Difference between revisions of "The Johns Hopkins Medical Journal 12 (1901)"

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==Contents - April-May-June==
  
[Price, 50 Cents.
 
  
 +
* On the Study of Anutomy. By Lewellts F. Bakker, M. B., . .
 +
* On tlic Occurrence of Tails in Man, with a Description of the Case Reported bv Dr. Watson. By Ross Gr.\nvii.i.e Harhlson, Ph.D., M. D., . '. "
 +
* Developinent of the Fist's Intestine. By Jons BurcE MacCallum, M. D.,
 +
* Bilateral Relations of the Cerebral Cortex. By K. Limion Mellus, M. D.,
 +
* A New Carbon-Dioxide Freezing- Microtome. By Cuari,e.s Russell Bardeen, M. D.,
 +
* Notes on Cervical Ribs. By Clinton E. Brush, Jr.,
 +
* On the Preservation of Anatomical Material in America by Means of Cold Storage. By Abkam T. Kerr, B. S., M. D.,
 +
* On the Development of the Nuclei Pontis during the Second and Third Months of Embryonic Life. By Margaret Long,
 +
* The Architecture of the Gall Bladder. Bv Mervin T. Si'dler, PlI. D., M. D., ."
 +
* Remarkable Cases of Hereditary Anchyloses, or Absence of Various Phalangeal Joints with Defects of the Little and Ring Fingers. By George Walker, M. D.,
 +
* Note on the Basement Membranes of the Tubules of the Kidney. By Franklin P. Mall,
 +
* A Comparative Study of the Development of the Generative Tract in Termites. By H. McE. Knoweh, Ph.D
 +
* A Composite Study of the Axillary Artery in Man. By J. M. IIitzuot,
 +
* On the Origin of the Lymphatics in the Liver. Bv Franklin P. Mall, = 140
 +
* Bern's Method of Reconstruction by Means of Wax Plates as Used in the Anatomical Laboratory of the Johns Hopkins University. By Charles Russell Bardeen, M. D., 148
 +
* Model of the Nucleus Dentatus of the Cerebellum and its Accessory Nuclei. By Harry A. Fowler, ISl
 +
* Use of the Material of the Dissecting Room for Scientific Purposes. By Charles Russell Bardeen, M. I)., 1.55
 +
* On the Development of the Human Diaphragm. By Franklin P. Mall,  158
 +
* Observations on the Pectoralis Major Muscle in Man. By Wauren Harmon Lewis, M D., 173
 +
* On the Blood-Vessels of the Human Lymphatic Gland. By W. J. Calvert, M. D., U. S. A., . . .'. . . , .177
 +
* Normal Menstruation and Some of the Factors Modifying It. By Clelia Duel MosHER, A. M., M. D., 178
 +
* Kctrojcction of Bile into the Pancreas, a Cause of Acute Hemorrhagic Pancreatitis. By W. S. Halsted, M. D., 170
 +
* The Etiology of Acute Hemorrhagic Pancreatitis. By Eugene L. Opie, m". D., 182
 +
* The John W. Garrett International Fellowship, 188
  
 +
Notes on New Books, ISO
  
CONTE
+
Books Received, 101
  
  
  
On the Study of Anutomy. By Lewellts F. Bakker, M. B., . .
+
ON THE STUDY OF ANATOMY.'
  
On tlic Occurrence of Tails in Man, with a Description of the Case Reported bv Dr. Watson. By Ross Gr.\nvii.i.e Harhlson, Ph.D., M. D., . '. "
 
  
  
 +
By Lewellts F. Barker, M. B., Tor. Professor of Anatomy, University of Chicago.
  
>AGE
 
  
87
 
  
 +
With tlio advent of October, with its cool and bracing days and restful nights, there is regularly a quickening of activities in academic circles. The occupant of a [irofcssional chair, reinvigorated by temporary sojourn in forest or field, at the seaside or in the hills, resumes his teaching with renewed enthusiasm, and engages again in that original investigation which represents the most absorbing interest of his life. The
  
  
flfi
 
  
 +
' An address delivered before the Faculty and students of Hush Medical College, October .5, 1000.
  
  
Dcvelopinent of the Fist's Intestine. By Jons BurcE MacCallum, M. D., . . . "
 
  
Bilateral Relations of the Cerebral Corte.x. By K. Limion Mellus, M. D.,
+
student, too, perhaps, as yet less conscious of the actual need of an occasional remittance from his labors, has nevertheless liad his holiday, and returns to the college of his clioice ready for another season of diligent application and eager to begin once more the arduous tasks which the pursuit of knowledge entails.
  
A New Carbou-Dioxide Freezing- Microtome. By Cuari,e.s Rl'ssell Bardeen, M. D.,
+
It has long been customary in colleges in which medicine is taught to call a meeting of tlie faculty and students at the beginning of the autumn session. Such a meeting permits of the reunion of former teachers and students and the intro
  
Notes on Cervical Ribs. By Clinton E. Brush, Jr.,
 
  
On the Preservation of Anatomical Material in America by Means of Cold Storage. By Abkam T. Kerr, B. S., M. D.,
+
88
  
On the Development of the Nuclei Pontis during the Second and Third Months of Embryonic Life. By Margaret Long, . .
 
  
The Architecture of the Gall Bladder. Bv Mervin T. Si'dler, PlI. D., M. D., ."
 
  
Kemarkable Cases of Hereditary Anchyloses, or Absence of Various Phalangeal Joints with Defects of the Little and Ring Fingers. By George Walker, M. D.,
+
JOHNS HOPKINS HOSPITAL BULLETIN.
  
Note on the Basement Membranes of the Tubules of the Kidney. By Franklin P. Mall,
 
  
  
 +
[Nos. 121-122-133.
  
103 1(18
 
  
  
 +
diiction and welcoming of new teachers and new students. It gives, further, opportunity for the making of certain special remarks; and I have noticed that there is almost universally a tendency on the part of the faculty to grant the privilege of remark-making to some memher of it who has lately been added to the staff. Being myself one of the most recent additions to an already large staff-family, the privilege has this year been gracefully allotted to me. However great a sacrifice on the part of my colleagues this may represent, I can assure you that the new-comer on this occasion, like the distinguished memher of the faculty who last year addressed you, considers it a great favor to have the opportunity of expressing the pleasure he has in coming among you and being counted one of you, and to meet with an occasion on which he can more or less generally indicate the aims and scope of the science which he represents, and so publicly justify the position which he holds. Fortunately. in this latter respect the task is an easy one, for anatomy has in medicine long ago won its place as a science essential as a basis for all the subsequent medical studies, and moreover, my predecessors in office have been men of such sterling merit, power and inspiration, that the subject is here appreciated and reverenced. Especially true is this of him who has immediately preceded me as the occupant of the chair, and who has left it in order to accept a chair in surgery; while we commiserate anatomy on losing so able a representative, we must congratulate surgery on the enlistment in its service of so well trained and enthusiastic an anatomist. He has at this college developed, among other things, a course in surgical anatomy — easily one of the best given in America — and this part of the anatomical work, I am glad to assure you, he has promised, for the present at least, to retain. You join with me I know in wishing my colleague, Professor Bcvan, a continuation of that success which he has already attained in the field of his ultimate choice.
  
113 114
+
The year in which we live marks an important epoch in the history of the college. Of a whole series of advances, I wish to call attention especially to one. Beginning with this autumn quarter, a closer relationship than has ever before existed between Rush Medical College and the University of Chicago has been established. Not entirely satisfied — for what true lover long is? — with that "sisterly" relationship which the term " affiliation " represents, the college has this year appointed to two of its fundamental chairs — physiology and anatomy — men who are already the occupants of chairs in the same sciences at the university. That such closer bond of union cannot fail to be of the greatest value, both for Rush Medical College and for the University of Chicago. I confidently believe. That it is only the forerunner of a still deeper intimacy, many, I am sure, both in the university and the college, fondly hope.
  
 +
On thinking over anatomical subjects in the search for material for this address, the ideas which came to me grouped themselves in the main under two headings: (1) Wiat does the science of anatomy include? and (2) How can the study of anatomy best be prosecuted? Each of these headings cor
  
  
117 133 131)
+
responds to matter enough for a single occasion; I have, therefore, decided to spend the time at my disposal this evening in a consideration of the former of the two questions, and to reserve for another time and place what I have gathered in answer to the latter.
  
 +
Of the whole group of the natural sciences, there is perhaps no other member, the jirovince of which is less well understood by the general public than is the science of anatomy. As ordinarily thought of by the layman, it is a science the study of which necessarily precedes the practical work of medicine and surgery; a science which is largely, if not wholly, descriptive, and one which to be mastered requires prolonged oeciipation, scalpel in hand and pipe in mouth, with dead and partially decomposed human beings. Such a view of the science, though perhaps not surprising when we recall the methods by which anatomy — so-called — has frequently in this and other countries been prosecuted, could, I do not need to tell you, be scarcely more widely removed from the truth. Anatomy is not simply a descriptive science; the study of it as a preparation for practical medicine and surgery represents only one side of its interest and usefulness; the scalpel is now perhaps the coarsest instrument it employs; its work is by no means confined to the human body alone, much less to the dead human body, and when it does deal with the latter, the material can be so well preserved that even the fragrant Havana is said to be more offensive to some sensitive souls than are the odors from the well kept preparation room.
  
 +
Even medical men differ markedly in their conception of what anatomy includes, their ideas being based largely upon the kind of anatomy they theniselves were taught, and upon the anatomical needs of the particular branch of medicine which, after graduation, they have cultivated.
  
130 loo
+
Nor is there uniformity of opinion among the pure anatomists themselves, as can be readily seen by a perusal of the various addresses made by scientific anatomists in different parts of the world during the last twenty years. A free expression of opinion upon the subject has, however, gone far .to make the aims and scope of the science clearer, until at present its principal representatives are more nearly in accord with regard to them than ever before.
  
 +
In what this accordance consists, I can, I believe, make clearest to you by glancing briefly at the various steps through which the science has passed from the period when the earliest anatomical observations were recorded to the present day.*
  
  
A Comparative Study of the Development of the Generative Tract in Termites. By H. McE. Knoweh, Ph.D
 
  
 +
- In the preparation of tliis address I have made free use of a large number of addresses made on similar occasions by other anatomists. I have had no hesitation in borrowing liberally as will be immediately apparent to those who are familiar with the bibliography. Especially useful to me have been the addresses and papers of His, Hertwig, von Kolliker, Macalister, Mall and Waldeyer. The following are some of the sources consulted :
  
 +
Baker, F.: The rational method of teaching anatomy. Med. Rec, N. T., 1884, sxv, 431-43.5.
  
A Composite Study of the Axillary Artery in Man. By J. M. IIitzuot,
+
Bevan, A. D.: What ground should be covered in the anatomical course in American medical colleges ? And what part of this ground
  
  
  
1H5 136
+
A I'UI L-M A Y-JUNE, 1 00 1 .
  
  
  
PAGE
+
JOHNS HOPKINS HOSPITAL BULLETIN.
  
On the Origin of tlie Lymphatics in the Liver. Bv Franklin P.
 
  
Mall, ' ." 140
 
  
Bern's Method of Reconstruction by Means of Wax Plates as Used in the Anatomical Laboratory of the Johns Hopkins University. By Charles Russell Bardeen, M. D., 148
+
89
  
Model of the Nucleus Dentatusof the Cerebellum and its Accessory
 
  
Nuclei. By Harry A. Fowler, ISl
 
  
Use of the Material of the DissectingRoom for Scientilic Purposes.
+
There can be no doubt that from the earliest times, curiosity concerning and interest in the make-up of the human body has existed. The references to man's body and its organization frequently to be met with in the pages of the old Hindu Vedas and of the earliest writings of all the Oriental nations make this evident. Nevertheless, the awe in which men stood before the human cadaver, together with the penalties threatened by religious leaders for its molestation appear to have effectually prevented any systematic examinations and the little knowledge possessed by the ancients, aside from the conclusions drawn from animals killed for food or for sacrifice, seems to have been drawn from the instances in which, through the violence of war, the chase, or of the natural elements, the human body became dismembered or eviscerated.
  
By Charles Russell Bardeen, M. I)., 1.55
+
The earliest dissections of the human body of which no doubt exists are those which were undertaken at the Alexandrian School (B. C.) by Herophilus and Erasistratus, supported and protected by the intelligent Ptolemaic rulers. The name of Herophilus is still familiar to every beginner of anatomical studies in tlie* term Torcular Herophili. The statement is made, though I hope it is not true, that these daring anatomists went so far, with Ptolemy's sanction, as
  
On the Development of the Human Diaphragm. By Franklin P.
 
  
Mall, . '. 158
 
  
Observations on the Pectoralis Major Muscle in Man. By Wauren
+
should be covered in the first year? What in the second year? Proc. Ass. Am. Anat., Wash,, l.S'.)4, vi, 47-40.
  
Harmon Lewis, M D., 173
+
Brown, .1. J[.: Tlie science of human anatomy ; its history and development. Edinb. M. J., 1SS4-5, x.xx, 58.5-596.
  
On the Blood-Vessels of the Human Lymphatic Gland. By W. J.
+
lirownina;, W. W.: Remarks on the teachins;; of practical anatomy. Brooklyn M. ,]., 1894, viii, 329-341.
  
Calvert, M. D., U. S. A., . . .'. . . , .177
+
Budge, J.: Die Auftrabeu der anatoraischen Wisseuschaft. Deutsche Rev., 1882.
  
Normal Menstruation and Some of the Factors Modifying It. By
+
Cleland, J.: Lecture on anatomy as a science and in relation to mctlical study. Lancet, Lond., 1892, ii, 93S, 982.
  
Clelia Duel MosHER, A. M., M. D., 178
+
Cooke, T.: The teaching of anatomy ; its aims and methods. Lancet, Lond., 1893, ii, 1153, 13.^)0.
  
Kctrojcction of Bile into the Pancreas, a Cause of Acute Hemorrhagic Pancreatitis. By W. S. Halsted, M. D., 170
+
Cuuniugham, D. J.: Bologna; the part which it has played in the history of anatomy; its octo-centenary celebration. Dublin. J. M. Sc, 1888, 3 s., .x.x.xvi, 4li5-484.
  
The Etiology of Acute Hemorrhagic Pancreatitis. By Eugene L.
+
Debierre, C: L'Anatomic, son passc, son importance et son role dans les sciences biologiques. Rev. Sclent., Par., 1883, 3 s., xv, 68-74.
  
Opie, m". D., 182
+
Duval, M.: L'Auatomie guucrale et son histoire. Rev. Sclent., Par., 1886, xxxvii, 65-107.
  
The John W. Garrett International Fellowship, 188
+
Dwight, T. : The scope and the teaching of human anatomy. Boston M. and 8. J., 1890, cxxiii, 337-340; also, methods of teaching anatomy at the Harvard .Medical School : especially corrosion preparations. Boston M. and S. J., 1891, cxxiv, 47.5-477.
  
Notes on New Books, ISO
+
Flower, W. U.: An address delivered at the opening of the section of anatomy. Tr. Interuat. M. Congr., Loud., 1881, i, 133-144.
  
Books Received, 101
+
Gegenbaur, C: Ontogenie und Anatomie iu ihrcn Wechselhezi'lchungen betraehtet. Morphol. Jahrb., Leipz., 1899, xv, 1-9.
  
 +
Ilertwig, O.: Der auatomische Unterricht, Jena, 1881.
  
 +
llartwell, E. M.: The study of human anatomy, historically and legally considered. Johns Hopkins Univ. Stud. biol. lab., Balto., 1881-2, ii, 65, lie,.'
  
ON THE STUDY OF ANATOMY.'
+
His, W.: Ueber die Aufgabcn und Zielpunkte der wissenscliaftlichcn Anatomie. 'Leipzig, 1873.
  
 +
His, W.: L^eber die Bedeutung der Entwickelungsgeschichtc fiir die Aufl'assung der organisehen Natur. Leipzig, 1870.
  
 +
Humphry, G. M.: An address on the study of human anatomy. Brit. M. J., Lond., 188T, i, 1030.
  
By Lewellts F. Barker, M. B., Tor. Professor of Anatomy, University of Chicago.
 
  
  
 +
to dissect living criminals, from which Tertullian designated Herophilus as laiiius (Fleischer).
  
With tlio advent of October, with its cool and bracing days and restful nights, there is regularly a quickening of activities in academic circles. The occupant of a [irofcssional chair, reinvigorated by temporary sojourn in forest or field, at the seaside or in the hills, resumes his teaching with renewed enthusiasm, and engages again in that original investigation which represents the most absorbing interest of his life. The
+
This opportunity for the anatomical investigation of the human body appears to have been unique, and it continued only for a short time. Even Galen's studies, the results of which were held for the following ten centuries at least to be infallible, were limited to the bodies of animals; he recommended, it may be remembered, the study of the bodies of apes and swine — the animals which in his opinion were nearest to human beings. After Galen, the natural horror which the examination of the dead body excites, together with the edicts of the church against dissection, prevented any further progress of descriptive human anatomy for a very long period. The church declared that Galen had been infallible, and that therefore no further anatomical studies were necessary. Fortunately for science, which knows but little infallibility, certain of its votaries in liigh favor at Eome gained permission, in the fourteenth century, to make dissections of human bodies, and to use them for demonstration before students. Mondini in Bologna again opened the path for scientific anatomical inquiry and started in Italy a movement which placed that country, as far as medicine is concerned, in the lead. Students from distant lands were at
  
  
 +
Kollikcr, von A.: Die .Vufgiihen der anatomischen Institute, Wiirzburg, 1884.
  
' An address delivered before the Faculty and students of Hush Medical College, October .5, 1000.
+
Krause, W.: Die Methode in der Anatomie. Internal. Monatschr. f. Anat. u. Histol., Berl., 1884, i.
  
 +
Keiller, W.: The teaching of anatomy. N. York M. J., 1894, ix, 289, 513, .545.
  
 +
Keen, W. W.: A sketch of the early history of practical anatomy. Philadelphia, 1870.
  
student, too, perhaps, as yet less conscious of the actual need of an occasional remittance from his labors, has nevertheless liad his holiday, and returns to the college of his clioice ready for another season of diligent application and eager to begin once more the arduous tasks which the pursuit of knowledge entails.
+
Macalister, A.: Introducing lecture on the province of anatomy. Brit. M. J., Lond., 1S83, ii, 808-811.
  
It has long been customary in colleges in which medicine is taught to call a meeting of tlie faculty and students at the beginning of the autumn session. Such a meeting permits of the reunion of former teachers and students and the intro
+
Mall, F. P.: The anatomical course and laboratory in the Johns Hopkins Medical School. Johns Hopkins Hospital Bulletin, 1896.
  
 +
Meyer, von H.: Stellungund Aufgabeder Anatomie in der Gcgenwart. Biol. Centralbl., 1883.
  
88
+
Marks, G. IT.: The study of anatomy; its position in medical education in England and in America. Boston M. and S. J., 1885, cxiii, 104107.
  
 +
Morris, 11.: An address on the study of anatomy. Brit. M. J., Lond., 1895, ii, 1337.
  
 +
Pepper, W.: Introductory remarks at the ojiening of the Wistar Institute of anatomy and biology. Univ. iM. Mag., Phfla., 1893-4, vi, 569-572.
  
JOHNS HOPKINS HOSPITAL BULLETIN.
+
Robinson, B.: A plea lor the more thorough study of visceral anatomy. (Jalllard's M. J., N. Y., 1894, ix, 289-296.
  
 +
Schiell'erdecker, P.: Der auatomische Unterricht. Deutsche Med. Wehnschr., Berl., 1882, viii, 46.5-467.
  
 +
Shiels, G. F-: A plea for the proper teaching of anatomy. J. .Am. Med. Assoc, Chicago, 1894, xxiiii, 110-112.
  
[Nos. 121-122-133.
+
Testut : Qu'est-ce que I'homme pour un anatomiste ? Rev. Scicnt., Par., 1887, 3 s., xiii, 6.5-77.
  
 +
Turner, W.: Address at the opening of the anatomical department in the new buildings of the University of Edinburgh. Lancet, London, 1880, ii, 724, 759.
  
 +
Virchow, R.: Morgagni und der auatomische Gedanke. Bcrl. Kl. Wehnschr., 1894, xx.xi, 34.5-350.
  
diiction and welcoming of new teachers and new students. It gives, further, opportunity for the making of certain special remarks; and I have noticed that there is almost universally a tendency on the part of the faculty to grant the privilege of remark-making to some memher of it who has lately been added to the staff. Being myself one of the most recent additions to an already large staff-family, the privilege has this year been gracefully allotted to me. However great a sacrifice on the part of my colleagues this may represent, I can assure you that the new-comer on this occasion, like the distinguished memher of the faculty who last year addressed you, considers it a great favor to have the opportunity of expressing the pleasure he has in coming among you and being counted one of you, and to meet with an occasion on which he can more or less generally indicate the aims and scope of the science which he represents, and so publicly justify the position which he holds. Fortunately. in this latter respect the task is an easy one, for anatomy has in medicine long ago won its place as a science essential as a basis for all the subsequent medical studies, and moreover, my predecessors in office have been men of such sterling merit, power and inspiration, that the subject is here appreciated and reverenced. Especially true is this of him who has immediately preceded me as the occupant of the chair, and who has left it in order to accept a chair in surgery; while we commiserate anatomy on losing so able a representative, we must congratulate surgery on the enlistment in its service of so well trained and enthusiastic an anatomist. He has at this college developed, among other things, a course in surgical anatomy — easily one of the best given in America — and this part of the anatomical work, I am glad to assure you, he has promised, for the present at least, to retain. You join with me I know in wishing my colleague, Professor Bcvan, a continuation of that success which he has already attained in the field of his ultimate choice.
+
Walton, G. L.: The study of anatomy in the Leipzig University. Boston M. and S. J., 1883, cvi, 389.
  
The year in which we live marks an important epoch in the history of the college. Of a whole series of advances, I wish to call attention especially to one. Beginning with this autumn quarter, a closer relationship than has ever before existed between Rush Medical College and the University of Chicago has been established. Not entirely satisfied — for what true lover long is? — with that "sisterly" relationship which the term " affiliation " represents, the college has this year appointed to two of its fundamental chairs — physiology and anatomy — men who are already the occupants of chairs in the same sciences at the university. That such closer bond of union cannot fail to be of the greatest value, both for Rush Medical College and for the University of Chicago. I confidently believe. That it is only the forerunner of a still deeper intimacy, many, I am sure, both in the university and the college, fondly hope.
+
Waldeyer, W.: Wiesoll man Anatomie lehren und lerneu. Berlin, 1884.
  
