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 LIGAMENTS 
 
 THEIR 
 
 NATURE AND MORPHOLOGY 
 
LIGAMENTS 
 
 THEIR 
 
 NATURE AND MORPHOLOGY 
 
 BY 
 
 JOHN BLANLVSUTTON, F.R.C.S. 
 
 LECTURER ON COMPARATIVE ANATOMY, SENIOR DEMONSTRATOR OF ANATOMY, AND 
 
 ASSISTANT SURGEON TO THE MIDDLESEX HOSPITAL; ERASMUS WILSON 
 
 LECTURER, ROYAL COLLEGE OF SURGEONS, ENGLAND. 
 
 LONDON 
 H. K. LEWIS, 136 GOWER STREET, W.C. 
 
 18S7 
 
PRINTED BT 
 ■ . K. LEWIS. 136 GOWEK STRELT, 
 LONDON, W.C. 
 
PREFACE. 
 
 Five years ago. whilst examining" a partially dissected 
 Ostrich, my attention was arrested by the remarkable 
 tendon-like appearance of the Ligamentum Teres in the 
 hip joint. Closer examination induced me to believe 
 that the ligament was connected with muscles at the 
 margin of the acetabulum. An investigation of the hip 
 joint in a Horse and the curious New Zealand Lizard 
 Hatteria (Sphenodon), lead me to regard the ligament 
 in man as the divorced tendon of the pectineus muscle. 
 Later I found muscle and ligament directly continuous 
 in an Ostrich chick. 
 
 The result was somewhat startling and incited me 
 to trace out the ancestry of various ligaments in the 
 body, as time and opportunity permitted. The results 
 of the investigation were made known in a series of 
 papers published in the Journal of Anatomy and Physiology, 
 vol. xvii. (1883), vols, xviii., xix., and xx. (1886), under 
 the title "The Nature of Ligaments." 
 
 In this present treatise an attempt is made to write a 
 systematic account of ligaments and fasciae generally, 
 taking care to avoid tedious descriptions, but being con- 
 tent to confine attention to morphology and ancestral 
 history. It has been necessary to appeal again and 
 again to Comparative Anatomy, and the student will feel, 
 
vi PREFACE. 
 
 in studying even ligaments, the truth of Bacon's remark 
 that, "No natural phenomenon can be studied in itself 
 alone, but, to be understood, must be considered as it 
 stands connected with all nature." 
 
 Lastly, facts revealed by one series of dissections have 
 led me to anticipate the existence of conditions in animals 
 which I had not previously dissected. This recalled to my 
 mind, with redoubled force, Miiller's statement, "Com- 
 parative Anatomy in its complete form leads to such 
 necessary consequences, that expressions may be found 
 for organizations, which are like the expressions of an 
 equation. If these expressions are found, the unknown 
 quantities may, in a given case, be reckoned from the 
 known." 
 
 In order to meet the wants of the student of human 
 anatomy, I have avoided overburdening the general 
 account with facts purely comparative. These have for 
 convenience been concentrated in one chapter. 
 
 To my talented friends, Messrs. E. B. Osmond and 
 W. E. Wynter, is due all the credit of the drawings 
 from which the illustrations were taken. Mr. Osmond, 
 in addition, transferred the drawings on to the blocks; 
 I owe him more thanks than can be well expressed. My 
 friend Mr. Daniel Thurston kindly assisted me in correct- 
 ing for the press. 
 
 22 Gordon Street, London. 
 January, 1887. 
 
CONTENTS. 
 
 PAGE 
 
 Introduction ........... i 
 
 CHAPTER I. 
 
 Regression of Muscles in its relation to Ligaments .... 8 
 
 CHAPTER II. 
 
 Examples of Metamorphosis and Regression of Muscles from the 
 
 Lower Vertebrates ......... 25 
 
 CHAPTER III. 
 
 Migration of Muscles in relation to Ligaments . . . -35 
 
 CHAPTER IV. 
 
 The Knee Joint and Ankle ........ 42 
 
 CHAPTER V. 
 
 The Ligaments of the Pectoral and Pelvic Girdles . . . -58 
 
 CHAPTER VI. 
 
 Ligaments in connection with the Appendicular Elements of the 
 
 Skull and Vertebral Column ....... 75 
 
 CHAPTER VII. 
 
 Ligaments of the Vertebral Column (continued) . . . .86 
 
 CHAPTER VIII. 
 
 The Manus ........... 93 
 
 An Appendix containing a list of Mammals with a well developed 
 
 Gleno-Humeral Ligament. ....... 100 
 
 Indix 105 
 
LIST OF ILLUSTRATIONS. 
 
 teres 
 
 of 
 
 FIG. 
 
 i. Humerus of a foetal lion 
 
 2. The supra-condyloid process in man .... 
 
 3. The scapula of a two-toed sloth (Choloepus hoffmanni) 
 
 4. The epitrochleo-anconeus muscle of man . 
 
 5. The epitrochleo-anconeal fascia .... 
 
 6. The epitrochleo-anconeus muscle of an opossum 
 
 7. 8, 9. The variations of the human coraco-brachialis muscle 
 
 10. The lumbar fascia .... 
 
 11. The forelimb of a porpoise . 
 
 12. The bicipital loop in the thigh of a fowl 
 
 13. The bicipital loop in a Rhea 
 
 14. The upper end of the femur of an ostrich with ligamentum 
 
 15. The femoro-caudal muscle of Iguana tuberculata 
 
 16. Vertical section of the knee joint of a human embryo 
 
 17. The inferior anterior annular ligament of the ankle joint 
 
 monkey ......... 
 
 18. The anterior annular ligaments of the ankle joint of a bird 
 ig. The leg of a chick at the fifth day of incubation 
 
 20. The leg of a chick at the eighth day of incubation 
 
 21. The tibio-tarsus of an ostrich chick 
 
 22. A general view of the ligaments of the pectoral arch 
 
 23. The shoulder girdle of an ostrich chick , 
 
 24. The shoulder girdle of Ornithorhynchus 
 
 25. The gleno-humeral ligament of a beaver 
 
 26. The shoulder girdle of a bird with the subclavius muscle 
 
 27. The pelvis of a sloth 
 
 28. The human chondro-cranium and appendages 
 
 29. The transformation of the appendages 
 
 30. The conjugal ligaments of a seal 
 
 31. The conjugal ligaments of a human foetus 
 
 32. The constitution of an intervertebral disc . 
 
 33. A portion of the vertebral column of a skate 
 
 34. The intervertebral disc between the odontoid process and the 
 
 body of the axis 
 
 35. The subnotochordal rod of a tadpole 
 
 36. The manus of the water tortoise 
 
 37. The carpus of a baboon .... 
 
 38. Rudimentary centrale of the embryonic carpus 
 
 39. Human scaphoids with fused centrals 
 
 PAOE 
 
 5 
 5 
 6 
 10 
 10 
 10 
 12 
 
 21 
 26 
 29 
 29 
 40 
 
 44 
 47 
 
 49 
 50 
 5i 
 52 
 54 
 59 
 60 
 
 63 
 66 
 
 67 
 73 
 76 
 76 
 78 
 79 
 79 
 81 
 
 88 
 9i 
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 94 
 96 
 96 
 
LIGAMENTS 
 
 THEIR 
 
 NATURE AND MORPHOLOGY. 
 
 INTRODUCTION. 
 
 As our mother earth receives alike the remains of kings, 
 philosophers and peasants, so Nature buries in fibrous 
 tissue, structures which were in histological rank far 
 superior to the ligamentous tissue which now hides them, 
 so disguising their former nature and true significance that 
 they become reduced to the level of structures whose duty- 
 is menial indeed. 
 
 Morphological problems of the greatest interest may 
 centre around a single band of fibrous tissue, whilst in the 
 immediate neighbourhood, ligaments abound of functional 
 value, but of no interest to the morphologist. 
 
 To sort out from among the enormous heap of structures 
 known as ligaments, those which can boast a noble de- 
 scent, and trace the history of their downfall is the object 
 of the present treatise. Attention will also be devoted to 
 those tracts of fibrous and tendinous tissues known as apo- 
 neuroses. Joints and ligaments have long been a dry study 
 with students, but the following pages will serve to shew that 
 some of the most important processes of evolution may be 
 inculcated by an earnest study of these apparently unin- 
 teresting bands. The more important ligaments of the 
 body are derived either from the metamorphosis and re- 
 gression of muscles, or the degeneration of osseous and 
 cartilaginous tissues. Each will therefore be separately 
 considered. 
 
 B 
 
LIGAMEXTS. [Introduction. 
 
 Metamorphosis of Muscle. — Any one dissecting- an 
 amphibian or reptile for the first time, must be impressed 
 with the small amount of tendon entering into the composi- 
 tion of the muscles. This becomes more marked when the 
 muscular system of an amphibian is compared with one of 
 the higher mammals. Muscle and tendon have too long- 
 been regarded as distinct tissues ; the arrangement of 
 the fibres in tendon strongly recalls those of the fasciculi in 
 the belly of a muscle. It is very difficult to determine how 
 the muscle and tendon are joined, or by what means the 
 union is brought about, for the parts become insensibly 
 blended. 
 
 The position of tendons has an important bearing on this 
 question : — As a rule they are situated at the extremities of 
 muscles where contractile tissue has little opportunity of 
 exerting itself advantageously, e.g., the long tendon of the bi- 
 ceps at the shoulder, the elongated tendons of the flexors and 
 extensors of the fingers and toes. When a tendon develops 
 in the centre of a muscle, as in the digastricus of man, it is 
 usually in a situation where muscular tissue would be of little 
 avail. Again, when a muscle is so circumstanced that its 
 contractile power can be brought into play throughout its 
 whole length, it may remain muscular in structure from 
 origin to termination, as in the case of the intrinsic and 
 extrinsic muscles of the tongue. If either or both extremi- 
 ties of a muscle fail to act to full advantage, the reason 
 for the existence of such a tissue fades, and the ends degen- 
 erate into tendons to play an important part nevertheless 
 as passive agents. Physiologists agree that voluntary 
 muscle fibre is to be regarded as one of the master- 
 tissues of the animal body. To maintain such highly 
 specialised structure in good condition the frequent exer- 
 cise of its function is necessary. Parts frequently used 
 are, as a rule, abundantly supplied with blood, for healthy 
 performance of function depends on the organ being 
 adequately nourished. If these premises be correct then 
 the conclusions which must necessarily follow are these: — 
 
Introduction.] REGRESSIOX OF MUSCLE, 3 
 
 The ends of certain muscles are badly situated to exert 
 their full contractile power, or on account of modification 
 in the creature's habits, portions of, and in some cases 
 whole muscles become rarely used or rended inoperative. 
 Loss of function leads to diminished blood supply, decrease 
 in the amount of nutrition ends in degradation of tissue- 
 The converse of this leads to hypertrophy. The ends of 
 muscles, when compared with the central portions, are 
 passive; they need little blood supply, and become in 
 consequence, metamorphosed into tendon. The active central 
 parts are often called into play, are well nourished and 
 increase in size and quality. A very good illustration of 
 this presents itself in the biceps flexor cubiti. 
 
 If the muscle to which the tendon belongs is one fre- 
 quently exercised as in the case of the gastrocnemius and 
 soleus, the attached tendon contains a very large amount 
 of elastic tissue. 
 
 Regression of Muscle. — When a muscle degenerates 
 either from morphological or pathological reasons, the 
 amount of contractile tissue is diminished, and the parts 
 take on the character of fibrous tissue and become liga- 
 ment. This change may conveniently be referred to as 
 regression. 
 
 These two processes metamorphosis and regression assisted 
 by a singular change of position in muscles known as 
 migration, which will be considered in detail later, have 
 been most active in providing ligaments in the limbs. 
 
 The view that tendon results from the metamorphosis of 
 muscle receives great support from the fact that nerves 
 terminate in them by developing end-organs something 
 like those of muscle. These curious terminations have 
 been especially studied by Golgi. They seem to be most 
 numerous near the muscular insertion. They may form 
 peculiar reticulated plates of primitive fibrillae, or end in 
 structures recalling the end-bulbs found in the conjunctiva. 
 The question of the relation of muscles, tendons, liga- 
 ments and nerves has a practical bearing, inasmuch as it 
 
 B 2 
 
 S 
 
LIGAMENTS. [Introduction . 
 
 affords an anatomical explanation of the knee-jerk phe- 
 nomenon so familiar to school-boys, which when used by 
 the physician becomes an example of "philosophy in sport 
 made science in earnest." 
 
 It also serves to account for the intense pain caused by 
 tension of a joint or the accumulation of pus under dense 
 fascia. The curious and intractable contractions of palmar 
 and plantar fasciae and other aponeurotic structures are 
 more comprehensible if we regard them as arising from the 
 metamorphosis and regression of muscles. 
 
 Degeneration of osseous and cartilaginous tis- 
 sues. — Ligaments arising by this method occur with 
 greatest frequency in the axial skeleton and pectoral 
 girdle. As a very large portion of what is to follow in 
 the succeeding chapters is devoted to the consideration of 
 this question, it will be unnecessary to spend much time in 
 giving illustrations here, but it may be mentioned as a 
 further inducement to those who are inclined to prosecute 
 the further study of this question, that the inquiry will 
 carry the investigator into some of the most fascinating 
 regions of morphological science. 
 
 As an example of the method by which ligaments arise 
 from the degeneration of bone or cartilage, we may 
 select the supra-condyloid foramen. 
 
 In many carnivora, rodents, lemurs, and others, there 
 exists above the internal condyle of the humerus, a bony 
 tunnel known as the supra-condyloid foramen. This 
 transmits as a rule, the median nerve and the brachial 
 artery. 
 
 In a young lion at birth as in the fcetal cat, the foramen 
 is in part formed by an outgrowth from the diaphysis, as 
 well as by an upgrowth from the epiphysis, as in fig. I. 
 In man the most frequent condition of this foramen when 
 existing, is to have the upper part of the ring formed by an 
 osseous outgrowth from the humeral shaft, and named the 
 supra-condyloid process. The lower part of the ring is 
 completed by a band of fibrous tissue extending to the 
 
Introduction.] DEGENERATION. 5 
 
 internal condyle, and as a rule affords attachment to the 
 
 pronator radii teres muscle. 
 
 Fig. 2. 
 
 Fig. i.— The humerus of a foetal lion, showing that the supra- 
 condyloid foramen x is formed by the diaphysis and epiphysis. 
 
 Comparing- the foramen when present in man with 
 that of the lion, it will be seen that the portion of the ring- 
 derived from the epiphysis is represented by fibrous tissue. 
 
 Fig. 2. — The supra-condyloid process in man. 
 
 (For full details the student should consult Struther's 
 Anatomical and Physiological Observations, 1 85 4). 
 
 * The observations of Baur seem to show that in the Armadillo the 
 supra-condyloid foramen is complete in the shaft without the aid of the 
 epiphysis. Morph. Jahrbuch, 1886. 
 
LIGAMENTS. [Introduction. 
 
 The notch in the upper border of man's scapula which 
 transmits the supra-scapular nerve and occasionally the 
 artery, is usually converted into a foramen by a band of 
 fibrous tissue. Frequently this ligament, known as the 
 transverse, is replaced by bone. 
 
 It is characteristic of sloths that this foramen is sur- 
 rounded by bone, and its mode of formation is interesting. 
 
 In the young ant-eater (I\/yn?iccophaga jubatd) the foramen 
 is composed in part by the body of the scapula and com- 
 pleted by the coracoid process, thus affording an interesting 
 example in the limbs of a passage of a nerve between two 
 centres of ossification, a condition of things almost con- 
 stant in the skull. Therefore I am disposed to the view 
 that the transverse ligament in man is the fibrous repre- 
 sentative of this bony bridge constant in sloths, and that 
 the occasional occurrence of a complete osseous foramen 
 
 Fig. 3.— The scapula of a sloth, showing F, the osseous coraco-scapular 
 (supra-scapular) foramen, C, coracoid. 
 
 in this situation is not to be regarded as an ossification of 
 the transverse ligament, but as a reversion to a former 
 condition. 
 
 As the suprascapular notch is formed in part by the 
 scapula and coracoid process in man and other mammals, 
 it would be far more convenient to refer to it by the name 
 it bears in comparative anatomy — the coraco-scapular 
 foramen, fig. 3. 
 
 In man the tendon of the biceps plays in a groove at the 
 upper end of the humerus, in him as in some carnivora, as 
 the lion, tiger, and bear, this groove is arched over at its 
 
Introduction.] DEGEXERA TIOX. J 
 
 upper end by a broad band of fibrous tissue, converting- 
 it into a tunnel. In the mole as my friend Mr. Austin 
 Freeman demonstrated to me, the tendon plays in a most 
 perfect osseous tunnel. 
 
 Among- other examples of the interchangeability of 
 fibrous and osseous tissues, the following may be briefly 
 referred to here : — 
 
 In many carnivorous mammals and a few others, the 
 tentorium cerebelli is replaced by a plate of bone. 
 
 Among reptilians, some turtles present a curious ano- 
 maly, for the temporal fascia, so conspicuous in man, 
 is in these animals represented by a layer of stout bone. 
 This condition is also found in a certain frog named 
 Pelobates. The only known mammal in which this arrange- 
 ment exists is a singular specimen of rodent from Africa 
 named Lophiomys. 
 
 The pillars of man's external abdominal ring, in that 
 they consist chiefly of fibrous tissue, agree with the majority 
 of mammals, yet in those singular groups, the Ornitho- 
 delphia and Didelphia, the internal pillar is directly ossified 
 to form the marsupial bone. 
 
 On the other hand, bones in man which as a rule are 
 well-formed, may be replaced by fibrous tissue. Thus the 
 fibula has been represented by ligament, and numerous 
 cases are on record of the shaft of the first rib in man 
 being merely a fibrous band extending to the sternum. 
 
 * Journal of Anatomy] and Physiology, vol. xx., p. 206. " On the 
 Myology of the Forelimb of the Mole." 
 
CHAPTER I. 
 
 Metamorphosis and Regression of Muscles in Relation 
 
 to Ligaments. 
 
 The principal arguments in this chapter concerning- the 
 nature of some of the ligaments of man's body, depend on 
 the circumstance that muscles under certain conditions 
 degenerate into fibrous tissue, which may become utilised 
 as ligament if occasion demands. It will be well, therefore, 
 to commence the discussion by the consideration of a few 
 indisputable instances. Professor Watson mentions the 
 occurrence of the curvatores coccygis muscles in man ; they 
 arose from the anterior surface of the sacrum between the 
 third and fourth sacral foramina, also from the anterior 
 surface of the body of the fifth sacral vertebra. They were 
 inserted into the front surface of the body of the second, 
 third, and fourth coccygeal vertebrae. 
 
 The Professor then goes on to relate that Albinus, in his 
 Histories Musculorum, p. 336, had noted this muscle in three 
 subjects, but that in others they were replaced by ligament- 
 ous or tendinous fibres. The exact statement is: " Inveni 
 cumintribus; in alio imperfectionem et degenerantium; 
 in aliis non musculo, sed ligamento simile." The -extract 
 is quoted here as affording excellent testimony to the 
 degeneration of muscles into ligamentous tissue, from so 
 famous an anatomist as Albinus (1734). 
 
 The bands of fibrous tissue passing from the lower sacral 
 vertebrae to the coccyx, and known as the posterior sacro- 
 coccygeal ligaments, represent in man the extensor 
 coccygis of anthropomorphae, or extensor of the caudal 
 vertebrae of other animals. In man the place of these 
 ligaments is occasionally occupied by muscles, the attach- 
 ments of which are thus described by Hyrtl : — 
 
 * Journal of Anatomy and Physiology, vol. xiv., p. 407. 
 
Chap, i.j METAMORPHOSIS OF MUSCLE. 
 
 "The muscles are found between the hinder surface of 
 the sacral vertebrae and the last piece of the coccyx. They 
 are a pair of tendinous muscles, repetition of a muscle 
 which appears in most mammals — sacro-coccygeus posticus seu 
 extensor coccygis" (Lehrbuch der Anatomie, 14M Aujiage, 487). 
 
 The preceding cases serve as excellent illustrations of the 
 rules to be followed in forming" conclusions as to whether 
 any particular band of fibrous tissue represents a degen- 
 erated muscle : — 
 
 1. It must correspond with its presumed representative 
 
 in origin and insertion. 
 
 2. The muscle should occasionally reappear as an 
 
 anomaly in the human subject and replace the 
 fibrous tissue. 
 
 3. Failing Rule 2, the muscle should assume a functional 
 
 importance in other animals. 
 
 If Rules 1 and 2 be satisfied, the assumption that a given 
 fibrous band represents the muscle is reasonable ; if the 
 third rule be sustained, the evidence is then very strong, 
 and becomes almost a certainty. 
 
 When Rules 1 and 2 are not satisfied, the notion of re- 
 presentation should be entertained with caution. 
 
 Thus — (1) The place of the curvator coccygis is occa- 
 sionally occupied by a fibrous band. (2) This band is 
 occasionally replaced by the curvator as a functional 
 muscle; it is then regarded as an anomalous structure. 
 (3) The curvatores coccygis, as seen in man, are repre- 
 sentatives in him of the depressores caudae present in very 
 many of the lower mammals. 
 
 These rules are well illustrated by the epitrochleo-anconeus, 
 an occasional muscle in man, which arises from the back 
 part of the internal condyle of the humerus and is inserted 
 into the inner side of the olecranon process. It forms the 
 tunnel for the ulnar nerve, and when not represented by 
 muscle a piece of fascia occupies its place, this fascia may 
 be regarded as .the degenerated muscle. Gruber has 
 described the epitrochleo-anconeus as being the most frequent 
 muscular abnormality in the body. 
 
IO 
 
 LIGAMENTS. 
 
 [Chap. i. 
 
 The chief points in its anatomy are represented in the 
 accompanying- drawings, fig". 4 represents the muscle as it 
 
 occurs in man, fig. 5 shows it replaced by a tract of fibrous 
 tissue — the usual condition. Fig-. 6 represents the elbow- 
 
 JUl. 
 
 joint of a Virginian opossum, in whom this muscle con- 
 stantly occurs. 
 
 UJl. 
 
 E.A.muscIe 
 Fig. 6. 
 
 The epitrochleo-anconeus exists in a very large number 
 of mammals. 
 
 * For further details consult J. C. Galton, Journal of Anatomy and 
 Physiology, vol. ix., p. 169. 
 
Chap, i.] C0RAC0-BRACH1ALIS. II 
 
 A muscular slip in the sole of the foot of man, known 
 as Wood's muscle, is a case in point. It arises from 
 the external tuberosity of the calcaneum, and is inserted 
 into the prominence at the base of the fifth metatarsal bone 
 in common with the outer margin of the plantar fascia. 
 The muscle is occasionally referred to as the abductor ossis 
 metatarsi quint 7. According- to most authorities it is present 
 once in every two subjects, but my observations shew it to 
 be even of such frequent occurrence that I am in the habit 
 of teaching - that the first layer in the sole of the foot con- 
 sists of four muscles, thus regarding Wood's muscle as of 
 normal occurrence. When not present in a functional con- 
 dition a stout band of fibrous tissue occupies its place. 
 
 The muscle was present in the feet of two chimpanzees 
 which I had the opportunity of dissecting- ; and it occurs in 
 many other quadrumana. 
 
 Like the preceding- muscles it well exemplifies the neces- 
 sary rules, thus it may be present as a functional muscle, or 
 represented by fibrous tissue, while it is a well and 
 normally developed muscle in lower mammals. 
 
 The Coraco-Brachialis Muscle. 
 
 For the true history of this interesting- muscle we are 
 indebted to the labours of Prof. Wood. This anatomist 
 has pointed out that the coraco-brachialis in mammals has 
 for the most part a triple constitution. The muscle arises 
 from the tip of the coracoid process of the scapula in 
 company with the short head of the biceps, with which it 
 is united for some distance, and is inserted into the inner 
 border of the humerus near its middle. Some of the 
 higher fibres are attached to a fibrous loop extending 
 from the coracoid process to the lesser tuberosity of the 
 humerus. Viewed in the light afforded by a study of the 
 
 * Journal of Anatomy and Physiology, vol. i., p. 44, 1867. 
 
12 
 
 LIGAMENTS. 
 
 [Chap. i. 
 
 variations this muscle is subject to in the human body, and 
 information gained from comparative myology, the coraco- 
 brachialis presents three parts. 
 
 1. The portion represented by the fibrous loop may 
 
 develop as a distinct muscle attached to a lesser 
 tuberosity of the humerus and known as the rotator 
 humeri. 
 
 2. The middle portion is the cot aco-brachialis of ordinary 
 
 human anatomy. 
 
 N 
 
 Fig. 7. — The usual arrangement of the muscle, C, fibrous ligament 
 representing coraco-brachialis sup., C", the medius, and C", the longus, 
 in part ligament, N, the musculo-cutaneous nerve. 
 
 3. The third piece may exist as a muscular belly extend- 
 ing from the common tendon to the internal condyle 
 of the humerus. It is rare to find this piece fully 
 developed, its situation being marked out by the 
 fibrous band which commonly extends from the 
 lower part of the muscle to the elbow, and is 
 familiar as the internal brachial ligament of Struthers. 
 Figs. 7, 8 and 9. 
 
 The first may be called the coraco-brachialis superior or 
 
Chap, i.] 
 
 CORA CO-BRA CHIALIS. 
 
 13 
 
 brevis, the second is the coraco-brachialis proprius or medius, 
 and the third coraco-brachialis longus. This arrangement 
 
 Fig. 8.— C C" C"\ as in fig. 7. 
 
 recalls in a very striking- manner the disposition of the 
 adductor brevis, longus, and magnus, in the thigh. Fig. 8. 
 
 Fig. 9. — C, functional upper segment, C'' and C" as in fig. 7. 
 
 A great deal of variation exists among mammals as to 
 the development of the various parts of this muscle. In 
 
i 4 LIGAMENTS, [Chap. i. 
 
 some the rotator humeri alone is developed, in others only 
 the middle segment. A few have the second and third 
 portions as a well developed muscle extending- to the in- 
 ternal condyle. For further details the student should 
 consult Wood's admirable paper before mentioned. 
 
 The Interosseous Membrane of the Forearm and Leg. 
 
 Passing - between the radius and ulna is a flat fibrous 
 membrane, known as the interosseous membrane of the 
 forearm. Its fibres are directed for the most part obliquely 
 downwards from the radius to the ulna, the membrane 
 commences a little below the bicipital tubercle. On the 
 posterior aspect small bundles of fibrous tissue intersect 
 the direction of the main fasciculi at right angles. Lying" 
 on the membrane are the anterior interosseous nerve and 
 arterv. Careful dissection shows that small bands of tissue, 
 intimately connected with the membrane, arch over and 
 thus enclose the nerve and artery in a fibrous tunnel. In 
 the leg a similar interosseous membrane exists, the fibres 
 of which pass more or less horizontally from the fibula to 
 the tibia and are intersected by fibres, passing- obliquely 
 between the two bones in different directions. The 
 anterior tibial nerve and artery bear the same relation to 
 the membrane as is the case in the forelimb. 
 
