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THE 
 
 ANATOMY 
 
 OF THE 
 
 HUMAN BODY. 
 
 IN FOUR VOLUMES, 
 
 ILLUSTRATED WITH ONKHUNDRED AND TWENTY-FIVE ENGRAVINGS. 
 
 VOLUME IV. 
 
 CONTAINING THE 
 
 ANATOMY OF THE VISCERA OF THE ABDOMEN \ 
 THE PARTS IN THE MALE AND FEMALE PEL- 
 VIS . , AND THE LYMPHATIC SYSTEM. 
 
 PART I. 
 
 OF THE ABDOMINAL VISCERA. 
 
 INTRODUCTORY VIEW OF THE SYSTEM OF THE VISCERA, 
 AND OF THE STRUCTURE OF GLANDS. 
 
 Chap. i. — O f the Stomach and Intestines Chap. zi. — O f the Liver, Spleer, 
 
 Pancreas, and Kidney. 
 
 PART II. 
 
 OF THE MALE PARTS OF GENERATION. 
 
 Chap. i. — Of the Parts within the Pelvis- Chap, ii — Of the Parts connected 
 
 with the Viscera of the Pelvis, but situated without it. 
 
 PART III. 
 
 OF THE PARTS OF THE FEMALE PELVIS. 
 PART IV. 
 
 OF THE LYMPHATIC SYSTEM, 
 an ^ppentriju 
 By CHARLES BELL , 
 
 FELLOW OF THE ROYAL COLLEGE OF SURGEONS OF EDINBURGH. 
 
 NEW- YORK : 
 
 PRINTED AND SOLD BY COLLINS AND CO. NO. 1 89. 
 PEARL-STREET. 
 
 1 812. 
 
CONTENTS. 
 
 —4—— 
 
 VOL. IV. 
 
 PART I. 
 
 OF THE ABDOMINAL VISCERA. 
 
 r 
 
 INTRODUCTORY VIEW OF THE SYSTEM OF THE 
 VISCERA, AND OF THE STRUCTURE OF GLANDS, 
 Page 1. 
 
 CHAP. I. 
 
 Of the Abdomen in general, and of the Peritoneum, 
 
 Page 
 
 17 
 
 CHAP. II. 
 
 Of the Membranous Viscera of the Abdomen, 
 
 Section 1. Of the CEsophagus, 
 
 2. Of the Stomach, - 
 
 3. Of the small Intestines, 
 
 4. Of the great Intestines, 
 
 CHAP. III. 
 
 Of the Solid or Glandular Viscera of the Abdomen, 
 Section 1. Of the Liver, - 
 
 2. Ot'the Pancreas, - - 
 
 3. Of the Spleen, - 
 
 4. Of the Kidney, - 
 
 24 
 
 25 
 28 
 40 
 52 
 
 58 
 
 ib. 
 
 76 
 
 79 
 
 84 
 
»v 
 
 CONTENTS 
 
 PART II. 
 
 OF THE MALE PARTS OF GENERATION. 
 CHAP. I. 
 
 Page 
 
 Of the P arts within the Pelvis, - - 96 
 
 Section 1. Of the Bladder of Urine, - - ib. 
 
 2. Of the Prostate Gland, - - 100 
 
 CHAP. II. 
 
 Of the Parts connected with the Viscera of the Pelvis, 
 
 but seated without it, ' - - - 101 
 
 Section 1 . Of the Penis and Urethra, - - ib. 
 
 2. Of the Testes, - - - 108 
 
 PART III. 
 
 OF THE FEMALE PARTS OF GENERATION. 
 CHAP. I. 
 
 The External Parts of Generation, - 128 
 
 CHAP. II. 
 
 Of the Parts contained within the Female Pelvis, 137 
 
 Section 1 . Of the Bladder of Urine, - - ib. 
 
 2. Ot the Vagina ; of its Shape, Connections, &c. 139 
 
 3. Of the Womb, - 142 
 
 4. Of the Ovaria, ... 148 
 
 PART IV. 
 
 OF THE LYMPHATIC A V D LACTEAL SYSTEMS OF 
 VESSELS. 
 
 CHAP. I. 
 
 Of the Lymphatic and Lacteal Systems of Vessels, 
 
 179 
 
CONTENTS, 
 
 V 
 
 Page 
 
 Introductory Views, - - * ■* 179 
 
 Section 1. Of the Capillary Vessels, - - 180 
 
 2. Of the Lymphatic System in particular, 182 
 
 3. Of the Glands of the Absorbent System, 183 
 
 4. Origin of the Lymphatics, and of the Doc- 
 
 trines of Absorption, - - 185 
 
 CHAP. II. 
 
 Of the Course of the Lymphatics, - - 195 
 
 APPENDIX. 
 
 Containing the Description of the Venous System and 
 
 the Anatomy of the Teeth, - 211 
 
 CHAP. I. 
 
 Of the Veins in general, .... jb. 
 
 Section 1 . Ofthe Veins of the Head and Neck, 217 
 
 2. Of the Veins ofthe Arm, - - 220 
 
 3. The superior Vena Cava, the Vena Azygos, 
 
 and the lesser V eins of the Thorax, 223 
 
 CHAP. II. 
 
 Ofthe Veins which unite to form the Inferior Vena Cava, 225 
 Ofthe Teeth, ■> 229 
 
Vol.lV.P/.I. 
 
 
 P ItuvD rooming of the Abdomen, Shouting the Inflections ot the Ptntotuum 
 
 Belt del* 
 
 JLenev Cc. 
 
EXPLANATION 
 
 OF THE 
 
 PLATES. 
 
 PLATE I. 
 
 This plate represents an ideal section of the abdomen, and 
 the cut edge of the peritoneum is represented by the white line. 
 
 A. The liver. 
 
 B. The INTESTINES. 
 
 C. The KIDN : Y. 
 
 D. The BLADDi.lt of URINE. - 
 
 E. The RECTUM. 
 
 1. The peritoneum, where it lines the abdominal muscles. 
 
 2. The peritoneum, where it is reflected to form the liga- 
 
 ment of the In er. 
 
 3. The liver being represented cut through, we can trace the 
 
 lamina ot the ligament 2, over its surface 3, forming 
 the peritoneal coat of this viscus. 
 
 4. Marks the peritoneum reflected from the liver upon the 
 
 diaphragm. 
 
 5. Here the peritoneum is reflected off from the spine, to 
 
 form one ol the lamina of the mesentery. 
 
 6. The peritoneal coat of the intestine, which we can trace 
 
 round the circle of the gut until it unites again with the 
 mesentery. 
 
 7. 7. The peritoneum, forming the lower lamina of the me- 
 
 sentery. 
 
 8. The p ritoneum at that part where it is reflected, and 
 
 covers the kidney. 
 
 9. The peritoneum is here descending upon the rectum E, 
 
 we see it reflected over the gut, and descending again 
 betwixt the rectum and bladder. 
 
vm 
 
 explanation op the plates. 
 
 10. The peritoneum where it forms a coat to the fundus of 
 
 the bladder. 
 
 11. At this part we see the peritoneum reflected up upon the 
 
 os pubis, and from that we trace it to fig. 1. Thus we 
 see, that the peritoneum can be traced round all its vari- 
 ous inflections and processes ; which shews, that it 
 forms one continuous sac, and that the intestines and 
 the liver are equally on the outside of this membrane 
 with the kidney. 
 
 Explanation of Plate II. 
 
 This Plate represents the epididimis and testicle, injected 
 with quicksilver, and dissected. 
 
 A. The body of the testicle with the tunica albuginea dissect- 
 
 ed off. 
 
 B. B. The seminal vessels in the body of the testicle, or tu- 
 
 buli testis.* 
 
 C. The rete testis formed by the union of the vessels B. 
 
 B. 
 
 D. The vasa efferentia, which as they proceed from the 
 
 testicle, are convoluted in a conical figure, and are call- 
 ed the VASCULAR CONKS. 
 
 E E. The epididimis formed of the union of the vascular 
 cones : it is a little dissected and spread out. 
 f. The vas deferens. 
 
 Explanation of Plate III. 
 
 This Plate represents the prostate gland, vesiculee seminales, 
 and lower part of the bladder, the parts being previously har- 
 dened in spirits, the vesicuke were afterwards cut open. 
 
 A A. The body of the prostate gland ; it is that lower part 
 of the gland which can be felt through the rectum. 
 
 B. The prostate gland is here cut into and dissected, in fol- 
 lowing the ducts of the vesiculse. 
 
 * Where the tubuli are emerging to form the rete vafculofum, or rete teftis, 
 they are called the vafa retta. 
 


 
 
 * 
 
 < • 
 
 ’ 
 
 
 
 
 * » 
 

 
 '/;,// rjr/.: 
 
 
 
 

 IWJK 
 
 P///7.A? ff/e *//!// •/ //; 
 
 _/y f /?/?// V, / 
 
 licit. 'rjrl* 
 
W.w 
 
 r/w 
 
Veil. IV. 
 
 ' Pl.v. 
 
 A . Crus fients 
 JJ Bui 6 of the Uret h ret 
 C Membranous fit of the Z r rethra 
 
 D. Prostate Gtanc? 
 
 E . Vet se etc £ ce Sem. t rz 
 EE ~Vasa. cte/erentia 
 G. E/ie Ureter 
 
 Jf Etuctcter corerect b y tfieEerifoneum 
 
 L crust/ set 
 
 /■>// - . 
 
explanation of the PLATES. ix 
 
 c. The extremities of the ducts common to the vesiculse semi- 
 nales and vasa deferentia. 
 
 E> D. The cells of the vesicuke serninales, which are laid open 
 by a section. 
 
 E. The left vas deferens, which is also laid open to shew 
 
 the cellular structure which it assumes towards its ter- 
 mination. 
 
 F. The RIGHT VAS DEFERENS. 
 
 G G. The foramina, by which the vasa deferentia open into the 
 common duct. 
 
 H. The lower and back part of the bladder. 
 
 I. The RIGHT URETER. 
 
 Explanation of Plate IV. 
 
 This plate represents a section of the neck of the bladder. 
 
 A. The lower part of the urinary bladder near the neck. 
 
 B. The opening of the right ureter, which is marked 1 fig. iii. 
 a c. The substance of the prostate gland, which is cut through ; 
 
 its thickness, texture, and the manner in which it sur- 
 rounds the beginning of the urethra, will be understood 
 from this plate, 
 d. The urethra laid open. 
 f. The verumontanum, or caput galinaginis. 
 
 G G. The points ol feathers put into the openings of the vesi- 
 culse serninales and vasa deferentia. 
 
 N. B. Round these ducts, on the surface of the verumon- 
 tanum, and in that part of the urethra which is surrounded by 
 the prostate gland, innumerable mucous ducts may be observ- 
 ed : into some of these small bristles are introduced. 
 
 Vol. IV. 
 
 b 
 
E XP LANA TION 
 
 OF THE 
 
 PLATE S. 
 
 PLATE VI. 
 
 Fig. 1. 
 
 An ovum in a verv early stage, representing the shaggy 
 surlace of the true chorion. 
 
 Fig. 2. 
 
 We may see here the fetus in a very early stage contained 
 in the transparent amnion, and, attached to the outside of the 
 amnion, the vlsicula umbilicalis. 
 
 N. B. These are not representations of the same abortion. 
 
 Fig. 3. 
 
 Represents the ovum a little more advanced. 
 
 A. The Chorion. 
 
 B. The Amnion. 
 
 c. The Fcetus hung by the Umbilical Chord. 
 
 Explanation of Plate VII. 
 
 This plate represents two views of a conception, we shall 
 say about the end of the first month, and here the decidua and 
 the ovum have been thrown off together. This abortion was 
 prepared so as to resemble the beautiful engravings in Dr. 
 Hunter’s xxxiv table. 
 
JSellTde?! 
 
Vol . IV. 
 
 Kg, a. 
 
 JEVirfe. VR; 
 
 ■ C 
 
 -L. s-s>,<ry b»v~ / 
 
explanation of the plates. xi 
 
 Fig. l. 
 
 The deciduous efflorescence formed by the womb is seen 
 here entire, and seen as if moulded to the cavity of the womb : 
 it is only necessary to observe that it hung inverted. 
 
 A. The lower part of the conception, which was near the 
 
 neck of the womb, and which has some coagula of 
 blood attached to it. 
 
 B. B. Quills introduced within the decidua by an opening near 
 
 the neck of the womb, and their points brought out at 
 that part of the membrane which answers to the ope 
 ing of the Fallopian tubes : there it is either en'th _ 
 deficient, or it is so thin that it has been torn at c. c. 
 
 Fig. 2. 
 
 Here the other side of the conception is shewn, and the 
 ovum is seen to have adhered to the outer surface of the 
 decidua. 
 
 aa.^-ST The quills introduced into the cavity of the decidua. 
 B. The shaggy surface of the decidua, 
 c. c. The fleecy o&tr surface of the chorion. 
 
 It is here to be observed that the ovum, c d e. may be sup- 
 posed to be as it has descended from the ovarium, only some- 
 what enlarged, and it is here evidently on the outside of the 
 decidua, but it has been torn open, and that deciduous surface 
 which connected it to the surface of the womb at this place has 
 been left with the womb, to be afterwards thrown off with the 
 discharges. 
 
 D. The delicate membrane the amnios. 
 
 E. The umbilical chord, and part of the foetus. 
 
 Explanation of Plate VIII. 
 
 This and the following plate represents a conception 
 third month, and as the abortion was thrown off very 
 we have another opportunity of observing the state 
 decidua in a more advanced state. 
 
 a. A thread passed through the more solid placentary mass 
 
 suspending the whole. 
 
 b. B. The decidua, having a peculiar reticulated appearance. 
 
 c. c. Shreds of the decidua, where it has burst in the de- 
 
 livery. 
 
 of the 
 entire, 
 of the 
 
XU 
 
 explanation op the plates. 
 
 d. The decidua REFLrxA, through which also the proper 
 membranes have burst. 
 
 E. The TRUK CHORION. 
 
 p. Very small curling arteries which are entering the decidua, 
 or what may be considered as the maternal portion of 
 the placenta. 
 
 Explanation of Plate IX. 
 
 We have here presented a view of a section of the same 
 conception. 
 
 A. The DECIDUA. 
 
 B. b. The cut edge of the decidua, which will be seen to 
 
 surround the whole ovum, and particularly it may be 
 observed to form on the upper part a distinct lamina 
 from the placenta f. 
 e. c. The decidua 
 d. The decidua REFLEXA. 
 
 p. ThepLAC.NTA already formed by the accumulated vessels 
 of the chorion. 
 
 G. The chorion towards the lower part of the womb ; here, 
 it may be observed the fleecy vessels have disappeared. 
 h. The AMNION. 
 
 t. The umbilical chord twisted three times around the neck 
 of the fcetus. 
 
'OTgr Q sut/joj .ty tytysTjg&j- 
 
 ■ . ■ 
 
 * 1 / /.> 
 
INTRODUCTION* 
 
 
 VIEW OF THE SYSTEM OF THE VISCERA, AND OF THE 
 STRUCTURE OF GLANDS. 
 
 In this last volume we have to comprehend the anatomy and 
 functions of the several viscera of the abdomen and pelvis, con- 
 sidered not only as individual parts, but as connected together 
 and as forming with the lymphatic and circulating systems of 
 vessels a great part of that chain of mutual dependence and 
 relation which constitutes the animal ceconomy a whole. It 
 becomes necessary therefore to take here a slight and cursory 
 view of the ceconomy of the intestinal canal and absorbing sys- 
 tem, including at the same time something of the history of 
 opinions regarding secretion and the structure of glands. It 
 will be understood, that these introductory observations are 
 meant only to combine the several parts, and to prevent that 
 manner of description, which is necessary to accuracy and mi- 
 nuteness, from leading us to consider the several parts as dis- 
 tinct and insulated. 
 
 An animal body is never for a moment stationary : the re- 
 motest part is in action, and every point is suffering a perpetu- 
 al change. From the first moment of our existence we have 
 commenced a revolution : we, by slow degrees, advance in ac- 
 tivity and strength, and ripen to maturity ; but by a slow and 
 as sure gradations we decline to feebleness and infirmities ; and 
 the more rapidly that animals advance in the first stage of their 
 progress, so is the proportion of their decline. 
 
 But it is not in observing the changes of the animal body 
 from youth to age that the operations of the ceconomy are the 
 most interesting. It is when we find the living body to con- 
 sist of parts performing a variety of functions, and these con- 
 nected and mutually dependent ; when we see the circulating 
 fluid throwing out fluid and solid secretions to build up and 
 support the body, which is in incessant and daily decay.= 
 Vol. IV. A 
 
.2 
 
 INTRODUCTION. 
 
 Again, our admiration is strongly excited when we observe the 
 system to consist of fluids and solids, and the existence of the 
 animal to depend upon the balance of their power ; the fluids 
 separating and combining in new affinities, and forming the 
 various secretions ; and the solids having action, and that ac- 
 tion controlling the affinities and new combinations of the cir- 
 culating fluids. We find that life subsists by the due action of 
 solids and fluids ; or that an incomprehensible influence in a 
 living body is exerted on the latter, and that the chemist can 
 never so combine the fluids out of the body as to imitate the 
 changes produced in a living system of fluids and vessels— 
 Forgetting that animation is the essential character of living 
 bodies, physiologists have too much endeavoured in every age 
 to explain the phenomena of animated nature by illustrations 
 drawn from mechanics, chemistry, or hydraulics. 
 
 In a body in which there is life there is a perpetual waste ; 
 first by secretions, which for particular purposes are thrown 
 into the cavities and afterwards carried out of the body en- 
 tirely by the excretions of the kidney, the perspiration by the 
 surface, the exhalation by the lungs, the secretions of the inter- 
 nal cavities as of the intestines. But more than this, there is 
 a decomposition of the solids of the body which are carried in- 
 to the circulating fluids, and finally dismissed from the sys- 
 tem. Lastly, we cannot but observe, that even the powers of 
 muscular motion, nay, the powers of the mind and of the sen- 
 ses, are exhausted by exercise, and renovated through the in- 
 fluence of the circulation. The continued action of a muscle 
 is followed by feebleness, and the continued impression of the 
 rays of light exhausts the retina, so that the object becomes 
 first faint and then vanishes. 
 
 Since there is waste of the solids and fluids, and exhaustion, 
 of the energies of the system, so also must there be a source of 
 supply and means of renovating its action. Accordingly ani- 
 mals have appetites requiring the supply of food, and the call 
 of hunger is controlled by the necessities of their svstem. — 
 When food is received into the first passages, there is thrown 
 out from the stomach a fluid, which dissolves it, changes its 
 properties, and is itself essentially altered. The work of assi- 
 milation is thus begun. As this converted fluid takes its course 
 through the intestines, it is more and more changed ; more 
 assimilated to the nature of the peculiar fluids of the animal ; 
 and having still additional secretions united to it, particularly 
 the bile, it is by these means separated from the grosser parts 
 of the aliment. This fluid, which is now called chyle, is ab- 
 sorbed by a particular and appropriate system of vessels, 
 which, from their conveying this white and milky-like fluid. 
 
INTRODUCTION. 
 
 3 
 
 are called the lacteals. These lacteal vessels carry the chyle to 
 the thoracic duct, the trunk of the absorbing system ; but not 
 directly ; for the chyle is deposited in the mesenteric glands, 
 from which it is again absorbed and carried forward. Or if 
 we suppose these glands to be merely convoluted vessels, its 
 -How is at least delayed, so that it is not at once thrown into the 
 mass of circulating fluids. 
 
 We find then that the stomach performs digestion, and the 
 spleen, we will venture to affirm, is subservient to it. The 
 secretion of the liver we find to prepare the chyle for absorp- 
 tion, while at the same time it is the peculiar stimulus to the 
 intestines. The pancreas pours out a fluid which tempers the 
 acrid bile. The superior part of the intestinal canal absorbs 
 the nutritious fluid or chyle, while the gross remains of the 
 food move on to be deposited in the great intestines. The 
 great intestines are not only receptacles, but form at the same 
 time an extensive secreting surface useful in the (Economy, by 
 throwing off - the waste of the system. 
 
 The lacteal vessels, which take up the chyle, are but branch- 
 es of the system of absorbents — which is a system consisting of 
 two great divisions, the lacteals and lymphatics : the first re- 
 ceiving the nutritious fluids from the intestinal canal, and the 
 latter being absorbents, taking up the fluids which have been 
 thrown out upon the cavities, and surfaces of the body; and 
 we presume upon the solid parts of the body also. Thus the 
 new ’fluids, rich in supplies, are mingled with those which are 
 fraught with the waste and decomposition of the system. — The 
 thoracic duct, the trunk of this system, conveys these fluids 
 thus mingled together into the right side of the heart, where 
 they are received into the vortex of the circulating red blood. 
 These fluids, now agitated and wrought up with the blood in 
 the cavities of the heart, are sent through the circulation of the 
 lungs, and submitted to the influence of their action and the ex- 
 posure to the atmospheric air. 
 
 When chyle is formed in the stomach and intestines, it is 
 observed to consist of albumen, serum, globules, and salts : 
 but the change which it may undergo by its reception into the 
 lacteals, its being deposited in their glands, its mingling with 
 the lymph, its agitation in the heart, have not been observed, 
 though it is natural to suppose that by degrees it assimilates in 
 its nature to that of the circulating blood, and does at last be- 
 come perfectly similar by the operation of the lungs. 
 
 By the exposure of the circulating fluids to the atmosphere 
 in the lungs a gas is absorbed, which becomes an active prin- 
 ciple in the blood, and from the blood is communicated to the 
 solids. 
 
4 
 
 INTRODUCTION. 
 
 That the blood of an animal has properties which distinguish 
 it from mere matter we readily allow ; but to say that it pos- 
 sesses life is to use a term in which few will acquiesce. It 
 possesses properties while circulating in the vessels distinct 
 from those which it shews out of the body ; and these do not 
 depend on the agitation and incessant motion, nor on the de- 
 gree of heat, nor on any similar circumstance, but apparently 
 on some secret influence which the vessels exert over it. The 
 analysis of the blood by the chemists holds out to us little hope 
 of advancing in the knowledge of the ceconomy of a living ani- 
 mal. Chemistry, when applied to the analysis of animal 
 matter, leaves its devotees in a perplexity of knowledge 
 and discoveries which have no end, and which point to no con- 
 clusion. 
 
 There are produced from the blood a variety of fluids by or- 
 gans which are called glands, and the formation or separation 
 of these fluids is secretion. But the solid parts of the body 
 ought to be considered as secretions equally with the matter 
 which flows from the ducts of glands. For there is formed 
 and deposited from the blood, during the round of its circula- 
 tion, bone to support the incumbent weight of the body ; mus- 
 cular fibre, to give it motion ; as well as all the other variety 
 of solids and fluids. The only difference betwixt these solid 
 depositions from the blood and the glandular secretions is, that 
 the former are still within the influence of the vascular system, 
 and that they are decomposed and re-absorbed, conveyed again 
 into the mass of circulating fluids before they can be finally ex- 
 pelled from the body. 
 
 The chemists have observed the division of animal bodies 
 into solids and fluids, but the subdivisions of these are very in- 
 accurate. The fluids they have distinguished into three class- 
 es ; 1st, Recrementitious humours, which go to nourish and 
 support the body : 2dly, The excrementitious fluids, which 
 are carried out cf the body by certain emunctuaries ; and the 
 Sd are of a compound nature, being partly recrementitious and 
 partly excrementitious. We must observe, however, that the 
 fluids enumerated under these heads shew it to be a very in T 
 correct arrangement. The first division comprehends the fat, 
 the marrow, the matter of internal perspiration, and the osse- 
 ous juice. The second comprehends the fluids of insensible 
 transpiration, the sweat, mucus, cerumen, urine, faeces. And 
 the last division comprehends the saliva, the tears, the bile, the 
 pancreatic juice, the gastric and the intestinal juice, the milk, 
 and the seminal fluid. To attend to their arrangements of the 
 golid parts of animals would be equally far from serving any 
 Useful end ; for they have throv/n together parts so discordant 
 
INTRODUCTION. 
 
 5 
 
 m function and so unlike in structure that they can be of no use 
 in a general view of the (economy, and cannot in chemical 
 analysis shew a uniform result.* 
 
 Perhaps all the correctness to which we can at present pre- 
 tend is some such division as this. Besides forming the solid 
 mass of the animal body, these secretions are drawn from the 
 blood : fluids which are subservient to the assimilating of new 
 matter to the system ; fluids which are useful in preserving the 
 mobility of parts ; and, lastly, the secretions which convey 
 away the waste and debris of the body, which is successively 
 replaced by the opposition of new matter. 
 
 From this short view of the system we understand how in- 
 cessantly the powers are spent in action, and the fluids ex- 
 hausted by deposition and secretion, and how essential to life 
 the functions of those parts are which act upon and assimilate 
 the food. It is the consideration of these parts which forms 
 the subject of the first section of the present volume. As in 
 the consideration of these functions the structure of the 
 glandular organs becomes a chief subject of inquiry, it will be 
 natural at present to consider in a general way the opinions 
 which have been entertained regarding the structure of glands. 
 
 The peculiar nature of that organization by which the 
 several secretions are formed, has hitherto eluded absolute 
 proof by experiment or dissection. It is imagined that there 
 are some organs which do little more than separate the parts of 
 the blood like to the exudation by exhaling arteries. But 
 neither in the exhalent arteries nor in the simpler organs can I 
 imagine a simple straining of the blood, but rather that the 
 same principle influences all, and that the several varieties of 
 secretion depend upon a modification of the action. It would 
 appear that the fluids in circulation and the vessels containing 
 them must reciprocally affect each other : we know that a 
 change on the state of the circulating fluids will alter the nature 
 of the glandular action, and an excitement of the gland will 
 still more powerfully change the nature of the secretion ; the 
 active power of the solids appearing to be an agent which con- 
 trols and directs the chemical affinities. 
 
 We are struck with the variety of form in the secreting 
 organs. We see a simple surface pouring out its fluids ; or a 
 simple canal into which the arteries throw out the secretion. 
 We find again the secreting vessels and their ducts convoluted 
 and massed together, forming proper glandular bodies ; of 
 which kind are the solid abdominal viscera. 
 
 When we dissect the glands we do not find them to have a 
 
 Spe Fourcroy’s Analyfisof Animal Subftances, 
 
INTRODUCTION. 
 
 6 
 
 similarity in structure. Thus the substance of the liver, the 
 kidney, the testicle, &c. are quite unlike, and as their secre- 
 tions are different so are their sympathies : the effect of dis- 
 ease upon them, and the consequences of medicine operating- 
 through the general circulation will be to attach to one indi- 
 vidually, leaving the others in their accustomed action. — » 
 Glands are different not only in their outward form, their 
 general appearance when cut into, and the manner of the con- 
 nection of their parts, but also in a remarkable manner in the 
 length, size, and form of their vessels and ducts. 
 
 In considering the opinions of physiologists or anatomists 
 regarding glandular secretion, and the structure of glands, we 
 find in the first instance that the old physicians contented them- 
 selves with saying that the glands or viscera possessed a pecu- 
 liar power to select and separate the fluids from the blood. 
 The next class had recourse to hypothesis : they spoke of the 
 separation of certain parts by means of fermentation,* or by 
 a kind of filtering through the pores or vessels of glands ; that 
 these pores allowed only particles of a particular size or figure 
 to pass them.f It was opposed to this hypothesis, that the 
 thinner fluids must have run through the organs destined for 
 the grosser secretions. But when a theory such as this is re- 
 ceived, no argument nor proof seems necessary to overthrow it. 
 Resting upon authority alone, it stood until it was overturned 
 by the fashion of new doctrines : one equally puerile was raised 
 upon its overthrow. 
 
 We observe, says the founder of this theory,^, that wet or 
 oiled paper will only transmit fluid of that kind with which it 
 is previously imbued, it will not transmit the oil when wetted, 
 nor will the water make any impression on the paper when pre- 
 viously oiled. Upon these facts are to be raised a theory of 
 secretion ! Betwixt the secreting vessels and the ducts, in the 
 peculiar tissue of which glandular structure consists, there is 
 interposed a fluid of that particular kind which is required to 
 be secreted, and when the blood is driven against this tissue so 
 imbued, no fluid but of a nature resembling that already de- 
 posited can be transmitted. By this hypothesis they explained 
 secretion, making it to depend on the attraction and repulsion 
 of the particles of the biood by fluids previously secreted. 
 We may surely leave this class of physiologists accounting for 
 the original depositation of the fluids in the glands, without a 
 wish to search with them into the mystery of glandular secre- 
 
 * Van Helmont. Vieuflens, &c. 
 f Charleton, Defcartes, Barelli, Verheyn, &c. &c, 
 
 1 Window. Heivetius. 
 
INTRODUCTION. 
 
 7 
 
 tion. Commentators on this -theory, by taking into the system 
 the action of the nerves, indicated that they did not altogether 
 forget that the body was alive.* 
 
 Another set of physiologists attributed the whole effect of 
 secretion to the velocity of the blood in the glands or secreting 
 vessels ;f others, to the length and curves of the vessels, and 
 their action upon the fluids. Again, others have been satisfied 
 with the round assertion that the vital action was the essential 
 cause of secretion. This, it ought to be understood, must be 
 universally acquiesced in, while yet there mav remain an in- 
 quiry as to the apparent structure of glands. Disappointed in 
 obtaining an unexceptionable general theory of secretion, we 
 are only enabled to conclude, that while a power exists in an 
 animal body, directing its actions, perhaps both in the solids 
 and fluids, and particularly in the mutual influence which they 
 exert, the form, length, and activity of the vessels and ducts 
 give occasion to the greater or less degree of intricacy in the 
 operation of the principles upon which the secretion depends. 
 
 Let us then attend to the observations of the strict anato- 
 mists, and to the appearance which the glandular viscera 
 piesent under the knife. 
 
 It is not perfectly clear what the older anatomists meant by 
 the expression Parenchyma. It would appear however to 
 have saved them the trouble of investigation, and all abstruse 
 speculation. They meant flesh, yet not muscular substance, 
 but such as the liver presents. This matter they seem to have 
 conceived to be formed by the blood. Thus Highmore de- 
 scribes the liver to be formed of the blood of the umbilical 
 vein : the opinion originally of Erasistratus. 
 
 Previous to the time of Malpighi it is fruitless to trace the 
 opinions of anatomists regarding the structure of glands. 
 He was the first who sought to throw light upon this obscure 
 subject by anatomical investigation, and he made a more rapid 
 progress than has been done by any man since his day. If we 
 take into consideration the difficulties he had to encounter in a 
 new field, and the prejudices of the learned with which he had 
 to combat, his merits will be found greater than even those of 
 Ruysch. The opinions of Malpighi were received by those 
 who, forsaking the authorities of names, saw the importance 
 of the study of anatomy. Ruysch himself gave credit to the 
 ©pinions of Malpighi in the early part of his life. But Ruysch’s 
 more attentive observations being contradictory to those 
 of Malpighi, his maturer judgment rejected that anatomist's 
 
 * Conor, Ten tamen epiilolare de Secretion^. 
 
 t Boerhaave, Pitcarne, &e. 
 
8 
 
 INTRODUCTION. 
 
 proofs, and with a boldness in which he was never remarkably 
 deficient he invented a new theory, or at least alleged new 
 facts, and swayed men’s opinions with an absolute authority. 
 
 Malpighi was an Italian, and born near to Bologna. 
 Whilst yet a young man, being sunk under the accumulation 
 of family distress, absorbed in grief, and lost to the considera- 
 tion of his interest, he received comfort and assistance from 
 his master, who urged him to embrace the medical profession. 
 His progress was rapid. After studying at Padua, he was 
 called to fill one of the chairs in Bologna. He was then so- 
 licited bv Ferdinand II., Duke of Tuscany, to be professor 
 in the university of Pisa. Here he was associated with liberal 
 men : and now only in his second professorship did he learn 
 to despise the scholastic learning of the time, and betook him- 
 self to experiment as the only means by which philosophy 
 could be raised from the oppressive barbarism of the schools. 
 Malpighi and Borelli were associated ; they dissected to- 
 gether ; they suggested thoughts to each other ; they doubted, 
 and canvassed freely each other’s opinions ; and were to each 
 other an excitement and encouragement to perseverance and 
 industry. They were supported by government ; popular in 
 their teaching; while they . collected round them the learned 
 men of the time. This was the origin of the famous Acade- 
 my del Cimento. Malpighi was, after this, professor in 
 Messene, and died in the Quirinal palace at Rome of a stroke 
 of the apoplexv,* after having been some time physician to 
 Pope Innocent XII. Malpighi had many enemies, and even 
 some of his colleagues were animated against him with a dis- 
 honourable jealous}'. Many laughed at his studies and occu- 
 pations, as frivolous and absurd. Something must be allowed 
 for men who had laboured with diligence to become learned ; 
 for these his opponents, had passed their lives in the study of 
 the Arabian writers. With them studies were enforced which 
 held science in subjection ; studies which, in place of invigo- 
 rating, served only to chill and paralyse exertion, and retard 
 ingenious investigation. Even Borelli, but from other mo- 
 tives, opposed and censured some of the dissertations of Mal- 
 pighi. 
 
 Malpighi has been considered as the inventor of this depart- 
 ment of anatomy, which the French, curious in distinctions, 
 have called the analytic method. He shewed the impropriety 
 of the term Parenchyma, as applied to the substance of 
 glands. He proved that the lungs, for example, (which the}' 
 
 * Two pounds of coagulated blood were found in the ventricles of his brain bjr 
 
INTRODUCTION. 
 
 also called parenchymatous,) were not fleshy, and had no re- 
 semblance to the glandular viscera of the abdomen. He 
 taught, that though glands are smooth on their outer surface, 
 they consist of lobules connected by cellular membrane : and, 
 upon a still more minute investigation, that they consist of in- 
 numerable little follicules or sacs ; that these are interposed be- 
 twixt the arteries which convey the fluids and the excretory 
 ducts going out from them ; that the arteries, or the vasa 
 afferentia, after ramifying and encircling these bodies, pierce 
 them and secrete the particular fluids into them. On other oc- 
 casions he describes these little glandular bodies as applied to 
 the ramifications of the arteries, like fruit hanging by the 
 branches of a tree. 
 
 Malpighi threw in his liquid injections ; dissected and ex- 
 amined with the microscope ; made careful observations and 
 experiments on living animals ; -and lastly, attended in a parti- 
 cular manner to the phenomena of disease. By disease no 
 doubt parts swell out and are magnified, and become distinct ; 
 but it is not a test of the natural structure, or implicitly to be 
 trusted to. 
 
 Scheme of Malpighi' s opinion. 
 
 m 
 
 Fig. 1. Boerhaave’s plan of Malpighi’s doctrine, a a a 
 folliculos glandularum simplicissimarum denotat. h b b sin- 
 gularia emissaria cuique utriculo o, propria atque in commu- 
 nem canalem excretorium d , c, suos humores demittentia qui 
 tandem per hujus aperturam c, emittantur. 
 
 Fig. 2. is a scheme farther to elucidate the opinions of 
 Malpighi. A, an artery entering a portion of a viscus. B, 
 the returning veins. C, the branch of communication betwixt 
 the artery and vein which serves to circulate the blood* and 
 convey a part into the veins. D, another division of the 
 artery, which after various plavful meanderings terminates in 
 Vol. IV. B 
 
10 
 
 introduction's 
 
 the follicule or little glandular bag E. F, the ducts which re- 
 ceive the secreted fluid from the follicules. 
 
 Ruysch studied at Leyden under Van Horne, and at a 
 very early age attached himself to anatomy and botany. At 
 this time he brought himself into notice by a defence of the 
 professors against one Bilsius, who, although he was learned 
 and acute, had attacked them with all the weapons of a 
 Charlatan. Returning to his native country, he was raised to 
 the professorship of anatomy and botany in Amsterdam. It 
 was here that Ruysch made those discoveries in anatomy, and 
 that wonderful and sudden progress in practical anatomy, 
 which not only raised him above his cotemporaries, but has 
 been the admiration of all since his time. Though new and 
 Various methods of preparing the body have been discovered 
 since the time of Ruysch, yet there has been no approach to 
 the elegance with which he displayed the structure of minute 
 parts. It has been said that, \vhile others preserved the hor- 
 rid features of death, Ruysch preserved the human body in 
 the softness and freshness of life, even to the expression of the 
 features. We must no doubt ascribe some part of this en- 
 comium to the exaggeration naturally arising from the novelty 
 of the thing. But as to his superiority in the manner of dis- 
 playing the minute vessels of delicate parts, and his methods 
 of preserving the parts in liquors, transparent and soft and so 
 as to float in their natural folds, there can be no doubt. — 
 Neither can the minuteness and success of his injections be 
 denied : we have too many occasions in which we must resort 
 to the catalogue of Ruysch’s museum for the true anatomy, to 
 doubt his great success, or to question the truth of those en- 
 comiums which have been bestowed upon him. 
 
 Kings, princes, ambassadors, and great generals, but more 
 than these, all the learned men of the time, crouded to the 
 museum of Ruysch. W e must not blame him if, whilst 
 others were merely speculating about the structure of parts, he, 
 surrounded by so princely a museum, should simply have laid 
 open his cabinets, and bid them satisfy themselves whether or 
 not he was right. Ruysch’s preparations went to contradict 
 the opinions ol Malpighi. His injections, pushed more 
 minutely, showed those round bodies which are to be seen in 
 some of the glandular viscera (and which Malpighi took to be 
 little bags into which the secreted fluid was poured) to be 
 merely convoluted arteries. Ruysch taught, that the minute 
 arteries after making these convolutions terminated in the be- 
 ginning of excretory ducts ; that there was no substance or 
 apparatus interposed, but that the vessels and ducts were con- 
 tinuous. His opinions being formed upon the strength of 
 
INTRODUCTION. 
 
 11 
 
 more minute preparations, and a superior dexterity of anato- 
 mical investigation, few anatomists chose to be outdone, or to 
 acknowledge that they could not see what he saw. This I 
 believe to be one reason of the rapid progress of Ruysch’s 
 opinions. 
 
 Scheme of RuyscK’s opinion. 
 
 r i 
 
 3 3 
 
 1 1 The smaller arteries which do not enter into follicules, 
 but are convoluted. 2 2 The appearance of bodies or bags, 
 but which are merely owing to the convolutions and tortuous 
 figure of the arteries before they terminate in the excretory 
 ducts. 3 3 Excretory ducts or vessels formed by the continued 
 extreme branches of the arteries.* 
 
 The opinions of Malpighi and Ruysch have held the schools 
 in perpetual controversy ; most anatomists however leaning to 
 the authority of Ruysch. There follows these a crowd of 
 French academicians, who, with Boerhaave, may be con- 
 sidered as mere commentators on the original authorities of 
 Malpighi and Ruysch. Some of these argue for secretion by 
 continuous vessels, and contend that the arteries terminate in 
 the excretory ducts ; others, that the secretions are made into 
 follicules ; and some, as Boerhaave, insist that both are right 
 in their observations, and in the proofs which they have 
 adduced, that secretion is in part performed by continuous 
 vessels, partly by a more intricate glandular apparatus. 
 
 * Ruyfch’s dodlrine again was thus opposed : Ruyfchius auget arte fua replendi 
 extenfionem vaforum ultra naturalem magnitudinem. Ruyfchius arte fua deftruit 
 glandulas ; dein negat. Ruyfchius negat omnes glandulas. Melius ell & tutius 
 omnia haec demonftrare in cadavere recenti.’’ F. Ruyfch Epift. ad Vir. Clar. Her, 
 Boerhaave, p. 50. 
 
 It may be farther obferved, that it was not in the mere fa< 5 t of there being 
 follicules, in which Malpighi and Ruyfch differed ; for the latter conceded that there 
 were hollow membranes, but contended that thefe were not glands. Their dif- 
 ference of opinion is expreffed in the following words of Ruyfch : “ Adeoque dif- 
 crepantia inter magnum ilium virum et inter me eft, quod ille putat humores 
 delabi in glandulas didtas fimpliciffimas,— ibi foveri, mutari : Ego puto, quod 
 arterias ultimo fuccos faciant, & fadtos ibi deponant,” 
 
12 
 
 INTRODUCTION. 
 
 As the forms of the parts which throw out secretions have 
 an infinite variety, it may be useful in this introductory view 
 to point out these varieties, and their appropriate names * * * § In 
 the first place, although in general language the term gland im- 
 plies a secreting body, yet this does not follow from the defini- 
 tion of that word. According to Hippocrates, it is a tumid 
 round body, soft, smooth, and shining. Many such bodies, 
 and which we call glands, have no excretory ducts, and do not 
 secrete a fluid ; while most secreting parts admit of no such 
 definition. When, again, we admit the definition of authors 
 who have taught their peculiar opinions regarding their struc- 
 ture, we have a still less admissible description. Thus Mal- 
 pighi defined a simple gland to be “Membrana cava cum 
 emissario and Ruysch says, “ Glandulse nulla compo- 
 nuntur ex sola membrana cava cum emissario, sed praecipue 
 ex vasis.” 
 
 These definitions of glands being optional and uncertain, it 
 is necessary to use names appropriated to the several varieties 
 of form in secreting parts. Indeed the term gland is inadmis- 
 sible as conveying any knowledge of the minute parts of which 
 the viscera are composed. 
 
 We must observe, however, that there is a division of glands 
 still in use into conglobate and conglomerate. The first implies 
 a gland simple in its form, the latter a gland having the ap- 
 pearance of an assemblage of several glands.f Now there is 
 no gland that has not more or less the appearance which is des- 
 cribed by conglomerated ; that is, consisting of several parts, 
 united by cellular membrane : and the distinction is attended 
 with no advantage. 
 
 Acini form the last sub-division which we observe in the vis- 
 cera, as in the liver ; they are round bodies, not regularly in- 
 vested with membranes, and which can be teased out into par- 
 cels of minute vessels.^ 
 
 Cryptce are numerous in the body. We have an example 
 of them in the great intestines.^ Crypta is a soft body, con- 
 
 • The terms acini, cotulae, crypt®, folliculi, glandul®, lacunae, loculi, utriculi, 
 have been almoft promifcuoufly ufed ; being fo many names for bundles, bags, 
 bottles, holes, and partitions. 
 
 f As the falivary glands and the pancreas. Farther, the lymphatic glands are 
 generally called conglobate glands, being fmooth and apparently fimple in their 
 flrudture ; but thefe, when injected, take exactly the appearance which lhould na- 
 turally' be defcribed by the term conglomerate, confifting of many little cavities. — 
 Thefe lymphatic glands, belonging to a diftindt fyftem, require no farther particu- 
 lar definition to diftinguiih them. 
 
 f See farther of the acini of the liver for example. 
 
 § Ruyfch ad Virarn Clar. H. Boerlwave, p. S3- 
 
INTRODUCTION. 
 
 13 
 
 sisting of vessels not completely surrounded with a membrane, 
 and resolvable by boiling or maceration.* 
 
 Fo'lkules are little bags appended to the extremity of the 
 ducts, into which the secretion is made, and from which it is 
 evacuated by the ducts.' 
 
 Lacunas are little sacs opening largely into the passages, (as 
 in the urethra,) and into which generally mucus is secreted ; 
 which, lodging there, is discharged when matter moves along 
 the passage. 
 
 Finally, we have to recollect that every part of the body se- 
 cretes ; that every surface is a secreting surface ; that even 
 that surface which is produced by an incision no sooner ceases 
 to bleed than a secretion begins. And that an ulcer in the skin 
 or flesh becomes by habit similar to those organs, the peculiar 
 function of which is to secrete some matter useful in the sys- 
 tem. This fact corrects the notions which we should other- 
 wise be apt to receive of the action of secretion from contem- 
 plating the more complicated glandular organs. 
 
 * “ Cryptarum vafcula poffum docere, fed funt tarn fubtilia, ut reptatus non 
 pofiit diftingui ; tanturfi circum affufa rubedo per repletionem videtur.’’ Ruyfch 
 ad Her. .Boerhaave, p. 77, 
 

 
PART THE FIRST. 
 
 OF THE ABDOMINAL VISCERA . 
 
 CHAP. I. 
 
 OF THE ABDOMEN IN GENERAL, AND OF THE 
 PERITONEUM. 
 
 The abdomen is that division of the body which is betwixt 
 the thorax and pejvis. It is bounded above by the arch of the 
 diaphragm ; behind, by the spine ; on the sides and fore part, 
 by the abdominal muscles ; and, below, the abdominal viscera 
 are supported by the alae ilii and the pubes. The abdomen 
 contains the viscera more or less immediately connected with 
 digestion, and the kidneys which secrete the urine. 
 
 We speak of the cavity of the abdomen: but it is an inaccu- 
 racy of language ; for there is really no cavity : the parietes 
 of the abdomen, viz. the abdominal muscles and peritoneum, 
 closely embrace the contained viscera. To understand what 
 is meant by the cavity of the abdomen ; to understand the 
 connection of the several viscera, and the manner in which 
 they lie contiguous, while they adhere at certain points only ; 
 we must previously attend to the peritoneum. But, in the first 
 place, let us notice the outward divisions of the belly. 
 
 OF THE REGIONS . OF THE BELLY. 
 
 To give greater accuracy to the description of the seat of 
 the viscera, or, perhaps rather, more strictly to connect the 
 knowledge of the internal parts with the outward marks of the 
 
16 
 
 OF THE PERITONEUM. 
 
 belly, it has been long customary to mark certain arbitrary di- 
 visions on its surface, which are called regions. 
 
 The epigastric region is the upper part of the belly, un- 
 der the point of the sternum and in the angle made by the meet- 
 ing of the cartilages of the ribs with the sternum. Upon the 
 sides under the cartilages of the ribs are the hypochondriac 
 regions, or the right and left hypochondrium. These three 
 regions make the upper division of the abdomen, in which are 
 seated the stomach, liver, spleen, pancreas, duodenum, and 
 part of the arch of the colon. The space surrounding the um- 
 bilicus, betwixt the epigastrium and a line drawn from the crest 
 of one os ilii to the other, is the umbilical region. The 
 hypogastric region is of course the lowest part of the belly, 
 consisting of the angle betwixt the umbilical region, the spines 
 of the ossa ilii and the pubis. The two lateral spaces betwixt 
 the false ribs and the spine of the os ilii are the iliac regions, 
 or the loins. 
 
 of the peritoneum. 
 
 The Peritoneum, like all the other membranes of the body, 
 consists of an expansion of dense cellular membrane ; yet it is 
 what is called a proper or simple membrane ; being a white 
 firm thin contexture of cellular substance, in which no fibre or 
 striated appearance is to be observed.* By its outer surface it 
 adheres to the adipose membrane, on the inside of the abdo- 
 minal muscles, and to the surface of the several viscera ; its 
 inner surface is smooth, and forms no adhesion while the parts 
 are sound and healthy ; its outer surface is looser in its texture, 
 and by the splitting of its lamina it degenerates into the com- 
 mon cellular membrane. 
 
 The cellular membrane on the outside of the peritoneum is 
 in some places short, firm, and dense ; as on the liver, the. 
 spleen, the uterus, and the intestines : but it is longer, lax, and 
 fatty, where it attaches the peritoneum to the muscles and ten- 
 dons of the abdomen. 
 
 The peritoneum has no termination ; or it is a sac ; yet so 
 curiously is it involved with the viscera, that though we say 
 the viscera are contained in the abdomen, yet, accurately 
 speaking, they are without the peritoneum, and consequently 
 lie not in the abdominal cavity.f 
 
 The peritoneum is expanded on the lower surface of the 
 
 * The meaning of fome anatomifls, faying that the peritoneum is a double 
 membrane, will be feen below, 
 f See Plate I. and the explanation. 
 
OF 'fHE PERITONEUI®. 
 
 If 
 
 diaphragm ; and at some of the interstices or perforations of 
 that muscle or its tendon it comes in contact with the pleura, 
 and adheres to it by cellular substance. From the diaphragm 
 the peritoneum is reflected off to the liver, forming the liga- 
 ments of thatviscus, and, expanded over its surface, it forms 
 its outer membrane. From the diaphragm it is also sent off 
 upon the oesophagus and stomach, and prolonged to the spleen 
 on the left side (as it is to the liver on the right) so as to form 
 the ligaments of the spleen. 
 
 The aorta, the great vena cava, the thoracic duct, and the 
 kidneys, are behind the peritoneum ; that membrane being 
 stretched before them. But the intestines are also in the same 
 respect behind this general.investing membrane : for it is mere- 
 ly reflected from the spine and psoas muscles, and from the 
 great vessels running down upon the spine, so as to involve 
 the intestines and form their outer coat. As it stretches to- 
 wards the tract of the intestinal canal, it consequently involves 
 the vessels of the intestines in its duplicature, and forms the 
 mesentery. 
 
 The peritoneum also lines the abdominal muscles : it is re- 
 flected from the diaphragm upon the surface of the transversa- 
 lis and rectus abdominis muscles. Here it is united to them 
 by a loose adipose membrane, and from the abdominal mus- 
 cles it is continued upon the inside of the pubes. From the 
 pubes it ascends upon the bladder of urine ; descends again be- 
 hind the bladder ; and there, making another reflection to 
 mount over the rectum and form the meso-rectum, it leaves 
 betwixt the rectum and bladder a particular sacculus. 
 
 From this detailed description we see that the peritoneum 
 has no termination : that it is continued from the surface of 
 the diaphragm to that of the abdominal muscles ; from that 
 over the bladder and rectum ; from the rectum in the whole 
 length of the intestinal canal ; and from the intestinal canal up 
 upon the diaphragm. We see then what is meant when it is 
 said that it is a shut sac ; we understand by the cavity of the 
 peritoneum merely the inside of this sac ; and that when dis- 
 tended with fluid, that fluid is contained betwixt the peritone- 
 um lining the abdominal muscles and that part of it which in- 
 vests or forms the outer membrane or coat of the intestines — — 
 This fluid, whether collected there by disease or thrown in by 
 experiments, has no natural outlet, nor does it transude in the 
 living body.* 
 
 * Soemmeiring, Corp. Hum. Fab. Contemp. Peritonei, § iii. 
 
 We not unfrequentiy find an accurate general defcription in authors, but fofne 
 incorrectness in the fubordinate detail; which throws back the ideas of the reader 
 into confufion. Such is the enumeration of the holes or perforations of the p&rito- 
 
 Vol. IV. C 
 
1 $ 
 
 OF THE PERITONEUM. 
 
 BLOOD-VESSELS OF THE PERITONEUM. 
 
 As the peritoneum is a membrane of great extent, and in- 
 vesting a variety of parts, its vessels come from many sources. 
 It receives arteries and veins from the mammary vessels ; 
 from the phrenic and epigastric vessels ; from the lumbar arte- 
 ries and veins ; and from the ilio-lumbalis, circumfiexa ilii, 
 renal, and spermatic arteries. It receives nerves from the in- 
 tercostal, lumbar, and diaphragmatic nerves. 
 
 It would appear that disease has given rise to the opinion 
 that the peritoneum has in it many little glands. This is con- 
 troverted decisively by Morgagni. • 
 
 OF THE USE OF THE PERITONEUM. 
 
 The peritoneum serves as a dense and outer coat to the ab- 
 dominal viscera ; conveys the vessels to them, as in the exam- 
 ple of the mesentery ; and, having its inner surface smooth and 
 lubricated by a watery secretion, it allows the parts to lie in 
 contact (they being strongly compressed by the surrounding 
 abdominal muscles and diaphragm,) and at the same time al- 
 lows in the intestinal canal a capacity of motion without fric- 
 tion. 
 
 There is no internal surface or cavity, as it is called, of the 
 living body, which is not moistened by an exudation from the 
 vessels of the surface. Thus it i3 with the peritoneum. An 
 exhalation from the extreme arteries bedews its surface, and 
 is again taken up by absorbent vessels ; so that it does not ac- 
 cumulate in health, nay even fluids poured into the abdominal 
 cavity will be taken up by the absorbents.* When the abdo- 
 men is opened in animals alive, or recently killed, as in the 
 shambles, a vapour is seen to exhale from the peritoneum 
 
 neum, “ pour donner paflage a i’oefophage, a la veine-cave,” &c. See Anatom, 
 Chirurg. par M. Palfm. We fee that there are no fuch perforations, that the oefo- 
 phagus never enters into the cavity of the peritoneum, nor does the reCtum pafs 
 out from its cavity. This was indeed explained by Fernelius in oppofition to Ga- 
 !en. Pee a defeription of the inflections of the peritoneum by Bartholin.— Speci- 
 men Kifloris Anatomies; Analedt. Ob. I. 
 
 * See Nuck Sialograph, c. ii. p. 27. 
 
 Qua copia in ftatu fecundum naturam fecernatur didtu difficile eft : ad uncias 
 certe colletta aquula in fani hominis abdomine reperitur. (Kaawn, 543.) In 
 homine, cui fponte abdomen fub umbilico ruptum erat ad quinque & fex libras de 
 die effluebat. (Journ. de Med. 1 75 7 M. Aug. ut denique Boo libr. effluxerent.) 
 This, however, proves nothing of the nature or quantity of the fecretion ; this has 
 probably been an inflammation and abfeefs of the peritoneum, which, we have 
 feen, pours out fuch a quantity of fluid, thin and ferous, as quickly to drop through 
 the bed-clothes upon the floor. 
 
OF THE PERITONEUM. 
 
 19 
 
 having a peculiar animal odour. Yet we ought not to say that 
 this vapour is collected in the dead body ; for before the open- 
 ing of the peritoneum, or the death of the animal, it is not in 
 a state of vapour, but is condensed into a watery exudation.^ 
 
 I have seen, in the high state of inflammation of this mem- 
 brane, pus formed upon the surface without ulceration, and 
 therefore, probably, from the same exhaling or secreting sur- 
 face ; and coagulable lymph lying in flakes upon it. The in- 
 crease of the serous discharge forms the common ascites ; but 
 whenever the natural secretion or exudation from the peritone- 
 um is altered, adhesions are apt to form. 
 
 One great use of the peritoneum is to retain the viscera in 
 their place, says Haller ; for when it is wounded they escape, 
 and sometimes with a sudden impetus, which makes it difficult 
 to reduce or retain them.f But this is not from the want of the 
 embracing of the peritoneum, but from the tendons or muscles 
 which support the peritoneum being cut ; for when there is a 
 deficiency in the support given by the abdominal muscles, or 
 their expanded tendons, the peritoneum does not prevent the 
 viscera from being protruded, but easily yields to their forci- 
 ble protrusion, and forms a sac involving this hernia. 
 
 Nor do the processes of the peritoneum, which have re- 
 ceived the name of ligaments, nor the mesentery, nor meso- 
 colon, sufficiently resist the prolapsus of the viscera when they 
 have escaped from the pressure of the surrounding muscles. 
 Sufficient example of this we have in hernia of the intestines, 
 in which the mesentery is greatly elongated, or in the displace- 
 ment of the stomach, or in the prolapsus and procidentia uteri. 
 
 The peritoneum which forms the sac of hernia retains little 
 elasticity, and does not shrink into the belly when freed from 
 the outer adhesions ; but the general peritoneum will allow 
 great distention, as in ascites, and quickly contract to its for- 
 mer dimensions on the evacuation of the fluid ; and so that 
 part of the membrane which invests the stomach and intestines, 
 the bladder of urine -and gall bladder, has considerable 
 elasticity, since it suffers these parts to be distended and again 
 returns to its former dimensions. 
 
 The consideration of the insufficiency of the peritoneum to 
 retain the viscera leads us to attend to a circumstance of the 
 greatest importance connected with the viscera of the belly. 
 The abdomen is every where (except towards the spine) sur- 
 
 * This vapour I have feen arifing from the inteftines of the human body during 
 the operation for hernia ; and alfo when the omentum and inteftines have efcaped 
 in confequence of a wound of the belly. 
 
 \ Element. Phyfiol. tom. ii. p. 380. 
 
20 
 
 or THE PERITONEUM. 
 
 rounded by muscles. Above we see the diaphragm ; before, 
 and to the sides, the abdominal muscles ; and even below, the 
 parts in the pelvis are surrounded and compressed by the leva- 
 tor ani, in such a manner that the whole of the viscera suffer a 
 continual pressure. This pressure upon the viscera appears to 
 be uniform and constant, notwithstanding the alternate action 
 of the abdominal muscles and diaphragm as muscles of respi- 
 ration : but it must be occasionally very violent during exer- 
 tions ; in pulling, for example, or in straining, as a sailor 
 must do in working of the great guns, or when pulling at the 
 oar, or when balancing himself upon his belly over the yard- 
 arm. And indeed by such violent and general compression of 
 the viscera of the belly, ruptures are sometimes produced, of 
 the worst kind, and followed by the immediate train of urgent 
 symptoms. 
 
 The viscera having in general delicate outer coats, and no 
 ligaments capable of supporting them, and being very vascu- 
 lar, require the support of this pressure of the surrounding- 
 muscles ; and the great venous trunks which take their course 
 through the abdomen are in a particular manner indebted to the 
 pressure of the abdominal parietes. We must recollect also 
 the bad consequences which result from the sudden relaxation 
 of the abdomen ; as in women after deliver} 7 , or in conse- 
 quence of withdrawing the waters of ascites without due 
 compression of the belly ; languor, faintness, and even death, 
 are sometimes produced, apparently by the balance of the 
 vascular system being destroyed. 
 
 Some good authors in former times have described the 
 peritoneum as a double membrane.^ This was no farther a 
 mistake than as they considered the cellular membrane, which 
 lies without the peritoneum, as a part of it. It is necessary to 
 recollect this in order to understand the meaning of their call- 
 ing the sheath of the cellular membrane, which accompanies 
 the vessels passing out from the abdomen, productions of the 
 peritoneum. The vaginal productions of the peritoneum are 
 the shtaths ol the common cellular substance which accompany 
 the aorta and oesophagus into the posterior mediastinum; or 
 which give a bed to the spermatic vessels, or passing under 
 PoupaiVs ligament accompany the vessels of the thigh. They 
 are improperly termed productions of the peritoneum. 
 
 The proper productions or prolongations of the peritoneum 
 are of a very different kind ; thev are the mesentery and 
 omenta and ligaments : but, as I have explained in general 
 how the mesentery and ligaments are formed by the peritone- 
 
 8 See .Ay.at. Chirurg. par M. Palfin, tom. II. p. 35. and note a. 
 
OF THE PERITONEUM. 
 
 21 
 
 tun, and as they must come presently to be considered more 
 particularly, we treat no farther of them here A' 
 
 OF THE OMENTA. 
 
 The Omenta are considered as secondary processes of the 
 peritoneum, because they are not formed by the peritoneum 
 reflected off from the spine upon the intestines, as the mesen- 
 tery is, — it being a primary process ; but they are reflected 
 from the surface of the stomach and intestines. Anatomists 
 distinguish the omentum majus^ — colico-gastricum : the omen- 
 tum minus, — hepatico-gastricum ; omentum colicum ; and 
 lastly, the appendices epiph i :ae. 
 
 The omentum, or epiploon, meaning thereby the great 
 omentum, is a floating membrane of extreme delicacy, ex- 
 panded over the surface of the small intestines, and attached 
 to the great arch of the stomach and intestinum colon. — 
 Although this membrane be of extreme delicacy and transpa- 
 rency in the young subject,! vet it is much loaded with fat, 
 and appears transparent in the interstices only ; and in advan- 
 ced age it loses much of its delicacy, and acquires a degree of 
 diseased consolidation or firmness, and is often irregularly 
 collected into masses, or adheres preternaturally to some of the 
 viscera. 
 
 The omentum majus hangs suspended from the cellular con- 
 nection betwixt the arch of the stomach and the great trans- 
 verse arch of the colon ; or rather it forms that connection be- 
 twixt the stomach and colon. It consists of two membranes, 
 or is as a sac collapsed and hanging from the stomach and 
 colon,! one °f th e sides being the peritoneum reflected off 
 from the oesophagus and along all the great arch of the sto- 
 mach, and the other that which comes from the arch of the 
 colon. And further, as each of these lamina may be supposed 
 to consist of two lamina ; for example, where the omentum is 
 formed by the meeting of the peritoneum from the lower and 
 upper surfaces of the stomach ; these two, meeting, form the 
 upper lamina : and as, where the lower layer of the omentum 
 comes off from the colon, it is alsoformed by the peritoneum 
 
 * See farther of the peritoneum under the head MefenterJ, Mefocolon, Dc- 
 fcent of the Tefticle, &c. 
 
 ■f Pr^terca tenerrimas effe ut nulla membranarum humanarum, retina oculi 
 excepta, tcquefit tenera. Haller, vol. vi lib. 20. § i. par. 12. 
 
 While its delicacy is remarkable in the young "fpliject, the retiform veffels (vid. 
 Ruyfch. Ther. II. V. Spegil. 1 .V 1 II. &c.) have the fat accumulated in 
 their tract as if it were thrown up by them to a fide ; but often the fat increafing 
 pbfeures the veffels. 
 
 \ Marfupium the common term.-— See Window, IV. § 35 2. 
 
22 
 
 OF THE PERITONEUM. 
 
 reflected in the same manner ; so with some truth the omentum 
 is supposed to consist of four lamina of membranes of extreme 
 tenuity ; but these four layers cannot be demonstrated. The 
 great omentum extends from the bosom of the spleen trans- 
 versely, until it terminates on the right side of the arch of the 
 colon, where the omentum colicum begins. 
 
 The great omentum varies considerably in extent. In a 
 child it is short ; in the adult further extended over the visce- 
 ra : sometimes it reaches only to the umbilicus ; sometimes it 
 is allowed to extend its margin into the pelvis, so that in old 
 people it is very apt to form a part of the contents of hernia ; 
 often it is wasted and shrunk ; sometimes collected into masses 
 leaving the surface of the intestines. 
 
 OF THE OMENTUM MINUS OR HEPATICO GASTRICUM. 
 
 This is a membrane of the nature of that last mentioned, 
 but in general less loaded with fat. It is extended from the 
 liver to the lesser arch of the stomach. It passes off from the 
 lower surface of the liver at the transverse fossa ; from the fos- 
 sa ductus venosi ; invests the lobulus spigellii ; involves the 
 branches of the cseliac artery ; and is extended to the lesser cur- 
 vature of the stomach and the upper part of the duodenum.* 
 
 OMENTUM COLICUM. 
 
 This is a continuation of the great omentum upon the right 
 side of the great arch of the colon, where it rises from the ca- 
 put coli ; but it seldom extends its origin from the colon the 
 length of the caput coli. It can be inflated like the great 
 omentum. 
 
 APPENDICES EPlPLOICdE, OR OMENTULA INTESTINI 
 CRASSI. 
 
 These are little fatty and membranous processes which 
 hang pendulous from the surface of the colon : they are of the 
 same texture and use with the greater omentum and right colic 
 omentum. 
 
 We have mentioned that the omenta are double reflections 
 from the peritoneum, and consequently they may be inflated so 
 as to demonstrate them JO be perfect sacs. To do this it is not 
 
 * “ Macilentius eft, ct vafa liabet minora.” Winflow, Haller. Indeed it feems 
 rather to anfwer the general purpofe of a cellular membrane conveying veffels, 
 T&an the purpofes of the omentum rnaju*. 
 
OF THE PERITONEUM. 
 
 required to puncture any part of them, for there is a natural 
 opening by which the whole may be inflated in a young sub- 
 ject, and in a healthy state of the viscera. 
 
 This natural opening into the purse or sac of the omentum is 
 betwixt the membrane involving the vessels and ducts of the 
 liver, and the peritoneum, where it invests the vena cava be- 
 twixt the neck of the gall bladder and the first turn of the duo- 
 denum, or where the lobulus caudatus hepatis touches the du- 
 odenum. By introducing a blow pipe into this natural fissure 
 the foramen of Winslow, the omentum minus may be raised : 
 the gastro colic, and colic omenta may be inflated. This open- 
 ing serves as a communication betwixt the cavities of the 
 omentum and the general peritoneal cavity ; but I am inclined 
 to think it is very frequently destroyed by adhesion.* * * § As this 
 opening points towards the right side. Dr. Monro thinks it a 
 sufficient reason for introducing the trochar on the right side in 
 the operation of tapping for ascites, (contrary to the usual cau- 
 tion of avoiding the liver, which is so often diseased in this 
 case,) and that by operating on the left side he thinks the water 
 will not be allowed to flow from the sac of the omentum. f It 
 appears to me that it will flow equally well from whatever point 
 of the belly the water is drawn. 
 
 There is a considerable variety in the form of the omentum 
 of animals, j: but still they seem to shew the same provision of 
 involving the intestines, filling up the inequalities which arise 
 from the rounded forms of the viscera, and still further lubri- 
 cating and giving mobility to the intestines.^ The surface of 
 the omentum, however, seems merely to furnish a fluid exu- 
 dation like the general surface of the peritoneum ; at least the 
 idea which has been entertained of the oil or fat exuding is 
 quite improbable.|| 
 
 The use assigned to the omentum of being subservient to 
 the function of the liver is deservedly neglected.^ 
 
 * Winflow, Duverney, and Haller. 
 
 f Quer. If I fhould fay to a patient, by punfluring here I am in danger of 
 thrufting this inftrument into your liver ; by introducing it here there is lefs pofli- 
 bility of any fuch accident, though I may not draw off all the water ; what would 
 be her anivver f 
 
 I Haller Element. Phyflol. tom. vi. lib. xx. § 2 and 3. • 
 
 § We mull; not fuppofe that becaufe a mad man ftabs himfelf in the belly, and 
 there is afterwards found coalition of the inteftines to the wounds, the omentum 
 has not done its office, (fee Boerhaavii Prelefliones, vol. i. § 45.) no more can we 
 give credit to the tale told by Galen (De Ufu Partium, T. iv. c. 9.) of the gladiator 
 who loft part of the omentum, and ever after had a coldnefs in his guts ! at leaft 
 we cut out a great part of the omentum from a man without any fuch fenfation be- 
 ing the confequence now-a-days. 
 
 (I “ Et dum halitu pingui & ipfa oburgit & peritoneum.” Hale loc. cit. Boer- 
 haave, &c. 
 
 ? Viz. by fupplylng a grofs oily matter to the vense porta- ■ 
 
( 24 ) 
 
 CHAP. II. 
 
 OF THE MEMBRANEOUS VISCERA OF THE 
 ABDOMEN.* 
 
 Having understood the nature of the general investing 
 membrane of the abdomen, and what is meant by its cavity and 
 its processes, we take a general survey of the (Economy of the 
 viscera, before entering upon the minute structure of the parts 
 individually. 
 
 The organs destined to receive the food, and to perform the 
 first of those changes upon it which fit it (after a due succession 
 of actions) for becoming a component part of the living body, 
 are the stomach and intestines primarily ; the glandular visce- 
 ra, the liver, pancreas, (and in all likelihood the spleen,) as 
 subservient or secondary organs. I have been accustomed in 
 my lectures to divide these parts into the membranous or float- 
 ing viscera, (viz. the whole track of the intestinal canal) and 
 the glandular viscera ; or perhaps, what is still better, they 
 ir»y be distinguished into those parts which have action arid 
 motion, and those which are quiescent or possessed of no pow- 
 er of contraction. Thus the stomach, intestines, gall-bladder, 
 and bladder of urine (though this belongs to the pelvis) have 
 muscular coats, and the power of contracting their cavities ; 
 while the liver, spleen, pancreas, and kidneys, have no mus- 
 cularity but in their vessels and excretory ducts. 
 
 This division of the viscera may lead to important distinc- 
 tions in pathology. During inflammation, it is observed, that 
 though the parts possessing a power of contraction may some- 
 times lie inactive without pain, yet in those parts when roused 
 to action there is excruciating pain. On the other hand, it often 
 happens that the glandular and solid viscera are the seat of long 
 continued disease, which is attended only with a dull or low 
 degree of pain ; while the anatomist is often struck upon ex- 
 amining the body after death with the wide ravages of the 
 disease. 
 
 W e divide the intestinal canal into three parts ; the stomach, 
 the small intestines, the great intestines. The small intestines 
 are subdivided into the duodenum, jejunum, and ileon. The 
 
 * Although the term Vifcus implies more particularly the flelhy or folid con- 
 tents, as the heart, liver, kidneys, yet we life it in general for all the parts 
 contained in the great cavities. 
 
Of THE OESOPHAGUS. &$ 
 
 • 
 
 great intestines are subdivided into the caecum, colon, and rec- 
 turn. The stomach is the seat of the digestive process : in the 
 duodenum the food receives the -addition of the secretions from, 
 the liver and pancreas, and is still further adapted to animali- 
 zation ; in the long tract of the jejunum and ileon the nutri- 
 tious part is absorbed ; and in the great intestines the effete 
 matters are carried slowly forward, and at the same time suf- 
 fer a further absorption of their fluid contents, until as fasces 
 they lodge in the rectum or last division of the canal. 
 
 From this view it is apparent that as each division of the in- 
 testinal canal is marked by some peculiarity in its use or func- 
 tion, we must carefully examine their minute structure as in- 
 dividual parts, at the same time that we do not allow our- 
 selves to forget the universal connection, the integrity of the 
 circle of actions, and the (Economy as a whole. With this in- 
 tention, following the course of the food, and with a view also 
 to connect the present subject with the last part of vol. iii. we 
 treat first of the oesophagus. 
 
 SECTION i. 
 
 OF THE (ESOPHAGUS. 
 
 The (esophagus or gullet is a cylindrical tube, partly mem- 
 branous and partly fleshy ; which is continued from the pha- 
 rynx down behind the larynx and trachea and close before the 
 spine. Still continuing its course in the back part of the tho- 
 rax, it perforates the diaphragm, and expands into the upper 
 orifice of the stomach ; its use is to convey the food by deglu- 
 tition into the stomach. 
 