On thinking over anatomical subjects in the search for material for this address, the ideas which came to me grouped themselves in the main under two headings: (1) Wiat does the science of anatomy include? and (2) How can the study of anatomy best be prosecuted? Each of these headings cor
 
  
  
responds to matter enough for a single occasion; I have, therefore, decided to spend the time at my disposal this evening in a consideration of the former of the two questions, and to reserve for another time and place what I have gathered in answer to the latter.
+
90
  
Of the whole group of the natural sciences, there is perhaps no other member, the jirovince of which is less well understood by the general public than is the science of anatomy. As ordinarily thought of by the layman, it is a science the study of which necessarily precedes the practical work of medicine and surgery; a science which is largely, if not wholly, descriptive, and one which to be mastered requires prolonged oeciipation, scalpel in hand and pipe in mouth, with dead and partially decomposed human beings. Such a view of the science, though perhaps not surprising when we recall the methods by which anatomy — so-called — has frequently in this and other countries been prosecuted, could, I do not need to tell you, be scarcely more widely removed from the truth. Anatomy is not simply a descriptive science; the study of it as a preparation for practical medicine and surgery represents only one side of its interest and usefulness; the scalpel is now perhaps the coarsest instrument it employs; its work is by no means confined to the human body alone, much less to the dead human body, and when it does deal with the latter, the material can be so well preserved that even the fragrant Havana is said to be more offensive to some sensitive souls than are the odors from the well kept preparation room.
 
  
Even medical men differ markedly in their conception of what anatomy includes, their ideas being based largely upon the kind of anatomy they theniselves were taught, and upon the anatomical needs of the particular branch of medicine which, after graduation, they have cultivated.
 
  
Nor is there uniformity of opinion among the pure anatomists themselves, as can be readily seen by a perusal of the various addresses made by scientific anatomists in different parts of the world during the last twenty years. A free expression of opinion upon the subject has, however, gone far .to make the aims and scope of the science clearer, until at present its principal representatives are more nearly in accord with regard to them than ever before.
+
JOHNS HOPKINS HOSPITAL BULLETIN.
  
In what this accordance consists, I can, I believe, make clearest to you by glancing briefly at the various steps through which the science has passed from the period when the earliest anatomical observations were recorded to the present day.*
 
  
  
 +
[Nos. 121-122-123.
  
- In the preparation of tliis address I have made free use of a large number of addresses made on similar occasions by other anatomists. I have had no hesitation in borrowing liberally as will be immediately apparent to those who are familiar with the bibliography. Especially useful to me have been the addresses and papers of His, Hertwig, von Kolliker, Macalister, Mall and Waldeyer. The following are some of the sources consulted :
 
  
Baker, F.: The rational method of teaching anatomy. Med. Rec, N. T., 1884, sxv, 431-43.5.
 
  
Bevan, A. D.: What ground should be covered in the anatomical course in American medical colleges ? And what part of this ground
+
tracted, as tliey always have been and always will be, to tlie point where progress was making the greatest headway.
  
 +
The great Vesalivas, often known as the father of anatomy, was among these wandering scientists. Born in Belgium and edneated in France, he prosecuted his anatomical studies in Italy, especially when professor at Padua, to such a degree that he merits a place among the world's greatest reformers. This energetic, truth-seeking, idol-breaking, authority-denying man, dared to look at things as he saw them rather than as Galen had said that they should be, and thus made discoveries of the first importance in anatomy; by his artistio powers he rendered many of tliem imperishable; best of all, lie broke forever the tyranny of tradition in anatomical knowledge, and threw wide open the gate by which men must always enter in the pursuit of anatomical truth. Vesalius was a contemporary of Liither; the year of his death is that of the birth of Galileo and of Shakespeare.
  
 +
It was the spirit which animated Vesalius which later led William Harvey, the founder of physiology, to the discovery of the circulation of the blood, and Giovanni Battista Morgagni, the founder of pathology, to that mode of conception which Virchow has designated " the anatomical idea in medicine." It is the spirit which is embodied in every scientific worker of to-day who accepts the records of past investigation only as a guide — a guide which must be fallible since it is human — and which, therefore, must be repeatedly controlled; a guide which needs constant revision on account of the ever-increasing extension of the domain of sense, and ime, which, if not added to significantly by the scientist in his lifetime, will stand as an everlasting witness to his inefficiency, a perpetual testimony to his lack of consequence.
  
A I'UI L-M A Y-JUNE, 1 00 1 .
+
Like all the natural sciences, anatomy in its earlier stages consists, of necessity, in the amassing in an empirical way of a store of naked facts. In other words, the subject is purely descriptive until a suflBcient number of facts have been collected to make their arrangement and classification a task worth while. Adequate descriptions are based upon intelligent ohscrvatioti, which in turn is dependent upon the skillful use of the organs of sense, including the means which modern technique is ever inventing to extend them. The body is e.xamined externally and internally in its various parts; it is looked at; it is felt. The size, shape, color, weight, consistence and reciprocal relations of the parts are noted; the results are recorded, the attempt being made to establish thd material content of the science with all possible certainty, sharpness and clearness. The parts have first to be distinguished and named; then accurately described, their physical characters being established in language. The description of a natural object that shall call up in the mind of the reader a precise image of the object and that shall serve as a reliable guide to a succeeding observer, does not fall within the province of every man's capacity; happy indeed is the anatomist who possesses the power, for as has more than once been pointed out, an exact and clear description of the known is often of as great value as the so-called " discovery " in the region of the unknown.
  
  
  
JOHNS HOPKINS HOSPITAL BULLETIN.
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The satisfactory naming of the various parts alone is a task of far greater difficulty than at first appears. An object must be studied for a long time, in many coimtries, and by men who know the relations of anatomy to every subject with which that science is allied, before a name for a part which shall be in accord with all the requirements can be decided upon. Almost every part has at various times received a series of names; periodical revisions of nomenclature by representative committees are accordingly desirable in order to arrive at uniformity among anatomists and to relieve the science of an immense niimber of names, since at best it must be grievously burdened.
  
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Ever since the time of Vesalius there has been an unbroken series of anatomical observers who have devoted their powei's to the attaining of skill in dissection and anatomical description. With energy and endurance and often at great personal sacrifice, this band of anatomists has developed this side of our science until it has reached the degree of precision which characterizes it to-day; a state indeed which many believe to be practically complete and incapable of further progress. Of the difficulties overcome by Americans in helping with this work since Mr. Giles Firman made the " first anatomy of the country," a good idea can be gained from the admirable historical review which we owe to E. M. Hartwell. While it is obvious that there must be a temporal limit to the discoveriea which the naked eye is to make in anatomical fields, one has nevertheless only to refer to the current journals to see that the limit has not yet been reached. But the limits of progress in anatomical description will by no means be synchronous with those of macroscopic discovery of the objects themselves, indeed, considering the complexity of man's architecture and the different and ever-varying view-points whence descriptions are being written, it is scarcely conceivable that man will ever attain to descriptions which will be satisfactorily final. To the surgeon, to the artist, to the physiologist, to the scientific anatomist, the details of parts are of utterly different significance; the varying scale of anatomical values requires in each case a special description; an objective characterization of all details, merely as such, would make anatomical descriptions so ponderous and chaotic as to render them totally useless to any one. Nor can anatomical illustrations, in colors and otherwise, which are perhaps even more valuable than anatomical descriptions, ever be completely objective. The exact plates of anatomical objects which approach of late years ever nearer to that degree of accuracy which will permit of the taking from them of mathematical measurements, never attain actually to perfection; there must always be an element of subjectivity in them which may be inconsonant with the needs of some other observer at some other time.
  
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Again, the greater or less degree of variability to which all parts of the animal body are subject, makes it difficult for anatomists to agree as to what shall be called normal, and thus the same object has frequently to be described in several different ways and multiply and exactly represented in pictures. There thus remains and ever will remain a task for
  
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Apeil-Mat-June, 1901. J
  
There can be no doubt that from the earliest times, curiosity concerning and interest in the make-up of the human body has existed. The references to man's body and its organization frequently to be met with in the pages of the old Hindu Vedas and of the earliest writings of all the Oriental nations make this evident. Nevertheless, the awe in which men stood before the human cadaver, together with the penalties threatened by religious leaders for its molestation appear to have effectually prevented any systematic examinations and the little knowledge possessed by the ancients, aside from the conclusions drawn from animals killed for food or for sacrifice, seems to have been drawn from the instances in which, through the violence of war, the chase, or of the natural elements, the human body became dismembered or eviscerated.
 
  
The earliest dissections of the human body of which no doubt exists are those which were undertaken at the Alexandrian School (B. C.) by Herophilus and Erasistratus, supported and protected by the intelligent Ptolemaic rulers. The name of Herophilus is still familiar to every beginner of anatomical studies in tlie* term Torcular Herophili. The statement is made, though I hope it is not true, that these daring anatomists went so far, with Ptolemy's sanction, as
 
  
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JOHNS HOPKINS HOSPITAL BULLETIN.
  
  
should be covered in the first year? What in the second year? Proc. Ass. Am. Anat., Wash,, l.S'.)4, vi, 47-40.
 
  
Brown, .1. J[.: Tlie science of human anatomy ; its history and development. Edinb. M. J., 1SS4-5, x.xx, 58.5-596.
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lirownina;, W. W.: Remarks on the teachins;; of practical anatomy. Brooklyn M. ,]., 1894, viii, 329-341.
 
  
Budge, J.: Die Auftrabeu der anatoraischen Wisseuschaft. Deutsche Rev., 1882.
 
  
Cleland, J.: Lecture on anatomy as a science and in relation to mctlical study. Lancet, Lond., 1892, ii, 93S, 982.
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the anatomist in the domain of anatomical description and of anatomical illnstration.
  
Cooke, T.: The teaching of anatomy ; its aims and methods. Lancet, Lond., 1893, ii, 1153, 13.^)0.
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If it be true that in the fields just referred to there is still much work to be done, the statement is all the more justified with regard to the taking of measurements and weights of the body and its jjarts. The shape of the natural objects is nearly always such that the localization of fixed points whence measurements can be taken is rendered very difficult — so difficult that frequently the comparison of the measurements of one observer of an object with those of another observer of the same are useless. Again, owing to. the variability of the bodily dimensions in the two sexes, in different races, at the various ages of life, according to individuality or under different physiological conditions, nnless a whole series of data accompany a given measiu'ement, the result may be of no value to a succeeding observer. In modern anthropology, however, definite criteria are always attended to and tlie measuring metliod is proving to be of the highest service in the elucidation of the questions that science has to solve.
  
Cuuniugham, D. J.: Bologna; the part which it has played in the history of anatomy; its octo-centenary celebration. Dublin. J. M. Sc, 1888, 3 s., .x.x.xvi, 4li5-484.
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The difficulties of anatomical measurement in large part obtain also when the weighing of anatomical objects is imdertaken. Notable results have already been obtained, however, not the least of those in connection with the central nervous system being gained through the comparatively recent work of my colleague. Dr. Donaldson, in the university. The application of the method to the determination of the normal by Thoma may also be referred to as the beginning of a long series of investigations which, in the end can scarcely fail to be of the greatest importance. As liis, who has discussed this and the foregoing subjects in an admirable manner, points out, it is difficult to imagine how the study of variations in constitution is to be approached unless this and similar methods are employed. As he says, it must be of decisive influence for the physiological capability of an individual, whether in his organization the musculature predominates over his nervous system, his epithelial tissues or his glandular organs, whether his heart is relatively large or small, whether accordingly it can increase the average blood pressure in the arteries to a great or to a slight degree, whether the man has a large or a small liver or whether ho has a long or short alimentary canal. The study of anatomy with the unaided sense-organs is, as we have seen, one of no small magnitude, and one not yet completed. What then is to be said of that descriptive anatomy which invades the territory in whicli the eye only with the aid of the microscope can penetrate? The field of the microscopic anatomist is at least a thousand times wider than that of the macroscopic worker, and in that field, what has been said above concerning description, pictorial representation and anatomical measurement, equally holds good. It will yet be long ore the collection of microscopic data will have been completed. New methods open up new problems, and at present progress, descriptive and microscopic anatomy may probably occupy workers for centuries to come. Even with the methods and microscopes now at our disposal, we have entered a museum. the largest part of whicli has yet to be accurately catalogued,
  
Debierre, C: L'Anatomic, son passc, son importance et son role dans les sciences biologiques. Rev. Sclent., Par., 1883, 3 s., xv, 68-74.
 
  
Duval, M.: L'Auatomie guucrale et son histoire. Rev. Sclent., Par., 1886, xxxvii, 65-107.
 
  
Dwight, T. : The scope and the teaching of human anatomy. Boston M. and 8. J., 1890, cxxiii, 337-340; also, methods of teaching anatomy at the Harvard .Medical School : especially corrosion preparations. Boston M. and S. J., 1891, cxxiv, 47.5-477.
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and who can say what new doors the methods and the microscopes of the century just before us are about to open vip? The science of histography is almost as undeveloped as was geography before the voyage of Columbus. Between the histographic world of to-day and the arcbitectural world of stereochemistry who will dare to prophesy what rich territories may exist?
  
Flower, W. U.: An address delivered at the opening of the section of anatomy. Tr. Interuat. M. Congr., Loud., 1881, i, 133-144.
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The mere observation and registration of naked facts does not, however, satisfy for long the cravings of the investigating human intelligence. Indeed, there is something of a blunting character about the process if long continued without the synchronous operation of other faculties of the intellect. Man is a classifying and generalizing animal; there lies deep in his nature a desire to arrange the facts he observes in an orderly manner, with the object of understanding them. It is in the attempt to satisfy this human tendency that anatomy, instead of remaining a purely descriptive science, becomes elevated to a plane on a level with the other inductive sciences.
  
Gegenbaur, C: Ontogenie und Anatomie iu ihrcn Wechselhezi'lchungen betraehtet. Morphol. Jahrb., Leipz., 1899, xv, 1-9.
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Evidences of attempts at anatomical classification are found among the earliest anatomists. The close resemblance of certain parts of one another soon gave rise to the idea of organic systems; such as the muscular system and the nervous system. The keen observations of Aristotle on the paries similares and the partes dissimilares may be recalled, as well as those of Fallopius outlined in his Tradatus quinque de partibus similaribus. It was left to the organizing brain oi the yoimg Frenchman, F. Xavier Bichat, to get a grasp for the first time of the relations of elementary tissjies to tho general architecture of the body. Although, through overwork and impecuniositj', his penetrating eyes were forever closed at the early age of about 30 years, Bichat left behind him three treatises — his " Traite des Membranes," liis " Eecherches physiologiques sur la vie et la mort," and his " Anatomic generale " — a legacy so immense that we cannot help lamenting with wondering regret the too early arrest of his labors. He recognized the fact that whereas in chemistry the more complex bodies are composed of simple elements, so in the architecture of man's body, simple tissues are variously combined to form the complex mixture of tissues which are ordinarily known as organs. He distinguished some 21 systems or tissues — the cellular, the osseous, the fibrous, the cartilaginous, the nervous, the muscular, the medullary, etc., basing his classification on the manner in which each tissue behaves in the presence of various reagents, the physical and vital properties of each and, finally, the character of each when met with under diseased conditions. In other words, Bichat was the founder of the modern science of histology, or, as it is sometimes designated, " General Anatomy." '
  
Ilertwig, O.: Der auatomische Unterricht, Jena, 1881.
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Before following the progress of anatomy further along this line, a word must be said concerning what must be regarded perhaps as the first direction taken by the investigat
  
llartwell, E. M.: The study of human anatomy, historically and legally considered. Johns Hopkins Univ. Stud. biol. lab., Balto., 1881-2, ii, 65, lie,.'
 
  
His, W.: Ueber die Aufgabcn und Zielpunkte der wissenscliaftlichcn Anatomie. 'Leipzig, 1873.
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'Cf. Duval, M.: L'Aiiatomie generale et son liisloiro. Rev. Scient. Paris, 1886, xxxvii, 05, 107.
  
His, W.: L^eber die Bedeutung der Entwickelungsgeschichtc fiir die Aufl'assung der organisehen Natur. Leipzig, 1870.
 
  
Humphry, G. M.: An address on the study of human anatomy. Brit. M. J., Lond., 188T, i, 1030.
 
  
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to dissect living criminals, from which Tertullian designated Herophilus as laiiius (Fleischer).
 
  
This opportunity for the anatomical investigation of the human body appears to have been unique, and it continued only for a short time. Even Galen's studies, the results of which were held for the following ten centuries at least to be infallible, were limited to the bodies of animals; he recommended, it may be remembered, the study of the bodies of apes and swine — the animals which in his opinion were nearest to human beings. After Galen, the natural horror which the examination of the dead body excites, together with the edicts of the church against dissection, prevented any further progress of descriptive human anatomy for a very long period. The church declared that Galen had been infallible, and that therefore no further anatomical studies were necessary. Fortunately for science, which knows but little infallibility, certain of its votaries in liigh favor at Eome gained permission, in the fourteenth century, to make dissections of human bodies, and to use them for demonstration before students. Mondini in Bologna again opened the path for scientific anatomical inquiry and started in Italy a movement which placed that country, as far as medicine is concerned, in the lead. Students from distant lands were at
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JOHNS HOPKINS HOSPITAL BULLETIN.
  
  
Kollikcr, von A.: Die .Vufgiihen der anatomischen Institute, Wiirzburg, 1884.
 
  
Krause, W.: Die Methode in der Anatomie. Internal. Monatschr. f. Anat. u. Histol., Berl., 1884, i.
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[Nos. 121-122-133.
  
Keiller, W.: The teaching of anatomy. N. York M. J., 1894, ix, 289, 513, .545.
 
  
Keen, W. W.: A sketch of the early history of practical anatomy. Philadelphia, 1870.
 
  
Macalister, A.: Introducing lecture on the province of anatomy. Brit. M. J., Lond., 1S83, ii, 808-811.
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ing mind toward the understanding of organic forms — namely, the pli3'siological (in its first stages, the purely teleological). As has long since been pointed out, the language of anatomy is sufficient evidence of the long existence of the teleological conception in this science. For thousands of years the individual parts of the body have been known as " organs," and the processes going on in them as " functions." Just as function was unthinkable without a corresponding organ, so an organ without function was inconceivable, and thus wherever, in the series of well-understood parts of the body, one remains over whose purposeful participation in the processes of life is not understood, towards this is directed over and over again the mental acumen of the investigator to assign to the reluctant organ a definite significance.* It is not my purpose here to enter into a discussion of teleology. The world has been widely enough explored to utterly dispose of that gross anthropomorphic form of teleology which pointed to a humanly scheming architect of the universe, and whether or not we accept some more correct form of teleology is, at present, matter for individual opinion. This much is certain, that while no teleological view of nature actually explains the organization of a human body, the teleological conception has been particularly heuristic in its effects in the investigation of the relation between the physical processes in, and the physical characters of, the various parts of the body. Ever since Galen, though animated by a false teleology, wrote his De usu partium, in which the size, position, number, consistence and structure of the various parts are treated as facts which can be understood only through the investigation of the purposes which they subserve, this mode of consideration has been among the most influential. Even to-day a large part of the profitable research undertaken by anatomists, physiologists and pathologists, has for its aim tho elucidation of the relation of structure to function, especially in microscopic domains. The work done in Ludwig's laboratory was largely of this nature, and as recently as 1883, H. v. Meyer" has asserted that the only possible way of understanding the organs is to proceed to the study of them froii) the physiological view-point. But if this were true, then all scientific anatomy would be physiology, a statement which narrow-minded physiologists might applaud, but whirli broader men know to be untrue. Physiology is one of tho daughters of anatomy, and is not likely so soon to forget the fifth commandment. Johannes Miiller was the last great scientist who covered both fields of anatomy and physiology; since his time investigators have cultivated one of (lie two at the expense of the other, a division of labor which we must recognize on the whole as beneficial, though that it is accompanied by certain drawbacks must also be confessed. Especially difficult is it to sharply separate the study of strueturo from that of function in the science of cytology, founded by Schleiden and Schwann, pupils of Johannes Miiller in the
  
Mall, F. P.: The anatomical course and laboratory in the Johns Hopkins Medical School. Johns Hopkins Hospital Bulletin, 1896.
 
  
Meyer, von H.: Stellungund Aufgabeder Anatomie in der Gcgenwart. Biol. Centralbl., 1883.
 
  
Marks, G. IT.: The study of anatomy; its position in medical education in England and in America. Boston M. and S. J., 1885, cxiii, 104107.
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Cf. His, W.: Ueber die Bedeutuna; tier Entwickehingseeschiclite fiir
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die Auffassiing dcr Organiscbe. Natiir. Leipzig, 1870.
  
Morris, 11.: An address on the study of anatomy. Brit. M. J., Lond., 1895, ii, 1337.
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>■ V. Meyer, IT.: Stellnno' und Aiifgabe der Anatomie iu der Gegenwart. Biol. Ceutralbl., 188.3, No. 12.
  
Pepper, W.: Introductory remarks at the ojiening of the Wistar Institute of anatomy and biology. Univ. iM. Mag., Phfla., 1893-4, vi, 569-572.
 
  
Robinson, B.: A plea lor the more thorough study of visceral anatomy. (Jalllard's M. J., N. Y., 1894, ix, 289-296.
 
