did not pass as such across the band, -<span class='pageno' id='Page_27'>27</span>but appeared to break up into minute branches before -reaching the liver of Eng. At the same time there -was undoubted distension of the portal capillaries -with the colored fluid under the capsule of the dorsal -surface of the right lobe of Eng’s liver, one and -one-half inches from the band. Examination of the -branches of the mesenteric veins of Eng revealed the -curious fact that some of them had received the injection. -This had not been transmitted through the -liver, for the portal vein at the transverse fissure was -empty, but through a distinct extra-hepatic portal -track, which was found lying under the peritoneum -<span class='pageno' id='Page_28'>28</span>beneath the position of the hepatic pouches, and in -association with the umbilical pouches. This vessel -began by relatively large radicals towards Chang’s side, -became larger as these encroached on Eng’s side, and -was finally received within the portal system of Eng’s -body, as a tributary to its mesenteric vein.</p> - -<div class='div-fig'> - -<div id='fig11' class='figcenter id001'> -<a href='images/fig11_l.jpg'><img src='images/fig11.jpg' alt='' class='ig001' /></a> -</div> - <dl class='dl_1'> - <dt><span class='sc'>Fig. 11.</span></dt> - <dd>The surface, <span class="nowrap">C. R.,</span> <span class="nowrap">E. L.,</span> with - pouches removed to display the hepatic tract. - </dd> - <dt><span class='fss'>A.</span></dt> - <dd>Liver of Chang. - </dd> - <dt><span class='fss'>B.</span></dt> - <dd>Liver of Eng. - </dd> - <dt><span class='fss'>C.</span></dt> - <dd>Portal vessel of Chang. - </dd> - <dt><span class='fss'>D, D.</span></dt> - <dd>Minute branches of hepatic artery. - </dd> - <dt><span class='fss'>E.</span></dt> - <dd>Subcutaneous fat of surface, <span class="nowrap">E. R.,</span> <span class="nowrap">C. - L.</span> - </dd> - </dl> - -</div> - -<p class='c011'>No other vessels were met with in the band excepting -a few insignificant branches of the hepatic artery, -and the terminal twigs of the right internal mammary -of Eng. The former vessels are marked <span class='fss'>D, D</span>, Fig. <a href='#fig11'>11</a>. -The latter vessel terminated by piercing the diaphragm, -and giving ultimate filaments to the integument of the -“front” of the band as shown in Fig. <a href='#fig12'>12</a>.</p> - -<div class='div-fig'> - -<div id='fig12' class='figcenter id001'> -<a href='images/fig12_l.jpg'><img src='images/fig12.jpg' alt='' class='ig001' /></a> -</div> - <dl class='dl_1'> - <dt><span class='sc'>Fig. 12.</span></dt> - <dd>The surface, <span class="nowrap">C. R.,</span> <span class="nowrap">E. L.,</span> with - pouches, hepatic tract, and peritoneal attachments removed to display the diaphragms. - </dd> - <dt><span class='fss'>A.</span></dt> - <dd>Subcutaneous fat of surface, <span class="nowrap">E. R.,</span> <span class="nowrap">C. - L.</span> - </dd> - <dt><span class='fss'>B, C.</span></dt> - <dd>Symmetrical muscular fasciculi. - </dd> - <dt><span class='fss'>D.</span></dt> - <dd>Fasciculi of Eng crossing the median line of the band. - </dd> - </dl> - -</div> - -<p class='c011'>4. <i>The diaphragms.</i>—The subject being in the same -position as in Fig. <a href='#fig2'>2</a>, the livers were removed, the -<span class='pageno' id='Page_29'>29</span>peritoneal coverings dissected from the band, and the diaphragms -exposed (Fig. <a href='#fig12'>12</a>). The point (<span class='fss'>A</span>), marked by -the terminal twigs of the right internal mammary of -Eng, indicated the “anterior” of the band. A broad -slip of fibres of Chang (<span class='fss'>B</span>) was seen to pass across the -median line, and to be inserted into the left border of -the ensiform cartilage of Eng (Fig. <a href='#fig17'>17</a>). This arrangement -would appear to correspond to the smaller collection -of fibres (<span class='fss'>C</span>) belonging entirely to Eng. A second -arrangement of fibres was seen above those just indicated, -immediately under the cartilages (<span class='fss'>D</span>). This -appeared to arise from the border of the cordiform tendon -of Eng by two distinct narrow slips, which crossed -the median line to be inserted dispersedly on the diaphragm -of Chang.</p> - -<div class='div-fig'> - -<div id='fig13' class='figcenter id001'> -<a href='images/fig13_l.jpg'><img src='images/fig13.jpg' alt='' class='ig001' /></a> -</div> - <dl class='dl_1'> - <dt><span class='sc'>Fig. 13.</span></dt> - <dd>The peritoneal linings of the anterior walls of both abdominal cavities. - </dd> - <dt><span class='fss'>A, A.</span></dt> - <dd>The summits of the bladders. - </dd> - <dt><span class='fss'>B, B.</span></dt> - <dd>The umbilical ligaments. - </dd> - <dt><span class='fss'>C, C.</span></dt> - <dd>The nodules of fat at the parietal scar. - </dd> - <dt><span class='fss'>D, D.</span></dt> - <dd>The isolated lobules of fat. - </dd> - </dl> - -</div> - -<p class='c011'><span class='pageno' id='Page_30'>30</span>5. <i>The ensiform cartilages.</i>—After removing the -diaphragms the cartilages were exposed. They may -be described as follows:—</p> - -<p class='c011'><span class='sc'>Chang.</span>—The cartilage measured <span class="nowrap">2-<sup>1</sup>/<sub>2</sub> in.</span> wide, and -8 in. in length along its axis. The right border was -very prominent, and projected <sup>1</sup>/<sub>2</sub> in. beyond the limit of -the corresponding border in Eng. It was almost in -close contact with the cartilage of the eighth rib; it was -very robust, with upper surface convex, under surface -nearly plane. The left lateral border was <span class="nowrap">2-<sup>1</sup>/<sub>2</sub> in.</span> in -length, right lateral border 11 lines in length. The -former was marked by three tubercles of about equal -size. One situated about 1 in. from the sternal origin; -the other about 2 in. from the same point; the third -at its extreme anterior border. None of these were -robust, or presented any of the thickening noticed on -the right side. The middle of these tubercles was on -a line with that of the posterior tubercle. The junction -of the ensiform process with the sternum was not -marked by the eminence characterizing the similar -point in Eng.</p> - -<p class='c011'><span class='sc'>Eng.</span>—The cartilage differed from that of Chang in -being <span class="nowrap">2-<sup>1</sup>/<sub>3</sub> in.</span> wide, 11 lines in length of axis. The -left lateral border was abruptly deflected downward, -and did not present the transverse smooth projection -noticed in Chang. This deflection was almost at right -angles to the dorsal surface, acuminate inferiorly, and -presenting a straight surface toward Chang, and an -oblique one toward the ribs. The length of left lateral -border was 1 in. The right lateral border, <span class="nowrap">1-<sup>1</sup>/<sub>3</sub> in.</span> in -length, presented a smooth sub-rounded edge without -tubercles, and terminated in a free rounded border on -a plane a little above that of Chang. On the whole -<span class='pageno' id='Page_31'>31</span>this border was more robust than that of Chang. On -the dorsal aspect of the process near its base was seen -the rounded eminence described in the account of the -external appearances (see page 7).</p> - -<p class='c011'>A comparison between the two ensiform cartilages -shows that in Chang the anterior border was longer -than in the right in Eng. In other proportions Eng’s -was equal if not larger than Chang’s, and was more -robust.</p> - -<div class='div-fig'> - -<div id='fig14' class='figcenter id001'> -<a href='images/fig14_l.jpg'><img src='images/fig14.jpg' alt='' class='ig001' /></a> -</div> - <dl class='dl_1'> - <dt><span class='sc'>Fig. 14.</span></dt> - <dd>A section of both ensiform cartilages, <span class="nowrap">C. R.,</span> <span - class="nowrap">E. L.</span> - </dd> - <dt><span class='fss'>A.</span></dt> - <dd>Chang’s cartilage. - </dd> - <dt><span class='fss'>B.</span></dt> - <dd>Eng’s cartilage. - </dd> - <dt><span class='fss'>C.</span></dt> - <dd>The synchondrosis. - </dd> - <dt><span class='fss'>D.</span></dt> - <dd>The bursa-like sac covering the same. - </dd> - <dt><span class='fss'>E.</span></dt> - <dd>An opening in the sac. - </dd> - <dt><span class='fss'>F.</span></dt> - <dd>Transversalis muscle of Eng. - </dd> - <dt><span class='fss'>G.</span></dt> - <dd>Transversalis muscle of Chang. - </dd> - </dl> - -</div> - -<p class='c011'>The union between the cartilages was of the character -of a symphysis. The union was very intimate -along the border <span class="nowrap">E. L.,</span> <span class="nowrap">C. R.,</span> “posterior” (Fig. <a href='#fig14'>14</a>); the -exposure of the junction by a delicate transverse cut -showed a close union between the cartilages, thus constituting -this part of the band a synchondrosis. That -<span class='pageno' id='Page_32'>32</span>this, however, did not characterize the entire line of -apposition was at once seen by turning to the border -<span class="nowrap">E. R.,</span> <span class="nowrap">C. L.