CHAPTER III. OF THE SKELETON AND BONES, JOINTS, CARTILAGES, LIGAMENTS, SYNO- I. Section of the Skeleton and Bones. III. Section of the Muscles and Tendons. II. Section of the Joints, Cartilages, Li- IV. Section of the Nerves subservient to gaments, and Synovial Membranes. Motion. CHAP. III. OF THE SKELETON ANDBONES, JOINTS, TENDONS, &c. AUTHORS on anatomy and physiology in general, commence their ob- MUSCLES, servations by separately considering the Skeleton and Bones, next the Joints, termed articulations, and then the Muscles with their Tendons, all these being concerned in supporting the entire frame, and producing, when influenced by the nerves, what (although not usual, and, perhaps, somewhat unmedical,) we will term the Function of Motion, or Locomotion. In this chapter, we will, for a clear understanding of the subjects, consider each of these organs or parts separately, and then for practical purposes take a combined view of the whole, because in every operation, whether of reducing a fracture or dislocation, or otherwise, the surgeon must be well informed, not only of the structure of every part, but also of the conjoint operation of every bone, joint, ligament, muscle, tendon, or nerve, for very generally he has to overcome the local counteracting contraction or force, of numerous muscles, and must take especial care not to injure any essential nerve. SECTION I.-OF THE SKELETON AND BONES. Bones. Before we proceed to consider the details of this subject, it has been SECT. I. deemed expedient to assist the reader by introducing two plates of the Of the Skeskeleton, the one anterior or frontal, the other posterior, with numbers leton and applicable to each bone; and the following table contains corresponding numbers and the names of each bone in explanation of those plates. These present to the view the names of most of the principal bones. The whole number in the Human Frame is 245, besides some very small bones; namely, in the head, sixty-seven, including the thirty-two teeth; in the trunk, fifty-four; in the upper extremities, sixty-four; and in the lower extremities, sixty bones.(a) (a) See the very useful tables of Bones, Joints, and Ligaments, Muscles, Brain, Nerves, &c., arranged for Students, and published by Messrs. Burgess and Hill, A. D. 1830, and which every Student is Bones in connexion The Human Skeleton is so associated with ideas of death and loss of First, of friends, that, to most persons, it is an object of horror, or of melancholy the Skelereflection; but upon due examination and reflection, we shall find that ton and the so admirable adaptation of all the parts to their purposes, and of parts which being purely mechanical, are perfectly understood, render it, in- general, in dependently of all professional considerations, an object of the deepest with their philosophic interest. Such mechanism, it has been observed, reveals, Joints, and by intelligible signs, the hand of the Creator-and man may be said sub- the Muslimely to commune with his Maker when he contemplates and under- cles and stands the structure aright. (b) In a general view of the skeleton we must remark the nice adaptation of all the parts to each other, to effect the intended purpose, and to the strains and supports which they have respectively to bear; as 1st, in the size of the spinal vertebræ increasing from above downwards, and the bones of the legs being larger than those of the arms. 2d. The objects of strength and lightness combined; as by the hollowness of the long bones, their angular form,-their increased thickness and flexures in particular places, where great strain has to be borne, the enlargement of the extremities for the purposes of forming joints, and to which the muscles are attached, lengthening the lever by which these act. 3d. We have to remark the nature and strength of material in different parts, so admirably adapted to the purposes which the parts serve; there is bone, for instance, in one place, incased in enamel, the latter of which is nearly as hard as iron, and having the form of Teeth, with the office of chewing and tearing all kinds of matter used as food. In the cranium, again, bone is softer, but tough and resisting. In the middle of long bones the bone is compact and little bulky, to leave room for the swelling of the muscles lying around it, while, at either end, with the same quantity of matter, it is large and spongy, in order to give a broad surface for articulation; (a) The study of the Bones is termed Osteology from the Greek Tov, a bone, and xos, a discourse. The works to be read relating to Bones and Joints, are referred to in Cooper's Dict. titles Bone and Necrosis. The celebrated modern treatises of Sir A. Cooper on Fractures and Dislocations, and of Mr. Brodie on Diseases of Joints, and Mr. Abernethy's third Physiological Lecture on Bones and Joints, must be read; see also Copeland's Diseases of the Spine; Wilson on Bones and Joints; Bell, Anat. vol. 1, p. 1 to 206; 1 Horner, (b) 1 Arnott, El. Phys. &c. 431, &c. Tendons. CHAP. III. and in the Spine the bodies of the vertebræ, each of which rests on an SECT. I. elastic bed of intervertebral substance, are light and spongy, while their SKELETON articulating surfaces and processes are very hard. AND BONES. The Skeleton. Secondly, In the Joints we see the tough, elastic, smooth substance, called cartilage, covering the ends of the bones, defending, and as it were padding them, and preventing friction. In infants we find all the bones soft, or gristly, and therefore calculated to bear with impunity the falls and blows incident to their age: and we see certain parts, where elasticity is necessary or useful, remaining cartilage or gristle for life, as at the anterior extremity of the ribs. About the joints we have to remark the Ligaments which bind the bones together, possessing a tenacity scarcely equalled in any other known substance: and we see that the Muscular fibres, whose contractions move the bones and thereby the body,-because they would have rendered the limbs clumsy even to deformity had they all passed over the joints to the parts which they have to pull,-attach themselves at convenient distances, to strong cords called Tendons; by means of which they make their effort effective at any distance. These Tendons are remarkable for the great strength to be found in their apparently slender forms, and for the lubricated smoothness of their surfaces.