  
Schiell'erdecker, P.: Der auatomische Unterricht. Deutsche Med. Wehnschr., Berl., 1882, viii, 46.5-467.
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fourth decade of this century. The development of the celldoctrine, modified as it was somewhat later by the introduction of the protoplasm-theory by Max Scliultze, marks a most important epoch in the history of both anatomy and physiology. Its value for the more practical side of medicine is sufficiently in evidence when one of its direct outgrowths, the cellular pathology of Eudolph Virchow, is recalled. The appalling elaboration of technical methods during the last few years has led to the accumulation of cytographic data which remove all the comfort we once had in looking upon the cells as elementary structures. Though cytophysiology is as yet far behind cytography in its state of development, there no longer remains any doubt that in approaching the cell we stand before an organism of enormous complexity of constitution, endowed with functional activities which must for long remain to us unfatliomable. Any one who has worked much with protoplasm and nucleus, with archiplasm and centrosome, with cell-fibrils and cell-granules under various physiological conditions, cannot fail to appreciate the fact that here only the threshold of inquiry has been crossed — the exploration of the real nature of the cell only just begun. Indeed the evidence is fast accumulating in favor of the opinion that many of these morphonuclcar cell constituents represent precipitates due to the action of reagents, and the laws governing their regular appearance under definite conditions are being investigated. It is exactly in these studies that structural and functional investigation still do well to go hand in hand, a fact which a survey of the cytoliigical handbooks, now becoming so nunioroiis, will show, is meeting with general recognition. I believe it was Du Bois Reymoud who ventured the statement that " an ocean steamer with all its machinery and intricacies of construction is far less complicated in its composition than a cell." Would that the cell were no more complicated than the ocean steamer in construction! — the modern investigator would then soon be ready witli the solution of its problems. Alas! the difficulties are not confined to the study of these organisms as individuals; already we have entered upon the investigation of their social relations, and cell-altruism and cell-egoism, cellstates and revolutionary cells are discussed as actively among cytologists as are the similar social questions concerning organic individuals of another order by the people at large. Further, in cytophysics and cytochemistry, research is at present most active — these subjects representing one of the most interesting subdivisions of recent physiology. Should the gulf between the present microscopic picture of the cell and its chemical structure ever be bridged, stereochemistry would enter into the domain of anatomy. So much in general, with regard to the physiological view-point in anatomy. Closely allied to the foregoing, and in reality an offshoot from it, is the mode of consideration of the surgical and topographical anatomist. In this branch, the- individual regions and cavities of the body are dealt with Avitb regard to the reciprocal position of the various organs and systems. Surgical anatomy studies these relations only in so far as they are of importance in operative procedures; topographical an
  
Shiels, G. F-: A plea for the proper teaching of anatomy. J. .Am. Med. Assoc, Chicago, 1894, xxiiii, 110-112.
 
  
Testut : Qu'est-ce que I'homme pour un anatomiste ? Rev. Scicnt., Par., 1887, 3 s., xiii, 6.5-77.
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Aphil-May-June, 1901.]
  
Turner, W.: Address at the opening of the anatomical department in the new buildings of the University of Edinburgh. Lancet, London, 1880, ii, 724, 759.
 
  
Virchow, R.: Morgagni und der auatomische Gedanke. Bcrl. Kl. Wehnschr., 1894, xx.xi, 34.5-350.
 
  
Walton, G. L.: The study of anatomy in the Leipzig University. Boston M. and S. J., 1883, cvi, 389.
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JOHNS HOPKINS HOSPITAL BULLETIN.
  
Waldeyer, W.: Wiesoll man Anatomie lehren und lerneu. Berlin, 1884.
 
  
  
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atomy, a wider subject, studies tlie relations mentioned and independently of their significance to the surgeon. The various regions of the body are studied sometimes in layers, sometimes with regard to serial clues to a particular structure. Sections of frozen cadavers have here proved to be of great value for the study of relations and for helping the student to make mental reconstructions of the parts analyzed by dissection. Surgical and topographical anatomy are thus seen to be subjects of very high practical importance — the former especially for the surgeon, the latter also for the worker in internal medicine. It is this kind of anatomy Which has been brought to so high a state of cultivation in Great Britain, and especially in London, where most of the anatomy has been taught by men in surgical practice. Valuable as such instruction is for furgery and medicine, it should not be forgotten that it is applied anatomy rather than anatomy proper, and no less a scientist than Macalister has deplored the lack of advances in anatomy in England, attributing it largely to the one-sided mode of instruction in vogue, and to the examinations, to the passing of which the teaching is in large part directed. Surely certain morphological considerations are as important for the student of anatom.y as the learning by heart of the various relations of an artery, especially if the student is not to become a surgeon; it would be melancholy indeed if there were not at least some members of the anatomical classes who regard the study of the architecture of the brain and spinal cord as interesting and as important as that of the perineum.
  
JOHNS HOPKINS HOSPITAL BULLETIN.
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But anatomy as a science would never have attained to the dignified position it now holds had the minds engaged with it remained satisfied, after observing and registering its material content, with attempting the explanation of the human body from the physiological view-point or by exliausting the possibilities of its relation to the surgeon's knife.
  
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As in the other natural sciences, the causality-need of the intelligence has forced the anatomist to undertake the investigation of the origin of the organic forms which he studies, and of the relations of these forms to other similar and dissimilar organic forms accessible to examination. In other words, the comparative and the genetic methods of study have been resorted to. Comparative anatomy and embryology together constitute morphology, at least in the senso in which the term is ordinarily used, and in morphology we recognize the part of anatomy which makes it truly worthy of being designated a science.
  
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In the application of the comparative method, not only are the different parts of the human body compared with one another — the arms with the legs, the brain with the spinal cord, the skull with the vertebral column, the various segments and segmental partitions with one another — but man, recognized as a member of a long series of animals, is compared with each of them in turn, and they with one another, with the object of establishing groups of type forms and of learning the plan of architecture, not only of the single creature, but also of the whole series. At first, anatomists studied the forma which to them seemed to resemble man most closely, but the
  
[Nos. 121-122-123.
 
  
  
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gradual transition from one form to another was so striking that animal after animal was studied until finally the whole world of organisms has been submitted to the examination of the comparative investigator. Oken and Goethe, Cuvier, Meckel, Geofl'roy, St. Hilaire, Lamarck, Wallace, Darwin, Haeckel, Huxley, Gegenbaur and Leidy are names which have become very familiar to us in this field. The world of living creatures is a unitary system, of which man is an inseparable portion. First, when the whole system has been worked through do the form and significance of many of man's parts become intelligible. The animal series can be thought of as a tree with the simplest forms at the root, the trunk branching at its origin, each branch in turn subdividing into limbs and twigs until the highest degree of differentiation is reached. It is this recognition of the lawful relation of organisms to one another which the study of comparative anatomy has afforded us. Such a recognition, now general, was little less than startling to those who first arrived at it. That it pointed to some more general law was obvious. As Goethe himself, no mean participator in comparative studies, beautifully expressed it:
  
tracted, as tliey always have been and always will be, to tlie point where progress was making the greatest headway.
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" Alle Gestalten sind ahnlich und Keine gleicbet der anderm, Und so deutet das chor auf ein gelieimes Gesetz."
  
The great Vesalivas, often known as the father of anatomy, was among these wandering scientists. Born in Belgium and edneated in France, he prosecuted his anatomical studies in Italy, especially when professor at Padua, to such a degree that he merits a place among the world's greatest reformers. This energetic, truth-seeking, idol-breaking, authority-denying man, dared to look at things as he saw them rather than as Galen had said that they should be, and thus made discoveries of the first importance in anatomy; by his artistio powers he rendered many of tliem imperishable; best of all, lie broke forever the tyranny of tradition in anatomical knowledge, and threw wide open the gate by which men must always enter in the pursuit of anatomical truth. Vesalius was a contemporary of Liither; the year of his death is that of the birth of Galileo and of Shakespeare.
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Has this secret law been discovered? Many believe so and look upon Darwin's doctrine of descent as a generalization worthy, on account of its scientific value, of being placed side by side with Newton's theory of gravitation. Whether the evolutionary doctrine be unequivocally accepted or not, certain it is that the relationship of forms which comparative anatomy reveals, finds in this genealogical conception of Darwin a more satisfactory explanation than any other hitherto offered.
  
It was the spirit which animated Vesalius which later led William Harvey, the founder of physiology, to the discovery of the circulation of the blood, and Giovanni Battista Morgagni, the founder of pathology, to that mode of conception which Virchow has designated " the anatomical idea in medicine." It is the spirit which is embodied in every scientific worker of to-day who accepts the records of past investigation only as a guide — a guide which must be fallible since it is human — and which, therefore, must be repeatedly controlled; a guide which needs constant revision on account of the ever-increasing extension of the domain of sense, and ime, which, if not added to significantly by the scientist in his lifetime, will stand as an everlasting witness to his inefficiency, a perpetual testimony to his lack of consequence.
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Closely allied to the phylogenetie mode of consideration is that \\hich we designate as the embryological ontogenetic or developmental. In the human species, as in every other, the life of the individual member is of short duration; each human organism has a beginning, a period of growth and development, followed, even in the life of maximum length. in the course -of a few decades, by decline and death. Generation follows generation as wave follows wave on the surface of a ruffied sea. In the transference of life from one generation to another the material substratum sinks to a minimal amount — the new human being begins as a fertilized egg-cell 1-120 of an inch in diameter, weighing only a minute fraction of a gramme. From this simplest of beginnings it gradually passes through a long series of developmental stages, the character of these stages varying somewhat under environmental influences, each .stage being the nnecessary consequent of a preceding stage, and at the same time the necessary antecedent of the stage which follows it until finally the organism attains to the fullness of differentiation of which, under the circumstances of its environment, it is capable.
  
Like all the natural sciences, anatomy in its earlier stages consists, of necessity, in the amassing in an empirical way of a store of naked facts. In other words, the subject is purely descriptive until a suflBcient number of facts have been collected to make their arrangement and classification a task worth while. Adequate descriptions are based upon intelligent ohscrvatioti, which in turn is dependent upon the skillful use of the organs of sense, including the means which modern technique is ever inventing to extend them. The body is e.xamined externally and internally in its various parts; it is looked at; it is felt. The size, shape, color, weight, consistence and reciprocal relations of the parts are noted; the results are recorded, the attempt being made to establish thd material content of the science with all possible certainty, sharpness and clearness. The parts have first to be distinguished and named; then accurately described, their physical characters being established in language. The description of a natural object that shall call up in the mind of the reader a precise image of the object and that shall serve as a reliable guide to a succeeding observer, does not fall within the province of every man's capacity; happy indeed is the anatomist who possesses the power, for as has more than once been pointed out, an exact and clear description of the known is often of as great value as the so-called " discovery " in the region of the unknown.
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In this long series of developmental stages which every mammal passes through, the earliest are very, very simple and correspond in form closely with the lower forms in the animal kingdom. But as cell-division in the embryo proceeds, the
  
  
  
The satisfactory naming of the various parts alone is a task of far greater difficulty than at first appears. An object must be studied for a long time, in many coimtries, and by men who know the relations of anatomy to every subject with which that science is allied, before a name for a part which shall be in accord with all the requirements can be decided upon. Almost every part has at various times received a series of names; periodical revisions of nomenclature by representative committees are accordingly desirable in order to arrive at uniformity among anatomists and to relieve the science of an immense niimber of names, since at best it must be grievously burdened.
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Ever since the time of Vesalius there has been an unbroken series of anatomical observers who have devoted their powei's to the attaining of skill in dissection and anatomical description. With energy and endurance and often at great personal sacrifice, this band of anatomists has developed this side of our science until it has reached the degree of precision which characterizes it to-day; a state indeed which many believe to be practically complete and incapable of further progress. Of the difficulties overcome by Americans in helping with this work since Mr. Giles Firman made the " first anatomy of the country," a good idea can be gained from the admirable historical review which we owe to E. M. Hartwell. While it is obvious that there must be a temporal limit to the discoveriea which the naked eye is to make in anatomical fields, one has nevertheless only to refer to the current journals to see that the limit has not yet been reached. But the limits of progress in anatomical description will by no means be synchronous with those of macroscopic discovery of the objects themselves, indeed, considering the complexity of man's architecture and the different and ever-varying view-points whence descriptions are being written, it is scarcely conceivable that man will ever attain to descriptions which will be satisfactorily final. To the surgeon, to the artist, to the physiologist, to the scientific anatomist, the details of parts are of utterly different significance; the varying scale of anatomical values requires in each case a special description; an objective characterization of all details, merely as such, would make anatomical descriptions so ponderous and chaotic as to render them totally useless to any one. Nor can anatomical illustrations, in colors and otherwise, which are perhaps even more valuable than anatomical descriptions, ever be completely objective. The exact plates of anatomical objects which approach of late years ever nearer to that degree of accuracy which will permit of the taking from them of mathematical measurements, never attain actually to perfection; there must always be an element of subjectivity in them which may be inconsonant with the needs of some other observer at some other time.
 
  
Again, the greater or less degree of variability to which all parts of the animal body are subject, makes it difficult for anatomists to agree as to what shall be called normal, and thus the same object has frequently to be described in several different ways and multiply and exactly represented in pictures. There thus remains and ever will remain a task for
 
  
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Apeil-Mat-June, 1901. J
 
  
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[Nos. 131-122-123.
  
  
JOHNS HOPKINS HOSPITAL BULLETIN.
 
  
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shaping of tlie organism becomes more complex, resembling higher and higher forms of animal life, nntil finally that of mammals is assumed. Even at this period the nnskilled observer might easily be confused if he were required at a glance to distinguish a human embryo from those of several other mammals at a similar period of development. Ultimately, the differential characters of the species become clearly marked, and even the tyro can easily recognize them Tiio more skilled the observer, however, the earlier in the development will the species-criteria be decisive.
  
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Comparative embryology becomes all the more astonishing a study when we realize that the embryological history of every higher animal is, for a long period at least, almost identical with that of a whole series of allied forms. No wonder, then, this state of things being acknowledged, that the embryologists, like the comparative anatomists, have pictured the genetic relations of the different animal forms also as a tree, a tree which on close examination is found to accord very closely with the tree of relationship constructed by the comparative anatomists.
  
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Comparative anatomy and embryology are, therefore, closely interwoven subjects, and each may, in a way, be looked upon as a control for the other, though each has its special problems, and each sets about the solution of these in a manner peculiar to itself. Take, for example, the attempts at an explanation of the series of forms through which the individual passes in its development. Many comparative anatomists, accepting Darwin's doctrine of the origin of species through a struggle for existence among generations influenced by heredity and variation, would explain the development of tlie individual member of a species as a temporarily compressed recapitulation of the developmental course of the species as a whole. While this doctrine that " ontogeny repeats phylogeny" has been maintained by eminent scientists there are others who are unwilling to accept what cannot bo proved; and some of the embryologists especially feel it their province to attempt to explain from embryological studies alone, and without reference to phylogenetic history, the origin of the various form-stages through which the individual passes. Already great strides have been made in the direction mentioned, especially through the investigation of the laws of growth; and the field of developmental mechanics, though so lately entered upon, has proven to be one of the most fruitful of those thus far tilled. One of the foremost investigators along these lines goes so far as to assert that the growth of every organic germ must, as a process strictly regulated according to time and space, possess a mathematical expression in which the velocity of growth of each point is determined in its dependence on the time and the position. Whether such formulaa will ever be set up and the kingdom of organic forms thus subordinated to the domination of simple numbers, seems doubtful, but in any case the conception is an interesting one. We need not, however, look into the nebulous distance for the advantages to accrue from developmental study. Fear at hand are thousands of facts of the greatest importance for anatomy as a whole and for
  
  
  
the anatomist in the domain of anatomical description and of anatomical illnstration.
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the practical branches of medicine and suvgei'y to be gained only through this method of study. Scarcely a part of the body but what is now better understood than was otherwise possible. I need only mention the remarkably complicated morphology of the brain and the sense organs, the distribution of the intestines, the grouping of the various voluntary muscles, the puzzling course followed by certain of the nerves and of the reproductive organs in the two sexes, to call to mind some of the features which embryology has gone far to illuminate.
  
If it be true that in the fields just referred to there is still much work to be done, the statement is all the more justified with regard to the taking of measurements and weights of the body and its jjarts. The shape of the natural objects is nearly always such that the localization of fixed points whence measurements can be taken is rendered very difficult — so difficult that frequently the comparison of the measurements of one observer of an object with those of another observer of the same are useless. Again, owing to. the variability of the bodily dimensions in the two sexes, in different races, at the various ages of life, according to individuality or under different physiological conditions, nnless a whole series of data accompany a given measiu'ement, the result may be of no value to a succeeding observer. In modern anthropology, however, definite criteria are always attended to and tlie measuring metliod is proving to be of the highest service in the elucidation of the questions that science has to solve.
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I dare not pass by unnoticed here two phases of investigation which naturally follow upon the others, but which have only very recently begun to be extensively cultivated, viz.: those of histogenesis and of comparative histology. Histogenesis stands in the same relation to comparative histology as does embryology to comparative anatomy. Indeed, it is simply jDUshing the microscope into embryology and comparative anatomy, and is, in a way, comparable to the advance from gross descriptive anatomy to microscopic anatomy. By histogenesis we mean the study of the development of the individual tissues, including that of the individual cells (cytogenesis). By comparative histology and cytology we refer to the comparative microscopic study of the various tissues and cells through a series of animals. The light throuTi upon many of the unsolved problems of structure by these methods is unexpectedly brilliant, and the future has much to hope from it; MacCallum, too, has shown how important these methods can be in helping to explain certain pathological phenomena met with in heart-muscle, and there can be little doubt that we are on the brink of the discovery of a series of relations between histogenetic ccmditions and j)athological processes.
  
The difficulties of anatomical measurement in large part obtain also when the weighing of anatomical objects is imdertaken. Notable results have already been obtained, however, not the least of those in connection with the central nervous system being gained through the comparatively recent work of my colleague. Dr. Donaldson, in the university. The application of the method to the determination of the normal by Thoma may also be referred to as the beginning of a long series of investigations which, in the end can scarcely fail to be of the greatest importance. As liis, who has discussed this and the foregoing subjects in an admirable manner, points out, it is difficult to imagine how the study of variations in constitution is to be approached unless this and similar methods are employed. As he says, it must be of decisive influence for the physiological capability of an individual, whether in his organization the musculature predominates over his nervous system, his epithelial tissues or his glandular organs, whether his heart is relatively large or small, whether accordingly it can increase the average blood pressure in the arteries to a great or to a slight degree, whether the man has a large or a small liver or whether ho has a long or short alimentary canal. The study of anatomy with the unaided sense-organs is, as we have seen, one of no small magnitude, and one not yet completed. What then is to be said of that descriptive anatomy which invades the territory in whicli the eye only with the aid of the microscope can penetrate? The field of the microscopic anatomist is at least a thousand times wider than that of the macroscopic worker, and in that field, what has been said above concerning description, pictorial representation and anatomical measurement, equally holds good. It will yet be long ore the collection of microscopic data will have been completed. New methods open up new problems, and at present progress, descriptive and microscopic anatomy may probably occupy workers for centuries to come. Even with the methods and microscopes now at our disposal, we have entered a museum. the largest part of whicli has yet to be accurately catalogued,
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Lastly, as a crowning piece to the whole system of anatomical study, experimental morphology must be recognized. As but a child among the kindred sciences, it is of robust constitution, being the offspring of vigorous parents, and, in this country especially, in an environment most suitable for its healthy growth. The anatomist is no longer confined to the study of adult forms, or of forms in their natural mode of development; he can now, to a certain extent, artificially control form-production by resorting to the experimental method. The experiments which have been made upon heteromorphism, upon the artificial production of malformations, and upon the grafting of embryos, are full of interest, so much so as to disturb the equanimity of the soberest of scientists. During the last year or two we have been — I was going to say — shocked by the bringing of the proof by my colleague. Professor Loeb, that the eggs of several forms not naturally parthenogenetic can be fertilized — or at any rate, brought to development in the absence of spermatozoa, solely through the action of (?) physico-chemical influences. With miracles such as these already performed, we can but stand in awe of the work of the future.
  
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Most sketchily and imperfectly 1 have tried to give yon an idea of what the study of anatomy includes, viz.: descriptive or systematic anatomy (gross and microscopic), physiological
  
  
and who can say what new doors the methods and the microscopes of the century just before us are about to open vip? The science of histography is almost as undeveloped as was geography before the voyage of Columbus. Between the histographic world of to-day and the arcbitectural world of stereochemistry who will dare to prophesy what rich territories may exist?
 
  
The mere observation and registration of naked facts does not, however, satisfy for long the cravings of the investigating human intelligence. Indeed, there is something of a blunting character about the process if long continued without the synchronous operation of other faculties of the intellect. Man is a classifying and generalizing animal; there lies deep in his nature a desire to arrange the facts he observes in an orderly manner, with the object of understanding them. It is in the attempt to satisfy this human tendency that anatomy, instead of remaining a purely descriptive science, becomes elevated to a plane on a level with the other inductive sciences.
+
April-Mat-June, 1901.]
  
Evidences of attempts at anatomical classification are found among the earliest anatomists. The close resemblance of certain parts of one another soon gave rise to the idea of organic systems; such as the muscular system and the nervous system. The keen observations of Aristotle on the paries similares and the partes dissimilares may be recalled, as well as those of Fallopius outlined in his Tradatus quinque de partibus similaribus. It was left to the organizing brain oi the yoimg Frenchman, F. Xavier Bichat, to get a grasp for the first time of the relations of elementary tissjies to tho general architecture of the body. Although, through overwork and impecuniositj', his penetrating eyes were forever closed at the early age of about 30 years, Bichat left behind him three treatises — his " Traite des Membranes," liis " Eecherches physiologiques sur la vie et la mort," and his " Anatomic generale " — a legacy so immense that we cannot help lamenting with wondering regret the too early arrest of his labors. He recognized the fact that whereas in chemistry the more complex bodies are composed of simple elements, so in the architecture of man's body, simple tissues are variously combined to form the complex mixture of tissues which are ordinarily known as organs. He distinguished some 21 systems or tissues — the cellular, the osseous, the fibrous, the cartilaginous, the nervous, the muscular, the medullary, etc., basing his classification on the manner in which each tissue behaves in the presence of various reagents, the physical and vital properties of each and, finally, the character of each when met with under diseased conditions. In other words, Bichat was the founder of the modern science of histology, or, as it is sometimes designated, " General Anatomy." '
 
  
Before following the progress of anatomy further along this line, a word must be said concerning what must be regarded perhaps as the first direction taken by the investigat
 
  
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JOHNS HOPKINS HOSPITAL BULLETIN.
  
'Cf. Duval, M.: L'Aiiatomie generale et son liisloiro. Rev. Scient. Paris, 1886, xxxvii, 05, 107.
 
  
  
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^5
  
92
 
  
  
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anatomy, surgical and topographical anatomy, histology or general anatomy, ineUiding histography and cytology, comparative anatomy, embryology, comparative histology and embryology, histogenesis and lastly experimental morphology. Assuredly the subject is wide. It is, I am sorry to say, too wide to be mastered in all its details even when a whole lifetime is devoted exclusively to it. The scientific anatomi;;!, after familiarizing himself with the main facts and principles of its various subdivisions, does best, in agreement with the great law of division of labor, to direct his efforts towards the acquisition and promulgation of knowledge in some one portion of it.
  