</span> (“anterior”), where an interval, two lines -in width, was seen between the cartilages, an interval -which had been evidently susceptible of variation -during life. This interval extended across one-fourth -the width of the band. The portion of the band -between the parts as above indicated, was occupied by -a bursa-like sac (Fig. <a href='#fig14'>14</a>, <span class='fss'>D</span>), which was opened by a -minute orifice (<span class='fss'>E</span>) to display its true nature. This sac -was crossed above by a stout band of fibrous tissue -(Fig. <a href='#fig15'>15</a>, <span class='fss'>A</span>) an inch in width. Beneath, the sac was -protected by a less well-defined band of the same -width as the upper ligament, and which crossed between -the two processes, to be lost in the perichondrium.</p> - -<div class='div-fig'> - -<div id='fig15' class='figcenter id001'> -<a href='images/fig15_l.jpg'><img src='images/fig15.jpg' alt='' class='ig001' /></a> -</div> - <dl class='dl_1'> - <dt><span class='sc'>Fig. 15.</span></dt> - <dd>Upper surface of ensiform cartilages. - </dd> - <dt><span class='fss'>A.</span></dt> - <dd>The upper ligament uniting the cartilages. - </dd> - </dl> - -</div> - -<p class='c011'>Viewing the cartilages as the constituent parts of -the band, we found the border <span class="nowrap">C. L.,</span> <span class="nowrap">E. R.,</span> the “anterior,” -to be longer than <span class="nowrap">C. R.,</span> <span class="nowrap">E. L.,</span> the “posterior.” -<span class='pageno' id='Page_33'>33</span><span class="nowrap">C. L.,</span> <span class="nowrap">E. R.</span> was a convex, nearly even border, <span class="nowrap">C. L.</span> -being larger than <span class="nowrap">E. R.,</span> with a gaping interval placed -nearer Eng than Chang. <span class="nowrap">C. R.,</span> <span class="nowrap">E. L.</span> was an irregular, -uneven border, without interval, <span class="nowrap">C. R.</span> being smaller -than <span class="nowrap">E. L.,</span> and placed to the outer side.</p> - -<h3 class='c012'>VI. <span class='sc'>Other Structures.</span></h3> - -<p class='c013'>1. <i>The spleens.</i>—This organ in Eng was 5 in. long, -<span class="nowrap">3-<sup>1</sup>/<sub>3</sub> in.</span> wide. The dorsum was marked by a large -sulcus, extending nearly across the organ, continuous -with the sulcus on the superior border. The hilus was -relatively shorter than that of Chang, beginning -above, fully an inch below its upper border, and terminating -within a half inch of its inferior border.</p> - -<p class='c011'>In Chang it measured 5 in. long, <span class="nowrap">2-<sup>1</sup>/<sub>3</sub> in.</span> wide. It -was sub-elliptical in form, upper lip somewhat abruptly -compressed. The lower border was obtuse and -rounded. The dorsum was smooth, and presented at -its posterior edge a single sulcus placed midway between -the tip and the inferior border. The hilus extended -nearly the entire length of the under surface.</p> - -<p class='c013'>2. <i>The livers</i> (Fig. <a href='#fig16'>16</a>).—In Eng the liver was 9 in. -broad. The right lobe was <span class="nowrap">7-<sup>1</sup>/<sub>2</sub> in.</span> wide, antero-posteriorly. -The fundus of the gall-bladder was seen on the -anterior edge of the organ. The only noticeable feature -on the under surface of the liver, was the lobus -Spigelii. This was large, measuring 2 in. in transverse -diameter, and <span class="nowrap">2-<sup>1</sup>/<sub>3</sub> in.</span> in antero-posterior diameter. It -presented a somewhat increased breadth of neck, which -was overlapped by an anterior prolongation of the lobe, -and terminated by a rounded compressed extremity at -the transverse fissure. The quadrilateral lobe was -<span class='pageno' id='Page_34'>34</span>well developed, 2 in. long in greatest diameter, 10 lines -wide.</p> - -<div class='div-fig'> - -<div id='fig16' class='figcenter id001'> -<a href='images/fig16_l.jpg'><img src='images/fig16.jpg' alt='' class='ig001' /></a> -</div> - <dl class='dl_1'> - <dt><span class='sc'>Fig. 16.</span></dt> - <dd>The livers. - </dd> - <dt><span class='fss'>A.</span></dt> - <dd>Right lobe of Eng. - </dd> - <dt><span class='fss'>B.</span></dt> - <dd>Left lobe of same. - </dd> - <dt><span class='fss'>C.</span></dt> - <dd>Right lobe of Chang. - </dd> - <dt><span class='fss'>D.</span></dt> - <dd>Left lobe of same. - </dd> - <dt><span class='fss'>E.</span></dt> - <dd>Hepatic tract. - </dd> - <dt><span class='fss'>F.</span></dt> - <dd>Round ligament of Eng. - </dd> - <dt><span class='fss'>G.</span></dt> - <dd>Round ligament of Chang. - </dd> - <dt><span class='fss'>H.</span></dt> - <dd>Accessory suspensory ligament of Eng, with termination of the right mammary artery. - </dd> - <dt><span class='fss'>I.</span></dt> - <dd>Fundus of gall-bladder of Chang. - </dd> - <dt><span class='fss'>J.</span></dt> - <dd>Fundus of gall-bladder of Eng. - </dd> - </dl> - -</div> - -<p class='c011'><span class='pageno' id='Page_35'>35</span>In Chang the liver was <span class="nowrap">8-<sup>1</sup>/<sub>3</sub> in.</span> broad. The right -lobe was 5 in. wide, antero-posteriorly. The appearance -of the gall-bladder corresponded to that seen in -Eng. The under surface was normal. The lobus -Spigelii presented a narrower neck than in Eng, the -anterior prolongation being greater. The quadrilateral -lobe was less developed than in Eng. Indeed it was -not raised above the under surface of the right lobe, -and its limits were so imperfectly marked that it could -not well be measured.</p> - -<div class='div-fig'> - -<div id='fig17' class='figcenter id001'> -<a href='images/fig17_l.jpg'><img src='images/fig17.jpg' alt='' class='ig001' /></a> -</div> - <dl class='dl_1'> - <dt><span class='sc'>Fig. 17.</span></dt> - <dd>Kidneys of Eng. - </dd> - <dt><span class='fss'>A.</span></dt> - <dd>Left kidney. - </dd> - <dt><span class='fss'>B.</span></dt> - <dd>Right kidney. - </dd> - <dt><span class='fss'>C.</span></dt> - <dd>Left renal vein. - </dd> - <dt><span class='fss'>D.</span></dt> - <dd>Left supra-renal vein. - </dd> - <dt><span class='fss'>E.</span></dt> - <dd>Left spermatic vein. - </dd> - <dt><span class='fss'>F.</span></dt> - <dd>Descending vena cava not distended with clot. - </dd> - <dt><span class='fss'>G.</span></dt> - <dd>Right renal vein. - </dd> - <dt><span class='fss'>H.</span></dt> - <dd>Aorta distended with plaster. - </dd> - <dt><span class='fss'>I.</span></dt> - <dd>Primitive iliac arteries. - </dd> - </dl> - -</div> - -<p class='c013'><span class='pageno' id='Page_36'>36</span>3. <i>The kidneys.</i>—In Eng, the body lying on the -table <span class="nowrap">E. R.,</span> <span class="nowrap">C. L.,</span> the left kidney (Fig. <a href='#fig17'>17</a>, <span class='fss'>A</span>) was -4 in. long, <span class="nowrap">1-<sup>1</sup>/<sub>2</sub></span> wide at its hilus, and of the usual kidney -shape. It lacked <sup>1</sup>/<sub>2</sub> in. of reaching the crest of the ilium. -The renal vein (Fig. <a href='#fig17'>17</a>, <span class='fss'>C</span>) of the same side measured -3 in. in length, and was decidedly oblique in -position, its termination in the cava being below the -level of the lower end of the kidney.</p> - -<p class='c011'>The right kidney (Fig. <a href='#fig17'>17</a>, <span class='fss'>B</span>) corresponded in position -to the left kidney of Chang, that is to say, it was -in the shallower portion of the abdomen, and in contact -with the abdominal wall. It measured 4 in. in -length, and <span class="nowrap">2-<sup>1</sup>/<sub>4</sub> in.</span> in width. Its inferior border lacked -2 in. of reaching the superior crest of the ilium. The -renal vein ascended a little upward to enter the cava -a little below the level of the upper end of the kidney.</p> - -<p class='c011'>In Chang, the body lying in such a way that the -great trochanter of the right side rested on the table, -the left trochanter being raised three inches from the -same plane, an obliquity was given to the trunk, and -rendered the position of the abdominal organs somewhat -anomalous.</p> - -<p class='c011'>The left kidney (Fig. <a href='#fig18'>18</a>, <span class='fss'>A</span>) lay with its lower -half clearly within the iliac fossa, its inferior border -answering to a point an inch and a half below the -termination of the aorta. The organ lay, at its inner -and inferior portion, upon the left primitive iliac vein; -it measured <span class="nowrap">3-<sup>3</sup>/<sub>4</sub> in.</span> in length, and <span class="nowrap">2-<sup>7</sup>/<sub>12</sub> in.