 Although' with? many authors I call it a cylindrical tube, and 
 it may take this form when dissected from the body and inflat- 
 ed, yet during life it lies collapsed with its inner membrane in 
 dose contact, and it transmits the morsel only by the continued 
 succession of the contraction of its fleshy coat. 
 
 The upper part of this tube is called the pharynx. It may- 
 be described as expanding funnel-like, and is attached to the 
 occipital bone, pterygoid processes of the sphenoid bone, and 
 jawbones; and further down it is kept expanded upon the 
 horns or processes of the os hyoides. This bag is very fleshy, 
 being surrounded with muscular fibres, which take their origin 
 Voe. IV. D 
 
26 
 
 OF THE (ESOPHAGUS. 
 
 • 
 
 from the neighbouring points of bone ; as the styloid process* 
 the horns of the os hyoides, the thyroid cartilage by which 
 it is enabled to grasp and contract upon the morsel when it has 
 been thrust by the tongue behind the isthmus faucium. This 
 strong tissue of muscular fibres which surrounds the pharynx, 
 is continued down upon the oesophagus in the form of a sheath, 
 which has been called vaginalis tunica. 
 
 STRUCTURE OF THE (ESOPHAGUS. 
 
 I believe we can with propriety enumerate no more than 
 two proper coats of the oesophagus ; its muscular and internal 
 coat ; for that which is sometimes considered as the outer coat, 
 is only the adventitious cellular membrane, and the nervous 
 coat is merely cellular tissue connecting the muscular and inner 
 coat. 
 
 The muscular coat of the oesophagus greatly surpasses in 
 strength and in the coarseness of its fibres any part of the whole 
 tract of the intestinal canal. There may be very distinctly ob- 
 served in it two layers of fibres ; an external one consisting of 
 strong longitudinal fibres, and an internal one of circular fibres. 
 These lamina of fibres are more easily separated from each 
 other than those in any other part of the body.f But an idea 
 is entertained that the one set of fibres, the circular and inter- 
 nal ones, are for contracting the tube, and the outer ones for 
 elongating and relaxing it. I believe on the other hand that 
 thev contract together, conducing to one end, deglutition.^; 
 
 What is called the tunica nerve a is the cellular connec- 
 tion betwixt the muscular and inner coat, and is Very lax, inso- 
 much that the muscular coat and the inner coat are like two 
 distinct tubes, the one contained within the other, and but 
 slightly attached. This appearance is presented particularly 
 when the oesophagus is cut across. 
 
 The inner coat of the oesophagus is soft ; glandular villi 
 are described as being distinguishable on its- -surface, and it is 
 invested with a very delicate cuticle to dull the ac&te sensibili- 
 ty, and prevent pain in swallowing. It in every respect re- 
 
 * See vol. i. p. 141. 
 
 f It appears that the oefophagus can be ruptured in two ways : acrofs, by the 
 tearing ol the longitudinal fibres ; and longitudinally, by the reparation of the 
 longitudinal fibres. This, though a rare accident, takes place in violent vomiting 
 or draining to vomit ; and, in the firft inftance, the tearing acrofs of the oefophagus 
 feems to be the tffetfl: of the action of the diaphragm on the oefophagus. By this 
 accident the fluids of the ftomach are poured into the cavity of the thorax. 
 
 | See farther of the mufcular coat of the inteftines. “ It was at onetime fup- 
 poied that the mufcular fibres of the cefophagus had a fpiral direction.” See Ver- 
 heyen, and Morgan. Adverfar. iii. 
 
OF THE OESOPHAGUS. 
 
 27 
 
 sembles the lining membrane of the mouth. The power, 
 however, which the oesophagus seems to possess of resisting 
 heat depends not on the insensibility bestowed by the cuticle, 
 but is owing to the rapid descent of the hot solids or liquids 
 swallowed ; for when they happen to be detained in the gullet 
 they produce a very intolerable pain. This inner coat has an 
 exhaling surface, like the rest of the body, with particular 
 glands to secrete and pour out that mucus which lubricates the 
 passage for the food. ^ The inner coat is capable of a great 
 degree of distention, but it is not very elastic, or at least con- 
 traction of the muscular coat throws it into longitudinal folds 
 or plicae.f 
 
 In the neck, the oesophagus lying betwixt the cervical verte- 
 brae and the trachea, is at the same time in a small degree to- 
 wards the left side. In the thorax it runs down betwixt the 
 pleura of either side, where they form the posterior mediastin- 
 um. Here, even when it descends upon the dorsal vertebrae, 
 the oesophagus lies rather to the left side ; it then passes under 
 the arch of the aorta, but quickly escapes from under its com- 
 pression and rises on the right side of the aorta, and as it 
 passes further down it gets more and more before the aorta. 
 This is sufficiently apparent when we attend to the relation of 
 the perforations in the diaphragm for transmitting the aorta and 
 the oesophagus. 
 
 Behind the oesophagus, in the thorax, there are one or two 
 lymphatic glands, which were understood by Vesalius to belong 
 to the oesophagus. What deceived him is an appearance ge- 
 nerally to be observed in these glands. The lymphatics, or 
 the small branches of veins, are generally filled with a black 
 matter, which, extending to the coats of the oesophagus, 
 resemble very much the ducts of the glands going to open into 
 the oesophagus.:): 
 
 The inner coat of the oesophagus shows so very different a 
 texture from that of the stomach, and this difference is marked 
 by so very abrupt a line, as sufficiently to indicate that the 
 
 * Thefe glands fuffer ulceration and fchirrous hardening, and are a terrible 
 caufe of difficulty of fwallowing. 
 
 t Some part of the food lodging in the natural lacunae of the cefophagus, or 
 fome folid body, as the ftone of fruit being received into them, has been the caufe 
 of a fac forming in the pharynx or cefophagus. And it has happened that fuch a 
 fac, gradually and for years enlarging, has formed a bag, into which nearly the 
 whole food, that fhould have paflfed into the ftomach, was received, fo as to opprefs 
 the cefophagus and occafion a lingering death. An example of this is to be feen in 
 my mufeum. 
 
 f Thefe glands in the pofterior mediaftinum are fometimes difeafed, and en- 
 larged fo as to comprefs the cefophagus and to caufe fo permanent an obftrutftion of 
 deglutition as to kill. 
 
28 
 
 OF THE STOMACH. 
 
 fluids poured out from the oesophagus are very distinct from' 
 those ol the stomach, and have no power of digestion. 
 
 SECTION II. 
 
 OF THE STOMACH. 
 
 Seat, Form, Displacement of the Stomach, 
 
 The stomach lies under the margin of the ribs of the left 
 side, and chiefly in the left hypochondrium. Its greater ex- 
 tremity is on the left side, in contact with the diaphragm ; but 
 towards the right, the shelving edge of the horizontal lobe of 
 the liver is betwixt it and the diaphragm. On the lower part it 
 is, by the mesocolon and arch of the colon, divided from the 
 small intestines ; and to the greater extremity the spleen is at- 
 tache d by vessels and by the loose intertexture of the omentum. 
 The stomach may be said to be a conical sac ; the extremities 
 of which being made to approach each other, gives it the 
 curve of a hunter’s horn, and gives occasion to the anatomist, 
 in strict description, to remark these parts ; the superior or 
 cardiac orifice into which the oesophagus expands; the 
 tow tit or pyloric orifice, which leads into the duodenum; 
 the i. ess : r and greater curvatures of the stomach. 
 
 The lesser curvature of the stomach extends from betwixt 
 the two orifices ; includes in its embrace the spine, the aorta, 
 And the small central lobe of the liver, while there is attached 
 to it the lesser omentum. The greater curvature of the sto- 
 mach is the outline ol its distended belly, which rises above 
 the arch of the colon, and is marked by the course of the 
 gastro-epiploic vessels. 
 
 When the stomach is distended the lower orifice is nearly on 
 a level with the upper one ; but when the stomach is allowed 
 to subside, it falls considerably lower ; so that whilst the sto- 
 mach is lying across the abdomen it is also tending obliquely 
 downwards. The ensiform cartilage will be found to present 
 commonly to the middle of the stomach ; and the lower orifice, 
 when in its natural situation, is opposite to the fossa umbili- 
 calis of the liver : the upper orifice is kept constantly in one 
 place from the stricter connection of the oesophagus with the 
 diaphragm. 
 
 Both orifices of the stomach present backward, especially 
 
OF THE STOMACH. 
 
 29 
 
 the upper one, while the lower one is pointed backward and 
 downward. By the distention of the stomach the great arch 
 is extended, the orifices are directed more backward and to- 
 Wards each other, and especially the greater extremity draws 
 upon the oesophagus. By these means I conceive that there is 
 sometimes produced a difficulty of the stomach discharging its 
 contents when greatly distended, the orifices being in a great 
 measure turned from the (Esophagus and duodenum. 
 
 The stomach being liable to frequent varieties in its degree 
 of distention, the natural relation of parts must frequently be 
 altered. It ought to be particularly recollected, that, in the 
 living body the stomach is supported and bound up by the in- 
 testines ; so that the great curve presents : and the broad ante- 
 rior surface which the stomach presents in the dead body is 
 turned directly upward, and the inferior downward.* By the 
 collapsing of the stomach and the consequent falling down of 
 the liver some have explained the sensation of hunger, con- 
 ceiving that the uneasy sensation proceeds from the liver being 
 allowed to hang upon the broad ligament.f From the great 
 simplicity of mechanical explanation, physicians have eagerly 
 indulged in them, but it will in ^general be found that when 
 thev are applied to the explanation of the phenomena of a liv- 
 ing body they are inadmissible. 
 
 OF THE COATS OF THE STOMACH. 
 
 The coats or membranes forming the stomach are, the 
 outer, the muscular, the nervous, the villous, and the three 
 cellular coats. For these subdivisions, however, I see no use, 
 nor are they authorised by the natural appearance of the coats 
 of the stomach. When there is a distinction in texture, 
 structure, or function, and where these lamina can be se- 
 parated, we should consider them as coats ; but a mere inter- 
 mediate tissue of vessels, or the connecting cellular mem- 
 brane, are improperly considered as distinct tunics. 
 
 First coat. — From what has been already said of the 
 peritoneum, it will readily be allowed that the outer coat of the 
 stomach is formed by the peritoneum ; a coat common to all 
 the intestines. Were this not sufficiently evident in itself, it 
 might be ascertained by dissecting the peritoneum from the 
 cardiac orifice of the stomach, where it will be found reflected 
 from the diaphragm. This coat is firm, simple in its texture, 
 
 • Thus the gaftro-epiploic artery prcfents diredtly forward. It has been 
 ■wounded, and bled both into the ftomach and outwardly. I fhould conceive it 
 pofhble in fuch a cafe to tie the artery. 
 
 t Winflow. 
 
30 
 
 OF THE STOMACH. 
 
 having no apparent fibrous texture, and smooth on its outer 
 surface, with many minute vessels. Under the peritoneal 
 coat is the first cellular coat, being in fact a short cellular tissue 
 betwixt the peritoneal coat and the muscular coat. 
 
 Muscular coat. — The muscular coat ol the stomach 
 consists chiefly of two lamina of fibres; less distinct however 
 than those of the (Esophagus, or, in other words, more closely 
 and irregularly connected. One set of fibres runs longitudi- 
 nally, that is, from the one orifice to the other ; the other set 
 runs encircling the stomach ; yet there are such irregularities 
 that it is difficult in every place to recognize the two great and 
 original divisions of fibres ; and on this account in general 
 three strata or series of fibres are described.* For an exam- 
 ple of this apparent irregularity, there comes down upon the 
 fiat side of the stomach an irregular fasciculus of fibres, appa- 
 rently from the longitudinal fibres of the cardiac orifice, and 
 continued from those of the oesophagus, which yet take a 
 course fairly encircling the stomach. They cannot be strictly 
 said tb belong to either the circular or longitudinal series, and 
 in many places those which run longitudinally on the stomach 
 seem to sink and lose themselves amongst the lower fibres, or 
 are reflected into transverse fibres. 
 
 Thtse muscular fibres of the stomach do not run in an un- 
 interrupted course, but split, rejoin, and form a kind of reti- 
 form texture through which the coats beneath are at intervals 
 discernible. This structure would appear to bestow a greater 
 power of contraction on the stomach. The strong longitudinal 
 fibres which are seen upon the oesophagus form the outer strat- 
 um of the muscular coat of the stomach, and they extend 
 from the oesophagus and cardiac orifice in a stellated form 
 along the upper curvature, and downward upon the great 
 end or sacculus ventrkuli. Then we h ive to observe a set of 
 circula r fibres, which forming rings upon the great end, ex- 
 tend tj.ver all the stomach, like the circular fibres of the arte- 
 ries. These fibres do not each encircle the stomach entirely, 
 but while their general direction is circular, they are so inter- 
 woven that no one fasciculus can be followed to a great extent. 
 These are called the transverse fibres or stratum ; while 
 the deepest stratum consists of the continued circular fibres of 
 the oesophagus. These last fibres are strong upon the cardiac 
 orifice, and may be presumed to form a kind of sphincter ; 
 but they diminish as they are remote from the superior orifice. 
 
 * The moil general opinion is, that there are three layers of fibres in the fto- 
 mach. Some defcribd an external longitudinal feries ; a middle tranfverfe ftrat- 
 iim ; and again the internal fibres running longitudinally. See Galeati Acad, dc 
 Bologne. 
 
OF THE STOMACH. 
 
 31 
 
 The lower or pyloric orifice of the stomach, however, is more 
 carefully guarded by muscular fibres ; having in the duplica- 
 ture of the inner coats a distinct circular ring of muscular 
 fibres. 
 
 The cellular tissue, being intermingled with the muscular 
 fibres, connects and strengthens them, and gives the appear- 
 ance of little white lines interwoven with the muscular fibres, 
 and which some have described as small tendons.* There is 
 also to be observed a broad ligamentous band on the two flat 
 surfaces of the stomach towards the pylorus. They are like 
 the bands of the colon, but not nearly so strong or evident. — - 
 They are formed by the denser nature of the cellular tissue, 
 and more intimate union betwixt the first and second coats. 
 
 OF THE ACTION OF THE MUSCULAR COAT. 
 
 Upon considering the weakness of the muscular fibres of the 
 stomach, and the membranous nature of the whole coats, it 
 appears that the general action of the stomach is slow, regular, 
 and by no means a forcible contraction ; not an apparatus for 
 triturating the food, but merely giving motion to its contents. 
 But regarding the extreme sensibility of the stomach, and the 
 gradual and regular succession of action, much will be found 
 that is worthy of attention. It should seem that the morsel is 
 sent down into the oesophagus by a succession of actions, pre- 
 ceded by a perfect relaxation ; and that when the food arrives 
 at the superior orifice of the stomach, by the same relaxation 
 preceding the contraction, the muscular fibres of the upper part 
 of the stomach yield and receive the food compressed by the 
 oesophagus. Attending to the form of the stomach, we see a 
 provision for the reception of the food into the great sacculated 
 fundus on the left extremity. And here we shall find that there 
 is a greater profusion of vessels for the secretion of the juices 
 of the stomach, and a set of muscular fibres, probably relaxing 
 and yielding to receive the food, and excited to action only 
 when the process of digestion has been in part or entirely ac- 
 complished. We have proof that when the food has remained 
 the usual time in the stomach, and comes in succession to be 
 presented at the lower orifice, if the stomach is healthy and the 
 change upon the food perfect, the lower orifice is relaxed, and 
 yields to the contraction of the muscular fibres of the stomach, 
 and the contents of the stomach are passed into the duodenum : 
 but if the food has been of an indigestible nature, it is rejected. 
 The pyloric fibres refuse the necessary relaxation, and by the 
 
 See Winilow, fed:, viii. p. 57. 
 
32 
 
 QF THE STOMACH. 
 
 unnatural excitement an antiperistahic motion is produced, 
 and the matter is again thrown into the great end of the sto- 
 mach, or rejected by vomiting. There is in the natural action 
 of the stomach a stimulus, followed by a regular succession of 
 motion in its fibres, conveying the contents from the upper to 
 the lower orifice of the stomach. Of this excitement and ac- 
 tion we are not conscious ; but when the action is disordered 
 by an unusual excitement, the lower orifice is not unlocked, 
 the action becomes violent (the reverse of what naturally takes 
 place,) and pain or uneasy feelings are produced. Upon this 
 principle may be explained the nausea and vomiting which 
 take place at certain times after eating, when balls or concre- 
 tions are lodged in the stomach. While the food lies in the 
 greater extremity, or in the body of the stomach, and the ball 
 or concretion with it, there is no great excitement ; but when 
 it has suffered the necessary change, and is approaching to ehe 
 pyloric orifice, this part, being as it were a guard upon the in- 
 testines, is suddenly excited, vomiting is produced, and the 
 ball is thrown into its old place in the sacculus or great end. 
 
 This great sensibility, producing effects almost like intelli- 
 gence, is apparent in the more common disorders of the sto- 
 mach. We shall find the meteorismus ventriculi (the great 
 distention of the stomach by flatus) existing for weeks, and 
 yet the food passing in regular course through its orifices. — 
 We shall find very frequently food of difficult digestion laying 
 in the stomach and oppressing its functions for days, while food 
 more recently received may have undergone the actual chan- 
 ges, and have passed through the pylorus into the duodenum. 
 
 Owing to the same slow and successive action of the sto- 
 mach, it often happens that ulceration and schirrus pylorus, or 
 other obstruction of the lower orifice of the stomach, is attend- 
 ed with pain, nausea, and vomiting, only at stated intervals 
 after taking food ; z. e. at the time in which the food should be 
 sent into the intestines in the natural course of action. 
 
 The muscular fibres of the stomach are excited by stimuli, 
 applied, not to their substance, but to the contiguous coats ; 
 and betwixt the delicate surface of the inner coat and the mus- 
 cular fibres there is the strictest sympathy and connection.— 
 The same connection holds in a less intimate degree betwixt 
 the outer coat and the muscular fibres ; for when a part on the 
 surface of the stomach of a living animal is touched with acid 
 or stimulating fluids, the part contracts.* The stomach is con- 
 
 •“ In ea fcde qua tangitur, contrahitur, fulcufque profundus nafcitur, et ruga: ; 
 cibufque aliquando propellitur ut a fede contradla fugiat. Minus tamen quam in- 
 teflina ventriculus irritabilis eft ; hinc emetica fortiora needle eft purgantibus,” — - 
 Haller. 
 
0F THE STOMACH; 
 
 33 
 
 sidered as less irritable than the intestines, because it is alleged 
 that a stronger dose of a medicine is required to prove emetic 
 than to act as a purgative : but we ought to consider that the 
 action thus excited in the intestines is merely an acceleration 
 of their secretions ; but vomiting is the interruption of the usu- 
 al action, requiring such a violent excitement as to invert the 
 natural action. 
 
 But there is something more than this ; as the function of 
 the stomach differs from that of the intestines, so may the 
 quickness of their action. Thus in the stomach a gradual 
 change is to be produced upon the food, requiring time and a 
 slow degree of motion ; but in the intestines there is a greater 
 agitation of their contents, and a quicker action of their coats, 
 to bring the fluids into more general contact with the absorbing 
 surface, and to give greater activity probably to the absorption 
 by the lacteals. I am inclined to think that the stomach is the- 
 most irritable part of the body, and susceptible of the most 
 minute distinctions in the nature of the stimuli applied to it. — 
 The phenomena of the living animal, and experiments in those 
 recently killed, sufficiently prove the contractile powers of the 
 two orifices. Experiments have been made which shew the 
 powers both of the cardiac and of the pyloric orifices in retain- 
 ing the contents of the stomach after the oesophagus and duo- 
 denum have been cut across. The stomach of a rabbit has 
 been squeezed in the hand after cutting the duodenum, with- 
 out any of its contents having escaped and in similar expe- 
 riments, the finger being introduced into the lower orifice of the 
 stomach of an animal yet warm, the fibres of the pylorus were 
 found to contract strongly upon it. Upon forcibly compres- 
 sing the stomach, the food will be made to pass into the oeso- 
 phagus much more readily than into the duodenum ; which is 
 another proof how necessary the natural series of actions is to 
 the relaxation of the pylorus. 
 
 Of vomiting — When there is an unusual or unnatural irri- 
 tation on the stomach, or when it is violently stimulated or op- 
 posed in its natural course of action, the motion becomes inver- 
 ted ; and drawing by sympathy other muscles to its aid, the 
 contents of the stomach are evacuated by vomiting. Thus 
 where the food takes changes inconsistent with healthv diges- 
 tion ; or when solid matters lodge in the stomach ; or when 
 secretions of the duodenum pass into the stomach, or unusual 
 actions are propagated backwards upon the stomach from the 
 upper portion of the canal ; or when emetics are taken, which 
 are unusual stimuli ; or when there is inflammation in the sto- 
 
 * See a paper in the 3d vol.of Sandifort, Thef. 
 
 Vol. IV. E 
 
34 
 
 OF THE STOMACH. 
 
 mach, which, from giving greater sensibility, produces th,e 
 same effect with more violent stimuli ; or when the coats are 
 corroded or ulcerated ; — vomiting is produced. That vomit- 
 ing may be produced by the inverted motion of the stomach 
 and (Esophagus alone, is apparent from experiments upon liv- 
 ing animals, where the abdominal muscles are laid open, and 
 from cases in which the stomach has lain in the thorax, and yet 
 been excited to active vomiting.** Again, it is equally evident 
 that, when the stomach is excited to vomiting, there is consent 
 of the abdominal muscles, by which they are brought into vio- 
 lent and spasmodic action ; not alternating in their action, as 
 in the motion of respiration, but acting synchronously, so as 
 greatly to assist in compressing the stomach : but at the same 
 time, the action of these muscles, however forcible their con- 
 traction, cannot alone cause vomiting ; nor has this action any 
 tendency to produce such an effect on other occasions in which 
 the utmost contraction of the diaphragm and abdominal mus- 
 cles is required to the compression of the viscera. Many have 
 conceived that vomiting is entirely the effect of the action of 
 the abdominal muscles and diaphragm. Such, for example, 
 has been the opinion not only of J. Hunter, but of Duverney, 
 and of M» Chirac in Hist, de l’Acad. des Sciences, 1700. M. 
 Littre opposed this notion, and contended before the Acade- 
 my, that the contraction of the diaphragm was the principal 
 cause of vomiting. M. Lieutaud in 1 752 supported the idea 
 that vomiting is the effect of the action of the stomach. He 
 found, upon dissection, in a patient whose stomach had resist- 
 ed every kind of emetic, that it was greatly distended and be- 
 come insensible ; and concluded that the want of action in the 
 stomach, and consequent loss of the power of vomiting, was a 
 strong proof of the action being the effect of the contraction of 
 the stomach only. There are other more curious instances of 
 disease of the stomach preventing the muscular contraction in 
 any violent degree, and consequently the absence of the usual 
 symptom of vomiting : — an instance of this kind will be seen 
 in Dr. Stark’s work. In my Museum, Surgeons’ Square, 
 there is a preparation of a stomach, in which the walls had be- 
 come so thick that they could no longer suffer contraction by 
 the muscular fibres ; the consequence of which was that, 
 although the inner coat of the stomach was in a raw and ulce- 
 rated state, there was no active vomiting. 
 
 The singultus seems the partial exertion of the sympathy 
 betwixt the upper orifice ol the stomach and the diaphragm, by 
 which a kind of weak spasmodic action is excited in it, but 
 
 See Wepfer de Cicuta Aquatica. p. 68. — Sauvage’s Vomitus, 
 
OF THE STOMACH. 
 
 35 
 
 without a concomitant inverted action in the stomach and oeso- 
 phagus. It is a convulsive and sonorous inspiration, owing to 
 an irritation of the upper orifice of the stomach and oesophagus, 
 but not exactly of that kind which causes inversion of the na- 
 tural actions of the stomach. Thus we have the hoquet des 
 gloutons, the singultus, from some medicines and poisons, 
 from some crude aliment, or even from some foreign body 
 sticking low in the oesophagus, or from inflammation. The 
 borborygmi and rumination seem to be gentler inverted actions 
 of the upper orifice of the stomach and oesophagus, unassisted 
 by any great degree of compression of the stomach by the ab- 
 dominal muscles and diaphragm. 
 
 The full action of vomiting is preceded by inspiration, which 
 seems a provision against the violent excitement of the glottis, 
 and the danger of suffocation from the acrid matter of the sto- 
 mach entering the wind-pipe ; for by this means the expiration 
 and convulsive cough accompanying or immediately following 
 the action of vomiting, frees the larynx from the ejected mat- 
 ter of the stomach. But the action of the diaphragm is farther 
 useful by acting upon the mediastinum, which embraces the 
 oesophagus, and no doubt supports it in this violent action. 
 
 NERVOUS OR VASCULAR COAT OF THE STOMACH. 
 
 What Haller calls the nervous coat, is the cellular structure 
 in which the vessels and nerves of the stomach ramify and di- 
 vide into that degree of minuteness which prepares them for 
 passing into the innermost or villous coat. It may with equal 
 propriety be called the nervous, the vascular, or the great cellu- 
 lar coat.'*' Taking it as the third distinct coat of the stomach, 
 it is connected with the muscular coat by the second cellu- 
 lar coat, and with the villous coat by the third cellular 
 coat. Strictly, however, it is the same cellular membrane, 
 taking here a looser texture to allow of the free interchange 
 and ramification of vessels. When macerated, it swells and 
 becomes like fine cotton, but has firmer and aponeurotic-like 
 filaments intersecting it, and it can be blown up so as to demon- 
 strate its cellular structure.! It is in this coat that anatomists 
 have found small glandular bodies lodged, especially towards 
 the extremities or orifices of the stomach. 
 
 Villous coat. — This is the inner coat, in which the ves- 
 sels are finally distributed and organized to their particular 
 
 * To call it cellular coat, however, would be to confound it with the three ceU 
 iular coats generally enumerated by authors, 
 f Win flow. fedt. viii. p. 64. 
 
36 
 
 OF THE ST0MA6H. 
 
 end. It is of greater extent than the outer coats of the ste? 
 mach ; which necessarily throws it into folds or plicse. These 
 folds take, in different animals, a variety of forms : but they 
 are simple in man ; from the (Esophagus they are continued in 
 a stellated form upon the orifice, but form no valve here. In 
 the body of the stomach they are more irregular, sometimes 
 retiform, and sometimes they form circles or squares, but they 
 have generally a tendency to the longitudinal direction. In 
 the pyloric orifice the villous coat forms a ring, called the valve 
 of the pylorus, which, however, has no resemblance to a valve 
 in its iorm or action. This ring is not formed by the inner 
 coat of the stomach alone, but by the inner stratum of fibres of 
 the muscular coat, the vascular and cellular coats, and the in- 
 ner or villous coat. The effect of all these coats, reflected in- 
 ward at the lower orifice, is to form a tumid and pretty thick 
 „ring, which appears like a perforated circular membrane when 
 the stomach has been inflated and dried ; but in neither state 
 is its direction oblique so as to act as a valve. It seems capa- 
 ble of resisting the egress of the food from the stomach, or the 
 return of the matter from the duodenum, merely by the action 
 of the circular fibres which are included in it. 
 
 On the surface of the inner coat of the stomach, small reti- 
 form rugae and a pile of innumerable villi are observed. But 
 this structure of the stomach has not been so fully examined, 
 and is not so perfectly understood as the analogous appearance 
 in the intestines. Glands are also described as opening upon 
 the inner surface of the stomach : and those who have not been 
 able to see these glands, which are seated in the third cellular 
 coat, yet believe in their existence from analogy ; while others 
 observe foramina toward the upper and lower orifice of the 
 stomach, which they suppose to be the opening or ducts of 
 glands. These, however, which I believe to be merely cryp- 
 tse or follicles, are themselves the secreting surface, and not 
 the ducts of the proper round glandular bodies ; at the same 
 time it must be admitted that disease, as if magnifying and giv- 
 ing size to the structure of the stomach, shews a glandular and 
 tuberculated structure. 
 
 Gastric fluid. There is secreted into the stomach a 
 fluid, which is the chief agent in digestion. The most common 
 opin ion is that it flows from the extreme arteries of the villous 
 coat in general, partly from the mucous cryptas and ducts.* — 
 When pure, it is a pellucid, mucilaginous liquor, a little salt 
 
 * But I fhould confider thefe glands rather as analogous to the mucous follicles 
 »f the oefophagus and lower portion of the inteftine, and merely as lubricating and 
 defending the paffages. 
 
OF THE STOMACH. 
 
 o/ 
 
 and brackish to the taste like most other secretions, and having 
 the power of retarding putrefaction and dissolving the food. — 
 It acts on those substances which are nutritious to the animal, 
 and which are peculiarly adapted to its habits. It has, con- 
 sequently, some variety of properties in different animals 
 
 The secreting powers of the stomach seem so far to accommo- 
 date themselves to the food received into it, that the property 
 of the gastric fluid is altered according to the nature of the 
 food. This affords another argument in favour of a simple 
 diet ; since in a variety of condiments received promiscuously 
 into the stomach, the chance is the greater of some ingredient 
 becoming an offensive load. 
 
 It seems to be a peculiarity in the human stomach, that it 
 has a greater capacity for digesting a variety of animal and ve- 
 getable bodies. But I should at the same time conceive that 
 the natural power of digesting the simple and appropriate food 
 is diminished as the stomach gains the power of dissolving a 
 variety of substances. In other creatures, a sudden change of 
 food is rejected, and the powers of the stomach are found in- 
 capable of acting duly on the aliment, though time so far ac- 
 commodates the gastric fluid to the ingesta that the animali- 
 zation becomes perfect. Mr. Hunter speaks of the power of 
 cattle eating and digesting their secundines.* I have known 
 a cow die from this ; the membranes being found coiled up 
 within the bowels. But the fact is sufficiently ascertained, that 
 the nature of the digestive process may be sogfmr altered that 
 graminivorous animals may be made to eat flesl|> and carni- 
 vorous animals brought to live upon vegetables. This fact 
 throws us back from the simple idea which we should be apt 
 to entertain of the nature of the change produced by digestion, 
 viz. that it is simply chemical. For we see that the nature of 
 the solvent thrown out from the stomach, and its chemical pro- 
 perties, may be changed by an alteration in the action of the 
 coats of the stomach. Thtis we are baffled in our inquiries, 
 and brought back to the consideration of this living propertv, 
 which can so accommodate itself to the nature of the ali- 
 ment. 
 
 The gastric fluid has been collected from the stomachs of 
 animals after death, by sponges which the animal has been 
 made to swallow, or which have been thrust down into its sto- 
 mach, incased in perforated tubes. And, lastly, it has been 
 obtained by exciting the animal to vomiting, when the stomach 
 was empty ; for the secretions of the stomach are then poured 
 
 See OMervations on Digeftion. 
 
38 
 
 OF THE STOMACH. 
 
 out unmixed with food.* Although by these means a fluid 
 may be obtained which may properly be called the succus gas- 
 tricus, yet it must contain a mixture of the saliva, and secre- 
 tions from the glands of the (esophagus and pharynx, with the 
 glandular secretions of the stomach, and the general vascular 
 secretion from the surface of the stomach. It is a fluid, then, 
 upon which the chemist can operate with no hope of a suc- 
 cessful or uniform result. And indeed chemistry seems no 
 farther to assist us in forming an accurate conception of the 
 changes induced upon the fluids in the alimentary canal, than 
 that the more perfect, but still very deficient, experience of 
 the modern chemist successfully combats the speculations of 
 the chemists of former ages. For example; it was formerly 
 supposed that digestion was a fermentation, and that this fer- 
 mentation was communicated and propagated by the gastric 
 juice. It is now found that the gastric juice has properties the 
 reverse of this ; that it prevents the food from taking an acid 
 or putrefactive fermentation ; that it acts by corroding and dis- 
 solving the bodies received into the stomach ; and that it is it- 
 self at the same time converted into a new fluid, distinct in its 
 properties.! It is almost superfluous to observe, that the gas- 
 tric juice has no power of acting upon the coats of the stomach 
 during life ; whether this be owing to the property, in the living 
 fibres, of resistance to the action of the fluid, or that there is a 
 secretion bedewing the surface, which prevents the action, it is 
 not easy to say,^>ut more probably it is owing to the resistance 
 to its actiort inherent in a living part. 
 
 Of digestion. By trituration and mastication, and the 
 union of the saliva with food in the mouth, it is merely pre- 
 pared for the more ready action of the stomach upon it. No 
 farther change is induced upon it than the division of its parts 
 and the forming of a soft pulp. But in the stomach, the first 
 of those changes (probably the material one) is performed, 
 which by a succession ol actions fits the nutritious matter for 
 being received into the circulation of the fluids of the living 
 body, and for becoming a component part of the animal. For 
 now the gastric juice acting on this fluid mass quickly dissolves 
 
 * By Spallanzani. 
 
 f Tlie moft curious fad is that property of the coats of the ftomach, or of the 
 fluids lodging in the coats of the ftomach, by which milk and the ferum of the 
 blood are coagulated. It has been found that a piece of the ftomach will coagulate 
 fix or feven thoufand times its own weight of milk This adtion feems a necefia- 
 ry preparation for digeftion, which fhews us that the moft perfect and finiply nutri- 
 tious fluid is yet improper, without undergoing a change, to he received into the 
 fyftem of veffels. For example ; milk and the white of eggs are firft coagulated, 
 and then pafs through the procefs of digeftion. See J. Hunter, Animal CEconomy, 
 Obfervations on Digeftion. 
 
OF THE STOMACH. 
 
 39 
 
 the digestible part, and entering into union with it produces a 
 new fluid, which has been called chyme. The mass has 
 changed its sensible and chemical properties; it has suffered 
 the full action of the stomach, and by the gradual and succes- 
 sive muscular action of the stomach it is sent into the duode- 
 num. The contents of the stomach consist of air (partly 
 swallowed, partly extricated by chemical change, but still more 
 in all probability by the heat ;) of chyme ; and of a grosser 
 part incapable of becoming nutritious, and the separation of 
 which from the chyme is accomplished by the action ol the 
 canal. Now the stomach being stimulated by fulness, by fla- 
 tus, and more still by the peculiar irritation of the food to 
 which it is natural to suppose its sensibility is adapted, the 
 muscular coat is brought into action, and the contents of the 
 stomach delivered into the duodenum. Here having additional 
 ingredients, it is farther changed in its nature, and approxi- 
 mates more to that of the fluids circulating in the vessels. It 
 is called chyle ; it has become a white milky fluid, which by 
 the property of the living surface of the villous coat is separated 
 from the mass, and absorbed by the lacteal vessels of the in- 
 testines.* 
 
 Hunger and thirst. We are solicited to take food by 
 the uneasy sensation of hunger, and by the anticipation of the 
 voluptuous sating of the appetite, and by the pleasures of the 
 palate. Hunger is considered as the effect of the attrition of 
 the sensible coats of the stomach upon each other bv the 
 peristaltic motion of the stomach and compression of the 
 viscera. This appears to be too mechanical an explanation. 
 If the sensation proceeded merely from such attrition of the 
 coats of the stomach, food received into the stomach would be 
 more likely to aggravate than to assuage the gnawing of hun- 
 ger ; tp excite the action of the stomach would be to excite the 
 appetite, and an irritable stomach would be attended with a 
 voracious desire of food. Something more than mere empti- 
 ness is required to produce hunger. There appears to be a 
 deficiency of the due stimulus to the stomach, and a conse- 
 quent uneasy sensation which is allayed by fulness. Hunger 
 does not appear to be occasioned by stimulus, but by a want of 
 due excitement, by which the irritability of the coats and 
 action of the vessels are as it were suffered to accumulate ; 
 and this tension, and irritation, and fulness of vessels, is re- 
 lieved by the food, which excites the action, draws out the 
 fluids, and gives activity to the system of vessels. 
 
 Thirst is seated in the tongue, fauces, oesophagus, and 
 
 * See farther of the lafteal and abforbent fyftem. 
 
40 
 
 OF THE SMALL INTESTINES. 
 
 stomach. It depends on the state of the secretions which 
 bedew these parts, and arises either from a deficiency of 
 secretion or from an unusually acrid state of it. It would ap- 
 pear to be placed as a monitor calling for the dilution of the 
 fluids by drink, when they have been exhausted by the fatigue 
 of the body and by perspiration, or when the contents of the 
 stomach require a more fluid state, — the more easily to suffer 
 the necessary changes of digestion. 
 
 The cardiac orifice is the chief seat of all sensations of the 
 stomach both natural and unusual, as it is the most sensible 
 part of the stomach. Indeed we might presume this much by 
 turning to the description and plates of the nerves ; for we 
 shall find that this upper part of the stomach is provided in a 
 peculiar manner with nerves, the branches of the par vagum. 
 
 The sympathy of the stomach with the rest of the intestinal 
 canal, the connection of the head and stomach in their affec- 
 tions, the effect of. the disorder of the stomach on the action 
 of the vascular system and of the skin, and the strict consent 
 and dependence betwixt the stomach and diaphragm and lungs, 
 and in a particular manner with the womb, testicle, &c. — and 
 again, the connection of the stomach with the animal (Econo- 
 my, as a whole, — must not escape the attention of the student 
 of medicine. 
 
 SECTION III. 
 
 OF THE SMALL INTESTINES. 
 
 The small intestines are described as that part of the intes- 
 tinal canal which is betwixt the pyloric orifice of the stomach 
 and the valve of the colon. They are reckoned in length at 
 four or five times the height of the body : they form that part 
 of the canal in which the digestion is completed, and the nu- 
 tritious fluids absorbed from the waste of the ingesta. They 
 are commonly subdivided into the duodenum, jejunum, and 
 ileon ; or more simply into the duodenum and intestinum 
 tenue.* 
 
 OF THE DUODENUM. 
 
 The duodenum stands distinguished from the general tract 
 of the small intestines by its shape, connections, and situation. 
 
 * Haller. 
 
OF THE SMALL INTESTINES.. 
 
 41 
 
 It is greatly larger than any other part of the small intestines ; 
 irregularly circular ; more fleshy ; and, although it has fewer 
 plicfe, it is more glandular and more vascular : hut its greatest 
 peculiarity, and that which must convince us of its importance 
 in the animal (economy, and of the necessity of attending to it 
 in disease, is this, that it is the part which receives the biliary 
 and pancreatic ducts, and in which a kind of second stage o£ 
 digestion takes place ; and that by the disorder of these 
 secretions it must be primarily affected. The duodenum takes 
 a course across the spine from the orifice of the stomach un.il 
 it touches the gad- bladder. First it goes in a direction down- 
 ward ; then it passes upward till it touches the gall-bladder ; 
 then making a sudden turn it descends directly near to the 
 right kidney, and is then involved in the lamina of the mesoco- 
 lon ; it then takes a sweep towards the right side, obliquely 
 across the spine, and a little downward ; it afterwards runs 
 behind the head of the pancreas and the great vessels passing to 
 the small intestines betwixt the vena cava and the vena portse ; 
 and then again toward the left of the aorta, but still hound 
 down by the root of the mesocolon.^ This portion of the in- 
 testine receives its name from being usually measured off 
 twelve fingers breadth, or from five to six inches, from the ori- 
 fice of the stomach. I have always preferred, however, a 
 natural and not an arbitrary division, and have considered that 
 
 f iortion of the intestines as duodenum, which is above the 
 ower lamina of the mesocolon, or the point at which it 
 emerges from the stricture of the mesocolon. As in this ex- 
 tent, besides being tied down to the spine by the mesocolon, it 
 has the peritoneum reflected off from it at other points, we 
 have to remark the ligamentum duodeni renale, ligamentum 
 duodeni hepaticum. 
 
 Although we shall presently treat of the coats of the small 
 intestines in general, yet it may not be improper here to ob- 
 serve what are announced as peculiarities in the coats of this 
 first division. The first or peritoneal coat is imperfect, as 
 must already be understood : for it does not invest the whole 
 circumference of the gut ; it ties it down more closely, or it 
 merely contains it in its duplicature, while a greater profusion 
 of cellular membrane accompanies this than the other divisions 
 of the intestines. The muscular coat is stronger than that ot 
 the jejunum and ileon ; the plies formed by the inner coats, 
 
 * How comes it then, feeing the acute turns of this inteftine, that Ruyfch 
 calls it “ Inteftinum digitate, vel inteftinum rectum brcviffimum ?’’ Adverfar. 
 Anat. Decad. II. 
 
 See a good defcription of the duodenum by M. Laurent Bonazzoli, in fhc 
 Tranfadtions of the Academy of Bologna. 
 
 Vol. IV. F 
 
42 
 
 OF THE SMALL INTESTINES- 
 
 smaller than those of the other part of the small intestine, ancl : 
 having more of a glandular structure. At the lower part of 
 the first incurvation of the duodenum, the inner coat forms a 
 particular process like to those which are called valvulse con- 
 niventes ; and in this will be discovered the opening of the 
 biliary duct, within which also the ductus pancreaticus gene- 
 rally opens. 
 
 It is not without some reason that anatomists have consider- 
 ed the duodenum as a second stomach, calling it ventriculus 
 secundus, and succenturiatus ; for there is here performed a 
 change upon the food, converting the chyme, (as they have 
 chosen to call it,) which is formed in the stomach, into perfect 
 chyle. But to suppose that the chyme is perfected in the 
 duodenum, is to suppose the biliary and pancreatic secretions 
 necessary to the formation of chyle ; a point which is not 
 allowed : for many suppose that the bile is merely a stimulus 
 to the intestines, holding a controul over their motions ; others, 
 that it is useful only in separating the chyle from the excre- 
 ment ; or again, that the bile is decomposed, part entering into 
 the composition of the chyle, while the other goes into that of 
 the faeces : it seems to bestow upon them a power of stimulat- 
 ing the intestinal canal in a greater degree ; and as the chyle is 
 formed occasionally without the presence of bile, we may be 
 induced the more readily to allow that the bile does not in the 
 natural actions and relations of the systems enter into the com- 
 position of the chyle. At all events, we see that it is the bile 
 which is the peculiar stimulus of the intestinal canal, and that 
 when interrupted in its discharge from the ducts, the motions 
 of the belly are slow, and costiveness is the consequence. 
 
 We see, then, that at all events there are poured into the 
 duodenum from the liver and pancreas, secretions which have 
 an extensive effect on the system of the viscera ; and we must ' 
 acknowledge that the derangement of these secretions must 
 operate as a very frequent and powerful cause of uneasiness, 
 and that the duodenum must often be the seat of disease and 
 distressing symptoms. We may observe that, from the course 
 of the duodenum, pain in it should be felt under the seventh 
 or eighth rib, passing deep, seeming to be in the seat of the 
 gall-bladder, and stretching towards the right hypochondrium, 
 and to the kidney, and again appearing as if on the loins. 
 We may observe farther, that from the connections of this 
 portion of the intestine, and from the manner in which it is 
 braced down by the mesocolon, spasm, when flatus is con- 
 tained in it, will sometimes produce racking pains. Nay far- 
 ther, when the irregularities of digestion affect the duodenum, 
 and spasm and distention follow ; the distention causes it to 
 
OF THE SMALL INTESTINES. 
 
 43 
 
 press upon the gall-bladder, and the pressure and the excite- 
 ment together cause an irregular and often an immoderate flow 
 of bile, which with the acrid state of the food, produces anxie- 
 ties and increased pain, inverted motion, vomiting, and even 
 cholera.* 
 
 W e must not forget, that the inverted action of the stomach 
 draws quickly after it the inverted motion of the duodenum. 
 It may be of consequence to attend to this in the operation of 
 an emetic, for the stomach will sometimes appear to be dis- 
 charging foul and bilious matter which we naturally may sup- 
 pose to have been lodged in it, but which has actually flowed 
 from the duodenum, or has even come recently from the ducts 
 in consequence of the operation of the vomit, f 
 
 From a defect in the natural degree of the stimulating pow- 
 er of the bile, it will accumulate in the duodenum, occasioning 
 anxiety and loss of appetite, and even congestion of blood and 
 a jaundiced skin ; we may certainly affirm that these at least 
 are often connected. Such accumulation in the duodenum 
 must be attended with a languid action of the whole canal, and 
 inactivity of the abdominal viscera, because the peristaltic mo- 
 tion is begun here in the natural action of the intestines and if 
 its peculiar stimulus be deficient, so must that of the whole sys- 
 tem of the viscera. Hence the necessity of rousing and evacu- 
 ating the whole canal. 
 
 I may farther observe, that it has been the opinion of the 
 most respectable old physicians, those vvhose knowledge of dis- 
 eases has been drawn from an acquaintance with anatomy, 
 from the frequent inspection of dead bodies, and the observa- 
 tion of the symptoms during life, that the study of the diseases 
 connected with the duodenum is the most important which can 
 occupy the attention of the medical enquirer. 
 
 OF THE SMALL INTESTINES IN GENERAL. 
 
 The small intestines, under the name of jejunum and ileon, 
 occupy the space in the middle and lower part of the abdomen, 
 the great mass forming convolutions in the umbilical region. 
 The cylindrical canal of the small intestines is gradually and 
 Imperceptibly diminished in diameter as it is removed from ;he 
 lower orifice of the stomach; so that the terminal on of the 
 ileon in the caput coli is considerably smaller than the duode- 
 num. This tract of the small intestines performs the most im- 
 
 * Indeed vomiting in confequence of concuffion and compreflion upon the whole 
 ■.outents of the abdomen, and in a particular manner on the liver, affords moft 
 powerful means of operating upon the infardfion and remora of the blood in the 
 hepatic fyflem. 
 
 t bee Samlifort, vol. iii. p, 288. See Hoffman. 
 
44 
 
 OF THE SMALL INTESTINES. 
 
 portant function of the chylipoetic viscera (if any can be said 
 to be peculiarly important where the whole is so strictly con- 
 nected ;) for here the food is moved slowly onward through a 
 length of intestine more than four times the length of the bo~ 
 dv,* * * § .and exposed to a surface amazingly extended by the pen- 
 dulous and loose duplicatures of the inner coat. Here the 
 fteces are gradually separated from the chyle, and the chvle 
 adhering to the villi is absorbed and carried into the system of 
 Vessels. 
 
 The jejunum| is the upper portion of the small intestine. 
 Its extent is two- fifths of the whole. Its convolutions are 
 formed in the umbilical region. 
 
 The i L eon lies in the epigastric and ileac regions, surrounds 
 the jejunum on the sides and lower part, and forms three-fifths 
 of the whole extent of the intestine from the mesocolon to the 
 valve of the colon. The coats of the ileon are generally de- 
 scribed as thinner and paler ; the valvular projections of the 
 inner coat less conspicuous: and the mucous glands are appa- 
 rent in the lower portion. The several parts however of this, 
 which we may call the long intestine, J do not preserve a very 
 exact relation in regard to their place in the belly, but in their 
 motions they may be drawn to the right or left, upward or 
 downward. Tiiis however I am convinced takes place in a 
 much less degree than is generally believed. 
 
 There is sometimes found a lusus in the lower part of the 
 ileon before it passes into the colon ; a blind pouch or caecum 
 is, as it were, attached to the ileon resembling the caput coli. I 
 have found this in one instance only. Sometimes there is more 
 than one in the course of the ileon.§ 
 
 MINUTE STRUCTURE OF THE SMALL INTESTINES. 
 
 We have in some measure anticipated the general enumera- 
 tion and character of the coats of the intestines, by what has 
 
 * The whole length of the inteftinal canal is generally eftimated at from fix to 
 feven times the length of the whole body. 
 
 1- So named Iron’ its being more generally empty. Indeed the higher parts of 
 the canal can never he diftended, becaufe the contents pafs flowly and gradually 
 and with little interruption through them ; but they are in a manner accumulated 
 below. 
 
 f We m’ay then fpealc of the firall inteftines in general, meaning the whole 
 tradl from the ftomach to the great inteftine ; the duodenum being the fpace be- 
 twixt the ftomach and the lower lamina of the mefocolon, the long inteftine being 
 the trail extending from the duodenum to the colon. 
 
 § The appendices citcalesof the ileon have given birth to a curious queftion in 
 the pathology of hernia. See “ Hernia ab ilii diverticulo.” Morgagni, Adv. 
 Anat III. “ Hernie formee par 1’appendice dc l’ileon.” Littre, Mem. de 
 l’Acad. Royaie de. Sciences, an 1700; Ruyi'ch, Pulfin, &c. See cafes of anus at 
 the groin in the Mufcum, Surgeons’ Square. 
 
OF THE SMALL INTESTINES. 
 
 45 
 
 been said upon the coats of the stomach ; for we have here to 
 distinguish the four great coats, the peritoneal, the muscular, 
 the vascular, and villous coats. 
 
 THE PERITONEAL COAT AND MESENTERY. 
 
 The peritoneal coat of the small intestines is of the same 
 nature with that of the stomach, liver, spleen, &c. It is a thin, 
 smooth, pellucid membrane. On the surface it has a moisture 
 exuding from its pores ; and it firmly adheres to the muscular 
 fibres beneath. Its transparency makes the muscular fibres, 
 blood-vessels, and lymphatics easily distinguishable ; and when 
 it is dissected or torn up, the longitudinal muscular fibres will 
 be found in general attached to it. Its use is to give a smooth 
 surface and strengthen the intestine, and in a great measure to 
 limit the degree of this distention. 
 
 The peritoneal coat of the intestine is continued and reflect- 
 ed off upon the vessels and nerves which take their course to the 
 intestine : or, what is the same thing, and indeed is the more 
 common description, the two laminae of the peritoneum which 
 form the mesentery, after proceeding from the spine and in- 
 cluding the vessels, nerves, and glands belonging to the tract 
 of the intestine, invest the cylinder of the intestine under the 
 name of peritoneal coat.* The mesentery is composed of 
 membranes, glands, fat, and the several systems of vessels, ar- 
 teries, veins, lacteals, and nerves. As in reality it is a pro- 
 duction of the peritoneum, it may be said to arise from the me- 
 socolon, or the mesocolon from the mesentery, reciprocally. 
 But at present we may trace the mesentery from the root of the 
 mesocolon ; for the jejunum, emerging from under the em- 
 brace of the mesocolon, carries forward the peritoneum with 
 it ; and the laminae of the peritoneum, meeting behind the gut, 
 include the vessels which pass to it and form the mesentery. 
 This connection of the small intestines by means of the pro- 
 longation ol the peritoneum, while it allows a considerable la- 
 titude of motion, preserves the convolution in their relations, 
 and prevents them from being twisted or involved. But it is 
 by the walls of the abdomen that the intestines as well as the 
 more solid viscera are supported ; for when the bowels escape 
 by a wound, a portion ot an intestine will hang down upon the 
 thigh, unrestrained by the connection with the mesentery. 
 
 1 he mesentery begins at the last turn of the duodenum, or 
 beginning of the jejunum. Its root runs obliquely from left 
 to right across the spine. Here it has no great extent ; but as 
 
 •See Plate I. 5.6. 7.8. 
 
48 
 
 OF THE SMALL INTESTINES. 
 
 Vf 
 
 readily yield to the relaxation that follows, as in the natural 
 contraction,) or when there is a mechanical and obstinate in- 
 terruption to the contents of the bowels ; then i? the natural 
 action reversed. This antiperistaltic motion must arise thus ; 
 a portion of the intestine being constricted, and not yielding to 
 the contraction which in the natural action of the gut should 
 follow in order, the motion of the gut must be stationary tor a 
 time, until the part above is again relaxed ; when, the con- 
 tents of the intestine finding a free passage upwards, and that 
 portion contracting and propelling the matter still upwards and 
 retrograde, (since it is opposed by the contraction below,) a 
 series of retrograde or antiperistaltic motions are produced. 
 The course of the action is changed ; the contraction of the 
 gut is not followed by the dilatation of the part below, but by 
 that of the part above. By this means the matter of the lower 
 portion of the intestinal canal is carried into the upper part, 
 and there acting as an unusual stimulus it aggravates and per- 
 petuates the unnatural action. Nav, from experiments it ap- 
 pears that a permanent irritation will cause an accelerated mo- 
 tion in both directions, that from the point stimulated there 
 will proceed downward the regular series of contractions and 
 dilatations, while the motion is sent upwards and retrograde 
 from the same point of the intestine toward the stomach.* 
 And this observation, the exhibition of medicine and the dis- 
 eases of the intestines confirm. But farther we may observe, 
 that the food is not uniformly moved downward ; it is shifted 
 and agitated by an occasional retrograde motion thus : 
 
 • Haller, loc. cit. Exper. 424. 
 
OF THE SMALL INTESTINES* 
 
 49 
 
 The portion of the intestine included under A contracts and 
 sends its contents into B. B contracting sends its fluid con- 
 tents in part backward into A, but in a greater portion into C. 
 While the contents of the middle portion are sent into the 
 lower part in a greater proportion than into the higher division, 
 the tendency of the food will be in its natural course, down- 
 ward ; whilst at the same time it suffers an alternate motion 
 backward and forward ; so that it is more extensively applied 
 to the absorbing surface of the intestines. 
 
 The stimulus to the intestines is matter applied to their inner 
 coat ; and although there is much sympathy in the whole 
 canal, yet unless there be matter within a portion of the canal, 
 that particular part has little action. Accordingly, when there 
 is obstruction to the course of the aliment, by whatever cause 
 it may be produced, the portion below becomes shrunk and 
 pale, and free from the effects of inflammation ; while that 
 stimulated by the food, being in a high state of excitement, 
 irritated by the presence of matter which it is unable to send 
 forward, evacuated only partially by an unnatural and highly 
 excited retrograde action, it becomes large, thick in its coats, 
 strong in its muscular fibres, and greatly inflamed, till it ter- 
 minate at last in gangrene.^ 
 
 The unusual excitement of the muscular fibres produces a 
 very curious effect in the intus-susceptio, or the slipping of one 
 portion of the gut within another. This maybe done by ap- 
 plying acrid matter to the intestines of living animals ; and I 
 have no doubt that it has been produced by giving purges too 
 strong and stimulating in cases of obstruction of the bowels. 
 By the contractions of the muscular coat greatly excited, the 
 intestine is not only diminished in diameter so as to resemble 
 an earth-worm, f but in length also. This great contraction of 
 the outer coats accumulates the vascular and villous coat as if 
 into a heap ; which from the compression of the muscular coat 
 is lorced into the neighbouring relaxed portion. This first step 
 leads only to a succession of actions ; for the fibres of the re- 
 laxed or uncontracted part, sensible to the presence of this ac- 
 cumulated and turgid villous coat, contracts in succession so as 
 to draw a part of the contracted gut within the relaxed portion. 
 If the irritation is done away or ceases quickly, as in the ex- 
 
 * Haguenot gives an experiment illuftrating the caufe of ileus. He tied a liga- 
 ture about the intcftine of a cat, and found no antiperiftaltic motion excited. 
 This is not wonderful ; it is the excitement arifing from matter within the gut, to 
 which there is no exit, and not the ftridture of it, which is the caufe of the violent 
 fymptocns — A cafe in the Mufeum will give the young ftudent a corredt judgment 
 on this fuhject. 
 
 t See Haller’s Experiments ; and “ DilTedlions of the Atrophia Ablactatorum 
 with plates ; by Dr. Cheyne. 
 
 Vol. IV. G 
 
50 
 
 01' THE SMALL INTESTINES. 
 
 periments on animals, another turn of the intestine coming 
 into play distends this, and undoes the intus-susceptio. But 
 if the cause continues, the intus-susceptio is continued ; the 
 included part of the gut is farther forced into the other. By 
 these means the vessels going to the included part are inter- 
 rupted ; the villous coat swells more and more ; and several 
 ieet of the upper portion of the intestine is often in this wa)' 
 swallowed down. It is not however in the natural course 
 downward that this preternatural action always proceeds ; for, 
 as the excitement is violent and unlike the usual stimulus of 
 food, and as we know that an unusual excitement is very apt 
 to cause an inverted action, it often happens that the intus- 
 susception is formed by the lower portion of the gut included 
 in the upper part. 
 
 VASCULAR COAT. 
 
 This third coat of the intestines, or what is commonly called 
 the nervous coat, is a stratum of cellular membrane in which 
 the vessels of the gut are distributed. It might with equal 
 propriety be called the cellular coat ; and is indeed what some 
 anatomists have called the third cellular coat. By inverting 
 the gut and blowing strongly into it, the peritoneal coat cracks 
 and allows the air to escape into this coat ; which then swells 
 out, demonstrating its structure to be completely cellular. ^ 
 Its use evidently is to suffer the arteries, veins, and lymphatics 
 to be distributed to such a degree of minuteness as to prepare 
 them for reflection into the last and innermost coat, and for en- 
 tering into the structure of the villi : for they come to the ex- 
 tremity of the mesentery as considerable branches, but forming 
 in this coat a uniform texture of vessels, their extreme 
 branches are finally distributed to the inner coat. This is the 
 coat in which, in some parts of the intestines, little glands of 
 criptas are lodged. 
 
 VILLOUS COAT. 
 
 The most curious part of the structure of the intestines is 
 the villous or inner coat ; for by its organization is the chyle 
 separated from the general mass of matter in the bowels, and 
 carried into the system of vessels. To this all we have been 
 describing is merely subservient. 
 
 The villous coat has a soft fleecy surface ; and being of 
 
 * An experiment, to which Albinus attaches much importance. See alfo, in 
 the Acad, de Bologna, a paper by Mr. D. G. Galeati on the flelhy coat of the 
 ftomach and inteftine6. 
 
OF THE SMALL INTESTINES. 
 
 51 
 
 greater extent than the other and more outward coats, it is 
 thrown into circular plaits which hang into the intestine, taking 
 a valvular form. They have the name of valvule conni- 
 ventes. Some of them go quite round the inside of the in- 
 testine ; others only in part. They are of larger or smaller 
 extent in different parts of the canal : for example ; they begin 
 a very little way from the lower orifice of the stomach irregu- 
 larly, and tending to the longitudinal direction ; further down 
 they become broader, more numerous, and nearly parallel ; 
 they are of greater length, and more frequent in the lower 
 part of the duodenum and upper part of the jejunum. — > 
 These valvular projections have their edges quite loose and 
 floating in the canal ; and from this it is evident that they can 
 have no valvular action. Their use is to increase the surface 
 exposed to the aliment ; to enlarge the absorbing surface ; and 
 at the same time to give to it such an irregularity that the chyle 
 may lodge in it and be detained.* Into the structure of these 
 plicae of the villous coat, the vascular or cellular coat enters, 
 and generally in the duplicature a small arterial and venous 
 trunk will be observed to run. That these plicae are formed 
 chiefly by the laxity of the connection and the greater relative 
 extent of the inner coat, is apparent upon inverting the gut, 
 and insinuating a blow-pipe under it, for then you may distend 
 the cellular substance of the vascular coat so as entirely to do 
 away the valvulae conniventes. 
 
 The pile or lanuginous surface from which this coat has its 
 name, is to be seen only by a very narrow inspection, or with 
 the magnifying glass. It is owing to innumerable small fila- 
 ments which project from the surface, like hairs at first view, 
 but of a flat or rounded figure as the state of fulness and ex- 
 citement or depletion shows them. They consist (as appears 
 by the microscope) of an artery and vein, and lacteal or ab- 
 sorbing vessels, and to these we may surely add the extremity 
 of the nerve. They have a cellular structure ; they are ex- 
 quisitely sensible ; and, when stimulated by the presence of 
 fluids in the intestines, are erected, and absorb the chyle. 
 They are the extremities of the lacteal absorbing system, and 
 their structure would seem to be subservient to the absorption 
 by the mouth of the lacteal vessel.f 
 
 But the surface of this coat is not only an absorbing one, it 
 
 * “ Superficies intern se hujus tunicx ad menfuram geometricam, aliquoties in- 
 tegumentorum communium fuperficiem amphtudine fuperat.” Soemmering, vol. 
 vi.p. a 95 . 
 
 t See further of their ftru&ure under the title of the Lacteal and Lym- 
 phatic System, in this volume, where the fubjeft of abforption and the 
 itriufture of the villi is treated. 
 
52 
 
 OF THE GREAT INTESTINES. 
 
 also pours out a secretion : and indeed it is as a secreting sur- 
 face, upon wh;ch medicines can act, that it is to us one of the 
 most power lul means of acting upon the system in disease. 
 The fluid which is supplied by the surface of the intestines is 
 called the liquor intericus ; a watery and semipellucid fluid, 
 resembling the gastric fluid. This fluid, physiologists have 
 affected to distinguish irom the mucous secretion of the glands 
 of the inner surlace of the intestines ; but it is impossible te 
 procure them separate.* 
 
 GLANDS. 
 
 Anatomists have observed small mucous glands seated in 
 the cellular membrane, of the intestines, f the ducts of w'hich 
 they describe as opening on the villous surlace oi the intestines. 
 They are seen as little opaque spots, when the intestine is cut 
 in its length and held betwixt the eye and the light. They 
 have been chiefly observed in the duodenum ; few of them in 
 the general tract of the small intestines. Little collections or 
 agmina are observed, which increase in frequency toward the 
 extremity of the ileon. It is natural to suppose that as the 
 contents of the intestines become in their descent more acrid 
 and stimulating, there will be a more copious secretion of mu- 
 cus in the lower intestines lor the defence of the villous coat. 
 
 SECTION IV. 
 
 OF THE GREAT INTESTINES. 
 
 The great intestines form that part of the intestinal canal 
 which is betwixt the extremity of the ileon and the anus. 
 They differ essentially from the small intestines in their size^ 
 form, and general character ; and in the texture, or at least in 
 the thickness of their coats. 
 
 The great intestine, beginning on the right side of the belly, 
 
 * It lias been fuppbfed that the fluids excreted from the furface of the inteflines 
 were iurnifhed by very minute foramina (which are vifible by particular prepara- 
 tion) in the interfticc6 ot the villi. See the letter of Malpighi to the Royal So- 
 ciety of London on the Fores of the Stomach ; and the paper by M. Galeati in the 
 Bologna tranfadtions on the Inner Coat, which he calls the Cribriform Coat. 
 Thefe pores, according to Galeati, are vifible through the whole tradl of the 
 canal, and particularly in the great inteflines. 
 
 f Peyruf. Biblio. Manget. Brunnerus de glanaulis duodeni. Wepfer, Mor- 
 gagni, &c. Thefe he fuppofed additional pancreatic glands- 
 
OF THE GREAT INTESTINES. 
 
 53 
 
 rises before the kidney ; passes across the upper part of the 
 belly, under the liver, and before or under the stomach.* * * § 
 Then making a sudden angle from under the stomach and 
 spleen,f h descends into the left iliac region. Here, making a 
 remarkable turn and convolution, it descends into the pelvis 
 by a curve running in the hollow of the sacrum. 
 
 The great intestines are accounted to be about seven feet in 
 length, and to bear a relation to the small intestines as five to 
 twenty- five. 
 
 The natural division of this portion of the intestine is into 
 the coecum, colon, and rectum.^ 
 
 VALVULA COLI. 
 
 The extremity of the intestinum ileon enters as it were into 
 the side of the great intestine at an angle.§ And here there 
 is a valvular apparatus formed by the inner membrane of the 
 gut, which, more than any other circumstance, marks the 
 distinction betwixt the small and great intestines ; for as the 
 effect of this valve is to prevent the regurgitation of the feces 
 into the small intestines, it marks sufficiently the nature of the 
 change produced on the ingesta in their passage through the 
 small intestine, and how unfit in their acrid and putrescent 
 state they are to be longer allowed lodgment there. 
 
 Upon opening the caput coli, or lower part of the colon, on 
 the right side, and examining the opening of the ileon into it, 
 we see a slit formed betwixt two soft tumid plicse of the inner 
 membrane of the gut : the one of these is superior ; the other 
 inferior. They are soft, and moveable, and seem scarcely 
 calculated for a valvular action. But there is little doubt that 
 when the great gut is distended or in action, they are calculated 
 to resist the retrograde passage of the feces into the ileon. In 
 the oblong opening of the ileon, and in the broadness of the 
 valvular membranes, there is considerable variety. The 
 superior valve is transverse, smaller and narrower than the 
 lower one ; the lower one is longer, and takes a more exten- 
 sive curve : and sometimes the lower one is so remarkably 
 larger than the upper valve, that it gives a great degree of ob- 
 liquity to the insertion of the ileon into the colon, so as to ap- 
 
 * This turn cf the colon from the right acrofs the belly is flexura prima, fuperior 
 dextra hepatica Soemmering. 
 
 f Flexura fecunda, fuperior finiftra lienalis. 
 
 | Some authors divide the great intefline into fix parts, enumerating the coecum ; 
 pars vermiformis ; the right ; the left ; and the tranfverfe colon ; and the laft part 
 or redlum. 
 
 § Of the entering of the final! intefline into the greater, fee Morgagni Ad- 
 verfar. iii. Ahimad. xi. 
 
OF THE GREAT INTESTINES. 
 
 5 ^ 
 
 proach to that structure which we see in the entrance of ducts, 
 as the biliary duct into the intestine, or the ureter into the 
 bladder. At the extremities of these valves they coalesce and 
 run into the common transverse folds of the colon : and this is 
 what Morgagni has called the fraena. At this place of union 
 of the ileon and colon the longitudinal muscular fibres of the 
 ileon are mingled and confounded with the circular fibres of the 
 colon.* The circular muscular fibres certainly enter so far 
 into the composition of the valve, that they embrace the mar- 
 gin, and, by contracting during life, must make the experi- 
 ments on the action of this valve in the dead body less decisive 
 than they would be were we certain that this valve acts on 
 principles strictly mechanical. 
 
 The discovery of the valve of the colon, and which, from 
 its action in guarding the ileon, might rather be called the valve 
 of the ileon, has been claimed or attributed to many anato- 
 mists, chiefly to Varolius, Bauhin, and Tulpius ; and it some- 
 times receives the name of the two latter anatomists. 
 
 C CECUM. 
 
 We have seen that the ileon is inserted into the side of the 
 colon : now that portion of the gut which is below this union 
 of the ileon is a round or slightly conical sac, from two to three 
 inches in length. It is attached by cellular membrane to the 
 iliacus internus muscle. It is not a regular sac, but is divided 
 into large cells like those in the rest of the colon, and has con- 
 siderable varieties in different subjects. 
 
 PROCESSUS, SEU APPENDIX VERMIFORMIS. 
 
 There is appended to the crecum a small gut, also blind ; 
 but bearing no relation in size or in figure to any part of the in- 
 testinal canal. This gut, from its smallness and twisted ap- 
 pearance, like the writhing of an earthworm, has received the 
 name of vermiformis. It is somewhat wider at the connec- 
 tion with the great intestine, and stands off obliquely, so that 
 sometimes its inner membrane takes the form of a valve.f It 
 scarcely ever is found containing faeces, but only a mucus ex- 
 creted from its glands. In the foetus the appendix vermiformis 
 is comparatively much larger, its base wider ; upon the whole, 
 more conical, and containing meconium ; and in the young 
 child it often contains faeces. 
 
 * Window. 
 
 t Morgagni. M. I.aur. Bonazzoli in the Acad, of Bologn#. 
 
OF THE GREAT INTESTINES. 
 
 
 GREAT DIVISIONS OE THE COLON. 
 
 The great divisions of the colon (which I conceive it neces- 
 sary to enumerate, chiefly with a view to the accurate descrip- 
 tion of the seat of disease) are these: First, the right divi- 
 sion of the colon rises irorn the insertion of the ileon, and 
 from that part of the great intestine which is tied down by the 
 peritoneum and cellular membrane, and ascends on the right 
 side of the small intestines, until it gets under the margin of 
 the liver, and in contact with the gall-bladder. Of course, 
 this part will be found to take some considerable varieties in 
 its form, depending upon its state of distention. 
 
 THE TRANSVERSE COLON.^ 
 
 The transverse colon is that part of the great intestine which 
 often takes a course directly across the belly, but which gene- 
 rally forms an arch before or immediately under the stomach. 
 When this part of the colon however is much distended, being 
 at the same time held down by the mesocolon, its angular 
 turns reach under the umbilicus, nay even to the pelvis. For 
 the varieties in the situation of this intestine and the viscera in 
 general, see Morgagni Adversar. Anat. ii. Animadver. ii. 
 
 The left or descending colon is short : for between the 
 point, where the colon begins to bend down on the left side, and 
 those violent turns which it takes before terminating in the 
 rectum, is but a short space. It is here attached to the dia- 
 phragm and psoas muscle. 
 
 The sigmoid flexure of the colonf is formed by a narrow- 
 ing and contraction, and closer adhesion of the gut to the 
 loins below the left kidney, and to the cup of the ileum by the 
 peritoneum, which seems to have the effect of throwing it into 
 some sudden convolutions. The colon then terminates in the 
 rectum. 
 
 peculiarities in the c6lon distinguishing it from 
 the small intestines. 
 
 The coats of the great intestines are the same in number and 
 in structure with those of the small intestines ; but they are 
 thinner and more difficult to be separated by dissection. The 
 villi of the inner coat are smaller ; the mucous glands or folli- 
 
 * Colo v traksversdm. Zona Colt. 
 
 From its refembling the Roman S. 
 