JOHNS HOPKINS HOSPITAL BULLETIN.
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And now for a word of welcome to the class just entering upon the study of medicine. You have taken, gentlemen, the first direct step which is to lead you into one of the noblest professions in the world — into a profession in which your lives are to be consecrated to the service of suffering men and women. You have to learn the laws which govern hcallli and those which underlie disease. Yon, like your predecessors, will find that a large proportion of your time and .energy in life will be directed toward the prevention" of the occurrence of disease, rather than to the cure of it, for medical men have the proud distinction of being perhaps tlie only workmen " who make it their first duty to stop the sources of supply from which they derive their income." Hard work during the next four years will be required of every one oT you; indeed, your time will be so occupied and your mental powers so strenuously engaged that you will have but little opportunity for recreation or for the amenities of life. But while this is the most difB.cult period of your career as far as intellectual work is concerned, do not, I beg of you, forget altogether the man in the making of the physician or surgeon. However much your instructors may stimulate you, however much work they may ask you to do, you will be wise if you retain some period of the day, be it only half an hour or even less, when you can withdraw from men and medicine and in some quiet nook indulge a wholesome longing for good general literature. Keep your old friends by you — your Plato and Marcus Aurelius, your Emerson, Carlyle, your Dante, Shakespeare and Milton, your Goethe, Shelley and Keats. If your osteological studies prove refractory you may find the stoicism of Epictetus a remedy for your disturbed spirit; after the depressive influences of pathological anatomy the lyric of Goethe, the raptures of Shelley, or an essay of Stevenson may prove to be uplifting; to combat the intoxicating fumes of the chemical laboratory try the antidotal effects of Burton, of Sterne or of Eabelais. The time so spent will not only be revivifying for the moment, but will be of the greatest value to you in your professional life after graduation. Skill is more and more reverenced, but skill without culture has lost half its power. And culture, like reputation, has not only to be gained but to be kept, nor is it gained or kept without cfTort, without constant vigilance.
  
  
  
[Nos. 121-122-133.
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Permit me to hope that you have laid broad foundations in the sciences which arc fundamental for medicine; viz.: physics, chemistry and biology. Without thorough training in these it is impossible to keep abreast of the rapidly swelling tide of discovery in modern medicine. If, further, you are familiar with the French and German languages you will find it possible to become conversant with important new facts and discoveries months and sometimes years before they enter into the English text-books. Of the distinctly medical sciences, anatomy, physiology and physiological chemistry, together with pathology, form the framework upon which all the rest of the medical sciences are built. Failure to make this framework solid renders the superstructure inevitably unsafe. Do not forget that the medicine of to-day differs from that of the years close behind us chiefly in the substitution of "handcraft" for much of the former "redecraft." In these days, too, as it has well been put: The eye cannot say unto the head, I have no need of thee." Instead of accepting the statements of others about things as of yore the medical student is nowadays being made to do things. Instead of memorizing text-books, quiz compends and lecture notes, he is more and more required to study the natural objects, to observe accurately, to record concisely and adequately, to experiment intelligently. While good lectures, good recitations and good text-books still have their place, the student is wisely encouraged to interrogate Nature for himself and to believe in the replies he obtains from her rather than to put implicit confidence in the descriptions of others.
  
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The new methods of medical education arc costly; they demand large laboratories, expensive equipment and scientifically trained instructors. They cannot be satisfactorily introduced into schools where the sole income is derived from the fees of students; large endowments are absolutely essential for the proper carrying out of the plan.
  
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Finally, gentlemen, let me give expression to the hope that among this class now entering, besides the large number who will go on into beneficent and successful practice, there may be some who, willing to scorn delights, to live laborious days, will set before them the high hope of making actual additions to knowledge. It is not fair that we should accept the gifts of our forerunners without making the effort ourselves to enrich the general stock of knowledge. The paths of investigation are not smooth; the way of research is difficult. But the goal is strife-worthy, and the rewards are sufficient.
  
ing mind toward the understanding of organic forms — namely, the pli3'siological (in its first stages, the purely teleological). As has long since been pointed out, the language of anatomy is sufficient evidence of the long existence of the teleological conception in this science. For thousands of years the individual parts of the body have been known as " organs," and the processes going on in them as " functions." Just as function was unthinkable without a corresponding organ, so an organ without function was inconceivable, and thus wherever, in the series of well-understood parts of the body, one remains over whose purposeful participation in the processes of life is not understood, towards this is directed over and over again the mental acumen of the investigator to assign to the reluctant organ a definite significance.* It is not my purpose here to enter into a discussion of teleology. The world has been widely enough explored to utterly dispose of that gross anthropomorphic form of teleology which pointed to a humanly scheming architect of the universe, and whether or not we accept some more correct form of teleology is, at present, matter for individual opinion. This much is certain, that while no teleological view of nature actually explains the organization of a human body, the teleological conception has been particularly heuristic in its effects in the investigation of the relation between the physical processes in, and the physical characters of, the various parts of the body. Ever since Galen, though animated by a false teleology, wrote his De usu partium, in which the size, position, number, consistence and structure of the various parts are treated as facts which can be understood only through the investigation of the purposes which they subserve, this mode of consideration has been among the most influential. Even to-day a large part of the profitable research undertaken by anatomists, physiologists and pathologists, has for its aim tho elucidation of the relation of structure to function, especially in microscopic domains. The work done in Ludwig's laboratory was largely of this nature, and as recently as 1883, H. v. Meyer" has asserted that the only possible way of understanding the organs is to proceed to the study of them froii) the physiological view-point. But if this were true, then all scientific anatomy would be physiology, a statement which narrow-minded physiologists might applaud, but whirli broader men know to be untrue. Physiology is one of tho daughters of anatomy, and is not likely so soon to forget the fifth commandment. Johannes Miiller was the last great scientist who covered both fields of anatomy and physiology; since his time investigators have cultivated one of (lie two at the expense of the other, a division of labor which we must recognize on the whole as beneficial, though that it is accompanied by certain drawbacks must also be confessed. Especially difficult is it to sharply separate the study of strueturo from that of function in the science of cytology, founded by Schleiden and Schwann, pupils of Johannes Miiller in the
+
In closing then let me quote those stirring words of the sage of Chelsea, which I excerpt from his Sartor Eesartus.
  
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"Produce! Produce! Were it but the pitifulest infinitesimal fraction of a Product, produce it in God's name! 'Tis the utmost thou hast in thee: out with it then. Up, up! Whatsoever thy hand findeth to do, do it with thy whole might. Work while it is called To-day, fur the night comctli, wherein no man can work! "
  
  
Cf. His, W.: Ueber die Bedeutuna; tier Entwickehingseeschiclite fiir
 
die Auffassiing dcr Organiscbe. Natiir. Leipzig, 1870.
 
  
>■ V. Meyer, IT.: Stellnno' und Aiifgabe der Anatomie iu der Gegenwart. Biol. Ceutralbl., 188.3, No. 12.
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96
  
  
  
fourth decade of this century. The development of the celldoctrine, modified as it was somewhat later by the introduction of the protoplasm-theory by Max Scliultze, marks a most important epoch in the history of both anatomy and physiology. Its value for the more practical side of medicine is sufficiently in evidence when one of its direct outgrowths, the cellular pathology of Eudolph Virchow, is recalled. The appalling elaboration of technical methods during the last few years has led to the accumulation of cytographic data which remove all the comfort we once had in looking upon the cells as elementary structures. Though cytophysiology is as yet far behind cytography in its state of development, there no longer remains any doubt that in approaching the cell we stand before an organism of enormous complexity of constitution, endowed with functional activities which must for long remain to us unfatliomable. Any one who has worked much with protoplasm and nucleus, with archiplasm and centrosome, with cell-fibrils and cell-granules under various physiological conditions, cannot fail to appreciate the fact that here only the threshold of inquiry has been crossed — the exploration of the real nature of the cell only just begun. Indeed the evidence is fast accumulating in favor of the opinion that many of these morphonuclcar cell constituents represent precipitates due to the action of reagents, and the laws governing their regular appearance under definite conditions are being investigated. It is exactly in these studies that structural and functional investigation still do well to go hand in hand, a fact which a survey of the cytoliigical handbooks, now becoming so nunioroiis, will show, is meeting with general recognition. I believe it was Du Bois Reymoud who ventured the statement that " an ocean steamer with all its machinery and intricacies of construction is far less complicated in its composition than a cell." Would that the cell were no more complicated than the ocean steamer in construction! — the modern investigator would then soon be ready witli the solution of its problems. Alas! the difficulties are not confined to the study of these organisms as individuals; already we have entered upon the investigation of their social relations, and cell-altruism and cell-egoism, cellstates and revolutionary cells are discussed as actively among cytologists as are the similar social questions concerning organic individuals of another order by the people at large. Further, in cytophysics and cytochemistry, research is at present most active — these subjects representing one of the most interesting subdivisions of recent physiology. Should the gulf between the present microscopic picture of the cell and its chemical structure ever be bridged, stereochemistry would enter into the domain of anatomy. So much in general, with regard to the physiological view-point in anatomy. Closely allied to the foregoing, and in reality an offshoot from it, is the mode of consideration of the surgical and topographical anatomist. In this branch, the- individual regions and cavities of the body are dealt with Avitb regard to the reciprocal position of the various organs and systems. Surgical anatomy studies these relations only in so far as they are of importance in operative procedures; topographical an
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JOHNS HOPKINS HOSPITAL BULLETIN.
  
  
Aphil-May-June, 1901.]
 
  
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[Nos. 121-122-123.
  
  
JOHNS HOPKINS HOSPITAL BULLETIN.
 
  
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ON THE OCCURRENCE OF TAILS IN MAN, WITH A DESCRIPTION OF THE CASE REPORTED
  
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BY DR. WATSON.
  
93
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By Eoss Granville Harrison, Ph. D., M. D., Associate Professor of Anatomy, Johns IIopMns University.
  
  
  
atomy, a wider subject, studies tlie relations mentioned and independently of their significance to the surgeon. The various regions of the body are studied sometimes in layers, sometimes with regard to serial clues to a particular structure. Sections of frozen cadavers have here proved to be of great value for the study of relations and for helping the student to make mental reconstructions of the parts analyzed by dissection. Surgical and topographical anatomy are thus seen to be subjects of very high practical importance — the former especially for the surgeon, the latter also for the worker in internal medicine. It is this kind of anatomy Which has been brought to so high a state of cultivation in Great Britain, and especially in London, where most of the anatomy has been taught by men in surgical practice. Valuable as such instruction is for furgery and medicine, it should not be forgotten that it is applied anatomy rather than anatomy proper, and no less a scientist than Macalister has deplored the lack of advances in anatomy in England, attributing it largely to the one-sided mode of instruction in vogue, and to the examinations, to the passing of which the teaching is in large part directed. Surely certain morphological considerations are as important for the student of anatom.y as the learning by heart of the various relations of an artery, especially if the student is not to become a surgeon; it would be melancholy indeed if there were not at least some members of the anatomical classes who regard the study of the architecture of the brain and spinal cord as interesting and as important as that of the perineum.
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Some years ago Bartels' gave an excellent resume of onr knowledge and beliefs concerning the occurrence of caudal appendages in man, showing that references to this peculiarity are to be found as far back as the writings of Pliny and Pausanias. Appended to Bartels' paper is a map, which shows the various lands supposed at one time or other to have been the haunts of human races with tails. These regions include not only widely distant portions of South America, Asia and Africa.- but also the greater part of western Europe. While numy of the statements cited by Bartels are to be classed as legendary, it is of interest to note how persistent and wide in range the belief in the existence of such races has been. The most remarkable stories have been told and have found credence; in these the significance of the caudal appendages has been variously interpreted. On the one hand, a tail has been considered a distinction of the highest degree, even a mark of divine descent, as in the case of the Kanas of Poorbunder; ' on the other hand, it has usually been looked upon as a curse or a stigma of degradation.'
  
But anatomy as a science would never have attained to the dignified position it now holds had the minds engaged with it remained satisfied, after observing and registering its material content, with attempting the explanation of the human body from the physiological view-point or by exliausting the possibilities of its relation to the surgeon's knife.
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While cai-eful investigation of the many travellers' stories has invariably given negative results regarding the existence of tailed races, so many individual instances of homo caiulatus have been observed, that the popular belief in them has been kept alive without difficulty. With the growing interest shown by anatomists and anthropologists in the subject, the number of cases which have been reported has become considerable, and the fact that the human embryo at a certain period of development is provided with a tail-like appendage has lent color to the discussion of the question. Bartels in 1884 referred to one hundred and sixteen persons who had recorded observations upon tailed men. Of these, over sixty cases had been more or less completely described. In 1892 Schaeffer collected additional cases, adding in all twenty-five. Pyat
  
As in the other natural sciences, the causality-need of the intelligence has forced the anatomist to undertake the investigation of the origin of the organic forms which he studies, and of the relations of these forms to other similar and dissimilar organic forms accessible to examination. In other words, the comparative and the genetic methods of study have been resorted to. Comparative anatomy and embryology together constitute morphology, at least in the senso in which the term is ordinarily used, and in morphology we recognize the part of anatomy which makes it truly worthy of being designated a science.
 
  
In the application of the comparative method, not only are the different parts of the human body compared with one another — the arms with the legs, the brain with the spinal cord, the skull with the vertebral column, the various segments and segmental partitions with one another — but man, recognized as a member of a long series of animals, is compared with each of them in turn, and they with one another, with the object of establishing groups of type forms and of learning the plan of architecture, not only of the single creature, but also of the whole series. At first, anatomists studied the forma which to them seemed to resemble man most closely, but the
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' M. Bartels: Die geschwUuzteu Mensclien. Arcliiv f. Aiitliropol., B<1. XV, 1884.
  
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5 These were the rulers of the Jaitwa or Camari, one of the Rajpoot tribes. "They trace their descent from the monkey-god Ilauuman, and confirm it by alleging the elongation of the spine of their princes, who bear the epithet 'Pooncheria, or the long-tailed Ranas of Saurashtra.' " — James Tod: Annals and Antiquities of 'Rajasfhau, or the Central and Western R.ajpoot States of India, vol. i, Loudon 1839.
  
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3 Bartels cites an instance of this in the stories regarding a certain community of tailed men in Turkestan. These were held in the utmost contempt by the other people, and were therefore condemned to constant inbreeding. They were referred to as "Kuju rukly Tatar," which in German is rendered " Stiitkendes ZIhgeziefer mil Schwanzen." The tail was supposed to be a special curse in that it hindered the possessor from sitting properly on his horse.
  
gradual transition from one form to another was so striking that animal after animal was studied until finally the whole world of organisms has been submitted to the examination of the comparative investigator. Oken and Goethe, Cuvier, Meckel, Geofl'roy, St. Hilaire, Lamarck, Wallace, Darwin, Haeckel, Huxley, Gegenbaur and Leidy are names which have become very familiar to us in this field. The world of living creatures is a unitary system, of which man is an inseparable portion. First, when the whole system has been worked through do the form and significance of many of man's parts become intelligible. The animal series can be thought of as a tree with the simplest forms at the root, the trunk branching at its origin, each branch in turn subdividing into limbs and twigs until the highest degree of differentiation is reached. It is this recognition of the lawful relation of organisms to one another which the study of comparative anatomy has afforded us. Such a recognition, now general, was little less than startling to those who first arrived at it. That it pointed to some more general law was obvious. As Goethe himself, no mean participator in comparative studies, beautifully expressed it:
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^Oskar SchaefTer: Beitrag ?.ur Aetiologie der Schwauzbildungen beim Menscheu. Archiv f. Anthropol., Bd. xx, 1833.
  
" Alle Gestalten sind ahnlich und Keine gleicbet der anderm, Und so deutet das chor auf ein gelieimes Gesetz."
 
  
Has this secret law been discovered? Many believe so and look upon Darwin's doctrine of descent as a generalization worthy, on account of its scientific value, of being placed side by side with Newton's theory of gravitation. Whether the evolutionary doctrine be unequivocally accepted or not, certain it is that the relationship of forms which comparative anatomy reveals, finds in this genealogical conception of Darwin a more satisfactory explanation than any other hitherto offered.
 
  
Closely allied to the phylogenetie mode of consideration is that \\hich we designate as the embryological ontogenetic or developmental. In the human species, as in every other, the life of the individual member is of short duration; each human organism has a beginning, a period of growth and development, followed, even in the life of maximum length. in the course -of a few decades, by decline and death. Generation follows generation as wave follows wave on the surface of a ruffied sea. In the transference of life from one generation to another the material substratum sinks to a minimal amount — the new human being begins as a fertilized egg-cell 1-120 of an inch in diameter, weighing only a minute fraction of a gramme. From this simplest of beginnings it gradually passes through a long series of developmental stages, the character of these stages varying somewhat under environmental influences, each .stage being the nnecessary consequent of a preceding stage, and at the same time the necessary antecedent of the stage which follows it until finally the organism attains to the fullness of differentiation of which, under the circumstances of its environment, it is capable.
+
nitski ' has also given an elaborate account of the subject, and still more recently Kohlbrugge," in connection with an admirable description of a very interesting case, has made valuable comparisons with previous work. From the United States five cases have, to my knowledge, been reported.'
  
In this long series of developmental stages which every mammal passes through, the earliest are very, very simple and correspond in form closely with the lower forms in the animal kingdom. But as cell-division in the embryo proceeds, the
+
Undoubtedly we have in these so-called tails a most heterogeneous collection of anomalies. Anything appended to the sacral or coccygeal region is described as a tail. Many do actually bear certain resemblances to the tails of lower animals, and have in fact been compared with a great variety of these. On the other hand, some are vesicular or of irregular shape and accompany the condition of spina bifida, while others are to be classed as teratomata or other tumors. A further very significant fact is that a large proportion of the eases have been complicated by the coexistence of ectopia viscerum, hypospadia, atresia ani, or deformities of the limbs, all of which are known to result from amniotic adhesions. This circumstance has led Schaeffer to the conclusion that human caudal appendages are always due to this cause.'
  
 +
There are, however, a great many cases in which the anatomical relations of the tail are such as to indicate that it owes its existence to the persistence of at least part of the vestigeal tail found in the human embryo. In some of these it seems that the coccyx extends down into the tail, though there is no good evidence that there is ever an increase over the normal number of coccygeal vertebrae in these instances. Under this latter head would come the majority of the adherent (angewachsene) tails described by Bartels,' and also some
  
  
u
 
  
 +
5 1, S. Pyatnitski : On the Question of the Formation of a Tail in Man, and of Human T.ails in General, according to Data from Literature and Personal Researches. Dissertation. St. Petersburg, 1893 (Russian).
  
 +
« J. H. F. Kolilhrugge: Schwanzbildung und Steissdriise des Menschen nnd das Gesetz der Riichscklagsvererburg. Natuurkundig Tijdschrift voor Nederlandsch-Indic, Deel Ivii, 1S9S.
  
JOHNS HOPKINS HOSPITAL BULLETIN.
+
'Dickinson: A Child with a Tail. Brooklyn Medical .lournal, vol. viii, 1894.
  
 +
Halsted Myers: j\ Caudal Appendage. Proceedings of the New Tork Pathological Society, (1893) 1894.
  
 +
Julian Berry: Baby with a Tail. Memphis Medical Journal, vol. xiv, 1894.
  
[Nos. 131-122-123.
+
A. Ecker: Der Steisshaarwirbel (vertex coccygeus), die Steissbeiuglatze (glabella coceygea) und das Steissbeingriibchen (foveolacoccygea), wahrscbeiuliche Ueberbleibsel embryonaler Formen, in der Steissbeingegend beira ungeboreuen, neugeborenen und erwachsonen Menschen. Archiv f. Anthropol., Bd. xii, 1880. Ecker describes a case reported to him in a letter from Dr. Neumayer, of Cincinnati.
  
 +
Miller: Medical and Surgical Reporter, 1881. (Not accessible.)
  
 +
8 Archiv f. Anthropol. Bd. xx, p. 319.
  
shaping of tlie organism becomes more complex, resembling higher and higher forms of animal life, nntil finally that of mammals is assumed. Even at this period the nnskilled observer might easily be confused if he were required at a glance to distinguish a human embryo from those of several other mammals at a similar period of development. Ultimately, the differential characters of the species become clearly marked, and even the tyro can easily recognize them Tiio more skilled the observer, however, the earlier in the development will the species-criteria be decisive.
+
' M. Bartels: Ueber Menschenschwanze. Archiv f. .Anthropol., Bd. xiii, 1881. In this paper Bartels classifies persistent tails, dividing them into two main types, adherent and freely suspended (/roV) ; of the latter
  
Comparative embryology becomes all the more astonishing a study when we realize that the embryological history of every higher animal is, for a long period at least, almost identical with that of a whole series of allied forms. No wonder, then, this state of things being acknowledged, that the embryologists, like the comparative anatomists, have pictured the genetic relations of the different animal forms also as a tree, a tree which on close examination is found to accord very closely with the tree of relationship constructed by the comparative anatomists.
 
  
Comparative anatomy and embryology are, therefore, closely interwoven subjects, and each may, in a way, be looked upon as a control for the other, though each has its special problems, and each sets about the solution of these in a manner peculiar to itself. Take, for example, the attempts at an explanation of the series of forms through which the individual passes in its development. Many comparative anatomists, accepting Darwin's doctrine of the origin of species through a struggle for existence among generations influenced by heredity and variation, would explain the development of tlie individual member of a species as a temporarily compressed recapitulation of the developmental course of the species as a whole. While this doctrine that " ontogeny repeats phylogeny" has been maintained by eminent scientists there are others who are unwilling to accept what cannot bo proved; and some of the embryologists especially feel it their province to attempt to explain from embryological studies alone, and without reference to phylogenetic history, the origin of the various form-stages through which the individual passes. Already great strides have been made in the direction mentioned, especially through the investigation of the laws of growth; and the field of developmental mechanics, though so lately entered upon, has proven to be one of the most fruitful of those thus far tilled. One of the foremost investigators along these lines goes so far as to assert that the growth of every organic germ must, as a process strictly regulated according to time and space, possess a mathematical expression in which the velocity of growth of each point is determined in its dependence on the time and the position. Whether such formulaa will ever be set up and the kingdom of organic forms thus subordinated to the domination of simple numbers, seems doubtful, but in any case the conception is an interesting one. We need not, however, look into the nebulous distance for the advantages to accrue from developmental study. Fear at hand are thousands of facts of the greatest importance for anatomy as a whole and for
 
  
 +
April-Mat-June, 1901.]
  
  
the practical branches of medicine and suvgei'y to be gained only through this method of study. Scarcely a part of the body but what is now better understood than was otherwise possible. I need only mention the remarkably complicated morphology of the brain and the sense organs, the distribution of the intestines, the grouping of the various voluntary muscles, the puzzling course followed by certain of the nerves and of the reproductive organs in the two sexes, to call to mind some of the features which embryology has gone far to illuminate.
 