</span> in width at its -widest part. It was larger below, where it retained the -usual appearance, but was somewhat <a id='corr86.36'></a><span class='htmlonly'><ins class='correction' title='original: abruptedly'>abruptly</ins></span><span class='epubonly'><a href='#c_86.36'>abruptly</a></span> pointed -<span class='pageno' id='Page_37'>37</span>above, and was marked by the characteristic notch on -its inner side. The renal vein (Fig. <a href='#fig18'>18</a>, <span class='fss'>C</span>) was very -obliquely situated, indeed was almost parallel with the -cava, and was <span class="nowrap">3-<sup>1</sup>/<sub>2</sub> in.</span> long. The termination of the renal -vein answered to a line running across the abdomen -lying fully 1 in. above the upper end of the left kidney.</p> - -<div class='div-fig'> - -<div id='fig18' class='figcenter id001'> -<a href='images/fig18_l.jpg'><img src='images/fig18.jpg' alt='' class='ig001' /></a> -</div> - <dl class='dl_1'> - <dt><span class='sc'>Fig. 18.</span></dt> - <dd>Kidneys of Chang. - </dd> - <dt><span class='fss'>A.</span></dt> - <dd>Left kidney. - </dd> - <dt><span class='fss'>B.</span></dt> - <dd>Right kidney. - </dd> - <dt><span class='fss'>C.</span></dt> - <dd>Left renal vein. - </dd> - <dt><span class='fss'>D.</span></dt> - <dd>Right renal vein. - </dd> - <dt><span class='fss'>E.</span></dt> - <dd>Left spermatic vein. - </dd> - <dt><span class='fss'>F.</span></dt> - <dd>Aorta filled with plaster. - </dd> - <dt><span class='fss'>G.</span></dt> - <dd>Primitive iliac veins. - </dd> - <dt><span class='fss'>H.</span></dt> - <dd>Descending cava distended with clot. - </dd> - <dt><span class='fss'>I.</span></dt> - <dd>Left supra-renal vein. - </dd> - </dl> - -</div> - -<p class='c011'>The right kidney (Fig. <a href='#fig18'>18</a>, <span class='fss'>B</span>) was normally situated. -It measured 4 in. in length, and <span class="nowrap">1-<sup>1</sup>/<sub>2</sub> in.</span> in width at its -centre, and presented the usual reniform appearance. -<span class='pageno' id='Page_38'>38</span>Its inferior edge just reached an eminence answering -to the superior crest of the ilium.</p> - -<p class='c013'>4. <i>The testicles.</i>—The right testicle of Eng was -normal. The left testicle was not within the scrotum. -Dissection from within the abdomen showed that the -organ had been retracted. It lay well concealed within -the inguinal canal, slight traction making it appear -within the abdomen.</p> - -<p class='c011'>The testicles of Chang were normal.</p> - -<p class='c013'>5. <i>The hearts.</i>—The heart in Eng was situated -nearer the median line than normal. The abdominal -incision was very unfavorable for studying its exact -position in the mediastinum. It was removed through -an opening made in the diaphragm. The right side of -the heart was occupied by a soft grumous clot much -smaller than was found in the same locality in Chang, -and which did not distend the cavities. The left side -was normal. It was without clot so far as could be -determined in the injected condition of the ventricle.</p> - -<p class='c011'>The heart of Chang presented a right auricle and -ventricle distended with a dense venous clot; this -extended from the right ventricle along the pulmonary -arteries. The left side of the heart was empty.</p> - -<p class='c011'>The ductus arteriosus and foramen ovale were firmly -closed in both hearts.</p> - -<p class='c013'>6. <i>The vessels.</i>—The arteries of both subjects were, -so far as examined, in an extremely atheromatous condition. -Large plates of calcareous matter were deposited -in the abdominal aortas. The injecting matter -flowed insufficiently in the left lower extremity of -Chang, from a clot plugging the femoral artery.</p> - -<p class='c011'><span class='pageno' id='Page_39'>39</span>The venous system of Chang was engorged, giving -the appearance of these vessels having been injected -after death; that of Eng was comparatively empty.</p> - -<p class='c013'>7. <i>The lungs.</i>—The lungs were so altered by <i>post-mortem</i> -changes prior to embalming, their contraction -by the chloride of zinc, and their increase of -weight from the plaster, that no extended examination -was made of them. But little difference was -seen between the conditions of the lungs in the two -men. No hepatization was present in Chang.</p> - -<p class='c013'>8. <i>The vertebral column and ribs.</i>—There was -marked lateral curvature of the vertebral column in -both bodies. This was more conspicuous in Chang. -The convexity of the curve was about half-way down -the vertebral column, and inclined in Chang to the -right side. The distance from the centre of the vertebral -column to the left abdominal wall, 2 in.; to the -right abdominal wall, 5 in. The left side of the abdominal -cavity, measuring from about the level of the -band to the last rib of the right side, <span class="nowrap">7-<sup>1</sup>/<sub>2</sub></span> inches.</p> - -<p class='c011'>The ribs in both Chang and Eng were 22 in number, -7 true and 4 false. On the right side of Eng the first, -second, and third ribs were normal. The fourth, fifth, -sixth, and seventh presented diminished intercostal -spaces, owing probably to the extreme traction made -on them by the deflection of the ensiform cartilages. -The intercostal space between the third and fourth -ribs was slightly contracted; that between the fourth -and fifth ribs was very much contracted, the muscle -being bulged inward. Between the fifth and sixth, and -<span class='pageno' id='Page_40'>40</span>sixth and seventh ribs the space was less contracted. -The remaining intercostal spaces were about normal. -The fifth rib near its articulation with the vertebral -column formed a well-defined ridge within the thorax, -carrying with it the sixth and seventh ribs, thus forming -a rounded elevation, distinguishing the positions of -these ribs from the thoracic wall above and below -this point, where the parietal surface presented the -usual concave appearance.</p> - -<p class='c011'>On the left side of Chang a similar arrangement of -ribs and intercostal spaces was seen to the above.</p> - -<p class='c011'>The remaining organs were not examined.</p> - -<div class='chapter'> - <h2 class='c008'>REMARKS.</h2> -</div> - -<p class='c009'>With reference to the cause of death of the Siamese -twins it may be briefly said that, in consequence of -the restrictions by which we were bound, no examination -of the brains was made. It cannot, therefore, be -proved that the cause of Chang’s death was a cerebral -clot, although such an opinion, from the suddenness -of death, preceded as it was by hemiplegia and an -immediate engorgement of the left lung, is tenable. -Eng died, in all probability, in a state of syncope -induced by fright—a view which the over-distended -bladder and the retraction of the right testicle would -appear to corroborate.</p> - -<p class='c011'>The existence of lateral curvature was not unsuspected. -It was known to those who had examined the -twins before death. Indeed, it must have been a -necessity of the acquired position.</p> - -<p class='c011'>The presence of a pad of subperitoneal fat at the -usual position of the umbilicus was certainly curious. -<span class='pageno' id='Page_41'>41</span>It would appear to be an example of a localized nutritive -change about the peritoneum, at the centre of the -umbilical region, anticipating the exit of the vessels of -the cord at that point. Familiar examples of this anticipation -between structures developing from different -layers of the embryo are seen in malformations of the -genital organs, eye, ear, etc. In the above example it -is remarkable only from the rarity of the conditions -yielding it.</p> - -<p class='c011'>The circulation in each individual of the twins was -practically complete, since the demonstration of continuity -between the portal systems, although satisfactory, -invites the conclusion that the amount of blood -which passed from one to the other side of the band -must have been, in the condition of the parts at the -time of the demonstration, very inconsiderable, and -was not competent in all probability to modify the -performance of any act of the economy.</p> - -<p class='c011'>In the fœtal and early period of extra-uterine life the -vessels must have been more capacious, and associated -with a large tract of liver tissue. It follows, all things -being equal, that an attempt at division of the band -in early life would have been accompanied with more -venous hemorrhage than at any subsequent period.</p> - -<p class='c011'>In proof that the twins were the product of a single -conception, the strict correspondence between the -markings of the two spleens, as well as the number of -the ribs, may be observed. The absence of available -data bearing upon the question of symmetry between -visceral organs of twins, prevents us from drawing -here too positive an inference. It is probable, however, -that the twins were individuals of a single organism, -<span class='pageno' id='Page_42'>42</span>remarkable for its complete expression of duplex <span class="nowrap">bilaterality.