56 
 
 OF THE GREAT INTESTINES. 
 
 cules are sometimes very distinct ; and, lastly, the muscular 
 fibres have some peculiarities in their arrangement. The 
 most characteristic distinction in the general appearance of the 
 great and small intestines, is the notched and cellular appear- 
 ance of the former. The cells of the colon, being formed be- 
 twixt the ligamentous-like stripes which run in the length of 
 the gut, have a regular three-fold order. These cells give 
 lodgment to the feces ; retain the matter; and prevent its rapid 
 descent or motion to the rectum. Here the fluids are still more 
 exhausted, and the feces take often the form of these cells. 
 When the great intestines are torpid, and inert in their mo- 
 tions, the faeces remain too long in the cells of the colon, and 
 become hard balls or scibulse. But when in this state of 
 costiveness the intestines are excited by medicine, not only is 
 the peristaltic motion of the intestines increased, but the ves- 
 sels pour out their secretions, loosening and dissolving the 
 scibufe.* 
 
 MUSCULAR COAT. 
 
 The ligamentous-like bands of the colon form three fasciculi 
 running in the length of the gut : one of these, obscured by 
 the adhesion of the omentum, is not seen without dissection ; 
 and the other is concealed bv the mesocolon. f These bands are 
 formed by the longitudinal fibres of the gut, being concentrated 
 into fasciculi, and not uniformly spread over the general sur- 
 face, as in the small intestines : and being at the same time 
 more firmly connected with the peritoneal coat, they give the 
 appearance outwardly of ligament more than of muscular 
 fibres.^ The inner or circular muscular fibres of the great in- 
 testines are like those of the small intestines, uniformly spread 
 over their surface, and are stronger than those of the latter. 
 
 Faeces. That the food digested, in part absorbed, and its 
 fluids exhausted, becomes feces in its progress through the in- 
 testines, will be universally allowed : but how much of the 
 excrementitious matter in the colon is a human secretion is not 
 equally attended to. Men who have died of want, and men. 
 exhausted by long fever or other distress, and who did not or 
 were incapable of taking nourishment, have had discharges of 
 feces ; and feces are found in their intestines upon dissection. 
 
 * See note of the pores of the inteflines. 
 
 f Stratum liberum, ftratum omentale & tertium Mefocolicum. Soemmer. § 
 ccxxx. 
 
 } See Morgagni. See alfo Galeati on the flefhy coat of the ftomach and intes- 
 tines, in the Memoirs of the Acad, of Bologna. 
 
OF THE GREAT INTESTINES, 
 
 of 
 
 The foetus has the intestines filled with meconium.'* The 
 effect of a purge is not only to stimulate the intestines to throw 
 ofF their contents, but the inner secreting surfaces pour out 
 their fluids. The surface of the intestines is not only calcu- 
 lated to absorb nourishment, and capable of throwing off the 
 fluids from the system, like the kidneys in secreting the urine, 
 but it seems destined in a particular manner to carry off the 
 earthy parts of the body, which in the circle of actions is al- 
 ternately undergoing renovation and de'cay. Thus the fieces 
 consist of the food and chvme, which has not been converted 
 into chyle and absorbed, but which has been decomposed, and 
 has entered into new combinations ; it is united to part of the 
 bile, which has also been decomposed ; to the secretion of the 
 pancreas ; to the secretion of the immense extent of surface of 
 the intestines ; and many substances are found in the excre- 
 ments which did not exist in the food. From the same sources 
 (viz. the secretions poured into the intestinal canal, or directly 
 from its surface) are formed concretions, often of an enor- 
 mous size ; often distinct from the nature of the more common 
 biliary secretions ;f and sometimes these earthy deposits enter- 
 ing into the composition of the fasces, give to them a stony 
 hardness. 
 
 RECTUM. 
 
 The rectum forms the last division of the great intestines j. 
 and I know no better proof of the impracticability of altering 
 the names in anatomy than this, that anatomists have, in almost 
 every age, insisted on the impropriety of calling this gut, 
 which answers in its shape to the curve of the sacrum, a 
 straight gut ; and yet always, and to the present day, it is 
 rectum. 
 
 From the last turns of the colon, called sigmoid, the gut is 
 continued over the promontory of the last vertebra and sacrum 
 (a little to the left side,) and falls into the pelvis. It runs 
 down, in a l curved direction, betwixt the sacrum and bladder 
 of urine. In the upper part it is covered by the peritoneum, 
 and has its fatty appendages like the colon, but less regular ; 
 and sometimes the fat merely deposited under the peritoneal 
 coat. It is tied down by the peritoneum, in form of meso- 
 rectum ; but, deeper in the pelvis, it loses the peritoneum 
 (which, as w r e have said, is reflected up upon the back of the 
 bladder, and forms here lateral folds,) and the rectum is c©n- 
 
 * See Haller Phis. Elem. tom. vii. feet. 6. § 3. 
 
 f Haller loc. cit. 
 
 Vol. IV. H 
 
58 
 
 OF THE LIVER. 
 
 nected with the lower part of the bladder and vesiculse semi- 
 nales by cellular membrane. In women, the muscular fibres of 
 the rectum and vagina are intimately connected.^ 
 
 The muscular coat of the rectum is particularly strong. The 
 fleshy bands of the colon, spreading out, are continued down 
 upon the rectum in an uniform sheath of external longitudinal 
 fibres. The circular fibres of this part of the gut are also par- 
 ticularly strong; and towards the extremity, appearing in still 
 stronger fasciculi, they obtain the name of sphincter, of which- 
 three are enumerated : and this, to distinguish it from the 
 others, is called the intestinal or orbicular sphincter. 
 
 The internal coat of the rectum does not deserve the name 
 of villous, nor of papillaris. Its surface is smooth, and there 
 are often distinctly seen little foramina like the mouths of ducts 
 or follicules, in part the source of the mucous discharge, which 
 is sometimes poured out from this gut. Towards the anus the 
 fold becomes longitudinal, and terminates in the notched-lik.e 
 irregularities of the margin. 
 
 
 GHAP. III. 
 
 OF THE SOLID OR GLANDULAR VISCERA OF 
 THE ABDOMEN. 
 
 SECTION I. 
 
 OF THE LIVER. 
 
 OF ITS SEAT, AND CONNECTIONS BY LIGAMENTS, AND OF 
 THE DIVISIONS APPARENT ON ITS SURFACE. 
 
 Our attention is now naturally drawn to the liver, as it 
 hoids, in so eminent a degree, the sovereignty over the mo- 
 tions of the intestinal canal, and as it is so strictly connected 
 
 * WinfloW: 
 
OF THE LIVER. 
 
 59 
 
 with it by its system of vessels, and by its functions. The 
 liver is the largest viscus in the body, and as in its size and 
 proportion to the whole body it is great, so are its connections 
 in other respects with the whole system very intimate. This is 
 particularly evident in the diseases of the liver, and was the 
 cause of the ancients ascribing to it so eminent a place in the 
 ceconomy. 
 
 Function of the liver. — In all ages authors have paid 
 particular attention to the liver, and have exercised their inge- 
 nuity in giving various explanations of its function. The an- 
 cients made it the supreme director of the animal system. 
 They supposed that they could trace the nutritious fluids of the 
 intestines through the meseraic veins into the porta and into the 
 liver, and that it was there concocted into blood. From the 
 liver to the right side of the heart they found the cava hepatica, 
 carrying this blood formed in the liver to the centre of the 
 system : and through the veins they supposed the blood to be 
 carried to the remote part of the body. 
 
 The liver is the largest glandular body of the whole system. 
 Its use is to secrete the bile, which is carried into the intestines, 
 and performs there an essential action on the food while passing 
 in the tract of the intestines. 
 
 Seat of the liver. — The liver is seated in the upper 
 part of the abdomen, under the margin of the ribs, and to- 
 wards the right side, or in the right hypochondrium. In the 
 foetus it occupies more of the left side than it does in the adult. 
 Indeed it is nearly equally balanced in the foetus, but the older 
 the animal (or at least for the five first years) the greater will be 
 the proportion of it found lodged in the right side. 
 
 Without going into the more minute subdivisions of this 
 viscus, we may observe, that it is more uniform, and smooth, 
 and convex on the upper surface ; on the lower, more irregu- 
 larly concave. Its upper surface is applied in close contact to 
 the concavity of the diaphragm, and in the foetus its margin is 
 in contact with the abdominal muscles, because it falls lower 
 than the margin of the ribs. Its lower and concave surface 
 receives the convexity of the stomach, duodenum, and colon. 
 In a healthy adult subject the liver does not extend from under 
 the margin of the ribs, unless near the pit of the stomach, but 
 in the foetus and child it is much otherwise. In a foetus of the 
 third and fourth month the liver almost fills the belly; it 
 reaches to the navel, covers the stomach, and is in contact 
 with the spleen. After the seventh month other parts grow 
 with a greater rapidity in proportion. Indeed some have af- 
 firmed, that the liver, or at least the left lobe, actually de- 
 
m 
 
 ®F THK LITER. 
 
 creases towards the time of birth.* But from this time to the 
 advance to manhood the chest becomes deeper ; the sternum 
 is prolonged ; and the diaphragm becomes more concave ; so 
 that the liver retires under the margin of the ribs, and its mar- 
 gin on the left side in the adult reaches no farther than to the 
 (Esophagus. When however the liver becomes schirrous and 
 enlarged, its hard margin comes down so as to be felt through 
 the abdominal paries under the border ofthe'chest. This en- 
 largement of the liver, and consequent descent of its margin, 
 is to be felt more easily by grasping the integuments of the 
 belly, as if you expected to lift up the acute edge of the liver, 
 than by pressing with the point of the finger. By this means 
 we shall be sensible of the elasticity and softness below the 
 liver, and of the resistance and firmness of the margin of it. 
 The ply sician, however, should not forget, that the depres- 
 sion of the diaphragm, and consequent protrusion of the liver 
 by disease in the thorax, gives the feeling of an enlargement 
 and hardening of the liver. The left great division of the liver 
 is perhaps as often diseased and enlarged as the right, in which 
 case it is more difficult to ascertain it by examination, and it 
 must be learnt from other circumstances besides the actual 
 touch. 
 
 Neither should a physician be ignorant, that by suppuration 
 in the lungs, and consequent rising of the diaphragm, the 
 liver is elevated considerably, so as to retire farther under the 
 protection of the false ribs.f 
 
 M. Portal, by running stilettos into the belly of the subject 
 as it lay upon the table, or was raised into the perpendicular 
 posture, found that in the latter posture the liver shifted two 
 inches. But it is almost superfluous to remark concerning 
 these experiments, that they are' by no means conclusive. ■ In 
 the dead body, the abdominal muscles are relaxed ; they yield 
 to the weight of the- viscera ; and the diaphragm is pulled 
 down by the weight of the abdominal viscera. The margin 
 of the liver necessarily falls lower, but in the living body 
 there is a close and perfect bracing of every part by the abdo- 
 minal muscles ; tlu-y do not yield, and very little if any altera- 
 tion can take place in the situation of the viscera. 
 
 It must be observed, however, that a considerable motion 
 of the liver is the effect of respiration, and of the action of the 
 diaphragm. This motion is chiefly on the back part of the 
 right lobe of the liver. The left lobe being more on the centre 
 of the belly, and consequently opposite to the centre and less 
 
 9 M. Porta], Acad, de Sciences, 1773. 
 
 •j: T hefe obfervations in detail belong to another place. 
 
GF THE LIVER. 
 
 6i 
 
 moveable part of the diaphragm, it is less affected by the respi- 
 ration than the larger right lobe. 
 
 LIGAMENTS OF THE LIVER. 
 
 The peritoneum is reflected in such a manner from the 
 neighbouring parts upon the liver as to form membranes re- 
 ceiving the name of ligaments. It has been explained, how- 
 ever, that these are not the sole support of this viscus ; and 
 that the compression of the surrounding abdominal muscles is 
 the principal support o-f the liver, as it is of the other viscera. 
 
 The broad ligament* of the liver is formed by two la- 
 mina of the peritoneum, connected by their cellular mem- 
 brane, descending from the middle of the diaphragm and 
 point of the sternum to the convex upper surface or dorsumf 
 of the liver. This ligament is broadest where it passes down 
 from the point of the sternum to the fossa umbilicalis ; but as 
 it retreats backward it becomes narrower, and is united to the 
 coronary ligament near the passage of the vena cava. This 
 circumstance, with the curve which it naturally takes on the 
 surface of the liver, gives it the shape of the falx, as it is 
 formed by the dura mater. 
 
 ligamentum teres. The round ligament of the liver is 
 the firmer ligamentous-like cord, which may be traced from 
 the umbilicus along the peritoneum into the duplicature of the 
 broad ligament, and into the fossa umbilicalis. It is formed 
 by the degenerated coats of the great vein which brings the 
 florid blood from the placenta into the veins of the liver, and 
 from thence conveys it into the right side of the heart of the 
 
 fcetus.f 
 
 The coronary ligament of the liver is formed in conse- 
 quence of the attachment of the liver to the diaphragm. The 
 attachment is of course surrounded by the inflection of the 
 peritoneum from the diaphragm to the liver. It is called the 
 coronary ligament, though it has been observed, that this 
 attachment of the liver is not circular, but of an oval, and 
 very oblong shape. It appears, that it is this close adhesion of 
 the liver to the diaphragm, which is the occasion of the sympa- 
 thy of the diaphragm in disease of the liver, and the cause of 
 the pain felt in the shoulder and neck from inflammation, and 
 suppuration in the liver, in consequence of the course and con- 
 nections of the phrenic nerve. 
 
 The lateral ligaments are formed by the peritoneum 
 
 * Ligamentum latum fufpenforium, falciforme. 
 
 f See Plate I. of this volume. 
 
 | See vol.ii. p. 106, and Plate, p. 107. 
 
62 
 
 0F THE LIVER. 
 
 continued laterally. The right lateral ligament, like a mesen- 
 tery, attaches the right and great lobe of the liver to the dia- 
 phragm, and the left lateral ligament connects the left lobe 
 with the diaphragm, and with the oesophagus and spleen. 
 
 FORM AND DIVISIONS OF THE LIVER. 
 
 The liver is convex and smooth on the upper surface ; con- 
 cave and more irregular on the lower part ; thick and massy 
 behind and towards the right side ; but anteriorly and toward 
 the left side it is thin, and has an acute edge, so that it lies 
 smooth over the distended stomach. 
 
 Great right and left lobf.s of the liver. — The 
 first great division of the liver is marked on the convex surface 
 by the broad ligament ; which running back from the fossa 
 umbilicalis divides it into the two great lobes, the right and 
 left. When the concave surface of the liver is turned up, we 
 see the same division into the right and left lobes by a fissure 
 which runs backwards. 
 
 It is on this lower surface of the liver that we have to mark 
 the greater variety of divisions in this viscus. Farther, it is 
 on the right lobe that those eminences are to be observed 
 which, with the indentations and sulci, give some intricacy to 
 this subject. 
 
 Lobulus spigelii.* — The lobulus spigelii is betwixt the 
 two greater lobes, but rather belonging to the right great lobe. 
 From its situation deep behind, and from its having a particular 
 papilla-like projection, it is called lobulus posterior, or papil- 
 latus. To the left side it has the fissure for the lodgment of 
 the ductus venosus ; on the right, the fissure for the vena 
 cava ; and above, it has the great transverse fissure of the 
 liver for the lodgment of the cylinder of the porta : obliquely 
 to the right, and upwards, it has a connection with the lower 
 concave surface of the great lobe by the processus caudatus, 
 which Winslow calls one of the roots of the -lobulus spigelii. 
 It is received into the bosom of the lesser curve of the stomach. 
 
 Lobulus caudatus. f — This really deserves the name of 
 processus caudatus, for it is like a process of the liver, stretch- 
 ing downward from the middle of the great right lobe to the 
 lobulus spigelii. It is behind the gall-bladder, and betwixt 
 the fossa vense portarum and the fissure for the lodgment of the 
 vena cava. 
 
 * Lobulus p ostcrior —posticus— -pap ell at us . 
 
 f Processus caudatus. 
 
OF THE LIVES. 
 
 63 
 
 Lobulus Anonymus* * * § is the anterior point of the great right 
 lobe of the liver : or others define it to be that space of the 
 great lobe betwixt the fossa for the umbilical vein and the gall- 
 bladder, and extending forward from the fossa for the lodg- 
 ment of the porta, to the anterior margin of the liver. 
 
 Sulci, and depressions of the liver. — On the lower 
 surface of the right lobe there may be observed two slight ex- 
 cavations, formed as it were by the pressure of the colon and 
 of the kidney. On the lower surface of the left lobe there may 
 also be observed depressions answering to the convexities oi 
 the stomach and colon. But these are only the slighter irregu- 
 larities which might pass unnoticed. There are, besides 
 these, deep divisions which pass betwixt the lobes and lobuli, 
 and indeed form these eminences. 
 
 Umbilical fissure.! — From the anterior point of the two 
 lobes there passes backwards to the left side of the lobulus 
 spigelii a deep fissure, which in the foetus gives lodgment to the 
 umbilical vein, and which in the adult receives the round liga- 
 ment, where it is about to terminate in the left division of the 
 vena portae. The back part of this fissure gives lodgment to 
 the ductus venosus in the foetus. This fissure divides the liver 
 into its two right and left divisions, and upon the right side 
 joins the transverse fissure. 
 
 The transvi rse fissure is that which passes above the 
 lobulus spigelii, and lobulus quadratus ; the processus caudat- 
 us, and the lobulus lobi sinistri. It is in this fissure that the 
 great transverse division of the vena portte lies. 
 
 The post rior fissure! gives lodgment to the ductus 
 venosus. It is a division in the posterior margin of the liver 
 betwixt the left lobe, and the lobulus spigelii, and great lobe 
 on the right. Sometimes, instead of the fissure or sulcus, 
 there is a canal, as it were, in the substance of the liver. 
 
 The fourth great fissure, is that for the lodgment of the 
 vena cava. It sometimes is called, in contradistinction to the 
 last, the right fissure, or the fissura vena; cava. It is a 
 large deep division betwixt the lobulus spigelii and the back 
 part of the right lobe, for receiving the vena cava as it passes 
 up upon the spine. 
 
 The gall-bladder being sunk in the substance of the liver,, 
 the pit or excavation which receives it has been considered 
 improperly as a fissure or fossa.§ There likewise occur irre- 
 
 * Lobulus accessorius — anterior — quadratus. 
 
 f Horizontal Allure, folia longitudinalis, longa anterior. 
 
 1 Or fulcus dudtus venoA, the left Allure. 
 
 § .It is generally called, fovea ftllis , or vallicula •veftcnlaj cllea. 
 
64 
 
 OF THE LIVER. 
 
 gular fissures in the substance of the liver, which are like the 
 cuts of the knife, and hold no regular place. 
 
 OF THE VESSELS OF THE LIVER, AND OF THE CIRCULATION 
 OF THE BLOOD THROUGH IT. 
 
 There belong to the liver five distinct systems of vessels : 
 these are the vena port* ; the arteria hepatica ; the vena cava 
 hepatic* ; the lymphatics ; and the' biliary ducts.* These, 
 with the nerves, form a very intricate svstem of vessels, but a 
 lesson of the most particular importance to the physician. 
 Before speaking of the connections which these vessels consti- 
 tute with particular parts, or with the entire svstem, we shall 
 take a strictly anatomical view of their origin and course. 
 
 THE VENA PORTjE. 
 
 This vein is divided into two parts ; that which belongs to 
 the intestines, and which, ramifying on the mesenterv, receives 
 the blood of the mesenteric arteries ; and that part which 
 branches in the liver, and distributes there the blood which it 
 has received from the arteries of the membranous viscera. 
 Even from this division we see that the vena ports has a very 
 particular distribution ; that while it is collecting its branches 
 from the spleen, stomach, and intestines, like the veins in the 
 other parts of the body, into a trunk, this trunk, instead of 
 leading directly to the heart, or uniting with other veins in 
 their course to the heart, enters the liver, and, like an artery, 
 spreads into minute ramifications ; hence it is called the vena 
 arteriosa. It resembles an artery in this also, that it has no 
 valves like other veins. 
 
 To be more particular ; the vena port* takes its origin from 
 the extreme branches of the cceliac, upper and lower mesen- 
 teric arteries. The roots of the port* answering to these ar- 
 teries are the splenic vein ; the gastro-epiploic vein which runs 
 upon the great arch of the stomach ; the mesenteric vein re- 
 turning from the small intestines ; and the right and middle 
 colic veins, and internal haemorrhoidal vein and left colic return- 
 ing upon the mesocolon. These answering to the three great 
 branches of the abdominal aorta, pass obliquely upward in 
 three great divisions, and unite with some lesser veins, as the 
 coronary and smaller veins of the stomach, and pancreatico- 
 
 * And we might add, the arteries of the outer membrane of the liver which 
 arife from the internal mammary, phrenic, epigaftric, and even the fpermatic 
 arteries. 
 
OF THE LIVER, 
 
 if 
 
 duodenalis. The trunk of the vena portae is now involved in 
 the irregularly reticulated web of the hepatic vessels, arteries, 
 veins, glands, lymphatics, nerves, and biliary ducts, with their 
 cellular membrane. It passes upward somewhat obliquely to 
 the right ; and enters the p. rta* or the sinus betwixt the pro- 
 cessus caudatus and lobulus spigelii. 
 
 V hen the vena portae has entered the liver, it divides into 
 two great branches, which running directly transverse, and be- 
 ing of large capacity, are sometimes called the cylinder of the 
 vena portae. Of these two great branches ol the vena portse 
 within the liver, the right is greater in diameter, but shorter :f 
 it ramifies in the great right lobe of the liver. The lelt is lon- 
 ger considerably, and filling the transverse fissure, it is reflect- 
 ed up into the umbilical or horizontal fissure, and is given to 
 the left lobe, to the upper and more anterior part of the right 
 lobe, viz. lobulus anonymus, and to the lobulus spigelii. 
 
 The minute ramifications of the vena portae every where 
 pervade the substance of the liver, and inosculate with the 
 veins of the surface belonging to the peritoneal coat. The 
 blood of the vena portae, alter secreting the bile, is received in- 
 to the extremities of the venae cavae hepatic^. 
 
 ARTERIA HEPATICA. 
 
 For the course of this artery from the root of the cceliac ar- 
 tery, to its entrance into the liver, see vol. ii. p. 257, and 259. 
 The arteria hepatica and the venae portae are supported by the 
 same sheath, the lesser vessel encircling the greater, like a ten- 
 dril. While they hat'e distinct functions, both terminate in the 
 same returning veins : that is to say, whether we admit chat 
 one or both open into the biliary ducts, yet they have the same 
 relation to the vense cavae hepaticae which the arteries of the 
 other parts of the body have to their returning veins. 
 
 VEN JE CAVJE HEPATIC.E. 
 
 We have seen, that the right auricle of the heart is close 
 to the diaphragm above, and that the liver adheres to the lower 
 surface of the diaphragm. We have also found that there was 
 a groove in the back part of the liver for the transmission of 
 the venae cavse abdominalis. Now as the vense cavse ascend- 
 ing from the lower parts of the body to the heart is perforating 
 
 * Sometimes it has been found divided before entering the liver. It has been 
 alfo found to divide into three branches, in which cafe, fays Haller, two go to the 
 left fide. 
 
 i Into this branch fometimes the vein of the gall-bladder entors- 
 
 Vol. IV. I 
 
60 
 
 OF THE LIVER. 
 
 the diaphragm, it is joined by two large veins from the liver, 
 which, from their size and form, being the returning veins of 
 the liver, are termed in general the vena; cavae hepaticae. These 
 veins sometimes pierce the diaphragm along with the cavae 
 abdominalis, so that there is to be observed one large perfora- 
 tion in the diaphragm, but generally they pass the diaphragm 
 close to the great vein, but so that there are three openings in 
 the diaphragm. When these hepatic veins are traced into the 
 substance of the liver, they are seen to be gathered together 
 from all parts of the liver in two, or sometimes three great 
 branches. The communication betwixt the vena portae and 
 the venae cavae hepaticae are so free, that several anatomists 
 have imagined a peculiar and more immediate communication 
 of their branches than holds in other parts of the body betwixt 
 the arteries and veins; a circumstance which app'earedto them 
 the more necessary, considering the lesser impetus with which 
 the blood flows in the vena portae than in the arterial system. 
 
 The last subdivision of the substance of the liver, or acini, 
 as we shall presently find, is supplied with a branch of the ve- 
 nae port.e, arteria hepatica, and venae hepaticae. With these 
 there is also seen a minute ramification of the excretory duct 
 of the liver. These last minute branches are the roots of the 
 
 * Explanation of the plate of the g all-bladder . 
 
 A The gall-bladder. 
 
 B The cyftic dudl. 
 
 C The hepatic dudl. 
 
 D The common du<5L 
 
 E The hepatic artery. 
 
 F The cyftic artery coming off from it. 
 
OF THE LIVER. 
 
 67 
 
 biliary duct ; which running into each other, form trunks re- 
 sembling the branches of veins, and which attaching them- 
 selves to the vena porta, form the greater trunks, answering to 
 the right and left side of the liver. These two divisions of the 
 hepatic duct approaching each other, unite (C), while they are 
 attached to the right branch of the vena porta. Their union 
 constitutes the hepatic duct, or ductus choledochus. 
 
 When the duct of the liver has advanced a little way from 
 the transverse fissure, it is joined by the cystic duct (B), or 
 perhaps we should rather say, considering the use of the cystic 
 duct, that it is reflected from it at an acute angle to the right 
 side. The ductus c\ r STicus is much smaller than the hepatic 
 duct ; and is somewhat curved in the direction towards its ex- 
 pansion into the gall-bladder ; for there it takes a very sudden 
 turn downward, as is seen in the marginal plate. 
 
 The hepatic duct, after being joined by the cystic duct, con- 
 tinues its course under the name of ductus communis choledo- 
 chus, or common duct.* Now become somewhat larger, it 
 takes its course under the head of the pancreas to the back 
 part of the duodenum, about five inches from the pylorus. 
 
 Before it enters the gut, or more generally while included in 
 the coats, it is joined by the pancreatic duct. Having pierced 
 the muscular coat, it runs for some time in the cellular coat, in 
 the length of the gut, and then opens upon the eminence of a 
 considerable valvular plica of the inner coat. 
 
 This hole is regularly limited, and by no means equal to the 
 diameter of the duct, either where it is contained within the 
 coats of the gut, or in its course from the liver to the gut. 
 Sometimes the hepatic and pancreatic duct open by distinct 
 perforations. 
 
 The outer coat of these ducts is smooth and strong ;f within 
 this a cellular and nervous coat is described,:}: and muscular 
 fibres imagined ; but the inner coat is worthy of attention. It 
 is reticulated in such away, that a probe pushed up the duct is 
 catched by their valve-like action. § 
 
 GALL-BLADDER. 
 
 We have already noticed, that the gall-bladder is attached to 
 the lower surface of the right lobe of the liver, and partly bu- 
 
 * Dudlus choledochus, hepatico cyftlcus, (D.) 
 
 f Although this coat refills, in a confiderable degree, the diftention of the du<S, 
 when blown into or injected, yet the whole are fonietimes fo diftended as to 
 admit the thumb. But this is rather to be confidered as growth and enlarge- 
 ment, than diftention. 
 
 f By Haller. 
 
 4 Thefe 1 have feen miftaken for adhial obftructions. 
 
S8 
 
 OF THE LIVER. 
 
 ried in its sinus : it has sometimes occurred that it was merely 
 suspended to the liver by a membrane like a mesentery. It is a 
 bag ol a pyriform shape ; its greater end or fundus is contigu- 
 ous to the colon ; its lower end or neck to the duodenum. It 
 has been found wanting altogether.* It is generally of a size 
 to contain an ounce, or an ounce and a half of bile. 
 
 The coats of the gall-bladder are the outer peritoneal coat ;f 
 a middle cellular coat, what from its analogy to that of the in- 
 testines we should call vascular coat ; and an inner coat. In 
 the intermediate coat muscular fibres have been looked for with 
 great eagerness, but none have been demonstrated, although a 
 conviction remains that there are muscular fibres in the com- 
 position of the coats of the gall-bladder. This coat gives 
 form, limit, and strength to the gall-bladder. The third or 
 inner coat is formed into innumerable rugse, so as to take a 
 cellular or reticulated texture. These loculi, as we may call 
 them, thus formed by the duplicature of the internal mem- 
 brane, are of considerable variety of shape, square, round, 
 or triangular. These rugae, and the whole internal membrane 
 of the gall-bladder, have a beautiful and- minute net-work of 
 vessels upon them ; and in these cells there can be little doubt 
 that there are small mucous foilicules, or pores, or an exudation 
 from extreme vessels, whose discharge sheaths the surface 
 from the irritation of the acrid bile. The extreme degree of 
 vascularity and reticulated texture of this inner coat of the 
 gall-bladder is not apparent before the sixth or seventh month 
 of the foetus, and then it takes a peculiar texture in preparation 
 for the reception of the secreted bile. 
 
 Towards the opening of the bladder into the cystic duct the 
 rugse take a semilunar figure, and seem to have a valvular 
 action, in at least so far that they seem intended to give a de- 
 gree of difficulty to the passage of the bile. The same struc- 
 ture of the internal coat prevails in the cystic duct. 
 
 However strange it may appear to one, considering the re- 
 lation of the liver as a gland to its ducts, and to the gall-bladder 
 as a receptacle of the bile, an opinion was entertained that the 
 bile of the gall-bladder was secreted by its own coats, and 
 that it was of a different nature from the bile conveyed from 
 the substance of the liver. Without further argument it is 
 
 • In which cafe the dilated dufts in their courfe would feeni to have been capable 
 ef retaining a quantity of bile ready to be evacuated into the inteftine. A double 
 gall-bladder has fometimes been found. 
 
 t Like the peritoneal coat of the liver, it feems to pofftfs very diftintft veflels 
 from the vafcular coat below. “ Si itaque ea, a reliquis membranis folvitur ex- 
 pletis antea materia quadam colorata vafis, ab arteria hepatica et vena portarum 
 venientibus ; videmus cam ne minimum quidem accipere furculum quo ornantlR’ 
 Ttervea et •vafculofa." Annotations Acad. F. Aug. Walter, p. 57, 
 
OF THE LIVER. 
 
 69 
 
 sufficient to say, that when the cystic duct is tied, or when it is 
 preternaturally obstructed, there is no bile secreted into the 
 gall-bladder.* 
 
 From the connections of the gall-bladder, and from the 
 consideration of ' the whole anatomy, there can remain no 
 doubt that the gall-bladder is a mere receptacle, reserving a 
 sufficient store of this fluid for the due change to be performed 
 upon the food : that as the stomach is not at all times loaded 
 with food, nor the chyme and fluid from the stomach inces- 
 santly passing through the duodenum, neither is the bile at all 
 times running from the gall ducts. On the contrary, as the 
 stomach is emptied of its contents at stated intervals, there 
 seems to be a provision for a quantity of bile being' evacuated 
 from the receptacle and ducts proportioned to the food, and 
 while it is passing the duodenum. Whether we should con- 
 ceive that this is a necessary consequence of the retention of 
 the bile in the gall-bladder, or a wise provision of nature, I am 
 uncertain ; but it appears, that the longer the bile is retained, 
 or the longer the fast and the deficiency of food in the duode- 
 num, the more acrid and inspissated is the bile, and the greater 
 also in quantity. This inspissation of the bile takes place in 
 consequence of the activity of the lymphatics, which ramifying 
 on the coats absorb the thinner part of the bile. 
 
 Further ; I cannot look upon the rugae and cellular structure 
 of the inner coat of the gall-bladder in any other light than as 
 the means of increasing the surface, and exposing the bile to a 
 further absorption of its watery parts than otherwise would 
 take place. 
 
 The gall bladder is supposed by some to be emptied by the 
 general pressure of the abdomen ; an opinion founded on ^ 
 mistake, which a very little consideration might correct. 
 Others think that the stomach, or duodenum, or colon, being 
 distended by the food, compress and empty the gall-bladder ; 
 while others with more apparent correctness allege, that it is 
 emptied in consequence of a consent of parts. With the latter 
 I would confidently affirm, that as the aliment passes the 
 duodenum, the bile follows apace, either from the alternate 
 contraction and relaxation of the duodenum occasioning a re- 
 laxation of the orifice of the ducts, or more probably from the 
 ducts being excited, as the salivary glands are excited by the 
 presence of sapid bodies in the mouth. By want and hunger, 
 
 * Were there no other proof of the gall-bladder being merely a receptacle, and 
 not in any degree for ferreting the bile, the courfe of its veins (which run into the 
 vena porta;) would be fufficient indication If they had returned the blood front 
 having performed the fecretion of the bile, they would have dropt into the cava, 
 and not into the ports. 
 
70 
 
 OF THE LIVER. 
 
 on the contrary, the gall-bladder is allowed to distend ; there 
 is no call for its evacuation. 
 
 Experiments would even teach us, that the gall-bladder has 
 not the same irritability excitable by stimuli applied to the 
 coats, as the stomach, intestines, or Sladder'of urine ; which 
 is a proof that, like the iris, and many other parts of the 
 body, its action is roused more powerfully by the stimulus of 
 sympathy and consent of remote parts, than by the distention 
 of its coats ; whereas the intestines and bladder have it in their 
 constitution to be excited to contraction by simple distention. 
 
 From experiments it would appear, in confirmation of what 
 is here alleged, that while the food is in the stomach little bile 
 is discharged ; but that it flows when the matter is passing the 
 duodenum, so that a great quantity is then formed in the gut. 
 On the contrary, in a state of want and hunger, the gall- 
 bladder is greatly distended, and yet little bile flows from it ; 
 although it is not only more accumulated, but more acrid and 
 bitter.* 
 
 The gall-bladder is not destitute, however, of irritability 
 and the power of contraction ; for it would appear from many 
 cases that, like the urinary bladder, it contracts upon concre- 
 tions, and becomes thick in its coats. 
 
 The retention of the bile, surcharging the ducts, and dis- 
 tending the gall-bladder, and the sudden discharge of ac- 
 cumulated bile, and the irregularities of its course when in- 
 fluenced by disorder of the viscera, are the source of the 
 most severe and distressing symptoms. f 
 
 In the dead body we see the colon and duodenum, or what- 
 ever parts lie in contact with the gall-bladder, stained with 
 bile ; but this evidence of transudation which is found in the 
 dead body, is not seen in the living ; while the stain from the 
 bile is observed to be deeper and more extensive in bodies long- 
 dead. It is therefore another example of the peculiar proper- 
 ties inherent in the living fibres, that no transudation is allow 
 ed ; but that the fluids, which appear as if exuding from the 
 living surfaces, are discharges from organic pores, or from the 
 extremities of vessels. 
 
 OF THE MINUTE STRUCTURE OF THE LIVER. 
 
 The liver is firmer and dryer in some degree than any of 
 the other viscera ; the intexture of membrane is weak, and in 
 
 * Anat. generale de Xav. Bichattom. iv. p. 6 5. 
 
 t We have one example of this in a late Treatife on the Difeafes of the Bowels 
 of Children, by Dr. Cheyne : an elfay mofl particularly ufeful in its objects ; and 
 the reafoning of which is founded on anatomical ohfcrvation, fupported by fads 
 and dedudtions from pradice. 
 
OF THE LIVER. 
 
 71 
 
 consequence the substance of the liver is friable and easily 
 torn. When cut or torn, it seems for the greater part vascu- 
 lar ; or it displays the mouths of innumerable ducts and ves- 
 sels, and, after a minute injection, the blood-vessels seem to 
 pervade every particle, even when examined with the micros- 
 cope. 
 
 This texture of vessels, in which we may say the substance 
 of the liver chiefly consistSj is surrounded with a delicate 
 membrane, the continued peritoneum. It retains the character 
 of peritoneum, in being a simple membrane, whitish, and a 
 little pellucid. In this membrane minute arteries and veins 
 ramify, which are unconnected with the internal system oi 
 vessels, and in the close cellular membrane beneath it the 
 lymphatic vessels take their course. 
 
 When a section is made of the liver, the vessels may be 
 thus distinguished : the ducts by the thickness of their coats, 
 and their yellow colour ; the arteries by a less degree of thick- 
 ness, and a more resisting elasticity ; the branches of the vena 
 portae and the cava hepaticae by the thinness of their coats, of 
 which those of the latter are considerably the weaker. 
 
 With the investiture of the peritoneal coat of the liver even 
 the vascular tissue of the body of the liver has no communica- 
 tion by vessels.* It is therefore considered as an organ of a 
 peculiarly distinct organization. By the proofs from anatomi- 
 cal injections we are informed, that there is a free intercourse 
 through the extreme branches of all the five systems of vessels 
 in the liver. From minute injections, and the trying and 
 making of sections in the liver, there seems no likelihood of 
 gaining information of the structure and connections of these 
 vessels. Walther, who seems to have examined more metho- 
 dically and minutely than any other anatomist in any age, 
 could make no distinction of parts. In whatever wav he 
 made his sections, whatever system of vessels he filled, whe- 
 ther the whole vessels or each separately, he could not ascer- 
 tain the direction and course of any particular vessel, nor its 
 inosculations, but all was obscure, and as if constituting one 
 chaotic mass. In wet preparations, however, he observed, 
 that the extremities of the branches of the hepatic artery 
 opened into the vena portae : that the branches of the vena 
 portae had a double termination : that some of them, by a sud- 
 den turn and serpentine course, terminated in the branches of 
 the venae cavae hepaticaef ; while others were seen to terminate 
 
 * Soemmering. Walther, loc. cit. &c. 
 
 t * ftould imagine that in this he might have been deceived by the Idler 
 branches of the portae (filled with injedHon) opening into the fide of the larger 
 
72 
 
 OF THE LIVER. 
 
 or open into the biliary ducts. Further he observed, that in 
 all the branches of the vena portae there was a peculiar com- 
 pressed appearance which distinguished them from all the 
 other vessels of the viscus. 
 
 There have been observed, by almost every author, inter- 
 sections of the intimate membrane of the liver, which divides 
 and subdivides the fasciculi of vessels. These are, however, 
 obscure divisions. The last perceptible divisions have been, 
 called acini ;* and they are rather presumed than directly 
 proved to have in their composition an extreme ramification of 
 the several vessels of which the liver consists.f 
 
 We have seen Malpighi conceiving that these bodies were 
 simple glands collected on the ramifications of the vessels ; 
 that they were little vesicles ; and that from them the pori 
 bilarii took their origin. In this opinion he was successfully 
 opposed by Ruysch, who affirmed that these were vascular ; 
 and in this he has been supported by Albinus. It would in 
 truth appear, that the description of these partitions of the 
 substance of the liver, and the ultimate subdivision of it into 
 these little grains, about which there has been so much specu- 
 lation, is not founded in an accurate observation, and that there 
 are neither criptce, hollow or cellular, nor little bodies made 
 up of convoluted arteries, but the minute parcels of vessels 
 which are observable may be called acini, in the strict definition 
 which has been given in the introduction. 
 
 Finally, Ruysch’s opinion may be given in these words : 
 (Epist. ad Virum Clar. Ner. Boerhaave, p. 69.) “ Sed nolo 
 
 diutius tergiversari, fateor ergo, quod, quando primo incipie- 
 bam me exercere in anatomicis, videbam tunc quidem, quod 
 in jecore humano se ostendebant acinuli parvi innumerabili 
 numero, qua: turn temporis appellabantur glandulae ; nam 
 nemo cogitabat aliter sed manet sola jam hsec questio, an aci- 
 nuli hi hie herentes sint glandulae simplicissimae, folliculi cavi 
 cum emissario an quid aliquid ? dico nemo demonstravit illos 
 tales esse ut hie assumis. Imo vero facile jam erit demon- 
 strate, acinos hos cum criptis antea pertractis nihil commune 
 habere : quia oculis nostris non apparent ut membranulae cavae 
 & quia etiam non habent emissarium. Sed componuntur tan- 
 tum ex extremitatibus ultimis vasculorum sanguiferorum unitis 
 in formam spherae rotunditatis, neque, quantum possum videre 
 etiam membranula aliqua sua singulari circumambiuntur.” 
 
 trunks ; and that there is no fuch termination of the hepatic arteries in the fides of 
 the vena portarum, fo that their open mouths are difcermhle. 
 
 * See the definition in the introduction to the prefent volume. 
 
 t Acinos nemo reiicit, ne Ruyfchius quidem, fed de interiori fabrica difputatur- 
 Haller. 
 
OF THE LIVER, 
 
 
 OF THE SECRETION OF THE BILE. 
 
 Upon reviewing the whole system of the liver the peculiari- 
 ties in the vena portae strike us the most. It occurs to us that 
 the passing of this profusion of blood retrograde into the 
 liver, with the slow motion peculiar to venous blood, and 
 after having gone the circulation through the intestines, and 
 consequently lost those properties which constituted it arterial 
 blood, is a provision for the secretion of the bile. It is almost 
 universally concluded, that the secretion of bile is made from, 
 the blood of the vena portae. 
 
 But as we see that this blood distributed by the branches of 
 the vena portae in the liver must be so far exhausted as to be- 
 come incapable of all the uses accomplished by the arterial 
 blood in other glands, that although the vena portae be pecu- 
 liarly adapted to secrete the bile, it is not capable of supplying 
 the nutrition and the energy to the substance and vessels of the 
 liver, there is a necessity for arterial blood being sent to this 
 gland through a branch of the arterial s\ stem. We have had 
 occasion to remark, that no part retains its function in vigour, 
 nor the living properties which are inherent in it, while the 
 whole osconomy is entire and correct, unless the blood be cir- 
 culated through it. Therefore it would appear necessarv that 
 the arteria hepatica, a branch of the aortic system, should 
 also be bestowed upon this viscus. These arteries perform 
 the same office here in the liver that the bronchial arteries do 
 in the lungs, or the coronary arteries in the heart, or the vasa 
 vasorum in the great vessels. The pulmonic artery carries 
 venous blood into the lungs, which having returned from the 
 circulation of the body cannoi send off smaller branches to 
 supply the membranes and vessels of the lungs, it is necessary 
 that for this purpose branches of the aortic system shall enter 
 the lungs. Again, in the heart the blood contained in its ven- 
 tricles is incapable of supplying its substance, or the blood 
 coming through the calibre of the great vessels cannot be the 
 means of ministering to their active powers, but for this pur- 
 pose the vasa vasorum are distributed through the coats of the 
 vessels. These vessels therefore bear an analogy to the arteria 
 hepatica in the liver. 
 
 We mu'st not however suppose that this scheme of the 
 action of the vascular system of the liver, however rational 
 and simple, will be universally allowed. Indeed there are 
 circumstances which seem to stand in opposition to it. Of 
 these, the most interesting is the case of unusual distribution 
 Vol. IV. K 
 
74 
 
 01' THE L1V£R. 
 
 of the vessels of the liver communicated by Mr. Abernethy of 
 St. Bartholomew’s hospital. 
 
 The subject was a female infant which was supposed to be 
 about ten months old. Among other varieties it was observ- 
 ed, that the branch of the cceliac artery distributed to the liver 
 was larger than common, and exceeded by more than one 
 third the usual size of the splenic artery. This was the only 
 vessel which supplied the liver with blood for the purpose of 
 either nutrition or secretion. The vena portarum was formed 
 in the usual manner, but terminated in the inferior cava nearly 
 on a line with the renal veins. The liver was of the usual 
 size, but had not the usual inclination to the right side of the 
 body : it was situated in the middle of the upper part of the 
 abdomen, and nearly an equal portion of the gland extended 
 into either hypochondrium. The gall-bladder lay collapsed in 
 its usual situation. It was of a natural structure, but rather 
 smaller than common. On opening it there was found in it 
 about half a tea spoonful of bile. The bile in colour resem- 
 bled that of children, being of a deep yellow brown, and 
 tasted like bile, but it was not so acridly bitter and nauseating 
 as common bile. 
 
 Mr. Abernethy remarks upon this case, that when an anato- 
 mist contemplates the performance of biliary secretion by a 
 vein, a circumstance so contrary to the general ceconomy ol 
 the body, he naturally concludes that bile cannot be prepared 
 unless from venal blood ; and he also infers, that the equal and 
 undisturbed current of blood in the veins is favourable to the 
 secretion ; but that the circumstances of this case in which bile 
 was secreted by an artery prove the fallacy of this reasoning.* 
 
 We may further observe on this case, that it does not prove 
 the bile in the natural cecononty to be secreted by the arteries 
 and not by the vena portae ; for the artery here was unusually 
 large, so that it performed a function in this instance which it 
 does not usually perform. On the contrary, had the artery 
 been of the usual size, we might then have concluded that the 
 vena portae was distributed to the liver to serve some lesser use 
 in the ceconomy of the system, and that it did not secrete the 
 bile. 
 
 The liver, it is said, was of the ordinary size. Now as the 
 bulk of the liver is, in its natural state, made up of the dilated 
 veins, it is some proof of what I should imagine had taken 
 place here, that by some provision of the vessels the arterial 
 blood had been diffused, and the celerity of its motion checked 
 
 * See Mr. Abernethy’s cafe, of uncommon formation of the liver. Phys 
 TranfaCtionb. 
 
OF THE LIVER. 
 
 75 
 
 previous to its ultimate distribution. Nay, it may have 
 opened into the branches of veins answering to the extremities 
 of the vena porta;. 
 
 In the deficiency of the due acrid and bitter state of the 
 bile, there is in this case evidence that the bile formed from the 
 arterial blood is still unfit for the perfect secretion. I conceive 
 this to be countenanced by the circulation of the blood in the 
 liver of the foetus, and by its effects upon the secretion. We 
 have seen that almost the entire gland is supplied with arterial 
 blood returning from the umbilical vein ; and the natural 
 deduction from this is, that it is the cause of the less stimulat- 
 ing quality of the bile in the foetus. 
 
 I conclude, that this singular and interesting case may 
 strengthen the opinion which some have entertained that the 
 extreme branches of the hepatic artery pour blood into the ex- 
 tremities of the vena port* previous to this formation of the 
 bile by these veins ; but it strll leaves us with the general con- 
 clusion that the peculiarities in the distribution of the vena 
 portae are a provision for the secretion of the bile, and that the 
 branch of the aortic system, the hepatic artery, is otherwise 
 necessary to the support of the function of the liver. 
 
 Finally, as to the use of the liver independently of the 
 secretion of the bile, we must lay aside the opinions mentioned 
 by Haller that it supports the diaphragm, protrudes it up in 
 expiration, and receives the contraction of it equally in inspira- 
 tion, so as uniformly to compress the other abdominal viscera ; 
 or that it foments and cherishes the stomach by the heat of its 
 blood. These are at least as bad as the theories of the ancients 
 mentioned in the beginning of this section. Haller’s failing is 
 the promiscuous admittance of all facts and every kind of 
 theory, with a timorousness and indecision in giving his own 
 opinion. 
 
 There is another remark of Haller which deserves attention. 
 When I reflect, says he, that there is no bile required in the 
 foetus, there being no food received : when again I see that the 
 liver is of great size in the foetus, and not small like the lungs, 
 which are destined to an operation in the ceconomy after birth, 
 
 I cannot but suspect that it has some other use in the foetus than 
 the secretion of the bile. If the umbilical vein had opened 
 directly into the cava, he thinks it would have returned with 
 too great an impetus upon the heart, and would by its prepon- 
 derancy have retarded the return of the blood from the lower 
 extremities. He thinks that the liver is useful in breaking and 
 weakening the impulse of the blood from the umbilical vein ; 
 that it is a guard to the right auricle, which would be other- 
 tv; ;s endangered by the rapid flow of the blood. Now surely 
 

 OF THE PANCREAS. 
 
 the liver is much less able tc stand the impulse of the blood 
 than the heart ; and yet there is no provision for the breaking 
 of the force of the blood in the liver. FurthSr, there is a 
 direct duct of communication leading to the heart. There is 
 r.o reason to believe that the umbilical vein carries back the 
 blood witli greater force than any other returning vein : on the 
 contrary, from its size and the length of its course it is natural 
 to suppose the motion of the blood in it to be very slow and 
 equable. 
 
 We must look upon the peculiarities in the circulation of the 
 blood in the liver of the foetus as a provision against the secre- 
 tion of stimulating bile ; for when the child is born and the 
 circulation altered, bile is formed more abundantly, and be- 
 comes the stimulus to the whole abdominal viscera, rousing 
 them to new action. As to the comparison which Haller has 
 made between the state of the liver and that of the lungs, it is 
 evident that the latter, though small in bulk, are fully formed, 
 and want only inflation to complete their function. On the 
 contrary, in the liver of the foetus the vessels are necessarily 
 distended with blood, to give them the size requisite for this 
 future function ; but that blood, either from its qualities or 
 from the easy and direct passage it has into the heart, does not 
 secrete the bile in quantity and quality so as to stimulate the 
 ducts and intestines, as in the adult circulation. If it did, we 
 should not see the alimentary canal of the feetus loaded with 
 matter, and yet not stimulated to action, but in a state of in 
 'activity and torpor. 
 
 SECTION II. 
 
 OF THE PANCREAS. 
 
 The Pancreas is a gland the largest of those which have 
 be n called conglomerated, that is, distinctly consisting of 
 lesser parts united. It is of a long form like a dog’s tongue, 
 and lies across the spine, and behind the stomach. Its excre- 
 tory duct opens into the duodenum. 
 
 The pancreas is confined betwixt the two lamina of the me- 
 socolon, and it is united to them by a loose cellular membrane ; 
 it lies before the great mesenteric vessels : its small extremity 
 touches the spleen, and is near the capsuli of the left kidney-: 
 but towards the right extremity it increases gradually in jna#sit 
 
OF THE PANCREAS. 
 
 w 
 
 ness until its head lodges upon the duodenum. It is like the 
 salivary glands in its appearance, consisting of lobules succes- 
 sively smaller and smaller ; and it also resembles them in the 
 manner in which its duct is formed. The duct* begins to- 
 wards the left extremity by exceedingly small branches ; these 
 running together form a middle duct, which taking a serpen- 
 tine course towards the great extremity, and increased by the 
 accession of the lateral branches in its course, becomes nearly 
 of the size of a writing quill. Now approaching the duode- 
 num it unites to the biliar^ duct, and opens along with it into 
 the duodenum. A valve has been described as in the ex- 
 tremity of the pancreatic duct, but it is certainly incapable of 
 the action of a valve, as the bile has been found to have gone 
 retrograde into the trunk of the pancreatic duct. Sometimes 
 there are two pancreatic ducts, but more frequently the part of 
 the gland next the duodenum, and which is called the round 
 head of the pancreas, f has an excretory duct peculiar to itself, 
 which either opens into the duodenum separately from the 
 main duct, by piercing the coats of the intestines nearer the 
 stomach, or sometimes opens further do>vn. 
 
 De Graff, Ruysch and many others have made experiments 
 to discover the nature of the secretion from the pancreas. 
 Tubes were introduced into the ducts, and bottles were ap- 
 pended to them in living dogs, so as to catch the pancreatic 
 fluid : it was found ropy, insipid, and like the saliva. It has 
 therefore been concluded, from the colour, structure, ducts, 
 and secretion of the pancreas having so strict a resemblance to 
 those of the parotid and submaxillary glands, that it is of the 
 nature of the salivary glands of the mouth. The general 
 opinion has been, that it is useful in secreting a fluid which 
 dilutes and moderates the acrimony of the bile. More accu- 
 rate chemical examination of the pancreatic fluid has not been 
 made, or has not been successful in showing any peculiarity 
 in it. 
 
 Considering the pancreas as a salivary gland, hotv great 
 must be the quantity of fluid poured out by it, if, as we are 
 entitled to do, we take the analogy of the parotid submaxillary 
 and sublingual glands. These salivary glands, although they 
 may be said to surround all the jaws from the zigomatic pro- 
 cess on either side, are nothing in massiness and size to the 
 pancreas. Again, the pancreas is most plentifully supplied 
 with blood-vessels. Besides lesser branches of arteries, the 
 pancreatico-duodenalis gives two branches, which take an ex- 
 
 " Du&us Virfungi. 
 
 f This is what Winllow calls the little pancreas, and is fometimes schirrous fo 
 as to comprefs the biliary dinfts. 
 
ra 
 
 OF THE PANCREAS. 
 
 tensive course through it, and are joined by other mesenteric 
 twigs ; and twigs proceed from the vessels of the stomach, and 
 even irom the hepatic artery ; but more particularly we have 
 to observe the large branches bestowed upon it by the splenic 
 artery, where it takes its course close upon it. 
 
 While the masticators are working, the parotid gland pours 
 out so great a quantity of saliva, says M. Helvetius, that it is 
 inconceivable, and what I should not believe, had I not seen it 
 in a soldier of the guards. A cut with a sabre in the cheek 
 had opened the salivary duct : the wtmnd healing on the inside 
 of the cheek left a fistulous discharge from the parotid duct. 
 When he eat, there flowed from this hole a great abundance of 
 saliva, so that during dinner, which is not long in the Hotel 
 Dieu, it moistened several napkins. How much must flow 
 from all the salivary glands ? How much from the pancreas, 
 which is greater than them all collectively ? 
 
 Like the biliary secretion it is probable that the contents of 
 the stomach passing the duodenum or the bile flowing from the 
 biliary ducts, form the stimulus to the discharge of the pancre- 
 atic fluid ; and as we see that the morsel in the mouth will 
 quickly produce an almost instantaneous secretion and dis- 
 charge of saliva, so we are led to ’conclude that the flow of 
 pancreatic fluid may be as suddenly produced without the ne- 
 cessitv of a reservoir, as in the biliary system. We naturally 
 conceive that the effect of this fluid is to diminish the viscidity 
 of the bile, and by diluting it to mix it uniformly with the food. 
 There are however few facts to enable us to reason on the ef- 
 fects of the pancreatic fluid. If we give full credit to the ex- 
 periments of Malpighi and Brunner we may conclude, that 
 when the pancreas is taken away, the more acrid bile causes 
 vomiting or voracious appetite by its stimulus. Schirrus of 
 the pancreas has been found attended with a costive and slow 
 motion of the intestines ; which seems to contradict the result 
 of these experiments on animals; but by the schirrosity and 
 enlargement of the pancreas the biliary ducts may have been 
 more or less compressed, and the retarding of the usual quan- 
 tity oi the biliary secretion might produce the slowness of the 
 bowels.'* 
 
 * According to the hypothetic of Silvius, the ufe of the pancreas was to fupply 
 an acid fpirit or juice, and the biliary fecretion being of the nature of an alkali, 
 thefe two llruggling together caufed the reparation of the chyle Irom the feces. 
 This good fight did not flop here, but thefe enemies being carried into the blood, 
 Continued their warfare in the heart itelfand lighted up the vital flame there. 
 
 Nay, if we believe the experiment of F. Schuly, (dc Veteri Med.J this hypothefis 
 ■was not without its proofs ; for having tied in the portion of the duodenum ol a 
 living dog, where the pancreatic and biliary duds enter, he law the ebulition Irom 
 this ftruggle of the acid and the alkali ; and when he comprefied the hepatic dud:. 
 
OF THE SPLEEN. 
 
 / 
 
 SECTION III. 
 
 OF THE SPLEEN. 
 
 The spleen is a viscus of an irregular, oval figure, and dark 
 purple colour. It is attached to the great extremity of the 
 stomach. It is soft in its substance ; and has the peritoneal 
 coat very delicate. We should be glad could we say that it is 
 of a parenchematous structure, for in truth little is known of 
 its organization. 
 
 In treating of this subject we must be indulged in some spe- 
 culation ; and indeed it is priviledged ground ; for the history 
 of the opinions regarding the supposed function of the spleen 
 is full of loose conjectures or wild hypothesis, and nothing is as 
 yet certainly known of, its use. 
 
 SEAT AND CONNECTIONS. 
 
 The spleen is seated in the left hypochondrium ; above the 
 left kidney ; and under the protection of the false ribs ; and of 
 course it is under the edge of the diaphragm. It is connected 
 with the stomach by the cellular membrane, by the omentum 
 and in a still more particular manner by the vasa brevia. It 
 has also connections with the left extremity of the pancreas by 
 cellular membrane, and the branches of the splenic vessels. 
 Lastly, it has a firmer attachment to the diaphragm, by means 
 of a ligament formed by the peritoneum.* 
 
 The spleen is of no regular figure. Where it is contiguous 
 to the diaphragm it is uniformly convex : towards the stomach 
 its surface, while it is hollowed out and concave, presents two 
 sides, so that we say the whole mass is somewhat of a triangu- 
 lar form. The anterior edge of the spleen is notched with 
 deep sulci ; behind and at the upper part the margin is large 
 and round. 
 
 The substance of the spleen is the most spongy, tender, and 
 soft of the abdominal viscera ; so much so that not only does 
 the finger make an impression upon its surface, but it actually 
 disorders and tears its vessels. After a successful injection the 
 
 the tumefaction of the inteftine fubfided ; when he took off this comprefiion it 
 was again blown up. As this experiment has not fucceeded fince, as Haller ob- 
 ferves, Schuyl was probably deceived by the periftaltic motion of the inteftines. 
 
 * Yet the fpleen is very apt to change its Ctuation, or to fall down under the 
 protection of the falfe ribs. It is liable'to enlargement in afcites. From which 
 circumftances it will not be wonderful if it i9 wounded in tapping for the afcites. 
 See Monro on' Dropfy. 
 
80 
 
 OF THE SPLEEN. 
 
 whole seems made up of vessels ; and if any thing like acini 
 or globules are to be observed, the microscope will show them 
 to be accidentally produced by the fasciculi of vessels. It has 
 a strict resemblance to the substance of the placenta. The 
 spleen is seldom smaller than natural ; often greatly enlarged. 
 I have seen it equal to the liver in size, and filling the whole 
 left side of the belly. It has been frequently found thus en- 
 larged, without any peculiar symptoms indicating such a dis- 
 ease during life. From its soft texture and great vascularity, 
 like the liver, it has been found rent by blows and falls ; and 
 wounds here, as in the liver, by opening the large vessels are 
 suddenly fatal. Sometimes it is hard and schirrous, and 
 marbled in its colour. There is* seldom suppuration in it. 
 The spleen has been supposed to swell up and enlarge when 
 the stomach is empty, and to be contracted when it is full. It 
 has been observed, that it is large and spongy in those who 
 have died a lingering death, or who have been long ailing : 
 that on the contrary, it is smaller and firm in those who have 
 died suddenly of a violent death. 
 
 We are informed, that the blood of the splenic vein is pecu- 
 liar, insomuch that it does not coagulate like the blood in the 
 other veins of the body.'* 
 
 That which more than any other circumstance excites our 
 attention, is the great size of the blood vessels of the spleen. 
 Both the splenic vein and the artery are of great size in pro- 
 portion to the bulk and weight of the spleen ; and in their 
 course they are particularly tortuous. I conceive we may also 
 draw consequences’ from the distribution of their brum lies to 
 the stomach (viz. the vasa brevia and left g astro epiploic) and 
 to the pancreas. Its lymphatics are numerous. It is supplied 
 with nerves, but has very little sensibility. It has no excretory 
 duct. 
 
 OPINIONS REGARDING THE USE OF THE SPLEEN. 
 
 • 
 
 Of the various uses of the spleen, the lowest conjecture in 
 respect to ingenuity or probability is, that like a sand-bath it 
 foments the stomach, and promotes the process of digestion. 
 This notion is perhaps not inferior in absurdity to that opinion 
 which ascribed to the spleen the office of forming an acid juice, 
 which being carried by the vasa brevia into the stomach, was- 
 supposed to excite the appetite.f 
 
 * With regard to this point I have no opinion, having hitherto negledted to 
 examine the fadt. 
 
 f 1 am miftaken in calling this the lowed: in abfurdity. The fpleen has been 
 confidercd as the feat of the foul! the caufe of venereal appetite! the gland 
 
OF THE SPLEEN. 
 
 8X 
 
 it was a better conception that the spleen is the seat of me- 
 lancholy ; “ that moping here doth hypochondria sit or of 
 “ laughter holding both his sides,” of which the holding of the 
 sides was an evidence. And again, since tickling the ribs is a 
 demonstration of the effect from this excitement of the spleen,* 1 
 that the growth of the spleen promotes laughter to such a de- 
 gree, that it becomes a permanent silly simper impertinently 
 excited. Nay further, we have authority for the excision of 
 the spleen from those who are otherwise incurable in their pro- 
 pensity to laughter. 
 
 The following is a theory which has been very commonly 
 received. A great quantity of blood is imported into the 
 spleen with a slow motion, owing to its serpentine course. 
 When the stomach is empty, the blood is received in a greater 
 quantity by the spleen, where it has an opportunity of stagnat- 
 ing. Here the blood fomented, attenuated, and in a manner 
 dissolved by the neighbourhood of the putrid fseces in the co- 
 lon, enters upon the first steps of a begun putrefaction. By 
 this resolving of the blood it is made more fluid, in which 
 state it is returned by the veins, there being no excretory 
 ducts. Now when the spleen is compressed between the 
 distended stomach and the ribs, and the contracting dia- 
 phragm, the blood is pressed out from it in greater quantity 
 and celerity towards the liver, mixing with the sluggish blood 
 in the trunk of the vena portae, replenished with the fat and oil 
 of the omentum, it dilates it and prevents its stagnation and 
 tendency to congeal. In short, the spleen has been supposed 
 to be subservient to the function of the liver, and to the pre- 
 paration of a watery (and subalkaline) fluid to the blood of the 
 portae. Another opinion has been, that it counterbalanced the. 
 mass of the liver seated to the right side of the belly. 
 
 Hewson entertained a theory regarding the use of the spleen 
 which sullies his high character and reputation. He conceived 
 that the spleen added the flat vesicle of the globules of the- 
 blood : his only observation in way of proof was, that he saw 
 a few red globules returning by the lymphatics of the spleen : 
 the effect, I have no doubt, of the injury of its ■substance, or 
 of the compression of its vessels. It seems to me strange that. 
 
 which formed the mucilaginous fluids of the joints ! The atrabilis was received 
 here concocted and tranfmitted to the liver. It drew forth and formed blood front 
 the ftomach, &c. Other phyfiologifts, not contented with the theories prefented 
 to them, and yet incapable of fuggefting others more likely, have very modeftly 
 afferted that the fpleen was of no ul'e at all. 
 
 * Rifus in liene fedes videtur ex effedfu titilationis nataque in plurimis mcrtali- 
 hus rifum excitat. &c. Haller, His fober objection is, that tickling the right fide 
 will do as well as the left. 
 
82 
 
 OF THE SPLEEN. 
 
 such a man seeing the large splenic artery throwing its full tide 
 of perfect arterial blood into the spleen, full of globules, com- 
 plete in every respect, and again seeing a few globules carried 
 back by the lymphatics, should imagine that this artery formed 
 these few vesicles with which it was already so fully charged. 
 
 Oflate years we have seen men endeavouring to raise them- 
 selves into notice by an attachment to the opinions of their 
 departed patrons ; by supporting those opinions ; by holding, 
 as they imagine, the proofs and illustrations of them in their 
 possession : but seldom do we see the memory of great men 
 honoured by such obsequies. The officiousness of Hewson’s 
 friends in promulgating his opinions has done no honour to his 
 memory. They have attempted to support, on insufficient 
 grounds, what he might have had the ingenuity to render 
 plausible, and which are very far from honourable to his repu- 
 tation, imperfect as they now appear. 
 
 I conceive the spleen to be an organ subservient to the sto- 
 mach : and not only the constant attachment of it to the sto- 
 mach in the human body, but the constancy with which it is 
 found connected with the stomach in the lower animals, con- 
 firms the opinion. I regard it as a provision for giving the 
 vessels of the stomach an occasional power and greater acti 
 vity, enabling them to pour out a quantity of fluid proportioned 
 to the necessity of the digestion. In the first place, let us ex- 
 amine the course and form of the splenic artery, and I think 
 we shall find the great peculiarity of its size, and tortuous 
 form, and strong coats, a provision for occasional great in- 
 crease of power ; while, if not roused by the peculiar sympa- 
 thies which actuate it, it is of a form to retard and weaken the 
 velocity of the blood. This is founded on these propositions : 
 
 1. The muscular power of an artery increases as it recedes 
 from the heart ; the elastic power diminishes. 
 
 2. An artery, the nearer it approaches to its final distribu- 
 tion, is the more immediately under the excitement and con- 
 troul of the organ ; is active when the organ is excited ; is, 
 relatively speaking, quiescent when that organ is not called by 
 its sympathies to exercise its function. 
 
 3. An artery tortuous in its course has more muscularity 
 and greater power of action than one which takes a straight 
 course ; but in proportion to the increase of power which it 
 obtains by its increase of length in this tortuous and bending 
 course, will these turns retard and weaken the force of the 
 heart upon the extreme ramifications of the vessel. 
 
 Thus a tortuous artery is the means of increasing the velo- 
 city of the blood by its own action, but it makes the organ less 
 dependent on the general force of the circulation. We ac™ 
 
OF THE SPLEEN. 
 
 85 
 
 cordiflgly find that in those organs where there is occasional 
 activity alternating with a quiescent state, the artery is tortu- 
 ous ; and where there is an increase of force required in the 
 circulation, there, the artery, from being straight in its course, 
 becomes crooked and twisted in every way.* 
 
 From these remarks, we may be inclined to draw, from the 
 tortuous figure of the splenic artery, a conclusion somewhat 
 different from that which has hitherto been deduced. We 
 may conclude that it is not the means of retarding the blood in 
 its circulation, but of giving force to it. The splenic artery 
 does not only ramify in the spleen, but it supplies all the left 
 part of the stomach, and that great sacculated extremity in 
 particular which receives the food, and in which the process 
 of digestion is chiefly performed. My idea is, that when the 
 stomach is empty, when there is no food in it to solicit the dis- 
 charge of the gastric fluid, the blood circulates in a moderate 
 degree in the coats of the stomach, and the spleen receives the 
 surcharge of blood ; but when a full meal is taken into the 
 stomach, when the action of the gastric juice is required in 
 great quantity, the action of the splenic arteiy is solicited to 
 the vasa brevia and left gastroepiploic artery, and thus a sud- 
 den flow of the gastric fluid is bestowed by the increased 
 activity of the splenic artery. When again the contents of the 
 stomach are fully saturated with the fluids from its coats, there 
 is no longer an excited action of the splenic vessels, and the 
 artery terminating in the veins, the spleen returns the blood to 
 the liver. While the vessels of the stomach partake largely 
 of the supply of blood, the arteries to the pancreas also re- 
 ceive some increase of activity ; and even the blood of the 
 vena portae requires an additional activity. 
 
 We have seen that the stomach and intestines, the liver, 
 pancreas, and spleen are combined in function, connected by 
 the same system of vessels, mutually subservient to each 
 other, and tending to the same end, the reception, digestion, 
 and first stage of the assimilation of nutritious matter to the 
 system. We leave this subject therefore until we can take up 
 that of absorption and the lymphatic system, and pass to the 
 kidney and viscera of the pelvis. 
 
 * This has been fuppofed the effect of the impulfe of the blood, but nothing can 
 be more falfe. Let any one examine the artery of a limb when a great tumour is 
 growing ; the artery will be found tortuous to fupply it. Again, in the aneurifmal 
 varix where there is a breach in the artery, and the blood finds a freer return to the 
 heart, the artery will be found enlarged and tortuous in order to fupply the lower 
 part of the limb ; while there is a quantity of the blood withdrawn from the circu- 
 lation by the communication with the vein. 
 
OP THE JtlDHET. 
 
 SECTION IV. 
 
 OF THE KIDNEY. 
 
 The kidnies are distinct from those parts which have hitherto 
 engaged us, as they secrete the urine, and form therefore the 
 link betwixt the viscera of the abdomen and those of the pel- 
 vis ; for though lying in the abdomen, they are more strictly 
 connected with the parts in the pelvis. The structure of the 
 kidney forms a very interesting subject of inquiry ; because it 
 is the field of dispute betwixt the contending parties regarding 
 the structure of glands and the theory of secretion. It is 
 chiefly from the kidnies that the facts are drawn in illustration 
 of the opinions of Malpighi, Ruysch, and all the others. 
 
 Form, seat, and connections. The kidnies lie on each 
 side of the spine ; sunk as it were in the fat of the loins ; 
 attached to the muscles of the loins ; and in part lying on the 
 lower belly of the diaphragm ; which last connection is the 
 cause of the pain felt in respiration during inflammation in the 
 kidney. The kidney lies betwixt the spine of the ilium and 
 the lowest rib. The right kidney is placed somewhat lower 
 than the left, which is owing to the great size of the liver on 
 that side. 
 
 The kidnies are without the abdomen, that is to say, behind 
 the peritoneum ; for the kidney lying close upon the muscles 
 of the loins, the peritoneum is merely stretched over it. This 
 is the reason why calculi in the kidney have wrought them- 
 selves out by fistulse in the loins ; and it is the ground of the 
 hazardous proposal of cutting into the kidney to extract 
 calculi. 
 
 The adipose membrane surrounds the kidney, and forms a, 
 perfect capsule ; for it is this which is sometimes in an extra- 
 ordinary degree loaded with accumulated fat. Upon this cap- 
 sule the caecum is attached on the right side, the colon on the 
 left, and betwixt the kidnies and the intestines there is a strict 
 Sympathy, which is apparent in the nephritic colic. 
 
 The figure of the kidney is that of an oval bent, or a little in- 
 curvated, so as to form a sulcus or general concavity to one 
 side, while the other takes a greater convexity. By the con- 
 cave surface of the kidney, which is towards the spine and 
 great vessels, the arteries and veins and ureter pass in by the 
 sinus round which the substance or glandular body of the kid- 
 ney terminates abruptly. 
 
 The abdominal aorta and the vena cava lying close on the 
 spine and near to each other, give off laterally the emulgejjt 
 
OV THE KIDNEY. 
 