 In the iguana, gecko, menopoma, sphenodon. chameleon, 
 and the like, a muscle exists, the fibres of which arise from 
 the fibula to be inserted into the tibia, thus occupying the 
 position of the interosseous membrane so common among 
 mammals. The muscle in question has been named the 
 peroneo-tibial and it exists in a well-developed form in the 
 hind leg of the wombat. 
 
 The anatomical relations of the muscle may be studied 
 most completely among the lizards. 
 
 If the interosseous membranes in the forearm and leg of 
 man were not originally derived from a peroneo-tibial 
 
Chap, i.] PALMAR AND PLANTAR FASCIA. 15 
 
 muscle, they are at least the morphological representatives 
 of that structure. As the muscle occurs within the mam- 
 malian circle, it is not unreasonable to regard these mem- 
 branes as degenerated muscles. If this view be accepted, 
 then the anterior interosseous arteries and nerves are to 
 be regarded as those originally ministering to this re- 
 markable muscle. The fibrous tunnel in which they lie is 
 formed as a consequence of the degeneration of the muscle 
 which they once supplied. 
 
 It is quite possible that the popliteus is a remnant of the 
 original peroneo-tibial muscle, also the rotator fibulae of 
 the gibbon. 
 
 The Palmar and Plantar Fascia. 
 
 The palmar and plantar fasciae are structures so well 
 known to the student of human anatomy, that it would be 
 tedious even to recapitulate the details connected with their 
 anatomy. It is sufficient for the purposes of morphology 
 to remember that the palmar fascia is connected superiorly 
 with the anterior annular ligament, whilst the middle, 
 strongest portion of the fascia, is directly continuous with 
 the tendon of the palmaris longus muscle. This muscle, 
 so far as man is concerned, presents itself normally as a 
 feeble structure; its importance may be estimated from the 
 fact that it is frequently absent without in the least im- 
 pairing the utility of the limb. It is calculated that this 
 muscle is wanting in ten per cent, of all bodies examined. 
 Usually it consists of a definite belly with a rounded 
 tendon, occasionally two bellies are present with a ten- 
 dinous intersection ; the muscle may end in the fascia of 
 the forearm, or may be wholly represented by ligament. 
 
 In many animals, e.g., the armadillo and aard vark, 
 the palmaris longus is large and important, muscular 
 throughout its whole extent, sending slips to all the 
 
 
1 6 LIGAMENTS. [Chap. i. 
 
 digits, and serving- as one of the chief agents in flexing 
 them. 
 
 That the palmar fascia arises from the degeneration of 
 the distal end of the palmaris longus muscle, admits of no 
 doubt, for it occasionally happens that portions of the fascia 
 reassume their lost character and present themselves as 
 slips of muscle. This occurs most frequently in connection 
 with the strips of fascia going to the thumb. There is good 
 reason to believe that the abductor pollicis and abductor 
 minimi digiti are derived from the distal end of this once 
 extensive muscular sheet, of which the sole representatives, 
 in a muscular form besides them, are the belly of the 
 palmaris longus and the palmaris brevis muscles. 
 
 The plantar fascia. — The disposition of this fibrous 
 sheet in the sole of the foot exactly repeats that seen in the 
 hand, and the same arguments will be used to show that 
 in this case the fascia results from the regression of the 
 plantaris muscle. This muscle, like the palmaris longus, 
 is vestigial in man, and like such structures in general is 
 liable to all kinds of variations. Normally it is inserted 
 into the inner side of the tendo Achillis, but it may join the 
 deep fascia, the internal annular ligament, or plantar fascia, 
 occasionally it is absent. 
 
 These vagaries alone are sufficient to indicate that the 
 muscle has an interesting ancestry. Turning to lower 
 forms we find that in the armadillo the plantaris muscle, 
 instead of being, as in man and many mammals, chiefly 
 represented by a long, thin, and straggling tendon, is 
 larger than the gastrocnemius. The muscle arises as 
 usual from the back part of the external condyle of the 
 femur, it then expands into a large fleshy belly extending 
 the whole length of the calf; at the heel it forms a tendon 
 which glides in a well-formed groove on the back of the 
 os calcis, and spreads out as the plantar fascia, slips of 
 which pass to the hallux, second, and third toes, extending 
 even to the terminal phalanges. 
 
 As many of the short muscles belonging to the thumb 
 
Chap, i.] PLANTAR LIGAMENTS. 17 
 
 and fifth digit may have arisen from portions of the 
 original palmaris longus, so may some of the short 
 muscles in the first layer of the sole be considered as 
 detached portions of the plantaris. An exception must be 
 made in the case of the abductor hallucis, which is prob- 
 ably a migratory muscle, and will be considered later. 
 For an excellent account of the plantaris and palmaris 
 longus muscles in Orycteropus, the student should consult 
 Mr. J. C. Galton's account of the myology of this animal in 
 the Transactions of the Linnean Society, vol. xxvi., p. 567. 
 
 The Long and Short Plantar Ligaments. 
 ( Calcaneo- Cuboid). 
 
 If the hind leg of a horse be examined, a strong ligament 
 passing from the posterior surface of the os calcis to the 
 cuboid and head of the rudimentary external metatarsal 
 bone may be readily dissected. This fibrous band is 
 known as the calcaneo-metatarsal ligament. Near the 
 origin of this ligament from the calcaneum, the tendo 
 Achillis or combined insertion of the gastrocnemius and 
 soleus muscles is attached. In the fcetal horse and foetal 
 deer, the tendo Achillis and the calcaneo-metatarsal 
 ligament form one continuous structure. It would be most 
 illogical to say that because the tendon and ligament were 
 one structure in a limb so peculiarly modified as that of the 
 horse, the same source of the ligament could be maintained 
 for the long and short plantar ligaments of man's foot, 
 unless other evidence exists. If a hiuTian foetus even as late 
 as the sixth month of intra-uterine life be examined by a 
 vertical section carried through the tendo Achillis, os calcis 
 and cuboid, the ligament and tendon will be seen to form 
 one continuous band, and the attachment of the tendon to 
 the under surface of the os calcis is of the loosest kind. 
 After the seventh month of intra-uterine life the tendon is 
 
 c 
 
i8 LIGAMENTS. [Chap. i. 
 
 gradually divided by extra growth occurring at the posterior 
 extremity of the os calcis, the inferior portion becoming" 
 the long- and short plantar ligaments, the other gaining a 
 permanent attachment to the lower border of the os calcis. 
 If in the adult foot, the origin of the muscles composing 
 the third lay< r of the sole of the foot be dissected, they 
 will be found, with the exception of the transverse pedis, 
 10 be thoroughly incorporated with the plantar ligaments. 
 
 When th _■ corresponding- parts are dissected in the foot of 
 a seal the anatomist will quickly come to the conclusion that 
 the adductor pollicis, flexor brevis pollicis, flexor minimi 
 digiti, long plantar ligaments, tendo Achillis, gastrocnemius, 
 and soleus muscles, have been derived from a muscular 
 layer which in lower primitive forms was a continuous 
 muscular stratum. 
 
 The conclusion is inevitable, that the long and short 
 plantar ligaments are degenerated muscular tissue. 
 
 The Deep Fascia of the Limbs. 
 
 On comparing the limbs of a lizard or a bird with that 
 of man or any of the higher mammals, we shall be struck 
 with the fact that in the latter forms the muscles are 
 invested by strong aponeuroses known as the deep fasciae, 
 and separated one from the other by fibrous intermuscular 
 septa. Not so in the Sauropsida (birds, lizards, croco- 
 diles). 
 
 Careful inquiry, by means of dissection will force an 
 impartial worker in the end to the conclusion, that the 
 deep fasciae and the intermuscular septa are in reality the 
 result of the metamorphosis and regression of muscular 
 tissue, at least so far as the fore- and hind-limbs of most 
 mammals are concerned. 
 
 An attempt is made on page 31 to show that there is 
 good ground for believing that the broad band of fascia 
 continuous with the biceps temoris tendon and extending 
 
Chap, i.] DEEP FASCIA 19 
 
 thence to the external annular ligament of the ankle may 
 be traced to a large and functional muscle in lizards, 
 crocodiles, and birds. 
 
 It is commonly recognised that the thickening of the 
 fascia lata known as the ilio-tibial band is the degenerate 
 representative of that portion of the tensor fasciae femoris 
 muscle which in some animals extends to the knee. 
 
 There can be little doubt that the larger portion of the 
 fascia lata on the posterior aspect of the limb is derived 
 from degeneration of the distal portion of the gluteus 
 maximus muscle. 
 
 The glutei muscles in birds are very numerous, as many 
 as four are present in some species. In others some of 
 these muscles are entirely represented by tracts of fibrous 
 tissue or fascia. 
 
 If the dissector wishes to find the external cutaneous 
 nerve in the thigh he has to seek it in a tunnel formed in 
 the fascia lata. When dealing with the interosseous mem- 
 brane of the forearm it was shown that the artery and 
 nerve were enclosed in a tunnel in consequence of the 
 degeneration of the muscle to which they ministered. 
 Comparative anatomy supports the view that the external 
 cutaneous nerve of man lies in a tunnel in consequence of 
 the muscle which it supplied, having undergone regression, 
 and burying the nerve and artery in fibrous tissue, for, as in 
 the case of the interosseous membrane, the nerve is always 
 accompanied by an artery. 
 
 The same line of argument is true of the deep fascia of 
 the arm. I have seen an instance in which the bicipital 
 expansion was replaced on both sides by a thin sheet of 
 muscular tissue, much broader than the fan-shaped arrange- 
 ment of fibrous tissue which it replaced. In the ensuing 
 section evidence is forthcoming that the same line of argu- 
 ment is applicable to the fasciae of the trunk especially 
 those in the loins. 
 
 C2 
 
20 LIGAMENTS. [Chap. i. 
 
 The Lumbar Aponeurosis. 
 
 Under this name human anatomists have found it conve- 
 nient to describe three stout layers of fascia ensheathing 
 the erector spinae and quadratus lumborum muscles. 
 
 The superficial layer springs from the spines of the lumbar 
 vertebrae and the posterior part of the iliac crest. After 
 closely investing the erector spinse, it joins with the middle 
 layer of the aponeurosis at the outer border of that muscle. 
 
 The middle layer springs, by strong fibrous bundles, from 
 the tips of the transverse processes of the lumbar vertebrae ; 
 and, passing between the erector spinae and quadratus 
 lumborum muscles, blends with the posterior layer, as 
 already described, and forms a strong tendon of origin for 
 the transversalis abdominis muscle. 
 
 The anterior layer of the lumbar aponeurosis is attached to 
 the front of the transverse processes of the lumbar vertebrae, 
 covers the anterior surface of the quadratus lumborum 
 muscle, and blends with the middle layer of fascia. Thus 
 the anterior layer blends with the middle at the outer 
 border of the quadratus lumborum, whereas the posterior 
 and middle layers of the aponeurosis blend at the outer 
 border of the erector spinae muscle. 
 
 Careful inquiry into the comparative anatomy of the 
 posterior layer of the aponeurosis makes it evident that it 
 arises from the metamorphosis of the lower fibres of the 
 latissimus dorsi muscle ; for in many animals this fascia is 
 wholly replaced by muscle-fibres continuous with the 
 latissimus dorsi sheet. The same mode of origin may be 
 maintained for the anterior aponeurosis of the external 
 oblique, internal oblique, and transversalis muscles, also 
 the resplendent tendon of the serrati postici superior and 
 inferior, and the rhomboids. Even the central tendon of 
 the diaphragm has arisen from the metamorphosis of its 
 muscular fibres ; for in the porpoise there is no trace of 
 
Chap, i.] LUMBAR APONEUROSIS. 
 
 21 
 
 tendon, but it is muscular in structure throughout the whole 
 of its extent. 
 
 The middle layer has a very curious origin. If a recent 
 subject be chosen, and the structures of the loin be re- 
 
 Fig. io. — To show the mode of origin of the posterior and middle 
 layers of the lumbar aponeurosis from the latissimus dorsi and de- 
 generate levatores costarum muscles respectively. 
 
 moved down to the quadratus lumborum muscle, care 
 being taken not to injure its investing fascia, there 
 will be seen arising from the tips of the transverse 
 
22 LIGAMENTS. [Chap. i. 
 
 processes of the three upper lumbar vertebrae a fan- 
 shaped arrangement of fine fasciculi composed of fibrous 
 tissue, but more elastic in character than the rest of the 
 aponeurosis, and strongly recalling in appearance the 
 nacreous-looking fibres of origin of the serratus posticus 
 inferior muscle. These fan-shaped masses have a direction 
 downwards and outwards, the apices being attached to the 
 tip of the transverse process exactly like a levator costae 
 muscle, and there can be little doubt that the thickenings 
 in the middle layer of the lumbar fascia are the degenerate 
 remains of a set of muscles in continuation of the levatores 
 costarum series. These fan-shaped collections of tissue in 
 the middle layer of the transversalis aponeurosis are by no 
 means occasional, but may be demonstrated in any dissect- 
 ing-room subject with ordinary care. 
 
 In bodies possessing a lumbar rib. however small, the 
 fan-shaped ligament attached to the twelfth dorsal vertebra 
 is replaced by a functional muscle, as shown in fig. 10. 
 
 The anterior layer is in all probability derived from the 
 regression of that portion of the transversalis muscle lying 
 nearest the spine. 
 
 An examination of the pleuro-peritoneal cavity of lizards 
 leads me to believe that in a typical condition the abdo- 
 minal and thoracic parietes may be conceived as possess- 
 ing in their lateral and ventral aspects three muscular 
 strata. 
 
 1. The external oblique sheet intersected in a part of its 
 course by the ribs, giving rise to the external intercostal 
 muscles. 
 
 2. An internal oblique stratum, also partially interrupted 
 by the ribs forming the internal intercostal muscles. 
 
 3. The transversalis sheet immediately subjacent to the 
 serous lining of the pleuro-peritoneal cavity. 
 
 Mammals are distinguished from lower vertebrata in the 
 possession of a complete diaphragm. This singular struc- 
 ture probably represents that portion of the transversalis 
 sheet which covers in lizards the inner aspect of the ribs. 
 
Chap, i.] LUMBAR APONEUROSIS. 23 
 
 The thickenings known as the ligamentum arcuatum in- 
 ternum and externum, are to be regarded as tendinous 
 intersections between the thoracic and abdominal segments. 
 The original extension of this muscular stratum into the 
 thorax is indicated by the occurrence of the sub- or infra- 
 costal muscles which are found most frequently near the 
 angles of the ribs on their inner aspect. 
 
 There is good ground for believing that the longus colli 
 muscle of man is a derivative of this same transversalis 
 sheet, for in such animals as Jfenopoma, Cryptobranchus, etc., 
 a prolongation extends forwards to the basis cranii. 
 
 The origin of the three layers of the lumbar aponeurosis 
 may be briefly stated thus. 
 
 (a) The posterior layer results from the metamorphosis 
 
 of the lower fasciculi of the latissimus dorsi muscle. 
 (&) The middle layer contains degenerate elements of the 
 lower representatives of the leva/ores costarwn series 
 of muscles, one of which forms the ilio-lumbar 
 ligament, and possibly this sheet of fascia is made 
 up entirely in this way. 
 (c) The anterior layer is the result of the metamorphosis 
 of the vertebral portion of the transversalis muscle. 
 In that man possesses in the posterior and anterior 
 regions of the trunk, (for there can be little doubt that the 
 aponeuroses of the obliqui and transversalis muscles are 
 the result of the metamorphosis of the fasciculi of these 
 muscles,) large sheets of tissue composed of minute glisten- 
 ing tendons, he contrasts markedly with amphibians, 
 lizards, and ophidians, in whom these aponeurotic tracts 
 are represented by sheets of well developed muscular 
 tissue. 
 
 Absent Muscles. 
 
 In the Journal of Anatomy and Physiology, vol. xix., p. 333, 
 Professor Sir W. Turner notes a case of absence of the 
 extensor carpi ulnaris muscle. On careful dissection, 
 
24 LIGAMENTS. [Chap. i. 
 
 however, a narrow band could be detected in the deep 
 surface of the aponeurosis of the forearm, somewhat 
 stronger and more opaque than the rest, extending- longi- 
 tudinally down the limb, parallel with the ulna. Above 
 the styloid process the band became isolated from the 
 fascia and entered the groove on the back of the ulna in 
 which the tendon of the ex. carpi ulnaris ought to have 
 been lodged ; finally it became attached to the base of the 
 fifth metacarpal bone. 
 
 Turner regards this as an example of the conversion of 
 a muscle into fibrous tissue, and refers to a similar case 
 recorded by Gruber.° 
 
 The interest of the case is this : when a muscle is found 
 wanting in a subject in which normally it exists, search 
 should be made for its fibrous representative. Doubtless 
 many instances of muscular variations and absence of 
 muscles receive explanation in this way. 
 
 Thus, Professor Flower and Dr. Murief, in their account 
 of the dissection of a bushwoman, state that there was no 
 abductor ossis metatarsi quinti, but a strong tendinous band 
 stretched from the plantar surface of the os calcis, close to 
 the origin of the abductor minimi digiti to the head of the 
 fifth metatarsal bone. 
 
 In an old woman, Mr. Macdonald Brown found the 
 muscles of the thenar eminence replaced by bands of 
 fibrous tissue. In the six-banded armadillo, Mr. Galton 
 found the short flexors in the sole of the foot similarly 
 represented. Every anatomist of experience must also 
 have come across examples of this not infrequent form of 
 replacement in the human subject. 
 
 * Virchow's Archiv, bd. xcix., p. 478. 
 
 f Journal of Anatomy and Physiology, vol. i., p. 204, 1867. 
 
CHAPTER II. 
 
 Examples of Metamorphosis and Regression of Muscles 
 from the Lower Vertebrates. 
 
 Instances of the transformation of muscles into ligaments 
 are almost as frequent in the lower vertebrates as in man. 
 It may not be uninteresting- to devote a chapter to the con- 
 sideration of some striking examples chosen from the 
 horse, whales, and birds. 
 
 William Percivall in his excellent work on the Anatomy 
 of the Horse, 1858, adds a foot note to his accountof the sus- 
 pensory ligament of the fetlock, stating that Bourgelat 
 regarded it as a tendon, but Girard as a muscle. 
 
 Percivall describes it thus: — ''The suspensory ligament 
 (so-called, I imagine, because the sesamoid bones seem to 
 be suspended by it) is, perhaps, the strongest in the whole 
 body, and is remarkable for its high degree of elastic 
 property. It takes root, superiorily, in a projection at the 
 upper and back part of the cannon, whence it passes, 
 enclosed within a cellular sheath, between the splint bones, 
 filling up their interspace. Opposite to about the termina- 
 tions: of these small bones, it splits into two divisions, 
 which, diverging in their descent, become implanted into 
 the lateral and posterior parts of the sesamoid bones, and 
 into the fibro-cartilaginous substance uniting them. From 
 the places of implantation, two lateral slips are continued 
 from it downward and forward to join the extensor tendon. 
 Between the suspensory ligament and the joint, enveloped 
 in adipose membrane, are some large bursa mucosa. In 
 composition and texture, this ligament possesses peculiari- 
 ties : it has a sanguineous tinge interiorly, which is not 
 perceptible in other ligaments or in tendons ; and its 
 fibres, which are very coarse, are disposed in layers. But 
 its chief peculiarity consists in its exhibiting an inter-tex- 
 
26 
 
 LIGAMENTS. 
 
 [Chap. II. 
 
 ture of delicate, pinky, fleshy fibres, which appear to be the 
 uniting medium of the ligamentous fasciculi." 
 
 The most conclusive evidence on this question is 
 furnished by Prof. Cunningham in a paper on "The 
 
 Fig. ii. — The forelimb of a Porpoise. The muscle of the forearm 
 and manus are represented by fibrous tissue. 
 
 Development of the Suspensory Ligament of the Fetlock in 
 the fcetal Horse, Ox, Roe-deer and Sambre-deer," he 
 shows most conclusively that this ligament is formed by 
 the transformation of the short flexor muscle of the middle 
 digit into fibrous tissue. The corresponding structure in 
 
 * Journal of Anatomy and Physiology, vol. xviii., p. i. 
 
Chap, ii.] THE BICIPITAL LOOP. 27 
 
 the ox, sheep and camel arises by the coalescence and 
 fibrous metamorphosis of the short flexor muscles of the 
 middle and annular digits. 
 
 In the forelimb of the porpoise represented in fig". 1 1 the 
 muscles are no longer present, but tracts of fibrous tissue 
 occupy corresponding positions. 
 
 Professor Struthers has pointed out that in the Narwhal 
 the finger muscles are present morphologically, but histo- 
 logically they are represented by fibrous tissue. A similar 
 but not >o extreme a condition may be studied in the wing 
 of the Penguin. f 
 
 The Bicipital Loop in the Thigh of Birds. 
 
 Let anyone take the trouble to dissect the thigh of a fowl 
 from the outer side, then a most interesting arrangement 
 of myological structures will reward his labour, but the 
 one to which especial attention is invited, is the singular 
 loop which transmits the tendon of the biceps muscle and a 
 branch of the great sciatic nerve. 
 
 The great point of interest in connection with the 
 bicipital loop is the fact that it is an exclusively avian 
 character, at least so far as recent forms are concerned, 
 and that with very few exceptions, among them a 
 Steganopod {Phtzthon), no known bird lacks this sling. 
 
 On reflecting the skin, the most superficial muscle is the 
 tensor fascia or gluteus primus as it is termed by some. If 
 this muscle be turned up, or removed, the deep structures 
 will be exposed ; the most conspicuous is the biceps, which 
 has the following attachments: — It arises from the upper- 
 three-fourths of the post-acetabular ridge (a slight bony 
 elevation which separates the post-acetabular area from 
 
 * "On some points in the Anatomy of a Great Fin Whale," Journal 
 of Anatomy and Physiology, 1871. 
 
 f See especially Watson's " Report on the Spheniscidas," Zoology of 
 the Voyage of H. M. S. " Challenger:' 
 
28 LIGAMENTS. [Chap. ii. 
 
 the external lateral surface of the ischium). Just in front 
 of the tensor fasciae the fibres converge to form a rounded 
 tendon, which on the outer side of the popliteal region is 
 bent sharply downwards by passing- through a tendinous 
 sling or loop; it is inserted nearly half way down the 
 fibula to a bony prominence on its outer side. The loop in 
 question is attached to the lower end of the femur; the 
 outer limb is slightly connected with the head of the gas- 
 trocnemius, which is situated to its outer side. A nerve to 
 the leg and foot, derived from the great sciatic, accompanies 
 the tendon through this sling (fig. 12). This tendinous 
 loop, studied in the fowl and similar birds, is curious and 
 puzzling, and evidence will be adduced in support of the 
 view, that it is derived from the metamorphosis of the 
 muscular fibres of the outer head of the gastrocnemius 
 muscle. Before doing so, however, it will be necessary to 
 state that the muscle, here termed biceps, has not the same 
 anatomical relationship as the muscle so named in the leg 
 of mammals, indeed, to my mind it is certainly not 
 homologous with that structure, and there is little utility in 
 discussing the morphology of muscles in so highly special- 
 ised a form as that of the fowl as compared with man. In 
 the thigh of the Rhea {Rhea Americana), the Emu (Dromceus 
 Novce-hollandice), Ramphastos loco and many other avian 
 forms, the loop through which the biceps tendon passes is 
 modified in this way: — The inner limb is a tendon of 
 great strength and of considerable thickness, but the outer 
 limb of the loop is constituted by the muscular and ten- 
 dinous fibres of that head of the gastrocnemius muscle 
 which is attached to the external femoral condyle ; hence 
 one half of the loop is tendinous, the other muscular (fig. 
 13). This arrangement clearly affords the clue by which 
 we may seek to interpret the origin of so singular a pulley, 
 for clearly it is the result of the metamorphosis of muscle fibres. 
 
 In the lizard, Iguana tuberculata, if the dissection be com- 
 menced from the outer side, as in the bird, a prominent 
 muscle, referred to by Mivart as the ilio-peroneal, is easily 
 
Chap, ii.] 
 
 THE BICIPITAL LOOP. 
 
 29 
 
 recognised. It has the following- attachments and rela- 
 tions: — It arises from the posterior part of the outer side 
 
 Fig. 12. — Thigh of a bird (Tinamou) dissected from the outer side to 
 show the tendinous loop which transmits the tendon of the biceps and a 
 nerve, the latter is represented by X. B. Biceps. G. Gastrocnemius. 
 
 of the ilium, covered by the posterior portion of the 
 tendinous origin of the gluteus maximus, and even a little 
 overlapped by the gluteus medius. It is inserted by a 
 
 llill 
 
 Fig. 13. — The bicipital loop in the thigh of an Emu. One half is 
 formed by the gastrocnemius, the other half is tendinous, the nerve is 
 represented by X . 
 
 strong tendon, which dips between a muscle called 
 peroneus pri?nus by Mivart, and the external head of the 
 gastrocnemius, into the outer side of the fibula near its 
 summit. 
 
 * Mivart's admirable account of the " Myology of Iguana tubercu- 
 lata" (Proc. Zool. Soc, 1867), has been to me of the utmost utility in my 
 dissections. 
 
30 LIGAMENTS. [Chap. ii. 
 
 It will be necessary, before discussing the ilio-peroneal 
 muscle, to take into consideration the muscles named 
 peroneus primus and the gastrocnemius. The first muscle 
 arises by a strong tendon from the summit of the outer 
 side of the external condyle of the femur. It becomes 
 tendinous below the outer malleolus; a portion of this 
 expansion gains an insertion into the peroneal border of 
 the fifth metatarsal bone, a little above its middle. On 
 the posterior aspect of the ankle-joint it forms a broad 
 aponeurosis, and joins with the expansion of the gastroc- 
 nemius. 
 
 The gastrocnemius consists of two distinct parts ; one 
 arises from the internal condyle of the femur, with a 
 slight attachment to the head of the tibia near the insertion 
 of the semi-membranosus and semi-tendinosus. Passing 
 downwards it becomes aponeurotic near the ankle-joint, 
 and blends with a broad tract of tissue — the plantar fascia. 
 The second portion arises from the femur, just above the 
 external condyle ; passing down the leg it becomes apo- 
 neurotic near the ankle-joint, and blends with the plantar 
 fascia. 
 
 In very many birds the gastrocnemius arises by three 
 heads, an inner one from the tendon of the rectus, and 
 cnemial crest of the tibia ; the middle head from between 
 the condyles of the femur, and an outer one arising from 
 the external condyle of that bone. Between these two 
 heads — the middle and the external — passes the biceps 
 tendon. 
 