<a id='r5'></a><a href='#f5' class='c010'><sup>[5]</sup></a></span></p> - -<div class='div-fig'> - -<div id='fig19' class='figcenter id001'> -<a href='images/fig19_l.jpg'><img src='images/fig19.jpg' alt='' class='ig001' /></a> -</div> - <dl class='dl_1'> - <dt><span class='sc'>Fig. 19.</span></dt> - <dd>Foreshortened view of the trunks, showing in the acquired position the band from above - and the contours of its lateral surfaces. - </dd> - </dl> - -</div> - -<div class='chapter'> - <span class='pageno' id='Page_43'>43</span> - <h2 class='c008'>DESCRIPTION OF FIGURES.</h2> -</div> - -<h3 class='c014'>FROM PHOTOGRAPHS.</h3> - -<div class='figure_list'> - - <dl class='dl_2 c003'> - <dt><a href="images/fig1_l.jpg" title="Larger image"><span class='sc'>Fig. 1</span></a>.</dt> - <dd>Twins in acquired position (<span class="nowrap">E. R.,</span> <span class="nowrap">C. - L.)</span>. Taken in St. Petersburg, 1870. <span class='pglink'><a href='#fig1'>Page 3</a>.</span> - </dd> - <dt><a href="images/fig2_l.jpg" title="Larger image"><span class='sc'>Fig. 2</span></a>.</dt> - <dd>Twins in acquired position (<span class="nowrap">E. R.,</span> <span class="nowrap">C. - L.)</span>. Taken after death at Philadelphia. <span class='pglink'><a href='#fig2'>Page 8</a>.</span> - </dd> - </dl> - -<h3 class='c014'>FROM SKETCHES.</h3> - - <dl class='dl_2 c003'> - <dt><a href="images/fig3_l.jpg" title="Larger image"><span class='sc'>Fig. 3</span></a>.</dt> - <dd>The surface, <span class="nowrap">C. R.,</span> <span class="nowrap">E. L.,</span> - exposed by removal of skin and superficial fascia to display the tendons of the external - oblique muscles and adjacent parts. <span class='pglink'><a href='#fig3'>Page 12</a>.</span> - </dd> - <dt> <span class='fss'>A.</span></dt> - <dd>The superficial fascia—lost over the position of Chang’s umbilical pouch. - </dd> - <dt> <span class='fss'>B, C</span>.</dt> - <dd>Supplemental layers of fibrous tissue of Eng not seen in Chang; <span - class='fss'>B</span> is a continuation toward Eng of aponeurotic fibres having a source - from the linea alba of Chang; <br /> <span class='fss'>C</span> is independent of - the former, and is continuous with the deep pectoral fascia. - </dd> - <dt> <span class='fss'>D.</span></dt> - <dd>The interlacing of fibres on tendon of external oblique muscle of Chang. - </dd> - <dt> <span class='fss'>E.</span></dt> - <dd>The linea alba of Chang, beginning at <span class="nowrap">C. R.</span> - </dd> - <dt> <span class='fss'>F.</span></dt> - <dd>Its continuation to <span class="nowrap">E. L.,</span> and insertion upon the ensiform - cartilage. - </dd> - <dt class='c000'><a href="images/fig4_l.jpg" title="Larger image"><span class='sc'>Fig. 4</span></a>.</dt> - <dd class='c000'>The umbilical ligament in Eng. <span class='pglink'><a href='#fig4'>Page 15</a>.</span> - </dd> - <dt> <span class='fss'>A.</span></dt> - <dd>The umbilical ligament. - </dd> - <dt> <span class='fss'>B.</span></dt> - <dd>The lobule of fat at position of normal umbilicus. - </dd> - <dt class='c000'><a href="images/fig5_l.jpg" title="Larger image"><span class='sc'>Fig. 5</span></a>.</dt> - <dd class='c000'>The umbilical ligament in Chang. <span class='pglink'><a href='#fig5'>Page 16</a>.</span><br /> -     The letters as in Fig. 4. - </dd> - <dt class='c000'><a href="images/fig6_l.jpg" title="Larger image"><span class='sc'>Fig. 6</span></a>.</dt> - <dd class='c000'>The abdominal organs of Eng—the small intestines removed. <span - class='pglink'><a href='#fig6'>Page 17</a>.</span> - </dd> - <dt> <span class='fss'>A.</span></dt> - <dd>Left lobe of liver. - </dd> - <dt> <span class='fss'>B.</span></dt> - <dd>Right lobe of liver. - </dd> - <dt> <span class='fss'>C.</span></dt> - <dd>Gall-bladder. -<span class='pageno' id='Page_44'>44</span> - </dd> - <dt> <span class='fss'>D.</span></dt> - <dd>Suspensory ligament. - </dd> - <dt> <span class='fss'>E.</span></dt> - <dd>Lobules of fat in the position of the termination of the umbilical ligament. - </dd> - <dt class='c000'><a href="images/fig7_l.jpg" title="Larger image"><span class='sc'>Fig. 7</span></a>.</dt> - <dd class='c000'>The abdominal organs in Chang—the small intestines removed. <span - class='pglink'><a href='#fig7'>Page 19</a></span>.<br />     The letters as in Fig. 6. - </dd> - <dt class='c000'><a href="images/fig8_l.jpg" title="Larger image"><span class='sc'>Fig. 8</span></a>.</dt> - <dd class='c000'>The surface, <span class="nowrap">C. R.,</span> <span class="nowrap">E. L.,</span> - showing the interior of band by free division of the aponeuroses seen in Fig. 7, and - their underlying peritoneal attachments. <span class='pglink'><a href='#fig8'>Page 24</a>.</span> - </dd> - <dt> <span class='fss'>A.</span></dt> - <dd>The orifice of umbilical pouch of Eng. - </dd> - <dt> <span class='fss'>B.</span></dt> - <dd>The orifice of umbilical pouch of Chang, showing connection with suspensory ligament of - Eng. - </dd> - <dt> <span class='fss'>C.</span></dt> - <dd>The fenestrated umbilical pouch of Eng passing between the folds of the suspensory - ligament of Chang. - </dd> - <dt> <span class='fss'>D.</span></dt> - <dd>Suspensory ligament of liver of Eng. - </dd> - <dt> <span class='fss'>E.</span></dt> - <dd>Hepatic tract. - </dd> - <dt> <span class='fss'>F.</span></dt> - <dd>Hepatic pouch of Eng. - </dd> - <dt> <span class='fss'>G.</span></dt> - <dd>The septum. - </dd> - <dt class='c000'><a href="images/fig9_l.jpg" title="Larger image"><span class='sc'>Fig. 9</span></a>.</dt> - <dd class='c000'>The septum viewed from Chang’s side. <span class='pglink'><a href='#fig9'>Page 25</a>.</span> - </dd> - <dt> <span class='fss'>A.</span></dt> - <dd>The orifice of umbilical pouch of Chang. - </dd> - <dt> <span class='fss'>B.</span></dt> - <dd>The orifice of hepatic pouch of Chang. - </dd> - <dt> <span class='fss'>C.</span></dt> - <dd>Suspensory ligament of Chang, containing umbilical pouch of Eng. - </dd> - <dt class='c000'><a href="images/fig10_l.jpg" title="Larger image"><span class='sc'>Fig. 10</span></a>.</dt> - <dd class='c000'>The septum viewed from Eng’s side. <span class='pglink'><a href='#fig10'>Page 26</a>.</span> - </dd> - <dt> <span class='fss'>A.</span></dt> - <dd>The orifice of umbilical pouch of Eng. - </dd> - <dt> <span class='fss'>B.</span></dt> - <dd>The orifice of hepatic pouch of Eng. - </dd> - <dt> <span class='fss'>C.</span></dt> - <dd>Suspensory ligament of Eng, containing umbilical pouch of Chang. - </dd> - <dt class='c000'><a href="images/fig11_l.jpg" title="Larger image"><span class='sc'>Fig. 11</span></a>.</dt> - <dd class='c000'>The surface, <span class="nowrap">C. R.,</span> <span class="nowrap">E. L.,</span> with - pouches removed to display the hepatic tract. <span class='pglink'><a href='#fig11'>Page 27</a>.</span> - </dd> - <dt> <span class='fss'>A.</span></dt> - <dd>Liver of Chang. - </dd> - <dt> <span class='fss'>B.</span></dt> - <dd>Liver of Eng. - </dd> - <dt> <span class='fss'>C.</span></dt> - <dd>Portal vessel of Chang. - </dd> - <dt> <span class='fss'>D, D.</span></dt> - <dd>Minute branches of hepatic artery. - </dd> - <dt> <span class='fss'>E.</span></dt> - <dd>Subcutaneous fat of surface, <span class="nowrap">E. R.,</span> <span class="nowrap">C. - L.</span> -<span class='pageno' id='Page_45'>45</span> - </dd> - <dt class='c000'><a href="images/fig12_l.jpg" title="Larger image"><span class='sc'>Fig. 12</span></a>.</dt> - <dd class='c000'>The surface, <span class="nowrap">C. R.,</span> <span class="nowrap">E. L.,</span> with - pouches, hepatic tract, and peritoneal attachments removed to display the diaphragms. - <span class='pglink'><a href='#fig12'>Page 28</a></span>. - </dd> - <dt> <span class='fss'>A.</span></dt> - <dd>Subcutaneous fat of surface, <span class="nowrap">E. R.,</span> <span class="nowrap">C. - L.</span> - </dd> - <dt> <span class='fss'>B, C</span>.</dt> - <dd>Symmetrical muscular fasciculi. - </dd> - <dt> <span class='fss'>D.</span></dt> - <dd>Fasciculi of Eng, crossing median line of band. - </dd> - <dt class='c000'><a href="images/fig13_l.jpg" title="Larger image"><span class='sc'>Fig. 13</span></a>.</dt> - <dd class='c000'>The peritoneal linings of the anterior walls of both abdominal cavities. <span - class='pglink'><a href='#fig13'>Page 29</a></span>. - </dd> - <dt> <span class='fss'>A, A.</span></dt> - <dd>The summits of the bladders. - </dd> - <dt> <span class='fss'>B, B.</span></dt> - <dd>The umbilical ligaments. - </dd> - <dt> <span class='fss'>C, C.</span></dt> - <dd>The nodules of fat at the parietal scar. - </dd> - <dt> <span class='fss'>D, D.</span></dt> - <dd>The isolated lobules of fat. - </dd> - <dt class='c000'><a href="images/fig14_l.jpg" title="Larger image"><span class='sc'>Fig. 14</span></a>.</dt> - <dd class='c000'>A section of both ensiform cartilages, <span class="nowrap">C. R.,</span> <span - class="nowrap">E. L.