 85 
 
 arteries and veins. The renal or emulgent artery comes from 
 the side of the aorta betwixt the upper and the lower mesenteric 
 arteries : that of the left kidney has its origin a little higher 
 than the right : and the aorta being on the left and the cava 
 towards the right side of the spine, the left emulgent artery is 
 shorter than the vein ; the artery longer than the vein on the 
 right side. Again, the aorta being more closely attached to 
 the spine, the emulgent vein lies rather above the artery. 
 
 The vessels, and especially the arteries of the kidney, are 
 very irregular in their number and form. Where they enter 
 the body of the gland, they are accompanied with a capsule 
 which continues with them to this final distribution. Some- 
 times a solitary vessel is seen making its exit by the convex 
 surface of the kidney. 
 
 We have had occasion to remark on the nerves of the kid- 
 nies and their connection with the coverings of the testicle, and 
 to notice their effect in producing numbness of the thigh and 
 retraction of the scrotum in inflammation of the gland, when 
 stones lodge in the pelvis or ureter. 
 
 Upon the subject of the sensibility of the kidney, however, 
 we must be aware that disease, inflammation, suppuration, nay 
 even total wasting of the kidney may take place without any 
 indication from pain. 
 
 The excretory duct of the kidney is called ureter : it 
 leads from the kidney to the urinary bladder. When we trace 
 it into the kidney it is found to enter the navel-like sulcus of 
 its concave side ; here it is enlarged into a considerable sac 
 which is called the pelvis of the kidney. This is a kind of 
 reservoir which, lying in the embrace of the solid and glandu- 
 lar part of the kidney, sends up several elongations almost like 
 the finger of a glove, which receive into them the papilke, the 
 concentrated uriniferous tubes. These processes of the pelvis 
 are called the colices or infundibuli. 
 
 It may be observed, however, that the term pelvis is taken 
 from the greater dilatation of the ureter within the gland, 
 which is seen in brutes ; and that in man it is not so remarka- 
 ble, the ureter branching with only a lesser degree of the sac- 
 culated form into three or four divisions, and these into the 
 lesser infundibuli. 
 
 The coats of the ureter are three in number ; a dense outer 
 eoat; a middle coat, apparently consisting of circular muscu- 
 
86 
 
 ®F THE KIDNEY. 
 
 lar fibres, though this has been denied ; and a smooth inner 
 coat, (very improperly called villous,) which secretes a mucus 
 to defend it from the acrimony of the urine. The ureters do 
 not run in a direct course to the bladder of urine ; they take a 
 curving direction ; are in some places irregularly dilated, as 
 when they pass over the psoas muscle,* dropping deep into the 
 pelvis, and getting betwixt the rectum and bladder they open 
 obliquely into the latter. 
 
 MINUTE STRUCTURE OF THE KIDNEY. 
 
 The ancients, says Malpighi, contented themselves with the 
 idea of a sieve, as conveying a knowledge of the manner in 
 which the urine was drawn off by the kidney ; that the fibres 
 of its parenchematous matter attracted the serum of the blood ; 
 that the fibrous matter was perforated with innumerable fora- 
 mina ; or that the whole was a congeries of canals through 
 which the urine was strained and drawn off. Malpighi set 
 himself to refute these vague opinions by the minute examina- 
 tion of the structure of the kidney ; and he seems to have 
 known almost all that we now know. Though we do not ac- 
 quiesce in his opinions regarding the final and minute struc- 
 ture, he describes accurately every part of the gland. 
 
 Capsuhe Renalis. 
 
 ‘The Lobulated ICidnies of the Foetus. 
 
 * When the bladder is contracted in confequence of a ftone, or when it is dilated 
 by obftruction, the ureters are dilated all'o ; particularly in the firft cafe. Whilft 
 fhejr are dilated, their coats become thickened, and their courfe is tortuous. 
 
OF THE KIDNEY. 
 
 87 
 
 In the first place, when we examine the outward appearance 
 of the kidney of the fcetus, as in this annexed plate, we observe 
 that it is not, like that of the adult, smooth and uniform ; but 
 that it is tuberculated or lobulated ; that it consists of distinct 
 parts, or glands united together. Again, when we examine the 
 kidnies of other animals, we find in several instances that the 
 full-grown animal retains this lobulated form. In short, it im- 
 mediately strikes us that the kidney is not a uniform mass of 
 glandular matter, but that it must resemble those glands which 
 they call conglobate, and which consist of several compartments 
 or distinct glands united together. 
 
 Accordingly a section of a kidney shows us that this is the 
 fact. 
 
 Example of the Lobulated Kidney. 
 
 The ^ section of the kidney shows us th 
 we see towards the surface that which is called 
 
 * Explanation of the annexed plate. 
 
 A B C D. The feveral divifions of the kidney which give it 
 figure. 
 
 E E. The cortical part of the kidney, being the outer, and it^is fuppofed, the 
 fecreting part. 
 
 F F. The tubular part of the kidney. 
 
 G. The papilla, or that part which projects into the calyx or divifion of the 
 pelvis. 
 
 H. The perceptible duffs in the point or apex of the papilla. 
 
 1 1 I. The other papillae. 
 
 L. The point of one of the papilla which we fee projecting into the pelvis. 
 
 M. The pelvis of the kidney. 
 
 N. B. This reprefents only one half of the kidney. 
 
88 
 
 OF THE KIDNEY. 
 
 glandular part E. Secondly, strise, converging towards the 
 centre of the kidney, being what is called the tubular part of 
 the kidney.* These tubuli are divided into fasciculi, taking 
 a conical shape ; and these converging unite at the apex ; two 
 or three of them united form the papilla. The papillae are 
 generally ten or twelve in number, or even more in each kid- 
 ney ; their points are received into the extremity of the infun- 
 dibula ; they pour the urine into these tubes, and it is collected 
 in the pelvis. Now when we examine one of these papillae in 
 a lobulated kidney, we find that it is the centre of one of these 
 subdivisions. Thus, 
 
 B 
 
 A 
 
 A A. Cortical Subjlancc*.. B. ^Tubular part, 
 
 Co Papilla . D. D ufts. 
 
 The papilla C is merely the continuation of the tubuli B ; 
 but it is that part which projects from the body of the kidney 
 into the calyx ; and although these divisions of the substance 
 of the kidney are enumerated as three distinct parts, the corti- 
 cal, tubular, and papillar parts, they are properly only two, the 
 cortical and tubular parts. 
 
 Some however have made a new distinction, by asserting 
 that a vascular part is to be observed betwixt the cortical and 
 tubular or striated parts, as at;* but it is not the case ; for al- 
 though when we make a regular section of the whole gland, 
 the mouths of some larger vessels will be observed betwixt the 
 fasciculi of the urinary tubes, yet they are irregular ramifica- 
 tions tending to the outer cortical part, and not such as separate 
 the tubular and cortical part, nor so regular as to be considered 
 as one of the subdivisions of the kidney. 
 
 * Improperly medullary, fometimes striata sulcata. F F. 
 
OS THE KIDNEY* 
 
 89 
 
 OF THE CORTICAL PART* 
 
 The external and cortical part of the kidney is by all allow- 
 ©d to be the secreting, or, as they rather term it, the secerning 
 part of the organ. It was this part which the older writers 
 considered as in a more particular manner to consist of a 
 peculiar fleshy substance of parenchymatous matter. It is in 
 this cortical matter that the glandular bodies described by 
 Malpighi are supposed to be seated. The appearances whicli 
 he describes are to be very distinctly seen in many animals j 
 for example, in the horse’s and cow’s kidney ; and are to be 
 seen represented in these plates. But he asserted these bodies 
 to be also observable in the human kidney ; to demonstrate- 
 which he ejected a black liquid mixed with spirit of wine, by 
 which the kidney becoming universally tinged, you may then 
 see, he said, when you have torn off the coats of the kidney, 
 small glands partaking of the colour of the arteries. These 
 are the glands of the cortical part of the kidney, which Mal- 
 pighi described -as hanging upon the branches of the arteries 
 like fruit upon the pendant branches, and round which the 
 arteries and veins ramified and convoluted, like delicate 
 tendrils, so as to give them the dark colour which they have. 
 
 Into these bodies he supposed the urine to be secreted, and 
 from these bodies it was conveyed into the uriniferous ducts or 
 tubular part of the kidney ; but he acknowledges that the com- 
 munication betwixt the ducts and glands is very obscure. 
 
 Ruysch and Vieussens held a very opposite opinion regard- 
 ing the structure of the kidney.* Ruysch, by throwing his 
 injections into the renal arteries, found that he filled the urinary 
 tubes, the ducts of Bellini, and the pelvis itself. Hence he 
 conjectured that the tubuli uriniferi or excretory ducts of the 
 kidney were the continued branches of the renal artery, with- 
 out the intervention of any glandular apparatus-! 
 
 * Ruyfch and Vieuffens long contended for the claim of the difcovery of the 
 continuation of the arteries of the kidney into the urinary da£b. Ruyfch at firft 
 acquiefced in the opinion of Malpighi, as we have faid. 
 f Thes. Anat. ii. p. gi. 
 
 Vol. IV. 
 
 M 
 
90 
 
 OF THE KIDNEY 1 . 
 
 Example of Ruysch’s doctrine.* 
 
 Ruysch's Plate . 
 
 Kuysch did not neglect the examination of the little bodies 
 which are to be seen in the cortical substance. He did not 
 however allow they were glands, but confidently asserted that 
 they were merely the convoluted arteries which were formed 
 into these contorted bundles before finally stretching out, and 
 terminating in the straight urinary tubes. f 
 
 * Exhibet renis humani dimidiatn partem ita diflfedtam, ut reptatus vaforum, 
 prefertim fanguineorum, luculentus quam in precedent! Thefauro, tab. iv fig. 
 iii. videre poffit ; ubi magis inherebam, ut conjundtiones arteriolarum cum dudti- 
 bus Bellini exhiberern, in hac autem figura diftindtiffime vaforum fanguineorum 
 curium vermicularem per interiorem renis partem exprimere volui. 
 
 A. Facies renis exterior per quam vafa fanguinea reptatum obfervant vermi= 
 cularem. 
 
 B. Facies renis interior ubi vafa fanguinea non minus curfum vermicularem 
 obfervant quam in facie exteriore. 
 
 C. Papilla; renales. 
 
 D. Pelvis renis. 
 
 E. Cavitas pelvis in quam papillx urinam (tillando exprimunt See The- 
 
 faur. Anat W. p. 27. 
 
 f In hoc Thefauro X. quoque inveniuntur ©bjedta renalia ex homine defumpta, 
 in quibus non folum luculenter apparet quid judicandum fit de prxtenfis glandulis 
 renalibus, verum etiani quid inveftigatoribus renum impofuerit, fe in renibus in. 
 dagandis fxpifiime occurrunt corpofcula rotunda glandulas mentientia qux revera 
 nil funt nifi arteriolarum ultimx extremitates contorts ; cum autem exadHffime 
 repkantur arterix renales diifolvtntur vel expanduntur, quemadmodum fili glo- 
 
QF THE KIDNEY. 
 
 •91 
 
 When after minute injection of the kidney we make a section 
 of its whole substance, we see vessels emerging from the more 
 confused intricate vascularity of the cortical part, and running 
 inward in striae towards the papillae ; what we see there, are, 
 in my conception, chiefly veins. And this I conclude, both 
 from the result of injections, and from knowing that the veins 
 are in general numerous surrounding the excretory ducts ; 
 besides they retain the blood in them like the veins. These 
 vessels running in straight lines and converging towards the 
 papillae are not the tubuli uriniferi, but the blood vessels accom- 
 panying them, the tubes themselves being transparent. 
 
 Yet I imagine it was by these vessels that Ruysch was de- 
 ceived ; for tracing them from the extreme arteries, and seeing 
 them suddenly altered in their form and direction, and run- 
 ning towards the Papillae, he imagined them to be the excre- 
 tory ducts continued from the extreme branches of the arteries. 
 
 Winslow supposes the corpuscules, which are seen in the 
 cortical part of the kidney, to be the extremities of the cut 
 tubuli, filled either with blood or with a coloured injection. 
 But this they evidently are not ; for by making the substance 
 around them transparent, they are seen within the surface, and 
 they are little grains not the extremity of tubes, nor extended 
 in lines. 
 
 Boerhaave, although he saw in the preparations of Ruysch 
 the injection passed into the uriniferous tubes, yet in the main 
 favoured the opinions of Malpighi ; and having sometimes 
 observed these tubes filled with injections, while at intervals 
 they were transparent or pale, and contained only a watery 
 fluid, he ventured to conclude that there was a double opera- 
 tion going forward in the kidney ; that the pale watery urine 
 was quickly drawn off by the continuous tubes ; but that the 
 urine of the other quality and higher colour was separated by 
 a more perfect and slower secretion through the glandular 
 bodies. 
 
 In the history of opinions, to Boerhaave succeeds Berlin, 
 who writes a long and laboured paper in the Memoirs of the 
 Academy of Sciences for 1744; upon the whole, he may be 
 considered as endeavouring to prove by dissection what was 
 rather an hypothesis with Boerhaave. Benin describes glands 
 
 mer, ita ut nil minus fint, Ccuti dixi. quam partes per fe fubfiftentes, & peculiari 
 membranula obdufta; fine quo immerito dicuntur glandulae. Interim confideran- 
 dum ejufmodi contorfiones vaforum fang, nufquam in caiteris vifceribus reperiri. 
 In the epift. to Boerhaave, p. 77, we find Ruyl'sh fpeaking much more modeftly : 
 “ In rene humano rotunda corpufcula efle, faceor, fed funt tarn exilia, ut nihil 
 poffim definirede illis. Adeoque non b'cet magis dicerequod fint glarjdulie, quam 
 sliud quid.’’ 
 
92 
 
 OF THE KIDNEY. 
 
 in the substance of the kidney ; but these he is careful to dis- 
 tinguish from the corpuscules of Malpighi, which he also con- 
 ceives to be the extremities of vessels merely. 
 
 ]VL, Berlin $ Plate, 
 
 From this plate we shall easily understand Bertin’s descrip~ 
 tion. He observes, in the first place, that there are to be seen 
 serpentine vessels, such as Ruysch described : for example, at 
 A A A,* which arising at 4 the circumference of the cortical 
 substance, are reflected inward in a tortuous form, and which, 
 at last, approaching the tubular part, terminate in straight- 
 tubes, or are continued into the tubuli uriniferi (for example at 
 B B.) 
 
 But # betwixt the mesches of vessels which are described, 
 and which are seen here to terminate in the tubuli, there are 
 beds of glands C C C, which acervulse of small glandular 
 bodies are as it were laid in the tract from the circumference 
 towards the centre, and appear to terminate, or to be connected 
 with the tubuli uriniferi as the arteries are. 
 
 M. Ferrein has opposed all these opinions in a paper of the 
 Academy of Sciences for 1749. He asserts that the body of 
 the kidney is neither composed of glands nor a congeries of 
 blood vessels ; that it is a peculiar substance, which when ex- 
 amined is found to consist of transparent vessels. These, he 
 says, are wonderfully convoluted in the cortical part of the 
 
 * Mefches de M. Winflow on vefleaux fpongieux de Vieuffens ou tuyaux fef> 
 gentans de Ruyfch, 
 
or THE KIDNEY. 
 
 93 
 
 kidney, so as to resemble glands, and stretch in parallel lines 
 towards the papillae, where they form what is called the tubuli 
 uriniferi. Amongst these transparent tubes, the blood vessels 
 ramify to great minuteness, and accompany them where they 
 are reflected directly inward to form the tubuli. Much ridi- 
 cule, he observes, has been thrown upon the term parenchyma 
 of the ancients ; but notwithstanding he affirms that there is in 
 all glands a substance dissimilar from the blood vessels, a 
 gelatinous-like matter, which consists of or contains these 
 pellucid tubuli. 
 
 Tubular Part. — The term here used is universally re- 
 ceived ; and all seem agreed that the striae converging to the 
 centre of the kidney, and taking a pyramidal shape are the ex- 
 cretory ducts. We have seen that they were supposed by 
 some anatomists to be formed by the continuation of the ex- 
 treme branches of the arteries ; but this opinion we shall ven- 
 ture to say arose from the appearance of the blood vessels in- 
 jected, which lie parallel and close to them. They are evi- 
 dently transparent tubes, and probably the fibrous appearance 
 ©f the whole pyramidal body formed by them is owing to the 
 accompanying blood vessels. These lesser ducts, as they ap- 
 proach the papilla;, terminate in larger ducts, which finally 
 open into the ducts of Bellini at the point of the papillae. The 
 papillae we have seen to be that part of the pyramidal body 
 which projects into the calyx or infundibulum, and from their 
 point little drops may be perceived to run (from the ducts of 
 Bellini) when they are compressed. 
 
 I have detailed the several opinions regarding the structure 
 of the kidney ; and neither do I wish here to vamp up an 
 opinion from the aggregate of these contradictory reports, nor 
 have I been able to draw a decided conclusion from my own 
 experience. In truth, the observation from one dissection I 
 have hitherto found so completely contradicted by other ex- 
 periments, that I must conclude there yet remains much to be 
 done in investigating the minute structure of the glandular 
 viscera. 
 
 OF THE CAPSULE RENALES.* 
 
 The renal capsules are glandular-like bodies one attached to 
 pach kidney. The capsule is seated like a cap on the upper end 
 of the kidney. It is of a form like an irregular crescent, and 
 suited to the shape of that part of the kidney to which it is 
 attached ; at the same time that it has three acute edges, or 
 
 * Glandule atraiilarie renes ficcenturiat<r. Glandule renales, &c. 
 
94 
 
 OF THE KIDNEY. 
 
 takes a triangular form. — (See the drawing of the kidnies of 
 the foetus.) — The upper edge has been called crista, while the 
 lower edges have the name of lobes. It is in the foetus that the 
 renal capsule is large and perfect ; in the adult it has shrunk, 
 and no longer bears the same relative size to the kidney. In 
 the foetus the renal capsule is as large as the kidney, and the 
 capsules of each side are continued into each other, being 
 stretched across the aorta and vena cava. 
 
 The vessels sent to this body are somewhat irregular ; they 
 come from the renal or emulgent arteries and veins, from the 
 caeliac artery or phrenic, or from the trunk of the aorta, and 
 even from the lumbar arteries. 
 
 By separating the lobes of this body we find something like 
 a cavity, which has been roundly asserted by some to be a re- 
 gular ventricle ; by others altogether denied. Finding a 
 cavity, they supposed they must discover the excretory duct. 
 Some conceived that it must be connected with the pelvis of the 
 kidney ; some with the thoracic duct ; some with the testicle ; 
 but every thing relating to the use of this body has hitherto 
 eluded research, and all is doubt and uncertain speculation. 
 For my own part I rather conceive that this body is useful in 
 the foetus, by deriving the blood from the kidney, that gland 
 not having its proper office, of secreting the urine, to perform 
 in the foetus. 
 
PART THE SECOND. 
 
 OF THE MALE PARTS OF GENERATION ; 
 
 S there is no very accurate division betwixt the viscera of 
 the abdomen and those of the pelvis ; as the viscera of the 
 pelvis, when distended, rise into the belly, and are in every re- 
 spect like the abdominal viscera, many have objected to a divi- 
 sion of the viscera of the abdomen and pelvis : nevertheless, 
 there appears to be good reason for this division of the subject. 
 The function of the parts is different ; the manner of their con- 
 nection is different ; their diseases have widely different effects. 
 
 We have seen that the pelvis consists of the sacrum and ossa 
 innominata, and that anatomists have distinguished the true 
 and the false pelvis. The false pelvis is formed of the extend- 
 ed wings of the ossa ilii, and supports the viscera of the abdo- 
 men. The true pelvis, marked by the cavity sinking beneath 
 the promontory of the sacrum and the linea innominata, con- 
 tains the rectum ; the urinary bladder ; the prostate gland ; 
 the vesiculae seminales ; and part of the urethra. 
 
 The manner in which these parts are connected, and the ana- 
 tomy of the urinary bladder, prostate gland, and urethra, will 
 form the subject of the first section ; while the anatomy of the 
 parts connected with those of the pelvis in function, but seated 
 without, will form the subject of the second. 
 
( 56 ) 
 
 CHAP. I. 
 
 OF THE PARTS WITHIN THE PELVIS. 
 
 E have seen that the abdominal viscera are involved in a 
 common membrane ; that this membrane is uniformly smooth ; 
 and that it has a secretion on its surface which bedews the 
 whole, and allows the parts an easy shifting motion on each 
 other. The parts in the pelvis must also have motion, but they 
 are at the same time more strictly connected ; a loose cellular 
 membrane is the medium of adhesion here : the parts are im- 
 bedded in cellular membrane, which is interwoven with mus- 
 cular fibres towards the lower opening of the pelvis, and fur- 
 ther braced by the levator ani muscle. This gives to the 
 whole due support ; enabling them to resist the compression 
 and action of the abdominal muscles, which they must receive 
 in common with the higher viscera of the belly. 
 
 By turning to the first plan in this volume we find, that the 
 division of the parts in the pelvis and abdomen is not well de- 
 fined ; but we see that the peritoneum is reflected from the pu- 
 bes over the urinary bladder, and mounts again upon the rec- 
 tum. The line of division, therefore, is the peritoneum ; while 
 we understand how the bladder which belongs to the pelvis, 
 being distended, carries the peritoneum before it, and rises into 
 the abdomen. 
 
 SECTION I. 
 
 or THE BLADDER OF URINE. 
 
 As the general nature of the urinary bladder is so well 
 known, nothing is more superfluous than a general definition or 
 description. It is attached behind the os pubis ; is nearly of a 
 regular oval, when moderately distended, with the ends ob- 
 tuse ; but from its connections, and the pressure of the sur- 
 rounding parts, this regular extension is not allowed in the 
 living body ; it stretches more laterally ; its fore part is attach- 
 ed broad to the back part of the os pubis ; and, behind, it is 
 opposed by the rectum. What the name would imply to be 
 the lower part, is above ; for th z fundus of the bladder is that 
 part which, when distended, rises into the belly : the neck is 
 where it terminates in the urethra behind the arch of the os 
 
OF THE BLADDER OF URINE. 
 
 9 ? 
 
 pubis. When the bladder is empty, or contains only a mode- 
 rate quantity of urine, it takes a triangular figure, the base of 
 which rests on the rectum, and the apex is attached to the back 
 of the os pubis ; and when in dissection you look down into 
 the pelvis, you find the back part of the bladder flat, and as it 
 were stretched obliquely up upon the os pubis. ^ 
 
 Structure of the bladder — Like the other hollow vis- 
 cera, the bladder consists of several coats. 
 
 The peritoneal coat of the bladder does not surround 
 the bladder, but only covers the fundus and back part. It is 
 like in every respect to the peritoneal coat of the abdominal 
 viscera ; smooth without ; and adhering to the inner coat by 
 cellular membrane ; which cellular membrane is, however, of 
 a looser texture, and in greater quantity than in the abdominal 
 viscera. This peritoneal coat is no doubt of much service as a 
 division in obstructing the course of inflammation arising from 
 the diseases in the lower part of the pelvis, or from operations 
 performed on the bladder, rectum, or perinaeum : were it not 
 for the loose peritoneum spreading over the cellular texture of 
 the pelvis, we could neither be so bold or so successful in our 
 operations here. That portion of the peritoneum which co- 
 vers the back part of the bladder, forms a particular transverse 
 fold when the bladder is contracted. This fold surrounds the 
 posterior half of the bladder, and its two extremities are 
 stretched towards the side of the pelvis, so as to form a kind of 
 lateral ligament. 
 
 Though in the contracted or moderately distended state of 
 the bladder, the peritoneum stretches from the back of the os 
 pubis to the bladder, the distention of the bladder, in an immo- 
 derate degree, raises the peritoneum off from the pubes, so 
 that the bladder can be struck with a trochar, or lithotomy per- 
 formed above the pubes, by an incision directly into the blad- 
 der, without piercing the outer or peritoneal coat. 
 
 Towards the lower part, the bladder, as we have seen, is in- 
 vested only by cellular membrane, which takes the place of tne 
 peritoneal coat of the fundus. While we are aware of the ef- 
 fect of the peritoneum, stretched over the parts in the pelvis, 
 in obstructing the progress of inflammation from the bottom 
 of the pelvis towards the abdominal viscera, we must recollect 
 that there exists such a sympathy betwixt the bladder, and the 
 stomach and bowels, that both after operation, and in conse- 
 quence of obstruction of urine, the patient will sink, in conse- 
 
 * This flatnefs of the bladder, and the nearnefs of the back part of it to ;be os 
 pubis, the furgeor, would do well to remember, be'ore he thiufts the gorget 
 ftilet with fuch relentlefs impetuolity as I have feen done. 
 
 Vol. IV. " N 
 
( 36 ) 
 
 CHAP. I. 
 
 OF THE PARTS WITHIN THE PELVIS. 
 
 "W E have seen that the abdominal viscera are involved in a 
 common membrane ; that this membrane is uniformly smooth ; 
 and that it has a secretion on its surface which bedews the 
 whole, and allows the parts an easy shifting motion on each 
 other. The parts in the pelvis must also have motion, but they 
 are at the same time more strictly connected ; a loose cellular 
 membrane is the medium of adhesion here : the parts are im- 
 bedded in cellular membrane, which is interwoven with mus- 
 cular fibres towards the lower opening of the pelvis, and fur- 
 ther braced by the levator ani muscle. This gives to the 
 whole due support ; enabling them to resist the compression 
 and action of the abdominal muscles, which they must receive 
 in common with the higher viscera of the belly. 
 
 By turning to the first plan in this volume we find, that the 
 division of the parts in the pelvis and abdomen is not well de- 
 fined ; but we see that the peritoneum is reflected from the pu- 
 bes over the urinary bladder, and mounts again upon the rec- 
 tum. The line of division, therefore, is the peritoneum ; while 
 we understand how the bladder which belongs to the pelvis, 
 being distended, carries the peritoneum before it, and rises into 
 the abdomen. 
 
 SECTION I. 
 
 OF THE BLADDER OF URINE. 
 
 As the general nature of the urinary bladder is so well 
 known, nothing is more superfluous than a general definition or 
 description. It is attached behind the os pubis ; is nearly of a 
 regular oval, when moderately distended, with the ends ob- 
 tuse ; but from its connections, and the pressure of the sur- 
 rounding parts, this regular extension is not allowed in the 
 living body ; it stretches more laterally ; its fore part is attach- 
 ed broad to the back part of the os pubis ; and, behind, it is 
 opposed by the rectum. What the name would imply to be 
 the lower part, is above ; for the fundus of the bladder is that 
 part which, when distended, rises into the belly : the neck is 
 where it terminates in the urethra behind the arch of the os 
 
OF THE BLADDER OF URINE. 
 
 9f 
 
 pubis. When the bladder is empty, or contains only a mode- 
 rate quantity of urine, it takes a triangular figure, the base of 
 which rests on the rectum, and the apex is attached to the back 
 of the os pubis ; and when in dissection you look down into 
 the pelvis, you find the back part of the bladder flat, and as it 
 were stretched obliquely up upon the os pubis. ^ 
 
 Structure of the bladder — Like the other hollow vis- 
 cera, the bladder consists of several coats. 
 
 The peritoneal coat of the bladder does not surround 
 the bladder, but only covers the tundus and back part. It is 
 like in every respect to the peritoneal coat of the abdominal 
 viscera ; smooth without ; and adhering to the inner coat by 
 cellular membrane ; which cellular membrane is, however, of 
 a looser texture, and in greater quantity than in the abdominal 
 viscera. This peritoneal coat is no doubt of much service as a 
 division in obstructing the course of inflammation arising from 
 the diseases in the lower part of the pelvis, or from operations 
 performed on the bladder, rectum, or perinsum : were it not 
 for the loose peritoneum spreading over the cellular texture of 
 the pelvis, we could neither be so bold or so successful in our 
 operations here. That portion of the peritoneum which co- 
 vers the back part of the bladder, forms a particular transverse 
 fold when the bladder is contracted. This fold surrounds the 
 posterior half of the bladder, and its two extremities are 
 stretched towards the side of the pelvis, so as to form a kind of 
 lateral ligament. 
 
 Though in the contracted or moderately distended state of 
 the bladder, the peritoneum stretches from the back of the os 
 pubis to the bladder, the distention of the bladder, in an immo- 
 derate degree, raises the peritoneum off from the pubes, so 
 that the bladder can be struck with a trochar, or lithotomy per- 
 formed above the pubes, by an incision directly into the blad- 
 der, without piercing the outer or peritoneal coat. 
 
 Towards the lower part, the bladder, as we have seen, is in- 
 vested only by cellular membrane, which takes the place of the 
 peritoneal coat of the fundus. While we are aware of the ef- 
 fect of the peritoneum, stretched over the parts in the pelvis, 
 in obstructing the progress of inflammation Irom the bottom 
 of the pelvis towards the abdominal viscera, we must recollect 
 that there exists such a sympathy betwixt the bladder, and the 
 stomach and bowels, that both after operation, and in conse- 
 quence of obstruction of urine, the patient will sink, in conse- 
 
 * This flatnefs of the bladder, and the nearnefs of the back part of it to the os 
 pubis, the furgeon would do well to remember, before he thiufts the gorget e r 
 ffilet with fuch relentlefs impetuofity as I have feen done. 
 
 Vol. IV. ‘ N 
 
S8 
 
 OF THE BLADDER OF DRINK. 
 
 quence of abdominal inflammation, without the direct spread 
 ing of the inflammatory action. 
 
 Muscular coat — The muscular coat of the bladder is 
 , very strong. Three strata of fibres are described by authors. 
 They are so strong as to have been classed with the distinct 
 muscles, and the whole coat has been called detrusor urisle. 
 Towards the lower part of the bladder the fibres are particu- 
 larly strong, and formed into fasciculi, and are like a net of 
 muscles inclosing the bladder. 
 
 Towards the neck of the bladder the circular fibres are 
 strengthened ; and embrace the beginning of the urethra ; and 
 form a sphincter, which, no doubt, is assisted in its operation 
 by the levator ani muscle, throwing its strong fibres around 
 the neck of the bladder. The muscular coat of the bladder 
 becomes greatly stronger, where difficulties oppose its dis- 
 charge ; and when there is a source of irritation, within the 
 bladder, acting for any time, the whole coats become thicken- 
 ed, sometimes to the depth of half an inch or more ; in which 
 case, as we have observed, to take place in the stomach, it is 
 capable but of a very inconsiderable change, either by deten- 
 tion or contraction ; consequently the urine runs frequently by 
 painful discharges. The lithotomist would do well to distin- 
 guish when this symptom is merely the consequence of a stone 
 in the bladder, and when it is owing to an increase in thick- 
 ness, and a rigidity of the coats of the bladder ; for, in the 
 latter case, the operation of the gorget is attended with very 
 serious evils. 
 
 We have an idea of the wonderful degree of contraction in 
 the bladder, and indeed the extent of motion in the muscular 
 fibre in general, v/hen we consider that the bladder extends so 
 as to contain two pounds of urine, and contracts so as to force 
 out the last drop from its cavity. When, however, the fibres 
 are stretched too far, they lose the power of contraction, and 
 often the young surgeon is deceived by what he conceives to be 
 an incontinence of urine while it is really an obstruction. 
 
 VASCULAR COAT, OR CELLULAR COAT. 
 
 When I call this third coat of the bladder the vascular coat, 
 it is merely from its analogy to that coat of the intestines which 
 I have distinguished by the name of vascular. Anatomists 
 have called it the nervous and cellular coat ; the first of which 
 is quite improper and the last apt to be confounded with the 
 surrounding cellular outer coat. This coat (if coat it may be 
 called) consists of very’ extensile white lamellae, of cellular 
 
OF THE BLADDER OF URINE. 
 
 99 
 
 membrane. It gives distribution to a few vessels, and connects 
 the muscular fibres and inner coat. 
 
 The internal coat of the bladder is very smooth on its 
 general surface, and is bedewed with a sheathing mucus.’ 
 When the bladder is distended, no inequalities are to be ob- 
 served ; but when contracted it falls into folds and rugae. 
 From an acrid state of the urine ; from strangury, from cal- 
 culus, the mucous discharge is increased, even so as to form a 
 great proportion of the fluid evacuated from the bladder. No 
 visible source of this mucus is to be observed on the inner sur- 
 face of this membrane ;* so that probably it is a general dis- 
 charge from the surface. Indeed, it appears, that no follicules 
 or criptse, discharging at particular points of the surface, 
 could have the effect of bedewing and defending the whole 
 surface from the acrimony of the urine. The great sources of 
 the mucus discharged with the urine are, the neck of the 
 bladder, the prostate gland, and the urethra.^ 
 
 The Ureters, which convey the urine from the kidnies to 
 the bladder of urine, open very obliquely into the bladder, to- 
 wards the back and lowest part of it. The consequence of 
 their oblique perforation of the coats is, that, the greater the 
 tendency of the urine to pass retrograde into them from the 
 bladder, (there being a proportioned distention of the coats of 
 the bladder,) the more their mouths are compressed. Thus, 
 in the dead body, there is no degree of distention which causes 
 the water to pass by the ureters. The contraction, or rather 
 the resistance to distention, of the ureters and pelvis of the 
 kidnies seems much greater than the powers of the bladder 
 are able to oppose ; for in obstructions of urine in the urethra, 
 there is still an incessant accumulation in the bladder, even 
 when the bladder has increased to such a size as to be com- 
 pressed by the action of the abdominal muscles. The cause of 
 this yielding of the bladder to the secretion of the kidney is, 
 that it has little permanent contraction, though occasionally its 
 action is very great. 
 
 The urachus does not belong to the human bladder. It is 
 a tube which, in the foetus of quadrupeds, communicates be- 
 twixt the bladder of urine, and the membrane called alantoes. 
 But in the human foetus there is no such communication ; both 
 in the foetus, and somewhat less distinctly in the adult, there is 
 a ligament like the remains of the duct which runs up between 
 
 * Window, however, defcribes the glands, and Heilter and Haller dcfcribe fol- 
 licules, near the neck of the bladder, and round the infertion of the ureti rs. 
 
 f When the mucous fecretion is diminiihed by a difeafe of the furface, it feems 
 much more readiiv to allow the calculous concretion to form upon it. 
 
100 
 
 ©F THE PROSTATE GLAND. 
 
 the peritoneum and linea alba of the abdomen towards the 
 umbilicus.* 
 
 SECTION II. 
 
 OF THE PROSTATE GLAND. 
 
 On the neck of the bladder, and surrounding about half aa 
 inch of the beginning of the urethra, there is a gland nearly of 
 the size and figure of a chesnut. This body is called the 
 prostate gland. In all the extent of anatomv, there is not a 
 more important subject for the attention of the surgeon than 
 this of the size, relation and connection, and diseases (with 
 th ir effects) of the prostate gland: but to enter upon these is 
 not now our object. 
 
 The shape of this body is round, but at the same time 
 somewhat pyramidal, for it is broad towards the bladder, and 
 points forward. It has also a division, forming it into two 
 lobes ; and the older anatomists speak of it as double. The 
 urethra passes through it , not in the middle, but towards its 
 upper surface ; so that the gland is felt more prominent down- 
 ward, and is distinctly felt by the point of the finger in ano . 
 This gland indeed rests, as it were, on the rectum. By the 
 annexed drawing,) it is meant only to give an accurate com 
 ception of these parts, and not to represent them as they are 
 feh in the living body. For this reason the drawing is made 
 from a preparation, and not from the recent dissection. When 
 the catheter is introduced, and the surgeon examines the state 
 of parts by the rectum, he will first distinguish the curve of 
 the staff, covered with the bulb of the urethra : behind this the 
 catheter will feel more bare of parts, but still covered with a 
 greater thickness of parts than one should expect from the 
 description of the membraneous part of the urethra. And 
 behind this, again, he will feel the prominence of the prostate 
 gland, not round, distinct and accurately defined, but gradu- 
 ally lost in both before and behind, among the surrounding 
 cellular membrane and muscular fibres which involve it. 
 
 The texture of the gland is a compact spongy substance, 
 and when cut has considerable resemblance to a schirrous 
 
 * It has occurred, that the urine has been in part difcharged by the umbilicus. 
 This, no doubt, isowing to the ligament remaining permaaently asadudt. 
 
 + Plates III. and IV. 
 
STRUCTURE OF THE PENIS. 
 
 ioi 
 
 gland. From each lobe there are small follicules opening into 
 the urethra, and from these the ducts may be injected. 
 
 It has been said, that there is really no division of this 
 gland into lobes : but perhaps the best authority on this 
 question is disease. Now it happens sometimes that only one 
 side of the gland is enlarged, which is a proof that there is 
 some division betwixt the lobes. This unequal swelling of the 
 gland distorts the urethra, and gives it a direction very difficult 
 to be followed by the catheter. In general, when equally 
 swelled, the greater part of the gland, being beneath the 
 urethra, raises it up so that the point of the catheter must be 
 raised over the enlarged gland before we can pass it into the 
 bladder. This body is little liable to inflammation, and occa- 
 sional tumefaction, so as to obstruct the urine ; its enlargement 
 is a chronic state, and peculiar to advanced age. 
 
 CHAP. II. 
 
 OF THE PARTS CONNECTED WITH THE VIS- 
 CERA OF THE PELVIS, BUT SEATED WITH- 
 OUT IT OF THE PENIS AND URETHRA.— 
 
 OF THU TESTES. 
 
 SECTION I. 
 
 OF THE PENIS AND URETHRA. 
 
 STRUCTURE OF THE PENIS. 
 
 T HE penis consists of three spongy bodies ; which, being 
 constituted to receive the influx of blood, admit of distention, 
 and consequent erection. Two of these bodies are called the 
 corpora cavernosa penis, and form the body of the penis ; 
 the other is the corpus spongiosum urethra, a vesicular and 
 spongy substance, which surrounds the whole length of the 
 
102 
 
 STRUCTURE OF THE PENIS. 
 
 V> 
 
 urethra, and expands into the bulb of the urethra in the peri- 
 neum, and into the glands on the point of the penis. 
 
 Corpora cavernosa. The body of the penis consists of 
 two tubes formed of a very strong sheath. This sheath has a 
 great degree of elasticity, but at its utmost extension power- 
 fully resists the farther distention with blood. These tubes are 
 united in the greater part of the length of the penis, or they 
 are parted by an imperfect partition. The root of these bodies, 
 or crura penis, as they are called, separate in the perineum, 
 so as so take hold on the ramus of the os pubis. Foreward, 
 these bodies or tubes terminate in rounded points under the 
 glans penis. 
 
 These tubes are of a ligamentary nature, bating that they 
 have a certain degree of elasticity. They inclose and support 
 the cavernous structure of the penis. This substance consists 
 of cells connected with each other and having a free commu- 
 nication through the whole extent of the penis. These cells 
 are interposed betwixt the extremities of the arteries and 
 veins, or probably while the arteries have communication, 
 and open into the extremities of the veins, in the common 
 way, they have such connections with the cellular structure, 
 that in the accelerated action they pour their blood into the 
 cells ; yet the blood circulates in the penis during erection as 
 at other times. 
 
 Section of the Penis as inflated. 
 
 Section of 
 
 A, Corpus Cavernosum Penis. B, Septum. C, Urethra, 
 D, Corpus Spong. Minus, or spongiosum Urethra. 
 
STRUCTURE OT THE PENIS. 
 
 102 , 
 
 Corpus spongiosum urethra. 
 
 Surrounding the urethra there is a spongy body similar to 
 that which forms the body of the penis. Where this spongy 
 sheath of the urethra lies in the perineum, betwixt the crura 
 of the penis, it is enlarged with a round head, which is called 
 the bulbous part ; — it is upon this, and on about an inch and an 
 half of the lower part of the spongy body, that the ejaculator 
 seminis, or accelerator urinse acts ; and, as -within this enlarge- 
 ment of the spongy body which surrounds the urethra there is 
 also a dilatation of the tube of the urethra itself, the use of the 
 muscle is evident. It contracts upon this sinus of the urethra 
 when distended with the discharge from the vesiculee, the 
 prostate glands, and testicle. As an accelerator urinse, it can- 
 not act, but it expels the last drop of urine, as a consequence 
 of their detention in this more dilatable part of the urethra. 
 
 The spongy sheath of the urethra, as we have hinted, is 
 enlarged into the gl an s, so that the action of the accelerator 
 muscle affects the whole length of the spongy body of the 
 urethra and the glans by the compression of the blood in the 
 bulb. 
 
 There is a connection betwixt the glans, spongy tube of the 
 urethra, and accelerator muscle. The excitement of the glans 
 gives the action to the accelerator or ejaculator muscle ; the 
 action of this muscle compresses the bulb, and in consequence 
 the whole spongy body to the extremity of the glans is made 
 tense, elongates, and contracts the diameter of the urethra, 
 adapting it to the emission of semen. Mr. Home, I observe, 
 supposes “ that an action takes place in the membrane of the 
 urethra during copulation, to reduce the size of the canal, and 
 fit it for throwing out the semen with the necessary velocity:” 
 but for this, there seems no ground nor proof ; and I imagine, 
 the action of the accelerator, and the state of distention of the 
 spongy body, will be a good substitute to his conjecture. 
 
 The obtuse point of the glans is spread upon the extremities 
 of the cavernous bodies of the penis, which yet have no com- 
 munication with the glans. We observe a circular margin, the 
 corona glandis, and behind this the cervix. About the corona 
 and cervix there are many little glandular follicules,^ which 
 are no doubt for preserving the mobility of the preputium. 
 
 The preputium is a loose prolongation of the integuments 
 of the penis, which hangs over and defends the delicate and 
 sensible surface of the glans. Its inner surface is of course 
 
 * Glandul. odorif. of Tyfon, See Morgagni. 
 
104 
 
 STRUCTURE OF THE PENIS* 
 
 the continued surface of the common integuments, while it 
 again is reflected over the glans. Upon the lower side the 
 preputium is tied in a particular manner to the surface of the 
 glans behind the orifice of the urethra. This connection li- 
 mits the motion of the preputium, and is called frenUm 
 preputii. 
 
 The whole integuments of the penis are of the same cellular 
 structure with those of the rest of the body, and may be with 
 equal facility inflated : they are particularly loose and distensi- 
 ble, and unincumbered with fat. 
 
 A third common integument of the penis is distinguished, 
 and is called the tunica nervosa. It is of a more firm elastic 
 ligamentary substance. A ligament, however, is not elastic, 
 and the firmness here is merely that of a greater degree of 
 condensation in the common membrane. It is this membrane, 
 which being attached to the os pubis, and supporting the penis, 
 forms the ligamentum elasticum suspensorium. 
 
 A Glans. 
 
 B B Corona Glandis. 
 
 C Cervix. 
 
 D Corpus Caverno- 
 fum Penis. 
 
 E E Corpus Spongi- 
 ofum Urethrae. 
 
 F Crura of the Penis, 
 by which it is 
 attached to the 
 Ramus of the 
 Pubes. 
 
 H Vena ipfius Penis. 
 
STRUCTURE OE THE PENIS. 
 
 1Q§ 
 
 OF THE URETHRA. 
 
 The urethra is all that length of the canal from the neck of 
 the bladder to the extremity of the penis. It is formed of the 
 continuation of the inner and third coat of the bladder, which 
 last forms a reticular membrane, uniting the inner membrane 
 to the spongy body. It .is, however, supported through all its 
 length, near the bladder, by passing through the prostate gland 
 and sphincter fibres ; further forward than this, where it passes 
 from the prostate to the beginning of the spongy body of the 
 urethra, it is invested and supported by firm cellular and liga- 
 mentous membranes ; and in the length of the penis it is in- 
 cluded in the spongy body, which extends from the bulb to the 
 glans. It cannot be described as a cylindrical canal, for it ad- 
 mits of very unequal distention. It begins large at the neck of 
 the bladder, where, immersed in the prostate gland, it forms 
 a little sinus ; it is contracted again in a remarkable degree 
 behind the bulb; it dilates into the sinus of the urethra 
 within the bulbous enlargement of the spongy body ; it is 
 gradually diminished forward ; and it may be considered as 
 cylindrical forward to the point of the glans, where it is much 
 contracted,* and where we often find calculi detained, which 
 have passed the whole length of the canal. 
 
 The canal of the urethra is bedewed with mucus. The 
 sources of this mucus are here particularly apparent ; for, 
 besides the general surface, there are lai ge lacunae seen ; into 
 which the mucus is secreted, and from which, as from recep- 
 tacles, it is pressed as the urine flows. The inner membrane 
 of the urethra is very delicate, and, when torn bv the catheter, 
 or by violent chordee, or opened by the caustic, bleeds pro- 
 fusely. 
 
 The internal membranes of the bladder and urethra are 
 particularly sensible ; drawing after them, when excited, not 
 only the action of all the muscles in the lower part of the pelvis, 
 but having sympathies in a particular manner with the testicle, 
 stomach, and bowels, and with the whole system. The more 
 curious and important effect of the injurvof the urethra is the 
 paroxysm of fever which it induces. Observing the regular 
 occurrence of an intermitting fever in cases of fistula in the 
 perineum, we should imagine it to be the effect of the extra- 
 vasation of the urine in the cellular membrane, and the effect 
 of general irritation ; until it is observed that the simple 
 
 * Haller Cam. lib. xxvii. £e<ft. i. § xxx, Mr. Home’s Strictures. 
 
 Vol. IV, O 
 
106 
 
 STRUCTURE OF THE PENIS. 
 
 stricture produces that effect, and that a touch of the caustic 
 brings on a violent paroxysm. 
 
 When the reticular membrane is inflamed, of course it loses 
 its elasticity, and gives pain in erection. Sometimes the in- 
 flammation, being continued to the spongy body surrounding 
 the urethra, makes it unequal in its capacity of distention to 
 the cavernous bodies of the penis, and sometimes their cells are 
 united by adhesion in the worst cases of chordee. 
 
 I cannot imagine with some, that the urethra is muscular ; 
 first , because I see no end it could serve in the ceconomy ; 
 secondly , because there is no proof in support of the opinion ; 
 thirdly, because it is surrounded with strong fibres and a 
 spongy body, which conjointly seem calculated for every pur- 
 pose of the ceconomy, and likely to account for every symptom 
 which might be mistaken for spasmodic action in the canal it- 
 self. The idea of muscularity is derived from the symptoms 
 of stricture and irritability of the canal. I shall therefore, iu 
 the first place, shew how I conceive stricture is produced. 
 
 The urethra is very elastic ; not only allowing a very large 
 bougie to be passed, and closing upon a thread, but it still 
 more remarkably admits of elongation than of distention in the 
 width of the canal. It is surrounded, as we have seen, with 
 a spongy body and the cellular coat which is betwixt the deli- 
 cate lining membrane of the urethra, and the spongy bodt' 
 partakes of the structure of both, and is very elastic. But 
 when an inflammation attacks the canal,, this cellular mem- 
 brane is its principal seat. The point affected loses its 
 elasticity ; no longer stretches with the penis and urethra, but 
 consolidates, and throw’s the inner 
 membrane into a fold in a direction 
 across the canal. Thus the mem- 
 brane at A has contracted and con- a 
 densed in consequence of inflamma- 
 tion, or rather, when contracted by B 
 the shrinking of the urethra in length 
 and its spongy body has formed an 
 adhesion, and, in consequence of in- 
 flammation, has lost its elasticity and 
 no longer dilates in the proportion of 
 the rest of the canal. The conse- 
 quence of this is, that the point of the 
 
 inner membrane B makes a projecting ring round the urethras. 
 To suppose this stricture to have been formed by the muscular 
 
STRUCTURE OF THE PENIS. 
 
 107 
 
 contraction in the diameter of the canal, * would be to allow 
 the partial action of one or two fibres ; (for the stricture is like 
 that which would be produced by the tying of a pack-thread 
 round the canal, being a narrow circular ridge ;) which is very 
 unlikely. Sometimes, however, the stricture is only' on one 
 side of the canal, which, allowing it to be formed as I have 
 here supposed, is very likely to happen : but in consequence 
 of the muscular action, cannot easily be supposed to take 
 place, since the drawing of the muscular fibres would equally/ 
 affect the whole circle. 
 
 As to the effect of heat and cold on an obstruction, it may 
 be explained simply, without the supposition of muscular con- 
 traction : for as we know that the penis, spongy bodies, and 
 of course the whole canal, relax and elongate in warmth, as 
 they are shrunk up and contracted in cold, like the skin of the 
 body in general, without implying muscular contraction : so 
 we see how this state would affect a stricture ; — that, when the 
 penis and the urethra was shrunk, the effect of the stricture 
 would be increased, and the patient could pass his urine only 
 when the parts were relaxed, by sitting in a warm room, or by 
 the use of the bath. 
 
 But when surgeons speak of spasms of the urethra, they 
 seem to forget the action of the surrounding muscles. Thus 
 acrid and stimulating urine, or an irritable state of the urethra, 
 will be followed by a small stream of urine : or perhaps a 
 temporary obstruction is the consequence : but why should we 
 suppose that the membrane of the urethra, which has no ap- 
 pearance of muscularity, causes this effect, when it is probably 
 produced by the sphincter muscle, the fibres which surround 
 the membraneous part of the urethra, the levator ani, and, 
 above all, by the accelerator urinae, a muscular sheath of fibres 
 surrounding three or four inches of the canal. Round the 
 membraneous part of the urethra, and behind the bulb, there 
 is much interlacing of muscular fibres ; and the levator ani, 
 splitting, embraces it. Round the sinus of the urethra and the 
 bulb which covers it, is the accelerator urinae, more properly 
 the ej aculator seminis : and as the ejaculator seminis contracts 
 upon the sinus, it drives onward the semen along the urethra, 
 since the seminal fluids do not pass backward into the bladder, 
 unless when the action of the parts is much disordered ; there 
 must be a contraction round the urethra behind the bulb during 
 the action of the ejaculator. The sensibility of the glans 
 
 * lt A ftricture,” fays Mr. Home, “ whether in the fpafmodic or permanent 
 date, is a contraction of the trarifverfe fibres of the membrane which forms the 
 
 -:annV ’ 
 
108 
 
 OF THE TESTES. 
 
 holds a controul over the action of these muscles ; and the 
 d st ase of the bladder and of these parts affects the glans. 
 There is, in short, a complicated apparatus here, and we can- 
 not wonder, that the most frequent seat of disease is just at 
 the beginning of the sinus of the urethra, where the muscular 
 action is stronger, and the canal narrowest. At this place is 
 the stricture of the urethra most common, and here if spasm 
 and muscular action should bring it on, if spasmodic action 
 should prevail during the permanent stricture, or blistering 
 bring on a strangury, (seeing that this point is so surrounded 
 with muscular fibres destined to a particular action,) we must 
 not take these symptoms as indicating a muscularity in the 
 whole tract of the urethra. I believe it is found, that stricture 
 is most frequent just behind the bulb of the urethra ; where I 
 have alleged, the muscularity is greatest ; and also about the 
 distance from the extremity of the urethra which answers to 
 the termination of the ejaculator muscle. 
 
 SECTION II. 
 
 OF THE TESTES. 
 
 The testicle might be considered as more naturally con- 
 nected with the abdominal viscera, than with those of the 
 pelvis, as its original seat is on the loins amongst'the abdominal 
 viscera, and as it receives its coats from the peritoneum, and 
 its vessels from the abdominal vessels. 
 
 The testes are two glandular bodies which secrete the se- 
 men : they receive their vessels from the aorta and cava, or 
 the emulgent vessels ; their excretory duct runs up into the 
 belly, and it terminates in the urethra near the neck of the 
 bladder. 
 
 The scrotum, in which the testicles are lodged, is a con- 
 tinuation of the common integuments ; its cellular membrane 
 is particularly lax and free from fat, and anasarca extremely 
 apt to fall down into it, so as sometimes to distend the scrotum 
 to a transparent bag of enormous size ; and not unfrequently 
 it has been blown up to counterfeit rupture and other diseases. 
 
 The cellular substance of the scrotum is peculiar in its ap- 
 pearance, being red and fibrous. It has been considered as a 
 muscle, and called dartos : although this is denied by many. 
 Its action is to support and brace the scrotum ; and in bad 
 health,* and iii old age, it is so much relaxed as to allow the 
 
 * Nurfes particularly attend to the ftate of the ferotum in children. 
 
OP THE TESTES. 
 
 109 
 
 testicles to hang upon the chords. But besides the simple cor- 
 rugation and relaxation, the scrotum has a motion like the 
 vermicular motion of the intestines, from side to side, and 
 alternately. Its contraction has a relation to the healthy secre- 
 tion of the gland within. 
 
 Upon the surface of the scrotum, directly in the middle, 
 there is a line passing from the lower part of the penis to the 
 anus ; the rapha. This line marks a division in the scrotum, 
 not superficial merely ; but a partition, or septum, is formed, 
 dividing the scrotum into two distinct cellular beds for the 
 testicles. 
 
 Coats of the testicle. Besides the involving scrotum, 
 each testicle has two distinct coats, the tunica vaginalis and 
 tunica albuginea. The tunica vaginalis covers the testicle 
 loosely ; that is, without adhering to its general surface ; but 
 the albuginea is in close union with it, and is the immediate 
 coat of the testicle. The inner surface of the vaginal coat is 
 perfectly smooth, and an exudation is poured out from it, as 
 from the peritoneum within the belly, the outer surface of the 
 tunica albuginea is also smooth and firm, and white, whence 
 its name. But on its inner surface, like the peritoneum, which 
 covers the intestine, and adheres to the muscular coat, it 
 adheres to the tubes of the testicle itself. These investing 
 coats are in some respects dissimilar, yet in general much 
 alike, being continuations of the same membrane, and both 
 prolongations of the peritoneum. The outer membrane, the 
 tunica vaginalis, is a protection to the testicle, gliding easily 
 on the inner coat, and with the mobility of the cellular mem- 
 brane of the dartos it preserves the testicles from bruises and 
 strokes to which it would be exposed if it were more firmly 
 attached. The inner tunic, or albuginea, gives strength and 
 firmness to the substance of the testicle. Betwixt these coats 
 is the fluid collected, which forms the hydrocele. They also 
 contain the congenital hernia ; but the common hernia is with- 
 out both coats of the testicle. To understand the principles of 
 anatomy of this part, we must attend to the descent of the 
 testicle, and to the manner in which these coats are formed. 
 
 of the descent of the testicle. 
 
 In the fcEtus, some months before birth, the testicles are 
 lodged in the belly, and are in every respect like the abdominal 
 viscera. They are seated on the fore part of the psoae muscles, 
 by the side of the rectum. They are of course covered and 
 invested by the peritoneum ; for, as we have explained how 
 the solid viscera and the intestines are behind the peritoneum, 
 
110 
 
 or THE TESTES. 
 
 so it will be understood how the testicles lying on the loins are 
 behind the peritoneum : that is to say, the glandular substance 
 of the testicle is invested by a single coat, and that coat is the 
 peritoneum, which, alter covering the body of the testicle, is 
 reflected upon the loins ; as the coats of the liver, for example, 
 are to be traced from its surface to the diaphragm : no words, 
 however, can well explain this subject, and it will be better 
 understood by sections and plans. 
 
 First Plan of the Testicle. 
 
 • ist Plan of the Tefticle. 
 
 We see that the body of the testicle A is seated on the loins, 
 that it is attached by vessels, and invested by the peritoneum. 
 This surrounding of the body of the testicle by the peritoneum 
 forms that coat which is in union with its substance, and which 
 descends with it into the scrotum, and forms the tunica al- 
 buginea. 
 
 The figure and presenting surfaces of the testicle, while 
 within the belly, are the same which we find after it has de- 
 scended into the scrotum. It stands edge-ways forward, and 
 the epididimis lies along the outside of the posterior edge of 
 the testes. We see that it is attached, by the peritoneum 
 being reflected off from its back part, and we can trace the 
 peritoneum upwards over the kidnev G, and downward over 
 the rectum F, and bladder of urine E. 
 
 We may also observe a process of the peritoneum which has 
 
OF THE TESTES. 
 
 lit 
 
 passed through the abdominal ring, and which in this plan is 
 marked D. Now it may easily be understood that the testicle 
 A, gradually shifting its place from its connections in the 
 loins, drops down into this sheath D. It will also be easily 
 understood how the testicle covered with its first coat B, (viz. 
 the tunica albuginea,) when it has fallen into D, is invested by 
 this sac of the peritoneum, and that this last covering will 
 come to be the tunica vaginalis. The tunica vaginalis is so 
 called because it covers the testicle like a sheath ; that is, it 
 does not universally adhere to the surface of the albuginea, as 
 that coat does to the body of the testicle. 
 
 Understanding the nature of the peritoneum, we may learn 
 the meaning of this looseness of the outer coat of the testicle. 
 By turning to the introductory section of the abdominal mus- 
 cles, we find, that the inside of the sac of the peritoneum is 
 smooth, and forms no adhesion ; whilst the outer surface, 
 being in contact with the substance of the several viscera, has 
 a connection with them by a common cellular membrane. 
 Now, as the inside of the peritoneum does not adhere, as the 
 surface of the peritoneum, (which in this first plan is towards 
 C,) is smooth, and has no tendency to unite with the surface 
 of the viscera ; so neither has the surface of the peritoneum 
 at D, the tendency to unite with the peritoneum (or the sur- 
 face of the albuginea,) at B, when it descends to meet it : 
 consequently the coat of the intestines may be represented in 
 this second plan, thus. 
 
 Second plan of the Testicle- 
 
 3d. Plan of the Teftide. 3d. Plan of the Tefticle, 
 
112 
 
 or THE TESTES. 
 
 In the first plan, we had the situation of the testicle in the 
 foetus represented. In the second plan, we have the middle 
 stage of the descent represented : and, in the third, we have 
 the full descent. In the second figure, A is the body of the 
 testicle, B is the first peritoneal covering or tunica albuginea, 
 which can be easily traced, reflected off from the loins at C; 
 again, D is the portion of the peritoneum, which having de- 
 scended before the testicle is presently, when the testicle has 
 fully descended, to become the second, or vaginal coat of the 
 testicle ; F is the continuation of the peritoneum upon the 
 inside of the abdominal muscles. 
 
 In the third figuie of this series, we find the testicle A has 
 descended into the scrotum ; that it has one coat covering it, 
 which we recognize to be the same with B, in the first figure, 
 and that the peritoneum in this third plate at B, can be traced 
 to C, the peritoneum within the belly. 
 
 Now supposing this to be the state of the testicle immedi- 
 ately after it has descended, we see that there is still a com- 
 munication betwixt the cavity of the tunica vaginalis D, and 
 the cavity of the peritoneum E. F is the kindey, covered by 
 the peritoneum, and nearly in the situation in which the testi- 
 cle was before its descent. 
 
 Fourth Plan of the Testicle. 
 
 From this fourth plan of the testicle, we may learn the 
 nature of the congenital hernia. It is a hernia produced by 
 
OF THE TESTES. 
 
 113 
 
 ihe intestine slipping down, from the communication betwixt 
 the general cavity of the peritoneum, and the cavity of the 
 tunica vaginalis, or in consequence of an adhesion betwixt the 
 testicle and a portion of the gut, which of course causes the 
 gut to follow the testicle, and prevents the communication be- 
 twixt the belly and the cavity of the tunica vaginalis from being 
 shut. Thus, fig. 4. A, is the testicle, as it is seen in plan 3d. 
 B, the tunica albuginea; C, the peritoneum within the belly ; 
 D, the tunica vaginalis, which we can trace from C, and which 
 is distended and separated from the surface of the testicle, 
 (i e. of the albuginea) by a portion of the gut, which has de- 
 scended through the ring: F, the intestines within the belly: 
 G, the intestine which has fallen into the tunica vaginalis, and 
 is in contact with the testicle ; that is, in contact with the tuni- 
 ca vaginalis, which is in close union with the gland, and is con- 
 sidered as its surface. 
 
 We have explained the change which takes place in the situ- 
 ation of the testicle, as it relates to the peritoneum ; but how 
 this change is brought about, it is very difficult to understand. 
 It is not a sudden pulling down of the testicle, but a very gra- 
 dual process, continuing for months ; it is not the effect of gra- 
 vitation, for the fetus may be in every variety of posture while 
 in the womb, and generally the head presents. It is not respi- 
 ration. Is it then the effect of the action of the cremaster mus- 
 cle ? or must we refer it to a law such as that which controuls 
 and directs the growth of parts ? 
 
 When the parts in a fetus before the descent of the testicle 
 are dissected, there is found a ligamentous, or cellular cord, 
 mingled with the fibres of the cremaster muscle, and which 
 takes its origin from the groin, is reflected into the abdominal 
 ring, and stretches up to the body of the testicle. This body 
 is called ligament or gu'oernaculum, and to the agency of this 
 bundle of fibres, is the descent of the testicle attributed. 
 There are, however, objections to this. If we suppose that 
 the cremaster muscle, by its exertion, brings down the testicle 
 to the ring, how does it pass the ring ? for surely we cannot 
 suppose that this muscle, which takes its origin from the inter- 
 nal oblique muscle, consequentlv within, can contract, not only 
 so as to bring the testicle to the very point of its origin, but to 
 protrude it past that point, and through the tendon of the ex- 
 ternal oblique muscle. Again, animals have the cremaster 
 muscle, whose testicles never descend out of the bellv ; — again, 
 the vessels of the chord, before the testicle has fully descended, 
 show no marks of being dragged down, for they are elegantly 
 tortuous. 
 
 As the testicle passes verv slowly from the loins to the ring ; 
 Vol. IV. ' P 
 
114 
 
 OF THE TESTES. 
 
 so, after it has escaped from the belly, it passes slowly from the 
 ring to the bottom of the scrotum. It commonly remains 
 some time by the side of the penis, and only by degrees de- 
 scends to the bottom of the scrotum.* 
 
 In this change the testicles do not fall loose into the elonga- 
 tion of the peritoneum like a piece of gut or omentum in a 
 rupture ; — but, carrying the peritoneum with them, they conti- 
 nue to adhere to the parts behind them, as they did to the psoas 
 muscle while in the loins : a point of importance to be recol- 
 lected by the young surgeon. 
 
 The communication betwixt the belly and the sac of the va- 
 ginalis is very soon obliterated by the adhesion of the upper 
 part, and then the whole extent of the passage (viz. from E. 
 to E). in plan 3d of this series,) is shut. When this process is 
 prevented in the first instance, when nature is baulked in the 
 humour of doing her work, as Mr. Hunter observes, she can. 
 not so easily do it afterwards. 
 
 It has also occurred that, this communication remaining af- 
 ter birth, a hydrocele has been produced by the distention of 
 the tunica vaginalis, by fluids descending from the belly. The 
 character of such a tumour will be, that the fluid will be easily 
 forced into the belly. It may, however, be mistaken for a con- 
 genital hernia. f 
 
 It will already be understood, that in the common hernia of 
 the groin or scrotum, the gut does not pass by the communica- 
 tion from the belly into the vaginal coat ; that such communi- 
 cation no longer exists, and that when there is a rupture from 
 preternatural wideness of the abdominal ring, or in conse- 
 quence of a great violence, a new portion of the peritoneum de- 
 scends with the gut before the chord of the testicle. 
 
 " Mr. Hunter has {hewn, that the detention of the tefticle in the belly is in corr- 
 fequcnce of fome defetft and want of adtion in the tefticle. and that thofe who 
 have the tefticle remaining in the belly have it imperfedf or fmall. This is con- 
 trary to an old authority : — I he tefticles are feated externally, “ for chaftity’s 
 fake, for fuch live-wights as have their ftones hid within their body, are very lech- 
 erous, do often couple, and get many young ones.” 
 
 t Such is the remark of Mr. Hunter. 
 
OF THE TESTES, 
 
 115 
 
 Fifth Plan of the Testicle . 
 
 Hernia. 
 
 This 5th plan will now illustrate the relation of the testicle 
 to the herniary sac in the common scrotal hernia. A, the scro- 
 tum : B, the testicle ; which will be easily understood to pre- 
 serve its attachment to the back part of the scrotum : C, the 
 tunica vaginalis, which here invests the testicle, but which is 
 not now (in the adult or perfect state of the coats of the testi- 
 cle,) as is seen in plan 3d, open from D to E, but forms a short 
 sac surrounding the tunica albuginea : D, the cellular mem- 
 brane of the chord of vessels passing down to the testicle. And 
 now there are no remains of the tube of communication be- 
 twixt the belly and vaginal cavity ; it is obliterated and resol- 
 ved into this cellular membrane. 
 
 We see then, that in this plan the testicle and its coats, and 
 the spermatic chord, are in their natural situation, and that the 
 herniary sac has descended before them. E, is the ring of the 
 external oblique muscle of the abdomen, through which not 
 only the testicle, with its coats and vessels, has descended, but 
 also the hernia : F, the herniary sac, which contains a portion 
 of the gut ; it is formed of the peritoneum, fallen down from 
 the belly, but it is quite distinct from the sac of the tunica vagi- 
 nalis C. Whilst this new process of the abdominal peritone- 
 
116 
 
 ©F THE TESTES, 
 
 um has descended, it has contracted adhesions, and cannot now 
 be replaced. 
 
 In thus explaining these important principles of anatomy, 
 and which the anatomical student will find wonderlully to faci- 
 litate the more minute study of surgical anatomy, it only re- 
 mains to show the nature of the hydrocele. 
 
 The hydrocele is a collection of water within the sac of the 
 tunica vaginalis ; that is, betwixt the tunica vaginalis and tuni- 
 ca albuginea. For, as we have seen, that the same surface of 
 the vaginal coat is contiguous to the surface of the testicle 
 (viz. the albuginea,) with that of the peritoneum, which is 
 contiguous to the viscera of the belly ; and as it has the same 
 exudation, so it has the same disease, viz. a collection of water, 
 from the absorption being disproportionate to the exudation. 
 When the tunica vaginalis is distended with the water of a hy- 
 drocele, the testicle is towards the back part o.f the scrotum ; 
 it can he felt there ; and when the scrotum is placed betwixt the 
 candle and the eye, we see the transparent sac on the fore part 
 of the tumour, the opaque mass of the testicle behind ; gene- 
 rally the distended vaginal coat stretches up before the chord, 
 conically. Thus, 
 
 A, the penis ; it is generally corrugated thus, in consequence 
 of the distention of the scrotum in scrotal hernia and hydro- 
 
 Sixth Plan of the Testicle . 
 
 Hydrocele. 
 
 1 
 
OF THE TESTES. 
 
 117 
 
 cele : B, the scrotum : C, the testicle, covered only by the tu- 
 nica albuginea ; D, the cellular membrane of the chord : E, the 
 tunica vaginalis, distended with the water of the hydrocele, 
 and consequently separated from the surface of the testicle : 
 F, that part of the sac of the vaginal coat, which often extends 
 conically before the cellular membrane of the chord D. Now 
 we see that the distention of the vaginal coat does not open up 
 the old communication with the belly ; but that, the former 
 communication being shut, and the peritoneum there degene- 
 rated into the cellular membrane of the chord, the hydrocele is 
 a distinct sac, surrounding the testicle, and formed of the tuni- 
 ca vaginalis. 
 
 To understand this subject of the coats of the testicle, it is 
 not necessary merely to consider the descent of the testicle ; 
 but the student must consider it in every point of view, turn it 
 as it were into every variety of posture, without which his dif- 
 ficulties will perpetually return upon him. It is for this reason 
 that I have endeavoured to represent simply the various states 
 sf the coats of the testicle in disease. 
 
 OF THE VESSELS OF THE CHORD AND TESTICLE. 
 
 In attending to the descent of the testicle, we have a cue al- 
 so to the vascular system. If we did not know that the testi- 
 cles were originally placed in the loins within the belly, we 
 might wonder at the length and origin of the spermatic ves- 
 sels. 
 
 The spfrmatic artery rises from the fore part of the 
 aorta, below the emulgent arterv, or from the emulgent artery, 
 (generally on the right side,) and sometimes from the arteries 
 of the renal capsule ; sometimes there is only one, sometimes 
 there are two spermatic arteries. This artery, which the chord 
 receives from the aorta or emulgent, is called the superior sper- 
 matic artery, because there is another which rises from the hy- 
 pogastric artery : this branch runs upward, connected to the 
 vas deferens, as it rises out of the pelvis. 
 
 These arteries, taking their course under the peritoneum, 
 join the fasciculus forming the chord, and supply thechord,and 
 send twigs to the investing peritoneum ; they then pass through 
 the abdominal ring, and in their course they are beautifully tor- 
 tuous. 
 
 The veins of the testicle rise on the right side from the 
 trunk of the cava, a little below the emulgent vein, and from 
 the emulgent vein on the left side. In the origin of these veins 
 there are frequent varieties ; there is also, accompanying the 
 vas deferens, a vein, which joins the internal iliac vein. These 
 
118 
 
 OF THE TESTES. 
 
 veins, in their course from the testicle, are protected from 
 the column of blood, and from the bad consequences of com- 
 pression, by numerous valves. These valves are very strong, 
 and will bear a great column of mercury before they give way 
 or burst. This plexus of convoluted veins of the chord is the 
 most beautiful in the body. This convoluted state of the veins 
 is ever attendant on great activity and exertion of the arteries 
 of the part. If there is a provision in the shape, course, and 
 strength of the arteries, for occasional acceleration of the 
 blood through them ; so will there be found in the veins a tor- 
 tuous and varicose appearance ; and again, if by accident there 
 is excited an uncommon action in the arteries of a living body, 
 that action will be apparent from the distended or enlarged state 
 of the veins. In the testicles of such animals as have their 
 seasons, the artery and veins of the testicle are still more con- 
 voluted, and form a mass of vessels, which has been called the 
 corpus pyramidale.* 
 
 The nerves of the testicle, like the blood-vessels, come from 
 the loins, and are continued down upon the vessels in the sper- 
 matic plexus. This still farther allies the testicle to the abdo- 
 minal viscera, giving them much of the same sympathies. The 
 stomach, intestines, and testicle, sympathise readily with each 
 other. As we find the tunica albuginea of the testicle to be 
 very firm, dense, and unelastic, the great pain in inflammation 
 of the testicle has naturally been attributed to the resistance 
 made by this coat to the swelling of the substance of the testi- 
 cle, but much must be ascribed to the natural sensibility of the 
 part, independently of swelling and tension ; for in the very 
 moment of a blow, a person faints and falls down from exqui- 
 site pain. 
 