 On comparing the fowl's leg muscles with those of 
 Iofuana, it becomes evident that the muscle marked 
 peroneus primus in the Iguana is really the equivalent of 
 the outer head of the fowl's gastrocnemius, and that the 
 bird's biceps cruris is really the representative of the ilio- 
 peroneal of the Iguana; they agree in position and 
 especially in their relation to the great sciatic nerve. 
 
 Admitting this to be so, it will give us the steps or stages 
 by which the bicipital sling has become fashioned. They 
 may be briefly summarised as follows: — 
 
Chap, ii.] THE BICIPITAL LOOP. 3* 
 
 1. In its original condition the so-called biceps passed 
 
 between two muscles ; one the third head of gas- 
 trocnemius or peroneus primus, and the other the 
 outer head of gastrocnemius. 
 
 2. The two muscles tend to fuse near the knee-joint, 
 
 and enclose the distal end of the biceps. 
 
 3. The leg becomes bent at a more or less acute angle 
 
 with the thigh ; this leads the biceps to drag on the 
 muscle-fibres of the gastrocnemius through which it 
 passes. The muscular tissue in relation with the 
 tendon of the biceps thus piays a passive part, and 
 becomes metamorphosed into tendon. 
 
 4. The inner limb first separates from the parent muscle; 
 
 the outer head may do so and form a complete 
 tendinous sling ; differentiation may not proceed so 
 far, the outer head remaining in many birds per- 
 manently attached to the outer portion of the 
 gastrocnemius. 
 The question at once arises, Have the facts any bearings 
 on the myology of the mammalian limb? My answer is 
 this. If the biceps femoris in man be carefully traced, the 
 insertion is not by any means confined to the head of the 
 fibula, but its fibres spread into a broad aponeurotic ex- 
 pansion covering the outer side of the leg. The relative 
 size of the biceps in man, as Mivart points out, is much 
 inferior to its possible development. In some forms, e.g., 
 the Agouti (Dasyprocta agouti)^ the muscle combines with 
 the tensor fasciae and gluteus maximus to form an almost 
 continuous sheet of muscle, extending from the pelvis over 
 the outer side of the leg to the ankle-joint. I was very 
 much interested in the biceps of a rhinoceros, in whom the 
 muscle, after being inserted into the fibula, was prolonged 
 by means of an enormously thick and broad tendon to the 
 ankle-joint. This and similar facts induces me to venture 
 the following explanation. The muscle in Iguana called 
 peroneus primus, that in birds known as outer or third head 
 of gastrocnemius, the broad muscular expansion in the 
 
32 LIGAMENTS. [Chap. ii. 
 
 Agouti, the enormous tendon of the biceps femoris in the 
 Rhinoceros, and its broad fibrous expansion in man, must all 
 be regarded morphologically as one and the same structure. 
 The nerve which originally supplied this muscle, lies in 
 part of its course beneath the fascia, and in part superficial 
 to it, and is named musculo-cutaneous. 
 
 The Wing of a Bird. 
 
 A bird's wing abounds in examples of the conversion of 
 muscular tissue into tendon. In this place we cannot do 
 more than notice a few of the more important ones. 
 
 In most birds the flexor carpi ulnaris is a fairly well 
 developed muscle, but in the Vulture and in the Rail, 
 Rallus aquaticus, Razor bill, Aha torda, and others, this 
 muscle is replaced by a strong, thick and elastic tendon. 
 
 Mr. D'Arcy Thompson in a paper " On the Nature and 
 Action of Certain Ligaments," which is worthy careful 
 perusal, points out that ligaments of this kind, though 
 degenerate muscles, continue to perform the function of 
 the muscle they represent. Tendons of this kind are 
 developed from muscles which pass over two joints and 
 which have a more or less ligamentous action. f This is 
 well seen in the case of the bird's flexor carpi ulnaris, for 
 when the elbow is flexed the tendon serves automatically 
 to flex the wrist joint. Mr. Thompson writes that he 
 " knows of no case in which the muscles have become 
 purely ligamentous, it is indisputable that the stronger the 
 wing the weaker these muscles, and the longer are their 
 tendons in proportion to the fleshy bellies." 
 
 As a matter of fact the flexor carpi ulnaris is purely 
 ligamentous in many birds. 
 
 The observations of Prof. Thompson are confirmatory 
 
 • Journal of Anatomy and Physiology, vol. xviii., p. 406. 
 t See especially Cleland, Ibid., vol. i., p. 85. 
 
Chap, ii.] WING OF A BIRD. 33 
 
 of the opinion regarding tendons of muscles frequently 
 used, as stated on page 2. 
 
 Every student of human anatomy must have experienced 
 a certain amount of curiosity when he dissected for the first 
 time the plantaris muscle ; this strange structure sinks into 
 insignificance when compared with the celebrated ambiens 
 of the bird's leg, or the tendon of the femoro-caudal in the 
 lacertilia. Of all strange muscles, the one known as the 
 expansor secundariorum (Garrod) in the bird's wing stands 
 pre-eminent. It is a small triangular muscle arising from 
 the quills of the last few secondary remiges at the elbow. 
 Its remarkably long and slender tendon, which frequently 
 traverses a fibrous pulley on the axillary margin of the 
 teres muscle, runs up the arm side by side with the axillary 
 vessels and nerves, to be inserted in the thorax into the 
 middle of a tendon which runs from the inner side of the 
 middle of the scapular element of the scapulo-coracoid 
 articulation, to near the middle of the thoracic border of 
 the sterno-coracoid articulation, at right angles to it when 
 the fore-limb is extended. 
 
 In the ducks and geese, among the Anseres, the tendons 
 under consideration, when they enter the thorax, run 
 towards one another and join, (after having expanded out), 
 in the middle line in front of the oesophagus, and behind 
 the trachea. 
 
 Not the least interesting feature in this muscle is the im- 
 portance Garrod attached to it for the aid it afforded him 
 in his Classification of Birds. For all that relates to this 
 extraordinary muscle, I must refer the reader to Garrod's 
 memoirs: — " On the Anatomy of Chaufia derdiana" (Proc. 
 Zool. Soc, 1876), " The Anatomy of Passerine Birds" 
 .(Hid., 1874, 1877, and 1878), and to the volume of his 
 Collected Scientific Papers, 1 88 1 . 
 
 My investigations into the morphology of this tendon in- 
 duce me to believe that it is the representative in the bird's 
 wing of the coraco-brachialis longus of mammals, and the 
 long brachial ligament of man. See page 13. 
 
 D 
 
34 LIGAMENTS. [Chap. ii. 
 
 Thompson in the paper already alluded to, insists that 
 as a general rule when a muscle by reason of it passing 
 over two joints is capable of being replaced partly or 
 wholly by ligament without its efficiency being lost, then 
 ligamentous change will set in. 
 
 The best example is furnished by the flexor sublimis 
 muscle of the mole. In this remarkable mammal there 
 lies in the front of the forearm an enormous ligament, 
 thicker than the ulna. It divides in the palm to be inserted 
 into the five digits. Above it is attached to a depression 
 in front of the internal supra-condyloid ridge and process 
 of the humerus, it represents the flexor sublimis muscle 
 metamorphosed completely into a tendon. For full details 
 concerning the mechanism of this arrangement, the reader 
 must refer to the original paper. 
 
 The heart furnishes another illustration. The valves of 
 the auriculo-ventricular orifices are muscular in the foetus, 
 but later metamorphose into tissue, ligamentous in its 
 essential characters. The right ventricle of a bird's heart 
 contains a muscular valve, and this is the case even in the 
 mammalian circle, e.g., in the echidna. 
 
 The conclusion, however, seems to be this ; when a 
 muscle undergoes metamorphosis into tendon, it is because 
 its action is needed frequently and forcibly. It is of course 
 unnecessary to remind the reader that it is essential to bear 
 well in mind the distinction between tendinous metamor- 
 phosis and fibrous regression, the latter being the immediate 
 result of disuse. 
 
CHAPTER III. 
 
 The Migration of Muscles in Relation to the 
 Formation of Ligaments. 
 
 The term " migration of muscles " may be denned as: — 
 The changing of the situation of a muscle by alteration of 
 its origin, or insertion, or both. 
 
 The lateral ligaments of the knee joint furnish some 
 excellent examples, not only of the process, but also of its 
 results. 
 
 In adult men the adductor magnus muscle terminates 
 at a tubercle on the internal femoral condyle ; from near 
 this spot the internal lateral ligament of the knee joint 
 takes origin. In two young orangs this muscle was found 
 directly continuous with the ligament. 
 
 In the human foetus at the fourth month of intra-uterine 
 life the proportions of the various parts of the limbs 
 to one another, are more or less anthropomorphous. 
 At this date the adductor magnus muscle is inserted into 
 the head of the tibia. Later migration occurs, the muscle 
 becoming attached to the condyle of the femur, whilst the 
 distal portion of the tendon becomes the internal lateral 
 ligament. 
 
 The External Lateral Ligament of the Knee Joint. 
 
 Every student engaged in dissecting a knee joint must 
 have had his attention arrested by the beautiful, rounded, 
 cord-like conditions of the external lateral ligament. The 
 notion of it being, or rather that at some time it had been, 
 the tendon of a muscle seems irresistible, and this suspicion 
 
 D 2 
 
36 LIGAMENTS. [Chap. hi. 
 
 is strengthened on finding occasionally, in young- subjects, 
 a synovial sheath investing it. 
 
 After dissecting this joint in a large number of animals, 
 the muscles to which it could possibly have belonged were 
 limited to two, — the peroneus longus and the extensor 
 longus digitorum pedis muscles. The external lateral 
 ligament is in reality the tendon of the peroneus longus, 
 which has become gradually separated from the belly of 
 the muscle, and formed a new attachment to the head of 
 the fibula. The extensor longus digitorum muscle may be 
 safely excluded for this reason : in many animals this 
 muscle takes origin from the external condyle of the femur, 
 e.g., hyrax, pig, horse, hare, and the orang among apes, 
 and in the ostrich among the birds, and at the same time a 
 well-developed external lateral ligament may be found 
 quite apart from and in no way connected with this muscle. 
 On the other hand, the peroneus longus muscle may often 
 be found connected with the ligament, as in the opossum, in 
 the domestic ox, and, what is more pertinent to this ques- 
 tion, in the gibbon {Hylobates leucucus), the tendon of the 
 peroneus longus arises from the external condyle of the 
 femur, and replaces the ligament, the tendon itself having 
 no attachment to the head of the fibula. This arrange- 
 ment leaves the fibula free to submit to the action of 
 the well-developed rotator fibulse which is present in this 
 ape. Even in man the muscular fibres of the peroneus 
 longus often have a considerable origin from the external 
 lateral ligament. 
 
 But by far the most important contribution to our know- 
 ledge of migration is afforded by Dr. Ruge of Heidelberg, 
 who satisfactorily traces out the history and ancestry of the 
 extensor brevis digitorum muscle. He shows that in the 
 Monotremata this muscle belongs to the peroneal group, 
 and arises entirely from the fibula. Ascending the scale 
 
 * " Untersuchung iiber die Extensorengruppe am Unterschenkel [und 
 Fiisse der Saugethiere," Morph. Jahrbxich for 1878. 
 
Chap, hi.] LIGAMENT OF KNEE-JOINT. 37 
 
 of mammalian forms we find the muscle passing down 
 tendon by tendon until it reaches the condition presented 
 in the foot of man. 
 
 The koala or native bear, as it is called in New Zealand, 
 presents an intermediate condition, for we find two tendons 
 on the dorsum of the foot, whilst the remainder still retain 
 an attachment to the fibula. 
 
 In very many mammals and even quadrumana we find 
 two muscles arising" from the fibula, and gaining the dor- 
 sum of the foot by passing behind the external malleolus. 
 They are known as the peroneus quarti metatarsi, and 
 peroneus quinti metatarsi muscles. They are really the 
 representatives of the slips from the ex. brevis digitorum 
 muscle to the fourth toe and the peroneus tertius muscle. 
 
 The peroneus tertius muscle is regarded as a muscle 
 exclusively human, but it is simply the most external slip 
 of the short extensor of the digits, which has failed to 
 migrate when its companions passed downwards from the 
 leg to the dorsum of the foot. 
 
 Dr. Hans Gadow° in an interesting paper on " Com- 
 parative Myology," gives some examples of the process, 
 and states that as a rule the origin of a muscle is more 
 subject to variation than the insertion. My own obser- 
 vations lead me to concur with this statement, and the 
 history of the foot muscles serves as a striking instance. 
 
 I am also of opinion that the abductor hallucis muscle is 
 an emigrant, having descended from the tibia to its 
 present position on the os calcis. For arguments in 
 support of this, the student anxious for a full discussion of 
 the matter should consult the reference. f 
 
 The interest this singular process has for us is, that as 
 the muscles migrate they leave some part of their structure 
 to be transformed into ligament, and there is satisfactory 
 reason to believe that the external and internal lateral 
 
 * Journal of Anatomy and Physiology, vol. xvi., 1882. 
 f Especially, Ibid., vol. xix., p. 42. 
 
38 LIGAMENTS. [Chap. hi. 
 
 ligaments of the ankle joint have arisen in this manner. 
 Before quitting- the foot it may be interesting - to refer to 
 the excellent observations made by Ruge on a remarkable 
 change of position he has detected in the case of the dorsal 
 interosseus muscles of the foot. 
 
 In the early embryo the dorsal interossei are plantar in 
 position and the metatarsals are in contact with each 
 other, gradually the metatarsals separate and the interossei 
 make their way between them eventually appearing on the 
 dorsum of the foot. 
 
 In their earliest stage these muscles possess one head, it 
 is only when in their new position that they become bi- 
 penniform. 
 
 It is also important to remember that the varying posi- 
 tion these muscles pass through, indicate stages which are 
 permanent in lower vertebrates. Thus, the first stage is 
 characteristic of the majority of mammals and may be con- 
 veniently studied in the dog. In others, the second stage 
 is represented ; whilst the third stage is probably never so 
 completely attained in any mammal as in man. 
 
 To those anxious to follow up this inquiry I would 
 recommend them to study Ruge's paper, " Processes in the 
 Development of the Muscles of the Human Foot," Morpho- 
 logische Jahrbuch, 1878, and Cunningham's admirable 
 monograph on the muscles of the foot, contained in the 
 Zoology 0/ the Challenger Expedition, part xvi., 188 1, vol. v., 
 " Marsupialia," also a paper " On the Intrinsic Muscles of 
 the Human Foot," published in the Journal of Anatomy and 
 Physiology, vol. xiii., p. i., 1878. 
 
 The Ligamentum Teres. 
 
 The round ligament of the hip joint has long been an 
 anatomical puzzle, and many opinions have been held 
 concerning its nature. It is, however, best regarded as the 
 divorced tendon of a muscle, and here arguments will be 
 
Chap, hi.] LIGAMENT UM TERES. 39 
 
 raised in order to show that in all probability it belonged 
 to the pectineus, but has become separated from it in con- 
 sequence of skeletal modifications. The ligamentum 
 teres is a structure fairly constant in Mammalia, but is 
 wanting in the Seal, Elephant, Rhinoceros, Walrus, 
 Ornithorhynchus, Echidna, Sea-otter, (Enhydra marina) (of 
 this form I have had the good fortune to dissect the joints 
 in two specimens), Sloth, Orang, Walrus, Hyrax, and 
 Pangolin. 
 
 The two last mentioned animals are additions to the list 
 which I have been enabled to make, in consequence of 
 dissecting two specimens of each. In birds the ligament 
 is said to be present with only one exception — the 
 cassowary, — but in a specimen of Casuarius appendiculaia 
 dissected by me, the ligamentum teres was present in both 
 hip joints. 
 
 In reptiles possessing limbs, and in amphibians, a band 
 representing the round ligament is universally present. 
 
 It is in the horse that we first get the glimpse of the true 
 nature of the ligament, for in this animal it consists of two 
 parts, one hidden within the joint termed the cotyloid 
 portion, the other passes out of the cavity to join the linea 
 alba at its junction with the pubes, hence it is termed the 
 pubio-femoral portion. From this band the pectineus 
 takes origin. 
 
 In the ostrich the ligamentum teres has a true tendinous 
 structure. It is dense and strong, contains a large quantity 
 of yellow elastic tissue arranged in fasciculi as in the 
 tendon of a muscle. In this bird it may measure three-fifths 
 of an inch in transverse section. 
 
 Many birds possess in their thigh a very extraordinary 
 muscle known as the ambiens, full of interest on account 
 of its remarkable course, variability, and relations. When 
 fully developed it has the following attachments. It arises 
 from the tip of the short anteriorly directed spine which is 
 situated just above the anterior border of the acetabulum, 
 and runs along the inner side of the thigh to the inner side 
 
4 o LIGAMENTS. [Chap. hi. 
 
 of the knee, where it is covered by the sartorius, which is 
 above it in the former part of its course. Its thin tendon 
 then crosses the knee, running in the substance of the 
 fascial extensor tendon, just in front of the patella, to the 
 outer side, where it joins the fibres of origin of the flexor 
 perforatus digitorum. 
 
 In the adult ostrich a section carried through the ace- 
 tabulum so as to divide the ambiens at its point of origin, 
 and the ligamentum teres, will show that the two latter are 
 connected by fibrous tissue. 
 
 In the winter of 1883, I was fortunate enough to obtain 
 an ostrich chick, and a dissection of its hip joint showed 
 clearly enough the ligament and a small muscular slip, 
 parallel with the ambiens, in direct continuity, as shown in 
 fig. 14. The actual specimen is preserved in the museum 
 
 Fig. 14. — The femur of an Ostrich chick with the pectineus muscle 
 and ligamentum teres in continuity. 
 
 of Middlesex Hospital. The ambiens and the muscular 
 slips mentioned above, are the representatives in birds of 
 the mammalian pectineus. 
 
 The hip-joint of a sphenodon was then examined. In this 
 very curious lizard, as in lacertilia generally, the hip joint 
 is of very simple character, and the muscle corresponding 
 to the ambiens of birds and the pectineus of mammals 
 arises by two heads, one from the lateral spine of the 
 pubes, the other lies inside the capsule and gains an 
 attachment to the head of the femur, thus corresponding 
 in its relation with the joint, to the ligamentum teres of 
 mammals and birds. 
 
Chap, hi.] LIGAMENTUM TERES. 41 
 
 The varying relation of muscle and ligament may be 
 arranged in a tabular form thus : — 
 
 9/)/ // (Tendon of ambiens (pectineus) passes in- 
 " c { side the capsule to the head of the femur. 
 
 0j jL . (Ligamentum teres and ambiens muscle 
 Struthio . \ ,. ., 
 
 I directly continuous. 
 
 „ (Ligament in two parts, one continuous with 
 
 1 U ' \ the pectineus outside the joint. 
 
 jr fLigamentum teres, a fibrous band carrying 
 
 ( blood vessels to the head of the femur. 
 
 There is no ligament in the body which can boast such 
 an extensive literature, or has exercised more the ingenuity 
 of physiologists and surgeons than the one we have been 
 considering. 
 
 Teleologists like Paleyf have been enraptured with this 
 structure, and anatomists have ascribed to it wonderful 
 mechanical resistance and uses. Alas ! in this, as in so 
 many like cases, morphology demands for it a low level 
 and determines it to be a vestigial and practically useless 
 ligament. In this sense teleology is as poetry, but mor- 
 phology as plain history. 
 
 * For all that relates to this strange muscle consult Garrod's remark- 
 able paper in Proc. Zool.Soc, 1873^.626. "On certain muscles in 
 the Thigh of Birds, etc." 
 
 t See especially his Natural Theology, page 55. 
 
CHAPTER IV. 
 The Knee Joint and Ankle. 
 
 The general relations of the fibro-cartilages of the knee 
 joint in man are familiar to every student of human 
 anatomy. It must sound somewhat startling to him, how- 
 ever, to learn that they are metamorphosed muscles and 
 tendons. The history of the mode by which they have 
 acquired so remarkable a position is replete with interest. 
 
 The interarticular fibro-cartilages. — If one of the 
 tailed batrachians be examined, and Menobranchus lateralis 
 will serve as an excellent example, we shall find the knee 
 joint deficient in crucial ligaments and interarticular fibro- 
 cartilages, so that this animal forms a very good starting 
 point. 
 
 On looking closely into the myology of these amphibians, 
 a curious fact at once becomes evident; in mammals, and 
 in man especially, the muscles destined for the pes take 
 origin, with very few exceptions, from the tibia and fibula; 
 in these animals they arise almost exclusively from the 
 femur. This is significant, and clearly indicates that it is 
 in the forms filling up the gap between Urodele batra- 
 chians and the lowest mammals that we must seek for an 
 explanation of the change. 
 
 In our first ascensive step we are encountered by the 
 frogs, who startle us with the richness of the musculature 
 of their limbs, for in many respects myological differentia- 
 tion in them surpasses that which pertains in man. 
 
 On examining the knee joint of a frog, it will be found 
 to possess interarticular fibro-cartilages and crucial liga- 
 ments, but these structures differ in a very important 
 manner from those of mammals. 
 
 In the first place, the interarticular fibro-cartilages are 
 directly continuous with the tendons of muscles; the inner 
 
Chap, iv.] KNEE JOINT AND ANKLE. 43 
 
 cartilage is in direct continuity with a muscular mass 
 corresponding to the semi-membranosus. This muscle is 
 usually described as being inserted into the back of the 
 tibia, but the main mass will be found inseparably asso- 
 ciated with the cartilage. The external fibro-cartilage is 
 not well formed, and seems rather to be a continuation of 
 the inner one than as representing a discrete element of 
 the knee joint, such as we find in higher forms. 
 
 The question at once suggests itself — Why should so 
 much difference prevail in the anatomy of this joint in 
 animals so closely related as the tailed and tailless ba- 
 trachians ? 
 
 Dr. Gadow,° in his instructive paper on "Comparative 
 Myology" puts the matter very beautifully thus : — 
 
 " We must remember that the change of an aquatic ani- 
 mal, which used its limbs simply like paddles, into a semi- 
 aquatic and partly terrestrial, and therefore crawling, 
 creeping and running creature, involved a complete 
 change of its muscles, and at a later period of its bony 
 framework. In swimming animals, such as ceratodus and 
 menobranchus, the longitudinal axis of the whole limb is 
 nearly straight, whilst a terrestrial life necessitates the 
 bending of a limb at several angles, and the development 
 of more or less complicated joints." 
 
 It is this flexion which explains how tendons outside the 
 joint in animals whose limbs are nearly straight, get drawn 
 into it when the limb is acutely bent. 
 
 When the leg is extended, the anterior surfaces of the 
 femur and tibia are in the same plane ; when the leg is 
 flexed, the broad upper extremity of the tibia is brought into 
 contact with the distal part of the posterior surface of the 
 femoral shaft, and immediately in relation with the ten- 
 dons of origin of the muscles destined for the foot, and in 
 many cases with muscular tissue. 
 
 Therefore in menobranchus, the axis of whose hind limb 
 
 * Journal of Anatomy and Physiology, vol. xvi., p. 501. 
 
44 LIGAMENTS. [Chap. iv. 
 
 is nearly straight, the tendons are excluded from the joint, 
 and arise from the femur. In the frogs, whose limbs are 
 flexed, the tendons of origin of many of the leg muscles in- 
 truding upon the joint get drawn between the opposed 
 surfaces of the tibia and femur, constituting fibro-carti- 
 lages, crucial or lateral ligaments, as the case may be. 
 
 The lizards furnish the strongest possible evidence that 
 the interarticular fibro-cartilages arise in this way. The 
 iguana may be selected as a type. 
 
 In the thigh we find a very remarkable muscle known 
 as the femoro-caudal. It is exceedingly large and 
 arises from the infero-lateral aspect of the caudal ver- 
 tebrae : it is inserted by a large, broad, and strong 
 
 Fig. 15. — The femur, with the femoro-caudal muscle, F., of an iguana. 
 Its long tendon X passes downwards to the interarticular cartilage of 
 the knee-joint. The cut ends of the muscles are those of the biceps, 
 semi-membranosus, etc. 
 
 tendon into the base of the trochanter on its extensor 
 aspect. A little space before its insertion the muscle 
 gives off, at right angles to its lower border, a long, thin, 
 and delicate tendon, which passes down the thigh, on the 
 inner side of the great sciatic nerve, to the popliteal re- 
 
Chap iv.] KNEE JOINT AND ANKLE. 45 
 
 gion, where it passes between the fibula and tibia to blend 
 with the outer part of the interarticular fibro- cartilage of 
 the knee joint. Fig - . 15. 
 
 This would seem to shew that in lizards, at least, the in- 
 terarticular cartilages are the modified tendons of muscles 
 which have become interarticular, during- the modifications 
 the joint has passed through in its evolution. For further 
 information concerning the morphology of this extraor- 
 dinary muscle, consult this reference. 
 
 An extended survey of the relation of these parts in ani- 
 mals from the lizards onward to man, leaves little doubt 
 that the fibro-cartilages in the human knee joint are sur- 
 vivals of the distal termination of the femoro-caudal and 
 associated muscles. 
 
 The crucial ligaments. It is fairly conclusive that the 
 muscles in the region of the knee joint have been affected 
 by very considerable disturbance For example, in primi- 
 tive forms, like lepidosiren, the muscular layers, pass 
 from the trunk and invest the limbs without any transverse 
 segmentation occurring. In frogs, lizards, and crocodiles, 
 a gap occurs in the muscular sheet, the proximal segments 
 attaching themselves to the tibia, the distal muscles arising 
 from the lower end of the femur. In this way the quadri- 
 ceps extensor, sartorius, gracilis, the hamstring group, 
 and the adductor magnus, become inserted into the tibia ; 
 whilst the extensors and flexors of the digits, the peroneal 
 group, gastrocnemius, plantaris, tibialis anticus and posti- 
 cus, arise from the femur. 
 
 Many of the muscles have shifted their insertion from 
 the tibia and formed new attachments to the femur, e.g. the 
 adductor magnus. On the other hand, many left their 
 acquired origin from the femur and descended to new at- 
 tachments on the tibia and fibula (migration). Hence, it is 
 necessary to decide whether a given ligament of the knee 
 joint, had its origin from one of the thigh muscles shifting 
 
 * Journal of Anatomy and Physiology, vol. xx., p. 39. 
 
46 LIGAMENTS. [Chap, iv, 
 
 its insertion, or a leg muscle migrating to the tibia or 
 fibula from the femur. 
 
 Both these processes have been in operation, and in 
 Chapter II. evidence was adduced to support the view that 
 the b>t^aal lateral ligament was originally the tendon of 
 the peroneus longus, which muscle has migrated from the 
 femur to the fibula. Whilst the internal lateral ligament 
 results from the adductor magnus muscle withdrawing its 
 point of insertion from the tibia to the femur. 
 