</span> <span class='pglink'><a href='#fig14'>Page 31</a>.</span> - </dd> - <dt> <span class='fss'>A.</span></dt> - <dd>Chang’s cartilage. - </dd> - <dt> <span class='fss'>B.</span></dt> - <dd>Eng’s cartilage. - </dd> - <dt> <span class='fss'>C.</span></dt> - <dd>The synchondrosis. - </dd> - <dt> <span class='fss'>D.</span></dt> - <dd>The bursa-like sac covering the same. - </dd> - <dt> <span class='fss'>E.</span></dt> - <dd>An opening into the sac. - </dd> - <dt> <span class='fss'>F.</span></dt> - <dd>Transversalis muscle of Eng. - </dd> - <dt> <span class='fss'>G.</span></dt> - <dd>Transversalis muscle of Chang. - </dd> - <dt class='c000'><a href="images/fig15_l.jpg" title="Larger image"><span class='sc'>Fig. 15</span></a>.</dt> - <dd class='c000'>Upper surface of ensiform cartilages. <span class='pglink'><a href='#fig15'>Page 32</a></span>. - </dd> - <dt> <span class='fss'>A.</span></dt> - <dd>The upper ligament uniting the cartilages. - </dd> - <dt class='c000'><a href="images/fig16_l.jpg" title="Larger image"><span class='sc'>Fig. 16</span></a>.</dt> - <dd class='c000'>The livers. <span class='pglink'><a href='#fig16'>Page 34</a></span>. - </dd> - <dt> <span class='fss'>A.</span></dt> - <dd>Right lobe of Eng. - </dd> - <dt> <span class='fss'>B.</span></dt> - <dd>Left lobe of same. - </dd> - <dt> <span class='fss'>C.</span></dt> - <dd>Right lobe of Chang. - </dd> - <dt> <span class='fss'>D.</span></dt> - <dd>Left lobe of same. - </dd> - <dt> <span class='fss'>E.</span></dt> - <dd>Hepatic tract. - </dd> - <dt> <span class='fss'>F.</span></dt> - <dd>Round ligament of Eng. - </dd> - <dt> <span class='fss'>G.</span></dt> - <dd>Round ligament of Chang. - </dd> - <dt> <span class='fss'>H.</span></dt> - <dd>Accessory suspensory ligament of Eng, with termination of the right mammary artery. - </dd> - <dt> <span class='fss'>I.</span></dt> - <dd>Fundus of gall-bladder of Chang. - </dd> - <dt> <span class='fss'>J.</span></dt> - <dd>Fundus of gall-bladder of Eng. - </dd> - <dt class='c000'><a href="images/fig17_l.jpg" title="Larger image"><span class='sc'>Fig. 17</span></a>.</dt> - <dd class='c000'>Kidneys of Eng. <span class='pglink'><a href='#fig17'>Page 35</a></span>. - </dd> - <dt> <span class='fss'>A.</span></dt> - <dd>Left kidney. -<span class='pageno' id='Page_46'>46</span> - </dd> - <dt> <span class='fss'>B.</span></dt> - <dd>Right kidney. - </dd> - <dt> <span class='fss'>C.</span></dt> - <dd>Left renal vein. - </dd> - <dt> <span class='fss'>D.</span></dt> - <dd>Left supra-renal vein. - </dd> - <dt> <span class='fss'>E.</span></dt> - <dd>Left spermatic vein. - </dd> - <dt> <span class='fss'>F.</span></dt> - <dd>Descending vena cava not distended with clot. - </dd> - <dt> <span class='fss'>G.</span></dt> - <dd>Right renal vein. - </dd> - <dt> <span class='fss'>H.</span></dt> - <dd>Aorta distended with plaster. - </dd> - <dt> <span class='fss'>I.</span></dt> - <dd>Primitive iliac arteries. - </dd> - <dt class='c000'><a href="images/fig18_l.jpg" title="Larger image"><span class='sc'>Fig. 18</span></a>.</dt> - <dd class='c000'>Kidneys of Chang. <span class='pglink'><a href='#fig18'>Page 37</a></span>. - </dd> - <dt> <span class='fss'>A.</span></dt> - <dd>Left kidney. - </dd> - <dt> <span class='fss'>B.</span></dt> - <dd>Right kidney. - </dd> - <dt> <span class='fss'>C.</span></dt> - <dd>Left renal vein. - </dd> - <dt> <span class='fss'>D.</span></dt> - <dd>Right renal vein. - </dd> - <dt> <span class='fss'>E.</span></dt> - <dd>Left spermatic vein. - </dd> - <dt> <span class='fss'>F.</span></dt> - <dd>Aorta filled with plaster. - </dd> - <dt> <span class='fss'>G.</span></dt> - <dd>Primitive iliac veins. - </dd> - <dt> <span class='fss'>H.</span></dt> - <dd>Descending cava distended with clot. - </dd> - <dt> <span class='fss'>I.</span></dt> - <dd>Left supra-renal vein. - </dd> - <dt class='c000'><a href="images/fig19_l.jpg" title="Larger image"><span class='sc'>Fig. 19</span></a>.</dt> - <dd class='c000'>Foreshortened view of the trunks, showing in the acquired position the band from above, - and the contours of its lateral surfaces. <span class='pglink'><a href='#fig19'>Page 42</a></span>. - </dd> - </dl> - -</div> - -<div class='chapter'> - <h2 class='c008'>Footnotes</h2> -</div> -<hr class='c015' /> -<div class='footnote' id='f1'> -<p class='c011'><a href='#r1'>1</a>. For this statement see an article in Lippincott’s Magazine, March, 1874.</p> -</div> -<div class='footnote' id='f2'> -<p class='c011'><a href='#r2'>2</a>. The folds of peritoneum containing remains of the hypogastric arteries -will be called throughout by the name of <i>the umbilical ligaments</i>.</p> -</div> -<div class='footnote' id='f3'> -<p class='c011'><a href='#r3'>3</a>. The presence of a great amount of adipose tissue throughout, in Eng, -was very noticeable as contrasted with the emaciated appearance of the tissues -in Chang.</p> -</div> -<div class='footnote' id='f4'> -<p class='c011'><a href='#r4'>4</a>. Before the septum was known to exist, the band was opened from behind -in the presence of the Fellows of the College (Feb. 18th, 1874). The exact -relations of the septum could not at that time be determined. Figs. <a href='#fig8'>8</a>, <a href='#fig9'>9</a>, and -<a href='#fig10'>10</a> are taken from studies of the parts made the day after the meeting.</p> -</div> -<div class='footnote' id='f5'> -<p class='c011'><a href='#r5'>5</a>. I desire to return thanks to Dr. T. H. Andrews and Dr. J. W. White, -Jr., for important assistance rendered in preparing the notes of the autopsy.</p> -</div> -<hr class="shortline" /> - -<p class='c016'><a id='endnote'></a></p> -<div class='tnotes'> - -<div class='nf-center-c0'> - <div class='nf-center'> - <div><span class='large'>Transcriber’s notes:</span></div> - </div> -</div> - - <ul class='ul_1'> - <li>The errors deemed most likely to be the printer’s have been corrected, and are noted - here. - </li> - <li>Where hyphenation occurs on a line break, the decision to retain or remove is based - on occurrences elsewhere in the text. - </li> - <li>Errors in punctuation and quotes have been silently restored. - </li> - <li>Illustrations have been moved to the corresponding paragraph. - </li> - <!-- <li>The <a href="images/cover.jpg">cover image</a> was generated by the transcriber and - is placed in the public domain.</li> --> - <li>In the list of figures herefore, the "Fig. x" link refers to the larger version. - </li> - <li>The page number links to the place in the text. - </li> - <li>The footnotes were moved to the end of the e-text. - </li> - <li>The numbers below reference the page and line in the original book. - </li> - </ul> - -<table class='table0'> -<colgroup> -<col class='colwidth15' /> -<col class='colwidth23' /> -<col class='colwidth61' /> -</colgroup> - <tr> - <th class='c017'>reference</th> - <th class='c017'>correction</th> - <th class='c018'>original text</th> - </tr> - <tr> - <td class='c017'><a id='c_86.36'></a><a href='#corr86.36'>86.36</a></td> - <td class='c017'>abruptly</td> - <td class='c018'>but was somewhat abruptedly pointed</td> - </tr> - <tr> - <td class='c017'><a id='c_26.4'></a><a href='#corr26.4'>26.4</a></td> - <td class='c017'>blood vessel</td> - <td class='c018'>A careful dissection of the bloodvessel</td> - </tr> -</table> - -</div> - -<div style='display:block; margin-top:4em'>*** END OF THE PROJECT GUTENBERG EBOOK REPORT OF AN AUTOPSY ON THE BODIES OF CHANG AND ENG BUNKER, COMMONLY KNOWN AS THE SIAMESE TWINS ***</div> -<div style='text-align:left'> - -<div style='display:block; margin:1em 0'> -Updated editions will replace the previous one—the old editions will -be renamed. -</div> - -<div style='display:block; margin:1em 0'> -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the United -States without permission and without paying copyright -royalties. Special rules, set forth in the General Terms of Use part -of this license, apply to copying and distributing Project -Gutenberg™ electronic works to protect the PROJECT GUTENBERG™ -concept and trademark. Project Gutenberg is a registered trademark, -and may not be used if you charge for an eBook, except by following -the terms of the trademark license, including paying royalties for use -of the Project Gutenberg trademark. If you do not charge anything for -copies of this eBook, complying with the trademark license is very -easy. You may use this eBook for nearly any purpose such as creation -of derivative works, reports, performances and research. Project -Gutenberg eBooks may be modified and printed and given away—you may -do practically ANYTHING in the United States with eBooks not protected -by U.S. copyright law. Redistribution is subject to the trademark -license, especially commercial redistribution. -</div> - -<div style='margin-top:1em; font-size:1.1em; text-align:center'>START: FULL LICENSE</div> -<div style='text-align:center;font-size:0.9em'>THE FULL PROJECT GUTENBERG LICENSE</div> -<div