 The lymphatics of the testicle are numerous, and easily de- 
 monstrated by blowing up the cellular structure of the body of 
 the testicle ; and we shall by-and-by find, that this has been the 
 ground of dispute between physiologists ; and the proofs of 
 some important points in the doctrine of absorption have been 
 drawn from the injection of the lymphatics of the testicle and 
 chord. 
 
 The cremaster muscle, as we have seen in the first vo- 
 lume, takes its origin from the internal oblique muscle of the 
 abdomen, and, passing down over the vessels of the chord, is ex- 
 
 * Corpus varicofum, — Corpus Pampiniforme ; Galen de Semine. Alias paraf- 
 Jatam varicofam, Hall. — As the old phyfiologifts faw and obferved this wonderful 
 tortuofity, and the tendril-like form of the fptrmatic artery, they thought that as 
 there muft be fomething peculiar in this flrudture, the blood was here begun to bp 
 changed into fetnen, apd therefore they called them the vafa preparantia. 
 
OF THE TESTES. 
 
 US 
 
 panded on the tunica vaginalis : its use is to suspend the testi- 
 cle, and prevent it from dragging upon the vessels of the chord. 
 
 By constitutional weakness, or the relaxation induced by 
 warm climates, this muscle becomes relaxed, and artificial sus- 
 pension becomes necessary. Sometimes this muscle draws the 
 testicle spasmodically to the groin ; yet I cannot allow that this 
 is the muscle which retracts and corrugates the scrotum, for 
 the testicle will be thus drawn up by the cremaster, without 
 corrugation or contraction of the scrotum. In some this would 
 appear to be a voluntary muscle ; it possibly accelerates the 
 motion of the semen, or at least promotes its secretion. 
 
 Thus we find the chord of the testicle, as it is called, to con- 
 sist of the arteries, veins, and nerves ; of the lymphatics re- 
 turning from the testicle ; of the cellular tissue embracing and 
 supporting all these vessels ; and lastly, of the fibres of the 
 cremaster muscle. 
 
 OF THE STRUCTURE OF TtlE TESTICLE. 
 
 It is to De Graaff that we owe the knowledge of the struc- 
 ture of the testicle ; and indeed the merit of this great anato- 
 mist has not been acknowledged with sufficient gratitude by 
 modern anatomists: but? after the fervour of disputation has 
 subsided, the merit of ingenuity and of discovery must return 
 to him to whom it is due. No one more highly values than I 
 do the improvements of anatomy by the Hunters and Monro : 
 but I must say, that the structure of the testicle was demonstra- 
 ted by De Graaff to his fellow anatomists of Montpelier, and 
 his discoveries published in a manner so perfect, as to leave us 
 little to learn from more modern authors. 
 
 De Graaff, by exciting animals to venery, and tying the sper- 
 matic chord, had the seminal vessels distended. He did not 
 depend upon injections ; by maceration and dissection in this 
 distended state, he unravelled all the intricacies of their tubes. 
 More modern anatomists have proved the truth of his observa- 
 tions by injections of mercury, and have succeeded in a variety 
 of ways of preparing the testicle. 
 
 Tubuli testis. — When the tunica albuginea testis is lifted, 
 the body of the testicle is found to dbnsist of innumerable very 
 delicate white tubes ; which, when disentangled from the mi- 
 nute cellular membrane which connects them, and floated in 
 water, exhibit a most astonishing extent of convoluted ves- 
 sels. By a closer attention, however, to this structure before 
 it is thrown into confusion by pulling out the tubes, they appear 
 to be regularly laid in partitions of the cellular membrane. 
 These sepimenta are very regular in some animals, and while 
 
320 
 
 OF THE TESTES. 
 
 they separate the seminal tubes, they support and convey the 
 blood-vessels to the secretion of the semen. Dr. Monro has 
 denied the formal divisions which De GraafF has engraved, 
 but acknowledges them less regular, less easily found, and not 
 so limited in their number ; nor does he find them to prevent 
 all communication betwixt the tubes ot the testicle. 
 
 These seminiferous tubes of Haller, or tubuli testis of 
 Monro, running in meshes, 15 or 20 in number, terminate on 
 the back of the testicle. Each of these tubes seems to be 
 cylindrical, or of one diameter throughout their whole extent : 
 we see no communication betwixt them ; no branches given 
 out or going into them ; no beginning for the whole, nor for 
 any on-e of them. Though we cannot prove it, yet there 
 seems to be only one tube wonderfully convoluted and folded 
 up in each subdivision of the testicle. 
 
 Rete testis. — When the tubuli come out from the body of 
 the testicle, they run along the back of it, and communicate 
 by inosculations with each other, so as to form a net-work of 
 vessels, from which appearance Haller named them rete testis. 
 
 Here it often happens that the mercury stops, when it has 
 been injected backward from the vas deferens ; and it is this 
 part which has been better described and drawn, in conse- 
 quence of mercurial injections, than jt was by De GraafF ; for 
 he, as we have said, saw this part only filled with semen. 
 
 Connected with the rete testis is the corpus highmorian- 
 um. — W here the lines of the membranous septa, and cellular 
 membrane of the testicle, meet on the back of the testicle, 
 and under the epidimis, they form a white line. This white 
 line running along the testicle, was supposed by Highmore to 
 be a hollow tube ; it was compared with the salivary duct ; it 
 was thought to be a cavity leading from the body of the testicle 
 to the head of the epididimis, and to form the communication 
 by which the semen flowed from the testicle. De GraafF first 
 refuted this notion, and shewed that it was not by this one 
 great duct, but by these smaller tubes forming ^vhat has been 
 now called the rete testis, that the semen came from the testi- 
 cle : still it had continued a question, whether this white line 
 was really solid, or a tube ; and upon faithful examination of 
 the point it appears, that$his is expressly as it was explained 
 bv De GraafF, viz. that it is a mere collection of the mem- 
 branes of the body of the testicle, forming a linen alba ; and 
 as the septa are more distinguishable in some animals, so is the 
 corpus highmorianum.^' 
 
 * This body called a mere frmanienium or binding, Winflow; the nucleus teftis- 
 
OB THE TESTES, 
 
 121 
 
 Vasa efferentia. — The tubes running on the back of the 
 testicle, and forming the rete testis, we have understood to 
 arise from the tubuli testis ; now it is the continuation of the 
 rete testis which is called vasa efferentia. The Vasa efferentia 
 are very delicate vessels which run out from the head of the 
 testicle, single at first, but they are soon convoluted, and by 
 these convolutions they are formed into an equal number of 
 vascular cones, which constitute the head or larger part of the 
 epididimis. These vasa efferentia and vascular cones are con- 
 nected by a very delicate cellular membrane ; and it is a piece 
 of very nice dissection to display them after they are injected 
 with mercury. 
 
 Epididimis. — The vasa efferentia, after forming thin coni- 
 cal convolutions, unite and form larger tubes ; these again 
 uniting, form one large excretory duct, the vas deferens : but 
 this vessel being convoluted to a wonderful degree, forms a 
 body, which being, as it were, placed upon the testicle, has 
 been called epididimis. 
 
 Seventh Ulan of the Testicle. 
 
 7th Plan of theTeftide. 
 
 In this representation of the dissected testicle, A is the body 
 of the testicle divested of its coats ; B, the tubuli testis 
 CC, the rete testis ; D, the vasa efferentia ; E, the vascular 
 cones ; F, the epididimis formed of the convolutions of the 
 vas deferens ; lastly, G is the vas deferens. 
 
 In the substance of the testicle there are no glands nor 
 
 * Where the tubuli are emerging to form the rete vafculofum, they are called 
 the vafa refta. 
 
 Vol. IV. Q 
 
122 
 
 OF THE TESTES. 
 
 follicules ; the arteries minutely ramify amongst the seminal 
 tubes, and, there is reason to believe, secrete the semen into 
 them. The seminal vessels in the substance of the testicle, or 
 tubuli testis, run together upon the surface of the testicle, and 
 form the rete testis. From the rete testis are continued the 
 vascular cones : these convolute, and running together form 
 the epididimis ; from which the tube is continued under the 
 name of the vas deferens. It passes up the chord ; enters by 
 the ring into the abdomen ; and then passing down into the 
 pelvis, terminates in the vesiculse seminales, in a manner 
 presently to be explained. It is not likely that the vis a tergo, 
 the power of the arteries, pushes the semen through all this 
 length of tube, of which the epididimis itself is reckoned to 
 be several feet in length, if the various convolutions were un- 
 done. Such an action on the testicle as that of the dartos or 
 cremaster muscle, could give only a general stimulus, but 
 could not force on the semen in tubes which take so great a 
 variety of directions. We are therefore left to the supposition, 
 that these tubes themselves have a power of accelerating the 
 fluids through them. # 
 
 Of the lymphatics of the testicle we shall afterwards treat ; 
 it is, however, necessary here to remark, that Prochaska 
 found in his injections a difficulty in making the mercury pass 
 the rete testis into the testicle. Observing at the same time in 
 his preparations, and in the drawings of all authors, an ap- 
 pearance of irregularities in this part like the valvular structure 
 of lymphatics, he has been led to suppose that there is a pro- 
 vision here for preventing the semen from being forced back- 
 ward into the testicle by the action of the cremaster muscle ; 
 he conceives that when the cremaster muscle draws up the 
 testicle to the groin, it may accelerate the semen in the epidi- 
 dimis, whilst this valvular structure prevents the regurgitation 
 upon the delicate vessels of the substance of the testicle. 
 
 The annexed plate represents the appearance which I have 
 found in my preparations. A, the vas deferens by which the 
 mercury was injected ; B, the epididimis ; C, vessels running 
 up the chord from the great head of the epididimis. 
 
 There is a duct which sometimes arises from the epididimis, 
 and which has been found to terminate abruptly in a blind 
 end — of this, Mr. Hunter speaks in the annexed note.* 
 
 * “ By a fupernumerary vas deferens, I mean a fmall duct, which fometimes 
 arifes from the epididimis, and paffes up the fpermatic chord along with the vas 
 deferens, and commonly terminates in a blind end, near to which it is fometimes 
 a little enlarged. I never found this dudt go on to the urethra, but in fome in- 
 flances, have feen it accompany the vas deferens as far as the brim of the pelvis. 
 There is no abfolute proof that it is a fupernumerary vas deferens ; but as we find 
 
OF the TESTES. 
 
 123 
 
 OF THE TESTICLE IN GENERAL. 
 
 The testicle is of an oval form, and of the size of a pigeon’s 
 egg : it is a little flattened on the sides : it hangs in the scrotum 
 by the spermatic chord ; one end of the oval, forward and 
 high ; see plan 8th B ; while the other is backwards, and 
 drops lower, C. The spermatic chord consists of the artery 
 which brings blood ; of the veins which return it ; of the vas 
 deferens, which carries the semen to the vesicuke seminales 
 at the neck of the bladder; of lymphatics, which are essential 
 to the structure of every part. This chord of vessels comes 
 down from the belly, and passes by the ring of the abdominal 
 muscle ; it is about four inches in length, and is fixed into the 
 upper and fore part of the body of the testicle. 
 
 The body of the testicle is easily distinguished, and is the 
 place where the secretion is performed. It is strictly the body 
 of the gland, while the part above it is only the duct by which 
 its fluid is discharged. 
 
 The ancients called the testicle dydimi, gemini, twins ; 
 they, therefore, called that part which is laid on the back of 
 the testicle epididimis, as added to it. To the surgeon, it is 
 essentially necessary to attend to the relation of the parts of 
 the testicle as felt through the scrotum. 
 
 Eighth Plan of the Testicle . 
 
 8th Plan of the Tefticle. 
 
 the dudls of glands in general very fubjedl to Angularities, and that there are fre- 
 quently lupernumerary dudls, there being often two ureters to one kidney, fome- 
 times diftindt from beginning to end, at other times both arifing from one pelvis ; 
 
m 
 
 ®F THE TESTES. 
 
 In this 8th plan, fig. 1. we see the testicle as in its natural 
 situation, covered with its membranes, and appearing like one 
 body ; while, in the second figure, it being represented freed 
 from its outer coat, we see the epididimis as laid upon the testi- 
 cle, and consisting of the convoluted tube. First, we observe 
 A, the body of the testicle ; B, the beginning of the epididi- 
 mis, or the large head of the epididimis.* Then we see it 
 laid .dong the back of the testicle, and observe C to be the 
 small head of the epididimis, f where the tube is reflected to 
 reascend upon the testicle, and to form D, the vas deferens. 
 
 Now, we have to observe, that the point C, fig. 2. or small 
 head of the epididimis, hangs over the testicle, and points 
 backwards to the perineum, and can be felt through the whole 
 coats ; and that the body of the testicle A, is towards us when 
 we examine a patient — Further, as the letters in figure 1 and 
 2. refer to the same points, we have only to notice the fainter 
 indication of the parts in fig. 1. it being invested with the coats ; 
 and to observe the general relation of the testicle to the scro- 
 tum and penis. 
 
 There is one other circumstance to be observed, viz. that 
 the epididimis is always laid on the outer side of the insertion 
 of the chord into the testicle ; from which we distinguish, 
 with ease, in a preparation, to which side the testicle belongs. 
 Thus, in the annexed plans, the testicle of the left side is 
 represented, w’hich we know from the points c, being directed 
 backward, while the epididimis is laid along the left side of the 
 insertion of the chord. 
 
 or THE VESICULiE SEMIFALES. 
 
 Behind the prostate gland, and attached to the lowest part 
 of the urinary bladder, lie two soft bodies, which are the vesi- 
 euke sem inales. They appear like simple bags when seen 
 
 from without, but dissections show them to consist of a cellu- 
 lar structure ; each oi these bodits is about three fingers- 
 
 thefe dufts, arifing from the epididimis, I am inclined to believe from analogy, 
 are of a nature fimilar to the double ureters. They refemble the vas deferens, as 
 being continuations of fome of the tubes of the epididimis, are convoluted where 
 they come off from it, and afterwards become a flraight canal paffing along with 
 it for feme way, when they are commonly obliterated. 
 
 “ The idea of their being for the purpofe of returning the fuperfluous femcn to 
 the circulation is certainly erroneous, from their being fo feldom met with, and fo 
 very feldom continued further than the, brim of the pelvis.” 
 
 * Globus major, or head. 
 
 f Globas minor canda. This part we often diflinguifh retaining its hardnef? 
 after the fubfiding of the general fwelling of hernia fcmoralis. From this poin r 
 we can trace all the connections of the other parts. 
 
oe the Testes'. 
 
 125 
 
 breadth in length ; their backmost point is large and round, 
 and, at the same time, that they diverge from each other, their 
 narrow points unite, or are contiguous to each other forwards, 
 and enter at the back part of the base of the prostate gland. 
 
 As we have seen, the peritoneum does not descend far 
 enough betwixt the bladder and rectum to cover or invest these 
 vesicula- ; they are therefore involved in the cellular texture, 
 and covered with strong fibres, besides being subject to the 
 compression of the levator ani muscle. When the vesiculse 
 are cut into, and especially when they are distended, dried, 
 and cut, they present a cellular appearance ; but if they are 
 carefully dissected, they present the appearance of a small 
 blind intestine convoluted. 
 
 This cellular appearance is given by the duplication of their 
 inner membrane, together with the distortions and curves of 
 the canal. Their outer surface is covered with a fine mem- 
 brane, which, like a frenum, connects these cellular convo- 
 lutions. 
 
 These are copiously supplied with arteries ; their surface is 
 covered with veins and lymphatics when these vessels are 
 minutelv injected, and their coat is thick and spongy. Heister, 
 Winslow, and others, have described small glands as seated 
 in their sinuosities ; but these are confidently denied, and in 
 their place there is described a pile or efflorescence. There 
 can be little hesitation in affirming, that these vesiculse are 
 themselves glands, or, in other words, that the arteries secrete 
 into them a peculiar fluid. The fore part of each of the 
 vesiculse, which we have said sink into the back part of the 
 prostate gland, runs under the neck of the bladder, and opens 
 by distinct mouths into the urethra, on the surface of the 
 verumontanum. 
 
 The connection of the vas deferens with the vesiculse, is 
 very particular, it does not open directly into them, but opens 
 with them into the urethra in such a way, that the semen from 
 the testicle can pass into the vesiculse, though its direct course 
 is into the urethra.^ 
 
 If air is blown into the vas deferens, the vesiculse will be 
 distended at the same time that the air passes into the urethra : 
 the union of the extremities of the vas deferens and vesiculse, 
 forms a kind of septum betwixt them. 
 
 The extremity of the vas deferens join^ the duct of the 
 vesiculse where it is imbedded in the prostate gland ; the union 
 of the vas deferens and duct of the vesiculse is not attended 
 with an enlargement of the duct ; on the contrary, as the duct 
 
 Sec explanation of plate TI-I. 
 
126 
 
 OF THE TESTES. 
 
 passes forward deep into the substance of the gland to arrive 
 at the urethra, it becomes remarkably narrower until it opens 
 in a very small orifice in the verumontanum, as we see repre- 
 sented in the third plate. The duct (if we may so call it,) of 
 the vesiculae passes a full inch forward into the gland before it 
 terminates in the urethra. 
 
 These vesiculae have been in general supposed to be recepta- 
 cles for the semen ; but as this is an opinion depending on the 
 connection of these bags with the extremities of the vas de- 
 ferens, and as comparative anatomy shows many instances of 
 these vesiculae being unconnected with the ducts of the testicle, 
 there is much reason to doubt whether they really are merely 
 reservoirs. They have always appeared to me as useful in 
 adding a fluid to the secretion of the testicle, which being 
 poured together into the sinus of the urethra, give a disten- 
 tion, exciting and giving effect to the contraction of the ejacu- 
 lator seminis : For unless there were a provision of fluid suf- 
 ficient to distend the sinus of the urethrae, the semen could not 
 be thrown out from the urethra. This supposition is not op- 
 posed by the facts stated by Mr. Hunter, that in many animals 
 the vesiculae and vasa deferentia open by distinct foramina into 
 the urethra, because in that case the fluids of these secreting 
 bags might be equally mingled with the semen in the sinus of 
 the urethra, although they do not flow from the same tube. 
 
 Verumontanum.— -The verumontanum, or caput galina- 
 ginis, is an eminence on the lower part of the urethra, where 
 it is surrounded by the prostate gland. As we observe in the 
 drawing, it is larger and round towards the bladder, and 
 stretches with a narrow neck forwards. On its summit, the 
 two orifices of the seminal vessels open ; and around it there 
 are innumerable lesser foramina and mucous follicules. 
 
PART THE THIRD. 
 
 OF THE FEMALE PARTS OF GENERATION. 
 
 THE ANATOMY OF THE PARTS IN THE FE- 
 MALE PELVIS. 
 
 There is considerable difficulty in presenting such a view 
 of the anatomy of the parts of generation in woman, as may 
 bear a due relation to this general system of anatomy, and, at 
 the same time, be intelligible and complete. The subject is in 
 itself extensive and important, sufficient to fill several volumes : 
 it is much connected with practice ; and the phenomena and 
 diseases of the system serve greatly to illustrate the strict ana- 
 tomy of the parts. I cannot here be allowed to give to it its 
 due importance, whilst yet it is a subject not easily understood 
 from a short abstract. 
 
 The parts of generation are divided into the external, which 
 are those without the pelvis ; and the internal, or viscera of the 
 pelvis, and which lie within the bony circle of the pelvis. 
 
( 128 ) 
 
 CHAP. I. 
 
 THE EXTERNAL PARTS OF GENERATION. 
 
 T- 1 HE external parts of generation are the mons veneris, labiae, 
 clitoris, nymphae, urethra, hymen, or carunculte myrtiformes. 
 Upon these subjects we have no want of books and informa- 
 tion ; for accoucheurs of the old school dwelt upon the descrip- 
 tion with particular accuracy. These parts were within their 
 ken, which we cannot say of the viscera of the pelvis : and, 
 therefore upon the former we shall be more brief. 
 
 In very young children these external parts bear a large pro- 
 portion to the body, greater than at any subsequent period be- 
 fore the age of puberty. At puberty they are suddenly and 
 completely evolved, and acquire an increase of size ; while, 
 from the age of two years to twelve or thirteen, there has 
 been little increase. Immediately before menstruation, com- 
 mences the connection which occasions, or accompanies that 
 flux. It begins to effect the evolution of the uterine system, 
 and to fit it for its peculiar function. The parts become turgid 
 and vascular ; the fat is deposited in the surrounding cellular 
 membrane. About the fortieth year, when the menses disap- 
 pear, this fulness of the private parts also ceases, and the fat 
 is reabsorbed. 
 
 The mons veneris is that prominence on the symphysis 
 pubis, which consists of the skin raised and cushioned up by 
 the fat inclosed in the cellular membrane. There is of course 
 a great variety in its size. In early life it is small : it be- 
 comes, as we have said, more prominent at the age of puberty ; 
 in fat women it is of an enormous size ; and in some warm 
 climates a particular laxity prevails. From the hair on this 
 part, marking the age of puberty, it is called pubis. As the 
 lax texture admits of distention with the fluid of anasarca, it 
 is sometimes from this cause very greatly swelled. 
 
 The labile. These are often named alse, from a slight 
 resemblance to wings, and they are also called externse, mag- 
 nse, or majores, from their place, and from their superiority 
 in respect of size over the nymphse. The labiae seem to be the 
 mons veneris continued downward, and laterally until meeting 
 below, they form the vulva ; at their lower angle, by their 
 union, they form the fourchette, or frenum labiorum. The 
 structure of the labise is similar to that of the mons veneris ; 
 sometimes one is larger than the other. 
 
THE EXTERNAL PARTS OF GENERATION. 129 
 
 The great sensibility of the membrane which lines the inside 
 of the labis, requires some defence, and therefore the whole 
 surface is amply supplied with mucous follicules and glands. 
 The labiae are a protection to the other soft parts, so necessary, 
 that the clitoris, or nymphse, when they project beyond them, 
 are subject to violent inflammation. 
 
 The parts here have either such folds, or are of so lax a 
 texture, as to permit a great degree of distention during the 
 passage of* the child. But, as the labiae have no muscular 
 power, and depend entirely on their elasticity for restoring 
 them to their original size, they commonly, after being very 
 much dilated, remain in some degree larger and more lax. It 
 is different with muscular p irts, as the orificium externum, 
 which, by the power of its sphincter, is restored after labour 
 to its original size. In man, hernia descends from the abdo- 
 minal ring into the scrotum ; but, in woman, when there is a 
 rupture from the ring, (which is rare) it may fall into the labiae, 
 though, I believe, it will be seldom found to descend thus far. 
 
 The nymphA named labiae vel alse minores, or labiae in- 
 temae, to distinguish them from the great labiae. They are 
 like a miniature representation of the great labiae ; they are 
 covered with a very delicate membrane, and have great sensi- 
 bility. They begin immediately under the glans clitoridis, 
 and seem to be only an extension of its preputium, formed by 
 a folding of the membrane. Their size varies much. They 
 commonly stretch downward, and backward to the middle of 
 the orifice of the vagina ; sometimes no further than to that of 
 the orificium urethrae, and in a few instances they extend even 
 the length of the fourchette.^ They are very vascular, and 
 have somewhat of a cellular structure, and thus partake of a 
 degree of turgidity, in consequence of irritation and vascular 
 action. The most modest of the uses ascribed to them is, 
 that of directing the stream of urine. As they are obliterated 
 during the passage of the child’s head through the vulva, it is 
 probable that they facilitate the necessary dilatation. 
 
 The nymphte are, in their natural situation, covered and 
 completely protected by the labiae externce. When naturally 
 large or increased by disease, or in a very relaxed state, they 
 are deprived of this covering : they project from under the 
 labiae, and are apt to become inflamed, and even to ulcerate. 
 The original disease, or tumour, is augmented, or they be- 
 come perhaps hard and callous. In children the)’ bear a very 
 great proportion to the other parts, and are more conspicuous 
 
 * Both Riolin and Morgagni have ohferved the part; wich®Ht the nvmnh'z- 
 
 Vol. IV. R 
 
130 
 
 THE EXTERNAL PARTS O? GENERATION. 
 
 and prominent than in the adult. Their diseased enlargement 
 sometimes requires to be extirpated, in which operation, as 
 they are very vascular, and as with their growth, their blood- 
 vessels enlarge, considerable hsemorrhagy may be expected. 
 A surgeon of this city, in extirpating a tumour of this kind 
 from a young lady, thought his duty fulfilled when he had ap- 
 plied a piece of lint upon the surface after the operation, so 
 that he even neglected to appoint an attendant. The haemorr- 
 hagy returned, and continued so profuse that before the sur- 
 geon arrived the lady had fainted. 
 
 The clitoris is similar to the male penis. Like the penis,, 
 it consists of cells for receiving blood, and in a similar manner, 
 it arises from, or takes hold of the rami of the os pubis by two 
 crura ; — these unite at the symphysis pubis, to form the body 
 of the clitoris, which is suspended from the os pubis, like the 
 penis, by a kind of ligament. The clitoris has also a kind of 
 glans, over which the integuments make a fold like a preputi- 
 um. In short, it has the same sensibilities, the same power of 
 erection with the membrum virile ; only it has no urethra nor 
 spongy body, like that of the urethra of man. 
 
 The stories of the increase of this instrument, even to its 
 pre-eminence in size over the male penis, are very idle, but 
 there seems to be a peculiar predilection for them. It is not 
 wonderful that a clitoris of such magnitude should suggest the 
 idea of a hermaphrodite, or person partaking equally of the 
 distinguishing attributes of either sex. 
 
 OP THE URETHRA. 
 
 The urethra of the female is short, straight, and wide ; its 
 length an inch and a half, or two inches ; its direction nearly 
 straight, or only slightly bending under the os pubis ; and its 
 diameter such as will admit a catheter the size of a writing- 
 quill. The consequences of these peculiarities are, that the 
 catheter is easily passed when there is no very unusual obstruc- 
 tion ; that women are not so much exposed to the disease of 
 stone in the bladder as men, for though this is much owing to 
 constitutional peculiarities, yet it is obvious, that when a small 
 stone is formed, and passes from the bladder, it is easily dis- 
 charged ; and, lastly, that lithotomy is a very simple operation 
 in woman. 
 
 The opening of the urethra is in a direct line under, or be- 
 hind the clitoris, and about an inch from it : It is in the middle 
 of a slight prominence, and its vicinity is plentifully supplied 
 with mucous glands. If the relation of the orifice to the 
 clitoris be observed, there is, in the natural state of the parts. 
 
THE EXTERNAL PARTS OF GENERATION. 
 
 131 
 
 no difficulty in slipping the point of the catheter, on the end of 
 the middle finger, from the clitoris, until it is catched, upon 
 the lacuna-like orifice of the urethra ; but even in this part of 
 the operation, I have experienced great embarrassment, from 
 an irregular ulcerated or cancerous surface of the parts, by 
 which all the usual distinctions were lost. 
 
 From the length and sudden turns of the male urethra, 
 from the double function it performs, and from its being em- 
 braced by the prostate gland, the obstructions of the urine are 
 more frequent, and the catheter less easily passed, than in 
 woman. The catheter too requires to be of a very peculiar 
 form. The short and wide urethra of woman requires only a 
 simple and almost straight tube : and although, accurately to 
 adapt it to the course of the urethra, a considerable curve 
 might be given to it, yet that is not necessary in common cases ; 
 and circumstances will occur to the accoucheur which will pre- 
 clude the possibility of using such an instrument. 
 
 We shall only mention here such cases of obstruction of 
 urine as are in a particular manner illustrated by the anatomy 
 and connection of the parts. These are tumours of the ovari- 
 um, tumours of the womb, polypi, distention of the vagina, 
 displacement of the womb, as procidentia, prolapsus, retro- 
 versio, &c. ; and lastly, the child’s head in labour. 
 
 The ovarium being enlarged, and falling down into the 
 pelvis, either presses upon the neck of the bladder, causing 
 obstructions, or pressing and weighing on the fundus of the 
 bladder, it occasions a stillicidium urinse. 
 
 Tumours of the womb, especially of the neck or orifice, as 
 it is in contact with the urethra, very soon affect this organ. 
 Thus, I have seen a cancer of the orifice of the womb, by ex- 
 citing inflammation in all the surrounding parts, and by mas- 
 sing them together into a tumour filling the pelvis, occasion ob- 
 stinate obstruction of urine. 
 
 Polypi attached to the orifice of the womb, and filling the 
 vagina, produce the same effect. In all such cases, perhaps, 
 the tumour may be pushed up, so as to permit the flow of urine,- 
 or the introduction of the catheter. 
 
 A case occurred to Mr. John Bell, in which the tumour of 
 -the womb compressed the neck of the bladder. A catheter 
 was passed, and gave instant relief. The midwife, after 
 some time came, and said, that the catheter would not pass. 
 He found that he could pass tire catheter into the bladder, but 
 no urine flowed ; and it was discovered, that the tumour in- 
 creasing backtvard, came to press upon the ureters, so as com- 
 pletely to obstruct them where they enter the bladder. Th? 
 
132 
 
 THE EXTERNAL PARTS ©F GENERATION. 
 
 woman unavoidably died ; each kidney and ureter was founci 
 to contain four or five ounces of urine. 
 
 A slight sketch of the parts in the female pelvis will, per- 
 haps, better explain the connections of the neck of the bladder 
 than any description, and will certainly better illustrate the 
 cause of some kinds of obstruction, particularly that arising 
 from the change in the posture of the womb. 
 
 First Plan of the Female Pelvis. 
 
 A, the os pubis cut through. — B, the spine and sacrum also 
 eut directly down. — C, the urinary bladder moderately disten- 
 ded, and rising behind the pubis. — D, the urethra, very short, 
 and taking a gentle curve under the symphysis of the os pu- 
 bis. — E, the fundus of the womb. — F, the os tines, or orifice 
 of the womb. — G, the vagina H, the rectum. 
 
 Prolapsus, or falling down of the womb, is frequent with 
 those who have born many children. By this slipping down 
 of the body of the womb F, into the vagina G, it presses on the 
 neck of the bladder, or urethra. This is also apt to happen in 
 the first months of pregnancy, from a degree of difficulty which 
 the womb in its enlargement has in rising above the brim of the 
 pelvis. 
 
 We may observe also from the place of the vagina G, that 
 its diseases, its scirrhous hardening, its distention by the men- 
 ses, will also compress the urethra and neck of the bladder. 
 
 The retroversion of the womb is the most formidable obstruc- 
 tion to the urethra. It is produced by distention of the blad- 
 der acting on the womb in a particular situation, and is the 
 cause of suppression of the urine. When the womb in the 
 
THE EXTERNAL PARTS OE GENERATION. 
 
 133 
 
 third or fourth month of gestation has increased so much as 
 to produce a degree of compression on the surrounding parts, 
 and to rise above the brim, and shoot up into the abdomen, a 
 distention of the bladder is apt to throw the fundus under the 
 projection of the sacrum. We have to observe the connection 
 betwixt the back and lower part of the vagina. By the disten- 
 tion of the bladder, the vagina is stretched, and the orifice of 
 the womb is raised, which throws back the fundus of the 
 womb, so that this comes to be the situation of the parts. 
 
 Second Plan of the Female Pelvis . 
 
 A, the os pubis; B, the sacrum ; C, the bladder of urine 
 much distended, and rising above the pubis ; D, the connection 
 betwixt the back part of the bladder and the upper part of the 
 vagina, and through which the rising of this part of the blad- 
 der (in consequence of its distention) has drawn up the orifice 
 of the womb, and thrown back the fundus. E, the orifice of 
 the womb, which being raised and turned up, no longer pre- 
 sents so as to be felt by the finger in the vagina. It will be ob- 
 served also, that the womb now lying across the pelvis, this 
 lower part is forced against the neck of the urethra, so as to 
 compress it, and cause total obstruction of urine. F, the va- 
 
184 
 
 THE EXTERNAL PARTS OF GENERATION. 
 
 gina, which is stretched in consequence of the rising and turn- 
 ing up of the orifice of the womb. G, the fundus of the 
 womb enlarged and distended by impregnation, fallen back 
 under the promontory of the sacrum, and compressing the rec- 
 tum H. 
 
 Now, when the fundus of the womb is thrust back, and the 
 orifice raised bv the distention and consequent rising of the 
 bladder, the natural and simple cure is to introduce the cathe- 
 ter, and draw ofT the urine. But should this not be done at 
 first, then there being distention of the bladder, and pressure 
 on the rectum, the abdominal muscles sympathize with these 
 parts, so that bearing-down efforts are made, and the fundus of 
 the womb is forced further down into the hollow of the sacrum, 
 while the orifice is directed upward. 
 
 Were this distention to happen at any other time than just 
 when the uterus is of such a size, that being thrown back, it 
 catches under the sacrum, and does not rise again, no harm 
 could follow. — I last year attended, with Mr. Cheyne senior, 
 a woman afflicted with obstruction of urine, who died. I after- 
 wards opened the body, where the womb being enlarged by 
 disease, had produced much the same effect as if it had been 
 enlarged by pregnancy, viz. obstruction of the urethra ; for 
 the body of the womb had fallen into the hollow of the sacrum, 
 and had formed adhesions there with the rectum, while the 
 orifice of the womb pressed forward upon the os pubis, so as to 
 produce an obstruction of urine. The parts were otherwise 
 diseased, but this was one cause of the obstinacy and fatal de- 
 termination of the complaint. 
 
 As we treat of those subjects only as connected with the 
 urethra, we may observe, that sometimes the urethra takes a 
 course not round behind the os pubis simply, nor straight up- 
 wards, but curved backwards, so that the convexity of the ca- 
 theter requires to be towards the sacrum, to allow the point to 
 pass over the orifice of the womb, or perhaps the flexible, or 
 the male catheter may be required. 
 
 The effect of the wedging of the child’s head in a tedious 
 labour, is to elongate and compress the urethra in a very parti- 
 cular manner. Many young men have felt the difficulty of in- 
 troducing the catheter in this case. But it is a difficulty pro- 
 ceeding generally from ignorance, or inattention. I have ne- 
 ver seen a case in which the compression was so great as to pre- 
 vent the passing of the catheter. But often practitioners forget 
 the direction which the urethra necessarily takes, when the 
 child’s head has sunk into the pelvis. 
 
THE EXTERNAL PARTS OF GENERATION, 
 
 12 $ 
 
 Third Plan of the Female Parts. 
 
 Thus, when in the second stage of the labour, the child’s 
 head A, has sunk into the pelvis, the urethra C, is pressed be- 
 twixt it and the os pubis D. The urine consequently collects 
 in the bladder, and the bladder E, rises above the brim of the 
 pelvis, and I have found it stretching to the scorbiculus cordis. 
 There is danger from the distention of the bladder, and the la- 
 bour-pains cease. Now the young surgeon or accoucheur, in- 
 troduces the catheter in the usual way, in the position F, of 
 course he finds great difficulty, and gives pain in the attempts. 
 But after inserting the point of the catheter, he must incline 
 its handle much towards the perineum, as in the inclinations of 
 the dotted lines G, so that the point may glide up in the direc- 
 tion betwixt the child’s head and the pelvis. 
 
 Orificiuji vagina. This is also named orificium ex- 
 ternum, in opposition to the uterine orifice. I notice it under 
 the head of the external parts, because we have to speak of the 
 parts which surround the orifice as the hymen. 
 
 The orifice of the vagina of the human female is abridged 
 b y the hymen, which is a peculiar membrane. It is of a semi- 
 
136 
 
 THK EXTERNAL PARTS OF GENERATION. 
 
 lunar form, and sometimes surrounds the lower part of the ori- 
 fice of the vagina ; — commonly it surrounds only the lower half 
 of the circle, though it would seem to vary considerably in 
 shape, place, and strength. It has been found surrounding the 
 whole circle of the orifice, leaving only a small hole in the cen- 
 tre, or upper part ; or it is described as perforated with lesser 
 holes, allowing the evacuation of the menstrual blood. In 
 other cases, it has been found a complete circle, preventing the 
 evacuation of the menstrual blood. This is a fact which I do 
 not dispute, for I know that the perforation for the evacuation 
 of the menstrual blood is sometimes necessary. When I have 
 seen the imperforated vagina in the child, it was not the hymen 
 which closed the orifice, but an adhesion of its sides ; yet this 
 adhesion, if it had come to be distended with the menstrual 
 blood of several periods, would have presented the appearance 
 of a tense membrane stretched across the orifice. 
 
 Such a membrane as I have described, will occasionally be 
 seen in the female parts ; but it has such an appearance as may 
 easily be destroyed in the preparation of the parts, if the ana- 
 tomist be inattentive or careless. It is neither a guard, nor is 
 its existence a test of female chastity. Often in tender chil- 
 dren there is no such thing to be seen ; while, on the other 
 hand, it has been cut to admit of labour and delivery.* Either 
 of these facts is sufficient proof of the idle notions entertained 
 concerning this membrane. It has been a favourite topic in 
 all ages, and in all situations. The savage, and the gentleman, 
 make much the same enquiries on visiting a museum ; and 
 such was the subject of Omai’s speculations in the museum of 
 t)r. Hunter. 
 
 The c aruncuLjE myrtiformes — are small and irregular 
 tumours at the back, or lower part of the external orifice ; they 
 are seated rather at the sides than exactly at the back part ; 
 they are generally supposed to be the ruins of the hymen, 
 which being lacerated, shrink into two or three tumours on 
 each side. Some have said, that these exist originally joined to- 
 gether by a thin membrane, or delicate tissue of small vessels, 
 the rupture of which causes an effusion of blood. They seem 
 to be simply corrugations of the inner membrane, which serve 
 as a provision for the dilatation of the parts ; and they accord- 
 ingly disappear during the passing of the child’s head. 
 
 The fossa navicularis is a sinus, supposed to be of the 
 shape of a boat, whence its name. It is formed betwixt the 
 
 * I need not fay how unneceffary and improper fuch operations are. All rigidity, 
 qallofities, even tumours, and undoubtedly the hymen, will yield to that general re- 
 laxation of all the parts, which takes place upon the commencement of labour. 
 
OF THE BLADDER OF URINE. 
 
 137 
 
 proper orifice of the vagina and the fourchette, or joining of 
 the labise at their lower edge. It is more conspicuous in young 
 subjects. 
 
 From the meeting of the labise below, the Perineum com- 
 mences : it includes that space from the frenum to the anus. 
 
 CHAP. II. 
 
 OF THE PARTS CONTAINED WITHIN THE 
 FEMALE PELVIS. 
 
 TThESE parts are the bladder of urine, Ihe vagina, the 
 womb, the ovaria. We shall consider them under distinct 
 sections. 
 
 SECTION I. 
 
 OF THE BLADDER OF URINE. 
 
 As the coats of the bladder of urine in woman do not vary- 
 from those of the male bladder, we have under this head only 
 to notice the peculiarities in its relative situation. It is seated 
 behind the os pubis, and betwixt it and the womb ; and on its 
 lower part it is attached to the vagina ; upon the neck of the 
 bladder, or the beginning of the urethra, there is not a body 
 like the prostate gland ; and, as we have seen, the urethra is 
 short, wide, and straight, and simple in its use. 
 
 Women are not subject to calculi, and the operation for the 
 stone is rare in them ; for, as already observed, when the 
 nucleus is formed, or when a stone slips down from the pelvis 
 of the kidney, it passes from the bladder with much greater 
 facility than in the male parts. The urethra of itself has been 
 known to dilate so, as to allow very large stones to pass, or it 
 has been artificially dilated. Indeed the old operation for li- 
 thotomy, was rudely to dilate, or rather tear, the urethra, and 
 the modern operation is simply to thrust the gorget along the 
 Vol. IV. S 
 
138 
 
 OF THE BLADDER OF URINE. 
 
 grooved staff, so as to lay open the side of the urethra and 
 neck of the bladder, by an incision above the vagina. Some- 
 times nature has effected her own relief by the stone working 
 from the neck of the bladder into the vagina. 
 
 A woman had for a very long period suffered great distress, 
 not only the ardor urinse, frequent desire to make urine, with 
 the urine turbid and bloody, and with all the usual symptoms 
 of stone violently aggravated ; but she was delicate and timor- 
 ous, and concealed her distress until the urine had run for 
 some time by the vagina. After she had been exhausted by 
 long suffering, her friends insisted that she shoultl allow an ex- 
 amination, when a stone was found partly in the bladder, 
 with one of the rough ends projecting into the vagina. The 
 opening was enlarged, and the stone extracted. 
 
 We must, in all cases, recollect the connection of the upper 
 part of the vagina and orifice of the womb, with the back part 
 of the bladder. We have seen its effect in producing re- 
 troversio uteri. We must also attend to this connection, as 
 tending to the displacement of the bladder in the procidentia 
 uteri. The uterus sinking into the vagina, and the upper part 
 of the vagina being at the same time reflected into the lower 
 part, pulls down the bladder with it, and when (the disease in- 
 creasing) the womb covered by the vagina comes to hang from 
 the external parts, it has happened that the bladder has sunk 
 down and lain upon the fore part of the tumour, but of course 
 within the everted vagina.. 
 
 Fourth Plan. 
 
 Section (hewing the effect of Procidentia on the Bladder. 
 
"> OF THE VAGINA, ETC. 1 3£) 
 
 Thus, by comparing this fourth plan with the first of the 
 female pelvis, we may judge of the nature of this displace- 
 ment of the womb, and its effects on the bladder of urine. 
 
 A, the os pubis ; B, the sacrum ; C, the intestines come 
 into the situation of the womb ; D, the uterus fallen down, 
 and carrying the vagina before it ; E, the vagina still covering 
 the womb, but the orifice of the womb appearing, which is 
 generally distorted and irregular ; F, the bladder, which, 
 from its attachment to the fore part of the vagina, has been 
 dragged down, but is now within the vagina. 
 
 In such displacement of the bladder, the urethra becomes 
 distorted from its natural direction, there is an obstruction of 
 urine, and the catheter is with great difficulty introduced. 
 We shall, perhaps, have to turn the handle of the catheter in 
 various directions after introducing the point, and bv chance 
 get it introduced at last. 
 
 SECTION II. 
 
 OF THE VAGINA J OF ITS SHAPE, CONNECTIONS, ETC. 
 
 The vagina is a tube stretching from the external orifice to 
 the orifice of the womb. Its orifice is bounded below by the 
 fourchette ; above by the arch of the pubes ; and directly over 
 it, or sometimes within it, is the orifice of the urethra ; below, 
 are the carunculse myrtiformes. It is surrounded by fasciculi 
 of fibres, which are called the sphincter muscle. The canal 
 of the vagina is of a conical form. At the outer orifice it is 
 constricted by the sphincter muscle ; but it is wider within, 
 and where it receives the orifice of the womb. It may be 
 distended to almost any degree, but naturally its sides, by their 
 own elasticity, or the contraction of the surrounding fibres, or 
 the pressure of the surrounding parts, are in contact. 
 
 In the natural state, the orifices of the vagina and womb, 
 are but three or four inches distant, often only two ; and some- 
 times, where there is a degree of relaxation, they are nearly 
 in contact. In the first months of pregnancy, the orifice of 
 the womb is kept down by the degree of difficulty the body of 
 the womb has in shooting up from the brim of the pelvis. But 
 the gravid uterus rising above the pelvis in the latter months, 
 draws up the orifice of the womb, and stretches the vagina. 
 
 The vagina bends gently round the pubes as it were, or foJU 
 
140 
 
 OB' THE VAGINA, ETC. 
 
 lows the axis of the pelvis ; and as the interior of two circles 
 cut off by the same radii is the shorter, the vagina is longer 
 behind than before. 
 
 And thus (in this fifth plan ) the fore part of the vagina A, is 
 shorter than the back part B. We may observe from this plan 
 also, that the orifice of the womb C, projects as it were into 
 the vagina, so that the finger touches the os tincae, and chiefly 
 its anterior lip, without reaching the upper part of the vagina. 
 
 The vagina takes its curve nearly in the centre of the pelvis ; 
 it is of necessity attached by cellular substance to the rectum 
 and bladder. The urethra, as we have said, opens above the 
 orifice, and that canal is attached to the vagina in its whole 
 length; and the neck of the bladder is attached to the upper 
 part. In consequence of this natural connection,- disease of 
 the vagina sometimes throws the whole parts, the rectum, 
 vagina, and bladder, into one fistulous ulcer. 
 
 The vagina has three coats ; that is to say, it has the inner 
 coat, or surface, a few muscular fibres, and around it a con- 
 densation of the surrounding cellular membrane, which mat 
 be considered as the third coat. 
 
 The internal, or villous coat, is a reflexure of the delicate 
 covering of the external parts. It is of larger extent, or 
 longer than the others ; and is therefore tucked up into rugae, 
 which run across the vagina. They are more remarkable on 
 the fore and back part of the vagina ; they are less in married 
 women, and considerably obliterated by repeated labours. 
 
 To supply a viscous secretion for the defence of this surface. 
 
141 
 
 OF THE VAGINA, ETC. 
 
 mucous glands are numerously, but irregularly scattered over 
 it, and they are particularly numerous at the orifice. 
 
 The muscular coat is not very strong, nor are the fibres 
 distinct, from which some have suspected their existence, 
 alleging, that there is here only condensed cellular membrane, 
 and that the contraction of the vagina is the effect of mere 
 elasticity. I observe so great a profusion of venous vascularity, 
 that I presume the vagina suffers an inflation of its coats, and 
 consequently contraction from an afflux of blood to it. The 
 muscular fibres are, however, as we have said, gathered into 
 fasciculi near the orifice, so as to be distinctly visible. 
 
 The firmness and stricture of the vagina support the womb ; 
 the dilatation of the vagina, the relaxation which old age, and 
 frequent labours produce, occasion the falling down of the 
 womb. It is a disease almost peculiar to those who have borne 
 many children, to the old, weak, and relaxed, and to those 
 who are subject to the fluor albus ; every flux from the womb, 
 or discharge from the vagina, havmg a remarkable effect in 
 relaxing the parts. 
 
 This, from the nature of the parts, must be an increasing- 
 disease ; for no sooner has the womb fallen down into the va- 
 gina, than it becomes a source of irritation, excites a bearing- 
 down pain like tenesmus, an uneasy sensation, a desire to 
 make urine, and an obstruction of urine ; all which is ex- 
 plained by the connection of the parts. The womb lodging in 
 the vagina dilates the orifice, and presses long on the peri- 
 neum, at last it is entirely forced out, and the prolapsus uteri 
 becomes the procidentia uteri : it is in truth a hernia of the 
 womb. 
 
 The third, and outer coat, as we have said, is formed of the 
 cellular membrane, by which it is connected with the sur- 
 rounding parts ; but the peritoneum comes down upon the 
 upper part of the vagina. This is the reason w r hy a portion of 
 the intestine, when it slips down betwixt the vagina and rectum, 
 forms a kind of hernial tumour in the vagina, and why the 
 water of ascites has pushed down the back of the vagina, so 
 as to make a bag capable of being punctured to draw off the 
 water. 
 
 For the greater space, however, the outer cellular coat of 
 the vagina connects it with the urethra oil- the fore part, and 
 -with the rectum behind. From which close connection oi 
 parts, we see the consequence of the delay of the child’s head 
 in the second stage of labour, that the head lies violently 
 distending, and compressing the parts, while the woman, ex- 
 hausted by the previous stage, is unable to complete the deli- 
 very. From violent inflammation, with a deficiency ofsecre- 
 
142 
 
 OF THE WOMB. 
 
 tion, there arises a cold and flabby state of the parts. When 
 the woman is delivered, the parts have suffered so much, that 
 they slough off ; sometimes the urethra is laid open on the fore 
 part, and sometimes the rectum behind. 
 
 SECTION III. 
 
 OF THE WOMB. 
 
 6th Plan of the Female Parts. 
 
 This little drawing will better explain the figure of the 
 womb, when dissected from the vagina and surrounding 
 membranes, than the usual necessary reference to a bottle, a 
 pear, or a powder-flask. As, indeed, it strictly resembles no 
 familiar object that I know, we must, for the convenience of 
 description, distinguish it into these parts : — The upper part, 
 or fundus, which is that part above the going off of the Fallo- 
 pian tubes. The body of the uterus, which is that larger 
 part betwixt the fundus and the narrowing below ; the cer- 
 vix, which is the narrow neck ; and the os tinc/E, or orifice 
 formed of the bulging lips, which project into the vagina, of 
 course that part over which the inner membrane of the vagina 
 is reflected. We distinguish also the two surfaces, for the 
 womb is of a flattened form. The anterior surface of the 
 
OF THE WOMB. 
 
 w k 
 
 body of the womb is convex, but the posterior surface is con- 
 siderably more so, and even during gestation it keeps this re- 
 lative figure. 
 
 The whole size of the uterus is about three inches in length, 
 and two in breadth, but there is a very great variety in this 
 respect, from age, the effect of pregnaricies, and other causes. 
 When, in its usual situation and relations, the fundus is on a 
 level with the brim of the pelvis, or a very little below it. In 
 the fetus, the womb is like the bladder, considerably above 
 the brim of the pelvis ; but, in a few weeks the pelvis enlarg- 
 ing, it sinks deeper, and soon assumes the same situation as in 
 the adult. 
 
 Fallopian tubes. From the lateral obtuse angles formed 
 betwixt the fundus and the body of the uterus, the Fallopian 
 tubes are continued. These tubes may almost be considered 
 as a continuation of the uterus, did not we find them so very 
 distinct in their substance. They are about three inches in 
 length, take a tortuous course, and their extremities have an 
 unequal fringed termination, which is called the fimbria. * 
 Their canal is very small towards the uterus, but enlarges, and 
 is patulous towards the extremities. These canals are the 
 communications by which the ovum formed in the ovarium is 
 carried down into the womb. 
 
 Ligaments of the uterus. To support the uterus from 
 sinking too deep into the pelvis, and to steady it, and direct it 
 in its ascent during pregnancy, anatomists have generally as- 
 signed as the use of the ligaments. But whatever good they 
 may do in the latter operation, they are certainly unfit for the 
 former. 
 
 There are four ligaments of the uterus. 
 
 The broad ligament of the uterus is formed of the peri- 
 toneum ; for this membrane passing down before the rectum, 
 and ascending again, and covering the neck, body, and fundus 
 of the womb, descends on the fore part, so as to reach the va- 
 gina before it rises over the bladder. Thus it invests the womb 
 as it does the abdominal viscera. This investing of the womb 
 with the peritoneum is indeed a provision for its becoming; an 
 abdominal viscus, for in pregnancy it rises .out of the pelvis; 
 and, being distended before the bowels, assumes in every 
 respect that relation totfhe peritoneum which they have. 
 
 As the womb then is included betwixt the duplicature of the 
 peritoneum, it is this peritoneal coat, which being continued 
 off laterally, forms the broad ligament of the womb. This 
 duplicature of the peritoneum being a thin expansion of it, 
 
 Morfus diaboli. 
 
J44 
 
 OF THE WOMB. 
 
 has sometimes had the name of ALvE vispertilionis : It is m 
 truth like a mesentery to the womb and Fallopian tubes, and 
 serves equally to support and convey the vessels to them. The 
 womb and the two ligaments make a complete partition running 
 across the pelvis. 
 
 From the side of the uterus, a little below, and before the 
 going off of the Fallopian tubes, the round ligaments arise. 
 I consider these ropes as ligaments, but they are totally unlike 
 any common ligament. They seem intended to give the due 
 inclination forward, and to direct the uterus in its ascent in 
 pregnancy, and accordingly they are not merely condensed and 
 unelastic cellular membrane ; but, on the contrary, they are 
 composed of fibres, with an intermixture of blood vessels, so 
 that whilst they keep a degree of tension on the uterus, they 
 yield and grow not only in length, but in thickness and 
 strength, as the uterus ascends in the advanced pregnancy : 
 they pass through the abdominal ring, and are attached to the 
 cellular membrane of the top of the thigh. In the gravid 
 uterus, both the broad and the round ligaments considerably 
 alter their position, appearing to rise lower, and more forward 
 from the womb than in the unimpregnated state. This is in 
 consequence of the greater increase of the fundus of the 
 womb, in proportion to. the lower part of it. 
 
 OF THE CAVITY OF THE UTERUS. 
 
 Sixth Plan. 
 
 The cavity of the uterus is properly confined to the fundus 
 and body, and takes a triangular figure. In the cervix, it is 
 more like a canal, and differs essentially from the proper ca- 
 
OF THE WOMB. 
 
 145 
 
 vity. A, the cavity of the uterus ; B, the continued cavity, 
 %vhere it is very narrow towards the cervix. C, the canal of 
 the cervix , where it has an enlargement like a sinus. The 
 Fallopian tubes going off from the cavity of the uterus. — • 
 These angles of the cavity admit no more than a hog’s bristle. 
 The third angle, towards the neck, is, of course, considerably 
 larger. The proper triangular cavity of the uterus is lined 
 with a peculiar soft and delicate membrane ; it is very vascular, 
 and the vessels either open on th^surface naturally, or bursting 
 out from time to time, pour out the menstrual blood. The canal 
 of the cervix shows a very different surface. We observe a 
 prominent longitudinal line on the fore and back part of it, 
 from which oblique and transverse rugae go out. The surface 
 is firmer and callous, and less vascular. Betwixt the rugae 
 there are lacunae, which throw out a mucilaginous fluid ; and 
 towards the orifice we see these larger, and sometimes distinct 
 glandular bodies. 
 
 This peculiar shape of the cavity of the womb, and the 
 hardness and small degree of vascularity of the low r er part, is 
 of the most essential importance. The upper part, the proper 
 cavity of the womb, is prepared for the reception and imme- 
 diate adhesion of the ovum, when it shall have descended 
 through the Fallopian tube ; but the long callous cervix is 
 provided, that there may be no adhesion to the lower part of 
 the womb, and that the placenta may not form over the orifice 
 of the womb, for if it should, the most dangerous kind of 
 flooding takes place on the approach of labour from the open- 
 ing of the orifice, and the tearing open of the adhesions of the 
 plgcenta, before the child can be delivered. The length of the 
 cervix, and the glandular structure of the orifice is also of 
 much importance in sealing up the cavity of the womb after 
 conception, that there may be no longer communication with 
 the vagina ; for this purpose, a viscid tenacious mucus is 
 poured out ; but, on the approach of labour, with the soften- 
 ing and relaxation of all the soft parts, this adhesion and 
 gluing up of the orifice is dissolved, and a more fluid secretion 
 is poured out. 
 
 From the cavity of the womb the menstrual blood is dis- 
 charged at certain periods, from the time of puberty to the 
 approach of old age, when the system is no longer capable of 
 giving nourishment to the fetus. We shall presently find, 
 that the subserviency of menstruation merely to the prepara- 
 tion of the surface of the womb for the reception of the fetus, 
 though it be a principal, is by no means the sole end of this 
 periodical discharge. 
 
 It was long disputed from what source the menstrual dis- 
 Vol. IV. T 
 
146 
 
 or THE WOMB. 
 
 charge flowed. Some affirmed, that it must flow from the va- 
 gina, and not from the womb, because it flowed sometimes 
 during gestation. This is a fact which cannot be denied. I 
 have attended a patient who menstruated during the 'entire 
 period, or to the eighth month ; and I have often observed 
 ladies to menstruate at the first period after conception. On 
 the other hand, we have every proof of the discharge being 
 from the orifice of the womb. For instance, some have ob- 
 served on dissection of the parts of women dying during the 
 flow of menses, that blood was effused under the delicate 
 membrane of the cavity of the womb. The vessels there 
 have been observed particularly turgid, or the whole surface 
 of the proper cavity, and especially the fundus, spotted with 
 bloody effusions. More particular observation has shewn, 
 not only the mark of blood poured out from the inner surface, 
 but that the whole substance of the womb whs become thick, 
 soft, and vascular and M- Littre affirms, that in the body of 
 a woman who had died during menstruation, and with a con- 
 ception in the Fallopian tube, he found a layer of red coagu- 
 lated blood ; upon removing which, he saw a number of small 
 foramina which admitted bristles.'!' 
 
 But the best and least equivocal proof is, that which has 
 been repeatedly observed in the inversion of the womb, when 
 the inner surface has been turned out after labour, and has re- 
 mained thus inverted, and protruding from the external parts, 
 for then the menstrual blood has been seen to distil from the 
 surface of the cavity of the uterus. 
 
 OF THE BLOOD-VESSELS OF THE WOMB. 
 
 These are four large arteries which supply the system of the 
 womb, and four large veins which return the blood. 
 
 The spermatic arteries come down from the aorta itself, 
 or from the renal or capsular arteries. The spermatic artery 
 taking a waving direction, becomes tortuous in a most re- 
 markable degree as it approaches the uterus, it is distributed 
 to the Fallopian tube, the ovarium, but chief!)' to the body and 
 fundus of the uterus, where it forms remarkable anastamoses 
 with the artery of the other side. 
 
 The low ; r artery — the uterine artery, comes in ge- 
 neral from the hypogastric artery, takes also a serpentine 
 course, and is distributed to the vagina, and the lower part of 
 
 * The authorities upon this fubjedt are Spigelius, Morgagni, M. Littre, 
 Mauriccau, Winflow, Sympfon. 
 
 f This might have been an early abortion, or perhaps the decidua which it h 
 laid is fometimes formed at the menltrual period. 
 
OF THE WOMB. 
 
 14 7 
 
 the uterus, and inosculates largely with the other vessels, both 
 in the uterus, and by particular branches on the side of the 
 uterus. 
 
 In the first place, it appears, that this copious supply of ves- 
 sels to the uterus, from four different sources, is a provision 
 that the womb and secundines shall not by any accident of po- 
 sition, or by the progress of labour, and the consequent com- 
 pression of one or both the lower vessels, be deprived of their 
 due supply of blood. Again, their tortuous forms give proof 
 of their occasional greater activity, that they admit of a pecu- 
 liar and local action during menstruation, and that the blood 
 will move more languidly when the stimulus of the womb has 
 ceased. It is also a provision for the growth and increase of 
 the womb, and the supply of nourishment to the ovum. And 
 that an increased activity in a part must be supplied by a more 
 tortuous form, as well as an enlargement of the calibre of the 
 vessels, is in a particular manner illustrated by the change which 
 takes place in these vessels during pregnancy. For they be- 
 come in a much more remarkable degree tortuous and en- 
 larged. 
 
 The substance of the uterus is said to be spongy and com- 
 pact, which, though it is a seeming contradiction in words, does 
 yet really convey an idea of the effects of its copious intertex- 
 ture of vessels. Some have said, (as Mauriceau,) that by 
 pregnancy the womb is distended, and grows thinner : others, 
 that it grows thicker, as Daventer : and others again, as Smel- 
 lie, assert, that it continues of its natural thickness. These as- 
 sertions are none of them perfectly correct : for the womb is 
 not distended by the growth of the fetus and membranes, but 
 grows with them. Again, that the substance of the womb 
 grows in a remarkable degree, is true, but still when distended 
 by the waters in the last months of pregnancy, its walls are thin- 
 ner than in the unimpregnated state. Thus, when it has been 
 cut in the living body, upon the approach of labour, in the Cae- 
 sarean section, I have observed it, not more than a quarter of an 
 inch in thickness, even at the part to which the placenta adhe- 
 red. When I have dissected the womb after a tedious labour, 
 the waters discharged, but the head wedged in the pelvis, I 
 have found it considerably thicker. And, lastly, in the full 
 contraction of the womb, after expelling the fetus and placen- 
 ta, (for example, in rupture of the womb, where the child and 
 placenta had been forced amongst the bowels, and the woman 
 soon after died,) I found the walls of the womb about three, 
 quarters of an inch in thickness. 
 
148 
 
 OF THE womb- 
 
 SECTION IV. 
 
 OF THE OVARIA. 
 
 The ovaria are two oval bodies, which are suspended in the 
 broad ligament behind, and a little below the Fallopian tubes : 
 while they have an oval figure, they are somewhat flattened. 
 By cutting out the ovaria, the animal loses the power of con- 
 ceiving, and desire is extinguished ; they, therefore, bestow 
 what is essential to generation upon the part of the female. In 
 vague speculations on the subject of generation, they were sup- 
 posed to prepare a female semen ! but more particular exami- 
 nation demonstrates, that they consist of vesicles, which are 
 ova ; but how far incomplete, or in what essential circumstance 
 requiring the approach of the male, is not determined. 
 
 When we hold the section of the ovarium betwixt the eye 
 and the light, we see a great many polluted vesicles ; and if 
 we examine the ovarium of an animal killed in full health, and 
 particularly in the season, we shall observe these ova to be in 
 all varieties of states of preparation for impregnation. Some 
 small and pellucid, and yet only discernible in the thick outer 
 coat, by having a degree of greater transparency ; others, which 
 have taken a slight tinge of bloody colour from vessels striking 
 into them ; and if the section be made after a minute injection, 
 the vesicles will be seen coloured in the proportion of their 
 maturity ; some without a speck of colour ; others tinged ; one 
 or two loaded with injection ; and some vascular, and particu- 
 larly prominent. 
 
 In very young girls, the substance of the ovarium is whitish, 
 and very soft ; the surrounding membrane is thick ; and the 
 round corpuscules scarcely discernible ; and no irregularities, 
 nor any of those bodies called corpora lutea, are to be seen on 
 the surface. But as the girl advances in years, the little vesi- 
 cles begin to appear, and when about ten years of age, or just 
 before menstruation, the ovarium is full of ova of various sizes, 
 and some of them more matured, and forming an eminence 
 upon the surface. In the adult woman, the substance of the 
 ovarium, which appeared as an uniform homogeneous mass in 
 the fcEtus, is become a cellular and vascular bed, giving nourish- 
 ment to those numerous vessels or ova. Before impregnation 
 can take place, there must be a certain state of preparation of 
 the ovaria, without which the approach of the male effects no 
 change in the uterine system. The lower animals having their 
 seasons, and these seasons being a state of preparation for the 
 male, impregnation follows the copulation with much certain- 
 
OF THE WOMB. 
 
 149 
 
 ty : but, in women, such a periodical revolution in their system, 
 and instinctive desires, would but ill accord with that superio- 
 rity in attributes of the mind, which distinguish us in the scale 
 of beings. But women also suffer such an occasional excite- 
 ment in the uterine system, though unaccompanied with de- 
 sires, which preserves the womb in a state of preparation for 
 the reception of the ovum, and the ovaria in a state of prepa- 
 ration for impregnation. This is the effect of menstruation. 
 
 OF PUBERTY. 
 
 Authors have long, with many expressions of surprize, la- 
 boured to assign a cause, or frame a theory for the explanation 
 of those changes which we observe in woman at the age of pu- 
 berty : and generally, in their theories, they have connected 
 with these changes the monthly and periodical discharges of 
 blood from the uterus, which commences with puberty. These 
 theories have been founded in general, on principles remote 
 from the laws of a living system. At this period of puberty, 
 the whole frame is expanded into the fulness of feminine beau- 
 ty ; the breasts rapidly increase, and are matured ; the parts 
 of generation are enlarged ; the hair of the pubes grows, and 
 the menses flow. In explanation of these changes, theoretical 
 conjectures after this model have been entertained. “ About 
 this time the growth of the body begins considerably to dimi- 
 nish, and the blood finding easy admittance into the completed 
 viscera is prepared in greater quantity, the appetite being now 
 very sharp in both sexes, a plethora consequently follows. In 
 the male it vents itself frequently by the nose, from the exhaling 
 vessels of the pituitary membrane being dilated, fxc. ; and now 
 the semen first begins to be secreted, and the beard to grow. 
 But, in the female, the same plethora finds a more easy vent 
 downwards, being that way directed, partly by the weight of 
 the blood itself to the uterine vessels, now much enlarged, of 
 a soft fleecy fabric, seated in a loose hollow part, with a great 
 deal of cellular fabric interspersed, which is very yielding and 
 succulent, as we observe in the womb : for these causes, the 
 vessels being easily distensible, the blood finds a more easy 
 passage through the very soft fleecy exhaling vessels which 
 open into the cavity of the uterus, as being there less resisted 
 than in its return by the veins, or in taking a course through 
 any other part ; because, in females, we observe the arteries of 
 the head are both smaller, in proportion, and of a more firm re- 
 sisting texture. The return of the same is, therefore, more 
 slow, both because the flexures of the arteries, from the in- 
 
150 
 
 OF THE WOMB. 
 
 creased afflux of the blood, become more serpentine and fit for 
 retarding the blood’s motion,* and likewise, because it now 
 returns with difficulty through the veins. The blood is there- 
 fore first collected in the vessels of the uterus ; next, it is ac- 
 cumulated in the arteries of the loins, and the aorta itself, 
 which urging on a new torrent of bloocl, augments the force so 
 far as to discharge the red blood into the serous vessels, which 
 at first transmit an increased quantity of warm mucus, after- 
 Avards a reddish coloured serum, and by suffering a greater dis- 
 tention, they at last emit the red blood itself. The same greater 
 impulse of blood determined to the genitals, drives out the 
 hitherto latent haiis, increases the bulk of the clitoris, dilates 
 the cavernous plexus of the vagina, and whets the female ap- 
 petite to venery, &c.” 
 
 We cannot give implicit trust to such speculation, we cannot 
 believe in this plethora, produced by the diminished growth of 
 the limbs ; neither can we believe that congestion and plenitude 
 is produced in the female system, from the deficiency of 
 perspiration, from their more lax and weaker solids compared 
 with man, from their indolent and sedentary life : for facts are 
 in direct contradiction. The growth and completed function of 
 parts at this particular age, is not to be explained bv any theory 
 so partially applicable ; during almost every period of life, 
 there are similar changes taking place in some one part of the 
 body. Paris lie dormant, and are stationary in their growth, 
 which at a particular and stated age of the animal, enlarge and 
 develope themselves by a new and invigorated action. Ob- 
 serve how different the proportions of the foetus are from those 
 of the adult. We see nature careful to perfect certain parts, 
 as the head and liver, at an early period. We see during early 
 childhood how the parts shoot out, and evolve in due propor- 
 tion. We see parts which were large in the foetus lose their 
 preponderance : we see others, which served some purpose in 
 the foetal system, gradually shrink and disappear, because they 
 have no longer the stimulus to action in the circle of connec- 
 tions Avhich take place in the adult system. We find other 
 parts, as the teeth, for example, lying long within the jaw, 
 instead of proceeding with a gradual and continual enlarge- 
 ment, suddenlv rising at certain stated periods from their 
 embryo state, and enlarging and pushing up through the gums, 
 when it becomes fit that the child should take more solid food 
 than the mother’s milk. So the second set of teeth, in a more 
 particular manner, lie quite stationary in their growth within 
 
 * I have fhown that the tortuous arteries always form a provifion for the oc- 
 cafional increafe of the action and acceleration of the blood. 
 
OF THE WOMB. 
 
 151 
 
 their little sacs, yet quickly, at stated periods, they increase, 
 the enamel is formed, and they rise above the gum. There is 
 an infinite number of such changes depending upon the same 
 laws of the oeconomy, and not different from those which con- 
 troul the growth, and direct the shape of parts. They depend 
 upon certain laws of the constitution, which give an excite- 
 ment to certain parts, at stated periods, and which no theory 
 partially applicable will explain. There is a series in which 
 the parts of an animal body are matured, and a succession in 
 v/hich the functions are brought to maturity : and in the female 
 constitution, there are laws determining an action upon the 
 womb and breasts, and all parts subservient to conception and 
 the nourishment of a foetus ; at that period when the woman is 
 arrived at the age fit to take upon her the part of a mother. 
 
 OF MENSTRUATION. 
 
 Under this head, I shall confine myself to such a general 
 view of the subject, as is necessarily connected with the pecu- 
 liar functions we are now endeavouring to comprehend. 
 
 Menstruation is a state of preparation for conception. 
 When, therefore, the menses flow at the natural periods, and 
 in due quantity, it is a sign that the woman may conceive, 
 and that her system is fit for the support and nourishment of a 
 child. It is a general affection of the system, which has a 
 tendency to relieve itself by a topical action, by the excited 
 action of the uterine system ; and this excitement of the 
 uterine system is the end which nature is accomplishing. To 
 explain this, I may be allowed to take a short preliminary 
 view : each particular organ or viscus, whilst it has its con- 
 nections with the general system, is, in truth, a system within 
 itself, having its peculiar functions, sympathies, and even 
 vascular action, in a certain degree, independently. Were 
 not this in some measure the case, we should see no local dis- 
 ease or topical action ; and no vascular action could be for a 
 moment stationary and confined to one part. The body would, 
 indeed, be then only one great hydraulic machine. But while 
 the several parts have the property of being excited separately 
 to an accelerated action, they are actuated by remote sympa- 
 thies, and by these sympathies and relations, is the whole sys- 
 tem in a great measure supported. 
 