(c) The Skeleton (from σκελετόν or σκέλλω, to dry) is the fundamental part of the living fabric in man as well as animals, inasmuch as it gives form, solidity, support, and means of tenacity to the whole, and constitutes the substratum to which the other parts are applied. The Skeleton serves to extend and support the muscles and other parts which would otherwise naturally fall together in one compressed mass. But this again is constituted of various parts, which during life, and even for a considerable time after death, are connected by Joints and Ligaments; for otherwise, as in the case of that defect (sometimes improperly termed disease of the bones) Anchylosis, (d) and constituting a soldering union of the joints, would be in one continuous mass and would be incapable of locomotion. And these several parts are admirably constructed in different lengths and dimensions, so as to admit of various degrees of motion between the parts. Bones, then, with their ligamentous connexions, constitute together the passive, whilst the muscles, influenced by the nerves, are the active instruments of locomotion. (e) The number of these bones vary in the different ages of life, being gradually reduced by the process of ossification, as in the instance of the sternum, or breast bone, which, in the infant, is in three pieces, united only by cartilage, but which in manhood become one entire bone. In manhood the principal bones are 197, though by enumerating certain smaller bones, they may amount to 260; and this number is made up by similar bones on each side of the head, as the two ossa parietalia and the two ossa temporum, and other parts, which we have seen are very generally symmetrical. (f) The foregoing frontal and posterior views of the Skeleton present to the eye a view of only the principal bones, with numeral references, giving the technical and popular names of each. A full account of some of the bones will presently be given. A knowledge of the appearance, situation and structure of the skeleton, and of each bone, is peculiarly essential to every surgeon, and to all con (c) See farther, 1 Arnott, El. Phys. 438. (d) From ava an absence of, and xuxos juice-or as others, though it should seem incorrectly, derive it from avaos crooked; see Cooper's Surg. Dict. tit. Anchylosis. Anchylosis is the union of two opposed surfaces when the intervening car tilage has been absorbed. It is not strict- (e) 1 Dunglison, Phy. 282, &c.. SECT. I. cerned in judicial inquiries, as exemplified in the case of Bowerman, who CHAP. III. was charged with the murder of his child, by perforating its skull with an awl, and which was considered as established by discovering a hole in the SKELETON skull, on one side, near the ear, and about three years after the death, AND BONES. supposed to have been made by a sharp instrument that occasioned the ance of the death; and upon which a coroner's inquest was about to find a verdict of knowledge murder, had not an intelligent surgeon proved, that such hole was an ordi- of Bones to nary and natural aperture usually to be found, and designed by nature, for well as the Lawyers as the passage of a vein, and which testimony saved the supposed criminal's Medical life.(g) So in cases of doubt respecting the sex of the skeleton of a per- Profession. son supposed to have been murdered, the proof of the peculiar structure of the female pelvis might remove all difficulty. (h) So the progress and dimensions of the bones in the fetus would also tend to fix with greater certainty whether at the time criminal means were used to cause miscarriage, the mother had quickened, so as to subject the party to capital punishment under the absurd, but still existing law.(i) And the very frequent actions against surgeons for the unskilful treatment of a fractured or dislocated bone, establish the great importance on their part, of acquiring a very minute knowledge of every bone and joint, and their connected muscles and tendons, and of their ordinary injuries and proper remedies. Sir A. Cooper, in his admirable work on Dislocations and Fractures, forcibly illustrates the disastrous consequences to professional character from the too frequent inability of even some practising surgeons correctly to pronounce whether or not a bone has been dislocated or fractured, and which incompetency is usually attributable to their ignorance of all the particulars of the natural state, and of the varying appearances constituting deviation from such natural state in cases of injuries. So a barrister can scarcely with skill examine professional witnesses upon such a subject unless he has himself acquired at least a general knowledge of the structure of the skeleton, bones and muscles.(k) Bones. The bones, with their joints and ligaments, serve to extend, support, Thirdly, defend, and place in various moveable positions the muscles, or flesh, General and other soft parts of the human frame, which would otherwise, from Utility of their natural gravity, fall into one compressed mass. The Bones have been termed the Levers, and the muscles and tendons the pulleys or cords of the living frame.(1) The bones enable us, with the assistance of the muscles and tendons, and influenced by the nerves and mental volition, to exercise the power of locomotion. They are generally hard and inflexible bodies, without contractility, and very little subject to decay, (m) they are considered as comparatively the most permanent and unchangeable parts (g) See Bowerman's case, 3 Paris & Fonb. 80, post. (h) Aran's case, 3 Paris & Fonb. 77, 311, 314, post. (i) See 9 G. 4, c. 31, s. 13; Amer. Cy. Prac. Med. tit. Ages; Smith, For. Med. 312 to 316; 1 Paris & Fonb. 239, 339, and see post, as to quickening. The quick ening is between the 4th and 5th month, and at six months the skeleton of the fetus is usually about twelve inches long, and the spine five; and certain other bones are formed after the fifth month. (k) Amongst others, he states an anecdote of a malevolent countryman having consulted Sir A. Cooper on the state of his shoulder joint, and being assured it was dis located, contrary to the report of his coun- (1) 1 Dunglison, Phy. 329, &c.; 1 Bost Ph. 75. |