  
I dare not pass by unnoticed here two phases of investigation which naturally follow upon the others, but which have only very recently begun to be extensively cultivated, viz.: those of histogenesis and of comparative histology. Histogenesis stands in the same relation to comparative histology as does embryology to comparative anatomy. Indeed, it is simply jDUshing the microscope into embryology and comparative anatomy, and is, in a way, comparable to the advance from gross descriptive anatomy to microscopic anatomy. By histogenesis we mean the study of the development of the individual tissues, including that of the individual cells (cytogenesis). By comparative histology and cytology we refer to the comparative microscopic study of the various tissues and cells through a series of animals. The light throuTi upon many of the unsolved problems of structure by these methods is unexpectedly brilliant, and the future has much to hope from it; MacCallum, too, has shown how important these methods can be in helping to explain certain pathological phenomena met with in heart-muscle, and there can be little doubt that we are on the brink of the discovery of a series of relations between histogenetic ccmditions and j)athological processes.
+
JOHNS HOPKINS HOSPITAL BULLETIN.
  
Lastly, as a crowning piece to the whole system of anatomical study, experimental morphology must be recognized. As but a child among the kindred sciences, it is of robust constitution, being the offspring of vigorous parents, and, in this country especially, in an environment most suitable for its healthy growth. The anatomist is no longer confined to the study of adult forms, or of forms in their natural mode of development; he can now, to a certain extent, artificially control form-production by resorting to the experimental method. The experiments which have been made upon heteromorphism, upon the artificial production of malformations, and upon the grafting of embryos, are full of interest, so much so as to disturb the equanimity of the soberest of scientists. During the last year or two we have been — I was going to say — shocked by the bringing of the proof by my colleague. Professor Loeb, that the eggs of several forms not naturally parthenogenetic can be fertilized — or at any rate, brought to development in the absence of spermatozoa, solely through the action of (?) physico-chemical influences. With miracles such as these already performed, we can but stand in awe of the work of the future.
 
  
Most sketchily and imperfectly 1 have tried to give yon an idea of what the study of anatomy includes, viz.: descriptive or systematic anatomy (gross and microscopic), physiological
 
  
 +
97
  
  
April-Mat-June, 1901.]
 
  
 +
cases in which the tail projects free from the trunk as, for instance, cases described by Brann,'° Ornstein," and by Dickinson. The majority of the embryonic tails contain, liowever, no prolongation of the vertebral column but are classed as what Virchow"' calls soft tails (weirhe Schivdnze).
  
 +
Description of Case.
  
JOHNS HOPKINS HOSPITAL BULLETIN.
+
Abont a year ago Dr. Watson exhibited before the Johns Hopkins Hospital Medical Society a baby with a tail, which is an example of the last-named class." The tail was removed later, and through the kindness of Dr. Watson, who gave me the specimen as well as his notes of the case, I am enabled to make a fairly complete report on it, including a description of its histological structure.
  
 +
The child, which was (lie tliird in the family, was a healthy, well-developed male. In its family history there is nothing which throws any light upon the case. Aside from the tail the baby presented only one other slight deformity, and that was in the four outer toes of the right foot. These toes were shorter than the normal ones of the left foot, their tips were turned up and the nails were small and thick. Tlie phalanges of these toes were short and there were but two in each toe. The great toe of this foot was normally developed.
  
 +
The tail appendage was attached in the mid-line about one centimeter below the tip of the coccyx. Examination of the saero-coccygeal region showed a well marked foveola coccygca (Eeker) (Figs. 1 and 3), but owing to the extreme fineness of the hairs of this region, which to the unaided eye were quite invisible, it was impossible to distinguish any particular coccygeal bald spot or glabella coccygea (Ecker). Beginning a little to the right and below the foveola is a sharply defined groove, which runs obliquely downward and to the left between the buttocks and passes to the left of the root of the tail.
  
^5
+
The appendage itself was of firm consistency, thougli containing no bone. It was covered with normal skin, containing fine hairs, and was apparently well vascularized. Three distinct portions or segments could l)o made out. The basal piece was short and on the dorsal side scarcely marked off from the next following, except when the tail was in a state of contraction (Fig. 2). On the ventral side a transverse furrow separated it from the next portion. The middle segment had a length of 2-5 mm., was curved a little to the right and tapered somewhat towards its distal end, where the much more slender end-segment was attached. These two portions were separated by a constriction more marked on the left side.
  
  
  
anatomy, surgical and topographical anatomy, histology or general anatomy, ineUiding histography and cytology, comparative anatomy, embryology, comparative histology and embryology, histogenesis and lastly experimental morphology. Assuredly the subject is wide. It is, I am sorry to say, too wide to be mastered in all its details even when a whole lifetime is devoted exclusively to it. The scientific anatomi;;!, after familiarizing himself with the main facts and principles of its various subdivisions, does best, in agreement with the great law of division of labor, to direct his efforts towards the acquisition and promulgation of knowledge in some one portion of it.
+
a number of subdivisions are made, between wliiob, bovvever, tbc distinction does not seem to me to be sharp.
  
And now for a word of welcome to the class just entering upon the study of medicine. You have taken, gentlemen, the first direct step which is to lead you into one of the noblest professions in the world — into a profession in which your lives are to be consecrated to the service of suffering men and women. You have to learn the laws which govern hcallli and those which underlie disease. Yon, like your predecessors, will find that a large proportion of your time and .energy in life will be directed toward the prevention" of the occurrence of disease, rather than to the cure of it, for medical men have the proud distinction of being perhaps tlie only workmen " who make it their first duty to stop the sources of supply from which they derive their income." Hard work during the next four years will be required of every one oT you; indeed, your time will be so occupied and your mental powers so strenuously engaged that you will have but little opportunity for recreation or for the amenities of life. But while this is the most difB.cult period of your career as far as intellectual work is concerned, do not, I beg of you, forget altogether the man in the making of the physician or surgeon. However much your instructors may stimulate you, however much work they may ask you to do, you will be wise if you retain some period of the day, be it only half an hour or even less, when you can withdraw from men and medicine and in some quiet nook indulge a wholesome longing for good general literature. Keep your old friends by you — your Plato and Marcus Aurelius, your Emerson, Carlyle, your Dante, Shakespeare and Milton, your Goethe, Shelley and Keats. If your osteological studies prove refractory you may find the stoicism of Epictetus a remedy for your disturbed spirit; after the depressive influences of pathological anatomy the lyric of Goethe, the raptures of Shelley, or an essay of Stevenson may prove to be uplifting; to combat the intoxicating fumes of the chemical laboratory try the antidotal effects of Burton, of Sterne or of Eabelais. The time so spent will not only be revivifying for the moment, but will be of the greatest value to you in your professional life after graduation. Skill is more and more reverenced, but skill without culture has lost half its power. And culture, like reputation, has not only to be gained but to be kept, nor is it gained or kept without cfTort, without constant vigilance.
+
•0 M. Braun; Ueber rudimentiire Scbwauzbildung bei eiuem erwacbsenen .\Iunschen. Arcliiv. f. Autbropol., Bd. xiii, 1881.
  
 +
"Ornstein: Scliwauzbildnng beim Menschen. Archiv f. Antlimpol., Bd. xiii, 1881.
  
 +
'2 R. Virchow : Sebwaiizbilduni^ beim Meusclion. Deutsche uied. Wociienschr., 10. Jahrg., 1884.
  
Permit me to hope that you have laid broad foundations in the sciences which arc fundamental for medicine; viz.: physics, chemistry and biology. Without thorough training in these it is impossible to keep abreast of the rapidly swelling tide of discovery in modern medicine. If, further, you are familiar with the French and German languages you will find it possible to become conversant with important new facts and discoveries months and sometimes years before they enter into the English text-books. Of the distinctly medical sciences, anatomy, physiology and physiological chemistry, together with pathology, form the framework upon which all the rest of the medical sciences are built. Failure to make this framework solid renders the superstructure inevitably unsafe. Do not forget that the medicine of to-day differs from that of the years close behind us chiefly in the substitution of "handcraft" for much of the former "redecraft." In these days, too, as it has well been put: The eye cannot say unto the head, I have no need of thee." Instead of accepting the statements of others about things as of yore the medical student is nowadays being made to do things. Instead of memorizing text-books, quiz compends and lecture notes, he is more and more required to study the natural objects, to observe accurately, to record concisely and adequately, to experiment intelligently. While good lectures, good recitations and good text-books still have their place, the student is wisely encouraged to interrogate Nature for himself and to believe in the replies he obtains from her rather than to put implicit confidence in the descriptions of others.
+
'3 W. T. Watson: Exhibition of a Three-nxintlis' Infant with a Caudal Appendage. Proc. J. H. II. Med. Soc. Johns Ilopl^ins Hospital Bulletin, vol. xi, 1900.
  
The new methods of medical education arc costly; they demand large laboratories, expensive equipment and scientifically trained instructors. They cannot be satisfactorily introduced into schools where the sole income is derived from the fees of students; large endowments are absolutely essential for the proper carrying out of the plan.
 
  
Finally, gentlemen, let me give expression to the hope that among this class now entering, besides the large number who will go on into beneficent and successful practice, there may be some who, willing to scorn delights, to live laborious days, will set before them the high hope of making actual additions to knowledge. It is not fair that we should accept the gifts of our forerunners without making the effort ourselves to enrich the general stock of knowledge. The paths of investigation are not smooth; the way of research is difficult. But the goal is strife-worthy, and the rewards are sufficient.
 
  
In closing then let me quote those stirring words of the sage of Chelsea, which I excerpt from his Sartor Eesartus.
+
The terminal segment curved to the right and ventrally and ended in a rounded blunt extremity. On the whole, the tail gave an impression not unlike that of a pig's tail, a similarity which has been noted' in a number of cases previously reported.
  
"Produce! Produce! Were it but the pitifulest infinitesimal fraction of a Product, produce it in God's name! 'Tis the utmost thou hast in thee: out with it then. Up, up! Whatsoever thy hand findeth to do, do it with thy whole might. Work while it is called To-day, fur the night comctli, wherein no man can work! "
+
The hairs upon the tail, which were considerable in number, were plainly visible to the unaided eye. They pointed towards the tip, as could readily be confirmed by examination of longitudinal sections (Fig. 4). The convergence of the hairs towards the tip of the tail corresponds with the arrangement of the hairs in the coccygeal whorl {vertex coccygeus of Ecker), found in normal, i. e. tailless individuals, and supposed to be a vestige of the embryonic tail.
  
 +
Two weeks after the birtli of the child the tail was 4.4 cm. long; at the age of two months it had gi'own to 5 cm.; and at six months, when it was removed, it had attained the length of 7.0 cm., showing altogether a fairly rapid rate of growth.
  
 +
The most remarkable characteristic of the tail was its movability. When at rest it would lie extended in the midline (Fig. 1), or bent over to one side upon the buttocks. The mother of the child said that she had seen the tail bent through an angle of 180°, its tip pointing towards the head. It must, however, have been brought into this position passively, for, as will be seen later, there was nothing in the arrangement of its muscles which could account for this. When the child was irritated, and cried or coughed, the tail would contract markedly. Between the basal and middle segments but little movement was ]50ssible; the contraction of the muscles merely brought out the constriction between tlie two portions more plainly. Between the middle and distal segments the movement was considerable. The latter could be drawn in sharply, telescoping the middle segment, and at the same time flexion to the left side took place. During this action the middle segment became much shorter and thicker.
  
96
+
When the child was about six months old the tail was removed by Dr. Watson.'* The amputated appendage was put immediately into Zenker's fluid to harden. After it had been washed and kept in strong alcohol for some time it measured 5.3 cm. in length. It was then cut into four pieces with a sharp razor, and the pieces were imbedded in celloidin. Cross sections were cut at three different levels, near the base, proximal to the second joint, and near to the tip, as is indicated in Fig. 4. After a few transverse sections were cut off, the pieces were stuck together and reirabedded in celloidin for the purpose of cutting longitudinal sections of the whole.
  
 +
From the study of sections it is seen that the skin covering the whole of the tail except a limited area on the ventral sur
  
  
JOHNS HOPKINS HOSPITAL BULLETIN.
+
" It seemed advisable to remove the tail, not only in order to accede to tbc wishes of the child's parents, who regarded its presence with chagrin, but also on more practical grounds. It loolied as if the tail might become the seat of a troublesome iutertrigo. Besides, its rate of growth was considerable, and it did not seem unlikely that the appendage might have later attained undue proportions, causing, as has been reported in several instances, considerable inconvenience in sitting. (See Lissner: Virchow's Archiv, Bd. 99, 188.5.
  
  
  
[Nos. 121-122-123.
+
98
  
  
  
ON THE OCCURRENCE OF TAILS IN MAN, WITH A DESCRIPTION OF THE CASE REPORTED
+
JOHNS HOPKINS HOSPITAL BULLETIN.
  
BY DR. WATSON.
 
  
By Eoss Granville Harrison, Ph. D., M. D., Associate Professor of Anatomy, Johns IIopMns University.
 
  
 +
[Nos. 121-122-123.
  
  
Some years ago Bartels' gave an excellent resume of onr knowledge and beliefs concerning the occurrence of caudal appendages in man, showing that references to this peculiarity are to be found as far back as the writings of Pliny and Pausanias. Appended to Bartels' paper is a map, which shows the various lands supposed at one time or other to have been the haunts of human races with tails. These regions include not only widely distant portions of South America, Asia and Africa.- but also the greater part of western Europe. While numy of the statements cited by Bartels are to be classed as legendary, it is of interest to note how persistent and wide in range the belief in the existence of such races has been. The most remarkable stories have been told and have found credence; in these the significance of the caudal appendages has been variously interpreted. On the one hand, a tail has been considered a distinction of the highest degree, even a mark of divine descent, as in the case of the Kanas of Poorbunder; ' on the other hand, it has usually been looked upon as a curse or a stigma of degradation.'
 
  
While cai-eful investigation of the many travellers' stories has invariably given negative results regarding the existence of tailed races, so many individual instances of homo caiulatus have been observed, that the popular belief in them has been kept alive without difficulty. With the growing interest shown by anatomists and anthropologists in the subject, the number of cases which have been reported has become considerable, and the fact that the human embryo at a certain period of development is provided with a tail-like appendage has lent color to the discussion of the question. Bartels in 1884 referred to one hundred and sixteen persons who had recorded observations upon tailed men. Of these, over sixty cases had been more or less completely described. In 1892 Schaeffer collected additional cases, adding in all twenty-five. Pyat
+
face is of normal stnicture. The layers of the epidermis are easily distinguishable. The thickness of the skin varies somewhat. Near the base of the tail on the ventral side it is found to be quite 2 mm. thick, while on the dorsal surface of tiie same jjortion it is scarcely 1.5 mm. Further out, i. c. at the middle cut (Fig. 4, a), there is the same difference in thickness between skin of the ventral and dorsal surface (Fig. 5), although the skin is here not quite so thick as at the base. Near the tip the thickness throughout the whole circumference is nearly 1.5 mm. The greater thickness of the skin on the ventral side at the base is due principally to the epidermis, the eoriuni being more nearly uniform throughout. In the thickened area the epidermal ridges extend down deep into the cutis, and the papillse are very long and slender. The various integumentary organs, sweat glands, sebaceous glands and hairs, are numerous and of normal build. In longitudinal sections (Fig. 4) it may be very plainly seen that the hair follicles are obliquely inserted, the hair pointing towards the tip of the appendage. This is without exception the case in the proximal two-thirds of the tail, although the regular arrangement is somewhat disturbed at the crease where the distal and middle segments join, especially on the left side. The corium contains a very abundant supply of elastic fibres which may be readily demonstrated in sections stained by Weigert's method.
  
 +
Beneath the skin the main bulk of the tail is made up of areolar tissue containing much fat. Blood-vessels, nerves, and striated muscle fibres are imbedded in this mass. There is no trace of anything like the medullary cord or of notoehordal tissue, as Gerlach found in the tail of a fcetus of four months.
  
' M. Bartels: Die geschwUuzteu Mensclien. Arcliiv f. Aiitliropol., B<1. XV, 1884.
+
The voluntary muscle consists of a few bixndles of fibres which take origin from the subcutaneous areolar tissue near the proximal end of the middle segment. They lie on the left side not far from the mid-line (Figs. 4 and 5), and run distally in parallel bundles diverging somewhat towards their insertion in the skin just beyond the joint between the middle and distal segments. The majority of the fibres are attached on the left side; a few, however, pass to the skin of the right side; and others are attached to the dorsal surface, and perhaps a few ventrally. The action of the muscle is thus clearly explained by its anatomical relations. There are no muscle fibres running between the trimk and the tail.
  
5 These were the rulers of the Jaitwa or Camari, one of the Rajpoot tribes. "They trace their descent from the monkey-god Ilauuman, and confirm it by alleging the elongation of the spine of their princes, who bear the epithet 'Pooncheria, or the long-tailed Ranas of Saurashtra.' " — James Tod: Annals and Antiquities of 'Rajasfhau, or the Central and Western R.ajpoot States of India, vol. i, Loudon 1839.
+
On the right side near the middle of the tail there are a few muscle fibres (Fig. 5, M'), but these are isolated in small bundles or as single fibres by a dense stroma of connective tissue. Moreover, nearly all of these fibres are in a state of degeneration. The fibrils are less distinct than usual, and the nuclei may be found scattered throughout the substance of the fibres. The muscle is, in fact, in an advanced stage of simple atrophy.
  
3 Bartels cites an instance of this in the stories regarding a certain community of tailed men in Turkestan. These were held in the utmost contempt by the other people, and were therefore condemned to constant inbreeding. They were referred to as "Kuju rukly Tatar," which in German is rendered " Stiitkendes ZIhgeziefer mil Schwanzen." The tail was supposed to be a special curse in that it hindered the possessor from sitting properly on his horse.
+
No one of the blood-vessels stands out preeminently in size. The largest artery is on the left side, held in place by strong connective-tissue bundles. This may be seen in sections through the middle (Fig. 5, A), as well as through the base of the tail. There are several smaller vessels in the
  
^Oskar SchaefTer: Beitrag ?.ur Aetiologie der Schwauzbildungen beim Menscheu. Archiv f. Anthropol., Bd. xx, 1833.
 
  
  
 +
vicinity. Two .'=niall arteries are seen in the riglit dorsal quadrant near the centre and one just beneath the curium, to the left of the mid-line. The veins are small and inconspicuous. There is nothing to be seen of a tuft-like branching of the vessels as Virchow " describes in one of his cases, nor is there anything resembling erectile tissue.'" There is, however, an abimdant supply of blood-vessels in the corium.
  
nitski ' has also given an elaborate account of the subject, and still more recently Kohlbrugge," in connection with an admirable description of a very interesting case, has made valuable comparisons with previous work. From the United States five cases have, to my knowledge, been reported.'
+
A number of small nerve trunks (Fig. 5, N) run longitudinally in the areolar tissue of the appendage. The majority of these accompany blood-vessels.
  
Undoubtedly we have in these so-called tails a most heterogeneous collection of anomalies. Anything appended to the sacral or coccygeal region is described as a tail. Many do actually bear certain resemblances to the tails of lower animals, and have in fact been compared with a great variety of these. On the other hand, some are vesicular or of irregular shape and accompany the condition of spina bifida, while others are to be classed as teratomata or other tumors. A further very significant fact is that a large proportion of the eases have been complicated by the coexistence of ectopia viscerum, hypospadia, atresia ani, or deformities of the limbs, all of which are known to result from amniotic adhesions. This circumstance has led Schaeffer to the conclusion that human caudal appendages are always due to this cause.'
+
Similar Cases. — While it is not practicable to enumerate here all of the similar cases which have hitherto been reported, there axe some which for one reason or other are of especial interest. The tail of a Moi," ten years of age, which had attained the length of over twenty-five centimeters, is interesting on account of its size. Many of the cases have been described very briefly and only as regards external appearance. There are, however, a number of cases which have cither been dissected or examined microscopically. These include Grove's case described by Virchow," and cases reported by Meyers,'" Vinogradow,"" Eodenacker "' and Scheboldayeff," all of which agree with the present case in general structure but differ from it in the absence of muscle. In two other cases, however, described by Pyatnitzki "" and Gerlach,* respectively, striated muscle fibres were found, and it is to be assumed that such tissue was present in Neumayer's ease, for the tail in this instance could be excited to reflex contraction by stimulation of the sacral region. The complicated arrangement of the muscles found in some instances is associated with the occurrence of bone, as in the case described by Hennig and Eauber,"" and especially in Kohlbrugge's case.'" The tail described by Gerlach in a foetus of 4.6 cm. also contained a continuation of the notochord, which has as yet never been seen in older subjects.
  
There are, however, a great many cases in which the anatomical relations of the tail are such as to indicate that it owes its existence to the persistence of at least part of the vestigeal tail found in the human embryo. In some of these it seems that the coccyx extends down into the tail, though there is no good evidence that there is ever an increase over the normal number of coccygeal vertebrae in these instances. Under this latter head would come the majority of the adherent (angewachsene) tails described by Bartels,' and also some
+
The Tail in the Human Embryo.
  
 +
The caudal region in human and other mammalian embryos has already been described by Ecker, His, Keibel, Fol, Braun and others. These accounts, while agreeing in the main, bring out considerable difl'erences of opinion as to details. For this reason I give here a further description of the tail
  
  
5 1, S. Pyatnitski : On the Question of the Formation of a Tail in Man, and of Human T.ails in General, according to Data from Literature and Personal Researches. Dissertation. St. Petersburg, 1893 (Russian).
 
  
« J. H. F. Kolilhrugge: Schwanzbildung und Steissdriise des Menschen nnd das Gesetz der Riichscklagsvererburg. Natuurkundig Tijdschrift voor Nederlandsch-Indic, Deel Ivii, 1S9S.
+
'5 Virchow' s Archiv, Bd. 7il, 1880.
  
'Dickinson: A Child with a Tail. Brooklyn Medical .lournal, vol. viii, 1894.
+
"Bai'tels; Archiv f. Antliropol., Bd. xv, p. 116.
  