 Before menstruation commences, there is a preceding indis- 
 position, and symptoms indicating a constitutional affection. 
 And these complaints are usually more severe in the first, than 
 in the subsequent periods. The general revolution in the sys- 
 tem begins to accumulate its action towards the womb, and 
 
152 
 
 OF THE WOMB. 
 
 those symptoms usually accompanying uterine irritation, show 
 how far it is affected, and in a little time the menses flow. 
 Now, I conceive, the flow of the menstrual blood, to be not 
 the end which nature is here labouring to accomplish, but the 
 means of allaying the excited state of the uterine system after 
 the object is accomplished. It is not the discharge of a few 
 ounces of blood which relieves the system ; for drawing blood 
 simply will not do it ; but it is the excited action of the uterine 
 system which relieves the general distress, and that topical 
 action has full relief in the menstrual discharge. General and 
 topical plethora are terms which have been of great service in 
 explaining this periodical change in the female system, but the 
 state of mere fulness, has little effect either on the constitu- 
 tional or topical change. Even in the exhausted and debilitated 
 state of the system, when menstruation ceases from the want 
 of energy and power in the vascular system, still there remain 
 the same laws governing the sympathies, and relations of the 
 several parts ; and although they are feebly and imperfectly 
 excited, they give rise to accumulated distress at the period in 
 which the menses should flow. 
 
 There is more general distress at puberty, and when the 
 menses first flow ; but afterwards, when the periodical action 
 and discharge is established, there is little or no previous in- 
 disposition. 
 
 With regard to vicarious haemorrhagy from remote parts of 
 the body, some, whose opinion I greatly value, do not con- 
 sider them as deviations of the menses. At all events, from 
 what I have seen of such hsemorrhagies (tumours, for exam- 
 ple, discharging blood at the menstrual periods,) I would ob- 
 serve, that there is an excitement, throbbing, and distention, 
 previous to the discharge of blood, which confirms me in the 
 notion of the necessity of a counter excitement and action, as 
 well as the discharge of blood, being necessary to make a 
 derivation from the uterine vessels. It is by dissection alone 
 that we can form an established opinion regarding the final use 
 of the periodical return of the menses. 
 
 By dissection we come to the knowledge of the most essen- 
 tial facts. In the first place, it is found, that the ovaria, and 
 their vessels, partaking of the general excitement of the 
 spermatic arteries, are enlarged, full of blood, and with every 
 sign of increased action. We find also, that the ovaria are 
 matured and brought to pubulate, and almost to start from 
 their investing membranes. Again, when we attend to the 
 womb, we find, that these are marks of its whole vascular 
 system being roused to action. It has become laxer in its 
 texture, and there is a change similar to what takes place itt 
 
OF THE WOMB. 
 
 153 
 
 the first stage of pregnancy, but less in degree. The vessels 
 on the inner surface of the womb have been influenced by an 
 action similar to inflammation, and it is asserted, that even 
 the decidua is sometimes formed. Thus, while the ovaria 
 are ripened to that degree of maturity, which prepares them 
 for impregnation, the surface of the womb, and its whole 
 vascular system, is preserved in a state of preparation for the 
 adhesion of the ovum, when it shall have descended through 
 the Fallopian tube. I conclude that in considering this subject 
 of menstruation, the mere circumstance of the discharge of 
 blood has been too much attended to, while these other more 
 essential circumstances have been neglected. 
 
 It is not easy to determine, says Haller, either in this, or in 
 any other spontaneous haemorrhagy, from what kind of vessels 
 the blood flows. From the circumstance of the hsemorrhoidal 
 discharge, which certainly is from veins, and from the lochia, 
 which is generally supposed to be a discharge from the venous 
 sinuses of the wom’b after delivery, we have the argument of 
 analogy, that in menstruation also it is a venous discharge. 
 This opinion is further confirmed from stagnant blood being- 
 found in the uterine veins of women dying during the flow of 
 the menses, and orifices being observed larger than could well 
 be supposed to be the extremities of arteries. 
 
 I would say, that it is little probable that spontaneous hae- 
 morrhagy proceeds from the rupture of the extreme arteries, 
 because it is the activity of the arteries which causes the hae- 
 morrhagy ; and because this activity is the exertion of a mus- 
 cular force, and the exertion of a muscular fibre never is such 
 as to tear the fibre itself. On the other hand, we observe that 
 it is the necessary consequence of an increase of the action of 
 arteries, that the .corresponding veins dilate, and seem to suffer 
 a force of distention proportioned to their increased activity. 
 We must not forget that many are of opinion, that the men- 
 strual blood flows from the exhaling arteries. This opinion 
 must rest upon argument, and not facts, unless the assertion of 
 Raauw be taken as proof, that he could distinguish their 
 mouths ; or that of Mebomius, who said he introduced 
 bristles into them. That anatomists have introduced bristles 
 into pores, or foramina, it would be ungracious to doubt, but 
 that these were the orifices of exhaling arteries, is difficult to 
 believe. I rather imagine, that there is a provision for this 
 evacuation in pores, or foramina, in the extreme veins on the 
 vascular inner surface of the womb. 
 
 From the consideration of the cause of menstruation, as I 
 have conceived it, from the symptoms .which precede and ac- 
 company it, and from the effect attributable to the menstrual 
 Vol. IV. U 
 
154 
 
 OF THE WOMB. 
 
 action on the uterine system, we cannot consider it as a mere' 
 evacuation of blood, but rather as of the nature of a critical 
 discharge relieving the symptoms which preceded it. With 
 regard to the opinion of its being a secretion, we must first 
 know accurately what is meant by the term. If those who 
 suppose the menstrual blood a secretion, mean only that the 
 blood is occasionally changed by the action of the vessels of 
 the womb, I should willingly acquiesce in their opinion, for 
 even during the bleeding from the arm by the lancet, or from a 
 common wound, the blood is altered in the space of the few 
 minutes during which it flows ; and before the final stopping of 
 a common haemorrhagy, there is a change in the properties of 
 the effused blood. 
 
 When there is an unusual source of irritation in the womb, 
 added to the natural and periodical excitement of the parts, the 
 menses become more profuse, they last for a longer period, 
 the time of their intermission is shortened, and, in the end, 
 from some diseases of the womb, there is a perpetual oozing 
 of blood, which debilitates the woman, and destroys her con- 
 stitution, or there is sudden and profuse discharge with coagula, 
 unlike the usual evacuation. 
 
 OF THE CHANGE PRODUCED BY THE UNION OF THE SEXES. 
 
 In considering those changes produced on the ovaria and 
 womb by impregnation, we must have recourse to analogy in 
 the first instance. By attending to the changes produced in 
 vegetables, and the lower animals, we maybe enabled to com- 
 prehend some of the changes in the female organs consequent 
 upon conception, and which we might not otherwise be enabled 
 to understand. 
 
 We see that vegetables propagate their branches in every 
 respect like the parent trunk. We see in the autumn the bud 
 lodged in the axilla of the leaf, and observe it pass through 
 the winter in a kind of dormant state ; but when it is influenced 
 by the returning heat of the spring, it shoots out to full ma- 
 turity. This growth is a natural power of propagation, and 
 increase, marked by no very peculiar circumstance, yet bearing 
 a strong analogy to the production of the seed. 
 
 In the formation of the fruit of the same tree, we see a 
 more complicated provision for the propagation of the plant. 
 We find that although the seed appears to be formed by the 
 natural growth of the part like the bud, yet before it becomes 
 prolific, and capable of growing, and arriving at maturity, it 
 must be influenced by r circumstances similar to the union of the 
 sexes of animals ; that its power of reproduction depends 
 
OF THE WOMB. 
 
 155 
 
 upon the reciprocal action betwixt the parts of the same plant, 
 or by the approximation of male and female plants. 
 
 Between the formation, maturity, and impregnation of the 
 seed of plants, and those of the ova of animals, there is a 
 close analogy. The seed is formed and matured while at- 
 tached to the parent plant ; but the vessels of the plant having 
 completed this operation, shrink from their connections with 
 the seed, leaving it with its little system of vessels complete, 
 and with a kind of imperfect life, which may be considered as 
 analogous to a dormant state. This imperfect life, or perhaps 
 a state merely capable of being excited into life and motion, 
 continues for the winter season, or for a longer period. 
 
 The flower of plants solicits the fluids to the seed, as the 
 influence of the leaf cherishes the bud in the axilla. The pulp 
 of the fruit is probably a provision of the same kind, or when 
 it has fallen, to lay the foundation, by its decay, of a soil 
 suited to the tender plant. 
 
 In the seed itself, we have much to admire. We find it in- 
 cased in a strong husk, or shell, which is in general provided 
 with a porous part ready to imbibe the moisture of the ground. 
 In the nut within the outer shell, there is a soft spongy sub- 
 stance, which, receiving the moisture, swells and bursts up the 
 shell, and relieves the seed. The kernel of the nut is then like 
 a common seed, it has begun to vegetate, and these are the 
 parts which form the system of its osconomy. The principal 
 part of the seed consists of albuminous matter for the supply 
 of the nourishment to the embryo plant, so as to prolong its 
 shoots, and to send down its roots into the earth. The little 
 embryo plant lies complete in all its parts, betwixt the Ibbes of 
 albuminous matter, in a state of torpor, or in which the opera- 
 tion of the living principle is suspended. From the embryo 
 plant there extends into the albuminous matter of the seed- 
 vessels, or tubes, inactive, but ready on the supply of heat and 
 moisture, to absorb the nutritious matter of the albumen, and 
 minister to the increase of the embryo plant. 
 
 Now the root of the little plant sprouts from the seed, and 
 has a tendency to strike into the ground, and the bud rises to 
 the surface towards the light, and the influence of the atmos- 
 phere. 
 
 We see in this instance, that the operation of the system of 
 tubes of the embryo plant in the albumen was merely sus- 
 pended, that upon the seed being put into the ground, the heat 
 and moisture promote the germination, by driving the nutriti- 
 ous matter of the albumens to the embryo plant. In the first 
 stage of this change, the matter absorbed by the vessels of the 
 albumen supply that nourishment, which afterwards is con- 
 
156 
 
 OF THE WOMB. 
 
 veyed from the root striking into the earth, and from the leaves 
 absorbing from the atmosphere. And when the roots have 
 struck into the earth, and the first leaves rise upon the surface, 
 the lobes of the albumen are exhausted and fade, or rise up in 
 form of leaves, still cherishing the tender plant. 
 
 When we come accurately to examine the situation of the 
 embryo in oviparous animals, we shall find the same provision 
 for the nourishment and growth of the young animals, inde- 
 pendent of external circumstances, nourishment prepared for 
 it until it shall be enabled to gain strength to feed itself. 
 
 The manner in which an egg is formed is this : The yolk, 
 with its delicate membranes, are formed in the ovarium of the 
 hen. The ovarium is placed on the back-bone, innumerable 
 yolks are seen gradually formed, and successively increasing 
 in size. When they are matured, they are of the full size we 
 see them in the perfect egg ; they are surrounded with a deli- 
 cate web of membranes, extremely vascular, which bursts 
 when they are mature and impregnated, and then they fall into, 
 or are grasped by the infundibulum, or what answers to the 
 Fallopian tubes in woman and quadrupeds. While yet in the 
 egg-bed, the cicatricula, or embryo, is seen to be included in 
 its membranes, upon the surface, or in the membrane of the 
 yolk ; as the yolk, and the imbibed cicatricula, passes through 
 the uterus, the yolk, in a most curious way, has the addition 
 of the other part of the egg. The uterus of a bird is not like 
 that of other quadrupeds or viviparous animals, simply for 
 the reception of the ovum ; but it is long and convoluted like 
 the intestines. And the yolk, as it drops into the upper part 
 of it, ‘collects as it passes along the uterus, the white of the 
 egg, which is a secretion from it. As it proceeds downwards, 
 it receives the membranes of the white, and before it is ex- 
 cluded, it is coated with the shell to preserve it from injury 
 when it shall be dropt from the hen. In the fully formed and 
 incubated egg this is the situation of the parts. Under the 
 shell is a membrane which invests the whole parts, but leaves 
 a space containing air in the greater end betwixt it and the 
 shell. Within this membrane the glairy white of the egg is 
 contained, and within the white or albuminous matter is the 
 yolk. Under the membrane of the yolk, there is a small spot 
 of a lighter yellow than the yolk. This, upon examination is 
 lound to be a vesicle, and within it we see a lesser circle 
 formed by an inner vesicle : this is cicatricula, and within 
 this the rudiments of the chick are contained. We may ob- 
 serve, that the yolk js specifically lighter than the white ; 
 again, it is fixed, towards the two extremities of the egg to 
 'the albumen, or white, by the chalaza. These are like twisted 
 
OF THE WOMB. 
 
 1 57 
 
 cords, which arise from the yolk, and expand in the white, so 
 that they take a pretty firm hold on its tenacious substance. 
 These chalaza are not fixed to the yolk in iis axis, but to the 
 side, so that the buoyancy of the yolk keeps it revolving as the 
 egg is turned, so as always to present the cicatricula to the 
 upper part of the egg, in whatever way it is placed ; conse- 
 quently it is always contiguous to the body of the hen, so as 
 immediately to receive the influence of the maternal heat. 
 By incubation, the principle of life in the chick and its mem- 
 branes is roused, and the first perceptible change appears in 
 little bloody streaks, which, running together, form a circle of 
 vessels, and which are seen to terminate in the umbilicus of 
 the chick. 
 
 This vascular circle, the most beautiful appearance of any 
 in the ceconomy of animals, ought to be particularly explained. 
 In Mr. Hunter’s book treating of the blood, there is a plate 
 which represents the embryo of the chick in the incubated eg^;, 
 at three different stages of its formation, beginning with the 
 earliest visible appearance of distinct organization. — The pre- 
 parations from which these figures are taken, form part of a 
 complete series contained in Mr. Hunter’s collection of com- 
 parative anatomy. — They are meant to illustrate two positions 
 laid down in his work, viz. that the blood is formed before the 
 vessels, and when coagulated, the vessels appear to rise ; that 
 when new vessels are produced in a part they are not always 
 elongations from the original ones, but vessels newly formed, 
 which afterwards open a communication with the original. 
 
 This to me seems an idea founded on a very limited view of 
 the state of the parts. We must recollect that this is not the 
 formation of new parts or new vessels. The embrvo is in that 
 state of which I have endeavoured to convey an idea, by the 
 term dormant ; possessing that degree of life which is to be 
 renewed by incubation, or artificial heat, but which will last a 
 great length of time, and, like the germ in plants, be brought 
 to vegetate only in particular circumstances. The tract of 
 these vessels is laid in the original conformation of the embryo 
 and surrounding membranes, they are now merely called into 
 action, and we see only the effect of this action. We see red 
 blood formed ; we know that the redness of the blood is 
 derived from the membranes, and matter which surround the 
 embryo, and that it is conveyed to the chick or embryo. Be- 
 fore we allow ourselves to conjecture what is the first motion 
 in the circle of actions which now take place, we must consider 
 whether it be not more likely that the first action of these ves- 
 sels is an absorption ; that is, an absorption in the extremities of 
 these vessels, or is there first, an action of the heart of the 
 
158 
 
 OS THE WOMB. 
 
 chick? — We are left to this question, Is it probable that a 
 change shall take place in the fluids which shall stimulate the 
 vessels ? or shall the heat of incubation stimulate the vessels to 
 act upon the contained fluids ? or, as seems most probable, 
 does the incubation, at the same time, produce a change in the 
 fluids, and stimulate the vessels to action ? To explain what I 
 should rather conceive to take place, I shall describe the pro- 
 bable series of actions. 
 
 In common seed, the small germ of the plant has its vessels 
 passing out into the lobes of the albumen to absorb the food, 
 upon the existence of the peculiar circumstances necessary to 
 its being stimulated to activity and growth. We have to ob- 
 serve, that where the nut was attached in its husk to the tree, 
 it has left a porous part ; by this cribriform kind of plate the 
 moisture of the earth enters ; — that dry scurfy substance which 
 we observe on the inside of the shell, swells with the moisture 
 tiPhich also penetrates the albumen or kernel — the moisture 
 forming combination when the albumen prepares it for absorp- 
 tion ; the vessels are, at the same time, excited, absorb, and 
 thus nutritious fluids are conveyed to the germ — the nut splits 
 by the swelling of the parts, and the corculum or bud sprouts 
 up. We find then, that in this instance the grain, or nut, is 
 brought into action by the fluids absorbed, forming new com- 
 binations with the albumen or kernel, and the active exertion 
 of the living powers, beginning by an operation in the fluids. 
 
 In the same manner, I conceive, that the incubation of the 
 egg causes an action first in the fluids, not in the solids (for 
 these are solids according to the strictest signification of the 
 term ; and strong membranes, as a little vinegar will show, 
 when poured upon the albuminous substance of the egg.) A 
 change takes place in the fluids, there are new arrangements 
 suiting them for absorption, by those circles of vessels which 
 are laid on the original formation of the membrane. The 
 fluids act as a stimulus to those vessels, whose alternate action 
 and relaxation never cease until the termination of life. I con- 
 ceive this explanation, which I have offered, to be more con- 
 sonant with the great principles of physiology, and an exten- 
 sive analogy of similar actions in the ceconomy, than that ex- 
 planation of Mr. Hunter, which supposes the specks seen at 
 the sides of the vessels, to be spots of coagulated blood, 
 destined afterwards to become blood-vessels. For, I am apt 
 to conceive, the red blood to be formed only after several 
 rounds of the circulation, and to depend upon a more perfect 
 assimilation than that first excited : and that Mr. Hunter is all 
 along in this mistake, that he is supposing these vessels to be 
 newly formed, which are laid in the constitution of the mem- 
 
OF THE WOMB. 
 
 159 
 
 branes surrounding the embryo, and which are now only called 
 into action, and only become apparent when they convey red 
 blood. 
 
 In the system of the egg there are other circumstances wor- 
 thy of notice : as the chick grows by the absorption of the 
 white, or albumen, the new combinations reduce to a lesser 
 bulk the whole mass, which is within the shell, and now we 
 perceive the use of the air cell, which enlarging, fills up this 
 space. When the chick has escaped from the shell, the yolk 
 of the egg is not exhausted, but it is found to be received into 
 the belly of the chicken, and to have a conduit leading into the 
 duodenum, by which it is poured into the intestinal canal. It 
 is for some time a source of supply to the young animal until 
 its strength is equal to the digestion of its appropriate food. 
 And in this respect it is analogous to the suckling of viviparous 
 animals. 
 
 Let us now observe what analogy exists betwixt the genera- 
 tion, or rather the birth and nourishment of the embryo of the 
 viviparous animal, and those of the oviparous. As to the pre- 
 cise effect which the approach of the male has upon the ovari- 
 um of the female, whether by this union of the sexes, there is 
 an actual addition to the ovum, or only an influence exerted on 
 the parts already there, by the presence of the male semen, it 
 seems almost needless to hope for an absolute decision. 
 
 The resemblance of the offspring to both parents, would in- 
 fluence us at once to conclude, that there must be a union of 
 the parts from both sexes. But when we consider how ipuch 
 the peculiarities of individual animals depend upon certain pe- 
 culiarities of action ; how the constitutional predispositions 
 must depend on the same peculiarities in the action of parts, 
 since the doctrine of absorption teaches us, that of actual sub- 
 stance nothing is permanent, but all suffers an incessant revolu- 
 tion and change, of which nothing can remain but certain pe- 
 culiarities of action ; we may then come to allow, that the male 
 semen merely influences the state of the parts already formed, 
 and does not bestow an actual substance. 
 
 In the speculations on the subject of generation, facts and 
 observations have been so very rarely attended to, that those 
 which have been offered seem to have had a preponderance 
 much beyond their real value. Thus the microscopical de- 
 monstration of animalculse swimming in the semen of the male, 
 has given birth to an idea that they were homunculi, which be- 
 ing introduced into the proper nidus of the female, grew up to 
 man’s estate. Though, where all is conjecture, and, perhaps, 
 as no better explanation is to be offered, it may seem improper 
 so directly to contradict any theory, still I must say, that this is, 
 
160 
 
 OF THE WOMB. 
 
 in my mind, the height of absurdity. To suppose an animal 
 secreted along with the seminal fluid from the testicle of the 
 male (and which, in all probability, is the production of stag- 
 nation and putridity,) to swim and be nourished in the male 
 semen, and yet to hold that on being introduced into the ovaria, 
 it changes from an active animal into an impalpable gelatinous- 
 like mass, and, after a series of changes, grows at last to the 
 maturity of a human being, is altogether beyond my compre- 
 hension. 
 
 The experiments made by the ingenious Dr. Heighton, 
 throw considerable light upon these delusive speculations re- 
 garding the impregnation of the female. He found by experi- 
 ments on rabbits, that upon cutting the Fallopian tubes, forty- 
 eight hours after the coitus, the impregnation was equally ob- 
 structed as when he had cut them previous to admitting the 
 male ; it would appear that in these animals impregnation is by 
 no means the instantaneous effect of the union of the male and 
 female, but that it requires at least fifty hours ; for, when Dr. 
 Heighton cut the Fallopian tubes at that period, it did not pre- 
 vent impregnation. Dr. Heighton proves, that the generative 
 process is not an instantaneous effect, as we should very natu- 
 rally suppose, but an operation requiring time. That the se- 
 men does not reach the ovaria during, or immediately after the 
 coitus, is sufficiently evident ; and it is still more so, that the 
 ovum is impregnated while in the ovarium, and not upon its 
 descent into the womb, which is proved from the foetus some- 
 times remaining in the ovarium, or tubes, and growing to ma- 
 turity. Dr. Heighton supposes the semen only to affect the 
 vagina and uterus, and that a consent of parts, or sympathy, is 
 communicated along the tubes and ovary to the ovum ; and 
 that neither the semen, nor the aura seminalis reaches the ova- 
 ria. When we look abroad for analogies, however, and find 
 the semen of some animals, as fishes, merely thrown out upon 
 the already evacuated spawn, we cannot readily acquiesce in 
 this opinion of the mere sympathy of the female parts calling 
 the young animal into life. 
 
 Leaving this subject, we have to observe, that previous to 
 impregnation there is a ripeness and prominence of some of 
 the ova, that by coition the Fallopian tubes do not instantly 
 grasp, impregnate, and cause the bursting of the ovum from 
 the ovarium ; but there is an action commenced which gradu- 
 ally brings about this change. Whilst the ovary is thus affect- 
 ed, the tubes are preparing for their action of embracing the 
 ovum, there is an increased turgescence in their vessels, and an 
 enlargement and swelling of the fimbriated extremity. When 
 
OF THE WOMB. 
 
 161 
 
 thus prepared, it approaches the ovarium, grasps, and receives 
 the ovum, and by a peristaltic motion, probably very slow and 
 gradual, the ovum is conveyed into the cavity of the uterus. 
 
 OF THE OVUM, AND ITS CONNECTIONS WITH THE UTERUS 
 IN THE EARLY MONTHS OF PREGNANCY. 
 
 The ovum, when it has descended into the uterus, and is 
 perfect in its structure, is a soft oval mass, fringed with vessels, 
 and composed of membranes containing the early fetus. 
 When opened, or dissected, it presents three cavities, or we 
 observe the fetus to be surrounded with three distinct mem- 
 branes. 1. Decidua, or tunica filamentosa, false chorion, or 
 spongy chorion. 2. The chorion. 3. The amnios. Of these 
 coats, the outer one is formed by the womb, the others consti- 
 tute the ovum as it has descended from the ovarium. We 
 shall, in the first place, attend to the original membranes and 
 general constitution of the ovum, and then to the deciduous 
 covering which it receives in the womb. 
 
 Plan of the Membranes. 
 
 \ 
 
 \ 
 
 A, The Fcetus. B, The Amnios. C, The Chorion. D, 
 ' 11 The Vesicula Alba. 
 
 Amnion. The amnion is the vesicle which immediately in- 
 volves -the' fetus. It is a very thin and pellucid membrane in 
 the early stage of pregnancy, but it acquires considerable thick- 
 ness and strength in the latter months. 
 
 The amnion contains a thin watery fluid in which the fetus 
 is suspended. In the abortion of the earlv months, we find the 
 quantity of this fluid very great in proportion to the whole 
 
 Vol. iv. ' X 
 
262 
 
 OF THE WOMB. 
 
 ovum, and this forms a defence to the delicate, and almost ge- 
 latinous substance of the fcetus, while it is a provision also tor 
 the regular presentation or the head of the child, for now the 
 fcetus being suspended in this fluid, and hanging bv the umbili- 
 cus, and the head and upper part of the body greatly prepon- 
 derating, it takes that position with the head presenting to the 
 orifice of the womb which is necessary to natural and safe la- 
 bour, the fcetus being prevented from shifting in the latter 
 months by the closer embracing of the child by the uterus. 
 
 Chorion. The chorion is the second involving membrane 
 of the fcetus ; on the inside it is smooth, and betwixt it and the 
 amnion a gelatinous fluid is interposed. In the early months 
 it is much stronger than the amnios, but in the advanced stage 
 it has come in contact with the amnios, no fluid being betwixt 
 them. And in proportion as the amnios gains strength to be 
 of essential service in dilating the orifice of the womb during 
 labour, the chorion has relatively become very thin and weak. 
 On the outside the chorion is shaggy and vascular, and consti- 
 tutes those minute extremities of the vascular system of the 
 ovum, which attach to the surface of the womb, or rather to 
 the flocculent membrane which it throws out. 
 
 The umbilical chord. When we can first discern the 
 fcetus, it is merely like an opaque oval body of the size of a 
 common fly, and closely attached to the amnion ; but, by de- 
 grees, it recedes from it, and then we perceive that it is attach- 
 ed by the umbilical chord, which consists of the trunk of the ves- 
 sels going out from the foetus, and which distributed upon the 
 chorion receive the supplies from the maternal system. 
 
 Now we perceive that the fcetal system which descends from 
 the ovarium, is not merely a foetus or embryo, but that this em- 
 bryo, besides a system of vessels within its own body, is sur- 
 rounded completely with membranes, and that from the vascu- 
 lar system of the embryo, there go out vessels, which being mi- 
 nutely distributed to the outer vesicle, or membrane, and actu- 
 ated by the same heart which circulates the blood through it, 
 our little corporal system prepares for imbibing the due nour- 
 ishment from the uterus. 
 
 Vesicula alba. The vesicula alba, or umbilicalis, is a 
 little vesicle which lies betwixt the chorion and amnion ; it con- 
 tains a white fluid ; it is connected with the navel or chord, by 
 an artery and vein. Very little has been offered as explanatory 
 of its use, it has been considered as similar to the alantois of 
 quadrupeds, and having a connection with the urachus ; but it 
 has no communication with the bladder, and soon disappears. 
 Whereas, if it had been for receiving the secretion of urine, it 
 would have been, prepared for the more mature sta te of the fcetus , 
 
OF THE WOMB. 
 
 163 
 
 I conceive it not to be improbable, that it is a provision of 
 supply for the embryo, previous to its perfect attachment to the 
 uterine system, and during its descent into the womb, perhaps 
 similar to the albumen of oviparous animals, but which, after 
 the perfect establishment of the connection betwixt the fcetal 
 and maternal system, shrinks and disappears, as being no lon- 
 ger necessary. 
 
 OF THE ADDITIONAL MEMBRANES WHICH THE OVUM RE- 
 CEIVES FROM THE UTERUS. 
 
 While the ovum is taking the changes consequent upon 
 impregnation, the womb partaking of the general sympathy 
 which prevails over the whole uterine system, takes a change 
 adapting it for its reception. The first appearance of action is 
 marked by a greater activity of the vessels, a swelling and soft- 
 ness of its substance. While on the inner surface there is an 
 exudation which being converted into a spongy membrane, is 
 peculiarly adapted for the reception and adhesion of the ragged 
 and vascular surface of the ovum. 
 
 In this plan we shall be able to observe the relations and in- 
 flections of the uterine membranes or decidua, as seen and de • 
 
164 } 
 
 OF THE WOMB* 
 
 scribed by Dr. Hunter, and of their correctness, my observa- 
 tions in dissection leave no doubt in my mind. AA, The 
 uterus in outline ; B, the amnion with the foetus ; C, the 
 chorion. Now it is observed, upon a careful examination of 
 an abortion of the early months, that besides the chorion and 
 amnion, there is a spongy membrane of two distinct lamina 
 which invests the chorion. The outermost of these is found 
 to surround the whole ovum, even investing that part which 
 has become the placenta by the accumulation of vessels. This 
 outer membrane then may be represented by the line DD. It 
 is represented as adhering to the surface of the womb, as it 
 must do in fact. We observe again, that it is perforated 
 where the Fallopian tube enters the womb, that at this part it 
 is not formed ; so that, according to Dr. Hunter, and the pre- 
 parations which I possess, these tubes open into its inside. 
 
 Upon dissecting up the outer lamina of the decidua, we find 
 that where the placenta commences, it is reflected over the 
 surface of the ovum and the shaggy chorion of the ovum, so as 
 to be represented by the letters EE. We shall now understand 
 the distinction betwixt the Decidua Vera DD, and the_De- 
 cidua Rejlexa EE. 
 
 It would appear that this membrane is either completely 
 formed, or at least the fluid which is to form it, is thrown out 
 previous to the descent of the ovum ; indeed, so intimate is 
 the Sympathy betwixt the whole uterine system, that this mem- 
 brane is formed in those cases where the ovum does not de- 
 scend, but constitutes the extra uterine conception. 
 
 Dr. Hunter supposed, that the ovum passed into the cavity 
 of the uterus whilst the coagulable lymph was pouring out by 
 the arteries of the uterus, and that it was thus immersed in, 
 and surrounded by the decidua, for he could not conceive that 
 
OF THE WOMB, 
 
 165 
 
 it could gain admission betwixt the lamina of the membrane 
 already formed. 
 
 I should conceive that the ovum A, upon its descent gets in- 
 tangled behind the deciduous membrane B, by which means 
 the ovum is not left loose in the cavity of the womb, but is 
 soon attached and surrounded with a membrane, or vascular 
 web, from which it can immediately draw supplies, and by 
 this provision also its adhesion to the superior part of the 
 uterus is insured. But as the same action of the uterus con- 
 tinues, and, as we must naturally suppose, be rather occa- 
 sioned by the presence of the ovum in its cavity, the surface of 
 the uterus at A continues to throw out a coagulable matter 
 which surrounds that part of the ovum, so that this will im- 
 mediately become its situation. 
 
 A, The Decidua Vera , formed before the descent of the 
 ovum. B, the Decidua Reflex a, formed by the ovum getting 
 behind it, and pushing it down. C, the efflorescence which 
 continued to be poured out, surrounds the upper part of the 
 ovum, and which, from its more immediate supply from the 
 uterus, will in time form the sole support of the foetus, viz., 
 the uterine portion of the placenta. 
 
 Of the placenta, and of the nutrition of the fcetus. 
 
 When the ovum first descends into the uterus, the fleecy 
 surface of the chorion establishes a universal adhesion, but no 
 sooner is the attachment of the ovum established, than the 
 vessels of the fcetus which are universally distributed over its 
 surface, begin to accumulate to that point from which the more 
 abundant supply is obtained. Thus, from the universal adhe- 
 sion the vessels of the fcetus are massed and accumulated tor 
 
166 
 
 OF THE WOMB. 
 
 gether, so as to form a thick cake or placenta. This takes 
 place upon the same principle that the roots of a plant stretch 
 towards the soil best suited to it, or the branches and leaves of 
 a plant grow and spread towards the light. The placenta is 
 destined to adhere to the fundus of the womb, and there we 
 observe the accumulation of the large vessels of the womb, it 
 being equidistant from the several sources of blood ; and to 
 this point is the tendency of the vessels of the chorion so 
 great, that we sometimes see the vessels of the chord running 
 three or four inches upon the membranes before they reach the 
 placenta, evidently shewing that the point to which the umbili- 
 cal chord had been originally attached, was not opposite to the 
 more vascular part of the womb ; but that the vessels had to 
 stretch and elongate some way from the insertion before they 
 accumulate in form of the placenta, towards that part of the 
 uterus where there was the greater vascularity. 
 
 But the formation of the placenta on the fundus of the 
 womb is not constant, although there are many provisions for 
 ensuring attachment there. But when it does form low in the 
 womb, or on the orifice itself, we thert perceive the reason of 
 nature’s solicitous care in preventing it ; for it occasions the 
 most dangerous floodings from the placenta presenting on the 
 approach of labour, and its connections being necessarily torn 
 up previous to the delivery of the child. 
 
 The placenta of the advanced stage of gestation is a mass 
 formed partly by the accumulations of the vessels of the fetus 
 (the trunk of which is the umbilical chord,) and partly of a 
 vascular and cellular portion formed by the uterus. On the 
 surface attached to the womb, the placenta exhibits deep and 
 irregular fissures which divide it into lobes ; but on the inner 
 surface is smooth from the investing membranes, but raised 
 into irregularities by the numerous and tortuous ramifications 
 of the umbilical vessels. When rudely torn or cut into, it ap- 
 pears to be a spongy substance, formed in a great part of an 
 irregular tissue of vessels. 
 
 In the human subject we find, that the maternal part of the 
 placenta is thrown off with the other secundines, and does not 
 separate from the festal part of it. While, in other viviparous 
 animals, the monkey excepted, the filamentous extremities of 
 the fcetal vessels separate from the glandular mass formed by 
 the maternal vessels of the uterus. 
 
 The placentary vessels of the feetus never touch the surface 
 of the womb, but communicate with the maternal system 
 through the vessels of the womb, which pierce the deciduous 
 membrane. Still the question of the precise manner in which 
 the vessels of the fetus communicate with those of the mother 
 
OF THE WOMB. 
 
 167 
 
 remains undetermined. I conceive that in the early stage the 
 deciduous membrane being thrown out by the action of the 
 uterine vessels, those of the chorion stretch into it, and absorb 
 the nourishment. The decidua is a vascular membrane, but it 
 has, at the same time, a peculiar spongy texture. This spongy, 
 or reticulated structure of lamina of the decidua ceases where 
 the placenta is affixed. When we carefully dissect up the 
 decidua to the margin of the placenta, it is found to be more 
 rigid, white, firm, and thick.* When we examine the out- 
 side of an entire ovum, we observe that at the place covering 
 the placenta, it is corrugated and full of irregular eminences 
 like the convolutions of the brain, and among those irregu- 
 larities many small- convoluted arteries may be discerned, with 
 spots of extravasation and the flat mouths of veins. Upon 
 dissecting up this maternal part of the placenta, we find it to 
 form the firmest part of it ; and by the difference of colour, as 
 well as by the possibility of tearing it up, or dissecting from 
 the mass of vessels of the chorion, we recognize it as the 
 decidua. This union, however, betwixt the maternal and 
 foetal parts of the placenta is intimate, and it is impossible to 
 determine by dissection with the knife, whether there be inos- 
 culations betwixt tjie maternal and foetal vessels, or whether 
 the nourishment of the foetus is by absorption, nor can we dis- 
 tinguish in the first months the cellular intertexture which may 
 be observed in the placenta of the full time, as described by 
 Mr. Hunter. 
 
 In explanation of this part of our subject, I have purposely 
 dissected, and made drawings of the ovum in several stages. 
 This point of anatomy relating to the decidua, is particularly 
 explained in Plates VI. and VII. to which I refer the reader. 
 
 Of the liquor amnii, as conducing to the nourish- 
 ment OF THE FCETUS. 
 
 Some physiologists observing the strict analogy, which exists 
 between the function of the placenta and the lungs of breath- 
 ing animals, have conceived, that the liquor amnii is the source 
 of nourishment, and that it is taken into the stomach. I be- 
 lieve they have conceived some analogy to exist betwixt the al- 
 bumen of the egg and the liquor amnii, which in their minds 
 has strengthened this opinion. But there is here no analogy : 
 we have seen, that the embryo of oviparous animals being 
 formed with the yolk in the egg-bed or ovarium, descends into 
 
 T fpeak after differing the ovtim of the third month. 
 
168 
 
 OF THE WOMB. 
 
 the uterus, and there receives the addition of the albumen or 
 white. On the other hand, we find that the ovum of vivipar- 
 ous animals is formed in the ovarium ; and that the liquor 
 amnii being within the membranes of the ovum, must be the 
 production of the fetal system. Further, when the ovum has 
 descended into the womb, and grown to some maturity, we 
 see that there is no connection by vessels betwixt the fetus and 
 mother but through the placenta ; that the liquor amnii is 
 within the involving membranes of the fetus, and that conse- 
 quently it must be thrown out by the vessels of the fetal sys- 
 tem. Thus, to suppose the fetus to be fed by the liquoT 
 amnii, would be to suppose it to draw resources from its own 
 system, and that the vessels poured out a fluid, which is after- 
 wards to be taken into the stomach.^ But without adducing 
 arguments, it is sufficient to say, that fetuses have been 
 brought forth, monstrous in their conformation, and without 
 mouths yet well grown. 
 
 Of the placenta as the source or nourishment to 
 The fcetus. When we consider the mere speck of the em- 
 bryo in the first weeks, we see that it can have no other source 
 of nourishment than through the extreme vessels of the 
 chorion, connected with the short umbilical chord ; and we 
 may be convinced also, that in its progress to maturity, when 
 the general connections of the chorion cease, and the placenta 
 is formed, the sole supply is through its vessels. Regarding 
 the manner of the communication betwixt the vessels of the 
 mother and child there are many opinions. The simplest ex- 
 planation, but the furthest from the truth is, that the arteries 
 of the womb are continued into the veins of the fetal portion 
 of the placenta. That on the other hand, the arteries of the 
 fetal system are continued into, or inosculate with the veins of 
 the womb ; and that thus, the blood of the mother’s system is 
 carried by direct inosculation. A little investigation will con. 
 vince us, that this is a very unlikely conjecture. We see the 
 embryo surrounded with its vessels, and forming a complete 
 system within itself, descend into the womb. We see that the 
 attachment betwixt the surface of the ovum and the womb, de- 
 pends on a reciprocal action betwixt them ; and when the fetus 
 is feeble, or diseased, or when it dies, the uterus immediately 
 separates from it, as from a dead part, and there is an abortion. 
 Again, it is not natural to suppose, that the circulating fluids 
 of the adult are calculated for the circulation in the embryo, or 
 
 * A greater abfurdity than that of which a foreign author is guilty cannot be 
 imagined, becaufe the liquoramnii, or fome fluid, is found in the trachea, he fup- 
 pofes that the foetus refpires, and receives oxigenation from the liquor amnii. 
 
OF THE WOMB. 
 
 169 
 
 that the blood of the adult is fit for the circulation of the fetus. 
 When we inject the vessels of the fetus, we find the veins and 
 arteries of the umbilical chord to inosculate freely with each 
 other, and the fluid passes from the arteries to the veins with 
 little extravasation or escape of fluid, and such only as may be 
 supposed to pass from torn vessels. Again, the bleeding of 
 the child does not draw from the maternal system ; for ex- 
 ample, when the accoucheur has to perform the operation of 
 embryulcia, and when the arteries of the brain pour out their 
 blood, the woman does not suffer, nor is there any danger of 
 haemorrhagy from the chord after the delivery of the child. 
 Again, what does the analogy of other animals show us ? 
 We may observe, in the first place, that probably on account 
 of the peculiar form of the womb of woman, and in these cir- 
 cumstances to guard her from danger of haemorrhagy during 
 deliver}', it is necessary that the placenta should be accumulated 
 towards the fundus of th;e womb. Now, to allow less danger 
 of the separation of the secundines from the womb, and con- 
 sequent abortion, there follows a necessity for the human pla- 
 centa being attached in a particular manner ; and in place of 
 the maternal part of the placenta remaining with the womb, as 
 in other animals, the whole mass separates on the delivery of 
 the child. The necessity for this firmer attachment of the 
 human placenta, causes the connection betwixt the fetal and 
 the maternal portions to be very intimate, and the manner of 
 the vascular connection by no means easily demonstrated. 
 
 In other animals, however, for example in those which 
 have the small and numerous placenta, or cotylidones, the fetal 
 and maternal portions of the placenta separate easily ; the ma- 
 ternal part being a prominent vascular bed, which is a part of 
 the womb, and is not deciduous. Here we find, that the 
 glandular-like portion which belongs to the womb may be 
 minutely injected, and no particle of colour pass into the fetal 
 part ; and again injection shows the fetal portion to be merely 
 composed of the fleecy extremities of vessels, which, how- 
 ever minutely injected, do not show any inosculations with the 
 maternal vessels ; in short, here the connection betwixt the. 
 extremities of the two systems is so very loose, and the fila- 
 ments so minute, and almost like an impalpable mucus, that 
 we can imagine no other kind of connection than that the ex- 
 tremities of the umbilical vessels take up by absorption the 
 nutritious matter necessary for the system of the child, and 
 that this is secreted by the vessels of the womb. 
 
 Investigation’in every department of natural history shows 
 a similarity, and a simplicity in the operations of nature. 
 Comparative anatomv mav be brought with much advantage. 
 Voe. IV. ' ' Y 
 
OF THE WOMB. 
 
 170 
 
 in illustration of the very obscure laws which guide the func- 
 tions of the parts of generation. When we turn our attention 
 to the egg, we find, in the first place, that the vascular system, 
 is complete within itself, and requires no permanent connec- 
 tion with the maternal system to invigorate its action. We 
 find that the artery which passes out of the umbilical chord of 
 the chick, and which is distributed to the membranes of the 
 white, pulsates strongly,, and carries venous coloured blood. 
 We find the returning vein carrying arterial coloured blood. 
 We find then that these vessels must have a double function, 
 they imbibe the nourishment from the white, and convey it to 
 the increase of the chick ; and they at the same time, perform, 
 an action similar to that of the pulmonary vessels of the adult, 
 seeing that they carry out dark-coloured blood, and convey it 
 back to the chick, of a bright vermilion colour. Now, I do 
 not conceive, that this change upon the blood is performed by 
 the communication with the atmosphere through the shell, for 
 I see no distinction in the colour of the vessels, which are con- 
 tiguous to the membrane of the shell, and those which are re- 
 moved from it by the expanding of the air-cell. Further we 
 find, that there is an intermediate kind of generation in fishes 
 which are oviparous, but retain the egg within their womb, 
 until the foetus is matured ; here no communication with the 
 air or water can be allowed. 
 
 Since we see that the chick in ovo is capable of ministering 
 in every essential particular to its own increase, wherefore- 
 should we suppose that the foetus of viviparous aqimals has any 
 other more particular connection with the womb of the mo- 
 ther ? — The difference is, in my mind, this simply ; the ovum of 
 the oviparous animals descending through the convoluted and 
 intestinal-like womb of the hen, accumulates a quantity ol 
 matter around it, which serves every purpose of nutrition 
 when the embryo shall be finally separated from the maternal 
 system ; but in the viviparous animals the ovum descending 
 into the womb remains there, and has an incessant supply of 
 nutritious fluid, secreted from the vessels of the womb, as it 
 is required by the appetenev of the foetal system. As in the 
 egg, the membranes surrounding the white have the same 
 effect upon the blood, which is afterwards produced by the 
 lungs ; so has the placenta of viviparous animals the double 
 1 unction of supplying nourishment, and the oxigenation of 
 their blood. The umbilical vein carries back pure arterial 
 blood, and the common opinion is, that the blood of the foetus 
 coming in contact with the blood of the maternal system, re - 
 ceives the principle from it, which bestows this quantity of 
 colour, with other i^cessary qualities, of which this of colour 
 
07 THE WOMB. 
 
 171 
 
 is but the sign to our observation. It is not necessary to this 
 change on the foetal blood, that it should come in immediate 
 contact with the maternal blood, for it is possible, nay probable, 
 that the matter thrown out by the maternal vessels, whilst it is 
 nutritious, has also in it, in a condensed, and not a gaseous 
 form, that which is essential to the change of the blood of the 
 foetus from the modena colour to bright vermilion. 
 
 OF THE EXTRA UTERINE CONCEPTION. 
 
 We find some curious facts relating to the action and sym- 
 pathy amongst the parts of generation, proved by the cases of 
 extra uterine conception. When nature, balked and inter- 
 rupted in her usual course of operation, shows unusual resour- 
 ces, it would appear, that the ovum, after impregnation, has in 
 some cases remained attached to its original seat in the ovari- 
 um, perhaps owing to some want of due sympathy and synchro- 
 nous action of the Fallopian tubes, which should grasp and. 
 receive the ovum. In other instances the ovum has been re- 
 ceived into the Fallopian tubes, but either from a want of suffi- 
 cient dilatation and action in them, they have not been able to 
 propel it forward, or the ovum taking upon it that action which 
 is destined to form its connections with the uterus, adheres, and 
 is enlarged in the tube, so that it cannot be conveyed down in- 
 to the womb. 
 
 But the most curious instance of the extra uterine conception 
 is, where after impregnation the ovum has dropt from the ova- 
 rium, and lies in the cavity of the abdomen amongst the visce- 
 ra. Here also the vessels of the fleecy chorion spread, and 
 .attach themselves to the surface of the viscera. 
 
 These instances of deviation from the natural action of the 
 parts, after conception, prove to us, I think, that from the mo- 
 ment of impregnation there is a principle of life and activity in 
 the system of vessels of the ovum, and that at a stated period 
 this action becomes such, that the efflorescent vessels of the 
 surface of the ovum, attach themselves to whatever vascular 
 surface they are in contact with. Further, it seems to shew, 
 that in the womb, and in the deciduous membrane which it 
 prepares for the reception of the ovum, there is nothing very 
 particularly necessary, and that any vascular surface will take 
 upon it the same changes, and being excited probably to some 
 peculiarity of action, will in every thing essential supply the 
 growth and nourishment of the ovum and foetus. 
 
 It shows us how far the action previous and consequent tG 
 impregnation is a universal and sympathetic excitement of the 
 uterine system ; that the decidua is formed in the cavity of the 
 
172 
 
 OF THE WOMB. 
 
 womb, although the ovum does not descend. This points out 
 to us how careful nature is, that there shall be a reciprocal ac- 
 tion in the ovum and womb, so as to ensure the adhesion of the 
 ovum, and the read)’ supply of a proper nidus for it, when it 
 shall have descended into the cavity of the womb. It informs 
 us, that the uterus is a spongy and vascular bed, having pecu- 
 liar sympathies which actuate its vessels, and a form of vessels 
 adapted to quick acceleration of action so as to grow, enlarge, 
 and supply the secundines with nourishment. 
 
 It is not, however, in the mere adhesion and supply afforded 
 to the foetus, that the peculiar adaptation of the womb for the 
 reception of the lostus is shown, but in the provision for the de- 
 livery of the child at a regular and stated period. For, it is a 
 curious fact, that in the case of extra-uterine foetus, on the ex- 
 piration of the nine months, the uterus takes upon it that ac- 
 tion, and that excitement of its muscularity which is destined 
 to expel the foetus. Accordingly we find, that at the usual 
 time of utero-gestation, there are pains excited, and flooding, 
 with the discharge of the decidua from the womb, although it 
 contains no foetus. 
 
 Nay, further it would appear from the result of several cases, 
 that at the expiration of the natural term of utero-gestation, the 
 foetus indicates that it is governed by prescribed laws, which 
 render a change necessary, and show that its system is no lon- 
 ger fit to be supplied through the placentary vessels, and as in 
 the situation of extra-uterine foetus this change cannot take 
 place, it dies and becomes with its secundines, as a load of fo- 
 reign or dead matter in the belly. This event is generally fol- 
 lowed by the death of the mother, though sometimes an abscess 
 has opened and discharged the foetus, or after much suffering, 
 the bones have been discharged by stool, with much matter and 
 colliquative diarrhoea. 
 
 Of the womb at the full period of gestation and 
 
 OF DELIVERY. 
 
 To complete this view of the female parts of generation, it 
 remains only to speak of the state of the parts at the full term 
 of nine months, and to observe the process of a natural deli- 
 very. 
 
 The rapid increase of size of the pregnant womb in the 
 short space of nine months, is perhaps the most surprising 
 phenomenon of the whole animal oeconomy, it shows the pow- 
 er of a peculiar excitement, in calling into action a partial and 
 local system of vessels. This state of pregnancy is the furthest 
 from a state of distention,, in so much, that it is observed the 
 
OF THE WOMB. 
 
 173 
 
 womb feels peculiarly soft on impregnation, and as if but im- 
 perfectly filled by the ovum. This soft state is a sign of vas- 
 cular action. We may often observe in the discussion of a tu- 
 mour, that before any change takes place, it swells and becomes 
 sofc, and this even where the tumour is about to be absorbed. 
 
 The fundus of the uterus is the part first enlarged ; and af- 
 terwards the inferior parts ; at length the cervix is obliterated, 
 and the uterus, which was originally pyriform, becomes nearly 
 oval, and the distention, as we have remarked, is greatest on the 
 back part of the womb. In the first months the uterus sinks 
 lower in the pelvis, they say, from its weight, but the specific 
 weight of the uterus is not increased, and on that account it 
 should not sink deeper ; it is, perhaps, rather from its enlarge- 
 ment, and the difficultv with which the fundus makes its way 
 among the viscera in the brim of the pelvis. Having descend- 
 ed considerably, the os tincse projects further into the vagina, 
 but the fundus continuing to enlarge, at last emerges from the 
 circle of the bones, and then from the conical form of the ute- 
 rus, it sometimes rises suddenly out of the pelvis ; now the va- 
 gina will be found elongated, and the os tincse removed from 
 the point of the finger. 
 
 Now the ligaments of the womb direct it forward, and it 
 rises close upon the abdominal paries, and before the bowels ; 
 in the first pregnancy it rises almost directly up ; in subsequent 
 pregnancies from the greater relaxation of the integuments 
 and the abdominal muscles, it is allowed to fall more forward ; 
 about the fourth month of pregnancy, the womb may be felt in 
 the abdomen, and rising out of the pelvis ; in the fifth month 
 the fundus is about half-way betwixt the pubes and navel ; in 
 the seventh, it is about half-way betwixt the navel and scrobi- 
 culus chordis ; in the eighth, it is at its highest, and towards 
 the end of the ninth month, it rather subsides. Finally, im- 
 mediately before labour it descends remarkably, and shifts into 
 the middle of the pelvis, so as fairly to present the orifice of 
 the womb. 
 
 The muscularity of the uterus is increasing from the first 
 moment of pregnancy. As the uterus increases in thickness- 
 and is distended, the muscular fibres become more distinct, and 
 their power of contraction greater ; but what is very particular 
 is the very great muscular efforts made by the womb during 
 labour by these fibres, which have not till that time felt the sti- 
 mulus to action, or been allowed to contract. 
 
 When the period for the approach of labour is arrived, the 
 nature of that viscid secretion which seals up the orifice of the 
 womb is altered, it loses its viscidity, and all the parts are re- 
 laxed and prepared for the transmission of the head ; even 
 
174 
 
 OF THE WOMB. 
 
 those rigidities, strictures, or callosities of whatever kind* 
 which would seem to promise an absolute obstruction to the 
 passage of the child, yield and relax previous to labour. The 
 action of the womb is at first feeble, as might be expected, and 
 accoucheurs have marked these stages of a natural labour. 
 
 1st. The womb has suffered no diminution of its size ; the 
 membranes are entire, and, of course, the contractions of the 
 womb are feeble, because before it is allowed to make some 
 contraction its efforts are not strong. This is a provision lor 
 the first stage of labour being slow ; by and by the orifice di- 
 lating, the membranes with the waters are felt protruding. 
 The membranes and water is as a soft conical cushion, gently 
 dilating the passage ; and in this stage there should be no 
 officious interference. While the membranes are entire, both 
 the mother and child are in perfect safety. 
 
 2d. The orifice continuing to dilate, and the efforts of the 
 womb increasing, the membranes burst, and the head of the 
 child presses on the orifice ; then the womb is allowed to con- 
 tract : this contraction is a stimulus to greater efforts, and, in a 
 few pains, the head descends into the cavity of the pelvis. The 
 orifice is completely retracted, and there is no longer a mark of 
 division betwixt the womb and the vagina ; they are as one 
 canal. If, however, the membranes are burst too early, the 
 labour is not accelerated, but retarded. The orifice is notf 
 dilated by the soft and elastic membranes ; the head of the 
 child presses broad on the orifice, which becomes rigid, and 
 perhaps inflamed, its dilatation is slow, and the labour tedious. 
 Though from the form of the bones, and particularly by the 
 retiring of the sacrum, there is a provision and guard for the 
 soft parts of the mother against compression by the head ; yet 
 nature intends this stage to be short, for it is the period of 
 danger. There is now obstruction of urine and faeces, and the 
 vessels of the parts suffer compression. 
 
 3d. Now the head of the child presenting at the orifice of 
 the vagina, forms a third stage ; it is the stage of most exquisite 
 suffering : the head is pushed forward during every pain, and 
 recedes again in the absence of pain. An interval of rest pre- 
 cedes this stage, at last the pains return, and the hard head of 
 the child coming to press on the orifice, and the womb coming- 
 in close contact with the body of the child, the pains are redou- 
 bled in strength. The face of the woman, perhaps, before pale 
 and flat, becomes red and turgid, the eyes gleam, and are in- 
 flamed ; the pulse becomes quick and hard ; and from the ex- 
 quisite expectation of relief, she looks wildly round on her at- 
 tendants, losing all reason and recollection ; she is frantic, with 
 the most agonizing pain to which the human frame is subject. 
 
OF THE WOMB. 
 
 175 
 
 Now the occiput of the child begins to project with its wrinkled 
 scalp through the external parts, but nature intends that this 
 also should dilate slowly ; the ligaments and os coccygis resist 
 several throes, and direct the head forward under the pubes ; 
 at last, after several pains, it rises with a half turn, and is de- 
 livered. 
 
 4th. The fourth stage, is the delivery of the body and shoul- 
 ders ; and, 
 
 5th. The fifth stage, is the delivery of the placenta. The 
 placenta is expelled by a continuation of the same action of the 
 womb, and is part of the natural process. First a flow of the 
 liquor amnii and blood follows the child, and the woman lies for 
 a time exhausted ; the extreme pain and excitement having 
 ceased. The womb generally recovers its powers in about 
 twenty minutes, and then there is grinding pain in the belly, 
 and the placenta is detached and expelled, or is pushed down 
 into the vagina. 
 
 Thus we have sketched, in the most superficial manner, the 
 progress of a natural labour, with a view merely to explain the 
 general notion of the entire function of the womb, not with that 
 minuteness which the accoucheur would look for in treating 
 the subject. Let us, for an instant, attend to the state of the 
 umbilical chord, and the final contraction of the womb. 
 
 I have already observed, that while the membranes are un- 
 broken, the child is safe, that is to say, there is no danger of the 
 compression of the umbilical chord ; but when the membranes 
 have burst, and the waters are evacuated, the chord must suf- 
 fer a degree of compression betwixt the uterus and the child, 
 and there is danger that the chord may fall down before the 
 head, until the head has descended into the brim ; as the uterus 
 contracts, and as it were follows the child, the circulation 
 through the placenta must become somewhat difficult, and the 
 usual function corresponding with that of the adult lungs im- 
 paired. This must be much more the case when the child is 
 delivered, and the placenta remains in the contracted womb. 
 No doubt nature intends by this, that the function of the pla- 
 centa shall be gradually diminished, and not suddenly cut off, 
 that the child may feel occasion for the play of the muscles of 
 respiration, and that the function of the lungs may. by degrees, 
 take place of the function of the placenta. When the child is 
 first delivered, the chord pulsates stronglv ; when the child 
 cries, it becomes feeble ; at first, the child has strong and 
 irregular catches of the respiratory muscles, but by and by it 
 breathes more regularlv, and cries lustily. At first the breath- 
 ing only renders the pulsation of the chord feeble, but presently 
 the pulsation becomes so weak, that it is felt only near the 
 
176 
 
 OF THE WOMB. 
 
 umbilicus, and it ceases when the regular and interrupted 
 breathing is established, and the crying ceases. 
 
 The delivery of the child and placenta is followed by a'con- 
 siderable efflux of blood. But after this there continues a dis- 
 charge from the uterus, which is called the lochia. It is like 
 the exudation of blood from an extensive wound, in as much 
 as by the contraction of the vessels from which it flows, it be- 
 comes serous in a few days, and ceases gradually like a hse- 
 morrhagy. 
 
 This open discharge from the womb after delivery, is no 
 doubt a provision against the consequence which would natu- 
 rally result from the sudden and perfect obstruction, and the 
 activity of the uterine vessels consequent on delivery. By this 
 discharge the activity of the vessels is gradually relieved, and 
 as it is a discharge taking place of the active state of the womb, 
 so the secretion of the milk in the breasts, and the giving of 
 suck, causes the discharge to cease much sooner than it would 
 do if the mother were not the nurse. 
 
 OF THE M A MM/E. 
 
 In man and in children of both sexes, there is no mark of 
 the breast, but the little cutaneous papilla, or nipple. These 
 tubercles are, however, surrounded by a zone or disk, of a 
 brownish red colour, the areola. 
 
 At puberty, as we have said, the breast of the female becomes 
 protuberant, and those parts which were in miniature, and 
 without action, quickly grow into a firm glandular mass (speak- 
 ing anatomically.) The shape, rotundity and firmness of the 
 gland depends much upon the adipose membrane surrounding 
 and intersecting the glandular body. 
 
 The glandular part itself is divided into little masses, which 
 again consist of small granules. These several subdivisions of 
 the glands are closely surrounded by membranes. 
 
 The lactiferous ducts are gathered together from these les- 
 ser granules, and unite into twelve or fifteen in number of a 
 very considerable size, as they converge towards the root of the 
 nipple. When milk is secreted, the glands are large, a re- 
 markable distention of the ducts also takes place, for they are 
 then become tortuous and varicose, and serve as reservoirs of 
 the milk. Where they pass through the nipple, however, they 
 are again contracted, and open by small pores upon its surface. 
 The nipple is of a spongy and elastic nature, and suffers a dis- 
 tention or erection. When the nipple is contracted, the lactife- 
 rous ducts must be compressed, and perhaps coiled together, so 
 
OF THE WOMB. 
 
 17 ? 
 
 that the milk cannot flow, or flows with difficulty : but by the 
 sucking of the child, the nipple is distended, and the ducts 
 elongated, so that the milk flows. There open upon the areola 
 several superficial or cutaneous glands, which pour out a dis- 
 charge to defend it and the nipple from excoriation. 
 
 Of the arteries, veins, or lymphatics of the mammae, we 
 need not treat here. 
 
 We have many occasions to observe the consent and sympa- 
 thy which exist betwixt the womb and the breasts. On the 
 first period of the menses, the breasts are much distended. In 
 many women at each return of the discharge, a degree of 
 swelling and shooting pain is felt in them, and the enlargement 
 and shooting pain in the breast, with the darker colour of the 
 areola, is marked as the most prominent sign of pregnancy : 
 with the ceasing of menstruation, which is the cessation of the 
 usual excitement and action of the womb, the breasts contract 
 and are absorbed. Any unusual stimulus or irritation in the 
 womb, as polypus, or cancers, or even prolapsus and excoria- 
 tion, will affect the breasts, causing them to enlarge and be- 
 come painful. 
 
 When the function of the parts cease, they seem to feel the 
 want of the usual excitement to correct action, and are apt to 
 fall into disease ; so it is at least with the womb and mammae, 
 for at that period of life, when the system is no longer able to 
 support and give nourishment to a child, and these parts sub- 
 side from their usual action, they often become schirrous or 
 cancerous, and terminate existence by a tedious, painful, and 
 loathsome disease. 
 
 
 Vol. IV. 
 
PART THE FOURTH. 
 
 OF THE LYMPHATIC AND LACTEAL 
 SYSTEMS OF VESSELS . 
 
 CHAP. I. 
 
 OF THE LYMPHATIC AND LACTEAL SYSTEMS 
 OF VESSELS. 
 
 INTRODUCTORY VIEWS. 
 
 E have understood that the red blood circulates in the 
 body, through vessels (the arteries and veins) which have a 
 direct communication at their extremities by inosculation ; that 
 although these vessels lie parallel to each other, and extend 
 from the heart to the remotest part of the body, yet the blood 
 is said to pass through the circulation, because it is transmitted 
 from the veins into the arteries through the medium of the 
 heart ; and from the extremities of the arteries directly into 
 the veins, returning again to the centre. In this transmission 
 of the blood through continuous tubes, there is in the coats of 
 the vessels an alternation of contraction and relaxation which 
 impels it forward. But besides these arteries and veins carry- 
 ing the red blood through the body, there are other vessels 
 more remote in their connection with what is generally called 
 the circulating system of vessels. 
 
180 
 
 OF THE CAPILLARY VESSELS*. 
 
 SECTION I. 
 
 or THE CAPILLARY VESSELS. 
 
 The capillary vessels ate those extreme branches which are 
 as minute as hairs ; but this, though the literal, is not the ge- 
 neral meaning of the term. By capillary vessels is rather un- 
 derstood those branches in which the changes are wrought 
 from the blood, and which are either so minute as not to allow 
 the promiscuous flow of the blood, or possessed of such a ' 
 degree of irritability and appetency, as only to allow certain 
 parts of that fluid to be transmitted. 
 
 It is proved that in the living body there is no exudation ; 
 but no sooner is the animal dead, than the fluids exude from 
 the vessels, the secretions pass through the coats of those 
 receptacles which formerly contained them, and the whole 
 parts partake of an universal colour. From this simple fact, 
 we are led to think that a property exists in the living fibre, 
 which by contraction or some other property repels the fluids. 
 Admitting this, it is very natural to suppose that the fibres, 
 and more particularly the vessels, have a discriminating pro- 
 perty ; so that the capillary texture of each organ possesses 
 sensibility, which has its relations to the fluids passing through 
 them, or to be secreted from them. 
 
 If we admit this, we may also foresee the explanation of the 
 most puzzling phenomenon of inflammation. Inflammation 
 is the effect of excitement : there is increased action of the 
 arteries ; and by the operation of the same cause, there is a 
 destruction of the natural sensibilities of the capillary vessels, 
 so that they no longer are possessed of their distinguishing 
 sensibility, and they admit the promiscuous passage of the red 
 blood : they become dilated by the action of the arteries, and 
 visibly distended with red blood. The effect is not merely the 
 mechanical derangement of the particles of the blood. The 
 chemical changes which take place in the extreme vessels are 
 disordered, and the blood deposits upon the extreme branches 
 of the nervous system an unusual proportion of irritability ; so 
 that with the redness arising from the circulation of red blood 
 through the hitherto pellucid vessels, in parts not endowed 
 with sensibility, there is acquired an unusual sensibility, and 
 the power of transmitting the sensation to the sensorium. 
 Since we see that in an inflammatory state the pellucid veins 
 transmit red blood, and that this red blood must be supplied by 
 the serous arteries ; then it is proved that answering to the 
 pellucid arteries (in their natural state) there are pellucid veins. 
 
OF THE CAPILLARY VESSELS. 
 
 181 
 
 We should acquiesce therefore in the opinion that supposes 
 both the arteries and veins to have pellucid capillary branches 
 answering to each other, collateral to the larger and more pal- 
 pable anastomosis of their red extremities. These anastomo- 
 sing branches of the arteries and veins in which the red blood 
 is seen to circulate, perpetuate the flow of the greater part of 
 the blood back to the heart, while the several secretions are 
 performed in the capillary vessels ; but there is no reason to 
 suppose that the fluids sent from the arteries into these pellucid 
 capillary vessels are all poured out in form of secretions ; part 
 returns into the extremities of the circulating veins. The 
 secreted fluids and solids are either carried away by ducts into 
 their receptacles, or thrown out from the body : while those 
 fluids which are exuded on the cellular membrane and cavities 
 are re-absorbed by the system of absorbent lymphatics. 
 
 We say then that arteries terminate, first, in red veins ; 
 which is proved by the microscope, and by mercurial and 
 other injections : secondly, in glands ; thirdly, in cells receiv- 
 ing red blood ; fourthly, in lymphatic veins ; fifthly, in ex- 
 halents, which pour their fluids into the cellular membrane, 
 cavities, joints, &c. and which fluid is taken up by the valvular 
 lymphatic absorbents. 
 
 But these absorbent vessels, of which we are now to treat 
 under the division of lymphatics, do also perform a circula- 
 tion, in as much as they convey back to the centre of the sys- 
 tem the fluids which have been thrown out from the extremi- 
 ties of the arteries. But as these lymphatic vessels are not 
 continued from the extremities of the arteries as the red veins 
 are, as they imbibe the fluids, which have been thrown out of 
 the other system ; their fluid contents cannot be conveyed 
 through them by the force of the heart and arteries, they must 
 be peculiar in having powers within themselves, first of ab- 
 sorbing, and then of propelling their fluid onward to the heart. 
 
 This common property of absorption in the lymphatics, ab- 
 sorbents, and lacteals, and their being connected with the 
 same trunk, occasions their being considered as one system of 
 vessels ; when, in fact, looking upon the general ceconomy of 
 the living body, we find them ministering to very different 
 purposes. The one branch of the system, the lymphatics (as 
 we have seen in the introduction to this volume,) takes up the 
 matter which has been secreted, and poured out from the 
 arteries, (viz. all the solids and fluids of the body,) and con- 
 veys it again into the circulating system. The lacteal vessels, 
 on the contrary, are those vessels which opening upon the inner 
 surface of the intestines receive into them the nutritious fluids, 
 prepared by the organs of digestion, and suited to supply the 
 
182 
 
 OF THE LYMPHATIC SYSTEM. 
 
 incessant waste and destruction of the solid and fluid parts of 
 our frame, and which have been absorbed and carried away by 
 the lymphatics. Following this simple view, although the 
 absorbent system be commonly divided into the thoracic duct, 
 lymphatics, lacteals, and glandular apparatus attached to them, 
 I shall throw the present section into the divisions of the 
 lymphatics and of the lacteals. 
 
 SECTION II. 
 
 OF THE LYMPHATIC SYSTEM IN PARTICULAR. 
 
 The lymphatic vessels are tubes whose coats are perfectly 
 pellucid, having a remarkable power of contraction, which 
 causes them to shrink, and disappear, so as to render it difficult 
 to demonstrate them. Indeed they are only to be observed by 
 an eye accustomed to the making of lymphatic injections. 
 They are called lymphatics, or ductus aqjjosi, from their 
 transmitting a fluid colourless as water. When they are 
 distended with their fluids, they show that they possess a very 
 distinct character from the other circulating tubes. They are 
 irregularly distended, knotty, and sometimes like a chain of 
 beads, or little irregular vesicles connected together. This 
 irregularity is owing to their numerous valves, which are 
 semilunar membranes, like those of the veins, and hung across 
 their cavities, so as to catch and interrupt the refluent lymph. 
 They say, in general, that in the space of an inch the lympha- 
 tic vessel has three or four pairs of valves. But this bears no 
 certain proportion ; for as these vessels run where they are ex- 
 posed to occasional compression from the suri'ounding parts, 
 or bear the weight of a high column of fluid, their valves are 
 more frequent. The lymphatics are improperly called cylin- 
 drical tubes, since they are irregular from their valves branch- 
 ing and frequent communications. The coats of the lymphatic 
 vessels are the strongest of any in the body ; for although ex- 
 tremely thin and pellucid, they give resistance to distention 
 beyond a certain point, and bear a column of mercury which 
 would burst through the valves of veins, and tear the coats of 
 arteries. If there be a muscular coat, and no one ever denied 
 the muscularity of the lymphatics, then we may reckon three 
 coats : First, The inner coat, which is the continuation of the 
 inner tunic of the veins, as may be observed in the opening of 
 the thoracic duct into the left subclavian and left jugular veins. 
 It is smooth and polished, forms duplicatures or valves, and 
 
OF THE GLANDS OF THE ABSORBENT SYSTEM. 188 
 
 prevents the transudation of their fluids : it is connected by 
 cellular membrane to the middle coat. Secondly, The mus- 
 cular or middle coat, which consists chiefly of muscular fibres, 
 which, according to Sheldon, run in every possible direction, 
 though the greater number take the circular direction. And, 
 lastly, the outer coat, which is connected with the general in- 
 vesting cellular membrane. As the inner coat must chiefly 
 form the valves, and as valves possess so wonderful a power of 
 resisting the column of mercury, I should hold that the inner 
 ■coat is that on which the strength and resistance to distention 
 of the lymphatics depends, though it has been said that it is to 
 the outer coat that they owe this property. The muscularity 
 of these vessels is rather inferred than proved : it is inferred 
 from the unassisted action which they have to perform in 
 pressing the absorbed fluids onward to the heart. Neverthe- 
 less we sometimes see the ly mphatics of the lower extremities 
 of a colour so red and fleshy, that we may say their muscu- 
 larity is demonstrable. 
 
 The lymphatics seem to possess little elasticity ; when they 
 are blown into, they rise with the slightest force, and remain 
 distended, although the passage of the air forward be uninter- 
 rupted : whereas, had they considerable elasticity', they would 
 contract and disappear. Indeed, when empty", in the dead 
 body they may be rather said to be collapsed than contracted. 
 Although the lymphatics can be distended with the slightest 
 inflations, yet when distended, as we have already observed, 
 they firmly resist further dilatation. This is a quality neces- 
 sary to their valvular structure, lor if thev were elastic beyond 
 this degree of dilatation, the caliber of the vessel would be oc- 
 casionally so enlarged as to render the valves incapable of 
 meeting, and of preventing the retrograde movement of the 
 fluids. 
 
 SECTION III. 
 
 OF THE GLANDS OF THE ABSORBENT SYSTEM. 
 