 There can be little doubt that the crucial ligaments have 
 a similar origin, but it is not quite clear to which muscles 
 they originally belonged. It is possible to limit the mus- 
 cles to three or four to which they may have been attached. 
 The long extensor of the toes and the tibialis anticus mus- 
 cle arise in many animals from the femur when crucial 
 ligaments are present, so that these may be excluded satis- 
 factorily enough. The muscles on which the lot falls are 
 the peroneo tibial, tibialis posticus, flexor longus and the 
 extensor brevis digitorum. See table on page 48. 
 
 The Synovial Membranes. — In the beaver the ar- 
 rangement of the synovial membranes of the knee joint is 
 after this fashion. There is a distinct synovial pouch for 
 the patella and the patellar surface of the femur. The 
 cavity for the articular surfaces of the femur and tibia is 
 divided into two parts by the crucial ligaments and a 
 septum of connective tissue, thus making three synovial 
 membranes in all : one for the patella, and one for each 
 femoral condyle and the corresponding articular surface on 
 the head of the tibia. 
 
 In man, however, this septum disappears, save a few 
 strong fibres in the middle line, which pass from the lower 
 border of the patella to the intercondyloid notch immedi- 
 ately below the patellar facet. This band of tissue, with 
 its lateral fringes, adipose and fibrous in structure, is 
 denominated in human anatomy the ligamentum mucosum 
 and the ligamenta alaria. In reality they are simply 
 vestiges of the sac-wall of the bursa, originally developed 
 between the patella and the femoral condyles. 
 
Chap, iv.] KNEE JOINT AND ANKLE. 47 
 
 Examine a human foetus at the third month, by dividing 
 the knee joint vertically, the synovial membrane will be 
 found arranged as follows : — The proper cavity ends on a 
 level with the upper border of the articular cartilage of the 
 femur. Immediately above this, and lying behind the 
 quadriceps extensor muscle, is a large bursa, whose sac 
 communicates with that of the knee joint proper by a small 
 opening in its lower part. After birth, however, the 
 diaphragm between the two cavities quickly disappears ; 
 the synovial membrane of the joint and the bursa blend to 
 form one common cavity. Thus it follows that the large 
 cul-de-sac of synovial membrane extending under the 
 extensor muscles ot the thigh is due to secondary causes, 
 
 Fig. 16. — Vertical section through the knee joint of a human foetus at 
 the third month. F. Femur; P. Patella; T. Tibia. I. Quadriceps 
 bursa. II. Patella bursa. III. Knee joint proper. 
 
 it has also been shown that this has occurred in connection 
 with the patella, so that the knee joint, as seen in man, is 
 made up of its own synovial membrane reinforced by two 
 very considerable bursae. 
 
 Viewed in full light, the evolution of the structures con- 
 cerned in man's knee joint may be considered as resulting 
 from the changes produced by the regression and migration 
 of muscles to provide it with ligaments, the metamorphosis 
 of tendon to furnish it with interarticular fibro-cartilages, 
 and lastly the annexation of bursae to extend the dimen- 
 sions of its synovial territory. 
 
43 
 
 LIGAMENTS. 
 
 [Chap. iv. 
 
 For convenience, the origin of the various structures of 
 the knee joint are arranged in a tabular form : — 
 
 Internal 
 External 
 
 Internal — External 
 
 Anterior 
 Posterior 
 
 Lateral Ligaments. 
 Tendon of the adductor magnus muscle. 
 Tendon of the peroneus longus. 
 
 Fibro-Cartilages. 
 
 j Modifications of the femoro-caudal, biceps and 
 ( semi-membranous muscles. 
 
 Crucials. 
 
 ( There are no certain facts as to which muscle 
 ( it originally belonged. 
 
 Tibialis posticus muscle. (?) 
 
 Synovial Membrane. 
 
 (Original bursa between the quadriceps extensor 
 The great cul-de-sac . \ . . . 
 
 & y and the femur. 
 
 Middle portion . . The original patellar bursa. 
 
 Lig. mucosum and (The remains of the original sac-wall of the 
 alaria . . . ( patellar bursa. 
 
 The Anterior Annular Ligament of the Ankle Joint. 
 
 The structures included under the above title are two in 
 number, one is placed at the lower end of the leg, and is 
 simply a transverse band of fibrous tissue passing from the 
 tibia to the fibula and serving to retain the vertical portion 
 of the extensor tendons. Although it is a structure very 
 general, from amphibians to man, it has apparently no 
 morphological significance. 
 
 The other ligament is opposite the bend of the ankle 
 joint, and is attached to the os calcis by its two extremities 
 which are in contact where they arise from the bone, so 
 
Chap, iv.] LIGAMENTS OF ANKLE JOINT. 49 
 
 that they form an exceedingly narrow loop, which just 
 admits of the passage of the extensor longus digitorum 
 tendon; from the inner limb of the pulley a fibrous cord 
 passes beneath the extensor proprius hallucis and tibialis 
 anticus muscles, to be attached to the internal malleolus, 
 blending- with the tibial attachment of the superior liga- 
 ment as shown in fig-. 17. 
 
 By studying the relations of this structure in a large 
 number of mammalian forms, it turns out that the loop 
 which encircles the extensor longus digitorum is the 
 essential portion of the ligament, but the fibrous cord 
 passing to the internal malleolus is entirely secondary, and 
 exhibits an extreme vagary in the way it disports itself with 
 regard to the extensor hallucis and tibialis anticus muscles. 
 
 F.L.D. 
 
 Fig. 17. — The inferior anterior annular ligament of the ankle joint of a 
 monkey. F.L.D., extensor longus digitorum muscle. 
 
 It is impossible to deal satisfactorily with the annular 
 ligament of the ankle joint without taking into considera- 
 tion the condition these ligaments present in birds, and as 
 the inquiry has led me deeply into the subject of the devel- 
 opment of the tarsus in the feathered tribe, and certain 
 facts of some interest have come under notice, it will be 
 necessary to go systematically into the matter. 
 
 The Avian Tarsus and Annular Ligaments. 
 
 The tibia, or more correctly tibio- tarsus, of a bird is a 
 bone very characteristic of this class. It is a cylindrical 
 bone, usually about half as long again as the femur. The 
 
So LIGAMENTS. [Chap. iv. 
 
 proximal extremity presents two somewhat concave articu- 
 lar surfaces for the femoral condyles; in front it is pro- 
 duced into a prominent cnemial crest or process, which in 
 a few cases (struthio and rhea) is ossified as an epiphysis. 
 In the Dinosauria this process may be variously subdivided. 
 The distal end of the bone is terminated by a trochlear or 
 pulley-like articular surface. Not unfrequently there is an 
 oblique bar of bone on the anterior face, just above the 
 trochlea ; this osseous loop transmits some of the extensor 
 tendons (fig. 18). The true composition of this bone will 
 
 Fig. 18. — The ligaments of the ankle-joint of a fowl. I. The super- 
 ficial; II. The deep ligament. 
 
 be considered when dealing- with its development. The 
 fibula of birds is usually imperfect, and presents itself as a 
 slender osseous rod attached to the outer side of the tibio- 
 tarsus. Its proximal end articulates with the outer con. 
 dyle of the femur being- received in the fibular fossa; the 
 distal end gradually thins and fuses with the tibio-tarsus. 
 Although as a rule the fibula is shorter in the adult bird 
 than the tibia, yet it may be of the same length as in 
 some of the penguins. 
 
 The segment beyond the tibio-tarsus is a compound of 
 certain bones of the tarsus and metatarsus, hence it may 
 be correctly referred to as the tarso-metatarsus ; the 
 various metatarsals which compose it, fuse together to form 
 a single bone. 
 
 As the proximal part of the tarsus becomes confluent 
 with the tibia, and the distal portion fuses with the meta- 
 
Chap, iv.] 
 
 THE A VI AN TARSUS. 
 
 5i 
 
 tarsus, it thus comes about that the joint between the 
 tibio-tarsus and the tarso-metatarsus is in fact a mesotarsal 
 articulation, really corresponding with the medio-tarsal 
 joint of man, which exists between the os calcis and 
 astragalus as its proximal elements, and the scaphoid and 
 cuboid as the distal bones. 
 
 The above statements are warranted by an appeal to 
 the development of the parts in birds. Gegenbaur 
 
 Fig. 19. — Leg of a chick at the fifth day of incubation (after Miss 
 Johnson). Fe. Femur ; T. Tibia ; F. Fibula. The numerals refer to 
 the digits. 
 
 ( Uniersuchungen zur Vergleichenden Anatomie der Wibelihiere, 
 Erstes Heft, " Carpus und Tarsus ") proved that the distal 
 end of the tibia, which in the young bird is separated from 
 the main bone by a suture, is not an epiphysis, for the 
 cartilage in which it ossifies is separate ; this individuality 
 in the cartilaginous state distinguishes it as an element, an 
 epiphysis being a distinct ossification in a continuous cartilage. 
 
 In order that the true nature of the parts shall be cor- 
 rectly comprehended, it will be safer to give in brief outline 
 
 e 2 
 
52 
 
 LIGAMENTS. 
 
 [Chap. iv. 
 
 the development of the bird's leg, which has been worked 
 out by Gegenbaur, Rosenberg-, Baur, and Miss Johnson. 
 
 In the limb of a chick, five days old, the tissue is con- 
 densed axially into a single mass, and the skeleton of the 
 
 Fig. 20.— The leg of a Chick at the eight day of incubation, (after 
 Johnson). Fe. Femur ; T. Tibia ; F. Fibula ; A. Astragalus (tibiale) ; 
 C. Os calcis (fibulare) ; Ta. Tarsalia. The numerals refer to the digits. 
 
 limb is produced by the subsequent elongation i ■ d seg- 
 mentation of the mass. 
 
 * " Development of the Pelvic Girdle in the Chick," Qitar. your. Mic. 
 Science, vol. xxiii. (This paper contains numerous references of value). 
 
Chap, iv.] THE AVIAN TARSUS. 53 
 
 At this stage the limbs present the condition represented 
 in fig-. 19. All the chief elements may be recognised, 
 though they are completely continuous. The tarsus is 
 continuous with the tibia and fibula above and with the 
 metatarsals below. Five metatarsals are present. 
 
 At the eighth day all the elements of the tarsus are at 
 their most distinct and independent stage, though they are 
 still united with one another, as well as with the tibia, 
 fibula, and the metatarsals, by the condensed tissue of the 
 groundwork of the tarsus (fig. 20). 
 
 Later, the distal and proximal parts of the tarsus become 
 separated, and the two proximal elements fuse together. 
 Next, the proximal parts fuse with the tibia, which has 
 grown more than the fibula, so that the latter no longer 
 reaches the tarsus. The posterior lower edge of the tibia 
 first becomes continuous with the proximal tarsal cartilage* 
 while the anterior face of the latter gives off an upward 
 process, the so-called "ascending process" of the astra- 
 galus, which fits into a groove in the tibia, and remains 
 lor a long time separate from it. At about the same time 
 the distal part of the tarsus fuses with the metatarsals, first 
 with the second, next with the fourth, and lastly with the 
 third. All these processes take place while the tarsus is 
 still cartilaginous. In the chick two ossific nuclei later 
 make their appearance in the proximal piece of cartilage, 
 the inner one representing the astragalus, the outer and 
 smaller piece the os calcis. The distal piece of cartilage 
 represents the tarsalia. 
 
 In the majority of birds the astragalus sends up a long 
 osseous " spike," which fits into a grove on the anterior 
 surface of the tibia, as shown in fig. 21, and is commonly 
 referred to as the ascending process of the astragalus. 
 This spike has been shown by Morse to have an inde- 
 
 * Anniversary Memoirs of the Boston Society of Natural History, i88o > 
 Morse, On the Identity of the so-called Ascending Process of the Astragalus, 
 with the Intermedium. 
 
54 LIGAMENTS. [Chap. iv. 
 
 pendent ossific centre, and he considers it to correspond 
 with the intermedium of the typical tarsus. The ques- 
 tion is one so full of interest, and as I wish to give an 
 account of some observations of my own on the subject, it 
 is well to refer in detail to Morse's paper. 
 
 It appears that Professor Wyman sent a note to Morse, 
 to the effect that he had found in the tarsus of an embryo 
 heron, a long style-shaped bone, broadest at its distal 
 
 Fig. 21. — The distal end of the tibio-tarsus of an Ostrich chick. A. 
 Astragalus ; C. Os calcis ; I. The so-called ascending spike of the 
 astragalus (intermedium) ; F. Fibula. 
 
 extremity, lying in front of and at the distal end of the 
 tibia, which he believed to represent the so-called ascend- 
 ing process of the astragalus, but which had an independ- 
 ent centre of ossification, and remained free from the other 
 tarsal bones until the young had left the egg. Morse had 
 previously shown that as the proximal series of bones 
 become united, the fibula diminishes in size proportionally 
 with the rapid increase of the tibia, becoming finally a 
 splint-like bone with its attenuated distal end far removed 
 from the tarsus ; the tibia, on the contrary, enlarges, so 
 that its distal extremity equals in transverse diameter the 
 two proximal tarsal bones. 
 
Chap, iv.] THE AVIAN TARSUS. 55 
 
 The intermedium, while occupying- its proper position 
 between the tibiale and fibulare, and finally uniting- with 
 them, becomes displaced, so to speak, by standing in 
 front of the tibia. As proving the correctness of this 
 assumption, it may be mentioned that the bone may be 
 found occupying its true position in the tarsal series, and 
 between the distal extremity of the tibia and fibula in the 
 embryos of those birds in whom it is represented. 
 
 An examination of the tarsus in the embryos of the Tern 
 (Sterna hirundo), Petrel (Procellaria pelagica), Sea Pigeon 
 (Una grylle), Eider Duck (Somateria mollesstma), Herring 
 Gull (Larus argentatus), and in the Great Auk (Aptenodytes 
 pennanti), showed that in these birds the intermedium is 
 present as a separate bone. It lies at first in a line with 
 the proximal row of tarsal bones, opposite the space be- 
 tween the tibia and fibula. As the tibiale and fibulare 
 coalesce the intermedium is crowded upwards and out- 
 wards so as to occupy a position in front of the tibia. It is 
 the last bone to unite with the confluent tibiale and fibulare. 
 
 Since reading Morse's paper, I have had an opportunity 
 of investigating the condition of the ascending process of 
 the astragalus in a cygnet of Cygnus mutis, and in an 
 ostrich and an emu chick. In the cygnet the "bony 
 spike " was present as a separate ossification, exactly as 
 Morse figures it. In the the case of Struthio and Dromoeus 
 the process was just in the act of uniting with the astra- 
 g-alus; on making a longitudinal section through the lower 
 end of the tibio-tarsus the line of separation was clearly 
 visible. These three specimens have convinced me that 
 the ascending process of the astragalus is an independent 
 element. 
 
 I felt it was absolutely necessary to enter minutely into 
 the details of the ossification of the bird's tarsus for two 
 reasons: — (i) To show that the bony bridge on the lower 
 end of the tibio-tarsus is an "adventitious" ossification, 
 (2) to prove its relationship with the tarsus— these two con- 
 ditions being essential to establish its identity with the in- 
 ferior annular ligament of the mammalian ankle joint. 
 
56 LIGAMENTS, [Chap. iv. 
 
 In order to show that a great deal of misconception pre- 
 vails as to the real nature of the oblique bar of bone, I will 
 make the following- extract from Mr. Parker's paper, "On 
 the Osteology of Balaniceps rex" (Trans. Zool. Soc, vol. 
 iv. ) : — '• The inferior or distal end of the tibia is developed 
 from a distinct osseous centre in young birds, which piece 
 forms all the articular parts and sends upwards a wedge- 
 shaped process in front, the seat of the ossification which 
 makes the large, wide, oblique, tendon-like brid.^ 
 
 Morse finds that this oblique tendon-like bridge in the 
 heron and many other birds has no relation with the in- 
 termedium, and I am convinced, from the examination of 
 a very large number of birds, that the pulley in question is 
 really the homologue of the loop which in mammals binds 
 down the tendon of the extensor longus digitorum, and 
 has its main attachment to the proximal row of tarsal 
 bones. It is. therefore, an adventitious ossification and not 
 an intrinsic element of the bird's tarsus. 
 
 So far as the anterior annular ligaments of the bird's 
 leg is concerned, it must be clear to any one who has fol- 
 lowed the preceding account that the two structures differ 
 very considerably in their mode of origin and in their rela- 
 tion to each other. It must also be very evident that the 
 upper ligament, which involves all the extensor tendons, is 
 the homologue of the superior ligament of the mammalian 
 ankle joint, but the deep or inferior band, ossified in some 
 birds, which transmits the extensor longus digitorum ten- 
 don, is the avian representative of the loop attached to the 
 os calcis in most mammals, including man. It may per- 
 haps be advisable to state that the fact of it often under- 
 going ossification in birds is no objection to it being con- 
 sidered as the homologue of a purely fibrous structure 
 (and. so far as one knows, always so in mammals) for in 
 the West African Lemur iPerodicticus potto) the anterior 
 annular ligament of the wrist joint (which arises as the 
 result of regression of certain portions of the short muscles 
 of the hand > contains an osseous nodule, thus completing 
 
Chap, iv.] THE AVIAN TARSUS. 5 7 
 
 a bony tunnel for the flexor tendons, comparable in a 
 certain measure to the osseous loop at the lower end of 
 the bird's tibio tarsus. 
 
 Admitting- then that the ligaments in the legs of birds and 
 mammals are homologous, it necessarily follows that the 
 question be asked, How do these structures arise, and 
 what is their nature ? 
 
 A full discussion of the mode of evolution of these two 
 ligaments, would lead us far beyond the scope and inten- 
 tion of this little work, the enthusiastic student is referred 
 to the author's original paper dealing with this particular 
 question. The principles involved are of great interest. 
 
 Briefly the ancestry of the anterior annular ligaments 
 may be stated thus : — 
 
 i. The upper or vertical band arises from thickening of 
 fibrous tissue the result of long continued strain. 
 
 2. The lower one represents an old attachment of the 
 extensor longus digitorum muscle as seen in Iguana and 
 Parson's Chameleon. 
 
 Lastly as far as my dissections have extended, an 
 anterior annular ligament is a structure peculiar to birds 
 and mammals. 
 
 * journal of Anatomy and Physiology, vol. xx., " Nature of Ligaments, 
 part iv." Consult also Mivart, "Myology of Parson's Chameleon," 
 Proceedings of the Zoological Society, 1870. 
 
CHAPTER V. 
 
 The Ligaments of the Pectoral Arch. 
 
 The term "pectoral arch " or "shoulder girdle " is applied 
 to those elements of the skeleton which serve the purpose 
 of attaching the anterior limbs to the trunk. The compo- 
 nent parts of this arch or girdle in the adult, consist of the 
 clavicles and scapulae with their connecting ligaments. It 
 will be necessary to briefly recapitulate the leading 
 characters of the ligaments, in order that we may fully 
 understand their significance when dealing with the devel- 
 opment of the parts and their morphology. 
 
 i. The Ligaments at the Sternal (Ventral) End of 
 the Clavicle. 
 
 (a) The interclavicular. This is a T-shaped band of dense 
 fascia uniting the clavicles across the median line and 
 sending a vertical slip downwards to be attached to 
 the top of the sternum. 
 
 (b) Capsular ligaments. 
 
 {c) An inter articular fibro- cartilage, interposed between the 
 sternum and the clavicle. Occasionally a cartilagin- 
 ous, or an osseous nodule may be found in the lower 
 end of these ligaments, named the epi-sternal bone. 
 
 2. The Ligaments at the Acromial End of the 
 Clavicle. 
 
 (a) The capsular, an insignificant structure. 
 
 (b) An interarticular cartilage, this is occasionally absent. 
 
 3. The clavicle is connected with the costal cartilage of 
 the first rib by the rhomboid ligament, and with the coracoid 
 process of the scapula by means of the conoid and trapezoid 
 ligaments. 
 
 4. Closely connected with the preceding group are two 
 ligaments passing from the scapula to the humerus; one 
 
Chap, v.] 
 
 PECTORAL ARCH. 
 
 59 
 
 the coraco- humeral lying outside the capsule of the shoulder 
 joint, the other the gleno-humeral which may be inside the 
 joint, but in man is usually situated between the capsule and 
 the synovial membrane. 
 
 5. The coraco- acromial ligament is a very strong- band of 
 fascia passing from the outer side of the coracoid to the 
 acromion process. 
 
 6. The cost 0- coracoid ligament, a dense band of tissue 
 marking the limit of the costo-coracoid membrane and 
 running from the tip of the coracoid to the costal cartilage 
 of the first rib, and thence to the sternum. Frequently it 
 contains cartilage nodules. It is stronger and more 
 pronounced in many of the quadrumana than in man, but 
 in him it is frequently very conspicuous. 
 
 Fig. 22.— A general view of the clavicular ligaments and associated 
 structures. I. The interclavicular ligament ; II. Interarticular fibro- 
 cartilage; III. Rhomboid ligament; IV. The subclavius muscle; V. The 
 conoid and trapezoid ; VI. The gleno-humeral ligament ; VII. The costo- 
 coracoid membrane and ligament; VIII. The minor pectoral muscle; 
 Its tendon as the coraco-humeral band. The dotted line indicates the 
 situation of the coraco-acromial ligament. 
 
 The ligaments of the arch when considered morpho- 
 logically readily fall into two groups ; viz., those derived 
 from its intrinsic elements, and those which arise from 
 muscular regression or metamorphosis. 
 
 To the first group belong the interclavicular ligamen^ 
 the interarticular fibro-cartilages at each end of the 
 
6o LIGAMENTS. [Chap. v. 
 
 clavicle, the coraco-acromial and the costo-coracoid 
 ligament. Those which constitute the second group will 
 be considered later. 
 
 The mode of origin of the ligaments derived from 
 intrinsic elements of the arch are so involved in the 
 ontogeny of the various bones and their cartilaginous pre- 
 cursors, that the development of the clavicle and scapula 
 must be detailed. Before doing so, however, it will be 
 advisable to give an account of what may be considered 
 the typical or generalised form of the cartilaginous arch. 
 
 This consists essentially of a bar of cartilage which may 
 be divided into three parts: — i. A dorsal segment repre- 
 senting the scapula. 2. A ventral bar, the coracoid, 
 forming with the scapula a socket for the reception of the 
 proximal bone of the limb. 3. A rod or bar situated 
 anteriorily to the coracoid, and named in consequence the 
 precoracoid. These two segments agree in the circum- 
 stance that they meet the sternum anteriorily and the 
 scapula posteriorily, but the precoracoid is, as a rule, 
 excluded from the glenoid fossa. Fig. 23. The bar of 
 
 Fig. 23 — The shoulder-girdle of an ostrich chick. S. Scapula ; Sc. 
 Supra-scapula cartilage; C. Coracoid; P. Precoracoid; E. Epicora- 
 coid ; G. Glenoid fossa. 
 
 cartilage which unites the ventral ends of the coracoid and 
 precoracoid is termed the epicoracoid. 
 
 From such a shoulder-girdle as this, we may derive any 
 form, from chelonians onwards to man, by the two pro- 
 cesses of addition and suppression, the suppressed parts 
 usually being represented by fibrous tissue. 
 
 This type form is also valuable, when we wish to com- 
 pare homologous parts of the pectoral with the pelvic 
 girdle, for although in the adult the differences are 
 
Chap, v.] OSSIFICA TION OF CLA VICLE. 6 1 
 
 considerable, yet in the cartilaginous state they are very 
 similar. 
 
 From the type-form, man's primitive pectoral arch differs 
 only in this particular. The continuity of the coracoid and 
 precoracoid bars is interrupted. This defect in the pre- 
 coracoid is due to the intrusion of the clavicle as a 
 secondary element in the arch. In the case of the coracoid 
 it is a consequence of partial suppression. 
 
 The ossification of the clavicle. — This bone is the 
 first in the skeleton to ossify. It commences about the 
 sixth week of intrauterine life by a deposition of ossific 
 matter, at a spot corresponding- to the middle of the shaft 
 of the clavicle, it may be detected before the formation of 
 the precoracoid cartilage, consequently it must be regarded 
 as a membrane bone. Later, the extremities of the clavicle 
 invade the cartilage and serve as an example of a bone 
 originally arising in membrane becoming secondarily 
 engrafted on cartilage and assuming a composite charac- 
 ter. This is interesting, for it serves to explain what 
 would otherwise be singular, viz., the occasional trans- 
 mission through the middle of the clavicular shaft of some 
 twigs of the descending cervical nerves, and at times 
 a cephalo-jugular vein. There can be little doubt that 
 these represent nerves and veins which should pass be- 
 tween the clavicle and precoracoid bar in forms where the 
 latter exist as distinct entities. When these elements fuse 
 to form man's composite clavicle, the nerves and veins are 
 involved in the ossification. 
 
 The clavicle is completed by an additional ossification 
 at the sternal end. The nucleus is usually detected about 
 the eighteenth year, and unites with the shaft at twenty- 
 two. 
 
 The interarticular fibro-cartilages at the sternal and 
 acromial ends of the clavicle, arise from the regression of 
 the inner and outer extremities respectively of the cartila- 
 ginous precoracoid. The nodule of bone known as epi- 
 sternal, is developed in this remnant of the precoracoid bar. 
 
62 LIGAMENTS. [Chap. v. 
 
 The ossification of the scapula. — This bone is pre- 
 formed in cartilage. The primary centre appears about 
 the third month of intrauterine life near the base of the 
 spine, and quickly extends itself throughout the cartilage, 
 so that at birth we only find a thin strip of cartilage 
 along the vertebral border; the glenoid fossa, the coracoid 
 and acromion processes are yet unossified. In the first year 
 after birth a nucleus appears for the coracoid, and from this 
 centre ossific matter extends into the glenoid fossa and as 
 far backwards as the notch in the upper border of the 
 scapula ; ossification only extends a short way into the 
 coracoid bar, the chief portion being represented by the 
 costo-coracoid ligament. At the fifteenth year the coracoid 
 becomes ankylosed to the scapula and two nuclei appear 
 for the acromion ; the supra-scapular cartilage ossifies 
 from two centres, one opposite the spine, the other at the 
 inferior angle. A thin lamina is added later to the glenoid 
 fossa, and by the twenty-fifth year the ossification of the 
 scapula is complete. 
 
 The most remarkable feature in the development of this 
 bone is the early appearance of the coracoid centre, and 
 the long persistence of the strip of cartilage at the 
 vertebral border. With regard to the coracoid, many 
 look upon its nucleus as a primary one, even then it differs 
 from the usual course of events, for its appearance is late, 
 so that considering it from either point of view its de- 
 velopment is anomalous and suggestive. This opinion is 
 confirmed when the part is studied morphologically. 
 