Halsted Myers: j\ Caudal Appendage. Proceedings of the New Tork Pathological Society, (1893) 1894.
+
1' Candiil Appeudage in Man. (From tlie French of I^ticnne Rabaud, iu " La Naturaliste.") Scientittc American, vol. 50, 18S9.
  
Julian Berry: Baby with a Tail. Memphis Medical Journal, vol. xiv, 1894.
+
18 Virchow's Archiv, Bd. 79, 1880.
  
A. Ecker: Der Steisshaarwirbel (vertex coccygeus), die Steissbeiuglatze (glabella coceygea) und das Steissbeingriibchen (foveolacoccygea), wahrscbeiuliche Ueberbleibsel embryonaler Formen, in der Steissbeingegend beira ungeboreuen, neugeborenen und erwachsonen Menschen. Archiv f. Anthropol., Bd. xii, 1880. Ecker describes a case reported to him in a letter from Dr. Neumayer, of Cincinnati.
+
'9 Proc. N. T. Pathol. Soc, 1893.
  
Miller: Medical and Surgical Reporter, 1881. (Not accessible.)
+
•" K. N. Vinogradow : On Human Tails. Vrach, vol. sv, 1894 (Russian).
  
8 Archiv f. Anthropol. Bd. xx, p. 319.
+
■-' G. Rodenacker: Ueber den Saugethierschwanz mit besonderer Beriicksichtigung der caudaleu Anhiinge des Menschen. Inaug.-Diss., Freiburg i. Br,, 1898.
  
' M. Bartels: Ueber Menschenschwanze. Archiv f. .Anthropol., Bd. xiii, 1881. In this paper Bartels classifies persistent tails, dividing them into two main types, adherent and freely suspended (/roV) ; of the latter
+
22 W. Scheboldayeff : Tailed Men. Zemsk. Vracb, vol. vi, 1893 (Russian).
  
 +
■"luang.-Diss., St. Petersburg, 1893.
  
 +
S L. Gerlach : Ein Fall von Schwanzbildung bei einem menscMicheu Embryo., Morphol. Jahrb., Bd, vi, 1880.
  
April-Mat-June, 1901.]
+
■5 C. Hennig and A. Rauber: Ein neuer Fall von geschwiinztem Menschen. Virchow's Archiv, Bd. 105, 188G.
  
 +
■■« Natuurkund. Tijdschr. v. Ned. Indiii, Deel. Ivii, 1898.
  
  
JOHNS HOPKINS HOSPITAL BULLETIN.
 
  
 +
April-May-June, 1901.]
  
  
97
 
  
 +
JOHNS HOPKINS HOSPITAL BULLETIN.
  
  
cases in which the tail projects free from the trunk as, for instance, cases described by Brann,'° Ornstein," and by Dickinson. The majority of the embryonic tails contain, liowever, no prolongation of the vertebral column but are classed as what Virchow"' calls soft tails (weirhe Schivdnze).
 
  
Description of Case.
+
99
  
Abont a year ago Dr. Watson exhibited before the Johns Hopkins Hospital Medical Society a baby with a tail, which is an example of the last-named class." The tail was removed later, and through the kindness of Dr. Watson, who gave me the specimen as well as his notes of the case, I am enabled to make a fairly complete report on it, including a description of its histological structure.
 
  
The child, which was (lie tliird in the family, was a healthy, well-developed male. In its family history there is nothing which throws any light upon the case. Aside from the tail the baby presented only one other slight deformity, and that was in the four outer toes of the right foot. These toes were shorter than the normal ones of the left foot, their tips were turned up and the nails were small and thick. Tlie phalanges of these toes were short and there were but two in each toe. The great toe of this foot was normally developed.
 
  
The tail appendage was attached in the mid-line about one centimeter below the tip of the coccyx. Examination of the saero-coccygeal region showed a well marked foveola coccygca (Eeker) (Figs. 1 and 3), but owing to the extreme fineness of the hairs of this region, which to the unaided eye were quite invisible, it was impossible to distinguish any particular coccygeal bald spot or glabella coccygea (Ecker). Beginning a little to the right and below the foveola is a sharply defined groove, which runs obliquely downward and to the left between the buttocks and passes to the left of the root of the tail.
+
region in several human embryos. This I nm enabled to do tlirough the kindness of Dr. Mall, who placed at my disposal his fine collection of human embryos. Two specimens, fourteen and sixteen millimeters long respectively, were found to be especially adapted for this purpose, for it is at this stage that the tail reaches the highest point in its development. The study of these was greatly facilitated on account of their excellent state of preservation, and by the fact that they were cut into perfect series of sagittal sections.
  
The appendage itself was of firm consistency, thougli containing no bone. It was covered with normal skin, containing fine hairs, and was apparently well vascularized. Three distinct portions or segments could l)o made out. The basal piece was short and on the dorsal side scarcely marked off from the next following, except when the tail was in a state of contraction (Fig. 2). On the ventral side a transverse furrow separated it from the next portion. The middle segment had a length of 2-5 mm., was curved a little to the right and tapered somewhat towards its distal end, where the much more slender end-segment was attached. These two portions were separated by a constriction more marked on the left side.
+
Embryo m. Greatest Length IJi mm. : N eck-Breech 12 mm. The tail of this embryo is marked oft' vcntrally by a fold of epithelium which extends eranially from the anus, forming a shallow pit or crease between the anal prominence and the tail. This fold extends to the level of the cranial end of the tliirty-third vertebra (Fig. 6), so that from this point on, i. c. distal to the third coccygeal vertebra, the caudal end of the embryo projects free from the trunk.
  
 +
The vertebral column extends throughout but half the length of the tail, in which, therefore, a vertoliral and nonvertebral portion may be distinguished.
  
 +
The terminal portion of the tail or caudal filament is bent dorsally and inclined to the left side, and becoming rapidly thinner distally, ends in a slight knob-like enlargement, which is scarcely shown in the figure. The most conspicuous structure in the caudal filament is the medullary cord, which runs to the tip and there ends in a vesicular enlargement. Tlie notochord and the terminal branches of the aorta and inferior vena cava also extend out into it though not so far as the medullary cord. The filament is supported by a diffuse mesenchymatous network, more concentrated in the ventral side just beneath the integument, which is perhaps an indication of the remains of the post-anal gut found in younger embryos.
  
a number of subdivisions are made, between wliiob, bovvever, tbc distinction does not seem to me to be sharp.
+
Counting from the atlas down, it is clear that there are in all thirty-six vertebrae present, of which the distal seven belong to the coccygeal or caudal region. In the trunk, down tlirough the sacral region, the vertebral bodies are composed of embryonic cartilage, which does not stain intensely. The intervertebral discs, owing to the greater concentration of the cells composing them, stand oiit in sections as deeply staining bands. Between the vertebral bodies and the discs there is a zone of cells, which stains more intensely than the cartilage and less so than the discs. In the well advanced vertebrffi of the lumbar region the intermediate zone is thin and clearly forms a part of the perichondrium of the vertebral cartilages. Beginning with the first coccygeal vertebra this intermediate or periehondrial layer forms a thick pad, especially on the distal surface of the disc. The vertebral body is licre proportionately thin, showing itself merely as a lighter streak between the more deeply staining perichondrium of each end. In fact the bodies of the distal coccygeal vertebra; can hardly be spoken of as cartilaginous. In thickness (craniocaudal) the vertebral bodies diminish steadily throughout the sacral and coccygeal regions, but there is very little diminution in the dorsoventraLdiameter xmtil the thirty-fourth vertebra is reached. The last three diminish rapidly towards the
  
•0 M. Braun; Ueber rudimentiire Scbwauzbildung bei eiuem erwacbsenen .\Iunschen. Arcliiv. f. Autbropol., Bd. xiii, 1881.
 
  
"Ornstein: Scliwauzbildnng beim Menschen. Archiv f. Antlimpol., Bd. xiii, 1881.
 
  
'2 R. Virchow : Sebwaiizbilduni^ beim Meusclion. Deutsche uied. Wociienschr., 10. Jahrg., 1884.
+
tip. In the last two the discs are fully as thick as the vertebral bodies themselves. The distal surface of the vertebra is capped by a well marked disc. There is on each side of the intervertebral discs in the coccygeal region a small mass of deeply staining tissue, which projects ventrally and laterally. They are visible only in sections which pass to the side of the mid-line. They represent undoubtedly rudimentary hypapophyses or hajmal arches found in the caudal vertcbrse of lower forms.
  
'3 W. T. Watson: Exhibition of a Three-nxintlis' Infant with a Caudal Appendage. Proc. J. H. II. Med. Soc. Johns Ilopl^ins Hospital Bulletin, vol. xi, 1900.
+
The spinal ganglia, not counting the ganglion of the bypoglossus, are thirty-three in number. In connection with the ' last a distinct ventral ramus arises and passes ventrally to the side of the vertebrre, bending distally; ventral to the vertebra; it joins a trunk from the next higher nerve. Its mode of ending is uncertain.
  
 +
The number of muscle plates could not be made out clearly.
  
 +
In the interval between the thirty-first and thirty-second vertebrffi the medullary cord (med.) becomes siaddenly attenuated into a filum terminale. There are apparently few or no neuroblasts beyond this point; the walls of the tube are made up of columnar epithelial cells. In the distal portion of the vertebral region and at the base of the caudal filament the cord takes a somewhat sinuous course. The central canal extends to the tip of the tail, where it ends in the slight enlargment mentioned above, the terminal ventricle.
  
The terminal segment curved to the right and ventrally and ended in a rounded blunt extremity. On the whole, the tail gave an impression not unlike that of a pig's tail, a similarity which has been noted' in a number of cases previously reported.
+
The notochord {cli.) forms the axis of the vertebral bodies and discs, and in the proximal portion of the coccygeal region, as in the trunk, is almost straight. In the region of the last two or three vertebra' it is more tortuous. It leaves the vertebral column near the dorsal surface of the last vertebral body and passes thence dorsally to the ventral side of the medullary cord, accompanying this nearly to the tip. In contrast to the vertebral portion, the terminal portion is scarcely differentiated and not well defined in the surrounding mesenchyme.
  
The hairs upon the tail, which were considerable in number, were plainly visible to the unaided eye. They pointed towards the tip, as could readily be confirmed by examination of longitudinal sections (Fig. 4). The convergence of the hairs towards the tip of the tail corresponds with the arrangement of the hairs in the coccygeal whorl {vertex coccygeus of Ecker), found in normal, i. e. tailless individuals, and supposed to be a vestige of the embryonic tail.
+
The continuation of the aorta {ao.), i. e. the a. sacralis media, at first ventral to the vcrtebraj, passes out into the caudal filament as an a. caudalis. From this are given off the segmental arteries, one for each vci-tebra down to and including the last or thirty-sixth. (The last two are not shown in the figure.) These pass up on each side of the vertebral bodies, but it is doubtful if the more distal ones arc as yet fully open. In the same way the vena cava continues into the tail, as the v. sacralis media and the v. caudalis, which lies ventral and to the right of the artery. At their termination in the caudal filament the artery and the vein meet. The vein is of largo calibre to the region of tlie thirty-second vertelira; here it narrows down very suddenly. There are numerous small blood-vessels throughout the mesenchyme of the tail.
  
Two weeks after the birtli of the child the tail was 4.4 cm. long; at the age of two months it had gi'own to 5 cm.; and at six months, when it was removed, it had attained the length of 7.0 cm., showing altogether a fairly rapid rate of growth.
+
Embryo JfS. Greatest Length 16 mm.; Neck-Breecli Jjength IJi mm. — The relations of the tail to the trunk are about the same as in the younger embryo first described, ?'. e. it is free from tlie thirty-third vertebra on.
  
The most remarkable characteristic of the tail was its movability. When at rest it would lie extended in the midline (Fig. 1), or bent over to one side upon the buttocks. The mother of the child said that she had seen the tail bent through an angle of 180°, its tip pointing towards the head. It must, however, have been brought into this position passively, for, as will be seen later, there was nothing in the arrangement of its muscles which could account for this. When the child was irritated, and cried or coughed, the tail would contract markedly. Between the basal and middle segments but little movement was ]50ssible; the contraction of the muscles merely brought out the constriction between tlie two portions more plainly. Between the middle and distal segments the movement was considerable. The latter could be drawn in sharply, telescoping the middle segment, and at the same time flexion to the left side took place. During this action the middle segment became much shorter and thicker.
+
The vertebral portion of the tail is longer, but the caudal
  
When the child was about six months old the tail was removed by Dr. Watson.'* The amputated appendage was put immediately into Zenker's fluid to harden. After it had been washed and kept in strong alcohol for some time it measured 5.3 cm. in length. It was then cut into four pieces with a sharp razor, and the pieces were imbedded in celloidin. Cross sections were cut at three different levels, near the base, proximal to the second joint, and near to the tip, as is indicated in Fig. 4. After a few transverse sections were cut off, the pieces were stuck together and reirabedded in celloidin for the purpose of cutting longitudinal sections of the whole.
 
  
From the study of sections it is seen that the skin covering the whole of the tail except a limited area on the ventral sur
 
  
 +
100
  
" It seemed advisable to remove the tail, not only in order to accede to tbc wishes of the child's parents, who regarded its presence with chagrin, but also on more practical grounds. It loolied as if the tail might become the seat of a troublesome iutertrigo. Besides, its rate of growth was considerable, and it did not seem unlikely that the appendage might have later attained undue proportions, causing, as has been reported in several instances, considerable inconvenience in sitting. (See Lissner: Virchow's Archiv, Bd. 99, 188.5.
 
  
  
 +
JOHNS HOPKINS HOSPITAL BULLETIN.
  
98
 
  
  
 +
[Nos. 131-122-123.
  
JOHNS HOPKINS HOSPITAL BULLETIN.
 
  
  
 +
filament is shorter and more shrunken. It bends sharply on itself to the dorsal side, almost through an angle of 180°.
  
[Nos. 121-122-123.
+
Thirty-seven vertebrae are present, with possible indications of a thirty-eighth; eight of these belong beyond doubt to the coccygeal region. The thirty-foTirth and thirty-fifth are partly fused in the middle. The hypapophyses of each are distinct.
  
 +
The spinal ganglia number thirty-two. The relations of the notochord, medullary cord and blood-vessels are the same as in the embryo first described. There is a slight irregularity in the notochord in the form of a process wdiich extends ventrally into the substance of the thirty-sixth vertebra.
  
 +
General Consideeations.
  
face is of normal stnicture. The layers of the epidermis are easily distinguishable. The thickness of the skin varies somewhat. Near the base of the tail on the ventral side it is found to be quite 2 mm. thick, while on the dorsal surface of tiie same jjortion it is scarcely 1.5 mm. Further out, i. c. at the middle cut (Fig. 4, a), there is the same difference in thickness between skin of the ventral and dorsal surface (Fig. 5), although the skin is here not quite so thick as at the base. Near the tip the thickness throughout the whole circumference is nearly 1.5 mm. The greater thickness of the skin on the ventral side at the base is due principally to the epidermis, the eoriuni being more nearly uniform throughout. In the thickened area the epidermal ridges extend down deep into the cutis, and the papillse are very long and slender. The various integumentary organs, sweat glands, sebaceous glands and hairs, are numerous and of normal build. In longitudinal sections (Fig. 4) it may be very plainly seen that the hair follicles are obliquely inserted, the hair pointing towards the tip of the appendage. This is without exception the case in the proximal two-thirds of the tail, although the regular arrangement is somewhat disturbed at the crease where the distal and middle segments join, especially on the left side. The corium contains a very abundant supply of elastic fibres which may be readily demonstrated in sections stained by Weigert's method.
+
Ecker" and His were the first to give detailed descriptions of the caudal region of the human embryo. Their conclusions regarding its definition and ultimate development may be taken as the starting point in the discussion of the subject. The agi-eemeut reached by Ecker and His may be rendered in part as follows:'" (1) The term "tail" may be applied only to that portion of the embryo which projects free beyond the cloaca. (2) The tail consists of a portion containing vertebrae and a portion without vertebra3 (caudal tUament). The latter contains only notochord and medullary cord. (3) Only the non-vertebral portion atrophies. The vertebral portion remains for some time as the coccygeal prominence (Sleisshbchcr), which, however, gradually disappears in consequence of the increase in the curvature of the sacrum and coccyx, and of the progressive development of the pelvic girdle and its musculature.
  
Beneath the skin the main bulk of the tail is made up of areolar tissue containing much fat. Blood-vessels, nerves, and striated muscle fibres are imbedded in this mass. There is no trace of anything like the medullary cord or of notoehordal tissue, as Gerlach found in the tail of a fcetus of four months.
+
Two matters which have a bearing upon the morphological significance of the ])crsisting caudal appendages in man are brought up in the above for consideration. The one concerns the structure of the tail in the human embryo in comparison with the tail in lower forms; the other is the nature and amount of regressive change which takes place in the human tail during development.
  
The voluntary muscle consists of a few bixndles of fibres which take origin from the subcutaneous areolar tissue near the proximal end of the middle segment. They lie on the left side not far from the mid-line (Figs. 4 and 5), and run distally in parallel bundles diverging somewhat towards their insertion in the skin just beyond the joint between the middle and distal segments. The majority of the fibres are attached on the left side; a few, however, pass to the skin of the right side; and others are attached to the dorsal surface, and perhaps a few ventrally. The action of the muscle is thus clearly explained by its anatomical relations. There are no muscle fibres running between the trimk and the tail.
+
Regarding the first, Keibel " discovered an additional fact (if importance in the presence of a post-anal gut in the human embryo. Braun's" observations on' the caudal filament of mammalian and bird embryos are of importance in showing that the caudal filament is of general occurrence and not a ]ieculiarity of the human tail. Again, the occurrence of spinal nerves and ganglia in a number of the coccygeal seg
  
On the right side near the middle of the tail there are a few muscle fibres (Fig. 5, M'), but these are isolated in small bundles or as single fibres by a dense stroma of connective tissue. Moreover, nearly all of these fibres are in a state of degeneration. The fibrils are less distinct than usual, and the nuclei may be found scattered throughout the substance of the fibres. The muscle is, in fact, in an advanced stage of simple atrophy.
 
  
No one of the blood-vessels stands out preeminently in size. The largest artery is on the left side, held in place by strong connective-tissue bundles. This may be seen in sections through the middle (Fig. 5, A), as well as through the base of the tail. There are several smaller vessels in the
+
- A. Ecker: Archiv f. Aiitbroiiol., Bil. xii, ISSO.
  
 +
A. Ecker: Besitzt der menscliliche Emliiyo eiuen Scbwanz? Archiv f. Anat. n. Physiol, auat. Abtheil., ISSO.
  
 +
ss W. His: Anatomie mensclilicher Embryoneii, I, Leipzig, 1880.
  
vicinity. Two .'=niall arteries are seen in the riglit dorsal quadrant near the centre and one just beneath the curium, to the left of the mid-line. The veins are small and inconspicuous. There is nothing to be seen of a tuft-like branching of the vessels as Virchow " describes in one of his cases, nor is there anything resembling erectile tissue.'" There is, however, an abimdant supply of blood-vessels in the corium.
+
W. His: Ueber den Schwanztheil des menscblieben Embryo. Archiv f. Anat. u. Physiol, anat. AbtheiL, 1880.
  
A number of small nerve trunks (Fig. 5, N) run longitudinally in the areolar tissue of the appendage. The majority of these accompany blood-vessels.
+
-9 A. Ecker: Replik und compromissitzc nebst Scblusserkarung von W. His. Archiv f. Anat. u. Physiol, anat. AbtheiL, ISSO.
  
Similar Cases. — While it is not practicable to enumerate here all of the similar cases which have hitherto been reported, there axe some which for one reason or other are of especial interest. The tail of a Moi," ten years of age, which had attained the length of over twenty-five centimeters, is interesting on account of its size. Many of the cases have been described very briefly and only as regards external appearance. There are, however, a number of cases which have cither been dissected or examined microscopically. These include Grove's case described by Virchow," and cases reported by Meyers,'" Vinogradow,"" Eodenacker "' and Scheboldayeff," all of which agree with the present case in general structure but differ from it in the absence of muscle. In two other cases, however, described by Pyatnitzki "" and Gerlach,* respectively, striated muscle fibres were found, and it is to be assumed that such tissue was present in Neumayer's ease, for the tail in this instance could be excited to reflex contraction by stimulation of the sacral region. The complicated arrangement of the muscles found in some instances is associated with the occurrence of bone, as in the case described by Hennig and Eauber,"" and especially in Kohlbrugge's case.'" The tail described by Gerlach in a foetus of 4.6 cm. also contained a continuation of the notochord, which has as yet never been seen in older subjects.
+
' Fr. Kevbel : Ueber den Scbwanz des menschliclien Embryo. Archiv
 +
f. Anat. u. Physiol, anat. AbthieL, 1891.
  
The Tail in the Human Embryo.
+
31 M. Braun: Eutwicklungsvorgantre am Schwanzende bci eiuigen Siiugethiereu mit Beriicksicbtigung der Verhiiltuisse beim Menschen. Archiv f. Anat. u. Phys. anat. AbtheiL, 1883.
  
The caudal region in human and other mammalian embryos has already been described by Ecker, His, Keibel, Fol, Braun and others. These accounts, while agreeing in the main, bring out considerable difl'erences of opinion as to details. For this reason I give here a further description of the tail
 
  
  
 +
ments, as shown by Fol," Phisalix '^ and Keibel, the continuation of the aorta and vena cava into the caudal filament, together with the presence of segmental arteries and the hypapophyses or rudimentary hjemal arches in all of the coccygeal segments as described in the present paper, show that the caudal region of the human embryo resembles that of other mammalian embryos in all respects except in size and in the number of its segments.
  
'5 Virchow' s Archiv, Bd. 7il, 1880.
+
Concerning the regressive development of the tail considerable difference of opinion has been expressed. Rosenberg, who holds that, strictly speaking, the caudal rudiment in man is not the homologue of the tail of other animals, but is the result of a precocious growth of the medullary cord," considers that the appendage disappears in consequence of the increase in volume of that end of the embryonic body and not through absorption. His,'" in supporting Rosenberg, makes the statement that no reduction in the number of segments takes place during the development of the human embryo, but that the regressive changes are confined to the caudal filament; this view is confirmed in the agreement with Ecker. On the other hand, Fol and Phisalix find thirty-eight segments in embryos of 8-10 mm., with indications that several of these disappear through fusion in the course of development. Allowing for the- possibility that these observers have counted in an occipital segment, there would be in embryos of this size at least thirty-seven trunk segments, which would correspond to thirty-six vertebra3. Keibel finds in an embryo of 8 mm. thirty-five trunk segments, together with a mass of unsegmentcd mesoderm, equaling two segments in length. Reckoning this as two instead of one segment, as Keibel does, we have again thirty-seven segment.^, corresponding to thirty-six vertebrae.
  