style='text-align:center;font-size:0.9em'>PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK</div> - -<div style='display:block; margin:1em 0'> -To protect the Project Gutenberg™ mission of promoting the free -distribution of electronic works, by using or distributing this work -(or any other work associated in any way with the phrase “Project -Gutenberg”), you agree to comply with all the terms of the Full -Project Gutenberg™ License available with this file or online at -www.gutenberg.org/license. -</div> - -<div style='display:block; font-size:1.1em; margin:1em 0; font-weight:bold'> -Section 1. General Terms of Use and Redistributing Project Gutenberg™ electronic works -</div> - -<div style='display:block; margin:1em 0'> -1.A. By reading or using any part of this Project Gutenberg™ -electronic work, you indicate that you have read, understand, agree to -and accept all the terms of this license and intellectual property -(trademark/copyright) agreement. If you do not agree to abide by all -the terms of this agreement, you must cease using and return or -destroy all copies of Project Gutenberg™ electronic works in your -possession. If you paid a fee for obtaining a copy of or access to a -Project Gutenberg™ electronic work and you do not agree to be bound -by the terms of this agreement, you may obtain a refund from the person -or entity to whom you paid the fee as set forth in paragraph 1.E.8. -</div> - -<div style='display:block; margin:1em 0'> -1.B. “Project Gutenberg” is a registered trademark. It may only be -used on or associated in any way with an electronic work by people who -agree to be bound by the terms of this agreement. There are a few -things that you can do with most Project Gutenberg™ electronic works -even without complying with the full terms of this agreement. See -paragraph 1.C below. There are a lot of things you can do with Project -Gutenberg™ electronic works if you follow the terms of this -agreement and help preserve free future access to Project Gutenberg™ -electronic works. See paragraph 1.E below. -</div> - -<div style='display:block; margin:1em 0'> -1.C. The Project Gutenberg Literary Archive Foundation (“the -Foundation” or PGLAF), owns a compilation copyright in the collection -of Project Gutenberg™ electronic works. Nearly all the individual -works in the collection are in the public domain in the United -States. If an individual work is unprotected by copyright law in the -United States and you are located in the United States, we do not -claim a right to prevent you from copying, distributing, performing, -displaying or creating derivative works based on the work as long as -all references to Project Gutenberg are removed. Of course, we hope -that you will support the Project Gutenberg™ mission of promoting -free access to electronic works by freely sharing Project Gutenberg™ -works in compliance with the terms of this agreement for keeping the -Project Gutenberg™ name associated with the work. You can easily -comply with the terms of this agreement by keeping this work in the -same format with its attached full Project Gutenberg™ License when -you share it without charge with others. -</div> - -<div style='display:block; margin:1em 0'> -1.D. The copyright laws of the place where you are located also govern -what you can do with this work. Copyright laws in most countries are -in a constant state of change. If you are outside the United States, -check the laws of your country in addition to the terms of this -agreement before downloading, copying, displaying, performing, -distributing or creating derivative works based on this work or any -other Project Gutenberg™ work. The Foundation makes no -representations concerning the copyright status of any work in any -country other than the United States. -</div> - -<div style='display:block; margin:1em 0'> -1.E. Unless you have removed all references to Project Gutenberg: -</div> - -<div style='display:block; margin:1em 0'> -1.E.1. The following sentence, with active links to, or other -immediate access to, the full Project Gutenberg™ License must appear -prominently whenever any copy of a Project Gutenberg™ work (any work -on which the phrase “Project Gutenberg” appears, or with which the -phrase “Project Gutenberg” is associated) is accessed, displayed, -performed, viewed, copied or distributed: -</div> - -<blockquote> - <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> -</blockquote> - -<div style='display:block; margin:1em 0'> -1.E.2. If an individual Project Gutenberg™ electronic work is -derived from texts not protected by U.S. copyright law (does not -contain a notice indicating that it is posted with permission of the -copyright holder), the work can be copied and distributed to anyone in -the United States without paying any fees or charges. If you are -redistributing or providing access to a work with the phrase “Project -Gutenberg” associated with or appearing on the work, you must comply -either with the requirements of paragraphs 1.E.1 through 1.E.7 or -obtain permission for the use of the work and the Project Gutenberg™ -trademark as set forth in paragraphs 1.E.8 or 1.E.9. -</div> - -<div style='display:block; margin:1em 0'> -1.E.3. If an individual Project Gutenberg™ electronic work is posted -with the permission of the copyright holder, your use and distribution -must comply with both paragraphs 1.E.1 through 1.E.7 and any -additional terms imposed by the copyright holder. Additional terms -will be linked to the Project Gutenberg™ License for all works -posted with the permission of the copyright holder found at the -beginning of this work. -</div> - -<div style='display:block; margin:1em 0'> -1.E.4. Do not unlink or detach or remove the full Project Gutenberg™ -License terms from this work, or any files containing a part of this -work or any other work associated with Project Gutenberg™. -</div> - -<div style='display:block; margin:1em 0'> -1.E.5. Do not copy, display, perform, distribute or redistribute this -electronic work, or any part of this electronic work, without -prominently displaying the sentence set forth in paragraph 1.E.1 with -active links or immediate access to the full terms of the Project -Gutenberg™ License. -</div> - -<div style='display:block; margin:1em 0'> -1.E.6. You may convert to and distribute this work in any binary, -compressed, marked up, nonproprietary or proprietary form, including -any word processing or hypertext form. However, if you provide access -to or distribute copies of a Project Gutenberg™ work in a format -other than “Plain Vanilla ASCII” or other format used in the official -version posted on the official Project Gutenberg™ website -(www.gutenberg.org), you must, at no additional cost, fee or expense -to the user, provide a copy, a means of exporting a copy, or a means -of obtaining a copy upon request, of the work in its original “Plain -Vanilla ASCII” or other form. Any alternate format must include the -full Project Gutenberg™ License as specified in paragraph 1.E.1. -</div> - -<div style='display:block; margin:1em 0'> -1.E.7. Do not charge a fee for access to, viewing, displaying, -performing, copying or distributing any Project Gutenberg™ works -unless you comply with paragraph 1.E.8 or 1.E.9. -</div> - -<div style='display:block; margin:1em 0'> -1.E.8. You may charge a reasonable fee for copies of or providing -access to or distributing Project Gutenberg™ electronic works -provided that: -</div> - -<div style='margin-left:0.7em;'> - <div style='text-indent:-0.7em'> - • You pay a royalty fee of 20% of the gross profits you derive from - the use of Project Gutenberg™ works calculated using the method - you already use to calculate your applicable taxes. The fee is owed - to the owner of the Project Gutenberg™ trademark, but he has - agreed to donate royalties under this paragraph to the Project - Gutenberg Literary Archive Foundation. Royalty payments must be paid - within 60 days following each date on which you prepare (or are - legally required to prepare) your periodic tax returns. Royalty - payments should be clearly marked as such and sent to the Project - Gutenberg Literary Archive Foundation at the address specified in - Section 4, “Information about donations to the Project Gutenberg - Literary Archive Foundation.” - </div> - - <div style='text-indent:-0.7em'> - • You provide a full refund of any money paid by a user who notifies - you in writing (or by e-mail) within 30 days of receipt that s/he - does not agree to the terms of the full Project Gutenberg™ - License. You must require such a user to return or destroy all - copies of the works possessed in a physical medium and discontinue - all use of and all access to other copies of Project Gutenberg™ - works. - </div> - - <div style='text-indent:-0.7em'> - • You provide, in accordance with paragraph 1.F.3, a full refund of - any money paid for a work or a