 On comparing the scapula of a human fcetus at the 
 seventh month with the type-form, we shall at once see 
 that the strip of cartilage along its vertebral border is 
 homologous with the supra-scapular cartilage, which in 
 batrachians persists throughout life, merely becoming im- 
 pregnated with lime-salts. There is substantial agreement 
 in that the glenoid fossa is formed by the confluence of the 
 coracoid and the body of the scapula. The coracoid 
 differs from the type-form, in the fact that it is repre- 
 
Chap, v.] OSSIFICATION OF SCAPULA. 63 
 
 sented by bone in only the scapular third, the sternal 
 portion being - replaced by fibrous tissue. 
 
 In order to elucidate the nature of the interclavicular 
 ligament, we must study Omithorhynchus. 
 
 The complex pectoral arch of this low mammal is shown 
 in fig - . 24, where S represents the scapula, tipped with its 
 thin streak of supra-scapular cartilage, C is the coracoid, 
 which in no group of mammals other than the monotremata 
 is prolonged as bone to the sternum. The precoracoid is 
 represented by an osseous nodule resting on the sternum 
 anterior to the coracoid, and as it articulates with the 
 latter it contains also the epicoracoid element. The 
 clavicles, C", are supported at their inner extremities by a 
 large T-shaped bone, of membranous origin, the inter- 
 clavicle. It is certainly remarkable that in order to find a 
 similar skeletal element we must descend to lizards. 
 
 Fig. 24. — The shoulder girdle of Omithorhynchus. S. Scapula ; C. 
 Coracoid ; C". Clavicle ; E. Epicoracoid ; X. The interclavicle. 
 
 A general survey of the pectoral girdle teaches us that 
 fundamentally it consists of a dorsally placed scapula and 
 two ventral segments, coracoid and precoracoid. The 
 scapula and coracoid together form a glenoid fossa. 
 The scapula is in relation with coracoid and pre-cora- 
 coid, whilst the two latter are united ventrally by a 
 
64 LIGAMENTS. [Chap. v. 
 
 bar of cartilage, the epicoracoid. In the majority of types 
 the precoracoid becomes divided in its centre by the 
 clavicle, and its extremities are invaded by the growing- 
 bone. Its median extremity is in man represented by the 
 interarticular fibro-cartilage between the clavicle and 
 sternum, occasionally a little cartilage or osseous nodule 
 is present in them (the episternal bones of Breschet). The 
 scapular remnant of the precoracoid finds a representative 
 in the interarticular fibro-cartilage between the acromion 
 and clavicle (Parker's confusing mesoscapular segment). 
 The coracoid in man is a stunted process, which early 
 fuses with the scapula, but its prolonged condition in 
 frogs, birds and monotremes, is represented by the long 
 costo-coracoid ligament running in the free border of the 
 membrane of that name, and presenting chondral particles 
 at its sternal attachment. The interclavicular ligament 
 is the fibrous representative of the bone of that name in 
 lizards and in monotremes. 
 
 The coraco-acromial ligament. — This is a dense 
 band of fascia passing from the acromion to the coracoid 
 process, and is supposed by teleologists to have been de- 
 signed to prevent upward dislocation of the head of the 
 humerus. It has, however, a far more interesting signifi- 
 cance. In the scapula of the sloth the acromion process 
 sends a long hook-like piece of bone to meet the cora- 
 coid. In the foramen triosseum of very many birds the 
 scapula joins the coracoid above as well as below the 
 foramen. 
 
 In man and other mammals this portion of the acromion 
 is represented by the coraco-acromial ligament. The view 
 is supported by the fact that in the foetus of many mammals 
 a tract of cartilage may be detected in the same situation. 
 
 The disposition of these parts in the sloth is repre- 
 sented in fig. 3. The nature of the transverse ligament 
 is discussed on page 6. 
 
 The following ligaments connected with the pectoral 
 girdle remain for consideration, viz., the rhomboid, the 
 
Chap, v.] THE GLENO-HUMERAL. 65 
 
 conoid and trapezoid, the gleno humeral and the coraco- 
 humeral. 
 
 The rhomboid ligament. — The costo- clavicular or 
 rhomboid ligament is attached to the cartilage of the first 
 rib near the sternal end, and passes obliquely upwards, 
 backwards and outwards to a rough impression on the 
 under surface of the clavicle near its inner extremity. 
 
 The coraco-clavicular ligament. — This ligament 
 consists of two parts, an inner fasciculus termed the 
 conoid, and an outer the trapezoid ligament. The conoid 
 fasciculus is attached by its base to the conoid tubercle 
 of the clavicle, whilst the apex is inserted into the root 
 of the coracoid process. The trapezoid portion passes 
 from the upper surface of the coracoid to a ridge on the 
 under aspect of the outer extremity ol the clavicle. Be- 
 tween the two ligaments a bursa may frequently be de- 
 tected. 
 
 The gleno-humeral ligament. — This ligament is 
 usually described as an accessory band, springing from the 
 edge of the glenoid fossa at the root of the coracoid 
 process, and passing downwards to the lesser tuberosity of 
 the humerus. It runs more or less parallel with the long 
 tendon of the biceps, and may be identified in the usual 
 conditions of the parts as a bulging into the joint, separated 
 from the synovial cavity by the thin serous membrane only. 
 Occasionally the ligament is completely surrounded by 
 synovial membrane and is as prominent a structure in 
 the joint as the biceps tendon ; indeed it then exists 
 as a veritable lig amentum teres. This condition is far more 
 frequent in the foetus than in the adult. It also exists as a 
 strong and well defined ligament normally in a very large 
 number of mammals. We shall return to this subsequently, 
 the general character of the ligament is shewn in fig. 25 
 from the beaver, Castor canadensis. 
 
 The coraco -humeral ligament. — This is a strong 
 wide band passing from the root and outer border of the 
 coracoid process to the neck of the humerus above the 
 
 F 
 
66 
 
 LIGAMENTS. 
 
 [Chap. v. 
 
 great tuberosity, it is intimately associated with the capsule 
 of the joint. 
 The morphology of the subclavius muscle. — In 
 
 man the subclavius muscle arises from the first costal arch 
 at the junction of the rib with its costal cartilage, close to 
 the costo-clavicular (rhomboid) ligament. The fibres pass 
 outwards and upwards arranged in a prismatic manner to 
 be inserted in a groove on the under surface of the clavicle 
 extending as far as the interval between the conoid and 
 trapezoid ligaments lying beneath the costo-coracoid mem- 
 brane. 
 
 Fig. 25. — The shoulder joint of a Beaver {Castor canadensis), to show 
 the large size of, G. The gleno-humeral ligament; S. Scapula; H. 
 Humerus; B. Biceps. 
 
 Its most important variations are the following : — 
 1. It may be inserted into the root of the coracoid 
 process instead of the clavicle. 2. The muscle may 
 divide its insertion, one part passing to the clavicle, 
 the other ending in the root of the coracoid process. 
 In some instances a few fibres may be inserted into 
 the conoid ligament. 3. Occasionally it is attached to 
 the coracoid process, and a bursa exists between the 
 tendon and the coracoid, whilst a prolongation may pass 
 from this tendon to the humerus. Other variations are 
 
Chap, v.] 
 
 SUBCLAVIUS MUSCLE. 
 
 67 
 
 described, but these three are alone of importance at 
 present. 
 
 Leaving- man for the present and descending- to the 
 amphibia we shall find that the interesting- form Mew 
 bronchus lateralis presents about the shoulder a very distinct 
 muscle, having the following- attachments: — 
 
 It arises from the ventral surface of the long- precoracoid 
 cartilage and passes backwards to be inserted into the 
 head of the humerus, between the deltoid, pectoralis major 
 and supraspinatus muscles. 
 
 St. George Mivart in his paper on the myology of this 
 creature, identifies the muscle as the subclavius. Whether 
 it deserves this name or that of epicoraco- humeral is a matter 
 
 Fig. 26.— The subclavius of a bird. H. Humerus. S. Subclavius. 
 T. Its tendon. C. Clavicle. Co. Coracoid. 
 
 of little moment, but its situation and points of attach- 
 ments are, for the purpose of the argument, of great 
 importance. It is probable that this muscle is the ancestor 
 of the subclavius of human myology. 
 
 If the shoulder joint of a carinate bird be dissected, a 
 muscle will be found arising from the keel and median 
 portions of the body of the sternum, as a broad fiat sheet, 
 which passing forward ends as a strong tendon, in order 
 to traverse the foramen formed by the union of scapula, 
 coracoid and clavicle; emerging from the osseous ring it 
 is inserted into the dorsal surface of the head of^the 
 humerus, in the immediate neighbourhood of the attach- 
 ment of the pectoralis major muscle. The tendon after 
 
 F 2 
 
68 LIGAMENTS. [Chap. v. 
 
 threading - the foramen triossium lies within the capsule of 
 the joint. This muscle enjoys a variety of names, e.g., 
 pec t oralis secundus, levator humeri, and subclavius. Fig". 26. 
 
 Prof. Rolleston proved most conclusively that this 
 muscle, whose main function consists in raising the wing, is 
 homologous with the mammalian subclavius and not with 
 the pectoralis minor. 
 
 Having discussed the morphology of this muscle, an 
 attempt will now be made to render it responsible for the 
 rhomboid, coraco-clavicular and gleno-humeral ligaments. 
 In many mammals the subclavius arises from the sides of 
 the sternum and the costal cartilage of the first rib, replac- 
 ing" the rhomboid ligament, and it is reasonable to regard 
 the rhomboid ligament as arising from the regression of 
 the sternal fibres of the subclavius. 
 
 We must now consider the relation of the subclavius 
 muscle to the coraco-clavicular ligaments. When describ- 
 ing the variations to which that muscle was liable, we 
 noted that it may be inserted into the coracoid process, or 
 partly into the coracoid and clavicle, and in some instances 
 into the fibres of the conoid ligament; under these con- 
 ditions it seems the most probable explanation that these 
 ligaments arise from regression of a portion of the sub- 
 clavius. If their relation to the gleno-humeral be ex- 
 amined, it will be found that the two sets come into 
 relation at the base of the coracoid process. Seeing" 
 that the gleno-humeral ligament is closely associated 
 with the coraco-clavicular set, and these are intimately 
 connected with the subclavius muscle, the inference would 
 be that the gleno-humeral ligament is the divorced tendon of that 
 muscle. This is further supported by a case reported by 
 Walshamy in which the subclavius was inserted into the 
 coracoid process, and a tendinous expansion passed thence 
 to the capsule of the shoulder joint. Between the tendon 
 and the coracoid a bursa existed. 
 
 * Linnean Soc. Trans., vol. xxvi., 1868. 
 f St. Bartholomew's Hospital Reports, vol. xvi. 
 
Chap, v.] SUBCLAVIUS MUSCLE. 69 
 
 Previously the only gleno-humeral known, besides that 
 of man, was the structure so commonly referred to as "the 
 ligamentum teres in the shoulder joint of the frog-." If 
 the view which would regard the gleno-humeral band as 
 originally belonging to the subclavius is correct, a gleno- 
 humeral ligament ought to be present with tolerable 
 frequency, especially as the subclavius is so constant in 
 mammals and in other forms above fishes. The examina- 
 tion of a very large number of mammals has shewn that a 
 gleno-humeral, as well-developed as that represented in 
 Fig. 25, is present very frequently, in many instances it is 
 as thick as the tendon of the biceps. In this condition it 
 exists in many Quadrumana, Lemuridae, and Insectivora, 
 in all Rodentia, and many of the Marsupialia. At the end 
 of the book a tabulated list of the various mammals is given 
 in whom the ligament has been detected. 
 
 It is curious that those mammals which have no liga- 
 mentum teres in the hip joint have not a gleno-humeral 
 ligament in the shoulder :— The Seal, Elephant, Rhinoceros, 
 Walrus, Ornithorhynchus, Echidna, Sea-otter (Enhydra 
 marina) (of this form I have had the good fortune to dissect 
 the joints in two specimens), Sloth, Orang, Hyrax, and 
 Pangolin. 
 
 1. Every mammal in whom I have up to the present time 
 
 found a gleno-humeral ligament, likewise possesses 
 a ligamentum teres in the hip. 
 
 2. Those mammals in whom a ligamentum teres is 
 
 absent, also lack a gleno-humeral band. 
 
 3. In those forms in whom the gleno-humeral is well 
 
 developed, the ligamentum teres of the hip is also 
 
 very thick and strong. 
 
 The reasons for regarding the gleno-humeral ligament 
 
 (or gleno-humeral band when it merely appears as a 
 
 thickening in the capsule) as the divorced tendon of the 
 
 subclavius muscle may be briefly enumerated. 
 
 1. All amphibians which possess the equivalent of the 
 subclavius — the epicoraco- humeral of Mivart — in a 
 
/O LIGAMENTS. [Chap, v. 
 
 well-developed form, lack the gleno-humeral liga- 
 ment. 
 2 In birds the subclavius muscle (under the name of 
 levator humeri) reaches its maximum of development, 
 and passes through the shoulder joint as a tendon 
 to be inserted into the humerus; no gleno-humeral 
 ligament is present. 
 3. In mammals the subclavius is a very constant muscle, 
 and a gleno-humeral ligament is present in a very- 
 large number of them ; when not represented as a 
 free ligament it may often be detected blended with 
 the capsule of the shoulder joint, lying betrceeii it and 
 the synovial membrane. 
 Viewed in the full bearings of this speculation the history 
 of the subclavius is as instructive a muscle as could well be. 
 Commencing with menobranchus we see it as a muscle 
 arising from the precoracoid, and at its insertion envelop- 
 ing the outer aspect of the head of the humerus, being 
 muscular throughout. 
 
 Next we see it luxuriating in full perfection in flying 
 birds, its distal end metamorphosed into tendon, per- 
 forming the laborious and important function of raising 
 the wing. 
 
 Lastly, in man it becomes reduced to almost insignificant 
 proportions lying as a small second rate muscle under the 
 clavicle and representing in its retirement the middle 
 portion only of the bird's levator humeri, its proximal end 
 degenerated into a uniting band to connect the clavicle 
 with the first costal arch, whilst its outer end is represented 
 by the coraco-clavicular ligaments, and the small insig- 
 nificant band, so far as function is concerned, known as the 
 gleno-humeral ligament. In some cases in man the 
 muscle may abort. 
 
 The coraco-humeral must now be disposed of. In 
 man it is usual for the pectoralis minor muscle to be in- 
 serted into the upper surface of the coracoid process near 
 its outer border ; a bursa frequently intervening between 
 
Chap, v.] 1HE CORACO-HUMERAL. 71 
 
 the tendon and the coracoid. Frequently it happens that 
 the tendon glides over the coracoid process and gains an 
 insertion into the great tuberosity of the humerus. In very 
 many monkeys this is the normal condition. This induced 
 some anatomists to believe that the gleno-humeral ligament 
 was the tendon of the pectoralis minor muscle. Their view 
 of the matter is invalidated on two points. 1. The tendon 
 of the pectoralis minor when it takes this course lies out- 
 side the capsule, whereas the gleno-humeral ligament is 
 situated between the capsule and the synovial membrane. 
 2. The tendon of the levator humeri is inside the capsule, 
 and this muscle of the bird is homologous with the sub- 
 clavius. Lastly, the relation of the pectoralis minor to the 
 capsule in certain cases occurring in man and monkeys, 
 induces me to believe that the coraco-humeral ligament is 
 the tendon of that muscle transformed into a fibrous band. 
 The ancestry of the various ligaments of the pectoral 
 arch may be arranged in two categories : — Those repre- 
 senting skeletal elements and those derived from muscles. 
 
 1st Group. 
 
 The ventral end of precoracoid . The interarticular fibro-cartilage 
 
 between clavicle and sternum 
 and the so-called episternals. 
 
 The scapula end of ,, . . Acromial interarticular fibro-car- 
 
 tilage. 
 
 Coracoid Coracoid and costo-coracoid liga- 
 ment. 
 
 Coracoid extension of acromion . Coraco-acromial ligament. 
 
 Coraco-scapular bridge, (sloth, Transverse ligament, 
 etc.) 
 
 Interclavicular bone, (lizards and Interclavicular ligament, 
 monotremes) 
 
 2nd Group. 
 
 Sternal end of subclavius . . . Rhomboid ligament. 
 Humeral ,, ,, ... Conoid, trapezoid and gleno- 
 
 humeral ligaments. 
 Humeral end of pect. minor . . Coraco-humeral ligament. 
 
72 LIGAMENTS. [Chap. v. 
 
 The Ligaments of the Pelvic Girdle. 
 
 As in the case of the shoulder girdle so with regard to 
 the pelvis, a study of the hard parts is not sufficient to 
 enable us to comprehend in its fulness their morphology. 
 The various ligaments in connection therewith must be con- 
 sidered. For this purpose the ancestry of the following 
 structures will be detailed. 
 
 The great and small sacro-sciatic ligaments, the triangu- 
 lar ligament of the urethra, and the sub-pubic ligament. 
 
 The great and small sacro-sciatic ligaments. — 
 When the tendons of origin of the hamstring muscles are 
 traced to the tuberosity of the ischium, they may by a very 
 little dissection be seen to pass onwards into the great sacro- 
 sciatic ligament, and by pulling on the muscles the ligament 
 is tightened. When traction is made on the biceps the 
 coccyx can be made to move on the sacrum. In fact the 
 ligament may not unfairly be described as a tendinous ex- 
 pansion of these muscles. This relation of the ligament to 
 the hamstring muscles was first pointed out by Mr. Morris 
 and the relation of the parts are shewn in a figure. Among 
 the Ruminantia this ligament is replaced by a broad, strong 
 tendon. 
 
 The lesser sacro-sciatic ligament has a very different his- 
 tory. This band of fibrous tissue passes from the spine of the 
 ischium to the side of the sacrum. In the sloth we find the 
 spine of the ischium extending to the sides of the pseudo- 
 sacral vertebra, and bounding the great sciatic foramen. 
 Fig. 27. In the armadillos this is an extensive piece of 
 bone. Except among the edentata including the extinct 
 mastodon and megatherium in mammals this bone is re- 
 placed by fibrous tissue. This ligament should be referred 
 to as the ischio-sacral ; those vertebrae into which it is 
 inserted are pseudo-sacral. 
 
 * Anatomy of the Joints of Man, 1S79. 
 
Chap, v.] TRIANGULAR LIGAMENT. 73 
 
 The triangular and sub-pubic ligaments. —These 
 
 are somewhat puzzling structures and the explanation now 
 offered to account for them, la^ks that amount of almost 
 absolute proof which has been brought to bear upon so 
 many of the ligaments which have been dealt with in this 
 work. The matter is, however, not devoid of interest, and 
 its consideration will serve to show how true is the remark 
 ''that morphology is the very soul of anatomy." 
 
 Fig. 27. — The pelvis of a sloth, Bradvpus didactylus, the small sacro- 
 sciatic (ischio-sacral) ligament replaced by bone. (After Albrecht). 
 
 In 1883, Professor Albrecht among his many contribu- 
 tions to morphological anatomy, published a paper on the 
 Pelvisternum of Edentata and endeavoured, but unsuccess- 
 fully, to shew that there is an arrangement of parts in some 
 animals, whereby anatomical relations similar to those of 
 the sternum, in the anterior pare of the trunk, are repro- 
 duced in the pelvis. 
 
 * De Bulletin dc V Academic royale de Belgique, t. vi., nos. 9-10. 
 
74 LIGAMENTS. [Chap. v p 
 
 Albrecht in this paper draws attention to the existence 
 of an independent ossicle in the pelvis of the sloths and 
 armadillos, indicated in fig - . 27 by the letter X, which he 
 names the pelvisternum. 
 
 The existence of this ossicle admits of no doubt, I was 
 able at once on reading- Albrecht's observations to confirm 
 them in a chlamydophorous and three armadillos. In 
 1886 Dr. J. R. Anderson showed that Prof. Owen knew of 
 the presence of this ossicle in the Potoroo, Hypsiprymnus, 
 and he has himself detected it in the beaver and in 
 phacochcerus. Anderson then cautiously pointed out that it 
 is quite possible that the triangular ligament of the human 
 urethra may be the fibrous representative of this bone. It 
 is difficult to imagine this ossicle as representing anything 
 more than the sub-pubic ligament, for the triangular liga- 
 ment is a broad tract of tissue as compared with this bone. 
 
 Beyond mentioning these views I shall not make any 
 further observation, for the whole subject requires investi- 
 gation with an abundant supply of material. 
 
 * Proceedings of the Zoological Society, 1886, " On the Pelvisternum." 
 
CHAPTER VI. 
 
 The Ligaments of the Appendicular Elements of the 
 Skull and of the Vertebral Column. 
 
 The appendicular elements of the skull are represented in 
 the early embryo by three rods of cartilage named from 
 before backwards the Eustachian, Meckelian and hyoidean 
 bars. A great deal of interest surrounds these cartilages, 
 for the last one is the undoubted representative of the 
 branchial cartilage of a fish, the Meckelian bar is homo- 
 logous with the lower jaw of certain fish whilst the anterior 
 one represents the pterygo-quadrate bar of Elasmobranchs. 
 They are diagrammatically shewn in the accompanying 
 drawing fig. 28. In the course of development they 
 undergo a most remarkable metamorphosis which will be 
 explained on reference to fig. 29. 
 
 The Eustachian bar becomes ossified at its distal end to 
 form the internal pterygoid plate, which later fuses with 
 the ala of the sphenoid and eventually with the lingulum. 
 The middle segment remains as the cartilaginous portion 
 of the Eustachian tube, the posterior and smallest piece 
 degenerates into ligament and remains permanently as a 
 connecting bond between the cartilage and the malleus. 
 The Meckelian bar is transformed thus : — Its distal end is 
 ossified and gives origin to all that portion of the inferior 
 maxilla which lies anteriorly to the mental foramen, round 
 the outer side of the bar, nuclei, fi\ e in number, are deposited 
 to form the inferior maxilla; their names are the dentary, 
 angular, coronoid, condyle and splenial. For a long time 
 the cartilage occupies a depression in the bone later recog- 
 nised as the mylo-hyoid groove, but eventually it disap- 
 pears leaving a fibrous band known as the long internal 
 lateral ligament of the jaw, extending from the inferior 
 
76 
 
 LIGAMENTS. 
 
 [Chap. vi. 
 
 dental foramen to the spine of the sphenoid bone. The 
 proximal segment becomes the malleus. 
 
 The hyoidean bar is somewhat complicated. Its distal 
 end fuses with the fellow of the opposite side and with the 
 remains of a fourth arch to form the hyoid bone ; from the 
 
 Fig. 28. — The Chondro-cranium of a human foetus at the third month 
 with its associated cartilaginous bars. FXP. Fronto-nasal plate; E # 
 Eustachian bar; If. Meckel's cartilage ; S. Styloid cartilage ; H. Hyoid 
 bone. 
 
 Fig. 29.— The later modification of the bars. P. Pterygoid bone ; E. 
 Eustachian tube ; M. Malleus; I. Incus; T. Tympano-hyal ; S. Styloid 
 cartilage; L\ Long internal lateral ligament of jaw; L. Stylo-hyoid 
 ligament. 
 
 lesser cornu to the styloid process it is, as a rule, repre- 
 sented by a ligament, the stylo-hyoid. Above this point 
 we get the styloid process, but for some months after 
 birth it remains as cartilage, movable upon a nodule of 
 
Chap, vi.] VERTEBRAL COLUMX. 77 
 
 bone, discovered and named by Prof. Flower the tympano- 
 hyal. Above, the cartilage is terminated by the incus, 
 which is continuous with the tympano-hyal by means of a 
 fibrous band. 
 
 The Ligaments of the Vertebral Column. 
 
 The ligaments which bind the vertebrae tog-ether may be 
 divided thus: — 1. Those common to all the vertebrae. 
 2. Those which are confined to two vertebrae. 
 
 To the first group belong the anterior and posterior 
 common ligaments, and the supra-spinous ligament. The 
 second group claims the intervertebral discs with the 
 ligamentum conjugale costarum, the interspinous and inter- 
 transverse ligaments, and the ligamentum subflavum. 
 
 The anterior common ligament. — This consists of a 
 longitudinal band of dense fibres placed on the anterior 
 aspect (ventral) of the vertebral column, extending from 
 the under surface of the basi-occipital bone, with a slight 
 break at the atlas, to near the middle of the sacrum ; here 
 it becomes scarcely distinguishable from the periosteum, 
 but as it nears the coccygeal vertebrae it again becomes 
 prominent, and ends at the tip of the coccyx. The super- 
 ficial fibres extend over several vertebras (four or five), the 
 intermediate ones pass over two, whilst the deepest fibres 
 only connect adjacent vertebrae. 
 
 The posterior common ligament Lying on the 
 
 dorsal surfaces of the centra of the vertebrae, and extending 
 from the upper surface of the basi-occipital bone to the 
 lower end of the sacrum, is a fairly broad fibrous band. 
 The upper part of the ligament, that which lies between the 
 occipital bone and the axis, is often designated the posterior 
 occipito-axial ligament. The more important features of 
 the posterior common ligament are these: — In the neck it 
 extends quite across the bodies of the vertebrae, in the 
 
yS LIGAMENTS. [Chap. vi. 
 
 thoracic and lumbar regions it is broader opposite the 
 intervertebral discs than at the middle of the bodies of the 
 vertebrae; between these narrower portions and the ver- 
 tebral centra is some loose connective tissue containing - a 
 venous plexus; the ligament is only connected with the 
 spine at the intervertebral discs and the corresponding- 
 margins of the vertebrae, presenting throughout its course 
 a series of attached and unattached segments. 
 
 The supra-spinous ligament. — This consists of bundles 
 of longitudinal fibres which form a continuous cord from 
 the seventh cervical vertebra to the sacrum. It serves to 
 connect the tips of the spinous processes together. 
 
 Fig. 30. — The intervertebral disc of a seal with the anterior and 
 posterior conjugal ligament. X' and X". 
 
 We must now consider the second group : — 
 The intervertebral discs. — These are plates composed 
 of fibrous tissue arranged in laminae externally, with a 
 pulpy nucleus internally. They are situated between the 
 centra of the vertebrae beginning at the axis and ending in 
 the adult at the sacrum, but in the young child they extend 
 even to the coccyx. The outer or circumferential portion 
 of each disc is composed of laminae of white fibro-cartilage 
 arranged concentrically, which run obliquely between the 
 vertebrae and are firmly attached to both. The direction 
 of the fibres is reversed in successive layers. The centre of 
 the disc is made up of pulpy substance which when exam- 
 ined microscopically is seen to be composed of fine fibrous 
 
Chap, vi.] INTERVERTEBRAL DISCS. 
 