"Bai'tels; Archiv f. Antliropol., Bd. xv, p. 116.
+
The following is an attempt to tabulate the number of segments found in embryos varying in length from 7.5 to 21.5 mm. With the exception of the last column the data are as recorded by the observers themselves. In the last column the number of vertebrse is given which would correspond to the total number of segments after certain changes have been made, such as deduction of occipital segments or addition of unsegmented mesoderm, which seemed justified by the descriptions of the authors.
  
1' Candiil Appeudage in Man. (From tlie French of I^ticnne Rabaud, iu " La Naturaliste.") Scientittc American, vol. 50, 18S9.
 
  
18 Virchow's Archiv, Bd. 79, 1880.
 
  
'9 Proc. N. T. Pathol. Soc, 1893.
+
3- H. Fol: Sur la queue dc rciubryon humain. Comptes Reudus, T. 100, Paris, 188.5.
  
•" K. N. Vinogradow : On Human Tails. Vrach, vol. sv, 1894 (Russian).
+
33 C. Phisalix: Etude d'uu embryon humain de ID milliniotres. Archives de Zool. Exp. et Gen. II"" S., T. vi, ISSS.
  
■-' G. Rodenacker: Ueber den Saugethierschwanz mit besonderer Beriicksichtigung der caudaleu Anhiinge des Menschen. Inaug.-Diss., Freiburg i. Br,, 1898.
+
■» E. Rosenberg: Ueber die Eutwickeluug der Wirbelsaule und das centrale carpi des Menschen. Morphol. Jahrb., Bd. i, 187G. "... dass die Gestaltung des hinteren Lcibesendes ebeutalls von dem MeduUarohr derart beeinflusst wird, dass letzteres, indem es in seinem Liingenwachsthnm dem der anderen, un der Zusammensetzuug des hinteren Lcibesendes Theilhabenden Bestandtheile vorauseilt, an demselben eiuen Vorspruug erzengt. ..." p. 138.
  
22 W. Scheboldayeff : Tailed Men. Zemsk. Vracb, vol. vi, 1893 (Russian).
+
35 " Es werdeu demnach beim menscblieben Embryo keine iiberzahligen zur Riickbildung bestimmten Segmeute augelegt." Auatomie menschlicher Embryonen, i, p. 93.
  
■"luang.-Diss., St. Petersburg, 1893.
 
  
S L. Gerlach : Ein Fall von Schwanzbildung bei einem menscMicheu Embryo., Morphol. Jahrb., Bd, vi, 1880.
 
  
■5 C. Hennig and A. Rauber: Ein neuer Fall von geschwiinztem Menschen. Virchow's Archiv, Bd. 105, 188G.
+
THE JOHNS HOPKINS HOSPITAL BULLETIN, APRIL-MAY-JUNE, 1901.
  
■■« Natuurkund. Tijdschr. v. Ned. Indiii, Deel. Ivii, 1898.
 
  
  
 +
PLATE XVII.
  
April-May-June, 1901.]
 
  
  
  
JOHNS HOPKINS HOSPITAL BULLETIN.
 
  
 +
Fi(i. 1. — I'liotnf;raiiU sliDWiiii;' tail ill exteiuleil cuiuliticiii.
  
  
99
 
  
 +
Fiu. 2. — Pliutuyrapli sliowini;' tail in state of ccjiitractioii.
  
  
region in several human embryos. This I nm enabled to do tlirough the kindness of Dr. Mall, who placed at my disposal his fine collection of human embryos. Two specimens, fourteen and sixteen millimeters long respectively, were found to be especially adapted for this purpose, for it is at this stage that the tail reaches the highest point in its development. The study of these was greatly facilitated on account of their excellent state of preservation, and by the fact that they were cut into perfect series of sagittal sections.
 
  
Embryo m. Greatest Length IJi mm. : N eck-Breech 12 mm. — The tail of this embryo is marked oft' vcntrally by a fold of epithelium which extends eranially from the anus, forming a shallow pit or crease between the anal prominence and the tail. This fold extends to the level of the cranial end of the tliirty-third vertebra (Fig. 6), so that from this point on, i. c. distal to the third coccygeal vertebra, the caudal end of the embryo projects free from the trunk.
 
  
The vertebral column extends throughout but half the length of the tail, in which, therefore, a vertoliral and nonvertebral portion may be distinguished.
+
Fig. ;!. — PiKitof^iapli sliowinu; tlie ventral surface of tail.
  
The terminal portion of the tail or caudal filament is bent dorsally and inclined to the left side, and becoming rapidly thinner distally, ends in a slight knob-like enlargement, which is scarcely shown in the figure. The most conspicuous structure in the caudal filament is the medullary cord, which runs to the tip and there ends in a vesicular enlargement. Tlie notochord and the terminal branches of the aorta and inferior vena cava also extend out into it though not so far as the medullary cord. The filament is supported by a diffuse mesenchymatous network, more concentrated in the ventral side just beneath the integument, which is perhaps an indication of the remains of the post-anal gut found in younger embryos.
 
  
Counting from the atlas down, it is clear that there are in all thirty-six vertebrae present, of which the distal seven belong to the coccygeal or caudal region. In the trunk, down tlirough the sacral region, the vertebral bodies are composed of embryonic cartilage, which does not stain intensely. The intervertebral discs, owing to the greater concentration of the cells composing them, stand oiit in sections as deeply staining bands. Between the vertebral bodies and the discs there is a zone of cells, which stains more intensely than the cartilage and less so than the discs. In the well advanced vertebrffi of the lumbar region the intermediate zone is thin and clearly forms a part of the perichondrium of the vertebral cartilages. Beginning with the first coccygeal vertebra this intermediate or periehondrial layer forms a thick pad, especially on the distal surface of the disc. The vertebral body is licre proportionately thin, showing itself merely as a lighter streak between the more deeply staining perichondrium of each end. In fact the bodies of the distal coccygeal vertebra; can hardly be spoken of as cartilaginous. In thickness (craniocaudal) the vertebral bodies diminish steadily throughout the sacral and coccygeal regions, but there is very little diminution in the dorsoventraLdiameter xmtil the thirty-fourth vertebra is reached. The last three diminish rapidly towards the
 
  
 +
THE JOHNS HOPKINS HOSPITAL BULLETIN, APRIL-MAY-JUNE, 1901.
  
  
tip. In the last two the discs are fully as thick as the vertebral bodies themselves. The distal surface of the vertebra is capped by a well marked disc. There is on each side of the intervertebral discs in the coccygeal region a small mass of deeply staining tissue, which projects ventrally and laterally. They are visible only in sections which pass to the side of the mid-line. They represent undoubtedly rudimentary hypapophyses or hajmal arches found in the caudal vertcbrse of lower forms.
 
  
The spinal ganglia, not counting the ganglion of the bypoglossus, are thirty-three in number. In connection with the ' last a distinct ventral ramus arises and passes ventrally to the side of the vertebrre, bending distally; ventral to the vertebra; it joins a trunk from the next higher nerve. Its mode of ending is uncertain.
+
PLATE XVIII.
  
The number of muscle plates could not be made out clearly.
 
  
In the interval between the thirty-first and thirty-second vertebrffi the medullary cord (med.) becomes siaddenly attenuated into a filum terminale. There are apparently few or no neuroblasts beyond this point; the walls of the tube are made up of columnar epithelial cells. In the distal portion of the vertebral region and at the base of the caudal filament the cord takes a somewhat sinuous course. The central canal extends to the tip of the tail, where it ends in the slight enlargment mentioned above, the terminal ventricle.
 
  
The notochord {cli.) forms the axis of the vertebral bodies and discs, and in the proximal portion of the coccygeal region, as in the trunk, is almost straight. In the region of the last two or three vertebra' it is more tortuous. It leaves the vertebral column near the dorsal surface of the last vertebral body and passes thence dorsally to the ventral side of the medullary cord, accompanying this nearly to the tip. In contrast to the vertebral portion, the terminal portion is scarcely differentiated and not well defined in the surrounding mesenchyme.
 
  
The continuation of the aorta {ao.), i. e. the a. sacralis media, at first ventral to the vcrtebraj, passes out into the caudal filament as an a. caudalis. From this are given off the segmental arteries, one for each vci-tebra down to and including the last or thirty-sixth. (The last two are not shown in the figure.) These pass up on each side of the vertebral bodies, but it is doubtful if the more distal ones arc as yet fully open. In the same way the vena cava continues into the tail, as the v. sacralis media and the v. caudalis, which lies ventral and to the right of the artery. At their termination in the caudal filament the artery and the vein meet. The vein is of largo calibre to the region of tlie thirty-second vertelira; here it narrows down very suddenly. There are numerous small blood-vessels throughout the mesenchyme of the tail.
+
--M
  
Embryo JfS. Greatest Length 16 mm.; Neck-Breecli Jjength IJi mm. — The relations of the tail to the trunk are about the same as in the younger embryo first described, ?'. e. it is free from tlie thirty-third vertebra on.
 
  
The vertebral portion of the tail is longer, but the caudal
 
  
 +
Fin. 4. — Frontal sections of tail, showing the arranifcnient of the muscle tibres (.V). a. Place from whicli the cross-section represented in Fii;. .5 was taken. x 3.
  
  
100
 
  
  
 +
W/i/i\tl
  
JOHNS HOPKINS HOSPITAL BULLETIN.
 
  
  
 +
Fig. .5, — Cross-section through the middle of the tail (Fig. 4, a). M, iinisclc; J/', degenerating muscle ; .1, artery; jV, nerve; i is jilaced on the left and It on the right of the apiicndage. x SI.
  
[Nos. 131-122-123.
 
  
  
  
filament is shorter and more shrunken. It bends sharply on itself to the dorsal side, almost through an angle of 180°.
+
Hari-ison del.
  
Thirty-seven vertebrae are present, with possible indications of a thirty-eighth; eight of these belong beyond doubt to the coccygeal region. The thirty-foTirth and thirty-fifth are partly fused in the middle. The hypapophyses of each are distinct.
 
  
The spinal ganglia number thirty-two. The relations of the notochord, medullary cord and blood-vessels are the same as in the embryo first described. There is a slight irregularity in the notochord in the form of a process wdiich extends ventrally into the substance of the thirty-sixth vertebra.
 
  
General Consideeations.
+
Fig. (i. — Caudal region of embryo of 14 nun. (No. 144 of Dr. Mall's collection), combined from several sagittal sections. An.^ auus; .lo., caudal aorta (.1. sncn/?«s Bi«?ia) ; ^'oi. ,/r7., caudal lilament; CA., notochord; ilcd., medullary cord ; S. iii/., ximix iiroi/eiiilulis : I'. :i:i, third coccygeal vertebra; ;i(i, seventh coccygeal vertebra; V. c. i'., caudal portion of fena ctnut ivffflor ( P. ann-aUs mcfjia}. x 1)1.
  
Ecker" and His were the first to give detailed descriptions of the caudal region of the human embryo. Their conclusions regarding its definition and ultimate development may be taken as the starting point in the discussion of the subject. The agi-eemeut reached by Ecker and His may be rendered in part as follows:'" (1) The term "tail" may be applied only to that portion of the embryo which projects free beyond the cloaca. (2) The tail consists of a portion containing vertebrae and a portion without vertebra3 (caudal tUament). The latter contains only notochord and medullary cord. (3) Only the non-vertebral portion atrophies. The vertebral portion remains for some time as the coccygeal prominence (Sleisshbchcr), which, however, gradually disappears in consequence of the increase in the curvature of the sacrum and coccyx, and of the progressive development of the pelvic girdle and its musculature.
 
  
Two matters which have a bearing upon the morphological significance of the ])crsisting caudal appendages in man are brought up in the above for consideration. The one concerns the structure of the tail in the human embryo in comparison with the tail in lower forms; the other is the nature and amount of regressive change which takes place in the human tail during development.
 
  
Regarding the first, Keibel " discovered an additional fact (if importance in the presence of a post-anal gut in the human embryo. Braun's" observations on' the caudal filament of mammalian and bird embryos are of importance in showing that the caudal filament is of general occurrence and not a ]ieculiarity of the human tail. Again, the occurrence of spinal nerves and ganglia in a number of the coccygeal seg
+
April-May-June, 1901.
  
  
■- A. Ecker: Archiv f. Aiitbroiiol., Bil. xii, ISSO.
 
  
A. Ecker: Besitzt der menscliliche Emliiyo eiuen Scbwanz? Archiv f. Anat. n. Physiol, auat. Abtheil., ISSO.
+
JOHNS HOPKINS HOSPITAL BULLETIN.
  
ss W. His: Anatomie mensclilicher Embryoneii, I, Leipzig, 1880.
 
  
W. His: Ueber den Schwanztheil des menscblieben Embryo. Archiv f. Anat. u. Physiol, anat. AbtheiL, 1880.
 
  
-9 A. Ecker: Replik und compromissitzc nebst Scblusserkarung von W. His. Archiv f. Anat. u. Physiol, anat. AbtheiL, ISSO.
+
101
  
' Fr. Kevbel : Ueber den Scbwanz des menschliclien Embryo. Archiv
 
f. Anat. u. Physiol, anat. AbthieL, 1891.
 
  
31 M. Braun: Eutwicklungsvorgantre am Schwanzende bci eiuigen Siiugethiereu mit Beriicksicbtigung der Verhiiltuisse beim Menschen. Archiv f. Anat. u. Phys. anat. AbtheiL, 1883.
 
  
 +
Observer.
  
  
ments, as shown by Fol," Phisalix '^ and Keibel, the continuation of the aorta and vena cava into the caudal filament, together with the presence of segmental arteries and the hypapophyses or rudimentary hjemal arches in all of the coccygeal segments as described in the present paper, show that the caudal region of the human embryo resembles that of other mammalian embryos in all respects except in size and in the number of its segments.
 
  
Concerning the regressive development of the tail considerable difference of opinion has been expressed. Rosenberg, who holds that, strictly speaking, the caudal rudiment in man is not the homologue of the tail of other animals, but is the result of a precocious growth of the medullary cord," considers that the appendage disappears in consequence of the increase in volume of that end of the embryonic body and not through absorption. His,'" in supporting Rosenberg, makes the statement that no reduction in the number of segments takes place during the development of the human embryo, but that the regressive changes are confined to the caudal filament; this view is confirmed in the agreement with Ecker. On the other hand, Fol and Phisalix find thirty-eight segments in embryos of 8-10 mm., with indications that several of these disappear through fusion in the course of development. Allowing for the- possibility that these observers have counted in an occipital segment, there would be in embryos of this size at least thirty-seven trunk segments, which would correspond to thirty-six vertebra3. Keibel finds in an embryo of 8 mm. thirty-five trunk segments, together with a mass of unsegmentcd mesoderm, equaling two segments in length. Reckoning this as two instead of one segment, as Keibel does, we have again thirty-seven segment.^, corresponding to thirty-six vertebrae.
+
Longtli
  
The following is an attempt to tabulate the number of segments found in embryos varying in length from 7.5 to 21.5 mm. With the exception of the last column the data are as recorded by the observers themselves. In the last column the number of vertebrse is given which would correspond to the total number of segments after certain changes have been made, such as deduction of occipital segments or addition of unsegmented mesoderm, which seemed justified by the descriptions of the authors.
+
of embryo
  
 +
in mm.
  
  
3- H. Fol: Sur la queue dc rciubryon humain. Comptes Reudus, T. 100, Paris, 188.5.
 
  
33 C. Phisalix: Etude d'uu embryon humain de ID milliniotres. Archives de Zool. Exp. et Gen. II"" S., T. vi, ISSS.
+
Seg-meuts in mesoderm.
  
■» E. Rosenberg: Ueber die Eutwickeluug der Wirbelsaule und das centrale carpi des Menschen. Morphol. Jahrb., Bd. i, 187G. "... dass die Gestaltung des hinteren Lcibesendes ebeutalls von dem MeduUarohr derart beeinflusst wird, dass letzteres, indem es in seinem Liingenwachsthnm dem der anderen, un der Zusammensetzuug des hinteren Lcibesendes Theilhabenden Bestandtheile vorauseilt, an demselben eiuen Vorspruug erzengt. ..." p. 138.
 
  
35 " Es werdeu demnach beim menscblieben Embryo keine iiberzahligen zur Riickbildung bestimmten Segmeute augelegt." Auatomie menschlicher Embryonen, i, p. 93.
 
  
 +
Spinal gjinglia.
  
  
THE JOHNS HOPKINS HOSPITAL BULLETIN, APRIL-MAY-JUNE, 1901.
 
  
 +
Correspoudinj?
  
 +
numlier of
  
PLATE XVII.
+
Vertebnu. Aertel)nr after
  
 +
allowing for
  
 +
corrections.
  
  
  
Fi(i. 1. — I'liotnf;raiiU sliDWiiii;' tail ill exteiuleil cuiuliticiii.
+
His 7..5
  
 +
Keibel S.O*
  
 +
Fol S.0-9.0
  
Fiu. 2. — Pliutuyrapli sliowini;' tail in state of ccjiitractioii.
+
Phisalix 10.0
  
 +
Keibel 11.5*
  
 +
Fol 13.0
  
 +
Harrison . . . 14.0
  
Fig. ;!. — PiKitof^iapli sliowinu; tlie ventral surface of tail.
+
Harrison ... 16
  
 +
His 16.0
  
 +
Rosenberg. . 16.5
  
THE JOHNS HOPKINS HOSPITAL BULLETIN, APRIL-MAY-JUNE, 1901.
+
Fol 19.0
  
 +
Rosenberg . . 19.6
  
 +
His 21.5
  
PLATE XVIII.
 
  
  
 +
S.'i 35 _L uiiseEmeiited
  
 +
meaoderni.
  
--M
+
38 —
  
 +
38 SG
  
 +
35 _|_ uueeKnienteil 34 meHcideriii.
  
Fin. 4. — Frontal sections of tail, showing the arranifcnient of the muscle tibres (.V). a. Place from whicli the cross-section represented in Fii;. .5 was taken. x 3.
 
  
  
 +
33
  
 +
33
  
W/i/i\tl
 
  
  
 +
34
  
Fig. .5, — Cross-section through the middle of the tail (Fig. 4, a). M, iinisclc; J/', degenerating muscle ; .1, artery; jV, nerve; i is jilaced on the left and It on the right of the apiicndage. x SI.
+
36
  
 +
35 36 36 37 34 33 34 35 34
  
  
  
Hari-ison del.
+
34
  
 +
36+
  
 +
36
  
Fig. (i. — Caudal region of embryo of 14 nun. (No. 144 of Dr. Mall's collection), combined from several sagittal sections. An.^ auus; .lo., caudal aorta (.1. sncn/?«s Bi«?ia) ; ^'oi. ,/r7., caudal lilament; CA., notochord; ilcd., medullary cord ; S. iii/., ximix iiroi/eiiilulis : I'. :i:i, third coccygeal vertebra; ;i(i, seventh coccygeal vertebra; V. c. i'., caudal portion of fena ctnut ivffflor ( P. ann-aUs mcfjia}. x 1)1.
+
36
  
 +
36+
  
 +
36
  
April-May-June, 1901.
+
36
  
 +
37
  
 +
34
  
JOHNS HOPKINS HOSPITAL BULLETIN.
+
33
  
 +
34
  
 +
35
  
101
+
34
  
  
  
Observer.
+
Neck-breech measurement.
 +
t Counting the terminal mesoderm as criui\'aleiit to two segments.
  
 +
From this it may be seen that the number of vertebrae or their equivalent is fairly if not quite constant in embryos between eight and sixteen millimeters in length. We have, then, seven vertebrae in the embryonic tail at its highest period of development. The stages studied by His and by Eosenberg were either too young or too far advanced to show the maximum number of vertebrae. That the reduction takes place by fusion, as is maintained by Fol, is confirmed by the study of the embryos described above. In the older embryo (16 mm.), in which an exceptionally large number of segments was present, partial fusion between several of the adjacent vertebrse had taken place. In still older embryos, as seen in the table, the number of segments is inconstant; most probably this is due to the varying extent to which fusion has taken place, though it is possible that it may be due in part to a difference in the original number. As Steinbach ■" shows, the usual number of segments is thirty-four, i. e. five coccygeal, although the number may be less or, in I'are instances, even increased by one.
  
 +
The spinal ganglia of the caudal region, as Keibel has shown, also suffer reduction. There are never quite so many ganglia developed as vertebrse, and the last ones are always more or less rudimentary; but there are always more formed than persist in the adult. For instance, in an embryo of 10 mm. Phisalix described thirty-six ganglia; in an embryo of 11.5 mm. Keibel found thirty-four; in the embryo of 14 mm. described above there were thirty-three, and in the embryo of 16 mm. thirty-two, while in the adult there are but thirtyone. The segmental arteries of the distal caudal segments also become obliterated as development proceeds.
  
Longtli
+
We conclude, then, with Keibel that, while as far as outward form is concerned the embryonic tail disappears largely as a result of the growth of the extremities and the gluteal region, a certain amount of regressive change takes place in the caudal appendage itself. This is manifest not only in the
  
of embryo
 
  
in mm.
 
  
 +
3« E. Steinbach : Die zabl der CiUidalwirbel beim Mensolieu. mss., Berlin, 1S89.
  
  
Seg-meuts in mesoderm.
 
  
 +
luaut;
  
  
Spinal gjinglia.
 
  
 +
absorption of the caudal filament, as supposed by Ecker and His, but also in the reduction of all essential structures of the vertebral portion of the tail, i. e. the vertebrae, muscle segments, spinal ganglia and blood-vessels. It is interesting to note that in this tendency to reduction the resemblance between human and other mammalian tails also holds. The caudal filament, as Braun has shown, is present in other embryos and atrophies as development proceeds. The tendency to fusion of the distal vertebra? has been observed in the embryos of various long-tailed animals. And in shorttailed varieties, as Bonnet has shown, this tendency is merely accentuated."
  