replacement copy, if a defect in the - electronic work is discovered and reported to you within 90 days of - receipt of the work. - </div> - - <div style='text-indent:-0.7em'> - • You comply with all other terms of this agreement for free - distribution of Project Gutenberg™ works. - </div> -</div> - -<div style='display:block; margin:1em 0'> -1.E.9. If you wish to charge a fee or distribute a Project -Gutenberg™ electronic work or group of works on different terms than -are set forth in this agreement, you must obtain permission in writing -from the Project Gutenberg Literary Archive Foundation, the manager of -the Project Gutenberg™ trademark. Contact the Foundation as set -forth in Section 3 below. -</div> - -<div style='display:block; margin:1em 0'> -1.F. -</div> - -<div style='display:block; margin:1em 0'> -1.F.1. Project Gutenberg volunteers and employees expend considerable -effort to identify, do copyright research on, transcribe and proofread -works not protected by U.S. copyright law in creating the Project -Gutenberg™ collection. Despite these efforts, Project Gutenberg™ -electronic works, and the medium on which they may be stored, may -contain “Defects,” such as, but not limited to, incomplete, inaccurate -or corrupt data, transcription errors, a copyright or other -intellectual property infringement, a defective or damaged disk or -other medium, a computer virus, or computer codes that damage or -cannot be read by your equipment. -</div> - -<div style='display:block; margin:1em 0'> -1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the “Right -of Replacement or Refund” described in paragraph 1.F.3, the Project -Gutenberg Literary Archive Foundation, the owner of the Project -Gutenberg™ trademark, and any other party distributing a Project -Gutenberg™ electronic work under this agreement, disclaim all -liability to you for damages, costs and expenses, including legal -fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT -LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE -PROVIDED IN PARAGRAPH 1.F.3. YOU AGREE THAT THE FOUNDATION, THE -TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE -LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR -INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH -DAMAGE. -</div> - -<div style='display:block; margin:1em 0'> -1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a -defect in this electronic work within 90 days of receiving it, you can -receive a refund of the money (if any) you paid for it by sending a -written explanation to the person you received the work from. If you -received the work on a physical medium, you must return the medium -with your written explanation. The person or entity that provided you -with the defective work may elect to provide a replacement copy in -lieu of a refund. If you received the work electronically, the person -or entity providing it to you may choose to give you a second -opportunity to receive the work electronically in lieu of a refund. If -the second copy is also defective, you may demand a refund in writing -without further opportunities to fix the problem. -</div> - -<div style='display:block; margin:1em 0'> -1.F.4. Except for the limited right of replacement or refund set forth -in paragraph 1.F.3, this work is provided to you ‘AS-IS’, WITH NO -OTHER WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT -LIMITED TO WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PURPOSE. -</div> - -<div style='display:block; margin:1em 0'> -1.F.5. Some states do not allow disclaimers of certain implied -warranties or the exclusion or limitation of certain types of -damages. If any disclaimer or limitation set forth in this agreement -violates the law of the state applicable to this agreement, the -agreement shall be interpreted to make the maximum disclaimer or -limitation permitted by the applicable state law. The invalidity or -unenforceability of any provision of this agreement shall not void the -remaining provisions. -</div> - -<div style='display:block; margin:1em 0'> -1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the -trademark owner, any agent or employee of the Foundation, anyone -providing copies of Project Gutenberg™ electronic works in -accordance with this agreement, and any volunteers associated with the -production, promotion and distribution of Project Gutenberg™ -electronic works, harmless from all liability, costs and expenses, -including legal fees, that arise directly or indirectly from any of -the following which you do or cause to occur: (a) distribution of this -or any Project Gutenberg™ work, (b) alteration, modification, or -additions or deletions to any Project Gutenberg™ work, and (c) any -Defect you cause. -</div> - -<div style='display:block; font-size:1.1em; margin:1em 0; font-weight:bold'> -Section 2. Information about the Mission of Project Gutenberg™ -</div> - -<div style='display:block; margin:1em 0'> -Project Gutenberg™ is synonymous with the free distribution of -electronic works in formats readable by the widest variety of -computers including obsolete, old, middle-aged and new computers. It -exists because of the efforts of hundreds of volunteers and donations -from people in all walks of life. -</div> - -<div style='display:block; margin:1em 0'> -Volunteers and financial support to provide volunteers with the -assistance they need are critical to reaching Project Gutenberg™’s -goals and ensuring that the Project Gutenberg™ collection will -remain freely available for generations to come. In 2001, the Project -Gutenberg Literary Archive Foundation was created to provide a secure -and permanent future for Project Gutenberg™ and future -generations. To learn more about the Project Gutenberg Literary -Archive Foundation and how your efforts and donations can help, see -Sections 3 and 4 and the Foundation information page at www.gutenberg.org. -</div> - -<div style='display:block; font-size:1.1em; margin:1em 0; font-weight:bold'> -Section 3. Information about the Project Gutenberg Literary Archive Foundation -</div> - -<div style='display:block; margin:1em 0'> -The Project Gutenberg Literary Archive Foundation is a non-profit -501(c)(3) educational corporation organized under the laws of the -state of Mississippi and granted tax exempt status by the Internal -Revenue Service. The Foundation’s EIN or federal tax identification -number is 64-6221541. Contributions to the Project Gutenberg Literary -Archive Foundation are tax deductible to the full extent permitted by -U.S. federal laws and your state’s laws. -</div> - -<div style='display:block; margin:1em 0'> -The Foundation’s business office is located at 809 North 1500 West, -Salt Lake City, UT 84116, (801) 596-1887. Email contact links and up -to date contact information can be found at the Foundation’s website -and official page at www.gutenberg.org/contact -</div> - -<div style='display:block; font-size:1.1em; margin:1em 0; font-weight:bold'> -Section 4. Information about Donations to the Project Gutenberg Literary Archive Foundation -</div> - -<div style='display:block; margin:1em 0'> -Project Gutenberg™ depends upon and cannot survive without widespread -public support and donations to carry out its mission of -increasing the number of public domain and licensed works that can be -freely distributed in machine-readable form accessible by the widest -array of equipment including outdated equipment. Many small donations -($1 to $5,000) are particularly important to maintaining tax exempt -status with the IRS. -</div> - -<div style='display:block; margin:1em 0'> -The Foundation is committed to complying with the laws regulating -charities and charitable donations in all 50 states of the United -States. Compliance requirements are not uniform and it takes a -considerable effort, much paperwork and many fees to meet and keep up -with these requirements. We do not solicit donations in locations -where we have not received written confirmation of compliance. To SEND -DONATIONS or determine the status of compliance for any particular state -visit <a href="https://www.gutenberg.org/donate/">www.gutenberg.org/donate</a>. -</div> - -<div style='display:block; margin:1em 0'> -While we cannot and do not solicit contributions from states where we -have not met the solicitation requirements, we know of no prohibition -against accepting unsolicited donations from donors in such states who -approach us with offers to donate. -</div> - -<div style='display:block; margin:1em 0'> -International donations are gratefully accepted, but we cannot make -any statements concerning tax treatment of donations received from -outside the United States. U.S. laws alone swamp our small staff. -</div> - -<div style='display:block; margin:1em 0'> -Please check the Project Gutenberg web pages for current donation -methods and addresses. Donations are accepted in a number of other -ways including