 79 
 
 tissue containing- cells. The ventral edge of each disc is 
 firmly attached to the anterior common, and the dorsal 
 bolder to the posterior common ligament. In many ani- 
 mals, notably the seal, a very strong rounded band glides 
 
 Fig. 31. — Ligamentum conjugate costarum, anterius and posterius, of 
 a foetus at the seventh month. 
 
 across the dorsal aspect of the disc, as shewn in fig. 30. 
 This serves to connect the heads of the corresponding ribs 
 and the ligament is provided with a synovial membrane. A 
 band also passes along the anterior face of the disc, and may 
 
 Fig. 32. — An intervertebral disc of an adult shewing the lig. conj. 
 cost. post, incorporated with the disc. Its ends as the interosseous of 
 the ribs. The anterior one represents the middle fasciculus of the stel- 
 late ligament ; N. remains of the notocord. 
 
 be named the anterior conjugal ligament. In the human 
 foetus similar bands can be dissected from the dorsal and 
 ventral aspect of the discs. The posterior band is continu- 
 
5u LIGAMENTS. [Chap. vi. 
 
 ous with the interosseous ligament of the rib-head, whilst 
 the anterior becomes later the middle fasciculus of the 
 well known stellate ligament of the costo-vertebral articula- 
 tion. After birth the intermediate portion of these ligaments 
 become incorporated with the intervertebral discs. The ac- 
 companying figures represent the ligaments in a foetus at the 
 seventh month and their fate in the adult. Figs. 31 and 32. 
 
 The ligamentum conjugale costarum was first described 
 by Mayer* of Bonn in 1S34 in various mammals. It has 
 escaped the attention of most anatomists. Prof. Humphry 
 in his well known work on the skeleton merely refers to 
 Mayer's observation in a foot note ; Cleland unaware of 
 Mayer's paper described the ligament in a seal in the 
 Edinburgh New Philosophical Journal, 1858. These researches 
 were unknown to me, when in 1S82 I noticed the ligament 
 whilst dissecting a seal. Mr. Henry Morris then drew my 
 attention to Cleland's papers. Later I examined the con- 
 dition of this structure in a large number of mammals, 
 including the horse, lion, otter, fox, dog, weasel, squirrel, 
 rabbit, calf, sheep, badger, pig, ape, etc. 
 
 The ligament is best developed in that part of the 
 thoracic region of the spine where the ribs articulate with 
 two vertebral centra. f 
 
 The credit of drawing attention to the existence of this 
 ligament in man rests with me, if we exclude the transverse 
 ligament of the atlas, to be considered in the succeeding 
 pages. It is very remarkable, but Hunter knew of this con- 
 jugal ligament. Mr. Henry Morris requested the admirable 
 assistant at the College of Surgeons, William Pearson, to 
 prepare some dissections of this structure and having his 
 attention thus drawn to the matter, Pearson shewed me an 
 old preparation labelled Hmiterian. It is the dissection of 
 two thoracic vertebrae of a horse so arranged as to shew 
 the posterior ligamentum conjugale costarum. 
 
 * Meckel's Arch. 
 
 f For further details the student may consult journal of Anatomy and 
 Physiology, vol. xviii., p. 225. 
 
Chap, vi.] LIGAMENTA SUBFLAVA. 8i 
 
 The interspinous and intertransverse ligaments. — 
 
 These are fibrous cords resulting from the regression of 
 muscles of the same name, occupying the spaces their 
 names indicate, but best studied as muscles in the cervical 
 region. 
 
 The ligamenta subflava.— Called also ligamenta 
 intercruralia, they are plates of yellow elastic tissue alter- 
 nating with the laminae of the vertebrae from the axis to 
 the middle of the sacrum. They are so arranged as to be 
 attached to the ventral surface of the laminae of the 
 anterior vertebra, but are attached to the dorsal surface of 
 the posterior laminae. 
 
 A great deal of light seems to be shed on the nature of 
 the ligamenta subflava by studying the vertebral column of 
 a cartilaginous fish. In the skate these ligaments are 
 
 Fig. 33 — A portion of the vertebral column of a skate shewing the 
 interneural plates, N. 
 
 represented by pieces of cartilage hexagonal in shape, 
 known as the interneural plates. Fig. 33. The laminae 
 are represented by a cartilaginous pedicle known as the 
 neural processes, these only exceptionally join the neural 
 spines. 
 
 In the skate the ventral root of a spinal nerve leaves by 
 a foramen in the neural process, whilst the dorsal root 
 traverse the interneural plate. 
 
 The elementary nature of the present book prevents me 
 pursuing the argument to the fullest extent, but it may be 
 mentioned that in man we have no alternation of the roots 
 of the spinal nerves as in some of the cartilaginous fishes, 
 
 G 
 
82 LIGAMENTS. [Chap. vi. 
 
 nevertheless, as in them, man's spine consists of segments 
 composite in character, thus : — 
 
 A centrum, with pedicles, laminae and a spinous process, 
 succeeded by a disc composed of notochordal remains, and 
 two plates of yellow elastic cartilage— the ligamenta 
 subflava. 
 
 The researches of American paleontologists, especially 
 Cope's, go to support the view that the intervertebral disc 
 may with good reason be regarded as representing a sup- 
 pressed segment. In many of the remarkable batrachian 
 forms, now extinct, unearthed in the Permian formation of 
 Texas, the vertebral column possessed intercentra rivalling 
 in size the true vertebral centra, and helping to form part 
 of the bony boundaries of the neural canal. 
 
 The first real attempt to attach a morphological value to 
 a spinal ligament was that of Rathke, in his famous 
 Entwicklung der Schildkroten, 1848, where, in a masterly 
 piece of anatomical reasoning, he shews most conclusively 
 that the os odontoideum of the Turtle is really the repre- 
 sentative of the body of the atlas, and that the ligamentum 
 suspensorium, a thin fibrous band passing from that process 
 to the margin of the foramen magnum, is the remains of 
 the notochordal sheath. 
 
 Rathke had previously promulgated this doctrine in his 
 Entwicklungsgeschichte der Natter, so far as the odontoid 
 process is concerned. Cuvier, in his Recherches sur les 
 ossemens fossiles, had previously identified the true homology 
 of this bone by a study of its condition in the Turtle and in 
 the Matamata Terrapin. Bergmann confirmed the state- 
 ments of Rathke, and now the matter rests beyond all 
 disputation after the investigations made into the subject 
 as regards mammals by J. Miiller, Robin, and Hasse. 
 Then, the fact that the nucleus pulposus in the middle of 
 the invertebral discs is the remains, in part, of the noto- 
 chord, lends additional interest to the matter. For this 
 last satisfactory advance we are indebted to Luschka- 
 It is a curious fact that, though in adult mammals, we 
 
Chap, vi.] LIGAMENTA SUBFLAVA. 83 
 
 find a definite ligamentum suspensorium attached only to 
 the odontoid process, yet in birds, as Jiiger* has shown in 
 Das Wirbclkcrpcrgehnk der Vogel, we find a suspensory 
 ligament in many other parts of the column. In its most 
 typical form the arrangement may be thus described: — 
 
 Between the centra of contiguous vertebrae is a fibro- 
 cartilaginous ring, which is continued inwards in the form 
 of a disc which has free anterior and posterior faces, this 
 portion is called the meniscus; this thins towards the 
 centre, which is always occupied by a hole. The meniscus, 
 when perfect, divides the space between the centra of the 
 opposed vertebra into two synovial cavities. The central 
 perforation in the meniscus is traversed by a ligament, 
 which in the chick contains the remains of the intervertebral 
 portion of the notochord. In- some instances the meniscus 
 is reduced to a mere rudiment, in other cases it is united 
 with the vertebral bodies, whilst in the caudal region, in 
 its relation to the bodies of the vertebrae, it resembles an 
 ordinary intervertebral disc. 
 
 There seems to be no rule by which one could predict the 
 presence or absence of this disc. In two specimens of Rhea 
 [Rhea Americana) dissected by me, the discs and suspensory 
 ligaments were absent, the vertebral centra coming into 
 direct apposition. In the emu the meniscus is alone repre- 
 sented, whilst in the pigeon, fowl, and similar birds the 
 meniscus and suspensory ligaments are present in a perfect 
 condition ; when carefully dissected, the neck vertebrae and 
 the discs, alternating and threaded as it were by the sus- 
 pensory ligaments, present a striking appearance. 
 
 If the cervical vertebrae of a child be macerated until the 
 intervertebral discs drop away, it will be found that the 
 vertebral bodies will in many cases remain attached to each 
 other by the thickened sheath surrounding the remains of 
 the notochord; in this way it strikingly resembles the 
 avian suspensory ligament. 
 
 * Sitzungberichte der Wiener Akademie, 1858. 
 
 2 G 
 
84 LIGAMENTS. [Chap. vi. 
 
 In the skeleton of a modern bird not the least among the 
 peculiarities of its bones is the shape of the articular 
 surfaces of the pre-sacral vertebrae. Choosing a typical 
 one from the middle of the cervical series, we find that the 
 anterior articular surface of the centrum is slightly exca- 
 vated from above downwards and convex from side to 
 side: the posterior is the reverse of this, being convex 
 from above downwards and concave from side to side. 
 The anterior aspect resembles the curious surface on the 
 trapezium for the metacarpal bone of man's pollex. 
 
 The origin of this curious mode of articulation among 
 the vertebrae of birds has long been a mystery, especially 
 as whole series of extinct avian forms from the tertiary 
 deposits present the same peculiarity. 
 
 Prof. O. C. Marsh has, however, described a remark- 
 able small Cretaceous bird named Ichthyornis, which had 
 great powers of flight and bi-concave vertebrae as in 
 fish, amphibians and a few reptiles. The third cervical 
 vertebra of Ichthyornis when viewed in vertical section is, 
 in its anterior articulation moderately convex, transversely 
 it is strongly concave, thus presenting a near approach to 
 the saddle-like articulation. 
 
 No other vertebrae in lchthyor?iis present this character. 
 The specialisation occurs at the bend of the neck and 
 greatly facilitates motion in the vertical plane. This is 
 the dominant motion in the neck of the modern bird ; any- 
 thing that facilitates this motion would itself tend directly 
 to produce the modification. 
 
 Such modification of the vertebrae would naturally appear 
 first where the neck had most motion, viz. in the anterior 
 cervical region and would gradually extend down the 
 neck ; and so on to the sacrum if the flexion continued. 
 
 In modern birds behind the axis we find no exception to 
 the saddle articulation in the whole cervical series. In a 
 
 • ■• The Vertebrae of Recent Birds." The American Journal of Science 
 and Arts, vol. xvii., p. 266. 
 
Chap, vi.] L1GAMENTA SUBFLAVA. 85 
 
 few birds especially that remarkable parrot, Stringops, the 
 penguins, the terns, and a few others, one or more ver- 
 tebrae are opisthoccelian, or imperfectly bi-concave. In 
 the caudal series of recent birds the vertebrae preserve 
 their orginal bi-concave structure. 
 
 Thus Bi-Concave Vertebra are the rule in fish and am- 
 phibians. From this form we derive : — The Plane Ver- 
 tebra of mammals. The Cup-and-Ball variety of reptiles 
 which are Procizlian in serpents and Opisthocalian in Dino- 
 saurs and Saddle-shaped in Birds. 
 
CHAPTER VII. 
 
 The Ligaments of the Vertebral Column (continued). 
 The Atlas and Axis. 
 
 The ligaments in connection with the first two cervical 
 vertebrae are of sufficient importance to require separate 
 mention, especially as they must be taken into considera- 
 tion in questions connected with the morphology of these 
 two extraordinary elements of the vertebral column. 
 
 The ligaments to be stu ied are : — 
 
 i. The transverse. 
 
 2. The check ligaments. 
 
 3. The ligamentum suspensorium. 
 
 4. The lateral occipito-atlantal ligaments. 
 
 5. The intervertebral disc between the odontoid process 
 
 and the body of the atlas. 
 
 It will also be necessary to extend the discussion to the 
 anterior arch of the atlas, for an endeavour will be made 
 to demonstrate that this part of the atlas may be considered 
 as an ossified anterior conjugate ligament, and is in its 
 nature comparable to the intercentrum of batrachians and 
 reptilians. 
 
 The transverse and check ligaments. — The trans- 
 verse ligament divides the ring of the atlas into two 
 unequal parts. The anterior space lodges the odontoid 
 process, whilst the posterior serves for the transmission of 
 the spinal cord. The ligament which is dense and strong 
 derives firm attachments from the tubercle on the inner 
 aspect of each lateral mass of the atlas. Where it glides 
 around the constricted portion of the neck of the odontoid 
 process it has a synovial covering. 
 
 The check ligaments arise from the tubercles on the 
 inner margin of the ex-occipitals. and passing transversely, 
 
Chap, vii.] INTERVERTEBRAL DISC. 87 
 
 meet tog-ether at the tip of the odontoid process into 
 which they are inserted. Many text-books of anatomy 
 figure them as though passing- obliquely to the odontoid 
 process from above downwards, but they maintain a 
 direction strictly parallel with that of the transverse liga- 
 ment. In two instances I have seen the check ligaments 
 form a continuous band so that it seemed as if there were 
 twO transverse ligaments. 
 
 There can be little doubt that these two bands are 
 repetitions of the ligamentum conjugale costarum posterius 
 which is described on page 79. This view of the matter 
 also occurred to Cleland in his paper before referred to. 
 To enter into a full discussion of the relationship would be 
 to enter step by step into the question of the morphology 
 of the atlas and axis, and is beyond the scope of this 
 treatise. The student anxious for further information on 
 this head may consult with advantag-e the references fur- 
 nished on pages 89 and 90. 
 
 The suspensory ligament.— Functionally of no value, 
 but morphologically intensely interesting is the ligamentum 
 suspensorium dentis. It passes from the summit of the 
 odontoid process and joins, at the margin of the foramen 
 magnum, the basi-occipital bone. Its true nature was de- 
 tected by Rathke when he shewed that it was derived 
 from the sheath of the notochord as it passed onwards 
 to the base of the skull. 
 
 The lateral occipito-atlantal ligaments are bands 
 of fibrous tissue passing from the lateral mass of the atlas 
 to the jugular process of the occipital bone. They run 
 parallel with the rectus capitis lateralis muscle. The last 
 named muscle is simply a continuation of the intertransver- 
 sales series, and the lateral cccipito-atlantal ligament results 
 from the conversion of a posterior rectus capitis lateralis 
 muscle into fibrous tissue, thus becoming homologous with 
 an intertransverse ligament. 
 
 The intervertebral disc between the odontoid 
 process and the body of the axis.— Cunningham has 
 
88 LIGAMENTS. [Chap. vii. 
 
 recently shewn that if, in the adult, an axis be bisected, a 
 lenticular disc of cartilage of the shape and situation shewn 
 in fig. 34. It is on all sides surrounded by bone so as only 
 to be brought into view by means of sections. It is best 
 marked in young subjects and gradually becomes smaller 
 as life advances, but only disappears in extreme old age. 
 
 The cartilage is of interest as it affords additional 
 support to the view, that the odontoid process is the 
 displaced body of the atlas. 
 
 The evidence mav be arranged in a table for con- 
 venience. 
 
 1. The notochord passes through the process on its way 
 from the axis to the basis cranii. 
 
 Fig. 34. — Transverse section of the body of the axis of a youth, aged 
 19. to shew the intervertebral disc between the odontoid process and the 
 body of the axis. 
 
 2. Between the odontoid process and axis there is a 
 
 •• swelling" of the notochord in the early embyro as 
 in other intervertebral regions. 
 
 3. This '•swelling*' is later indicated by an intervertebral 
 
 disc hidden in the bone, but persistent even in old 
 age. 
 
 4. The odontoid process has independent centres. 
 
 5. It persists as an independent ossicle in chelonians, 
 
 * For further information regarding this cartilage, and its comparative 
 significance consult author's paper in the Proceedings of the Zoological 
 Society, 1S86, " On the intervertebral disc between the odontoid process 
 and the axis."' 
 
Chap, vii.] ARCH OF THE ATLAS. 89 
 
 lizards, and crocodiles. In Ornithorhynchus it remains dis- 
 tinct for a very long time. 
 
 6. An epiphysial plate develops between it and the body 
 
 of the axis in man and many mammals. 
 
 7. The neck of the odontoid process is embraced by a 
 
 "conjugal *' ligament — the transverse. 
 
 The bilateral ossific nuclei for the main portion of the 
 mammalian odontoid process has given rise to a great 
 deal of speculation among morphologists. Cope° has 
 found that in an extinct batrachian, exhumed from the 
 Permian formation of Texas, the vertebral bodies com- 
 posed of two lateral pieces. The skeleton belonged to an 
 animal named Eryopsmegalocephala of the order Ganocephala. 
 This seems to indicate that in the possession of two lateral 
 nuclei, the odontoid process retains a primitive charac- 
 ter. 
 
 The anterior arch of the atlas.— In the seal, as 
 represented in fig. 30, the rib-heads of opposite sides are 
 united by a ligament passing round the dorsal aspect of 
 the intervertebral disc, known as the ligamentum con- 
 jugale costarum In addition they are united by a fibrous 
 band passing round the anterior aspect of the disc, known 
 as the ligamentum conjugate costarum anterius. The fate 
 of these ligaments has been fully described on page 79, 
 and evidence has also been adduced to prove that the 
 transverse ligament of the atlas, represents the posterior 
 conjugal ligament of the ribs. I shall now attempt to 
 show the anterior conjugal band has, in the case of the 
 atlas, become ossified. 
 
 In the first place it is necessary to mention the anterior 
 portion of the lateral mass of the atlas agrees in its nature 
 with the corresponding part of the transverse processes of 
 the remaining cervical vertebrae, and is a rudimentary rib. 
 The most conclusive arguments on this head are furnished 
 by Macalister.f 
 
 * Proc. American Philosoph. Soc, vol. xix., p. 51, 1SS0-S2. 
 f Journal of Anatomy and Physiology, vol. iii.. p. 54. 
 
90 LIGAMENTS. [Chap. vii. 
 
 Lying 1 between the vertebrae in the lumbar region of a 
 mole on the ventral aspect, are some small ossicles known 
 as hypapophyses or sub-vertebral wedge-bones. In the 
 remarkable lizard, sphenodon. these ossicles or intercentra 
 form a continuous chain in the cervical, thoracic and 
 lumbar regions of the spine. A careful examination of 
 these bones in the mole, convinced me that they must be 
 regarded as ossifications of the lig. conjugate costarum 
 anterius. According to this view, the anterior arch of the 
 atlas is really an intercentrum fused with the two rudi- 
 mentary ribs, which constitute the anterior boundary of 
 the lateral mass of the atlas of man." 
 
 The subnotochordal rod. — In all Ichthyopsida (fish 
 and amphibians), at a period slightly subsequent to the 
 formation of the notochord, there appears a rod-like 
 thickening, split off from the dorsal wall of the alimentary 
 canal. This singular body is known to embryologists as 
 the subnotochordal rod. Its situation and appearance are 
 drawn by Gcette, in sections of Bombinator igneus. The rod 
 lies between the notochord and alimentary canal, and is of 
 almost the same longitudinal extent as these two structures. 
 
 It was first detected by Gcette, who gave an account of 
 it in Schultze's Archiv. fur Mik. Ana/., 1869. In his ela- 
 borate account of the Entwicklungsgeschichte der Unke 
 {Bombinator igneus), 1 875, he refers to it under the name of 
 der Axenstrang des Darmblattes, and suggests that later it 
 becomes a lymphatic trunk (page 775). The subnoto- 
 chordal rod had been observed independently by Prof. 
 Semper, and Balfour has given a description of it in his 
 account of the development of Elasmobranch fishes. 
 
 It is now known to be present in the embryos of Elasmo- 
 branchs, Ganoids, the Teleostei, Dipnoi, and in the 
 Amphibia, in all of whom it develops fundamentally in the 
 same way. Fig. 35. 
 
 Although it has not yet been found in a fully developed 
 
 * Mivart, Elementary Anatomy, p. 217. Humphrey, The Human 
 Skeleton. 
 
Chap, vii.] SUBNOTOCHORDAL ROD. 
 
 form in any amniotic vertebrate, nevertheless a structure, 
 which in all probability is a rudiment of the subnoto- 
 chordal rod, was detected by Balfour and Marshall as a 
 thickening- of the hypoblast in the neck of chicks. 
 
 Salensky has further shown that in the sturgeon (Acci- 
 penser) the subnotochordal rod becomes in the adult the 
 subvertebral ligament, an observation which, according to 
 Balfour, confirms an earlier suggestion made by Bridge. 
 
 This point is important, and it will be interesting to 
 endeavour to extend this view to vertebrata in general, 
 and show that the anterior common ligament of the spine results, 
 in some forms at least, from the degeneration of the subnotochordal 
 
 Fig. 35. -Transverse section of a tadpole showing the subnotochordal 
 rod. Later this becomes the anterior common ligament. 
 
 rod, in the same way that ligamentous tissue in various 
 parts of the adult column is the vestige of the embryonic 
 notochord. I have made a series of observations on tad- 
 poles of the common frog (Rana temporaria), and have been 
 able to satisfy myself that in them, after the disap- 
 pearance of the subnotochordal rod, a band of tissue can 
 be seen in the sections replacing that structure. Further, 
 as chondrification proceeds in the tissue lying between the 
 notochord and the subnotochordal rod, the latter can be 
 seen to flatten out over the bodies of the future vertebrae 
 and finally assumes a fibrous appearance; having degene- 
 rated into fibrous tissue, which grows with the vertebral 
 column, it becomes in adults, the subvertebral ligament. 
 
92 LIGAMENTS. [Chap. vii. 
 
 It may be argued that, even admitting - this to be true, so 
 far as amphibians or fish are concerned, yet it cannot 
 apply to vertebrate forms above that group, in whom, with 
 the exception of the chick, a subnotochordal rod has not 
 yet been demonstrated. However, its existence in fish and 
 amphibia is indisputable, therefore we may assume, unless 
 later on its presence may be detected in higher forms, that 
 the process has suffered abbreviation, and that the anterior 
 ligament appears in these forms in obedience to the great 
 principle — heredity. In support of the notion that this 
 anterior common ligament may represent the subnoto- 
 chordal rod of Sauropsida, without actually existing in the 
 peculiar condition it presents in this class, I would draw 
 attention to the fact that although Comparative Anatomy 
 shows incontestably that the various structures about the 
 knee joint — ligaments and fibro-cartilages — are in reality 
 the disguised remnants of the tendons of muscles, yet 
 during the development of the human embryo, as Barth 
 has shown in an interesting article (" Die Entwicklungs- 
 geschichte der Menschen," Morph. Jahr., Bd. iv. s. 403, 
 1878), the various ligamentous elements of the joint arise 
 as thickenings of the connective tissue. In this case, as in 
 so many others, embryological testimony will not always 
 satisfy our demands when we ask for ancestral history, 
 because the process has become abbreviated ; hence we 
 are driven to Comparative Anatomy. 
 
CHAPTER VIII. 
 
 The Manus. 
 
 The skeleton of the manus consists of three distinct 
 segments, carpus, metacarpus, and phalanges. 
 
 The carpus. — This consists, as a rule, of eight small, 
 and for the most part cubical bones arranged in two rows, 
 a proximal and a distal, of four each. These bones com- 
 mencing from the radial side of the proximal row are 
 named, scaphoid, semilunar, cuneform and pisiform. Those 
 of the distal row are recognised, following the same order, 
 as trapezium, trapezoides, os magnum and unciform. 
 
 Occasionally the number of the bones composing the 
 carpus is increased to nine or even more. In order, there- 
 fore, to fully comprehend the significance of these variations 
 in the number of the carpal elements, as well as to com- 
 pare it with the various members of man's class, it is 
 essential first to consider some generalised form. It will, 
 therefore, be expedient to examine the carpus of the water 
 tortoise, Chelydra serpentina, for this presents, as Gegenbaur 
 shewed, an excellent type-form to serve as a standard 
 among most of the vertebrata. Fig. 36. 
 
 In the carpus of this chelonian we find three bones occu- 
 pying the proximal row, the preaxial or outer one articu- 
 lating with the radius is known as the radiale, the inner 
 or post-axial articulates with the ulna, and is termed the 
 ulnare, between these bones and in contact partly with the 
 ulna and radius is a third bone, named from its position 
 the intermedium. The distal row is composed of five 
 bones, each supporting a metacarpal. These, the carpalia, 
 are numbered 1, 2, 3, 4, and 5 from the radial side. Inter- 
 polated between the two rows of the carpus is a third 
 element named from its position the os centrale. 
 
94 LIGAMENTS. [Chap. viii. 
 
 If we compare the carpus of man with this type-form, it 
 is easy to see that the scapoid is the equivalent of the 
 radiale, the cuneform of the ulnare, and the semilunar 
 
 Fig. 36. — Manus of the Water Tortoise, Chelydra serpentina. R. 
 Radius; U. Ulna; R. Radiale; /. Intermedium; U. Ulnare; C. Os 
 Centrale; I-V. Carpalia. (After Gegenbaur). 
 
 fulfils the characters required of an intermedium. Of the 
 second row the carpalia, 1, 2, and 3, are represented by the 
 trapezium, trapezoides, os magnum, whilst the unciform is 
 
 Fig. 37.— Dorsal view of the carpus of a Baboon to shew the os cen- 
 trale, C. 
 
 the homologue of the fourth and fifth. The chief difference 
 is that in the adult carpus the os centrale is wanting. 
 
Chap, viii.] THE CARPUS. 95 
 
 If, however, we examine the carpus of other mammals, e.g., 
 baboons, macaques, orangs, lemurs, gibbons, and moles, 
 we find an os centrale wedged in between the trapezium, 
 trapezoides, os magnum and scaphoid. Fig. 37. In man 
 also, an additional ossicle exists occasionally in the carpus 
 at a spot corresponding to the position occupied by the 
 centrale in those mammals normally possessing this bone.° 
 
 The occurrence of this bone as an element in the carpus 
 attracted considerable attention when Henke, Reyher and 
 Rosenberg drew attention to its temporary existence in 
 in the human manus. Rosenberg shewed that the "cen- 
 trale" may be detected as a cartilage nodule in the 
 carpus of a human embryo at the second month of intra- 
 uterine life ; it is well marked during the third, but disap- 
 pears during the fourth month of embryonic life. 
 
 The existence of a cartilage between the trapezoides, os 
 magnum and scaphoid in the foetus of man at the third 
 month admits of no doubt whatever, and that it occasionally 
 persists and forms a conspicuous element in the carpus is 
 also indisputable. Opinions are, however, divided as to 
 what becomes of the cartilaginous nodule in the usual 
 course of development. The early investigations of 
 Rosenberg seemed to shew that it underwent suppression, 
 Kolliker also holds this view. Henke and Reyher, how- 
 ever, are of opinion that the nodule fuses with the cartila- 
 ginous scaphoid ; the scaphoid bone according to this 
 view would be a compound of the radiale and centrale. 
 Professor Gruber of St. Petersburg! has investigated 
 an enormous number of human hands and scaphoid bones, 
 (the total number of scaphoids in fresh hands, skeletons, 
 or as separate bones amount 105129) has come to the 
 conclusion from these macroscopic researches that the 
 scaphoid may in exceptional cases, be compounded of a 
 
 * Wenzel Gruber, Archiv. Anat. Phys., 1869, p. 331 ; also, Beobacht, 
 aus der Mensch. und Vergleich Anatomie, Heft iv., Berlin, 1883. 
 
 f " The Os Centrale in the Human Carpus," Journal of Anatomy and 
 Physiology, vol. xviii., p. 119. 
 