 Every where throughout the body and viscera betwixt the 
 extreme branches of the absorbent system and the trunk, glan- 
 dular bodies are interposed. Though of various forms they 
 are generally of an oval shape, and they vary in size from 
 the twentieth part of an inch to a full inch in diameter. 
 Sometimes they are segregated,' — sometimes accumulated and 
 
184 OF THE GLANDS OF THE ABSORBENT SYSTEM. 
 
 clustered together. The colour of those bodies is various in 
 the several parts of the body : in young animals they are red- 
 der, and become pale only with age. They are redder and 
 stronger in the outer parts of the body, as in the thigh, axilla, 
 &c. less so within the abdomen and thorax. 2. The latter 
 will not bear so high a column of mercury as the former. The 
 mesenteric glands are said totally to disappear in old age.* 
 
 It would appear that the glands of this system are of more 
 importance to young animals than to adults. In the icetus 
 and in children the lacteal and lymphatic glands are exceeding- 
 ly numerous ; but they shrink or disappear with old age. In 
 the foetus, indeed, they can be of no very essential use ; they 
 are then rather in a state of preparation for the actions neces- 
 sary in infancy and youth. It is then also that they are most 
 liable to disease, and seem more irritable and ready to inflame, 
 especially in superficial situations. About the age of fourteen 
 or fifteen this disposition is changed, which is commonly said 
 to proceed from the increased vigour of the constitution, and 
 the change which then takes place on the organs of generation. 
 It is rather to be attributed, however, to the diminution of 
 irritability and activity of their vessels in verging to the adult 
 state, which is marked by their comparatively less size, and 
 smaller degree of vascularity. We may further observe that 
 the lymphatic glands, even in the scrophulous diseases, are 
 seldom primarily affected : that they partake of diseased ac- 
 tion from the surface, or from an affection of the intestines, 
 or from the absorption of matter. The structure of these 
 glands has not been satisfactorily investigated ; or the inqui- 
 ry is attended with insurmountable difficulties. Some anato- 
 mists have said, that they consisted of the convoluted absor- 
 bent vessels ; others that they are of a cellular structure. 
 When they affirm that these cells are totally distinct from the 
 lymphatic vessels, it is not so easy to understand them : for 
 cells communicating with each other, and into which the lym- 
 phatic vessels enter, are very much the same with a series of 
 convoluted, varicose, and irregularly dilated vessels. If we 
 could dissect this series of cells, as Haller did the vesicuke 
 seminales, we should have represented to us the appearance of 
 a convoluted varicose vessel. 
 
 There is a coat of cellular membrane which surrounds the 
 glands. This coat is pervaded by a peculiar fluid which has 
 given rise to some speculation. It is observed chiefly in 
 young animals, and is for the most part, though not always, 
 white and milky, and in the glands of the lungs it is of a black- 
 
 By Ruyfch, Morgagni, Haller; Sheldfln- 
 
ORIGIN OF THE LYMPHATICS, &C. 
 
 185 
 
 ish colour. This is the fluid which having globules in it, was 
 supposed by Mr. Hewson to be the first stage of the formation 
 of the red globules of the blood. It is distinct from the ab- 
 sorbed fluids, and is a secretion from the arteries. Physiolo- 
 gists have not determined the nature or use of this fluid. 
 
 At present there seems no better hypothesis to be offered 
 regarding the use of the lymphatic and lacteal glands, than that 
 they serve to check, controul, and measure the flow of the ab- 
 sorbed fluids into the mass of the blood : without them it ap- 
 pears to me probable that at one time the lymph returning from 
 the body, or at another time the chyle, might flow too rapidly, 
 and in a disproportioned quantity into the veins and heart. 
 But by the check which the glands impose upon this flow, 
 giving a remora and serving as receptacles of the absorbed 
 fluids, those fluids are poured with a more uniform and con- 
 stant flow upon the heart. 
 
 SECTION IV. 
 
 ©RIGIN OF THE LYMPHATICS, AND OF THE DOCTRINES OF 
 ABSORPTION. 
 
 The lymphatics, forming a system of absorbents, %ve might 
 say, in general, that they take up all the fluids which have been 
 thrown out upon the surfaces of the body. Thus they arise 
 from the surface of the skin ; from the surface of the cavities 
 and viscera covered by the pleura and peritoneum ; from the 
 cells of the interstitial and adipose membrane, &c. This is 
 the simple use assigned to this system of vessels : but whe- 
 ther they are the only system of absorbents ; whether they car- 
 ry away all the parts of the system, fluids and solids ; whe- 
 ther they absorb the muscles, membranes, bones, tendons, 
 See. of which the solid body consists, is a question requiring 
 severe examination. It cannot be denied that although the 
 system and doctrines of absorption be the most beautiful and 
 interesting, and apparently the simplest in the whole (econo- 
 my, yet it is founded on very few facts, while there is much 
 doctrine tacitly acknowledged, which seems in symmetry 
 with the facts and the laws of the (economy, but which is not 
 founded in absolute proof. We shall first examine the proofs 
 of the lymphatics being the vessels which absorb the fluids of 
 the cavities and surfaces of the bodv. The animal machine 
 Vol. IV. 2 A 
 
186 
 
 ORIGIN OF THE LYMPHATICS, 
 
 universally partakes of motion. A principal provision for 
 this mobility of parts, is the looseness of the cellular mem- 
 brane which every where pervades the body, and supports 
 the vessels and connects the several parts. This interstitial 
 membrane is elastic, and being cellular, to allow of motion, its 
 surface is bedewed with serous exudation. This fluid is per- 
 petually passing from the extremities or sides of the lymphatic 
 arteries or capillaries, into the cellular membrane, and upon 
 all the cavities of the body. The fluid extravasated is called 
 lymph, and some have supposed that it passes through in- 
 organized pores, an expression that is not very intelligible ; 
 but if by this is meant (as has sometimes been explained) 
 “ accidental pores” in the sides of the vessels, it is a suppo- 
 sition quite improbable and unlikely.* The pores or ves- 
 sels from which this fluid exudes are called exhalent ; and 
 their action is no doubt as completely secretion as that which 
 produces the fluids, which in our wisdom we call more per- 
 fect secretions. 
 
 That the lymphatics take up the fluids thrown out in the 
 cavities of the body, as the abdomen, thorax, pericardium, 
 &c. there is what nearly amounts to an absolute proof, in com- 
 paring the fluids of those cavities with that contained in the 
 vessels, for by the experiments of Hewson it is found that if 
 the fluid moistening the cavities be collected, it will form a 
 jelly when exposed to the air, as the coagulable lymphatic 
 does. Again, if a lymphatic vessel be tied up in a living ani- 
 mal, and then opened so as to allow the fluid to flow into a cup, 
 it will also form a jelly like the coagulable lymph. f The 
 fluid of cavities alters in animals diseased ; sometimes retain- 
 ing its coagulability, and even acquiring stronger powers ; 
 sometimes losing it altogether. But what is most essential to 
 
 * Dr Hunter fupportcd this opinion (Commentaries p. 40.) viz. “ that the 
 fluids of cavities were collected by tranfudation, and rot thrown out by exha- 
 lents an opinion which could only have arifen from not correcting the ideas 
 received in making injections in the dead body by the phenomena of the living 
 fyftem. See Heufon on the Lymphatic fyjiem, chap. viii. where the opinion of in- 
 orgsnical filtering is fuccefsfully combated. — See alfo Cruickfhanks. 
 
 f But, by difeafe, the fluid in the cavities and cellular membrane is altered. 
 In dropfv, for example, the fluid of the abdomen lofes the property of coagulating 
 on mere txpofure ; it comes to refemble more the ferum of the blood : this were 
 fufficient proof that the collection is not owing merely to the diminifhtu abforp- 
 tion, but that there is a change of action in the veflels of the peritoneum, pleura, 
 pericardium, &c. An inflammatory action of the veflels will throw out a fluid 
 more coagulable, and which, in a high degree of action, will form a film of 
 coagulable lymph or even pus on the furface. But in a flate the reverfe of inflam- 
 mation, iuch lor example as the debility following inflammation, a ferous effufion 
 will be poured out, having little tendency to coagulate. 
 
AND OF THE DOCTRINE OF ABSORPTION. 
 
 187 
 
 our present purpose, it has been observed, that whatever change 
 takes place in the fluids of the cavities, the same is found to 
 have taken place in the lymphatics. 
 
 But the student naturally asks, how is the lymph taken into 
 the lymphatic vessels ; and here it must be confessed, there is 
 too much field for conjecture. 
 
 It was thought formerly that the lymphatic arteries termi- 
 nated in small pellucid veins : these veins carrying only the 
 thinner, and refusing the red part of the blood, were called lym- 
 phatics. When the anatomist threw in his minute injection, 
 and saw the coloured fluid return bv the red veins, and the co- 
 lourless fluid return by the lymphatics,* it was held as a suffi- 
 cient proof of the accuracy of the pre-conceived notion, and 
 tallied with observations of Leewenhoeck, and the theory of 
 Boerhaave. See Introduction to Vol. III. When, however, 
 anatomists more carefully examined the state of parts, they 
 found that the lymphatics were not filled, unless the cellular 
 membrane was previously injected by the extravasation of the 
 fluid from the blood vessels. Finding that this alleged experi- 
 ment was really no proof of the anastomosis, and direct com- 
 munication betwixt the extrenfe arteries and lymphatics, they 
 conceived that it was a proof that these lymphatics took their 
 rise from the cellular interstitial texture. Then injecting with 
 mercury, they found that when the vessels burst, and the co- 
 lumn suddenly descended, and the cellular membrane was fill- 
 ed, the mercury was seen to rise in the lymphatics. Following- 
 up this, they blew air, of injected various fluids directly into 
 the cellular membrane, and injected the lymphatics. Thus by 
 an error, by an accidental effect of their injection, the minds of 
 Dr. Hunter and Monro were opened to a freer discussion of 
 the received opinions and approved authorities. Soon, howe- 
 ver, it was understood by those conversant with anatomy, that 
 these accidental injections of the lymphatics did not prove the 
 lymphatics to take their origin either lrom the cells or from the 
 extreme arteries ; but already this good effect, at least, was 
 produced, that men’s minds were excited to inquire after new 
 facts and trains of observations. It was now recollected, that 
 a strict analogy and correspondence subsisted betwixt the lym- 
 phatics and lacteals ; the proofs of the lacteals being absor- 
 bents, were re-called to memory ; new proofs of their being the 
 sole absorbents of the intestines were brought forward ; the na- 
 ture of the fluids effused into the various cavities and cells of 
 the body was attended to ; and the conviction followed, that 
 the most essential use of the lymphatic vessels was to serve as 
 
 * It was probably Nuck who firft injected the lymphatics from the arteries. 
 
188 
 
 ORIGIN OF THE LYMPHATICS, 
 
 a system of absorbents, to take up the extravasated fluids. 
 They reflected that to distend the intestines with injection 
 would never fill the lacteals ; and were convinced that the in- 
 ]ection of the lymphatics could not be supposed to be through 
 the proper absorbing mouths of these vessels opening upon tbe 
 cells ; but rather that the injection had entered the vessels by 
 the rupture of their extreme branches. Thus the theory of .he 
 lymphatics being a system of absorbents, came to rest on ana- 
 logv, and the observation of the phenomena of the living body. 
 
 The chief proof of the lymphatic absorption has been deri- 
 ved from the manner in which the venereal virus is received 
 into the system. Venereal matter being allowed to lodge upon 
 the delicate skin of the glans penis or preputium, causes an ul- 
 cer there. The matter of this ulcer is absorbed by the lym- 
 phatic of the part ; an inflamed line is sometimes to be traced 
 into the groin ; and the lymphatic gland of the groin receiving 
 this absorbed matter, inflames and forms the bubo. Here, 
 then, is a proof that the red veins do not absorb, and that lym- 
 phatics do : else why are they inflamed, and why are the lym- 
 phatic glands inflamed to suppuration ? 
 
 We must observe, however, that this is by no means an abso- 
 lute proof of absorption ; nor is there here unequivocal evi- 
 dence of venereal matter having been absorbed. Although, 
 therefore, we believe in the general system, we may hazard 
 these queries : — If this matter is absorbed, why is there no in- 
 fection without ulcer (chancre) of the glands ? If this ulcer be 
 produced by absorption, how comes it that the constitution is 
 not infected by the first absorption of the matter, and before 
 it has formed an ulcer ? Is it not probable that the; irritation of 
 the venereal matter, lodging on this vascular suriace, and with- 
 out being absorbed, causes a peculiar inflammation, the tenden- 
 cy of which is to form a pustule, and to produce matter similar 
 to that which originally infected the part with the specific and 
 peculiar action ? Again it will be said, however the venereal 
 pustule was originally produced, it appears evident that the ab- 
 sorption of this matter, the conveying of it along the lympha- 
 tic, inflames the vessel, and the next lymphatic gland into 
 which it enters, receiving the venereal matter, inflames and 
 suppurates, &c. But again, I choose to say, with every show 
 of likelihood, that neither is this a proof of absorption ; but 
 that the lymphatic vessel being very irritable, and always re- 
 ceiving its stimulus to action from its extremities, it has parta- 
 ken of the venereal inflammation ; that this inflammation has 
 been propagated to the gland ; that, the gland being formed of 
 the convoluted lymphatic vessels, the effect of this inflammato- 
 ry action is then accumulated to so great a degree as to destroy 
 
AND OF THE DOCTRINE OF ABSORPTION. 
 
 189 
 
 the function of the gland and lead to suppuration.* And fur- 
 ther, that the disease is received into the constitution only in 
 consequence of the system at large partaking of the irritation (a 
 word which but imperfectly expresses the cnange) of the local 
 action of vessels. Matter might be absorbed and taken into 
 the constitution, and the disease propagated according to the 
 common explanation ; but, according to that offered here, there 
 must be a primary and local disease, from which the general 
 affection is propagated. If we are to take the inflammation 
 and hardening of the lymphatics and axillary glands as a symp- 
 tom of absorption from a diseased mamma, we must acknow- 
 ledge the same proof in evidence of the veins absorbing : for 
 although the lymphatics are more active, and their activity de- 
 pends on the state of their origins and extreme branches, more 
 irritable, more vascular (I will venture to say,) and more liable 
 to inflammation than the veins ; yet are the veins affected in 
 a waj that would as unequivocally prove them to be absorbents, 
 for we see how they enlarge around a diseased breast, become 
 prominent and hard, and lose their softness and elasticity. 
 But, as we would not say that this is a proof of absorption by 
 the veins, neither is the proof unequivocal that there is absorp- 
 tion by the lymphatics. Again, a suppurating stump, with 
 bad inflammation, will cause inflammation of the lymphatics, 
 and suppuration in the glands ol the groin ;f a proof of ab- 
 sorption of the matter of the stump : but we do not find that 
 from such a stump the veins ascend, inflamed and suppurating, 
 while sometimes a chain of abscesses is formed for a consider- 
 able extent. This, we can have no doubt, is the effect of the 
 inflammation continued along the vessel ; and is not the in- 
 flammation produced precisely in the same way in the lym- 
 phatic ? 
 
 I found my opinion of the lymphatics being absorbents, — 
 first, on the circumstance that their structure is adapted to this 
 action ; secondly, on the analogy between them and the 
 lacteals, in which absorption is proved ; thirdly and lastly, 
 upon their continuing to receive and transmit their fluids, after 
 the heart and arteries have ceased to beat, and the red blood 
 to circulate : for then how can they act, but by their own 
 powers ? How can they receive fluids, but by absorption ? 
 Finally, this phenomenon shows in the lymphatics, a greater 
 
 * If a chancre be indolent, although matter be formed in it, no bubo will be 
 produced : but if the furgeon applies fome corrofive dreffing, which, inftead of 
 entirely deftroying the difeafed fpot, inflames it, then will the gland in the groin 
 fympathife and rife into a bubo. 
 
 t See Hunter’s Commentaries. 
 
190 
 
 OF THE ABSORPTION OF SOLIDS. 
 
 degree of irritability, and stronger principle of activity and 
 tenacity of life, than actuates any other set of vessels. 
 
 OF THE ABSORPTION OF SOLIDS. 
 
 On examining the works which within the last forty years 
 have contributed to throw light on this subject, we at once 
 acknowledge how necessary it is for that part of a systematic 
 book of anatomy, which professes to treat of absorption, to 
 take the form of a critical inquiry. When the absorption of 
 the fluids of the cellular substance, or in the cavities, was 
 universally assented to, physiologists did not make sufficient 
 distinction betwixt the absorption of the fluid thrown out of the 
 influence of the circulating vessels, and that matter which 
 continued to be involved in the membranes and vessels, and 
 which formed the solid part of our frame. It will readily be 
 allowed that the fluid thrown out upon the surfaces of the body 
 and in the cells, might be absorbed without inferring that 
 every part of the body, solids and fluids, were also taken up 
 by the lymphatic absorbent vessels. But physiologists observ- 
 ing that the solid parts of the body were suffering perpetual 
 change ; that the whole body and the vessels themselves were 
 formed, decomposed, and carried away ; they hesitated not 
 to attribute this to the deposition from the arteries, and the ab- 
 sorption by the lymphatics. This alternate destruction and 
 renovation of parts, the perpetual change which the whole 
 body suffers, has been universally acknowledged and attributed 
 in part to the operation of the lymphatic system, without any 
 other proof than a slight analogy. 
 
 The interstitial fluids, and the fluid in the cavities, is im- 
 bibed by the absorbing mouths of the lymphatics on the sur- 
 face of the membranes ; but where is the analogy between 
 this and the destruction of solid parts ? It has been said that 
 the absorbents eat down the solids, and nibble like the mouth 
 of a worm! a conjecture, the falsity of which is equal to its 
 apparent absurdity. The solids are raised by the agency of the 
 vessels on the chemical affinities of the circulating fluids. 
 They must be resolved by their decomposition, reducing them 
 again to the state of fluids ; or the secreting vessels throw out 
 fluids which dissolve them : an operation anterior to their ab- 
 sorption. From the comparative simplicity of the fluids of 
 the circulating vessels, and that in the absorbents, we are au- 
 thorized to conclude, that as from the blood the several secre- 
 tions, solids, and fluids are formed ; these fluids, before they 
 are again taken into the active system of vessels, are resolved 
 into their original simple and constituent parts. Thus we are 
 
OF THE ABSORPTION OE SOLIDS. 
 
 191 
 
 not to look for the matter of the component parts of the body 
 in the absorbing system of vessels more than in the blood, from 
 which these parts were originally formed. 
 
 Upon this subject I conceive, that the absorption of the 
 solids depends but in a limited degree on the agency of the 
 lymphatics ; and that there is a necessary change in the aggre- 
 gation of the matter previous to the absorption by the mouths 
 of the lymphatic vessels. 
 
 EXAMINATION OF SOME OPINIONS OF MR. HUNTER ON THE 
 SUBJECT OF ABSORPTION OF SOLIDS. 
 
 Mr. Hunter says that his conception of the matter is, that 
 nature leaves little to chance ; and that the whole operation of 
 absorption is performed by an action in the mouths of the ab- 
 sorbents. Physiologists have laboured, he observes, to ex- 
 plain absorption on the principle of capillary attraction, be- 
 cause it was familiar ; but as they were still under the necessity 
 of supposing action in the vessels after the matter was absorb- 
 ed, they might as well have carried this action to the mouths 
 of these vessels. 
 
 One never could have ventured to suppose the extravagant 
 conclusion to which this idea, once entertained, has led Mr. 
 Hunter. — He proceeds to consider the many kinds of solids 
 the lymphatics have to carry away, and the variety of mouths 
 in different animals, suited to the great variety of substances 
 they have to work upon, and then draws the conclusion, or 
 leaves his reader to do so ; that not only are the mouths of the 
 lymphatics calculated to absorb fluids ; not only do they carry 
 away the solids, but each vessel, according to the hardness and 
 toughness of the material upon which it has to operate, has a 
 mouth adapted for the work. Here we do not see the genius 
 of Hunter, but a poverty of imagination. 
 
 Mr. Hunter takes the merit of a new doctrine relating to 
 absorption. — He admits that oil, fat, and earth of bones had 
 always been considered as subject to absorption ; and that some 
 other parts of the bodv, liable to waste had been supposed to 
 suffer by absorption ; but that any solid part should be absorb- 
 ed, he supposes to be entirely a new doctrine. — Now, I think 
 we may venture to affirm, that not only was it known that solid 
 parts of the body were taken away during life ; but that physi- 
 ologists knew each and every part of the living body to be un- 
 dergoing a perpetual decay and renovation. Nay, we may 
 venture further to say, that Mr. Hunter did not comprehend, 
 in its full extent, the relation in which the secreting and absorb- 
 
192 
 
 OF THE ABSORPTION OF SOLIDS. 
 
 ing vessels stand to each other. He is fond of calling the ab- 
 sorbents, modellers — u modellers of the original construction 
 of the body,” — “modellers of the form of the body while 
 growing.” No doubt he understood that such terms from 
 their novelty would be acceptable to minds incapable of real 
 conviction, or of receiving or appreciating a new fact or idea. 
 Mr. Hunter could contemplate no change in the body during 
 growth, decay, or disease, where there was an alteration of 
 form or quantity of matter, without attributing it to the 
 “ modelling absorption.” — A bone cannot lie removed without 
 absorption ; nor a part which is useless to the ceconomy (as the 
 alveoli of the teeth, the ductus arteriosus, the membrana 
 pupillaris, the thymus gland) diminished in size or totally car- 
 ried away, without the absorbents being in action. This is 
 undoubtedly true ; but in regard to the manner in which it is 
 performed we cannot agree with Mr. Hunter. When it be- 
 comes necessary that some part should be removed, it is evi- 
 dent that nature, in order to effect this, must not only confer a 
 new activity on the absorbents, but must throw the part to be 
 absorbed into such a state as to yield to this operation. This 
 is the only animal power capable of producing such effects ; 
 and like all other operations of the machine, it arises from 
 stimulus or irritation, &c. Now, this appears to be the fun- 
 damental error of Mr. Hunter’s doctrine. I conceive that the 
 absorption of parts in the natural action of health or in disease, 
 is not owing to increased stimulus, but often to a diminution 
 of it. 
 
 Does it not strike us forcibly that when a gland swells, and 
 leeches and blisters are applied, and it subsides, there can be 
 no means of exciting absorption ; that when pressure is made 
 on a part, and that part is absorbed, this is a strange way of 
 stimulating? Or when we bleed, is it not odd that this should 
 give new power to the lymphatic system ? for these are the 
 means of giving a counter irritation, and of suppressing action. 
 
 Mr. Hunter has given to the lymphatics not only the grovel- 
 ling qualities of animals, as eating ; but the higher attributes 
 of intellect. They do nothing without forethought and inten- 
 tion ; when they absorb, it is because they have found the 
 parts useless in the oeconomy. He has carried this notion so 
 far, that he does not only speak of the absorption of the thy- 
 mus gland, membrana pupillaris, alveoli of the teeth, &c. 
 but of the body in fever as a consequence of its becoming use- 
 less when under disease ! — The following may perhaps appear 
 to be the more natural supposition : 
 
 In a living body we may observe the agency of the nervous, 
 vascular, and absorbing systems : and the phenomena of life 
 
OF THE ABSORPTION OF SOLIDS. 
 
 193 
 
 are not to be attributed to any one, but to the whole of these. 
 We must also observe, that life, or the mutual action of parts 
 producing the phenomena of life, is proceeding from excite- 
 ment, and as in the whole system, so in the individual parts of 
 the bod}', the healthy action depends on the influence of this 
 excitement to action. The tendency of the growth of the 
 body to peculiar forms, and the increase of parts in disease 
 are produced by it. It acts upon the vascular system in dis- 
 ease, by producing increased action and secretion ; as a mus- 
 cle, in the use of frequent and strong action, will become 
 more fleshy and vascular ; as a gland, will be excited to greater 
 action and more profuse discharge, whilst it enlarges and 
 swells up. When a part enlarges in consequence of the stimu- 
 lus to increased action, either arising from the natural law of 
 the constitution or from disease, it proceeds from the secreting 
 vessels preponderating over the absorbing vessels. There is a 
 deposition of matter which the latter are unable to take away. 
 But diminish this action of the arteries, or take away their ex- 
 citement, or cause an excitement of some neighbouring part, 
 and thereby subdue their action, relieve them of their fulness, 
 and the absorbents regain their proportioned actions, and the 
 part subsides. The parts of the body, which, in the natural 
 changes from youth to age, are absorbed and carried away, 
 are those in which there is no longer the stimulus to vigorous 
 action, and of course the lymphatics preponderate over the 
 power of the secreting vessels, and the part gradually dimin- 
 ishes, loses its apparent vascularity, loses its redness, and is at 
 last totally absorbed. And as the tooth of a child lies long hid 
 under the jaw, where it partakes of the stimulus to the action 
 of its vessels, grows and rises up, and the alveoli, partaking 
 of this natural excitement, also form around it ; so when the 
 tooth decays and falls out, the alveoli will also decay and be ab- 
 sorbed ; because the moment these vessels have ceased to par- 
 take of the increased action, their absorbents, though acting 
 with no greater powers than formerly, do yet so preponderate, 
 that a gradual wasting is the consequence. Thus we have to 
 consider not the action of the absorbents merely, but the rela- 
 tion which their action has to that of the arteries. 
 
 I should conclude that a part which has ceased to be of use 
 in the oeconomy and is absorbed, has not been carried away by 
 the stimulus applied to the modelling lymphatics ; but in con- 
 sequence of a want of the usual excitement of the parts to 
 action, and of the consequent preponderance of the action of 
 the lymphatics ; not by an increase of their action, but by a 
 greater uniformity of action, less dependent on the state of ex- 
 citement of the part. This more uniform state of action, or 
 Vol. IV. 2 B 
 
i94 
 
 OF THE ABSORPTION OF SOLIDS. 
 
 lesser degree of dependence on excitement, will not be denied 
 when we see them continuing their action after the death of 
 the animal, and alter the other phenomena of life have ceased. 
 As to the absorption of the body in general from disease, as 
 in fever, it appears to be simply the effect of the continued ab- 
 sorption, while neither the organs for digesting and assimilat- 
 ing new matter, nor the vascular system for conveying the 
 fluids, are in a state to minister to the wants of the system, 
 but suffer under an unusual irritation, which disorders then- 
 function. 
 
 As to pressure causing absorption and producing the wast- 
 ing of parts, I cannot agree with Mr. Hunter in supposing 
 that the lymphatics are here excited to action ; but should 
 rather infer that the nerves of the parts being benumbed, 
 and the action of the arteries suppressed, the lymphatics con- 
 tinue to do their office, while the arteries are prevented from 
 depositing new matter. — -For example, when we see a curva- 
 ture of the spine, from a habitual inclination of the body to 
 one side, and consequently greater pressure on the one side 
 of the bodies of the vertebra : it is natural, at first sight, to say, 
 since the one side of the vertebra is of its natural depth, and 
 the other diminished, that the side which is deep has remain- 
 ed, but the other side has been absorbed ; but, when we in- 
 quire a little deeper into the phenomenon which has taken 
 place, we recollect that the matter of bone is undergoing a per- 
 petual change, and that the matter of both sides of the verte- 
 bra is changed ; we see that the pressure may not have excit- 
 ed the vessels to greater action so as to cause absorption ; but 
 that the pressure has prevented the deposition of new matter, 
 whentheold was taken away in the natural routine of the system. 
 
 Mr. Hunter has assigned five causes of absorption, which f 
 conceive may be very naturally resolved into one. — These are, 
 1, parts being pressed ; 2, parts being irritated ; 3, parts being 
 weakened j 4, parts being rendered useless ; 5, parts becoming 
 dead : of the first we have already spoken ; the second I should 
 deny, unless when it resolves into the third ; for irritation 
 does not cause absorption, unless when it is to an extent suf- 
 ficient to destroy the natural action and weaken the part. 
 The third and fourth come under the effect of the loss of the 
 natural and accustomed stimulus to action in the arterial sys- 
 tem, which of course gives a preponderance to the absorbents : 
 of the fifth we can have nothing to add illustrative of the liv- 
 ing system. 
 
( 195 ) 
 
 CHAP. II. 
 
 OF THE COURSE OF THE LYMPHATICS. 
 
 The lymphatics, in their course and relation to the fascia and 
 muscles of the extremities, bear a great analogy to the veins j 
 for there are two sets or grand divisions, — the deep lympha- 
 tics which accompany the arteries in their branchings a- 
 mongst the muscles ; and the superficial set which accom- 
 pany the external veins. 
 
 SECTION I. 
 
 Of the foot, leg, and thigh. Even in the toes the 
 same distinction of the origins of the lymphatics may be ob- 
 served, as in the limb. For while a plexus covers the toes 
 superficially, and runs up upon the foot with the veins, deep- 
 er branches accompany the arteries on the side of the toes. 
 When we observe the course and origins of the greater and 
 lesser saphena vein, we cannot fail to understand the course 
 of the several sets or divisions of the lymphatics of the foot 
 and legs. 
 
 From the toes, dorsum, and edges of the foot, the lympha- 
 tics climb up the leg in four classes. 1. One takes a course 
 from the root of the great toe and inside of the foot, over the 
 tendons of the great toe and tibialis anticus tendon. It then 
 passes on the inside of the tendon of the tibialis anticus mus- 
 cle, and before the head of the tibia, following the principal 
 branch of the great saphena vein ; and then continues its 
 course in company with the saphena to the inside of the knee. 
 2. There is at the same time a considerable number of lym- 
 phatics, taking their origin from nearly the same place, viz. 
 the inside of the foot, and before the inner ankle ; but they 
 take a different course on the leg from the last class ; for they 
 pass behind the lower head of the tibia : they now attach them- 
 selves to some branch of the saphena vein, and join the for- 
 mer set on the inside of the knee. From this they ascend 
 
196 
 
 OF THE COURSE OF THE LYMPHATICS. 
 
 superficially above the fascia to the glands of the groin. S. 
 From the outside of the foot there ascend several lymphatics ; 
 a division of which passes before the outer ankle and across 
 the tibia to join the lymphatics, parasites of the greater saphena 
 vein, and here they sometimes form plexus and contortions ; 
 others turn in behind the outer ankle, and join the branches 
 accompanying the lesser saphena. 
 
 The lymphatics which turn round behind the outer ankle 
 pass on the outside of the tendo achillis ; and accompanying 
 the lesser saphena vein, sink into the popliteal hollow. Here 
 they unite with the lymphatics which have accompanied the 
 several arteries of the leg and foot, and particularly the pos- 
 terior tibial artery. 
 
 Popliteal glands. The glands of the ham-string cavity 
 are generally three in number, and very small. They receive 
 the lymphatics, which pass with the internal tibial artery and 
 with the lesser saphena, stnd they of course swell and become 
 inflamed in consequence of sores on the calf of the leg, outside 
 of the foot, and sole of the foot. 
 
 From the popliteal glands there ascend two large lymphatics, 
 which accompany the popliteal artery and venae comites, and 
 ascend with the latter through the adductor magnus to the fore 
 part of the thigh. They run irregularly, or form a kind of" 
 network round the great vessels. On the fore part of the thigh, 
 and still deep, they (or at least some of the principal trunks) 
 enter the lower and deep inguinal glands, or emerging, they 
 pass into the outward glands of the groin. Sometimes these 
 deep lymphatics, instead of being accumulated into larger 
 trunks, divide into many branches, and only unite in the 
 glands of the groin. 
 
 Inguinal glands. The inguinal glands are in number 
 from five to ten ; they lie involved in cellular membrane on the 
 outside of the femoral ligament. Some of them are superficial 
 and moveable under the integuments ; some involved in the 
 laminae of the fascia, descending from the abdominal muscles ; 
 some are close on the femoral artery and vein, and under the 
 fascia. Nearer to the pubes may be observed a division of 
 these glands which belong to the lymphatics of the penis, pe- 
 rineum, &c. 
 
 The greater cluster of glands on the top of the thigh be- 
 come affected from disease of the integuments on the fore 
 part and inside of the thigh and leg ; and of that part of the 
 foot where the great saphena vein commences ; nay, further, 
 the inguinal glands swell from sores of the buttocks, about the 
 anus and private parts. They will even swell from disease of 
 the testicle ; but this only by sympathy. 
 
OF THE COtfRSE OF THE LYMPHATICS* 
 
 19 7 
 
 Lymphatics of the parts of generation in both sex- 
 es. From the penis there run backwards two sets of lympha- 
 tics : superficial ones, which take a course to the groin ; and 
 deeper ones, which take a course along the arteries of the penis 
 into the pelvis, or under the arch of the pubes. The superficial 
 lymphatics are the cutaneous vessels, and take their origin from 
 the prepuce, and it is these which, either absorbing the vene- 
 real matter of chancre, or sympathizing with the venereal ac- 
 tion, form sometimes an inflamed line along the penis, and 
 cause the bubo in the groin. But as there are two sets of lym- 
 phatics, the chancre may be in a place where the deep-seated 
 vessels are the absorbents, and consequently the constitution is 
 comaminated without any bubo in the groin ; and indeed it has 
 been observed, that a venereal ulcer of the prepuce will, in ge- 
 neral, produce bubo, when an ulcer of the glands will not.* 
 When the tract of the matter is through the deep lymphatics 
 which enter the pelvis from below, th^gland through which 
 the vessels pass, is not inflamed to form a bubo ; neither do 
 the lymphatic glands within the ligament of the thigh inflame 
 to the extent or forming a bubo, either from chancre orfrom bubo 
 in the groin. This, says a celebrated anatomist, Mr. Cruick- 
 shanks, is very fortunate ; for if the external iliac glands, like 
 the inguinal glands, should suppurate, they could not be open- 
 ed by the lancet, they must be left to themselves ; they might 
 burst ; the pus might fall into the cavity of the abdomen ; 
 might produce peritoneal inflammation ; and might probably 
 destroy the patient. Now, there appears no reason to dread 
 any such catastrophe. The matter of these glands would form 
 an abscess, which, like other abscesses in the track of these ves- 
 sels, would fall down upon the thigh. The fact, however, is 
 curious ; that when the lymphatics diseased enter one set of 
 glands, there will be no bubo ; when they take a course to the 
 other, they inflame and suppurate. This I believe may be ex- 
 plained, from considering the position of the inguinal glands, 
 as being immediately under the skin : for experience shows 
 that a part near the surface will inflame and proceed to suppu- 
 ration much more readily than a part deep seated, though suf- 
 fering from the same degree of excitement. 
 
 In the external parts of woman (by Mr. Cruickshanks’s ob- 
 servation) there are also two sets of lymphatics. Those near 
 the clitoris pass up in a direction to the ring; and those from 
 the lower part of the vulva and perineum to the glands of the 
 groin. 
 
 Lymphatics and glands within the ligament of the 
 
 Croickfhanks, page 138. 
 
198 OF THE COURSE OF THE LYMPHATICS. 
 
 thigh. The vasa efferentia of the inguinal glands are in num- 
 ber from two to six. The deep lymphatics which accompany 
 the femoral vein and artery, lying under the cellular membrane, 
 pass under the ligament, and soon form a large net- work of ves- 
 sels accompanying the iliac vessels, in which they are joined by 
 the branches of lymphatics from the superficial glands ; some- 
 times the trunks accompanying the great vessels of the thigh 
 pass into a gland, immediately within the ligament ; sometimes 
 one or two of them only enter into the glands high in the loins ; 
 nay, sometimes a large vessel passes on directly to the thoracic 
 duct. 
 
 From six to eight or ten glands are seated in the tract of the 
 external iliac vessels under the name of external iliac 
 glands. And upon the inside of the brim of the pelvis, and 
 on the hypogastric vessels, the glands are called the internal 
 iliac glands. In proportion to the frequency of disease in 
 the pelvis, these external iliac glands, being in the tract of the 
 lymphatics of the private parts and rectum, See. are particular- 
 ly subject to disease. Those glands also which are called sa- 
 cral glands, as lying on the meso-rectum, and in the hollow 
 of the sacrum, have been observed to be often diseased. On 
 the psoas muscle, and on the loins it is impossible to trace the 
 vessels as single trunks ; we may observe that one net-work of 
 vessels ascends upon each psoas muscle from the thigh ; that 
 there it is joined by the lymphatics of the pelvis. These ves- 
 sels are in a manner united by those which cover the prominen- 
 cy of the sacrum, and pass under the bifurcation of the aorta. 
 The two great lumbar plexus of lymphatics continuing their 
 ascent, many of the vessels enter into the lumbar glands ; and 
 on the loins they are joined by the absorbents of the testicle. 
 By the union of the lymphatics ascending from the right and 
 left side, with several large trunks of the lacteals from the root 
 of the mesentery, the thoracic duct is formed on the third and 
 fourth vertebra of the loins. 
 
 OF THE LYMPHATICS OF THE ARM. 
 
 In the arm, as in the leg and thigh, there are two sets of 
 lymphatics : — the superficial, and deep seated. The first of 
 these accompany the cutaneous veins, the latter the deep arteries. 
 
 As in general there are two great veins on the fore-arm, the 
 basilic and cephalic veins ; but particularly as the veins which 
 gather into the basilic trunk, on the inner and lower edge of the 
 fore-arm, are the larger and more numerous class ; so it is 
 found that the course of the more numerous class of lympha- 
 tics is on the lower and inner side of the fore-arm, and that 
 
OF THE COURSE OF THE LYMPHATICS. 
 
 199 
 
 they accumulate about the basilic vein. These are derived 
 from the palm of the hand, and from the ulnar edge of the 
 hand. This set sometimes passes into glands, seated on the 
 brachial artery, near the inner condyle of the humerus. 
 
 The absorbents which accompany the cephalic vein, arise 
 from the sides of the thumb and fore finger upon the back of 
 the hand ; they run on the radial edge of the arm, with the 
 veins which ascend to form the cephalic vein. From the bend 
 of the arm these vessels take a course on the outer edge of the 
 biceps, and then get betwixt the inner edge of the deltoid, and 
 outer edge of the pectoral muscles ; they' then pass under the 
 clavicle, and descend into the axillary glands. This set of ab- 
 sorbents receive the branches from the outside of the arm in 
 their whole course. 
 
 There are absorbents arising from the back of the hand, 
 next the little finger, which following some of the branches of 
 the basilic vein (a larger branch of which is called the ulnaris 
 externa) turn round the ulnar edge of the arm, are inserted 
 into a gland, very commonly found before and a little above 
 the inner condyle of the humerus. From this gland a large 
 lymphatic passes upwards, and attaching itself to the brachial 
 artery, splits and plays around it. 
 
 The deep-seated lymphatics of the arm accompany the ar- 
 teries in the same manner as the venae comites do ; in general 
 two with each artery. They all terminate in the glands of the 
 axilla, and can require no particular description. The lym- 
 phatics, from the muscles and integuments on the back of the 
 shoulder, also turn round and enter into the glands of the 
 axilla. 
 
 The glands of the arm are small, and irregularly placed 
 in the course of the humeral artery, from the condyle to the 
 axilla. They are from three to six in number. 
 
 The glands of the axilla are large and numerous ; 
 they receive the lymphatics from the arm, breast, and 
 shoulder they lie in the deep cavity of the axilla, formed by 
 the tendons of the pectoralis major, and latissimus dorsi mus- 
 cles. They are imbedded in a loose cellular membrane, which, 
 while it surrounds and supports the vessels of the axilla in the 
 motions of the joint, gives them strength from its elasticity. 
 These glands do not all surround the axillary artery ; but a 
 lower cluster is attached to the branches of the subscapular ar- 
 tery, going forward on the side of the chest, and to the thora- 
 
 * “ They even receive abforbents from the cavity of the cheft, and I have 
 known them fwell from pleunfy, peripneumony, and pulmonary confumption.’’ 
 Gruickfhanks, 
 
200 
 
 OF THE COURSE OF THE LYMPHATICS. 
 
 cic arteries. These it is which, indurating from cancer of the 
 breast, require so frequently to be extirpated. These glands 
 of the axilla greatly enlarging close upon the artery and plexus 
 of nerves, so as to preclude the possibility of an operation ; 
 they compress the veins and benumb the arm by pressure upon 
 the nerves. When they suppurate, they cause a condensation 
 of the cellular membrane which surrounds them, and in con- 
 sequence, a compression of the axillary nerves and a shrink- 
 ing of the arm. 
 
 When a wound or puncture, such as that which the student 
 of anatomy may receive in the dissecting room, has b^en made 
 on the little or ring finger, the red lines which often appear in 
 consequence of it, have taken the course of the ulnar edge of 
 the fore-arm, and terminated in the inside of the arm, near 
 the condyle ; in some instances they have been continued even 
 into the axilla. If venereal matter is absorbed at any point of 
 the hand, near the little or ring finger, or by those fingers, the 
 gland on the inner condyle ol the humerus, or some one in the 
 course of the brachial artery, will most probably inflame and 
 form a bubo, and the surgeon will be aware of this absorption ; 
 but if the venereal matter be absorbed on the thumb or fore- 
 finger, it is possible that it may not pass into the glands until it 
 comes into the inside of the clavicle. These glands being out of 
 our sight and feeling, the patient may be infected without the 
 surgeon suspecting it.^ 
 
 LYMPHATICS OF THE HEAD AND NECK. 
 
 Of the absorbents of the brain, little is known precisely ; 
 but none can deny the probability, next to an absolute assur- 
 ance and demonstration, that the arteries, veins, and lymphatics 
 bear the same relations in the brain as in the other parts of the 
 system. Lymphatic glands are observed in the course of the 
 internal jugular vein, and even in the foramen caroticum, 
 which are understood to belong to the lymphatics of the brain. 
 The lymphatics of the head are to be observed in the course of 
 the temporal and occipital arteries, which last terminate in 
 glands, seated behind the mastoid process of the temporal 
 bone. The lymphatics of the face have been observed very 
 numerous accompanying the facial and temporal arteries. But 
 those from the internal parts of the face and nose accompany 
 the internal maxillary artery, and fall into the glands under the 
 parotid, or in the course of that artery. These glands are 
 consequently liable to disease, in consequence of absorption of 
 
 Cruickfhanks, p. 182. 
 
OF THE COURSE OF THE LYMPHATICS. 
 
 201 
 
 matter from the face, throat, and nose, and their extirpation 
 is a very hazardous operation. The lymphatics from the gums 
 and jaws also accompany the internal maxillary artery, and 
 emerge under the angle of the jaw; and some of them joining 
 the external jugular vein, pass through glands near the top of 
 the shoulder. The lymphatic vessels from the tongue and 
 parts about the os hyoides, take also the same course. The 
 glands about the face and jaws are of the greatest impor- 
 tance to the surgeon, for nothing is more common than the 
 necessity of cutting out indurated lymphatic glands. These 
 are sometimes mistaken for diseased salivary glands ; now the 
 salivary glands are rarely diseased, the lymphatic glands often . 
 And it will be a guide to the surgeon to inquire into the origi- 
 nal cause of the induration, (perhaps a suppuration in the throat, 
 nose, or jaws) and to know precisely the gland diseased, its 
 depth, and connections. 
 
 On the side of the face, there are in general several small 
 lymphatic glands on the buccinator muscle immersed in the 
 surface of the parotid gland, under the zigomatic process. 
 There are also glands to be carefully noted, which lie under 
 the tip of the parotid gland, where it extends behind the angle 
 of the jaw, and also lying under the base of the jaw-bone, 
 close to the sub-maxillary gland, and on the course of the 
 facial artery. 
 
 The glands and absorbents of the neck are very numer- 
 ous, and the latter form an intricate and beautiful plexus, 
 several branches of which are to be observed accompanying 
 the external and internal jugular veins. Some of the glands 
 lie immediately under the skin, and in the cellular membrane, 
 on the outer edge of the platisma mvoides ; many under that 
 muscle, and in the course of the external jugular vein. But 
 there are many seated deep, for the greater number accompany 
 the internal carotid artery, and internal jugular vein or then- 
 branches. 
 
 The lymphatics of the thyroid gland have been raised by 
 Mr. Cruickshanks, by plunging a lancet at random into the 
 substance of the gland, and blowing into it, or throwing quick- 
 silver into its cellular membrane. The trunks of these lym- 
 phatics join the thoracic duct on the left side ; and on the right 
 side the right trunk, just as it is about to enter into the veins. 
 
 of the trunks of the absorbent system. 
 
 The larger and proper trunk of the lymphatic system, is 
 generally called the thoracic duct, because it was first oh - 
 Vol. IV. 3 C 
 
202 
 
 OF THE COURSE OF THE LYMPHATICS. 
 
 served by Pecquet* to be a vessel which conveyed the chyle 
 through the diaphragm, and which took its course through the 
 whole length of the thorax, to throw its fluids into the veins 
 near the heart. Before his time the lacteals which were dis- 
 covered by Asellius,| were supposed to terminate in the liver. 
 The first discoverers of the thoracic duct, described it as be- 
 ginning from a pyriform bag, to which they gave the name of 
 receptaculum chyli. In dogs, fish, and the turtle, such 
 a cistern or bag may be observed ; but in the human body no- 
 thing further is to be observed than an irregular dilatation of 
 this vessel, like a varicose distention, where it receives the 
 accession of the lacteals from the root of the mesentery. The 
 origin of this great trunk, called the thoracic trunk, is the uni- 
 on of the vessels, which running by the side ot the common 
 iliac vessels, are derived from the pelvis and lower extremities. 
 Upon the third and fourth vertebra, and under the aorta this 
 trunk is frequently joined by a large trunk of the lacteals, and 
 then ascending, it receives the greater number, or the larger 
 trunks of the lacteals. On the vertebrae of the loins, the tho- 
 racic duct is by no means regular, either in its course or size 
 or shape ; often it contracts, and again irregularly dilates, as 
 it seems to emerge from under the aorta. On the uppermost 
 vertebra of the loins, the thoracic duct lies under the right 
 crus of the diaphragm, and then passing the septum with the 
 aorta, it gets on the right anterior surface of the spine, and 
 runs up betwixt the aorta and the vena azygos ; it then passes 
 under the arch of the aorta, and there it is considerably en- 
 larged, from the contracted state which it assumes in the tho- 
 rax. Sometimes it splits, and again unites on the vertebrse of 
 the back. Having passed the arch of the jiorta, it crosses to 
 the left side of the spine, and w r e look for it under the pleura 
 on the left side of the oesophagus. 
 
 The thoracic duct now emerges from the thorax, and lies 
 deep in the lower part of the neck, behind the lower thyroid 
 artery, and on the longus colli muscle. 
 
 It gets above the level of the subclavian vein of the left 
 side, and here it receives the absorbents of the head and neck 
 (of the left side,) and descends again with a curve, and ter- 
 minates in the angle of the union of the subclavian vein and 
 jugular vein of the left side. 
 
 Sometimes there are two thoracic ducts ; but this is very rare. 
 Sometimes the duct splits near its termination, and the tw r o 
 
 * In the year 1651. 
 
 f In the year 1622 . — About the year 1652, the other branches of the fyf- 
 tem, which take their courfe to every part of the body, were difcovered by 
 Rudbeck, Jolyffe, and Thorn. Bartholin. 
 
OF THE COURSE OF THE LYMPHATICS. 
 
 203 
 
 branches enter the veins separately ; but, in general, when it 
 splits in this manner, it again unites before it terminates in the 
 vein. 
 
 There is constantlv a trunk in the anterior mediastinum un- 
 der the sternum, as large as the thoracic duct itself, which is 
 sometimes inserted into the termination of the thoracic duct ; 
 sometimes into the trunk of the absorbents of the left side, to be 
 immediately described.* 
 
 THE TRUNK OF THE ABSORBENTS OF THE RIGHT SIDE. 
 
 The absorbents, from the right side of the head and neck, 
 and from the right arm, do not run across the neck, to unite 
 with the great trunk of the system ; they have an equal oppor- 
 tunity of dropping their contents into the angle betwixt the 
 right subclavian and jugular vein. These vessels then unit- 
 ing, form a trunk which is little more than an inch, nay, some- 
 times not a quarter of an inch in length, but which has nearly 
 as great a diameter as the proper trunk of the left side. 
 
 This vessel lies upon the right subclavian vein, and receives 
 a very considerable number of lymphatic vessels : not only 
 does it receive the lymphatics, from the right side of the head, 
 thyroid gland, neck, &c. and the lymphatics of the arm ; but 
 it receives also those from the right side of the thorax and dia- 
 phragm, from the lungs of this side, and from the parts sup- 
 plied by the mammary artery. Both in this and in the great 
 trunk there are many valves. 
 
 OF THE LACTEALS AND LYMPHATICS OF THE INTESTINAL 
 
 CANAL. 
 
 We have already remarked the great length of the intestinal 
 canal, the effect of the imperfect valvular structure, in extend- 
 ing the inner coat to a great length : we have remarked also, 
 that while every surface of the body secretes, it is at the same 
 time an absorbing surface ; and finally, that while we chiefly 
 contemplate the intestinal canal, as imbibing and receiving 
 the nourishment, we must not forget that it is also a secreting 
 surface of the first importance to the (Economy. But at pre- 
 sent we have merely to understand that structure and organi- 
 zation, by w'hich this canal absorbs the nutritious fluid, the 
 chyle, from the food. 
 
 In the first place, as to the terms lacteals and lymphatics, we 
 presume that the absorbents throughout the whole length of 
 
 v Cruickthank*. 
 
204 
 
 OF THE COURSE OF THE LYMPHATICS. 
 
 the canal have the same structure and use ; and that the terns 
 lacteals has been suggested merely by the colour of the fluid, 
 which is absorbed from the small intestines. At one time these 
 lacteals convey a milky fluid : at another a transparent fluid, 
 like that which the stomach and great intestines in general ab- 
 sorb. 
 
 The lacteals, as it is natural to suppose, were the first disco- 
 vered of any part of the system of absorbents ; or, at least, 
 they were first understood to form a part of an absorbing sys- 
 tem. For although Eustachius, a Roman anatomist, disco- 
 vered the thoracic duct in the year 1563, yet he had very im- 
 perfect notions of its importance, and the discovery was very 
 little attended to, till after the discovery of the lacteals by Asel- 
 lius in 1622. This anatomist, in opening living animals, to ob- 
 serve the motion of the diaphragm, observed white filaments 
 on the mesentery, which he took at first for nerves ; but, on 
 puncturing them, and observing them to discharge their con- 
 tents and to collapse, he proclaimed his discovery of a new set 
 of vessels — a fourth kind.* 
 
 Had Aseilius only chanced to observe these vessels, his me- 
 rit would have been inconsiderable ; but he also investigated 
 and announced their peculiar offlce, viz. of absorbing the chyle 
 from the intestinal canal, and carrying it into the blood. 
 
 For some time, however, after the discovery of the vasa 
 lactea, the opinion of Hippocrates and Galen, viz. that the 
 mesenteric veins absorbed the chyle from the intestines, and 
 conveyed it to the liver, still prevailed. Even after the disco- 
 very of the lacteals was known and received, a part of the old 
 system was still retained, and it was supposed that those vessels 
 carried the fluids absorbed from the intestines into the liver ; 
 and that the fluids were there converted into blood. 
 
 About twenty years after the discovery of Aseilius, Rud- 
 beck, a Swede, and Bartholin, a Danish anatomist, saw Asel- 
 lius’s vessels in many other parts of the body ; discovered the 
 trunk of the system, and showed that the lacteals did not pass 
 to the liver, but that they were branches of a great and distinct 
 system ; they also demonstrated the unity of this system. 
 
 We have seen from this sketch that the ancients supposed 
 the veins of the intestines to be absorbents ; and even after the 
 discovery of the lacteals, this idea has been retained by some 
 of the best modern anatomists, and principally by Haller, and 
 professor Mickel, of Berlin. If the veins absorb from the 
 surface of the intestines, their doctrine would imply that they 
 are also absorbents in general throughout the body. Although 
 
 * The nerves being counted as vefiels, 
 
OF THE COURSE OF THE LYMPHATICS. 
 
 20o 
 
 Bartholin, in his epistle to Harvey, had asserted and given suf- 
 ficient proof that the mesenteric veins were not absorbents, yet 
 the controversy was left in so undecided a state, as to give oc- 
 casion to the series of experiments in the school of the Hun- 
 ters, which seems to have put the question to rest, in as far as 
 it is connected with the lymphatic s\ stem.* 
 
 We have already mentioned that Asellius was employed in 
 opening the belly of a living dog, when he fit st discovered che 
 lacteals. He perceived upon the surface of the intestines and 
 mesentery a great many small threads, which at first sight, he 
 took for nerves, but soon discovered his error ; and to dissipate 
 his doubt, opened one of the largest white chords, when no 
 sooner had the incision been made, than he saw a fluid like 
 milk or cream issue from the vessels. Asellius says he could 
 not contain his joy at the sight of this phenomenon ; and turn- 
 ing himself to Alexander Tadinus, and the senator Septalius, 
 who were present, he invited them to enjoy the spectacle ; but 
 his pleasure, he adds, was of short duration, for the dog died, 
 and the vessels disappeared. The natural and simple narra- 
 tion ol Asellius represents his astonishment, and gives an idea 
 of the sensation, which the anatomist experiences in the instant 
 of making an interesting discoverv.f 
 
 Origin of the lactkals. When the young anatomical 
 student ties the mesenteric vessels of an animal recently killed, 
 and finds the lacteals gradually swell ; when he finds them tur- 
 gid, if the animal has had a full meal, and if he has allowed 
 time for the chyle to descend into the small intestines — and 
 empty, or containing only a limpid fluid if the animal has 
 wanted food ; he has sufficient proof that these are the vessels 
 destined to absorb the nutritious fluids from the intestines. 
 Again, when coloured fluids are thrown into the intestines of a 
 living animal, and they are absorbed, he has sufficient proof of 
 their free and ready communication with the inner surface of 
 the gut ; but the actual demonstration of the absorbing mouths 
 ol the lacteal vessels is difficult and precarious. The difficul- 
 ty arises from these vessels being in general empty in the dead 
 body ; from the impossibility of injecting them from trunk to 
 branch in consequence of their valves ; and, lastly, from their 
 orifices never being patent, except in a state of excitement. 
 The anatomist must therefore watch his opportunity when a 
 man has been suddenly cut off in health, and after a full meal. 
 Then the villi of the inner coat may be seen turgid with chyle, 
 and their structure may be examined. Perhaps the first obser- 
 
 See the veins in this Volume, 
 f Sheldon, Portal. 
 
206 
 
 OP THE COURSE OF THE LYMPHATICS. 
 
 vations which were made upon this subject by Lieberkuhn, are 
 still the best and the most accurate. 
 
 The villi are apparently of a cellular structure, for although 
 they are flat or conical, or like filaments when collapsed ; yet 
 when minutely injected, and especially when they are full of 
 chyle, they take a globular form, and are called the ampullu- 
 Li£. Their distention, in consequence of a minute injection of 
 the veins or arteries, is probably owing to a cellular structure 
 (which they seem to have) into which the injection has extra- 
 vasated. The most probable account of the structure of these 
 ampullulse is that this cellular structure is a provision for their 
 inflation and erection by the blood, when excited by the pre- 
 sence of the chyle in the intestines ; that this erection gives 
 rigidity to the orifice of the lacteals ; and that the first step of 
 absorption is by capillary attraction, while the further propul- 
 sion of the fluid in the extreme absorbents is by the contraction 
 of their coats excited by the presence of the fluid. Thus the 
 absorption is not by an inorganized pore, but depending on 
 excitement and action. 
 
 Liebei kuhn’s observations of the villi are the most accurate 
 and curious. He observes, that having opened and washed a 
 portion oi the small intestine, its whole surface will be found 
 covered with little pendulant conical membranes of the fifth 
 part of a line in size, and the bases of which almost touch 
 each other. From the vascular membrane, to which they are 
 attached, he observes there is given off to each villus a branch 
 of a lacteal, an artery, a vein, and a nerve. He found it dif- 
 ficult by injection to show both the vein and artery, the fluid 
 passed so easily from the one into the other. He found that 
 the extreme branch of the lacteal was distended into a little 
 vessel within the villus. And on the apex of which, with the 
 microscope, he saw one or sometimes several openings ; with 
 his glasses he observed the arteries to ramify on the globules or 
 ampullulse and again collect into veins ; and he supposed that 
 still more minute branches plunged into the centre. But he 
 made a still more minute observation than this. Insulating a 
 piece of intestine betwixt two rings, only leaving a space for 
 the entrance of the ramification of the artery which supplied it, 
 he injected with a column, and examined its progress at the 
 same time with his microscope. As he raised the tube, he saw 
 the artery going in serpentine turns to the villus, and the injec- 
 tion returning by the veins ; at last it passed into the ampulla 
 lactea, distended it and made its exit by the foramina. He 
 prepared the villi in another way : — he inflated the ampullae, 
 and kept them so until they dried ; then he cut them with a 
 razor, and found them cellular. This cellular structure 
 
OF THE COURSE OF THE LYMPHATICS. 
 
 20 7 
 
 Cruickshanks thinks is the common cellular substance, uniting 
 the vessels of the villus. When this gentleman examined the 
 villi of a patient who died suddenly after a meal, he observed 
 some of them to be turgid with chyle, so that nothing of the 
 ramifications of the arteries or veins were to be observed ; the 
 whole appeared as one white vessel without any red lines, 
 pores, or orifices ; others of the villi contained chyle in a less 
 proportion ; and here the ramifications of the veins were 
 numerous, and prevailed by their redness over the whiteness of 
 the villi. 
 
 In some hundred villi he saw the trunk of a lacteal forming 
 by radiated branches, one branch in each villus. Mr. Cruick- 
 shanks and Dr. Hunter counted fifteen or twenty orifices in 
 some of the villi. 
 
 Mr. Cruickshanks has remarked a deep and a superficial set 
 of lacteals on the intestines ; but for this division there seems 
 no necessity. Deep in the coats the lacteals seem to accompany 7 
 the blood-vessels ; but when they get more superficial, they r 
 take a course longitudinally on the canal, and turn deviously, 
 or after running a little way, take a sudden turn towards the 
 mesentery. 
 
 As the greater frequency of the valvulae conniventes in the 
 jejunum, greatly increase the extent of its inner surface of the 
 gut, and consequently give a greater extent of origin to the 
 lacteals ; and, as here the chyle must be in the greater quanti- 
 ty, so the lacteals of this portion of the gut are larger and 
 more numerous than in any other part of the extent of the 
 can; 
 
 x ie lacteals do not attach themselves to the vessels of the 
 mesentery, but take a course individuallv, or forming plexus. 
 Before they enter the mesenteric glands, they have been called 
 lacteals of the first order ; when they emerge from the first into 
 the second glands, secondary lacteals, and glands of the 
 second order. The manner of the entering and going out of 
 glands is exactly 7 the same with that of the lvmphatics. The 
 lacteals (or perhaps we should now say the absorbents merely 7 ) 
 of the great intestines, are smaller and less numerous than 
 those of the small intestines ; for although the intestines be 
 large, still their inner surface is by no means so extensive ; 
 besides the chyle is absorbed, and the contents altered before 
 they have descended into the great intestines. Both Winslow 
 and Haller, however, assert, that they have seen chyle in the 
 absorbents of the great intestines. We know that the lacteals 
 absorb chyle, when it is presented to them : while at other 
 times they absorb different fluids. That the absorbents of the 
 great intestines imbibe the fluid contents is evident, from the 
 
208 OF THE COURSE OF THE LYMPHATICS. 
 
 change produced on the faeces in their passage. Copious and 
 nutritious injections have been given, which did not return in 
 . the same liquid form, and which have supported the strength 
 for some time. Clysters of turpentine give the urine a smell 
 of violets ; and the Peruvian bark has cured fever, when giv- 
 en by the rectum. 
 
 The absorbents of the stomach form three divisions : one 
 set accompany the coronary artery and vein, and enter the 
 glands on the lesser curvature and omentum minus. Those 
 of the second set accompany the left gastro-epiploic artery, and 
 are joined by the lymphatics of the omentum. The third pass 
 down upon the upper part of the duodenum following the ar- 
 teria gastrica dextra : these descend to pass into the same class 
 of glands, which receive the lymphatics of the liver. They 
 are joined in their course by the lymphatics of the right side 
 of the omentum. 
 
 The lacteals on the mesentery pass from one gland to another 
 till they form one or two large trunks only. These accompa- 
 ny the trunk of the superior mesenteric artery, and run down 
 on the right side of the aorta, and join the thoracic duct. The 
 absorbents, from the rectum and colon of the left side, pass in- 
 to their glands, or sometimes into the lumbar glands, and join 
 the thoracic duct separately ; those from the right side of the 
 colon join or mingle with the lacteals in the root of the me- 
 sentery. 
 
 OF THE REMAINING ABSORBENTS OF THE SOLID VISCERA. 
 
 Where the lymphatics of the lower extremity descend over 
 the brim of the pelvis, they are joined by the absorbents of 
 the bladder, vesicula; seminales, and other parts in the pelvis : 
 small glands belonging to this set are attached to the internal 
 iliac vessels. In the female, the lower set of lymphatics, 
 from the womb and vagina, also come by this route to join 
 those of the lower extremity, or run mingling with them. 
 Another set of lymphatics of the womb pass up with the sper- 
 matic vessels. 
 
 The lymphatics of the testicle are very numerous. They 
 come in distinct sets from the body of the testicle, from the 
 epididimis, and from the tunica vaginalis : then reaching the 
 chord, form six or ten trunks, and run up direct to the abdo- 
 minal ring ; passing the ring, they turn outward, and then 
 pass over the psoas muscle and into the lumbar glands. 
 
 The lymphatics of the kidney are in two sets, superficial 
 and deep seated ; but the former are seldom to be observed. 
 Sometimes disease makes them distinct. The internal lym- 
 
OF THE COURSE OF THE LYMPHATICS. 
 
 209 
 
 jfnatics are demonstrated by blowing into the veins, or tying 
 a ligature and kneading the substance of the kidney with the 
 fingers ; when they rise, they are seen attached to the emulgent 
 vessels, and go to join the lumbar glands, or terminate in 
 large lymphatics near the aorta. 
 
 It is needless to repeat that the absorbents of the spleen are 
 deep and superficial, — for this arrangement is general. Emerg- 
 ing from the spleen, the lymphatics pass along the splenic 
 vessels, and enter into glands attached to the splenic artery in 
 its whole course. In this course they receive the absorbents 
 from the pancreas, and near the head of the pancreas, they are 
 blended with those of the liver, and with them join the thora- 
 cic duct. 
 
 The lymphatics of the liver are the most easily detected, 
 and may be injected, to greater minuteness, than in any other 
 part of the body. Although they have many valves, yet they 
 do not seem to close the vessels entirely, nor interrupt the mer- 
 cury from passing from trunk to branch. The superficial 
 lymphatics, which are so numerous that we may sometimes 
 see the mercury in them covering completely a considerable 
 space, have free communication with the internal set of vessels 
 which are also numerous and large. The principal route of 
 the lymphatics of the upper surface of the liver, is by the broad 
 ligament : these perforating the diaphragm join the trunk, 
 which we have noticed under the sternum, and in the anterior 
 mediastinum. It would appear, however, that these lympha- 
 tics of the broad or suspensory ligament, are by no means con- 
 stant and uniform in their course ; for sometimes they run 
 down towards the lacteal ligament, and perforate it there ; some- 
 times they pass down into the thoracic duct while still in the 
 belly. Other lymphatics of great size, run off from the con- 
 vex surface of the liver upon the lateral ligaments, and pierce 
 the diaphragm. The lymphatics on the lower or concave sur- 
 face of the liver are more irregular than those of the convex 
 side. They unite with the deep lymphatics coming out of the 
 porta along with the vena portae, enter into the glands, which 
 are seated on the trunk of that vessel, and join the thoracic 
 duct near the root of the superior mesenteric artery. 
 
 The lymphatics of the lungs are nearly as numerous as 
 those of the liver ; but, indeed, in regard to this expression, it 
 is more in relation to the facility of injecting and demonstrat- 
 ing the lymphatics, than to their comparative number. For ex- 
 ample, if the lymphatics of the other viscera could be injected 
 to as great minuteness as those of the liver, we should cease 
 to consider that viscus as more abundantly supplied than other 
 parts. The superficial lvmphatics of the lungs form areoite, 
 VOL. IV. 2 D 
 
210 
 
 OF THE COURSE OF THE LYMPHATICS. 
 
 and cover the surface almost completely. They take a course 
 to the root of the lungs, where they are joined by the deep seat- 
 ed vessels, and together pass into the bronchial glands, and 
 here the lymphatics of both sides freely communicate. 
 
 The glands of the lungs are constantly found both before 
 and behind the bifurcation of the trachea : often these glands 
 are of a very dark colour ; nay, their substance is sometimes 
 found resolved as it were into a sac of inky-like fluid. Upon 
 the arch of the aorta, and the root of its great branches, are 
 the cardiac glands, which receive the lymphatics from the 
 heart. The absorbents of the heart are small, but very nu- 
 merous, and their larger branches attach themselves to the 
 coronary vessels. They then pass to the cardiac glands, and 
 mingling with those from the lungs, join the thoracic duct. 
 
APPENDIX ; 
 
 CONTAINING THE 
 
 DESCRIPTION OF THE VENOUS SYSTEM AND 
 THE ANATOMY OF THE TEETH. 
 
 CHAP. I. 
 
 OF THE VEINS IN GENERAL. 
 
 I HE veins are those vessels by which the blood carried out- 
 ward by the arteries, is returned to the heart. The system of 
 the veins however is not so simple as that of the arteries, for 
 while there are only two great arteries carrying the blood from 
 the heart, viz. the aorta and the pulmonic artery, there are 
 three great trunks of the veins, viz. the superior and inferior 
 vena cava, the trunks of the great veins of the body ; the pul- 
 monic vein, which returns the blood to the heart from the cir- 
 culation through the lungs ; and the vena portae, which col- 
 lects the blood of the intestines, and conveys it to the liver. 
 There are besides, a greater variety in the distribution, of the 
 veins, than in that of the arteries. 
 
 The French physiologists have departed from the old method 
 of Harvey, in explaining the circulation. He wisely took the 
 heart as the centre of the system, and described the vessels 
 going out from it, forming the two circulations, viz. through 
 • the body and through the lungs ; but they have assumed the 
 lungs as the centre ; and the veins of the body, and the arte- 
 ries of the lungs, they call systeme a sang noir, because it con- 
 tains the dark coloured blood ; and the pulmonic veins and the 
 arterial system of the body, they call systeme a sang rouge , 
 because it conveys blood of the bright vermilion colour. 
 
 This conceit is perhaps admissible, when introduced as an 
 
212 
 
 APPENDIX. 
 
 illustration of the relation of the lungs to the body ; but in the 
 general announcing of the system, and considered as a basis 
 oi demonstration, it gives to a difficult subject an unusual de- 
 gree of intricacy in the mind of the young student : besides, 
 the arteries and veins of the body, and the pulmonic artery 
 and vein, have that strict and mutual dependence in action, 
 •which shows how improper and how unnatural it is to make 
 this change, and to separate them in explaining the general 
 system. At all events, let those who adopt this novelty cease 
 to speak of the two circulations, for although in regard to the 
 heart, there are two circulations, yet as the movement of the 
 blood respects the lungs, there is only one. By this division, 
 the blood returning from the body and carried into the lungs, 
 cannot be called a circulation ; but only when it has passed 
 through the lungs, and returned to the same point of its course 
 through the body. 
 
 GENERAL CHARACTER OF THE VEINS. The Capacity of 
 
 the veins, is larger than that of the arteries ; the coats thinner 
 but stronger comparatively, and admitting of much dilatation. 
 The coats cf the lesser veins, are comparatively stronger than 
 those of the larger ones, and the veins of the lower extremity 
 much thicker and stronger, than in the upper parts of the body, 
 as they bear a higher column of blood. The veins are 
 transparent and the blood is seen through their coats. There 
 can be properly distinguished, only two coats in the veins ; 
 the outer coat, which is flocculent and cellular without, to con- 
 nect with the surrounding parts, smoother and more compact 
 •within, where it is united with the inner coat. In it are rami- 
 fied the vasa vasorum ; and a fibrous structure is to be observed 
 in some of the larger and superficial trunks ; the striae or fibres 
 running longitudinally. The inner coat is firm and compact 
 and intimately united to the other ; it is smooth, flexible, and 
 formed into valves in various parts. 
 
 In all the larger veins, excepting those of the viscera of the 
 abdomen, and those of the lungs and brain, there are valves : 
 these valves consist of the inner coat, forming folds like a 
 semilunar curtain, hung across the caliber of the vein ; but at 
 the same time attached so obliquely to the side of the vein, 
 that they present, a sacculated membrane to receive the refluent 
 blood. The loose margin of the valve is somewhat stronger 
 than the other part, and betwixt the duplicature some splendid 
 little filaments are sometimes observed. Each valve consists 
 in general, of two semilunar membranes, the margins of 
 which, falling together, prevent the blood from passing retro- 
 grade ; but they yield and collapse to the side of the vein by 
 the current of blood flowing towards the heart. As the veins 
 
APPENDIX* 
 
 213 
 
 are provided with valves only where they are exposed to occa- 
 sional pressure, and particularly to the compression of the 
 muscles ; their chief use would seem to be, to prevent the re- 
 trograde movement of the blood, from the occasional compres- 
 sion of the veins ; but no doubt, they at the same time support 
 the column of blood, as in the lower extremities : and when 
 those veins suffer distention by disease, a great aggravation is, 
 that the valves lose their action, become too small to close the 
 dilated vein, and the whole column of blood presses upon the 
 veins of the legs. 
 