checks, online payments and credit card donations. To -donate, please visit: www.gutenberg.org/donate -</div> - -<div style='display:block; font-size:1.1em; margin:1em 0; font-weight:bold'> -Section 5. General Information About Project Gutenberg™ electronic works -</div> - -<div style='display:block; margin:1em 0'> -Professor Michael S. Hart was the originator of the Project -Gutenberg™ concept of a library of electronic works that could be -freely shared with anyone. For forty years, he produced and -distributed Project Gutenberg™ eBooks with only a loose network of -volunteer support. -</div> - -<div style='display:block; margin:1em 0'> -Project Gutenberg™ eBooks are often created from several printed -editions, all of which are confirmed as not protected by copyright in -the U.S. unless a copyright notice is included. Thus, we do not -necessarily keep eBooks in compliance with any particular paper -edition. -</div> - -<div style='display:block; margin:1em 0'> -Most people start at our website which has the main PG search -facility: <a href="https://www.gutenberg.org">www.gutenberg.org</a>. -</div> - -<div style='display:block; margin:1em 0'> -This website includes information about Project Gutenberg™, -including how to make donations to the Project Gutenberg Literary -Archive Foundation, how to help produce our new eBooks, and how to -subscribe to our email newsletter to hear about new eBooks. -</div> - -</div> - </body> - <!-- created with ppgen.py 3.57c on 2022-05-23 13:44:36 GMT --> -</html> diff --git a/old/68165-h/images/fig1.jpg b/old/68165-h/images/fig1.jpg Binary files differdeleted file mode 100644 index 007445e..0000000 --- a/old/68165-h/images/fig1.jpg +++ /dev/null diff --git a/old/68165-h/images/fig10.jpg b/old/68165-h/images/fig10.jpg Binary files differdeleted file mode 100644 index 280f6e6..0000000 --- a/old/68165-h/images/fig10.jpg +++ /dev/null diff --git a/old/68165-h/images/fig10_l.jpg b/old/68165-h/images/fig10_l.jpg Binary files differdeleted file mode 100644 index 55c4afa..0000000 --- a/old/68165-h/images/fig10_l.jpg +++ /dev/null diff --git a/old/68165-h/images/fig11.jpg b/old/68165-h/images/fig11.jpg Binary files differdeleted file mode 100644 index 38a67a3..0000000 --- a/old/68165-h/images/fig11.jpg +++ /dev/null diff --git a/old/68165-h/images/fig11_l.jpg b/old/68165-h/images/fig11_l.jpg Binary files differdeleted file mode 100644 index c105d32..0000000 --- a/old/68165-h/images/fig11_l.jpg +++ /dev/null diff --git a/old/68165-h/images/fig12.jpg b/old/68165-h/images/fig12.jpg Binary files differdeleted file mode 100644 index f5d3708..0000000 --- a/old/68165-h/images/fig12.jpg +++ /dev/null diff --git a/old/68165-h/images/fig12_l.jpg b/old/68165-h/images/fig12_l.jpg Binary files differdeleted file mode 100644 index cd516ba..0000000 --- a/old/68165-h/images/fig12_l.jpg +++ /dev/null diff --git a/old/68165-h/images/fig13.jpg b/old/68165-h/images/fig13.jpg Binary files differdeleted file mode 100644 index b1157db..0000000 --- a/old/68165-h/images/fig13.jpg +++ /dev/null diff --git a/old/68165-h/images/fig13_l.jpg b/old/68165-h/images/fig13_l.jpg Binary files differdeleted file mode 100644 index c0bbdc2..0000000 --- a/old/68165-h/images/fig13_l.jpg +++ /dev/null diff --git a/old/68165-h/images/fig14.jpg b/old/68165-h/images/fig14.jpg Binary files differdeleted file mode 100644 index 502b6bd..0000000 --- a/old/68165-h/images/fig14.jpg +++ /dev/null diff --git a/old/68165-h/images/fig14_l.jpg b/old/68165-h/images/fig14_l.jpg Binary files differdeleted file mode 100644 index f66c141..0000000 --- a/old/68165-h/images/fig14_l.jpg +++ /dev/null diff --git a/old/68165-h/images/fig15.jpg b/old/68165-h/images/fig15.jpg Binary files differdeleted file mode 100644 index 6d937b5..0000000 --- a/old/68165-h/images/fig15.jpg +++ /dev/null diff --git a/old/68165-h/images/fig15_l.jpg b/old/68165-h/images/fig15_l.jpg Binary files differdeleted file mode 100644 index d9778b0..0000000 --- a/old/68165-h/images/fig15_l.jpg +++ /dev/null diff --git a/old/68165-h/images/fig16.jpg b/old/68165-h/images/fig16.jpg Binary files differdeleted file mode 100644 index 95ed4c4..0000000 --- a/old/68165-h/images/fig16.jpg +++ /dev/null diff --git a/old/68165-h/images/fig16_l.jpg b/old/68165-h/images/fig16_l.jpg Binary files differdeleted file mode 100644 index 83d3af4..0000000 --- a/old/68165-h/images/fig16_l.jpg +++ /dev/null diff --git a/old/68165-h/images/fig17.jpg b/old/68165-h/images/fig17.jpg Binary files differdeleted file mode 100644 index 38a9af5..0000000 --- a/old/68165-h/images/fig17.jpg +++ /dev/null diff --git a/old/68165-h/images/fig17_l.jpg b/old/68165-h/images/fig17_l.jpg Binary files differdeleted file mode 100644 index 257ce31..0000000 --- a/old/68165-h/images/fig17_l.jpg +++ /dev/null diff --git a/old/68165-h/images/fig18.jpg b/old/68165-h/images/fig18.jpg Binary files differdeleted file mode 100644 index cd58b36..0000000 --- a/old/68165-h/images/fig18.jpg +++ /dev/null diff --git a/old/68165-h/images/fig18_l.jpg b/old/68165-h/images/fig18_l.jpg Binary files differdeleted file mode 100644 index 347e4be..0000000 --- a/old/68165-h/images/fig18_l.jpg +++ /dev/null diff --git a/old/68165-h/images/fig19.jpg b/old/68165-h/images/fig19.jpg Binary files differdeleted file mode 100644 index 2146b11..0000000 --- a/old/68165-h/images/fig19.jpg +++ /dev/null diff --git a/old/68165-h/images/fig19_l.jpg b/old/68165-h/images/fig19_l.jpg Binary files differdeleted file mode 100644 index 3cb6e68..0000000 --- a/old/68165-h/images/fig19_l.jpg +++ /dev/null diff --git a/old/68165-h/images/fig1_l.jpg b/old/68165-h/images/fig1_l.jpg Binary files differdeleted file mode 100644 index 165aaa9..0000000 --- a/old/68165-h/images/fig1_l.jpg +++ /dev/null diff --git a/old/68165-h/images/fig2.jpg b/old/68165-h/images/fig2.jpg Binary files differdeleted file mode 100644 index 40e05d5..0000000 --- a/old/68165-h/images/fig2.jpg +++ /dev/null diff --git a/old/68165-h/images/fig2_l.jpg b/old/68165-h/images/fig2_l.jpg Binary files differdeleted file mode 100644 index 7fecc9e..0000000 --- a/old/68165-h/images/fig2_l.jpg +++ /dev/null diff --git a/old/68165-h/images/fig3.jpg b/old/68165-h/images/fig3.jpg Binary files differdeleted file mode 100644 index 5eb70da..0000000 --- a/old/68165-h/images/fig3.jpg +++ /dev/null diff --git a/old/68165-h/images/fig3_l.jpg b/old/68165-h/images/fig3_l.jpg Binary files differdeleted file mode 100644 index 2864228..0000000 --- a/old/68165-h/images/fig3_l.jpg +++ /dev/null diff --git a/old/68165-h/images/fig4.jpg b/old/68165-h/images/fig4.jpg Binary files differdeleted file mode 100644 index 4a73a53..0000000 --- a/old/68165-h/images/fig4.jpg +++ /dev/null diff --git a/old/68165-h/images/fig4_l.jpg b/old/68165-h/images/fig4_l.jpg Binary files differdeleted file mode 100644 index e6c0265..0000000 --- a/old/68165-h/images/fig4_l.jpg +++ /dev/null diff --git a/old/68165-h/images/fig5.jpg b/old/68165-h/images/fig5.jpg Binary files differdeleted file mode 100644 index edbb033..0000000 --- a/old/68165-h/images/fig5.jpg +++ /dev/null diff --git a/old/68165-h/images/fig5_l.jpg b/old/68165-h/images/fig5_l.jpg Binary files differdeleted file mode 100644 index 9a6694e..0000000 --- a/old/68165-h/images/fig5_l.jpg +++ /dev/null diff --git a/old/68165-h/images/fig6.jpg b/old/68165-h/images/fig6.jpg Binary files differdeleted file mode 100644 index 39f14fd..0000000 --- a/old/68165-h/images/fig6.jpg +++ /dev/null diff --git a/old/68165-h/images/fig6_l.jpg b/old/68165-h/images/fig6_l.jpg Binary files differdeleted file mode 100644 index c3a4501..0000000 --- a/old/68165-h/images/fig6_l.jpg +++ /dev/null diff --git a/old/68165-h/images/fig7.jpg b/old/68165-h/images/fig7.jpg Binary files differdeleted file mode 100644 index f6c42d7..0000000 --- a/old/68165-h/images/fig7.jpg +++ /dev/null diff --git a/old/68165-h/images/fig7_l.jpg b/old/68165-h/images/fig7_l.jpg Binary files differdeleted file mode 100644 index 85ca5c2..0000000 --- a/old/68165-h/images/fig7_l.jpg +++ /dev/null diff --git a/old/68165-h/images/fig8.jpg b/old/68165-h/images/fig8.jpg Binary files differdeleted file mode 100644 index 210ad5d..0000000 --- a/old/68165-h/images/fig8.jpg +++ /dev/null diff --git a/old/68165-h/images/fig8_l.jpg b/old/68165-h/images/fig8_l.jpg Binary files differdeleted file mode 100644 index 8428a25..0000000 --- a/old/68165-h/images/fig8_l.jpg +++ /dev/null diff --git a/old/68165-h/images/fig9.jpg b/old/68165-h/images/fig9.jpg Binary files differdeleted file mode 100644 index e2e939f..0000000 --- a/old/68165-h/images/fig9.jpg +++ /dev/null diff --git a/old/68165-h/images/fig9_l.jpg b/old/68165-h/images/fig9_l.jpg Binary files differdeleted file mode 100644 index e3bbc6b..0000000 --- a/old/68165-h/images/fig9_l.jpg +++ /dev/null diff --git a/old/68165-h/images/i11.jpg b/old/68165-h/images/i11.jpg Binary files differdeleted file mode 100644 index 024d59f..0000000 --- a/old/68165-h/images/i11.jpg +++ /dev/null |