9 6 
 
 LIGAMENTS. 
 
 [Chap. viii. 
 
 radiale and centrale, but that as a rule it consists of a 
 radiale only. 
 
 Gruber also believes that scaphoid bones with a paral- 
 lelogrammatic form, and those of a biscuit shape, which 
 
 Fig. 38.— Manus of an early human foetus shewing the cartilaginous 
 centrale. (After Leboucq). 
 
 possess a tooth, or small process on, or near, the dorsal 
 
 ulnar angle, are compounded of a radiale and centrale, 
 
 whilst all other scaphoids are formed solely of the radiale. 
 
 In support of this view Gruber also points out reasons 
 
 Fig. 39.— Scaphoid bones of the human carpus shewing fusion of ossa 
 centralia with them. 
 
 for regarding- the scaphoid in the gorilla and chimpanzee, 
 as being a compound of radiale and centrale ; whilst in 
 certain mammals normally possessing a distinct centrale, 
 it may, in old animals, fuse with the scaphoid, whilst in 
 certain mammals the scaphoid is normally thus com- 
 
Chap, viii.] THE CARPUS. 97 
 
 pounded. Prof. Flower has found in the carpus of a 
 dog six weeks old, the centrale as a separate element. In 
 this mammal the scaphoid and semilunar bone fuse to 
 form a scapho-lunar, and Flower's observation shows that 
 it is of triple constitution. 
 
 Prof. Leboucq of Gand has published some observa- 
 tions on the morphology of the carpus, which induce 
 him to believe that the os centrale fuses with the 
 scaphoid. His valuable research published in Bull, de 
 V Acad, royale des Sciences de Belgique, 3rd series, t. iv., no. 
 8, 1882, is illustrated with a very extensive series of draw- 
 ings. 
 
 In sections of the human carpus a small ligament passing 
 from the scaphoid to the neck of the os magnum, will be 
 occasionally detected; it is deemed so insignificant that 
 only a few text-books of anatomy deign to consider or 
 figure the little band. 
 
 In 1885 I made an investigation into the development of 
 the carpus with the hope of detecting the ancestry of this 
 band of tissue. The relations of the ligament closely 
 correspond to the position of the centrale, for it passes 
 from the scaphoid to be attached to the neck of the os 
 magnum. The result of the inquiry serves to show that 
 this ligament, when present, is the remains of the cartila- 
 ginous nodule, for whenever the cartilage nodule repre- 
 senting the os centrale is present, the ligament cannot be 
 detected, but in many cases, by no means in all, the spot 
 previously occupied by the cartilage is filled up by fibrous 
 tissue, which may persist through life, but in the largest 
 number of instances disappears entirely. 
 
 Thus the os centrale is represented in the carpus of the 
 human embryo by a distinct cartilaginous nodule, which 
 may undergo suppression, fuse with the scaphoid, or be- 
 come represented by ligament. Finally, in very rare cases 
 it may persist as an independent element. 
 
 * Journal of Anatomy and Physiology, vol. vi., p. 62, 1872. 
 
 H 
 
98 LIGAMENTS. [Chap. viii. 
 
 Weidersheim has observed in several specimens of 
 Axolotl, that the os centrale has been double, and in some 
 instance three ossa centralia were present. There were 
 also two centralia in the tarsus. 
 
 The duplicity of the os centrale in the carpus of Axolotl 
 is of some interest, for it appears that in the carpus of the 
 insectivorous mammal, Centetes Madagascariensis, there are 
 two distinct ossa centralia. 
 
 Leboucqf mentions that he had found in a foetus twenty- 
 five millimetres in the length, the os centrale divided into 
 two parts. One occupied the position of the normal 
 cartilage representing- this bone, it was in part fused with 
 the scaphoid. The other part was, on the palmar aspect, 
 in contact with the scaphoid and the distal extremity of 
 the semilunar. 
 
 The "os centrale" must therefore be counted as one of 
 the primitive elements of the carpus, and is of equal value 
 with the remaining bones. 
 
 The triangular fibro -cartilage in the wrist. — This 
 has been made the subject of some interesting investiga- 
 tions by Professor Leboucq, also contained in the paper 
 " On the Morphology of the Carpus " before referred to. 
 This observer finds that in the human foetus, from the 
 third to the fourth month, there exists in this structure a 
 small elliptical cartilaginous nodule, which at that period 
 of development is in close relation with the pisiform bone. 
 Until quite recently it has been customary to regard the 
 pisiform as a sesamoid bone developed in the tendon of 
 the flexor carpi ulnaris muscle. Recently, owing mainly 
 to the comparative researches of Gegenbaur and 
 Wiedersheim, doubts have been thrown over this view 
 of its nature. According to Leboucq, the cartilage for 
 the pisiform appears before the tendon of the flexor carpi 
 
 * Morph. Jahrbuch, vol. vii., § 581, 1880. " Ueber die Vermehrung 
 des Os Centrale im Carpus und Tarsus des Axolotls." 
 
 f " Sur la Morphologie du Carpe et du Tarse." Anatotnischer Anzeiger, 
 Jena, no. i., p. 17, 1886. 
 
Chap, vin.] FIBRO-CARTILAGE. 99 
 
 ulnaris, therefore it cannot be a sesamoid. He then points 
 out that the mode of development of the interarticular 
 fibro-cartilage and the pisiform ossicle induces him to' 
 believe that these two structures are part of a complex 
 apparatus, of which the pisiform bone is a separate 
 portion. Leboucq also figures the carpus of a Gibbon 
 (Hylobates leuctscus) preserved in the Museum of the Uni- 
 versity of Gand, in which there is a cartilage nodule 
 occupying the position of the interarticular fibro-cartilage 
 and articulating by its distal end with the pisiform bone; 
 this interarticular nodule he believes represents the tem- 
 porary cartilage nodule in the human foetus. 
 
 Although Leboucq's conjectures regarding the meaning 
 of this cartilaginous nodule are rather far-fetched, it is 
 nevertheless interesting to find, as in so many other in- 
 stances, that this interarticular fibro-cartilage is the rem- 
 nant of a structure which, in primitive forms, was of great 
 functional value. 
 
APPENDIX. 
 
 Containing a list of mammals which have been 
 examined to determine the presence or absence of 
 the gleno -humeral ligament. 
 
 In all the mammals enumerated in the accompanying- 
 list, the ligament was present and as well developed as 
 represented in the beaver on page 69. The numeral 
 refers to the number of each species specially examined. 
 
 Quad rum ana. — Cercopithecus cynosutus, 8; C. lalandii, J ; 
 C.callitrichus, 2; C.mona; C. erxlebeni ; C. campbelli ; C. me ti- 
 tans ; C.albigena. Macacus sinicus, 20; M. cynomologus, 10; M. 
 cyclopis; M. nemesirinus, 6. Theropithecus gelada. Cynocephalus 
 hamadryas ; Cyn. anubis, 2. Chrysothrix sciurea, 5. Cebus 
 fatuellus ; Ceb. capucinus, 3; Ceb. albifrons. Ateles paniscus ; 
 A. ater, 2. Hapale jacchus, 4; H. penicillata, 2. Cercocebus 
 albigena (in this species the ligament is thin). Semnopithecus 
 leucoprymus, Xyctipithecus vociferans. 
 
 Lemurid^:. — Lemur cat la, 3. Galago allem, 3; G. maholi, 
 2. Pcrodicticus potto, 2. Chirogaleus coquereli. Microcebus 
 smith'. In Chiromys madagascarensis it was present but very 
 thin. 
 
 Insectivora. — Talpa europcea, 3. Erinaceus europczus. 
 Tupaia peguana, 2. Centetes madagascaiensis. Microgale 
 longicauda. Sorex vulgaris. 
 
 Rodentia. — Pteromys magnificus. Arctomys monax. Cynomys 
 ludovicianus, 3. Castor canadensis, 8. Mvoxus glis ; M. dry as. 
 Fiber zibet hie us. Dipus cegypticus ; D. hirtipes. Myopotamus 
 coypus, 6. Hystrix cristata. Erithrizon dorsatus. Sphingutus 
 prehensilis. Ccelogenys paca. Dasyprocta agouti. Sciurus 
 hypopyrrhus. Xtrus getulus. Sciuropterus fimbriatus. Ger- 
 billus indicus. Cricetomys gambianus. Mus barbarus. Rhizomys 
 badius. Octodon cumingi. Ccrodon rupestris. Arvicola amphi- 
 bius. Mus musculus ; Mus decumanus. Lepus cuniculus. 
 
APPENDIX. 101 
 
 In some rodents the ligament is very large, and occupies 
 a groove in the cartilage covering the head of the humerus^ 
 
 Marsupialia. — Didelphys cancrivora ; D. virginiana, 2; D. 
 opossum ; D. philander, 2 ; D. viverrina. Phalangista vulpina, 
 3. Hypsiprymnus gaimardi. Phascolomys wombat. Cuscus 
 maculatus, 2. Belideus breviceps. 
 
 Edentata. — Chlamydophorus truncatus. 
 
 The gleno-humeral ligament is absent in the mammals 
 mentioned in the lists which follow, but in many a thick- 
 ened band was detected in the capsule which may have 
 represented it. 
 
 Quadrumana. — Chimpanzee (Anthropopilhecus troglodytes), 
 3. Orang-outang (Simia satyrus), 2. Gibbon (Hylobates 
 leuciscus), 2. Macacus inuus (in this form a thick band may 
 be seen in the capsule). 
 
 Chiroptera. — Pteropus poliocephalus. Desmodus rufous. 
 Plecotus auritus. 
 
 Hyraces. — Hyrax capensis, 2. 
 
 Ungulata. — Rhinoceros {Rhinoceros sumatrensis). Tapirus 
 americanus. Cariacus virginianus ; C. ru/us. Pudu humulus. 
 Tragulus meminno. Equus. Bos taurus ; B. indicus. Oreas 
 canna. Llama huanacos ; L. peruana. Sus scrofa. Porcula sal- 
 vania. Balirussa alfurus. Slrepsiceros kudu. Capra hircus. 
 Ovis aries ; O. bland/ordi ; 0. burrhel. Moschus moschiferus . 
 Tragulus, species incerta. Hydropotes inermis. Muntjac sclateri. 
 Hippopotamus amphibius. Oryx beisa. Cephalophus mergens ; 
 C. pygmcEus ; C. hydophylex. 
 
 Cetacea. — Phocaina communis. 
 
 Carnivora. — Felis leo ; F. tigiris. Cam's familiaris. Her- 
 pestes ichneumon ; H. griseus. Lycaon pictus. Lutra vulgaris. 
 Nasua rufa. N. narica. Phoca vitulina. Enhydra marina, 2. 
 The Common Cat. Felis Javanensis, 2. Paradoxurus typus. 
 P. trivirigatus. Ursus syriacus 
 
 Very many other species of Carnivora and Ungulata 
 
102 APPENDIX. 
 
 have been examined with a negative result, but at first I 
 did not make note of these cases, therefore, the species 
 cannot be indicated individually. 
 
 Although in most of the Carnivora the gleno-humeral 
 ligament is absent, yet it turns up in that singular form the 
 Two-spotted Paradoxure (Nandinia linotatta) ; it is also 
 present in the Himalayan Bear (Ursus tibetanus). 
 
 Edentata. — Bradypus tridactylus, 3. Tatusia peba ; T. 
 hybrida ; T. sexcinctus ; T. villosus. Myrmecophaga jubata, 2. 
 Tamandua tetradactyla, 2. Mam's didactyla, 2. Orycieropus 
 cap.nsis. 
 
 Marsupialia. — Perameles lagotis. Phascolarctos cinereus, 3. 
 Ttlacropus rufus ; M. giganticus ; M. melanops. Halmaturus 
 bennettu ; H. ualabatus ; H. derbia?ius. 
 
 Moxotremata. — Echidna hystrix. Ornithorhynchus para- 
 doxus. 
 
 * It was absent in a specimen subsequently dissected. 
 
REFERENCE LIST OF AUTHORS. 
 
 Albinus, 8 
 Albrecht, 73 
 Anderson, 74 
 
 Balfour, 90 
 
 Barth, 92 
 
 Baur, 5, 52 
 
 Bourgelat, 25 
 
 Bridge, 91 
 
 Brown, Macdonald, 24 
 
 Cleland, 80 
 Cope, 82, 89 
 Cunningham, 26, 38, 87 
 Cuvier, 82 
 
 Flower, 24, 77, 97 
 Freeman, 27 
 
 Gadow, 37, 43 
 
 Galton, J. C, 10, 17, 24 
 
 Garrod, 33, 41 
 
 Gegenbaur, 51, 93 
 
 Girard, 25 
 
 Gcette, go 
 
 Golgi, 3 
 
 Gruber, g, 10, 24, 95 
 
 Hasse, 82 
 Henke, 95 
 Humphry, 80 
 Hunter, 80 
 Hyrtl, 8 
 
 Jager, 83 
 Johnson, 51, 52 
 
 Kolliker, 95 
 
 Leboucq, g7 
 Luschka, 82 
 
 Macalister, gi 
 Marsh, 84 
 Marshall, 91 
 Mayer, 80 
 
 Mivart, 29, 31, 57, 90 
 Morris, 72, 80 
 Muller, 82 
 Murie, 24 
 
 Owen, 74 
 
 Paley, 41 
 Parker, 64 
 Percival, 25 
 
 Rathke, 82, 87 
 Reyher, 95 
 Robin, 82 
 Rolleston, 68 
 Rosenberg, 52, 95 
 Ruge, 36 
 
 Salensky, 91 
 Semper, go 
 Struthers, 5, 12, 27 
 
 Thompson, 32 
 Turner, 23 
 
 Walsham, 68 
 Watson, 12, 27 
 Wood, 11, 14 
 Wyman, 54 
 
INDEX. 
 
 Aard vark, 15 
 
 Agouti, 31 
 
 Alca torda, 32 
 
 Amphibia, 2, go 
 
 Ankle-joint, 42, 48 
 
 Anteater, 6 
 
 Aponeurosis, abdominal, 23 
 
 lumbar, 20 
 Articulation, meso-tarsal, 51 
 Astragalus of birds, 53 
 
 ascending process of, 54 
 Atlas, 89 
 
 Auriculo-ventricular valve, 54 
 Avian metatarsus, 53 
 
 tarsus, 49 
 Axis, ligaments of, 86 
 
 intervertebral disc of, 78 
 
 ossification of, 89 
 
 Band, gleno-humeral, 58, 65 
 
 ilio-tibial, 19 
 Beaver, 46 
 
 Bicipital loop of birds, 27 
 emu, 28 
 Bombinator igneus, go 
 Brady pus didactylus, 73 
 
 Carpus, morphology of, 98 
 Casuarius appendiculata, 39 
 Chelydra serpentina, 93 
 Chimpanzee, 11 
 Chondro-cranium, 76 
 Clavicle, ligaments of, 58 
 
 ossification of, 61 
 Costo-coracoid membrane, 58 
 Coraco-scapula foramen, 6 
 Cretaceous birds, 82 
 
 Cryptobranchus, 23 
 Cygnus mutis, 55 
 
 Degeneration of bone, 4 
 
 cartilage, 4 
 muscle, 3 
 
 Diaphragm, 22 
 
 Dinosauria, 50, 85 
 
 Dipnoi, 90 
 
 Disc intervertebral, 78 
 
 DramcBus novce-hollandia, 28 
 
 Echidna, 34, 3 g, 6g 
 Edentata, 72 
 Eider duck, 55 
 Elasmobranchs, 75, go 
 Elephant, 3g 
 Emu, 28 
 
 End-organs in tendon, 3 
 Enhydra marina, 3g 
 Episternal bones, 64 
 Eryops megalocephala, 89 
 Eustachian cartilage, 75 
 Expansor secundariorum, 33 
 
 Fascia lata, ig 
 
 palmar, 15 
 plantar, 16 
 temporal, 7 
 Femoro-caudal, 44 
 Fibro-cartilage of clavicle, 58 
 knee, 42 
 wrist, g8 
 Fin of porpoise, 26 
 Foramen coraco-scapular, 6 
 supra-condyloid, 5 
 triossium, 64 
 
 I 
 
io6 
 
 INDEX. 
 
 Ganocephala, 89 
 Gecko, 14 
 Gibbon, 36 
 Great Auk, 55 
 Gull, 55 
 
 Horse, 39, 69 
 Hylobates leuciscus, 96 
 Hypsiprymnus, 74 
 Hyrax, 36, 69 
 
 Ichthyornis, 85 
 
 Iguana tuberculata , 14, 28, 44 
 Ilio-tibial band, 19 
 Insectivora, 69 
 Intermedium, 55 
 
 Koala, 37 
 
 Lemuridas, 69 
 Ligament, alaria, 46 
 
 annular of ankle, 49 
 of wrist, 56 
 anterior of spine, 77 
 arcuatum, 23 
 atlantal, 87 
 calcaneo-cuboid, 17 
 check, 86 
 conjugal, 79 
 coraco-acromial, 58, 64 
 coraco-clavicular, 65 
 coraco-humeral, 65, 70 
 costa-coracoid, 58 
 crucial, 45 
 
 ex-latera! of knee, 35 
 gleno-humeral, 58, 65 
 interclavicular, 58 
 internal brachial, 12 
 interspinous, 81 
 intertransverse, 81 
 intervertebral, 78 
 ischio-sacral, 73 
 mucosum, 46 
 occipito-atlantal, 87 
 of pectoral arch, 58 
 
 Ligament, plantar, 17 
 
 post, of spine, 77 
 rhomboid, 65 
 sacro-sciatic, 72 
 subflava, 81 
 supraspinous, 78 
 suspensory of axis, 87 
 of horse, 25 
 of deer, 25 
 teres, 38 
 transverse, 86 
 
 Lophiomys, 7 
 
 Lumbar aponeurosis, 20 
 
 Manus, 93 
 
 of baboon, 93 
 tortoise, 93 
 
 Marsupial bone, 7 
 
 Marsupialia, 38, 6g 
 
 Mastodon, 72 
 
 Matamata terrapin, 82 
 
 Meckle's cartilage, 75 
 
 Megatherium, 72 
 
 Membrane, interosseous, 14 
 
 synovial, of knee, 46 
 
 Menobranchus, 67 
 
 Menopoma, 23 
 
 Muscle, abduct, metatarsi, 11 
 absence of, 23 
 ambiens, 39 
 biceps of birds, 27 
 coraco-brachialis, 11 
 curvator coccygis, 8 
 degeneration of, 3 
 epicoraco-humeral, 67 
 epitrochleo-anconeal, 9 
 extensor coccygis, 9 
 
 digitorum, 36 
 femoro-caudal, 44 
 ilio-peroneal, 29 
 interosseous, 14, 19 
 latissimus dorsi, 20 
 levator costarum, 22 
 humeri, 86 
 
INDEX. 
 
 107 
 
 Muscle, metamorphosis of, 2, 25 
 migration of, 3 
 obliqui, 23 
 palmaris longus, 14 
 peroneus longus, 36 
 primus, 36 
 quartus, 37 
 quintus, 37 
 tertius, 37 
 peroneo-tibialis, 14 
 plantaris, 15 
 regression of, 3, 25 
 rotator humeri, 12 
 subclavius, 66 
 transversalis, 22 
 
 Narwhal, 27 
 
 Nerve, external cutaneous, 19 
 
 interosseous, 19 
 
 great sciatic, 27 
 
 Odontoid process, 82 
 Orang, 36, 39, 69 
 Ornithorhynchus, 39, 63, 69, 89 
 Orycteropus, 17 
 Ostrich, 36, 39 
 Os centrale, 94 
 
 intermedium, 54, 94 
 
 magnum, 95 
 
 odontoideum, 82 
 
 scaphoid, 95 
 
 trapezium, 95 
 
 Pangolin, 39, 69 
 Parson, chameleon, 57 
 Pelobates, 7 
 Penguin, 50, 55 
 Petrel, 55 
 Porpoise, 27 
 Potto, 56 
 Potoroo, 74 
 
 Quadrumana, 69 
 
 Rallus aquaticus, 32 
 Razor bill, 32 
 Rhamphastos loco, 28 
 
 Rhea, 28, 50, 55, 83 
 Rhinoceros, 32, 39, 69 „ 
 
 Rod, subnotochordal, 91 
 
 Sauropsida, 92 
 
 Scapula, ossification of, 62 
 of sloth, 6 
 
 Seal, 69 
 
 Sea otter, 3g, 69 
 pigeon, 55 
 
 Skate, vertebrae of, 81 
 
 Skull, appendicular elements of, 75 
 
 Sloth, 6, 39, 6g 
 
 Sphenodon, 14, 90 
 
 Struthio, 50, 55, 60 
 
 Sturgeon, 91 
 
 Subnotochordal rod, gi 
 
 Subvertebral wedge bones, 90 
 
 Supra-condyloid foramen, 5 
 of cat, 5 
 of lion, 5 
 of man, 5 
 formation of, 4 
 
 Teleostei, go 
 Tendo-Achillis, 17 
 Tendon, end-organs in, 3 
 
 metamorphosis of, 2 
 
 migration, 2, 35 
 
 relation to muscle, 3 
 
 use of, 32 
 Tern, 55 
 
 Tentorium cerebelli, 7 
 Tibio-tarsus, 4g 
 
 of ostrich, 54 
 
 Vertebra atlas, 86 
 
 axis, 86 
 
 opisthoccelian, 85 
 
 procoelian, 85 
 
 saddle shaped, 85 
 Vulture, 32 
 
 Walrus, 3g, 6g 
 Wombat, 14 
 
 Printed by H. K. Lewis, 136 Gower Street, London, W.C. 
 
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 BRANCH OF MECHANICAL SURGERY. With over 350 Illustra- 
 tions, 8vo, 16s. 
 
 E. A. KIRBY, M.D., M.R.C.6. ENG. 
 
 Late Physician to the City Dispensary. 
 
 I. 
 
 A PHARMACOPOEIA OF SELECTED REMEDIES, 
 
 WITH THERAPEUTIC ANNOTATIONS, Notes on Alimentation 
 in Disease, Air, Massage, Electricity and other Supplementary Remedial 
 Agents, and a Clinical Index ; arranged as a Handbook for Prescribers. 
 Sixth Edition, enlarged and revised, demy 410, 7s. 
 
 II. 
 ON THE VALUE OF PHOSPHORUS AS A 
 
 REMEDY FOR LOSS OF NERVE POWER. Fifth Edition, 8vo, 
 2s. 6d. 
 
Catalogue of Works Published by H. K. Lewis. 11 
 
 J. WICKHAM LEGG, f.r.c.p. 
 
 Assistant Physician to Saint Bartholomew's Hospital, and Lecturer on Pathological 
 
 Anatomy in the Medical School. 
 
 ON THE BILE, JAUNDICE, AND BILIOUS DiSEASES. 
 
 With Illustrations in chromo-lithography, 719 pages, roy. 8vo, 25s. 
 
 A GUIDE TO THE EXAMINATION OP THE URINE: 
 
 intended chiefly for Clinical Clerks and Students. Sixth Edition, revised 
 and enlarged, with Illustrations, fcap. 8vo, 2s. 6d. 
 
 III. 
 A TREATISE ON HAEMOPHILIA, SOMETIMES 
 CALLED THE HEREDITARY HEMORRHAGIC DIATHESIS. 
 Fcap. 4to, 7s. 6d. 
 
 DR. GEORGE LEWIN. 
 
 Professor at the Fr. IVilh. University, and Surgeon-in-Chief of the Syphilitic Wards and 
 Skin Disease Wards of the Chariti Hospital, Berlin. 
 
 THE TREATMENT OP SYPHILIS WITH SUBCUTA- 
 NEOUS SUBLIMATE INJECTIONS. Translated by Dr. Carl 
 Prcegle, and Dr. E. H. Gale, late Surgeon United States Army, 
 Small 8vo, 7s. 
 
 LEWIS'S PRACTICAL SERIES. 
 
 Under this title Mr. Lewis is publishing a Series of Monographs, em- 
 bracing the various branches of Medicine and Surgery. 
 
 The volumes are written by well-known Hospital Physicians and Sur- 
 geons, recognized as authorities in the subjects of which they treat. The 
 works are intended to be of a thoroughly practical nature, calculated 
 to meet the requirements of the general practitioner, and to present the 
 most recent information in a compact and readable form ; the volumes 
 will be handsomely got up, and issued at low prices, varying with the size 
 of the works. 
 
 HANDBOOK OF DISEASES OF THE EAR FOR THE USE OF STUDENTS 
 
 AND PRACTITIONERS. By URBAN PRITCHARD, M.D. Edin., F.R.C.S. 
 Eng., Professor of Aural Surgerv at King's College, London ; Aural Surgeon to 
 King's College Hospital ; Senior Surgeon to the Royal Ear Hospital. With 
 Illustrations, crown 8vo, 4s. 6d. [Sow ready. 
 
 A PRACTICAL TREATISE ON DISEASES OF THE KIDNEYS AND 
 
 URINARY DERANGEMENTS. By CHARLES HENRY RALFE, M.A., 
 M.D. Cantab, Fellow of the Royal College of Physicians, London; Assistant 
 Physician to the London Hospital ; Examiner in Medicine to the University of 
 Durham, etc., etc. With Illustrations, crown 8vo,ios. 6d. [Now leady. 
 
 DENTAL SURGERY FOR GENERAL PRACTITIONERS AND STUDENTS 
 
 OF MEDICINE. Bv ASHLEY W. BARRETT, M.B. Lond., M.R.C.S., L.D.S. 
 Dental Surgeon to, and Lecturer on Dental Surgery and Pathology in the Medical 
 School of, the London Hospital. With Illustrations, cr. 8vo, 3s. [Sow ready. 
 
 BODILY DEFORMITIES AND THEIR TREATMENT: A HANDBOOK OF 
 
 PRACTICAL ORTHOPEDICS. By H. A. REEVES, F.R.C.S. Edin., Senior 
 
 Assistant Surgeon and Teacher of Practical Surgery at the London Hospital; 
 
 Surgeon to the Royal Orthopaedic Hospital, &c. With numerous Illustrations, 
 
 cr. 8vo, 8s. 6d. l Noxv read y- 
 
 FEVERS AND THEIR TREATMENT. 
 