 The commencement of the minute branches of the veins, is 
 from the extreme ramifications of the arteries ; they are con- 
 tinuous, and perpetuate the motion of the blood in that course 
 which is called the circulation. In contemplating the capillary 
 tissue of vessels, the most striking circumstance is, the pre- 
 dominance of the dark venous ramifications : and in general, 
 two sets of veins will even in these minute ramifications, be ob- 
 served ; one superficial, the other more intimately blended 
 with these minute ramifications of the arteries ; but in the in- 
 ternal parts of the body, and particularly the viscera, the veins 
 uniformly accompany the ramifications of the arteries, and in 
 the solid viscera, a dense cellular membrane gives promiscuous 
 lodgement to both sets of vessels. 
 
 In the extremities and head, indeed every where but in the 
 viscera, the veins form two distinct sets ; the deep and the 
 superficial veins : the deep veins accompanying the arteries ; 
 and the subcutaneous veins, which emerge from the compres- 
 sion ol the muscles, and run above the fascia. The union be- 
 twixt the branches of the veins, is very frequent, not only be- 
 twixt the veins, ramifying in the same plane in so much as to 
 make them a mere network ; but also betwixt the deep and the 
 superficial set of veins : such are the venae emissarise of the 
 scull ; the free communications betwixt the external and inter- 
 nal jugular vein, betwixt the deep and superficial veins of the 
 arm, &c. When in bleeding, the blood flows from the vein of 
 the arm, accelerated by the working of the muscles, the blood 
 escapes by the anastomosis, from the compression of the 
 muscles, and fills the superficial veins ; but the increase of the 
 jet of blood, is more the effect of the swelling of the muscles, 
 causing the fascia to compress the veins of the fore-arm. 
 
 In the dead body the veins are flat, but when distended, they 
 resume the cylindrical figure which they possessed in the living 
 body : yet they are in general of the cylindrical figure, for a 
 very little way only, owing to the irregular dilatations by the 
 side of the valves, or by the frequent union of their branches. 
 The manner in which the branches join the trunk, has a peculi- 
 
214 
 
 APPENDIX. 
 
 arity which always distinguishes it from the ramifications of 
 arteries ; the arteries branch off at a direct and acute angle, the 
 veins in a direction more removed from the course of the trunk, 
 and in general with a curve or shoulder. 
 
 In infancy and youth, the veins are little turgid, and especi- 
 ally the cutaneous veins, are so firmly embraced by the elastic 
 skin and cellular membrane, that they have a less degree of pro- 
 minency than in more advanced years. In old age, the veins 
 are enlarged, and rise turgid on the surface, and the internal 
 veins also become enlarged and varicose. I do not consider 
 this change in the vascular system, as the effect of mere disten- 
 tion, or of the enlargement of the veins from the long-conti- 
 nued action of the arteries ; but as a necessary change in the 
 proportionate distribution of the blood, which is preceded or 
 accompanied with other peculiarities, the character of old age. 
 When we consider the great proportion of the veins in size, 
 over the arteries, we must conclude that the blood flows but 
 slowly in the venous system : that from the narrowness of the 
 trunks of the veins near the heart, the blood must be accelera- 
 ted, as it approaches the heart, and that receiving the impulse 
 from the ventricle, it must take a rapid course through the ar- 
 teries, until again approaching the extreme branches of the ar- 
 teries and passing into the veins, its motion becomes more lan- 
 guid and slow. In youth, as the size of the veins is not in so 
 great a proportion to the arteries, as in advanced life, the blood 
 in a young person, must be in more rapid and quick circula- 
 tion ; but in old age, in proportion to the largeness of the veins 
 and the accumulation of blood in them, the quantity of blood 
 moving slowly through the venous system, and almost stagnant 
 in the dilated veins and sinuses, is very great ; it moves but 
 slowly and progressively on towards the centre of the circula- 
 tion ; and upon the whole, the blood in old people, moves less 
 briskly through the vessels, and the proportionate quantity im- 
 mediately under the influence of the arterial system, is less 
 than in youth. 
 
 There is no pulsation to be observed in the veins, but what 
 they receive laterally from the contiguous arteries. There is 
 no pulsation in the veins, because they are removed from the 
 heart ; because they do not receive the shock of the heart’s ac- 
 tion in their trunk, but only by their widely spread branches ; 
 because the contraction of the heart, and of the arteries so al- 
 ternate with each other, in such a manner as to keep up a per- 
 petual and uniform stream of blood into the veins ; whereas 
 the pulsation in the arteries is owing to the sudden and inter- 
 rupted contraction of the heart. 
 
 In this general account of the venous system, it remains only 
 
APPENDIX. 
 
 215 
 
 to speak of the subject of absorption. Before the suit of expe- 
 riments made on this subject by Mr. Hunter, a vague notion 
 was entertained that the veins were absorbents ; but about that 
 time,* the doctrine that lymphatics are absorbents having been 
 established, the opinion that the red veins were also absorbents, 
 was first questioned, and finally confuted, at least in the opinion 
 of most physiologists. 
 
 The chief argument to show that veins, arising from cavi- 
 ties, particularly from the intestines, acted as absorbents, was, 
 that some anatomists said they had seen white chyle in the 
 blood taken from the mesenteric veins. It was however soon 
 observed that the serum of the blood, taken from the veins of 
 the arm, was sometimes white, which must arise from some 
 other cause than the absorption of chyle. f 
 
 The experiments of Mr. John Hunter, proved that there is 
 no absorption of fluid, from aliment contained in the intestinal 
 canal, by the veins of the mesentery, while the lacteals were 
 Papidly absorbing. Emptying a portion of the gut, and the 
 veins of their blood in a living animal, he poured milk into the 
 intestine. The veins remained empty, and without a drop of 
 the milk finding its way into them, while the lacteals became 
 tinged with it. In another experiment, leaving the arteries 
 and veins of the mesentery free and the circulation through 
 them perfect ; still no white fluid could be discovered, tinging 
 the stream of blood in the veins. Neither did pressure upon 
 the gut, in any instance force the fluid of the intestines into the 
 veins. — He repeated and varied these experiments, so as to 
 show in a very satisfactory manner, that chyle, or the fluid of 
 the intestines, never is absorbed by the veins. 
 
 Yet I must say that these experiments are still unsatisfacto- 
 ry, as they regard the general doctrine of absorption by the 
 veins : in the intestines there is a peculiar set of vessels evi- 
 dently destined to the absorption of the chyle and of the fluids 
 of the cavity ; but there remains a question which will not be 
 easily determined : do not the veins throughout the body re- 
 sume a part of that substance, or of those qualities, which are 
 deposited or bestowed by the arteries ? — We are assured that 
 in the circulation of the blood through the lungs, and in the ex- 
 tremities of the pulmonic veins, there is an imbibing or absorp- 
 tion : and in the veins of the placenta, there is not only an ab- 
 sorption similar to what takes place in the extreme branches of 
 the pulmonic circulation, but the matter and substance which 
 goes to the nourishment of the foetus, is imbibed from the ma- 
 
 * 1 758. 
 
 f See-Hewfon’s Exper. Efiays and Lymphatic Syftem. 
 
216 
 
 APPENDIX. 
 
 ternal circulation.* So by the vessels in the membrane of the 
 chick in ovo, there is absorbed that which being carried to the 
 chick, bestows nourishment and increase. For my own part, 
 I cannot but suppose that, while the lymphatics absorb the 
 loose fluids which have been thrown out on surfaces, or into 
 cavities — the veins receive part of what is deposited from the 
 arteries ; but, which is not so perfectly separated from the in- 
 fluence of the circulating system, as that which the lymphatics 
 receive ; and that there are certain less palpable, and perhaps 
 gaseous fluids, which they imbibe in the course of the circula- 
 tion by an affinity of the venous blood, similar to the attraction 
 which takes place in the lungs. We must at the same time ac- 
 knowledge, that the conclusions made in favour of absorption 
 by veins, from experiments upon the dead body/are fallacious, 
 and have no weight. — It is seldom we can determine whether 
 minute injections have taken a course by a natural, or by a 
 forced passage : neither are the experiments of some of the 
 older physiologists more satisfactory or conclusive. Lower 
 affirmed that, by throwing a ligature on the inferior cava of a 
 dog, he produced ascites. He tied the jugular veins of a dog, 
 and the head became dropsical. Hewson repeated these expe- 
 riments, but without the same result. And if the tying of the 
 veins had always produced oedema or dropsy, the experiment 
 would have proved nothing more than is already established by 
 the very common occurrence of oedema of the legs, from the 
 pressure of the womb on the iliac veins, or a tumor in the groin, 
 or in the pelvis. Now in these instances the compression of 
 the vein does nothing more than cause a difficult circulation of 
 the blood, from the extreme arteries into the veins, and con- 
 sequently a greater profusion of the discharge into the cellu- 
 lar texture by the serous arteries. 
 
 OF THE VEINS, BRANCHES OF THE SUPERIOR VENA CAVA. 
 
 The superior vena cava, or the descending cava, is the su- 
 perior trunk of the venous system ; which receives the veins 
 of the head, neck, and arms, and throws the blood directly into 
 the great right sinus, or auricle of the heart. 
 
 * Dr. Hunter, Hewfon, &c.fay that it is probable there are many fmall lym- 
 phatics in the placenta, which open into fhe branches of the veins, and do not 
 take a courfe along the chord. This is very improbable, and has no fupport from 
 analogy. 
 
APPENDIX. 
 
 217 
 
 SECTION I. 
 
 OP THE VEINS OF THE HEAD AND NECK. 
 
 The anterior facial vein.'* The facial, or anterior 
 facial vein, runs down obliquely from the inner canthus of the 
 eye, towards the angle of the lower jaw-bone. Here uniting 
 with the temporal vein, it forms the external jugular vein. 
 The most remarkable branches of veins which assist in form- 
 ing the facial vein, are the frontal veins ; which receive 
 the blood from the forehead and frontal portion of the occipito- 
 frontalis muscle, and the ophthalmic vein, which is one of 
 the emissariae, and comes from the cavernous sinus through 
 the orbit. — In its course down the cheek, the facial vein re- 
 ceives the several cutaneous branches of veins, from the sur- 
 rounding parts : but which have in reality no such importance 
 as to require description.! 
 
 The posterior facial vein ; or, great temporal 
 vein. — This vein descends from the temple before the ear, 
 through, or under the mass of the parotid gland, and behind 
 the angle of the lower jaw. 
 
 This posterior vein receives those branches which are the 
 proper temporal veins, and which are four in number, and 
 descend upon the side of the head and those which answer 
 to the submaxillary artery, and also the vena transversa faciei, 
 and the auricular veins. Finally into some of the deep branch- 
 es of this vein § the blood enters from the veins accompanying 
 the arteria meningea. The posterior facial vein, uniting with 
 the anterior one, forms a common trunk, which in general lies 
 over the division of the carotid artery. 
 
 EXTERNAL JUGULAR VEINS. 
 
 The external jugular vein takes a course obliquely down 
 the neck, and across the middle of the mastoid muscle. It 
 lies under the fibres of the plat\sma myoides muscle, and 
 drops either into the subclavian vein, or into the internal jugu- 
 lar vein. Sometimes there are two external jugular veins on 
 each side ; more commonly there are two branches high in the 
 neck, from the anterior and posterior facial veins, which unite 
 
 9 Facial •vein ; V, Angular is j V. 'Triangularis . • 
 
 *f* Vena dotfalis naf y fuperior et inferior— -Vena palp cbralis inferior externa et inter • 
 na—V ma alaris naji— Veres labia et m agree et minores 3 &C. Verne buccales 3 &C. 
 
 t Being in two fets, the deep, and fuperficial. 
 
 § Viz. Vsnce Fterygoidece. 
 
 Vol. IV. 2 E 
 
APPENDIX. 
 
 218 
 
 about the middle of it. When they are double they have this 
 course ; the anterior and external jugular vein, may be said to 
 begin from the anterior facial vein ; it then receives the sub- 
 mental vein, which comes in under the base of the lower jaw— 
 the ranine veins also, and veins from the glands under the jaw 
 join it here : where it is before the mastoid muscle, it forms 
 free communications w r ith the internal jugular veins ; and here 
 also, it receives veins from the side of the throat.* 
 
 Almost all the ramifications of veins, which in one subject 
 unite to the external jugular vein, and which come from che 
 face and throat, do in others sink down into the internal jugu- 
 lar vein. 
 
 Sometimes the anterior and external jugular veins join the 
 internal jugular vein ; sometimes the subclavian vein. 
 
 The posterior external jugular vein is form, d chieflv by the 
 temporal vein, or, posterior facial vein, which comes down 
 from under the parotid gland ; it is then joined by the occipi- 
 tal veins,f a little lower by the cervical veins, and lastly on the 
 lower part of the neck it receives the muscular branches from 
 the flesh of the shoulder ; it then sinks into the subclavian 
 veins. 
 
 Of the thyroid veins. — The thyroid gland has two sets 
 of veins, as it has of arteries ; the superior thyroid veins car- 
 ry back the blood from the muscles of the fore part of the 
 throat, from the larynx, from the substance of the thvroid 
 gland, and from the neighbouring part of the trachea and pha- 
 rynx, and even from the fauces. Sometimes these thyroid 
 veins enter the external jugular vein ; sometimes they descend 
 upon the neck, taking the name of guttural veins ; they 
 unite themselves with the internal jugular vein. 
 
 The lower thyroid veins. — Come from the lower part 
 of the thyroid gland, and descend upon the fore part of the tra- 
 chea, and enter the subclavian ; or, more generally, the great, 
 or internal jugular veins. 
 
 Of the internal jugular vein — The internal jugular 
 vein is formed by the conflux of the several great and posterior 
 sinuses of the dura mater into the lateral sinus, which coming 
 out by the foramen lacerum posterius of the basis cranii, ceases 
 to be constricted into the triangular shape, and takes the form 
 and peculiarities of a vein. From this foramen, common to 
 the temporal and occipital bone, the jugular vein descends ob- 
 liquely forward and downward, becoming from its deep situa- 
 
 * Viz. The fuperior thyroid veins, and the deep laryngeal veins. 
 
 f Thefe communicate with the vertebral veins, and through the pofterior 
 znaftoid foramen with the lateral finus; 
 
APPENDIX. 
 
 219 
 
 tion somewhat more superficial, but in all its extent protected 
 by the sterno-cleido-mastoideus muscle ; and it passes under 
 the omo-hyoideus muscle. The internal jugular vein is very 
 irregular in its form ; being sometimes much contracted under 
 the angle of the jaw ; bulging and much enlarged, or rather 
 capable of being much distended in the middle of the nerk ; 
 and again contracted before it joins the subclavians. The 
 carotid artery, the internal jugular vein, and the par vagum 
 lie together in the same sheath ot loose cellular membrane. 
 
 The internal jugular vein receives these communications 
 and branches ; behind the angle of the lower jaw, a branch of 
 communication, generally goes down from the posterior facial 
 vein, and often it is joined by the internal maxillary vein : un- 
 der the jaw, it either forms free communications with the be- 
 ginning of the external jugular vein, or it receives the ranine 
 and guttural veins; at all events, there is a branch from the side 
 of the throat, and the muscles ot the os hyoides which passes 
 into the internal jugular vein. From under the back part of 
 the mastoideus muscle, it receives branches from the occipital 
 veins, and forms communications with the vertebral veins : 
 near its termination the great jugular vein receives the guttural 
 and lower thyroid veins. 
 
 Of the vertebral vfins. — There is difficulty in assign- 
 ing origins to these veins, for they are rather like a chain of 
 communication ; they run in the holes of the transverse 
 apophysis of the cervical vertebrae, and surround the processes 
 with areolae. First a communication is formed with the great 
 lateral sinus, then they receive the flat sinuses from under the 
 dura mater, covering the cuneiform process of the occipital 
 bone, (the basilar sinuses) and as they descend they form 
 transverse communications, which receive the branches of that 
 chain of inosculations, which runs down upon the spinal mar- 
 row. The vertebral veins, in their descent, send out divisions 
 which run down upon the outside of the canal, and receive 
 branches of veins from the muscles on the fore part of the 
 vertebra, and some of the proper cervical veins from behind. 
 The vena cervicalis coming from the side of the neck, unites 
 with the vertebral vein near its termination, in the back part 
 of the subclavian, or sometimes in the axillary vein. 
 
220 
 
 appendix. 
 
 SECTION II. 
 
 OF THE VEINS OF THE ARM. 
 
 The veins of the arm are in two sets, the vense comites 5 
 and the external or subcutaneous veins, being those without 
 the fascia, and not subject to the compression of the muscles. 
 Of these, the latter are the more important and require a par- 
 ticular description. 
 
 On the palm of the hand, the veins are few and small, be- 
 cause they are there subject to compression in the frequent 
 grasping of the hand; but on the back of the hands and fin- 
 gers, the veins are numerous and large. The veins creeping 
 along the fingers, make a remarkable inosculation on the back 
 of the first phalanges, and then passing in the interstices of the 
 knuckles, form a great and irregular plexus on the back of the 
 hand the principal branch of which sometimes takes the 
 form of an arch.f 
 
 The plexus of veins from the back of the hand is continued 
 over the back of the wrist : when some of the larger branches, 
 after playing over the heads of the radius and ulna, take a 
 course, the one on the lower, and the other over the upper edge 
 of the arm, whilst the back of the arm is left without any re- 
 markable veins taking their course there. 
 
 The veins on the back of the hand have nerves interming- 
 ling with them, viz. branches of the ulnar nerve, and the ex- 
 treme branches of the muscular spiral nerve : so that it is a 
 great mistake to suppose that bleeding in the back of the hand 
 might be substituted with advantage for the common operation 
 in the bend of the arm. 
 
 Vena cephalic a. — The vein of the back of the thumb 
 running into a trunk, which takes a course over the outside of 
 the wrist, is called cephalic a pollicis. 
 
 From this vein and the division of the plexus of the back of 
 the hand, a considerable trunk is generally formed, which 
 takes its course on the radial edge of the arm, and is called 
 cephalica minor, or radjalis externa. This vein in its 
 tract over the extensor radialis, and the supinator longus, has 
 many lateral communications, particularly with the median 
 vein. 
 
 This vein, now joined by the median cephalic, and rising 
 upon the outside of the humerus, is the great cephalic vein ; 
 and it passes, first betwixt the biceps and triceps brachii, and 
 
 * Plexus dorfalis manus . Arcus ‘venojus dor/alis* 
 
APPENDIX. 
 
 221 
 
 then betwixt the deltoides and pectoralis major muscles. Se- 
 veral small cutaneous veins play over the belly of the biceps 
 muscle, and communicate with the basilic vein ; a little below 
 the external condyle ot the os humeri, the cephalic vein de- 
 taches a branch which ascends betwixt the brachialis internus 
 and supinator longus, and which afterwards forms inoscula- 
 tions with the basilic vein, on the back of the arm. 
 
 The great cephalic vein passing up betwixt the tendons of 
 the pectoralis major and the deltoid muscles, sinks into the 
 axilla and joins the axillary vein. The lesser cephalic is a 
 vein which runs up betwixt the pectoral and deltoid muscles, 
 and sinks generally into the subclavian vein : sometimes it 
 joins the external jugular vein. 
 
 Vena basilica.* We trace the origin of the basilic vein 
 from those veins which, being continued from the plexus, on 
 the back of the hand, take their course over the lower head of 
 the ulna. (A conspicuous branch of these veins, from the 
 little finger, was called salvatella by the ancients.) From this 
 origin, the basilic vein takes a spiral course on the ulnar edge 
 of the fore-arm, sometimes in one great trunk, oftener in two, 
 sometimes in a plexus of veins ; here it may be called ulnaris 
 supfrficialis, or cubitalis interna. This vein, now 
 rising before the inner condyle of the humerus, passes on the 
 inner margin of the biceps flexor muscle ; here it forms very 
 free and numerous connections with the internal or brachial 
 vein ; the satellites and cephalica, now passing up, until it sinks 
 under the tendon of the pectoral muscle, it joins the axillary 
 vein. 
 
 The great basilic vein, or the great trunk, after it has as- 
 cended above the elbow, and received the median basilic, is 
 joined by several deep branches of veins, as those which ac- 
 company the brachial artery, called satellites or comites, a 
 vein which is called profunda brachii ; and still nearer its de- 
 termination, it receives the addition of the vena subhumeralis 
 or ( irticularis , and the vence scapulares , viz. those answering to 
 the arteries of that name. 
 
 Vena mediana major. j — This is a vein which runs up the 
 middle of the fore-arm, beginning from the plexus of veins, 
 which play over the flexor tendons, and come from the ball of 
 the thumb ; it is a vein which is very irregular, being some- 
 times double, and sometimes rather in the form of a plexus, 
 
 * Brachialis. The ancients termed the bafilic vein of the right arm, the vein 
 of the liver, or vena hepatica brachii, and that of the left, the vena fplenica 
 brachii. 
 
 + V erta Media. ■~'er.a fvpcrficia/is communis. 
 
222 
 
 APPENDIX. 
 
 than to be considered as a regular trunk ; often it is particularly 
 short, and can be considered as a trunk, only for a few inches 
 as it approaches the bend of the arm ; not unlrequently it is 
 entirely wanting, and as if annihilated by the preponderance 
 of the branches of the cephalic or basilic vein. But to take 
 the more common course, as an example, when it has ascend- 
 ed on the middle of the fore-arm, near to the bend of the arm 
 it divides ; one branch passes obliquely outward, and joins 
 the cephalic vein, the other inwards and unites with the basilic 
 vein ; the first, is of course the median cephalic vein, the 
 second, the median basilic vein. 
 
 These are the two branches which the surgeon most com- 
 monly selects for bleeding. Around the median cephalic, the 
 cutaneous nerves play more profusely, and under the median 
 basilic vein the humeral artery passes. It is by the aukward 
 plunging of the lancet into the median basilic, that the country 
 bleeder so frequently produces the aneurism of the artery ; but 
 the dreadful symptoms following the pricking of the nerve, are 
 more frequently produced by bleeding in the median cephalic ; 
 cases however occur of the pricking of the nerves, while 
 bleeding in the median basilic vein. 
 
 Axillary vein — Thetrunkof the veins of the arm pass- 
 es through the axilla, until it arrives betwixt the first rib and 
 clavicle, under the name of axillaris. Here lying by the side 
 of the artery, it receives many muscular branches from the 
 flesh of the shoulder, the external and internal scapular veins, 
 and the thoracic veins ; in general where it passes by the head 
 of the humerus it receives the cephalic vein. 
 
 Subclavian veins. — The axillary vein continuing its pro- 
 gress over the first rib, becomes the subclavian vein : on the 
 right side the vein is shorter, and descends more obliquely ; 
 on the left it is longer, of course less oblique, but still its di- 
 rection is downward ; passing before the trachea, and the 
 branches of the arch of the aorta, it joins the subclavian of the 
 right side, and together they form the superior cava : the sub- 
 clavian vein receives these veins, a vein from the shoulder and 
 lower part of the neck, the vertebral vein, with some lesser 
 plexus of veins descending from the neck, the internal jugu- 
 lar vein (and in the angle of the union of these the thoracic 
 duct,) and lastly the th\'roid veins. From below they receive 
 the lesser internal thoracic veins. 
 
APPENDIX. 
 
 263 
 
 SECTION III. 
 
 THE SUPERIOR VENA CAVA, THE VENA AZYGOS, AND LES- 
 SER VEINS OF THE THORAX. 
 
 The superior vena cava is the trunk of all the veins of the 
 head, neck, arms, and of the parts in the thorax ; soon after 
 it is formed by the subclavian veins, it is joined by the vena 
 azygos, and receiving the internal mammary veins and 
 the VEN.E thymicjE and pericardiac branches, the inter- 
 costal and bronchial veins, it descends into the pericar- 
 dium, and dilates or opens into the right sinus or auricle. 
 
 Vena azygos.* This is the principal vein of the thorax, 
 and chiefly of the walls of the thorax. It is observed to take 
 its origin upon the vertebra of the loins from some of the lum- 
 bar veins, or by inosculations with the renal spermatic or lesser 
 branches of the abdominal cava, receiving the first and second 
 lumbar veins, as in its ascent in the thorax, it receives the in- 
 tercostal veins on either side ; f ascending betwixt the crura of 
 the diaphragm, and by the side of the aorta, it sometimes re- 
 ceives the lower phrenic veins ; in the thorax lying on the 
 right side of the bodies of the vertebra, and before intercostal 
 arteries, it receives the bronchial veins from the root of the 
 lungs, and from the trachea it receives the veins of the poste- 
 rior mediastinum and oesophagus ; through the intercostal 
 veins, it communicates with the external and internal mamma- 
 ry veins, and with the venal circles of the spinal marrow. 
 
 Upon the third vertebra, the azygos vein separates from the 
 spine, and with an arch, and bending round the root of the 
 lungs, it opens into the superior cava, just where it is about to 
 enter the pericardium : where it opens into the great vein, it 
 is guarded by a valve. 
 
 This vein however, like most others, has considerable varie- 
 ty, and does not always merit the name of azygos, for some- 
 times it is double, a division ascending on the left side of the 
 spine, and uniting with the branch of the other side, just as it 
 is about to enter into the superior cava. 
 
 Of the lesser veins in the thorax — The ven,e mam- 
 marine take a course by the side of the internal mammary arte- 
 ry, and require no description. Like the arteries, they spread 
 their branches on the muscles of the bell) 7 , and communicate 
 
 * Sine pari. 
 
 t We except feme of the veins from the interlaces of the higher ribs, parti- 
 cularly on the right fide, which enter the fubdavian vein. 
 
224 
 
 APPENDIX. 
 
 with the diaphragmatic and lumbar and epigastric‘veins. The 
 left mammary vein terminates in the left subclavian vein, the 
 right in the superior vena cava. 
 
 The vfNjE thymic^ enter, either into the union of the sub- 
 clavian veins, or they enter into the guttural veins, or the inter- 
 nal mammary veins. 
 
 The pericardiac veins gather their branches from the 
 pericardium, from the aorta, trachea and lymphatic glands ; 
 they send down branches by the side of the phrenic nerve, 
 which inosculate with the veins of the diaphragm ; they enter 
 the internal mammary vein, or the superior cava, or the termi- 
 nation of the right subclavian. 
 
 The superior intercostal veins. — T he right and left 
 intercostal veins differ in their size and distribution ; the right 
 is small, and receives only one or two of the upper intercostal 
 veins, which do not enter into the azygos vein. The vein of 
 the left side begins even so low as the interstice of the seventh 
 rib ; it receives branches from the pleura, pericardium and 
 lungs (viz. the bronchial veins) and from the oesophagus } they 
 enter the subclavian veins. 
 
( 225 ) 
 
 CHAP. II. 
 
 OF THE VEINS WHICH UNITE TO FORM THE 
 INFERIOR VENA CAVA. 
 
 The inferior vena cava receives the veins of the lower ex- 
 tremities, the hypogastric and abdominal veins, and the veins 
 of the viscera of the abdomen ; but those of the membraneous 
 contents of the abdomen are received by it only indirectly, and 
 through the circulation of the liver. 
 
 OF THE VEINS OF THE LEG AND THIGH. 
 
 We have observed that the veins of the extremities are in 
 two sets ; the deep and superficial. In the leg and thigh the 
 deep-seated veins accompany the arteries, and receive the 
 same name : the cutaneous veins are the saphena major and 
 minor. 
 
 Saphena major.* — A large and beautiful plexus of veins 
 isfoimedon the fore-part of the foot, and coming from the 
 back of the toes, and outside of the foot. Two principal 
 veins arise from the arch which these form : one takes the 
 course behind the inner ankle, and is the saphena major ; the 
 other passes over the outer ankle, and forms the saphena minor. 
 
 The great saphena may be traced from the great toe, from 
 the inside of the foot, and behind the ankle : it receives one or 
 two branches from the sole of the foot. Sometimes the prin- 
 cipal branch passes behind the lower head of the tibia, some- 
 times before it, or it forms circles here : a little above the an- 
 kle a vein from the middle of the metatarsal arch comes ob- 
 liquely over the tendon of the tibialis anticus and joins it. 
 
 The saphena, now a considerable trunk, runs up the leg be- 
 fore the inner margin of the belly of the gastrocnemius muscle, 
 and on the inner ridge of the tibia. In this course it receives 
 numerous cutaneous branches, and backward, over the belly of 
 the muscles, it forms inosculations with the lesser saphena. 
 From the inside of the leg the trunk ascends on the inside of 
 the knee, where it receives several branches, coming round the 
 joint, and over the tibia. Now passing somewhat obliquely, it 
 
 Vol. IV. 
 
 * Saphena magna, interna. 
 
 2 F 
 
226 
 
 APPENDIX. 
 
 ascends upon the thigh, and, at the same time, turns from the 
 inside to the lore-part of the thigh. In the thigh the great sa- 
 phena receives many branches, and is not always a single vein : 
 for sometimes the branches collecting form a small trunk, run- 
 ning collateral to the greater vein, and which joins it in the 
 groin. In all this course the saphena vein is superficial, and 
 lies imbedded in the cutaneous fat ; with but a very slight and 
 imperfect aponeurosis inclosing it ; while it is external to the 
 proper fascia of the leg and thigh. As it ascends upon the 
 thigh, however, it does not dive suddenly under the' fascia; 
 but is gradually enveloped and embraced by the condensed 
 cellular membrane and fascia. 
 
 When it was more the practice than at present to bleed in 
 the ankle, the saphena major was the vein selected : but as in 
 all the course ol the vein, from the great toe to the knee, it is 
 connected with the nerve which bears its name, there are not 
 wanting Instances of those bad effects from pricking of the 
 nerve, which not unfrequently follow the bleeding in the arm. 
 
 Saphena minor.* This vein arises from the plexus on 
 the outside of the dorsum pedis : it runs over .the outer ankle 
 and above the fascia, covering the tendons of the peronei mus- 
 cles. Here receiving many branches, and forming frequent 
 deep inosculations, it mounts on the outside of the vagina or 
 fascia, which covers the back of the leg, until arriving betwixt 
 the hamstring tendons it sinks into the popliteal hollow, termi- 
 nating in the popliteal vein. 
 
 The other veins of the lower extremity which accompany the 
 arteries in their course, need little description. 
 
 Anterior tibial vein. — The veins accompanying the an- 
 terior tibia! artery form many inosculations, and when minute- 
 ly injected, almost conceal the artery. They are the anterior 
 tibial veins and only unite into a trunk, where perforating the 
 interosseous ligament it joins the popliteal vein. 
 
 Posterior tibial vein. — In the sole of the foot we have 
 the external and internal plantar veins, which uniting into 
 trunks, accompany the artery behind the inner ankle. In its 
 course betwixt the soleus and the tibialus anticus muscles, it 
 cannot be called the posterior tibial vein ; for it is a mere net- 
 work of veins surrounding the posterior tibial artery. It re- 
 ceives, near its termination, a branch called Suralis, from 
 the gastrocnemii and soleus : it terminates in the popliteal vein. 
 
 The Vi n^e PeroneyE are the vense comites by the tibial ar- 
 tery, and are two or three in number. All these veins have 
 free inosculations with each other. 
 
 Vena faphena par'ua, externa. 
 
appendix. 
 
 22 
 
 The Popliteal vein. — This vein is formed by the three 
 divisions of deep veins accompanying the arteries of the leg, 
 and the saphena minor. It lies more superficial than the arte- 
 ry, and seems to cling round it. As it ascends, however, it 
 twists round the artery, the artery being nearest the bone — a 
 little above the joint it receives the lesser saphena. 
 
 This vein, perforating the tendon of the triceps, comes to the 
 fore part of the thigh, still united to the artery : it is now the 
 crural vein. As it ascends it gets from behind the artery, 
 so that in the groin it lies nearer the pubes than the artery does : 
 opposite the trochanter minor it receives the internal and ex- 
 ternal circumflex veins, and the Profunda Femoris. About 
 an inch below Poupart’s ligament the crural vein receives the 
 saphena major, and the small external pudic veins. 
 
 External iliac vein. The femoral vein lying on the 
 inside of the artery or nearer the pubes, enters the abdomen 
 under the femoral ligament, and passing by the side of the 
 Psoas muscle becomes the external iliac vein. It receives se- 
 veral lesser veins just within the ligament particularly the epi- 
 gastric vein from the muscles and integuments of the belly, and 
 the veins accompanying the arteria circumflexa ilii. The ex- 
 ternal iliac vein is joined by the hypogastric vein which as- 
 cends from the pelvis. It requires no minute description ; it 
 answers to the distribution of the hypogastric artery. This 
 which is the internal iliac joining the trunk from the thigh forms 
 the common iliac vein. 
 
 Vena cava abdominalis.* — A little lower than the bi- 
 furcation of the aorta, the right and left common iliac veins 
 unite. By this union they form the vena cava. This vein 
 ascends upon the right of the aorta. It receives fewer branch- 
 es than would naturally be imagined, because the veins of the 
 viscera take their course by the porta into the liver. It re- 
 ceives the lumbar veins, the spermatic veins, the renal, super- 
 renal, and phrenic veins. Passing upward it is received into 
 its appropriate fossa in the liver, and seceding a little from the 
 spine it receives the ven^e cavi hepaticyE and perforates 
 the diaphragm ; entering the pericardium it expands into the 
 great sinus, or right auricle of the heart. 
 
 Renal veins. f — These veins are less irregular than the ar- 
 teries of the kidney, which relation of the veins and arteries is 
 uncommon. From the relative situation of the kidneys to the 
 cava it is evident that the right vein must be short ; the left 
 comparatively longer and taking a course from the kidney 
 over the aorta.j; 
 
 * Vena Cana inferior. f Emulgent veins. 
 
 1 The Renal veins however fometimes vary in their number, the right being 
 double or triple, the left even fometimes -in four branches 
 
iJ28 
 
 APPENDIX. 
 
 Supra-renal veins. — These little veins are like the arte- 
 ries in their course. The right one enters sometimes into the 
 vena cava, sometimes into the renal vein. The left sometimes 
 receives the phrenic vein of that side and enters into the renal 
 vein. 
 
 Spermatic veins. — Of the general distribution of these 
 veins nothing need be said, after looking to the description of 
 the arteries.* 
 
 The Vena Portae has been already described in the second 
 volume. 
 
 • See page ny . 
 
 ) 
 
OF THE TEETH. 
 
 TT HERE is naturally an inclination in the author of a system 
 to amplify some particular subjects, and to abridge, or bestow 
 less attention, on others which may to him appear less interest- 
 ing or curious. To restrain this tendency has been the most 
 irksome task which I have felt in completing the present work. 
 The growth and structure of the teeth forms an elegant and 
 interesting subject of inquiry ; and it is difficult to concentrate 
 the view of it so as to be consistent with the arrangement of a 
 systematic work. 
 
 As the general nature and use of the teeth are sufficiently 
 understood, there can be little objection to our beginning the 
 present subject with considering the structure of the human 
 teeth. 
 
 Of the structure of the teeth. 
 
 A tooth consists of these parts. — In the first place, the ena- 
 mel, a peculiarly hard layer of matter composing the surface 
 of the body of the tooth. The internal part, body, or sub- 
 stance of the tooth, is less stony and hard than the enamel, 
 but of a firmer structure and more compact than common bone. 
 In regard to the form of the tooth, we may observe that it is 
 divided into the crown, neck, and fangs, or roots of the tooth, 
 which go deep into the jaw. There is a cavity in the body of 
 the tooth, and the tube of the fangs communicates with it. 
 This cavity receives vessels for supplying the remains of that 
 substance upon which the tooth was originally formed. The 
 roots of the teeth are received into the jaw by that kind of ar- 
 ticulation which was called gomphosis. They are not firmly 
 wedged into the bone, for, in consequence of maceration, and 
 the destruction of the soft parts, the teeth drop from the scull. 
 There is betwixt the tooth and its socket in the jaw a common 
 periosteum. 
 
 Of the enamel. The surface of a tooth, that which ap- 
 pears above the gum, is covered with a very dense hard layer 
 of matter, which has been called the enamel. In this term 
 there is some degree of impropriety, as assimilating an animal 
 
230 
 
 appendix. 
 
 production with a vitreous substance, although the enamel 
 very widely differs from the glassy fracture when broken. This 
 matter bestows the most essential quality of hardness on the 
 teeth ; but it is probably useful in another way, being interme- 
 diate betwixt the central bony part of the tooth, which has life, 
 and is subject to disease, and matter altogether foreign to the 
 living body. When the enamel is broken off, and the body of 
 the tooth exposed, it quickly decays. 
 
 The enamel is the hardest production of the animal body. 
 It strikes fire with steel : in church-yard sculls it is observed to 
 resist decay when the centre of the tooth has fallen into dust. 
 It has been found that the component parts of the enamel are 
 nearly the same with those of bone : in bone the phosphate of 
 lime is deposited on the membranes, or cartilage, but this 
 hardening matter of bones is a secretion from the vessels of the 
 part, and is accumulated around the vessels themselves : it is 
 still within the controul of their action, and is suffering the 
 succession of changes peculiar to a living part. But, in the 
 enamel, the phosphate of lime has been deposited in union 
 with a portion of animal gluten, and has no vascularity, nor 
 does it suffer any change from the influence of the living sys- 
 tem. Although the hardening matter be principally phosphate 
 of lime, a small proportion of the carbonate of lime enters 
 into the composition both of bone and of enamel. 
 
 Although we call the earthy deposit the hardening matter, 
 yet it is the union of the glutinous matter which bestows the 
 extreme hardness, for, when the tooth is as yet within the jaw, 
 and in an early stage of its formation, the deposition is soft, 
 and its surface rough ; but, by a change in the surface, which 
 throws out this secretion, the first deposition is penetrated with 
 gelatinous secretion, which, either by this penetration simply, 
 or by causing a new apposition of its parts, (its structure in- 
 deed looks like crystallization,) bestows the density and ex- 
 treme hardness on this crust. When an animal is fed with 
 madder, the colouring matter coming, in the course of the 
 circulation, in contact with the earth of bone, is attracted by 
 it, and is deposited upon it in a beautiful red colour. This 
 colouring matter penetrates more than injection can be made 
 to do in the dead body ; and, as by this process of feeding, 
 the enamel is not tinged, we have a convincing proof that the 
 vascular system has no operation on the enamel after it is 
 formed. 
 
 From the composition of the enamel, we must be aware 
 of the baneful effects of acidulated washes and powders to the 
 teeth : they dissolve the surface, and give a deceitful whiteness 
 
OF THE TEETH. 
 
 231 
 
 to the teeth ; they erode the surfacfe, which it is not in the con- 
 stitution of the part to restore. 
 
 Of the central bony part of the tooth. The che- 
 mical composition, and the manner of combination of the 
 matter forming the central part of the tooth, and of the fangs, 
 is similar to the other bones of the body ; but when we exam- 
 ine the hardness and the density of the tooth, and see that it is 
 not even porous, or apparently capable of giving passage to 
 vessels, we doubt of its vascularity, and are apt to suppose 
 that it holds its connection with the living jaw-bone by some 
 other tenor than that of vessels, and the circulation of the 
 blood through it. I must acknowledge that the difficulty in 
 deciding on the vascularity, and degree of vitality which the 
 teeth possess, appears to me so great, that I shall at present 
 venture to give no decided opinion. The vascularity of the 
 periosteum, which surrounds the teeth and vessels which enter 
 by the fangs to the cavity of the teeth, seemed to shew a 
 sedulous care to supply the tooth plentifully with blood. As 
 this part of the tooth has often been colourecLby feeding young- 
 animals with madder, the reverse of that experiment, which 
 convinces us there is no circulation in the enamel, should satisfy 
 us that there is blood circulating through the body of the 
 tooth, and that it undergoes the same changes by absorption 
 which the other bones are proved to do ; but these experiments 
 may have been made while the teeth were forming by the de- 
 position from the pulp, and of course they might be coloured 
 without the experiment affording a fair proof that the circula- 
 tion continues in the tooth after it is formed. If it be proved 
 that the adult teeth, or a fully formed tooth yet within the 
 jaw, are uniformly tinged with the madder, we must without 
 reserve conclude, that the economy of the teeth is in all re- 
 spects like that of the common bones. 
 
 The teeth undergo changes of colour in the living body, to 
 which it would appear they could not be liable as dead matter. 
 They become yellow, transparent, and brittle with old age ; 
 and when a tooth has been knocked from its socket, and re- 
 placed, dentists have observed that it loses its w'hiteness, and 
 assumes a darker hue. 
 
 The absorption of the roots in consequence of the caries of 
 the body’ of the tooth, and the absorption of the fangs of the 
 deciduous teeth, are further alleged in proof of their vascu- 
 larity ; not only the pressure of the rising tooth on the fangs of 
 the temporary teeth will cause an absorption of the latter, but 
 the fangs of the temporary teeth will waste and be absorbed, 
 so as to drop out without the mechanical pressure of the per- 
 
232 
 
 APPENDIX. 
 
 manent teeth, and before they have advanced to be in contact 
 with the former. 
 
 The teeth seem acutely sensible, but a little consideration 
 teaches us that the hard substance of the teeth is not endowed 
 with sensibility, and that it must be the remains of the vascular 
 pulp, presently to be described, occupying the centre of the 
 tooth, which being supplied with nerves, gives the acute pain 
 in tooth-ach. It is as a medium communicating or abstracting 
 heat, that the tooth itself seems to give pain. When wrought 
 upon by the dentist, no sensation is produced unless the tremor 
 be communicated to the jaw, or unless the abrading, or cutting- 
 instruments, be so plied as to heat the tooth : then an acute 
 pain is produced from the heat communicated to the centre ; 
 and so, extremely cold substances, or liquids, taken into the 
 mouth, still produce pain, from the cold affecting the pulp of 
 the tooth. 
 
 As living parts, the teeth have adhesion to the periosteum, 
 and are connected with their internal pulp ; but when they 
 spoil, and are eroded, the disease spreads inwardly, probably 
 destroying the life of the bony part of the tooth, the progress 
 of which disease is marked by a change of colour penetrating 
 beyond the caries towards the centre of the tooth. When this 
 discolouration has reached the internal surface, the pain of 
 tooth-ach is excited, the pulp, vascular and supplied with 
 nerves, inflames, from a want of accordance with the altered 
 state of the tooth, just as the dead surface of a bone will inflame 
 the central periosteum and marrow. The extreme pain pro- 
 duced by this state of the tooth probably proceeds from the de- 
 licate and sensible pulp swelling in the confinement of the ca- 
 vity of the tooth. 
 
 In caries of the teeth, the body of the tooth is discovered 
 deep in its substance long before the pulp of the central cavity 
 is exposed by the progress of the caries. No exfoliation, or 
 exostosis, takes place upon that part of the tooth which is above 
 the gum, which may be owing to the mere compactness of the 
 ossific depositions, for we know that the bones ot greatest 
 density are the most apt to yield altogether to diseased action, 
 and die, instead of throwing off their surface, in exfoliations, 
 or taking any other variety of diseased action. 
 
 In the further consideration of this subject, there are cir- 
 cumstances which will make us doubt of there being vascular 
 action in the teeth, and perhaps incline us to believe that they 
 possess a lower degree of life, and are less subject to change 
 than other parts. Supposing the bonv part of the tooth to be 
 vascular, and to possess the principle of life, is not the firm 
 adhesion and contact of the enamel to the body of the tooth a 
 
OF THE TEETH. 
 
 233 
 
 curious instance of a part destitute of life adhering to the sur- 
 face of a living part, without producing the common effects of 
 excitement and exfoliation, or inflammation, in the latter ? Is 
 the enamel, though not a vascular part, possessed of some qua- 
 lity which distinguishes it from foreign matter, or is the bony 
 part of the tooth possessed of so low a degree of vascular ac- 
 tion, that it is not excited by the contact and adherence of the 
 enamel ? We must suppose that some accordance subsists be- 
 tween them from what is observed to be the effect of the loss 
 of the enamel, for then the bone of the tooth spoils rapidly, 
 and becomes carious. 
 
 In rickets, and mollifies ossium, and other diseases of de- 
 bility in which the body wastes, or the growth is retarded, the 
 growth of the teeth is not retarded in the one case, nor are the 
 grown teeth altered in their form or properties in the other. 
 This appears to me to support the idea of there being a distinc- 
 tion in the economy between the manner of the formation of 
 the teeth, and of common bone. The effects which we per- 
 ceive in the bony system under these diseases, are produced 
 by a preponderance of the absorbents over the activity of the 
 secreting vessels ; while in the teeth no such effect can take 
 place if they are formed by a deposition of bony matter which 
 is not re-absorbed, nor undergoes the revolution of deposition 
 and re-absorption, as in other parts of the body is. the case. 
 Accordingly we find in rickets, and the mollifies ossium, where 
 the hardest bone yields, where the jaw-bone itself is distorted 
 or altered in its form, that the teeth remain distinguished for 
 their size and beauty ; and in rickets the teeth are large, and 
 perfectly formed, while the jaws are stinted and interrupted 
 in their growth. The consequence of this is, that the teeth 
 form a larger range than the jaw, and give a characteristic pro- 
 tuberance to the mouth. 
 
 The roots of the teeth are sometimes found enlarged, dis- 
 torted, or with exostosis formed upon them. Again the ca- 
 vity of the tooth is found to have been filled up with the for- 
 mation of new matter, or around the fangs we often find a 
 small sac of pus, which is sometimes drawn out in extracting 
 the tooth. Nevertheless, in these examples of disease, there 
 are no unequivocal marks of vascular action in the teeth ; the 
 unusual form, or exostosis of the roots, is produced by an ori- 
 ginal defect in the formation. The filling up of the cavity of 
 the tooth is caused by the resumed ossific action of the pulp in 
 consequence of the disease and destruction of the body of the 
 tooth ; and the abscesses which surround the fangs are caused 
 by the death of the tooth, in consequence of which it has lost 
 Vox.. IV. 2 G 
 
234 
 
 APPENDIX. 
 
 its sympathy with the surrounding living parts, and becomes 
 a source of irritation like any other foreign body. 
 
 We must conclude, that the whole phenomena displayed in 
 the formation, adhesion, and diseases of the teeth, show them 
 to be possessed of life, and that they have a correspondence, 
 or sympathy with the surrounding parts. But are we prepar- 
 ed to acquiesce in the opinion of Mr. Hunter, that they pos- 
 sess vitality while yet they have no vascular action within 
 them ? We naturally say, how can such vitality exist inde- 
 pendently of a circulation ? But there are not wanting exam- 
 ples of an obscure and low degree of life existing in animals’ 
 ova, or seeds, for seasons without a circulation ; and if for 
 seasons, why not for a term of life? We never observe the 
 animal economy providing superfluously, and since there is no 
 instance to be observed in which the teeth have shown a power 
 of renovation, why should they be possessed of vascularity 
 and action to no useful end ? All that seems necessary to 
 them is, that they should firmly adhere without acting as a 
 foreign and extraneous body to the surrounding parts, and this, 
 vitality without vascular action, seems calculated to provide, 
 
 OF THE FORMATION AND GROWTH OF THE TEETH. 
 
 In the <jaws of a child newly born, there are contained two 
 set of teeth as it were in embryo : the deciduous, temporary, 
 or milk teeth ; and the permanent teeth. The necessity for 
 this double set of teeth evidently is to be found in the incapaci- 
 ty of alteration of shape or size in the teeth as in other parts of 
 the body ; the smaller teeth, which rise first, and are adapted 
 to the curve and size of the jaw-bone of an infant, require 
 to be succeeded by others, larger, stronger, and carrying their 
 roots deeper in the jaw. 
 
 Each tooth is formed in a little sac, which lies betwixt the 
 plates of bone that form the jaw-bone of the foetus, or child, 
 under the vascular gum, and connected with it. 
 
 When we open one of these sacs at an early period of the 
 formation of the tooth, a very curious appearance presents it- 
 self : a little shell of bone is seen within the sac, but no ena- 
 mel is yet formed. Upon raising the shell of bone, which is 
 of the shape of the tooth, and is the outer layer of the bony 
 substance of the tooth, a soft vascular stool, or pulp,* is found' 
 to have been the mould on which this outer layer of ossifi'c mat- 
 ter has been formed ; and a further observation will lead us to 
 conclude that this bony and central part of the tooth is in the 
 
 Lc noyau, la coque, or le germc de la dent, by the French authors. 
 
OF THE TEETH. 
 
 235 
 
 progress of being formed by successive layers of matter thrown 
 out from the surface of this vascular pulp ; though many have 
 explained the formation of the tooth, by supposing that the 
 layers of this pulp were successively ossified. 
 
 If we now turn our attention to the state of those teeth which 
 we know to be later of rising above the gum, we shall find the 
 ossification still less advanced, and a mere point, or perhaps 
 several points of the deposited matter on the top of the pulp. 
 
 The pulp, or vascular papilla on which the tooth is formed, 
 has not only this peculiar property of ossification, but, as the 
 period of revolution advances, where it forms the rudiments of 
 the molares for example, its base splits so as to form the mould 
 of two, three, or four fangs, or roots ; for around these divisions 
 of the pulp the ossific matter is thrown out so as to form a tube 
 continued downward from the body of the tooth. Gradually, 
 and by successive layers of matter on the inside of this tube, it 
 becomes a strong root or fang, and the bony matter has so en- 
 croached on the cavity, that only a small canal remains, and the 
 appearance of the pulp is quite altered, having shrunk in this 
 narrow space. 
 
 We have said that the tooth forming on its pulp, or vascular 
 bed, is surrounded with a membrane giving the whole the ap- 
 pearance of a little sac. This membrane has also an important 
 use. It is vascular also as the pulp is, but it is more connect- 
 ed with the gums, and receives its vessels from the surface, 
 while the pulp, lying under the shell of the tooth, receives its 
 blood-vessels from that branch of the internal maxillary artery 
 which takes its course in the jaw. 
 
 The enamel is formed after the body of the tooth has consi- 
 derably advanced towards its perfect form. It is formed by a 
 secretion from the capsule, or membrane which invests the 
 teeth,* and which is originally continuous with the pulp. The 
 enamel is thicker at the point, and on the body of the tooth, 
 than at its neck. Mr. Hunter supposed that the capsule always 
 secreting, and the upper part of the tooth being formed first, it 
 would follow of course that the point and body of the tooth 
 would be covered with a thicker deposition ; but it rather ap- 
 pears that the part of the sac opposite to the upper part, and 
 body of the tooth, has a greater power of secreting, being in 
 truth more vascular and spongy, for the whole of the body of 
 the bony part of the tooth is formed before the enamel invests 
 the tooth. 
 
 We are indebted to M. Herissant for much of the explana- 
 
 * This outer fac has been called chorion, from the numerous veflels diftributed 
 upon it. See HerilTant. 
 
236 
 
 APPENDIX. 
 
 tion of the manner in which the enamel is formed. He de- 
 scribes the sac,* its attachment to the pulp, and to the neck of 
 the teeth — as the tooth advances to its perfect form, the sac 
 also changes. At first it is delicate and thin, but it thickens 
 apace. And he asserts, that if after this progress is begun you 
 examine the inner surface of it with a glass, you will perceive 
 it to be composed of little vesicles in regular order, and which 
 sometimes have a limpid fluid contained in them. This liquid 
 exuded upon the surface of the teeth he supposes to form the 
 enamel. He explains also how this sac, originally investing 
 the body and neck oi the tooth, being pierced by the edge of 
 the tooth, and the tooth rising through it, is inverted, and by 
 still keeping its connection with the circle of the crown of the 
 tooth, rises up in connection with the gum, and in some degree 
 forms the new gum which surrounds the tooth. 
 
 Succeeding authors have found this membrane double. We 
 may examine it most successfully, says Mr. Hunter, in a new- 
 born child, and we find it made up oi two lamellae, an external 
 and an internal ; the external is soft and spongy, without any 
 vessels ; the other is much firmer, and extremely vascular, its 
 vessels coming from those that are going to the pulp of the 
 tooth. He acids, that while the tooth is within the gum, there 
 is always a mucilaginous fluid like the sinovia in the joints be- 
 tween this membrane and the pulp of the tooth. 
 
 Of the growth of the second set of teeth, and the 
 
 SHEDDING OF THE FIRST SET. 
 
 The first, or deciduous set of teeth, being adapted only for 
 the jaws of a child, are destined to be shed, and to give place 
 to the adult, or permanent set of teeth. Accordingly, in ob- 
 serving the progress of the formation of the first teeth, the ru- 
 diments of the second may also be seen in the foetus of the 
 seventh or eighth month : and in the fifth and sixth month after 
 birth, the ossification begins in them. The rudiments of the 
 permanent teeth maybe observed even when the sac is very small, 
 and appear like a filament stretching up to the neck of the sac of 
 the deciduous teeth. These sacs lie on the inner side of the 
 jaw-bone, and when further advanced, the necks of the two 
 sacs, (both as yet under the gum) are united ; but when the 
 first teeth are fully formed, and have risen above the gum, the 
 alveolar processes have been at the same time formed around 
 them, and now the sac of the permanent teeth have a connec- 
 
 Reffemble affez a une petite bourfe fertnee. 
 
OF THE TEETH. 
 
 237 
 
 tion with the gums through a small foramen in the jaw-bone, 
 behind the space through which the first teeth have shot. 
 
 The opinion now entertained, that the second set of teeth 
 pushes out the first, is very erroneous, for the change on the de- 
 ciduous and the growing teeth seems to be influenced by laws 
 of coincidence indeed, but not of mechanical action. Some- 
 times we observe the falling tooth wasted at the root, or on the 
 side of the fang, by the pressure of the rising tooth. Now 
 here vve should suppose that the newly-formed tooth should be 
 the most apt to be absorbed by the pressure of the root of the 
 deciduous tooth, did we not recollect that the new tooth is in- 
 vested with the hard enamel, while the pressure on the other 
 acts upon the bony root. But there is more than this in the 
 phenomenon of the shedding of the teeth, for often the fang is 
 wasted while the tooth adheres only by the gum, and the per- 
 manent tooth has made little progress in its elevation, and has 
 not pressed upon it. This decay and wasting of the fangs of 
 the teeth looks more like a satisfactory proof in support of their 
 vascularity, than any other change to which they are subject. 
 
 Yet there seems to be no reason why we should not suppose, 
 that as the rudiments of the teeth rise into action at a particu- 
 lar time, and form the bony centre of the tooth, this formation 
 should be affected by similar laws ; that at a particular period 
 the tooth should decay, and that the decay of the tooth should 
 begin with the destruction of the fangs. Neither can I resist 
 the belief that the bony part of the tooth has a tendency to 
 dissolution independently' of a circulation of blood through it, 
 or of an internal action of vessels, and that as the roots waste, 
 the surrounding vascular parts absorb its substance. 
 
 It is no proof of the first set being pushed out bv the second 
 set of teeth, that if the permanent teeth do not rise, the first 
 will remain, their roots unwasted and firm even to old age ; 
 for still I contend that there is an agreement and coincidence 
 betwixt the teeth in their changes, and also in the alveoli, by 
 which they are surrounded ; but this is not produced bv the 
 pressure of the rising teeth. When a dentist sees a tooth 
 seated out of the proper line, and draws it, and finds that he 
 has made the mistake of extracting the adult tooth, letting the 
 milk tooth remain, he must not expect that the milk tooth will 
 keep its place, for the contrary will happen, it will in general 
 fall out. 
 
 The old and the new teeth are lodged in distinct compart- 
 ments of the jaw-bone, and what is more curious, their 
 alveoli are distinct, for as the roots of the first teeth decay, 
 their alveolar processes are absorbed, while again, as the new 
 teeth rise from their deep seat in the jaw-bone, they are ac- 
 
238 
 
 APPENDIX. 
 
 companied with new alveoli ;* yet these alveoli are not suffi- 
 cient to support the teeth, for we find that the teeth will remain 
 long perfect while they uniformly retain their relative position 
 and number, but when one falls, the rest more quickly decay ; 
 and the chief art of the dentist in shifting the seat of the teeth, 
 is gradually to push them along the jaw notwithstanding these 
 bony partitions and processes, so as to bring them into equal 
 and seemly lines. 
 
 No circumstance can better illustrate how perfect the de- 
 pendence of the alveoli is upon the teeth, than that of their 
 being thrown off with them in extensive exfoliations. I have 
 a specimen of this in my collection, where the whole circle of 
 the alveolar processes and teeth is thrown off. This happened 
 after the confluent small-pox. I think I recollect a similar 
 case occurring to Dr. Blake. In those tumours which arise 
 from the alveoli and gums, filling the mouth with a cancerous 
 mass, and softening the upper part of the jaw, there is no 
 eradicating the disease but by taking away the whole adventi- 
 tious part of the jaw which belongs to the teeth, and leaving 
 only the firmer base. But even this operation will be too often 
 unsuccessful. 
 
 When a tooth is lost, it appears as if the space it occupied 
 were partly filled up by an increased thickness of the adjacent 
 teeth, and partly by the lengthening of that which is opposite : 
 indeed, this appearance has been brought as a proof of the 
 continual growth of teeth. But there is a fallacy in the obser- 
 vation ; for w hen the space appears to have become narrow by 
 the approximation of the two adjacent teeth, it is not owing to 
 any increase of their breadth, but to their moving from that 
 side where they are well supported to the other side where they 
 are not. For this reason they get an inclined direction ; and 
 this inclination may 7 be observed in several of the adjoining 
 teeth. j 
 
 The transplanting of teeth presents another very interesting 
 phenomenon. A tooth recently drawn, and placed accurately 
 into a socket from which one has been taken, will adhere there : 
 nay, it will even adhere to any living part, as in the comb of a 
 cock. This, however, proves nothing further than what all 
 allow, that the tooth possesses vitality, for after a time it w ill 
 not adhere ; it has become a dead part, and the living sub- 
 stance refuses to coalesce with it. Again, and in opposition 
 to this, is it not very extraordinary that the teeth may be 
 burnt by chemical agents, or the actual cautery, down to the 
 
 * Mr. Hunter, 
 f Mr. J. Hunter. 
 
OF THE TEETH. 
 
 239 
 
 centre, and yet retain their hold ; or that the body of the 
 tooth may be cutoff, and a new tooth fixed into it by a. pivot ? 
 Had the teeth any vascular action, this torturing would cause 
 re-action and disease in them. Sometimes the most terrible 
 effects are produced bv these operations, as tetanus, abscess in 
 the jaws, &c. ; but this happens in consequence of the central 
 nerve being bruised by the wedging of the pivot in the cavity 
 of the tooth, or by the roots of the teeth becoming, as dead 
 bodies, a source of irritation to the surrounding sockets. 
 
 The disease produced by the transplanting of teeth has not 
 been satisfactorily explained, though the investigation would 
 throw considerable light on the physiology of the teeth, and be 
 in itself of practical use. 
 
 About a month after transplanting the tooth, and after it has 
 taken perfect adhesion, the disease has appeared. An ulcera- 
 tion is perceived in the gum and jaw ; or the gum shrinking 
 and wasting by ulceration, leaves the tooth and alveoli bare. 
 Soon after, blotches appear on the skin ; and sometimes ulcers 
 in the throat. — In some cases, this disease has been cured 
 without mercury, and in others, seems only to have yielded to 
 the mercurial course. Mr. Hunter entertained the opinion 
 that it was not venereal, but a distinct disease ; and I find that 
 Richter supposes there are two diseases produced, the one ve- 
 nereal, and the other a peculiar affection. Others have suppos- 
 ed that this is not a disease propagated from the one person to 
 the other, but produced by the combination of the living prin- 
 ciple of two distinct systems ! In short, the case does not 
 seem to be well understood. Supposing it to be the venereal 
 disease thus propagated, (and this is the most likely sugges- 
 tion,) then it does not appear that we should consider it as an 
 inoculation of the matter of the disease, but of a part long con- 
 taminated, ingrafted : and in this view it will probably be 
 found necessary to continue the plan of cure as for an old affec- 
 tion, and not for the recent disease. 
 
 We may conclude that the teeth are peculiar in their sub- 
 stance and structure, in the manner of their growth and nutri- 
 tion ; and, as they are distinct from the other bones of the sys- 
 tem in their form and connections, so are they in their more 
 essential qualities. 
 
 Of the gums. — The necks of teeth are surrounded by the 
 gums, a red, vascular, but firm substance which covers the 
 alveolar processes. To the bone and to the teeth the gums ad- 
 here very strongly, but the edge touching the teeth is loose. 
 The gums have little sensibility in their healthy and sound 
 state ; and by mastication, when the teeth are lost, they gain a 
 degree of hardness which proves almost a substitute for the 
 
240 
 
 APPENDIX. 
 
 teeth. The use of the gum is chiefly to give firmness to the 
 teeth, and at the same time, as Mr. Hunter observes, to give 
 them that kind of support which breaks the jar of bony con- 
 tact. Like the alveolar process, the gums have a secret con- 
 nection with the state of the teeth. Before the milk-teeth ap- 
 pear, there is a firm ridge which runs along the gums,* but this 
 is thrown off, or wastes with the rising of the teeth : and as the 
 teeth rise the proper gums grow, and embrace them firmly. 
 The gum is firm, and in close adhesion, when the teeth are 
 healthy ; loose, spongy, or shrunk, when they are diseased. 
 The only means of operating upon the general state of the teeth 
 is through the gums ; and by keeping them in a state of healthy 
 action by the brush and tinctures, the dentist fixes the teeth, 
 and preserves them healthy ; but when they are allowed to be 
 loose and spongy, and subject to frequent bleeding, (which is 
 improperly called a scorbutic state,) the teeth become loose, 
 and the gums painful. If a healthy tooth be implanted in the 
 jaw, the gum grows up around it, and adheres to it ; but if it 
 be dead or diseased, the gum ulcerates, loosens, and shrinks, 
 from it ; and this shrinking of the gums is soon followed by 
 the absorption of the alveoli. 
 
 From the disorder of the teeth, the gums are subject to 
 many diseases ; some of them troublesome, some dangerous, 
 or at least giving rise to dangerous diseases. They swell from 
 tooth-ach and inflammation of the centre of the tooth (parulis,) 
 or form tumours from the side of the tooth (epulis.) Often 
 suppuration follows these swellings ; and the matter making its 
 way by the side of the jaw, and destroying the alveoli, trouble- 
 some fistulie are the consequence. The accumulation of tartar 
 on the teeth is the cause of an ulceration and wasting of the 
 gums, in the end very injurious to the teeth. The soft, spon- 
 gv, and bleeding tumours w r hich arise from the gums, are in 
 fact diseases of the bone, or rather the peculiar characteristic 
 of the disease of the alveoli and of the cancelli of the jaw- 
 bone ; and cannot be cured but by a practice which reaches to 
 the root and origin of the disease. 
 
 OF THE FIRST AND SECOND SET OF THE TEETH. 
 
 Before we observe the classing of the adult teeth, we must 
 attend to the two sets of teeth, the infantine or deciduous teeth, 
 and the adult or permanent teeth. 
 
 The first set of teeth are twenty in number : these are divid- 
 ed into three classes ; the incisores, four in each jaw ; the 
 
 See Heriffant. 
 
OF THE TEETH. 
 
 241 
 
 cuspidati, two in each jaw ; and the molares, four in num- 
 ber in each jaw. 
 
 The teeth of a child generally appear in this order : first the 
 central incisores of the lower jaw pierce the gum. In a month 
 after, perhaps, their counterparts appear in the upper jaw. 
 These, in a few weeks, are succeeded by the lateral incisores 
 of the lower jaw ; then the lateral incisores of the upper jaw. 
 The growth of the teeth is not after this in a regular progres- 
 sion backwards, for now, instead of the cuspidati, which are 
 immediately lateral to the incisores, the anterior molares of the 
 lower jaw slowly lift their white surface above the gum about 
 the fourteenth or fifteenth month. Now the cuspidati pierce 
 the gum ; and, lastly, the larger molares make their appear- 
 ance, the teeth of the lower jaw preceding those above. The 
 last tooth does not rise till the beginning of the third year. 
 
 The teeth do not always cut the gum in this order ; it is only 
 the more regular and common order. When the teeth appear 
 in irregular succession, more irritation and pain, and more of 
 those symptoms which are usually attributed to teething, are 
 said to accompany them, an opinion which I believe to have 
 arisen from some casual observations. 
 
 The deciduous set of teeth terminates with the rising of the 
 second molaris ; for the third molaris being formed about the 
 eighth year, when the jaw is advanced towards its perfect form, 
 is not shed, but is truly the first permanent tooth. The molares 
 of the adult are properly the permanent teeth (immutabiles,) 
 for all the others are deciduous, and are replaced by the adult 
 set ; yet we must recollect that, in opposition to Albinus, in 
 this arrangement, it is more common to speak of the whole set 
 of the adult teeth as the immutabiles. 
 
 In the sixth and seventh years the jaws have so much en- 
 larged, that the first set of teeth seems too small, spaces are 
 left betwixt them, and they begin to fall out, giving place to the 
 adylt teeth. But the shedding of the teeth is by no means re- 
 gular in regard to time ; the child is already no longer in a 
 state of nature, and a thousand circumstances have secretly af- 
 fected the health and growth. The teeth even fall out three 
 years earlier in one child than in another : nay, so frequently 
 are some of them retained altogether, that it would appear ne- 
 cessary to be assured of the forward state of the adult tooth 
 before the tooth of the first set should be thoughtlessly drawn. 
 
 The jaw-bones at e still so small, that the second set of teeth 
 must rise slowly and in succession, else they would be accumu- 
 lated into too small a circle, and of course turned from their 
 proper direction. 
 
 ' Vol. IV. 2 H 
 
‘242 
 
 APPENDIX. 
 
 The incisores of the under jaw are loose commonly when 
 the anterior of the permanent molares are thrusting up the gum. 
 The permanent central incisores soon after appear, and in two 
 or three months those of the upper jaw appear. In three or 
 four months more the lateral incisores of the lower jaw are 
 loosened, and the permanent teeth appear at the same time the 
 anterior molares have appeared. The lateral incisores of the 
 upper jaw follow next; and, in from six to twelve months 
 more, the temporary molares loosen, the long fangs of the cus- 
 piclati retaining their hold some time longer. 
 
 The anterior molares and the cuspidati falling, are succeeded 
 about the ninth year by the second bicuspides and the cuspi- 
 dati. The posterior bicuspides take the place of the posterior 
 molares about the tenth or eleventh year. The second perma- 
 nent molares do not appear for five or six years from the com- 
 mencement oi the appearance of the permanent teeth. The 
 last of the molares, c r the dens sapiente, appears from the fif- 
 teenth to the twentieth, or even to the twenty-fifth year. 
 
 CLASSES OF THE ADULT TEETH. 
 
 The teeth at full maturity are thirty-two in number,* and 
 they are divided into these classes, incisores , cuspidati , bicus- 
 pidi , and molares. 
 
 The incisores are eight in number, four in each jaw : they 
 are of the simplest form, their edges are even, and laterally 
 they contract equally to the neck : they are gibbous, forward, 
 and slightly concave on the inside ; their roots are simple. 
 The incisores of the upper jaw are larger and stronger; those 
 of the lower jaw are smaller, neater, and for the most part 
 evenly set, while the teeth of the upper jaw are more fre- 
 quently irregular from being crowded together. 
 
 The cuspidatif are four in number, one lateral to the in- 
 cisores of each jaw. They are stronger than the last in their 
 form ; thicker at their base : in the gum more convex forward, 
 and terminate with a notched central point. In general, and 
 particularly in the lower jaw, they project further than the other 
 teeth; their roots are single and long ; they stand betwixt the 
 incisores and grinders in form as in place, for they seOm 
 neither perfectly adapted to cut like the incisores, nor tor 
 grinding. “ We may trace in these teeth,” says Mr. Hunter 
 
 * From twenty-eight to thirty-two in number — Hunter. 
 
 f Dentes caiiini , tlie eye-teeth, from their place of original lodgment in the 
 upper jaw. 
 
OV THE TEETH. 
 
 243 
 
 u a similarity in shape, situation, and use, from 1 he most im- 
 perfect carnivorous animal which we believe to be the human 
 species, to the most perfect carnivorous animal, the lion.” 
 
 Next in order from the symphysis of the jaw rise the bi- 
 cuspides, the fourth and fifth teeth. These are eight in num- 
 ber, and accurately resemble each other. Taking one, we 
 may observe that it is flattened laterally, answering to the flat 
 side of the root, and that it terminates in two acute points : 
 the internal of these points, evtn when not worn down, is the 
 least. The second bicuspes is often wanting. The bicuspides 
 are veiy often called the anterior grinders. Their roots are 
 single, or appear like two fangs united ; or the first bicuspes has 
 in general two small fangs, or is rather forked ; the others 
 seldom more than one. Their roots are oftener curved than 
 those of the other teeth. 
 
 The first and second grinders are nearly alike. The body 
 of these forms almost a square ; generally five points project 
 from their grinding surface, which makes an irregular cavity 
 in the centre : often some lesser tubercles, or points, are to be 
 observed at the base of the larger ones. The neck of the 
 tooth is but little contracted. There are two fangs, one for- 
 ward, the other backward, with their edges turned outward ; 
 their extremities are broad, often bifurcated, and shorter than 
 those of the bicuspides. There are two cavities to each fang 
 leading to the general cavity in the body of the tooth. The 
 fangs at their middle part are generally bent a little backward. 
 The upper grinders have three diverging fangs, and they are 
 more pointed, and have but one canal. They are directly un- 
 der the floor of the maxillary sinus. 
 
 The jaw acquires its full proportion about the age of eigh- 
 teen or twenty, when the third molaris, or the dens sapientice , 
 makes its appearance. It is shorter and smaller, and is in- 
 clined more inward than the others. Its fangs are less regular 
 and distinct, being often squeezed together. From the cus- 
 pidati to the last grinder, the fangs are becoming much short- 
 er ; and from the first incisor to the last grinder, the teeth 
 stand less out from the sockets and gums. 
 
 FINIS. 
 

 
 
 
 
 
I 
 
 Bell