 By ALEXANDER COLLIE, M.D. Aberd., Member of the Royal College of 
 Physicians of London ; Medical Superintendent of the Eastern Hospitals ; Secre- 
 tary of the Epidemiological Society for Germany and Russia. Illustrated with 
 Coloured Plates, crown 8vo. i In the P resSt 
 
 Further volumes will be announced in due course. 
 *** Prospectus of the Series with specimen pages, &c, on application. 
 
12 Catalogue of Works Published by H. K. Lewis. 
 
 LEWIS'S POCKET MEDICAL VOCABULARY. 
 
 Over 200 pp., 321T10, roan, 3s. 6d. 
 
 J. S. LOMBARD, m.d. 
 Formerly Assistant Professor 0/ Physiology in Harvard College. 
 
 I. 
 
 EXPERIMENTAL RESEARCHES ON THE REGIONAL 
 
 TEMPERATURE OF THE HEAD, under Conditions of Rest, In- 
 tellectual Activity and Emotion. With Illustrations, 8vo, 8s. 
 
 II. 
 ON THE NORMAL TEMPERATURE OF THE HEAD. 
 
 8vo, 5s. 
 
 WILLIAM THOMPSON LUSK, a.m., m.d. 
 Prtfesser of Obstetrics and Diseases of Women in the Bellevne Hospital Medical College, &c. 
 
 THE SCIENCE AND ART OF MIDWIFERY. Third 
 Edition, revised and enlarged, with numerous Illustrations, 8vo, 18s. 
 
 JOHN MACPHERSON, m.d. 
 
 Inspector-General of Hospitals H.M. Bengal Army {Retired). 
 
 Author of " Cholera in its Home," &c. 
 
 I. 
 
 ANNALS OF CHOLERA FROM THE EARLIEST 
 
 PERIODS TO THE YEAR 1817. With a map. Demy 8vo, 7s. 6d. 
 
 11. 
 
 BATH, CONTREXEVILLE, AND THE LIME SUL- 
 
 PHATED WATERS. Crown 8vo, 2s. 6d. 
 
 DR. V. MAGNAN. 
 Physician to St. Ann Asylum, Paris; Laureate of the Institute. 
 
 ON ALCOHOLISM, the Various Forms of Alcoholic 
 
 Delirium and their Treatment. Translated by W. S. Greenfield, 
 M.D., M.R.C.P. 8vo, 7s. 6d. 
 
 A. COWLEY MALLEY, b.a., m.b., b.ch. t.c.d. 
 
 PHOTO-MICROGRAPHY; including a description of 
 
 the Wet Collodion and Gelatino-Bromide Processes, together with the 
 best methods of Mounting and Preparing Microscopic Objects for Photo- 
 Micrography. Second Edition, with Photographs and Illustrations, 
 crown 8vo, 7s. 6d. 
 
Catalogue of Works Published by H. K. Lewis. 18 
 
 PATRICK MANSON, m.d., cm. 
 
 Amoy, China. 
 
 THE FILARIA SANGUINIS HOMINIS ; AND CER- 
 TAIN NEW FORMS OF PARASITIC DISEASE IN INDIA, 
 CHINA, AND WARM COUNTRIES. Illustrated with Plates and 
 Charts. 8vo, ios. 6d. 
 
 PROFESSOR MARTIN. 
 
 MARTIN'S ATLAS OF OBSTETRICS AND GYNJECO- 
 
 LOGY. Edited by A. Martin, Docent in the University of Berlin. 
 Translated and edited with additions by Fancourt Barnes, M.D., 
 M.R.C.P., Physician to the Chelsea Hospital for Women ; Obstetric 
 Physician to the Great Northern Hospital ; and to the Royal 
 Maternity Charity of London, &c. Medium 4to, Morocco half bound, 
 31s. 6d. nett. 
 
 WILLIAM MARTINDALE, f.c.s. 
 
 Late Examiner of the Pharmaceutical Society, and late Teacher of Pharmacy and Demon- 
 strator of Materia Medica at University College. 
 
 AND 
 
 W. WYNN WESTCOTT, m.b. lond. 
 
 Deputy Coroner for Central Middlesex. 
 
 THE EXTRA PHARMACOPOEIA with the additions in- 
 troduced into the British Pharmacopoeia, 18S5, and Medical References, 
 and a Therapeutic Index of Diseases and Symptoms. Fourth Edition, 
 revised with numerous additions, limp roan, med. 24mo, 7s. 
 
 [Now ready. 
 
 WILLIAM MARTINDALE, f.c.s. 
 
 COCA, COCAINE, AND ITS SALTS : their History, 
 
 Medical and Economic Uses, and Medicinal Preparations. Fcap.8vo, 2s. 
 
 MATERIA MEDICA LABELS. Adapted for Public and 
 
 Private Collections. Compiled from the British Pharmacopoeia of 1885. 
 The Labels are arranged in Two Divisions : — 
 
 DiviBion I. — Comprises, with few exceptions, Substances of Organ- 
 ized Structure, obtained from the Vegetable and Animal King- 
 doms. 
 
 Division II.— Comprises Chemical Materia Medica, including Alco- 
 hols, Alkaloids, Sugars, and Neutral Bodies. 
 
 On plain paper, ios. 6d. nett. On gummed paper, 12s. 6d. nett. 
 %* Specimens of the Labels, of which there are over 450, will be sent on application. 
 
14 Catalogue of Works Published by H. K. Lewis. 
 
 S. E. MAUNSELL, l.r.c.s.i. 
 
 Surgeon-Major, Medical Staff. 
 
 NOTES OF MEDICAL EXPERIENCES IN INDIA 
 
 PRINCIPALLY WITH REFERENCE TO DISEASES OF THE 
 EYE. With Map, post Svo, 3s. 6d. 
 
 J. F. MEIGS, m.d. 
 Consulting Physician to the Children's Hospital, Philadelphia. 
 
 AND 
 
 W. PEPPER, m.d. 
 Lecturer on Clinical Medicine in the University of Pennsylvania. 
 
 A PRACTICAL TREATISE ON THE DISEASES OF 
 
 CHILDREN. Seventh Edition, revised and enlarged, roy. 8vo, 28s. 
 
 Wm. JULIUS MICKLE, m.d., m.r.c.p. lond. 
 
 Medical Superintendent, Grove Hall Asylum, London, &c. 
 
 GENERAL PARALYSIS OF THE INSANE. 
 
 Second Edition, enlarged and rewritten, 8vo, 14s. 
 
 MIDDLESEX HOSPITAL, REPORTS OF THE MEDI- 
 CAL, SURGICAL, AND PATHOLOGICAL REGISTRARS FOR 
 1883 ; and 1SS4. Demy Svo, 2s. 6d. nett each volume. 
 
 KENNETH W. MILLICAN, b.a. cantab., m.r.c.s. 
 
 THE EVOLUTION OF MORBID GERMS : A Contribu- 
 
 bution to Transcendental Pathology. Cr. Svo, 3s. 6d. 
 
 STEPHEN MONCKTON, m.d., f.r.c.p. 
 
 THE METAPHYSICAL ASPECT OF NATURAL HIS- 
 TORY. (A Lecture). Second Edition, with Illustrations, crown 8vo, 
 
 as. 
 
Catalogue of Works Published by H. K. Lewis. 15 
 
 E. A. MORSHEAD, m.r.c.s., l.r.c.p. 
 
 Assistant to the Professor of Medicine in University College, London. 
 
 TABLES OF THE PHYSIOLOGICAL ACTION OF 
 
 DRUGS. Fcap. 8vo, is. 
 
 A. STANFORD MORTON, m.b., f.r.c.s. ed. 
 
 Surgeon to the Royal South London Ophthalmic Hospital. 
 
 REFRACTION OF THE EYE: Its Diagnosis, and the 
 
 Correction of its Errors. Third Edition, with Illustrations, small 8vo. 
 
 [Just ready. 
 
 WILLIAM MURRELL, m.d., f.r.c.p. 
 
 Lecturer on Materia Medica and Therapeutics at Westminster Hospital ; Examiner in 
 
 Materia Medica and Therapeutics in the University of Edinburgh, and to the 
 
 Royal College of Physicians of London. 
 
 I. 
 
 MASSAGE AS A MODE OF TREATMENT. Crown 8vo, 
 
 3s. 6d. [Just published. 
 
 ii. 
 
 WHAT TO DO IN CASES OF POISONING. Fifth 
 Edition, royal 32mo, 3s. 6d. 
 
 [Just published. 
 in. 
 
 NITRO- GLYCERINE AS A REMEDY FOR ANGINA 
 
 PECTORIS. Crown 8vo, 3s. 6d. 
 
 WILLIAM NEWMAN, m.d. lokd., f.r.c.s. 
 Surgeon to the Stamford Infirmary. 
 
 SURGICAL CASES: Mainly from the Wards of the 
 
 Stamford, Rutland, and General Infirmary. 8vo, paper boards, 4s. 6d. 
 
 DR. FELIX von NIEMEYER. 
 
 Late Professor of Pathology and Therapeutics ; Director of the Medical Clinic of the 
 
 University of Tubingen. 
 
 TEXT-BOOK OF PRACTICAL MEDICINE, WITH 
 
 PARTICULAR REFERENCE TO PHYSIOLOGY AND PATHO- 
 LOGICAL ANATOMY. Translated from the Eighth German Edition, 
 by special permission of the Author, by George H. Humphrey, M.D., 
 and Charles E. Hackley, M.D. Revised Edition, 2 vols., large 8vo, 36s. 
 
16 Catalogue of Works Published by H. K. Lewis. 
 
 C. F. OLDHAM, m.r.c.s., l.r.c.p. 
 Surgeon H.M. Indian Forces ; late in Medical charge of the Dalhousie Sanitarium. 
 
 WHAT IS MALARIA ? and why is it most intense in 
 
 hot climates ? An explanation of the Nature and Cause of the so- 
 called Marsh Poison, with the Principles to be observed for the Preser- 
 vation of Health in Tropical Climates and Malarious Districts. Demy 
 8vo, 7s. 6d. 
 
 G. OLIVER, m.d., m.r.cp. 
 
 THE HARROGATE WATERS : Data Chemical and Therapeu- 
 tical, with notes on the Climate of Harrogate. Addressed to the 
 Medical Profession. Crown 8vo, with Map of the Wells, 35. 6d. 
 
 11. 
 
 ON BEDSIDE URINE TESTING: a Clinical Guide to the 
 
 Observation of Urine in the course of Work. Third Edition, revised 
 and enlarged, fcap. 8vo, 3s. 6d. 
 
 SAMUEL OSBORN, f.r.c.s., 
 
 Assistant-Surgeon to the Hospital for Women ; Surgeon Royal Naval Artillery Volunteers, 
 
 I. 
 
 AMBULANCE LECTURES: FIRST AID. With Illus- 
 trations, fcap. 8vo, is. 6d. 
 
 *" II. 
 
 AMBULANCE LECTURES : NURSING. With Illustrations, 
 fcap. 8vo, is. 6d. 
 
 ROBERT W. PARKER. 
 
 Surgeon to the East London Hospital for Children, and to the Grosvenor Hospital for 
 
 Women and Children. 
 
 TRACHEOTOMY IN LARYNGEAL DIPHTHERIA, 
 
 AFTER TREATMENT AND COMPLICATIONS. Second Edition. 
 With Illustrations, 8vo, 5s. 
 
 JOHN S. PARRY, m.d. 
 Obstetrician to the Philadelphia Hospital, Vice-President of the Obstetrical and Pathologi- 
 cal Societies of Philadelphia, &c. 
 
 EXTRA-UTERINE PREGNANCY ; Its Causes, Species, 
 
 Pathological Anatomy, Clinical History, Diagnosis, Prognosis and 
 Treatment. 8vo, 8s. 
 
 E. RANDOLPH PEASLEE, m.d., ll.d. 
 
 Late Professor of Gynecology in the Medical Department of Dartmouth College ; President 
 of the New York Academy of Medicine, &c, &c. 
 
 OVARIAN TUMOURS : Their Pathology, Diagnosis, and 
 
 Treatment, especially by Ovariotomy. Illustrations, roy. 8vo, 16s. 
 
Catalogue of Works Published by H. K. Lewis. 17 
 
 G. V. POORE, M.D., F.R.C.P. 
 
 Professor of Medical Jurisprudence, University College; Assistant Physician to, and Physi- 
 cian in charge of the Throat Department of, University College Hospital. 
 
 LECTURES ON THE PHYSICAL EXAMINATION OF 
 
 THE MOUTH AND THROAT. With an Appendix of Cases. 8vo, 
 3s. 6d. 
 
 R. DOUGLAS POWELL, m.d., f.r.c.p., m.r.c.s. 
 
 Physician to the Middlesex Hospital, and Physician to the Hospital for Consumption and 
 Diseases of the Chest at Brompton. 
 
 DISEASES OF THE LUNGS AND PLEURAE, INCLUD- 
 ING CONSUMPTION. Third Edition, entirely rewritten and en- 
 larged. With coloured plates and wood engravings, 8vo, 16s. 
 
 [Just published. 
 
 URBAN PRITCHARD, m.d. edin., f.r.c.s. eng. 
 
 Professor of Aural Surgery at King's College, London ; Aural Surgeon to King's College 
 Hospital ; Senior Surgeon to the Royal Ear Hospital. 
 
 HANDBOOK OF DISEASES OF THE EAR FOR THE 
 
 USE OF STUDENTS AND PRACTITIONERS. With Illustrations, 
 crown 8vo, 4s. 6d. [Now ready. 
 
 Lewis's Practical Series) . 
 
 CHARLES W. PURDY, m.d. (queen's univ.) 
 
 Professor of Genito-Urinary and Renal Diseases in the Chicago Polyclinic, &c, &c. 
 
 BRIGHT'S DISEASE AND THE ALLIED AFFECTIONS 
 
 OF THE KIDNEYS. With Illustrations, large 8vo, 8s. 6d. 
 
 CHARLES HENRY RALFE, m.a., m.d. cantab. 
 
 Fellow of the Royal College of Physicians, London ; Assistant Physician to the London Hos- 
 pital ; Examiner in Medicine to the University of Durham, etc., etc. 
 
 A PRACTICAL TREATISE ON DISEASES OF THE 
 
 KIDNEYS AND URINARY DERANGEMENTS. With Illustrations, 
 crown 8vo, 10s. 6d. [Now ready. 
 
 Lewis's Prattical Series] , 
 
 AMBROSE L. RANNEY, a.m., m.d. 
 
 Adjunct Professor of Anatomy in the University of New York, etc. 
 
 THE APPLIED ANATOMY OF THE NERVOUS SYS- 
 TEM, being a study of this portion of the Human Body from a stand- 
 point of its general interest and practical utility, designed for use as 
 a Text-book and a Work of Reference. With 179 Illustrations, 8vo, 
 20s. 
 
18 Catalogue of Works Published by H. K. Leivis. 
 
 H. A. REEVES, f.r.c.s. ed. 
 
 Senior Assistant Surgeon and Teacher of Practical Surgery at the London Hospital; 
 
 Surgeon to the Roy ai Orthopaedic Hospital, &c. 
 
 BODILY DEFORMITIES AND THEIR TREATMENT: 
 
 A Handbook of Practical Orthopaedics. With numerous Illustrations, 
 
 crown 8vo, 8s. 6d. [Now ready. 
 Lewis's Practical Series] . 
 
 RALPH RICHARDSON, m.a., m.d. 
 
 Fellow of the College of Physicians, Edinburgh. 
 
 ON THE NATURE OF LIFE : An Introductory Chap- 
 ter to Pathology. Second Edition, revised and enlarged. Fcap. 4to, 
 ios. 6d. 
 
 W. RICHARDSON, m.a., m.d., m.r.c.p. 
 
 REMARKS ON DIABETES, ESPECIALLY IN REFER- 
 ENCE TO TREATMENT. Demy 8vo, 4s. 6d. 
 
 SYDNEY RINGER, m.d., f.r.s. 
 
 Professor of the Principles and Practice of Medicine in University College; Physician to, 
 and Professor of Clinical Medicine in, University College Hospital. 
 
 I. 
 
 A HANDBOOK OF THERAPEUTICS. Eleventh Edition, 
 
 thoroughly revised, 8vo, 15s. [Now ready. 
 
 II. 
 
 ON THE TEMPERATURE OF THE BODY AS 
 
 A MEANS OF DIAGNOSIS AND PROGNOSIS IN PHTHISIS. 
 Second Edition, small 8vo, 2s. 6d. 
 
 FREDERICK T. ROBERTS, m.d., b.sc, f.r.c.p. 
 
 Examiner in Medicine at the Royal College of Surgeons ; Professor of Therapeutics in 
 
 University College ; Physician to University College Hospital ; Physician to 
 
 Brompton Consumption Hospital, &c. 
 
 I. 
 
 A HANDBOOK OF THE THEORY AND PRACTICE 
 
 OF MEDICINE. Sixth Edition, with Illustrations, in one volume, 
 large 8vo, revised and enlarged to over 1000 pages, 21s. [Just published. 
 %* Copies may also be had bound in two volumes cloth for is. 6d. extra. 
 
 II. 
 
 NOTES ON MATERIA MEDICA AND PHARMACY. 
 
 Fcap. 8vo, 7s. 6d. 
 
Catalogue of Works Published by H. K. Lewis. 19 
 
 R. LAWTON ROBERTS, m.d., m.r.c.s. 
 
 ILLUSTRATED LECTURES ON AMBULANCE WORK. 
 
 Second Edition, copiously Illustrated, crown 8vo. 2s. 6d. 
 
 [jf ust published. 
 
 A. R. ROBINSON, m.b., l.r.c.p., and l.r.c.s. edin. 
 Professor of Dermatology at : >h Polyclinic. 
 
 A MANUAL OF DERMATOLOGY. With 88 Illustrations, 
 large 8vo, 21s. 
 
 ROBSON ROOSE, m.d. 
 
 Fellow 0/ the Royal College of Physicians in Edinburgh. 
 
 GOUT, AND ITS RELATIONS TO DISEASES OF 
 
 THE LIVER AND KIDNEYS. Third Edition, crown 8vo, 3s. 6d. 
 
 {just ready. 
 
 D. B. St. JOHN ROOSA, m.a., m.d. 
 
 Professor of Diseases of the Eye and Ear in the University of the City of New York ; Surgeon 
 
 to the Manhattan Eye and Ear Hospital ; Consulting Surgeon to the Brooklyn Eye 
 
 and Ear Hospital, &c, &c. 
 
 A PRACTICAL TREATISE ON THE DISEASES OF 
 
 THE EAR, including the Anatomy of the Organ. Sixth Edition, 
 Illustrated by wood engravings and chromo-lithographs, large 8vo, 25s. 
 
 J, BURDON SANDERSON, m.d., ll.d., f.r.s. 
 
 Jodrell Professor of Physiology in University College, London. 
 
 UNIVERSITY COLLEGE COURSE OF PRACTICAL 
 
 EXERCISES IN PHYSIOLOGY. With the co-operation of F. J. M. 
 Page, B.Sc, F.C.S. ; W. North, B.A., F.C.S., and Aug. Waller, M.D. 
 Demy 8vo, 3s. 6d. 
 
 W. H. O. SANKEY, m.d. lond., f.r.c.p. 
 
 Late Lecturer on Mental Diseases, University College and School of Medicine for Women, 
 
 London; Formerly Medical Superintendent (Female Department) of Hanwell 
 
 Asylum ; President of Medico-Psychological Society, &c. 
 
 LECTURES ON MENTAL DISEASE. Second Edition, with 
 coloured plates, 8vo, 12s. 6d. 
 
 ALDER SMITH, m.b. lond., f.r.c.s. 
 Resident Medical Officer, Christ's Hospital, London. 
 
 RINGWORM : Its Diagnosis and Treatment. Third Edit., 
 rewritten and enlarged. With Illustrations, fcap. 8vo, 5s. 6d. 
 
20 Catalogue of Works Published by H. K. Lewis. 
 
 J. LEWIS SMITH, m.d. 
 
 Physician to the New York Infants' Hospital ; Clinical Lecturer on Diseases of Children 
 in Bellevue Hospital Medical College. 
 
 A TREATISE ON THE DISEASES OF INFANCY 
 
 AND CHILDHOOD. Fifth Edition, with Illustrations, large 8vo, 21s. 
 
 FRANCIS W. SMITH, m.b., b.s. 
 
 THE SALINE WATERS OF LEAMINGTON. Second Edit., 
 with Illustrations, crown 8vo, is. nett. 
 
 JAMES STARTIN, m.b., m.r.c.s. 
 Surgeon and Joint Lecturer to St. John's Hospital for Diseases of the Skin. 
 
 LECTURES ON THE PARASITIC DISEASES OF 
 
 THE SKIN. VEGETOID AND ANIMAL. With Illustrations, 
 crown 8vo, 2s. 6d. 
 
 LEWIS A. STIMSON, b.a., m.d. 
 
 Surgeon to the Presbyterian and Bellevue Hospitals ; Professor of Clinical Surgery in the 
 Medical Faculty of the University of the City of New York, &c. 
 
 A MANUAL OF OPERATIVE SURGERY. With three 
 
 hundred and forty-two Illustrations. Second Edit., post 8vo, 10s. 6d. 
 
 [Just published. 
 
 HENRY R. SWANZY, a.m., m.b., f.r.c.s.i. 
 
 Examiner in Ophthalmic Surgery at the Royal College of Surgeons, Ireland ; Surgeon to the 
 
 National Eye and Ear Infirmary, Dublin ; Ophthalmic Surgeon at the 
 
 Adelaide Hospital, Dublin. 
 
 HANDBOOK OF DISEASES OF THE EYE AND THEIR 
 
 TREATMENT. Illustrated with wood-engravings, colour tests, etc., 
 large post 8vo, 10s. 6d. [Now ready. 
 
 JOHN DAVIES THOMAS, m.d. lond., f.r.c.s. eng. 
 
 Physician to the Adelaide Hospital, S. Australia. 
 I. 
 
 HYDATID DISEASE, WITH SPECIAL REFERENCE 
 
 TO ITS PREVALENCE IN AUSTRALIA. Demy 8vo, 10s. 6d. 
 
 II. 
 HYDATID DISEASE OF THE LUNGS. Demy 8vo, 2s. 
 
Catalogue of Works Published by H. K. Leans. 21 
 
 HUGH OWEN THOMAS, m.r.c.s. 
 i. 
 
 DISEASES OP THE HIP, KNEE, AND. ANKLE 
 
 JOINTS, with their Deformities, treated by a new and efficient method. 
 Second Edition, 8vo, 253. 
 
 II. 
 
 CONTRIBUTIONS TO MEDICINE AND SURGERY :— 
 
 Part i. — Intestinal Obstruction ; with an Appendix on the Action of 
 Remedies. 10s. 
 „ 2. — The Principles of the Treatment of Joint Disease, Inflamma- 
 tion, Anchylosis, Reduction of Joint Deformity, Bone Set- 
 ting. 5s. 
 ,, 4. — The Collegian of 1666 and the Collegians of 1885 ; or what is 
 
 recognised treatment ? 2s. 6d. 
 ,, 5. — On Fractures of the Lower Jaw. is. 
 
 „ 6. — The Principles of the Treatment of Fractures and Disloca- 
 tions. 10s. 
 ,, 8. — The Inhibition of Nerves by Drugs. Proof that Inhibitory 
 Nerve-Fibres do not exist, is. 
 (Parts 3, 7, 9, io, are expected shortly). 
 
 J. ASHBURTON THOMPSON, m.r.c.s. 
 
 Late Surgeon at King's Cross to the Great Northern Railway Company. 
 
 FREE PHOSPHORUS IN MEDICINE WITH SPE- 
 CIAL REFERENCE TO ITS USE IN NEURALGIA. A contribution 
 to Materia Medica and Therapeutics. An account of the History, Phar- 
 maceutical Preparations, Dose, Internal Administration, and Therapeu- 
 tic uses of Phosphorus ; with a Complete Bibliography of this subject, 
 referring to nearly 200 works upon it. Demy 8vo, 7s. 6d. 
 
 J. C. THOROWGOOD, m.d. 
 Assistant Physician to the City of London Hospital for Diseases of the Chest. 
 
 THE CLIMATIC TREATMENT OP CONSUMPTION 
 
 AND CHRONIC LUNG DISEASES. Third Edition, post 8vo, 3s 6d. 
 
 EDWARD T. TIBBITS, m.d. lond. 
 Physician to the Bradford Infirmary ; and to the Bradford Fever Hospital. 
 
 MEDICAL FASHIONS IN THE NINETEENTH CEN- 
 TURY, including a Sketch of Bacterio-Mania and the Battle of the 
 Bacilli. Crown 8vo, 2s. 6d. 
 
 H. H. TOOTH, M.A., M.D., M.R.C.P. 
 Assistant Demonstrator of Physiology at St. Bartholomew's Hospital. 
 
 THE PERONEAL TYPE OF PROGRESSIVE MUSCU- 
 
 LAR ATROPHY. 8vo, is. 
 
22 Catalogue of Works Published by H. K. Lewis. 
 
 FREDERICK TREVES, f.r.c.s. 
 
 Hunterian Professor at the Royal College of Surgeons of England ; Surgeon to and Lecture* 
 on Anatomy at the London Hospital. 
 
 THE ANATOMY OF THE INTESTINAL CANAL AND 
 
 PERITONEUM IN MAN. Hunterian Lectures, 1885. 4 to, 2s. 6d. 
 
 D. HACK TUKE, m.d., ll.d. 
 
 Fellow of the Royal College of Physicians, London. 
 
 THE INSANE IN THE UNITED STATES AND 
 
 CANADA. Demy 8vo, 7s. 6d. 
 
 LAURENCE TURNBULL, m.d., ph.g. 
 Aural Surgeon to Jefferson Medical College Hospital, &c, &c. 
 
 ARTIFICIAL ANESTHESIA : A Manual of Anaesthetic 
 
 Agents, and their Employment in the Treatment of Disease. Second 
 Edition, with Illustrations, crown 8vo, 6s. 
 
 W. H. VAN BUREN, m.d., ll.d. 
 Professor of Surgery in the Bellevue Hospital Medical College. 
 
 DISEASES OF THE RECTUM : And the Surgery of 
 
 the Lower Bowel. Second Edition, with Illustrations, 8vo, 14s. 
 
 RUDOLPH VIRCHOW, m.d. 
 Professor in the University, and Member of the Academy of Sciences of Berlin, &c, &c. 
 
 INFECTION - DISEASES IN THE ARMY, Chiefly 
 
 Wound Fever, Typhoid, Dysentery, and Diphtheria. Translated from 
 the German by John James, M.B., F.R.C.S. Fcap. 8vo, is. 6d. 
 
 ALFRED VOGEL, m.d. 
 Professor of Clinical Medicine in the University of Dorpat, Russia. 
 
 A PRACTICAL TREATISE ON THE DISEASES OF 
 
 CHILDREN. Third Edition, translated and edited by H. Raphael, 
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Catalogue of Works Published by H. K. Lewis. 23 
 
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