 +
The view that a great many of the anomalous caudal appendages found in man are, as stated in the beginning, due to the persistence of the embryonic tail, is warranted by the facts gathered both from the study of the former as well as of the latter. Many of the differences in form are explained by the hypothesis of Bartels that tlie embryonic tail may be arrested in any stage of its development. The soft or boneless tails are clearly not due to the multiplication of vertebra; or even to the persistence of all which are developed in the emluyn, but, as His ™ first suggested, are to be regarded as persisting caudal filaments. The usual position of these appendages as well as their structure support this conclusion. The fact that they are not always attached exactly over the tip of the coccyx cannot be regarded as conflicting with this view, for, as has long been recognized, the curvature in the vertebral column, especially m the sacral and coccygeal regions, changes markedly during" development, and the caudal filament not being firmly united to the tip of the coccyx might easily be shifted slightly in relation to the latter.
  
Correspoudinj?
+
In the action of amniotic adhesions Schaeffer^" has suggested a cause which may undoubtedly bring about the persistence of the caudal filament, for it is a fact that in many, perhaps in a majority of the cases there are other evidences of such adhesions having been present, and, as Schaeffer points out, the caudal region, like other projecting portions of the embryo, is especially liable to stick to the amnion. The adhesions are to be regarded, however, merely ns a factor which may induce the persistence of an otherwise transitory structure and it does not follow that such persistence is always the result of adhesions. On the contrary, we find in certain animals that the caudal filament normally persists. According to Braun, this is probably the origin of the tail-stump, composed of areolar tissue, found in Inuus pithecus, and similar apendages are also found sometimes in the Ciiimpansee, as Eosenberg has described.
  
numlier of
 
  
Vertebnu. Aertel)nr after
 
  
allowing for
+
" R. Bonnet: Uio Rtiunnudscliw;in/.ii;en Hunde ini llinblich aiif die Vererbung erworbener EiKeuseliatteii. Zeigler's Beitriine z. path. .\nat. u. alli;. Pathol., Bd. iv, 18S9.
  
corrections.
+
■'" Anatomie meuschlicher Embryonen, i, p. 95.
  
 +
™ Archlv f. Anthroiiol., Bd. xx, 1S93, p. 319.
  
  
His 7..5
 
  
Keibel S.O*
+
102
  
Fol S.0-9.0
 
  
Phisalix 10.0
 
  
Keibel 11.5*
+
JOHNS HOPKINS HOSPITAL BULLETIN.
  
Fol 13.0
 
  
Harrison . . . 14.0
 
  
Harrison ... 16
+
[Nos. 121-133-133.
  
His 16.0
 
  
Rosenberg. . 16.5
 
  
Fol 19.0
+
===DEVELOPMENT OF THE PIG'S INTESTINE===
  
Rosenberg . . 19.6
+
By John Beuce MacCallum, M. T>., Assistant in Anatomy, Johns Hopkins University.
  
His 21.5
 
  
  
 +
By the work of Henke' and of AVeinberg' it was first shown that the various parts of the human intestine hold a definite relative position in the body. But it was not until 1897, when the researches of Mall' were published, that this subject was put on a satisfactory basis. Professor Mall described in detail the development of the human intestine, the protrusion of loops into the cosloni of the umbilical cord and their return to the general body-cavity. He traced the various loops through different stages in their development and showed that in the human adult these loops are massed together into definite groups, which maintain a constant position in the abdominal cavity.
  
S.'i 35 _L uiiseEmeiited
+
Merkel,' in his handbook, has considered all the literature on the subject and has given a description of his own work, the results of which are in accord with those of Mall.
  
meaoderni.
+
Dexter " has lately described the development of the intestine of the cat. He finds no definite arrangement of the intestinal loops to be present in this animal.
  
38 —
+
The following notes were made in the study of a considerable number of pig's embryos:
  
38 SG
+
Methods and Material.
  
35 _|_ uueeKnienteil 34 meHcideriii.
+
In this study there was used a series of pig's embryos varying in length from IS mm. to 13 cm. An attempt was made to obtain embryos with each stage, showing only the least possible advance on the one preceding it. In some stages several embryos from the same uterus were examined in order to determine the constancy of the loops of intestine in individuals of the same age. Types chosen from the various large groups of lower animals were also studied.
  
 +
The only method used was one of direct dissection. The embryos were hardened in formalin or alcohol, which rendered the intestines firm and not easily displaced. The abdominal cavity was opened and the liver carefully lifted away and dissected out under water. The Wolfiian body and kidney were similarly removed. The umbilical cord was then laid open to expose that part of the coelom which it contained. In this way the intestines could be well isolated without disturbing them in the least. Starting, then, with the stomach the various loops were followed and modeled with copper wire. Tliis could be bent so as to accurately represent the direction of each loop, and the general position of the loops of wire could be constantly compared with that of the intestinal loops, so that very little error could arise. On reaching the anus
  
  
33
 
  
33
+
'Henke; Arch. f. Anat. uud Pliys. Anat. Abtb., IS'.M, S."89. 5 Weinberg; Internat. Monatsch. f. Anat. und Pliys., xiii Bd., 1896. 2 Mall, F. P. ; Arch. f. Anat. und Entwickeluug. Anat. Abth. Supplementbaud, S. 403, 1807; and Anatom. Anz. Bd. 10, S. 4!)3, 1899. ■•Merkel; Handbuch der Topographischen Anatomic, ii Bd., 1899. 5 Dexter, F. ; Arch. f. Anat, und Phys., Anat. Abth., 1899.
  
  
  
34
+
the whole intestine was gone over again starting with the rectum and ending in the stomach. In this way any error could be well controlled. The whole model was then compared again with the emljryo to see that the surface coils corresponded. To aid in drawing and studying these models the various groups of coils were painted in different colors. The same method was employed in the study of the lower animals. In the simpler types, however, the wire models were unnecessary. In the earliest embryos also the arrangement could be made out perfectly well without modeling.
  
36
+
Description of Dissections.
  
35 36 36 37 34 33 34 35 34
+
Until the embryonic pig has reached a length of about 10 mm. there is in every case some part of the intestine in the umbilical cord. The portion nearest the stomach develops entirely outside the cord; while what corresponds with the lower end of the ileum, together with the coecum and a short stretch of the large intestine, remain in the cord until the stage mentioned above. The part in the neighborhood of the coecum is the last to leave the cord. All the loops which develop within the cord belong to the part of the intestine corresponding in position with the lower end of the ileum. This develops more slowly than the intra-abdominal portion of the gut.
  
 +
In the following descriptions the terms " right " and " left " refer to the pig's body and not to the figures tlicmselves. "Anterior" and "posterior" refer to the head and tail ends respectively; while the terms "dorsal" and "ventral" are used in their ordinary sense. The figures are all drawn from the right side of the embryo's body unless otherwise indicated.
  
 +
Figure 1 represents an early stage in the development of the pig's embryo, in which tlie intestine consists of a single loop extending out into the umbilical cord. The embryo itself is 13 mm. long and the loop in the cord is slightly less than 3 mm. in length. This loop is somewhat curved with the concave surface towards the head. As represented in Fig. 1 the intestine is sharply bent on itself in the cord, and on its return to the main body-cavity it turns at an acute angle to form the rectum. I can discover no trace of a ccecum at this stage other tlian a slight enlargement of the tube just after it bends in the cord. The arm of the loop which extends from the stomach into the cord is destined to give rise to the small intestine; while the arm returning from the cord to tlie rectum is, roughly speaking, the forerunner of the large intestine. Several embryos of this size were examined, and the condition described above found to be constant.
  
34
+
In Fig. 2 there is shown the dissection of a pig's embryo, 18 mm. in length. The loop of intestine extending into the cord is much like that represented in Fig. 1. A distinct coecum, however, can be made out in the rectal arm of the
  
36+
 
  
36
 
  
36
+
Ai'ril-.May-,Ii-.ve, 1901.]
  
36+
 
  
36
 
  
36
+
JOHNS HOPKINS HOSPITAL BULLETIN.
  
37
 
  
34
 
  
33
+
103
  
34
 
  
35
 
  
34
+
loop, a short distance from where the intestine bends on itself. This coecum is a short blind sac having an appearance very much like that shown in the iigurc. It will be noticed tliat a considerable part of the body-cavity is, in this stage, in tlie umbilical cord. Fully luilf the length of tlie intestine is contained in this extra-abdominal cielom. Just inside the main body-cavity a loop is beginning to 1)e formed in the small intestine. Its bends are marked 1, 'i and .'5. From the stomach it extends dorsally and to the right. Turning sharply it runs ventrally and to the left, and lieforo entering the cord it ))roceeds again posteriorly. On cumparing Figs. 1 and 2, there is seen a greater change in this part of the intestine near the stomach than in the part contained in the cord. The large intestine beginning at tliu cnn-um turns and passes into the rectum as before. Several enibryos of this size showed an identical structure.
  
 +
Fig. 3 represents a pig 21 mm. long. The portion of the intestine in the cord is still unchanged, while that in the body-cavity jirojier .shows a further development of the same loops seen in Fig. 2. In comparing the numbers on the two figures there is no ditficulty in recognizing the corresponding parts. The ca?eum holds the same relative position as in Fig. 2. After entering the cord at the loo]) 3 in Fig. 3 the intestine l)ends in a curve with the concave side towards the head. It then turns abruptly backward and to the left, and returns to the main body-cavity by almost the same path. This is represented i)lainly in Fig 3, and it will lie noticed in the succeeding stages that this particular arrangement of the intestine as it turns is quite characteristic.
  
 +
Fig. 4 shows a somewhat more advanced stage in the develojnnent. It is drawn from the dissection of a pig 23 mm. long. The general position of the intestine is very similar to that just described. The loops, however, have increased in number; and instead of one entire loop, as represented in Fig. 3, there are three, indicated by the letters a. h and c in Fig. 4, B. In Fig. 3 the stomach narrows into the small intestine, which bends rather aliruptly, and forms one complete loop overlying the large intestine. In Fig. 4 the same thing occurs, but following this tirst loop are two others. As shown in the figures there is a tendency for the loops to grow around the large intestine from the right side. The large intestine is on the left side of the small intestine and somewhat anterior. The part of the small intestine contained in the cord is less changed, and its growth is apparently somewhat slower. There is, however, to be seen the beginning of a new coil marked x in Fig. 4, B. This is an incompletelyformed loop and shows well the way in which the loops develop. It is simply a bending, as though the intestine had grown too long for the space it was obliged to occupy. Before reaching the ccecum the small intestine turns on itself in the characteristic way described in Fig. 3. The large intestine is unchanged.
  
Neck-breech measurement.
+
In Fig. 5 the same loops are seen in the first part of the small intestine, and those marked a, b and c correspond fairly wtII. In the cord, however, there are here too loops instead of the one shown in Fig. 4. These occur in the small
t Counting the terminal mesoderm as criui\'aleiit to two segments.
 
  
From this it may be seen that the number of vertebrae or their equivalent is fairly if not quite constant in embryos between eight and sixteen millimeters in length. We have, then, seven vertebrae in the embryonic tail at its highest period of development. The stages studied by His and by Eosenberg were either too young or too far advanced to show the maximum number of vertebrae. That the reduction takes place by fusion, as is maintained by Fol, is confirmed by the study of the embryos described above. In the older embryo (16 mm.), in which an exceptionally large number of segments was present, partial fusion between several of the adjacent vertebrse had taken place. In still older embryos, as seen in the table, the number of segments is inconstant; most probably this is due to the varying extent to which fusion has taken place, though it is possible that it may be due in part to a difference in the original number. As Steinbach ■" shows, the usual number of segments is thirty-four, i. e. five coccygeal, although the number may be less or, in I'are instances, even increased by one.
 
  
The spinal ganglia of the caudal region, as Keibel has shown, also suffer reduction. There are never quite so many ganglia developed as vertebrse, and the last ones are always more or less rudimentary; but there are always more formed than persist in the adult. For instance, in an embryo of 10 mm. Phisalix described thirty-six ganglia; in an embryo of 11.5 mm. Keibel found thirty-four; in the embryo of 14 mm. described above there were thirty-three, and in the embryo of 16 mm. thirty-two, while in the adult there are but thirtyone. The segmental arteries of the distal caudal segments also become obliterated as development proceeds.
 
  
We conclude, then, with Keibel that, while as far as outward form is concerned the embryonic tail disappears largely as a result of the growth of the extremities and the gluteal region, a certain amount of regressive change takes place in the caudal appendage itself. This is manifest not only in the
+
intestine ojipositc the ccecum and have relatively the same position as the bending of the tube marked .v in Fig. 4. They are lettered .v and // in Fig. -5. The remainder of the intestine is the same as in Fig. 4. The length of this pig was 25 mm.
  
 +
Fig. (i represents the intestine of a pig of approximately the same length a? that shown in Fig. 5. The small intestine in the main body-cavity, however, is slightly more advanced in develo])ment. The various loops can be readily recognized and niiuli more easily so on the wii'c model than on the drawing. A very slight change in the general position of a loop causes a most decided dilference in a flat drawing. The main difference, for example, between Figs. .5 and t), is the dislocation of the loop z towards the stomach. By comjjaring the lettering in the two figures this can be easily understood. The part of the intestine in the cord is practically the same in the two figures.
  
 +
Thus far the large intestine is a simple lube bending shar])ly near the stomach to form the rectum. 11 will be noticed that the small intestine has grown much more rapidly than the large iiitestiiu'; and also that the part of the small intestine neai' the stomach has increased in length uu:ire rajv idly than the part in the cord. Several jiigs, the same size as these last two described, were examined, ami their intestines fomid to be similar in every way. Endiryos tiiken from the same uterus did not seem to resemble one another in this respect more closely than pigs of the same length from different uteri.
  
3« E. Steinbach : Die zabl der CiUidalwirbel beim Mensolieu. mss., Berlin, 1S89.
+
Fig. 7 represents a dissection of a pig's embryo 28 mm. in length, and Fig. 8 is a drawing of the wire model made from this intestine. The stomach, it will be seen, occupies the same position and narrows into the small intestine in the same way as before The small intestine here forms a distinct mass of loops in the nuiin body-cavity, and then extends out into the cord in a manner identical with that shown in earlier endiryos. The loops form a cone-shaped mass with the base of the cone towards the stomach and its apex in the umbilical cord. This is due to the more rapid growth of that part of the small intestine near the stomach. This arrangement will be noticed in all the older embryos as well until after all the coils have returned to the main body-cavity. It is a little unsatisfactory to attempt to follow the individual coils of the intestine, and to trace them from one endjryo to another after their arrangement has reached a complexity as great as that shown in Fig. 8 and the figures following. But if the two models represented in Figs 6 and 8 be compared, there will be seen a certain correspondence which can hardly be overlooked. The identity of the two loops in the cord marked .r and // is recognized at first glance. In this part of the intestine there seems to have been very little if any change. The coils near the stomach, however, are distiiutly more complicated in Fig. 8 than in Fig. 6. The slight bend in Fig. 6 marked e is accentuated into the loop marked r in Fig. 8. The letters a and z mark corresponding parts in the two figures; and the loop b can be readily derived in Fig. 8 from the b in Fig. 6. Following this, however, there are in Fig. 8 three distinct loops, c, d and
  
  
  
luaut;
+
104
  
  
  
absorption of the caudal filament, as supposed by Ecker and His, but also in the reduction of all essential structures of the vertebral portion of the tail, i. e. the vertebrae, muscle segments, spinal ganglia and blood-vessels. It is interesting to note that in this tendency to reduction the resemblance between human and other mammalian tails also holds. The caudal filament, as Braun has shown, is present in other embryos and atrophies as development proceeds. The tendency to fusion of the distal vertebra? has been observed in the embryos of various long-tailed animals. And in shorttailed varieties, as Bonnet has shown, this tendency is merely accentuated."
+
JOHNS HOPKINS HOSPITAL BULLETIN.
  
The view that a great many of the anomalous caudal appendages found in man are, as stated in the beginning, due to the persistence of the embryonic tail, is warranted by the facts gathered both from the study of the former as well as of the latter. Many of the differences in form are explained by the hypothesis of Bartels that tlie embryonic tail may be arrested in any stage of its development. The soft or boneless tails are clearly not due to the multiplication of vertebra; or even to the persistence of all which are developed in the emluyn, but, as His ™ first suggested, are to be regarded as persisting caudal filaments. The usual position of these appendages as well as their structure support this conclusion. The fact that they are not always attached exactly over the tip of the coccyx cannot be regarded as conflicting with this view, for, as has long been recognized, the curvature in the vertebral column, especially m the sacral and coccygeal regions, changes markedly during" development, and the caudal filament not being firmly united to the tip of the coccyx might easily be shifted slightly in relation to the latter.
 
  
In the action of amniotic adhesions Schaeffer^" has suggested a cause which may undoubtedly bring about the persistence of the caudal filament, for it is a fact that in many, perhaps in a majority of the cases there are other evidences of such adhesions having been present, and, as Schaeffer points out, the caudal region, like other projecting portions of the embryo, is especially liable to stick to the amnion. The adhesions are to be regarded, however, merely ns a factor which may induce the persistence of an otherwise transitory structure and it does not follow that such persistence is always the result of adhesions. On the contrary, we find in certain animals that the caudal filament normally persists. According to Braun, this is probably the origin of the tail-stump, composed of areolar tissue, found in Inuus pithecus, and similar apendages are also found sometimes in the Ciiimpansee, as Eosenberg has described.
 
  
 +
[Nos. 121-132-133.
  
  
" R. Bonnet: Uio Rtiunnudscliw;in/.ii;en Hunde ini llinblich aiif die Vererbung erworbener EiKeuseliatteii. Zeigler's Beitriine z. path. .\nat. u. alli;. Pathol., Bd. iv, 18S9.
 
  
■'" Anatomie meuschlicher Embryonen, i, p. 95.
+
f, without counting x and y; wliile in Fig. 6 there is only one without considering x and y. At d in Fig. 6 there is the beginning of a new loop, as yet only a slight bending in the tube, and c corresponds with one of the three loops spoken of in Fig. 8. There is then in Fig. 6 only one entirely new loop not indicated in Fig. 6.
  
™ Archlv f. Anthroiiol., Bd. xx, 1S93, p. 319.
+
The copcum maintains the same position in Fig. 8 as in Fig. 6. The bend in the large intestine, however, where it passes into the rectum, shows quite a distinct alteration. It no longer forms a simi^le acute angle with the rectum, but is bent in two directions as shown in Fig. 8. This is the beginning of the formation of a very distinct group of convolutions which is perfectly constant and will be descrilu'd below.
  
 +
The general tendency in the formation of new loops in the small intestine is for the tube to become slightly bent on itself and to grow around an axis which is represented by the large intestine. The characteristic shape of the loops is shown iu Fig. 8, d and /. The loops do not meet above (on the surface towards the head of the embryo); for the large intestine is situated between the bends of the loops. in such a way that it could be lifted away from the small intestine by drawing it towards tlie head, but not by drawing it towards the tail of the embryo. The arrangement becomes less regular the nearer it is to the stomach, for the gi-owth in this rc'gion is more rapid and the pressure exerted on the coils greater than in other jiarts.
  
 +
Fig. 9 represents tlie dissection and Fig. 10 the model of the intestines of a pig 30 mm. long. The general position of the various parts is much like that in Fig. 8. By following the letters on Figs. S and 10 the corresponding loops can be made out. There are yet no groups of coils to be distinguished. Tlie small intestine can be roughly compared with a hollow^ cone whose axis is represented by tlie large intestine. The loops ;r and ?/ have become more fully developed and grow around the large intestine in the characteristic fashion. The loops in the figures arc lettered only on the right side, since they arc in a certain sense duplicated on the left side of the large intestine. A loop, however, is a fold which begins and ends somewhere in the same neighborhood; and it might be possible to take the median line as the starting point, and make loops on either side; but it is much simpler to treat as complete loops only those folds which start on one side and return to that side.
  
102
+
The large intestine in Fig. 10 holds a straight course from the ccecuin until it reaches the stomach. It then makes a complete Ijeiid on itself and enters the rectum as shown in Fig. 10, g.
  
 +
Fig. 11 is the dissection of a pig 32 mm. long, and Fig. 12 is a drawing of the model made from its intestinal canal. A certain general resemblance in outline is seen between Figs. 10 and 12. The intestine is a cone-shaped mass in each with the apex extending a short distance into the cord and the large intestine forming an axis for the cone. The arrangement of the small intestine in relation to the large intestine is the same as that spoken of before. The loops
  
  
JOHNS HOPKINS HOSPITAL BULLETIN.
 
  
 +
are bent around the axis of the large intestine, especially near the apex of the cone, i. e. near the cord. At the stomach end the gut has become so twisted that the individual loops cannot be traced with any satisfaction. Certain landmarks, however, can be recognized. For example, the loops .r, y, f and d correspond fairly well in the two stages, and it is not difficult to conceive of the transformation of the loop c in Fig. 10 to the same loop in Fig. 12. This transformation takes place by a flattening of the loop which will be spoken of later. It gives rise to a figure which is often seen in the intestines of pig's embryos.
  
 +
Although the loops can no longer be individually followed with ease, there begins at this stage to arise a grouping of the coils. In Fig. 12 four fairly distinct groups can be made out. Starting with the stomach end the intestine forms a mass of loops which are situated mainly on the left side of the body. In no place does a whole coil of this grouji reach the surface of the intestinal cone on the right side. Thi.s will be called group A. After bending in five or six loops, as represented in the more liglitly shaded part of Fig. 13 near the stomach, the gut reaches the right side and forms a group of more or less flattened coils, which form all the surface coils of the right side up to nearly the beginning of the cord. This group is shaded darkly in Fig. 12 and ends after the loop marked d. It includes the coil c described above and will be designated group C. The intestine leaves this region at the termination of loop d, and forms three complete loops of the type described in earlier embryos. These are unshaded in Fig. 13 and include /, x and //. They form the group />. These coils are associated more closely than the rest of the intestine with the cadoni of the c(n'd. At the end of this group the small intestine takes a straight path for a short distance and turns on itself in the way seen in all the embryos so far pictured, and enters the large intestine at the cn?cuiii. The large intestine is straight as before until it reaches the region whei'e it turns to form the rectum. Here it is thrown into irregular twists, as shown in Fig. 13, E. The convolutimis formed in this region will be spoken of as the rectal group or group E, and will be followed through the various embryos. At this stage it is directly anterior (towards the head) and lies partly between the groups A and C.
  
[Nos. 121-133-133.
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Fig. 13 represents the model of the intestine of an embryo 40 mm. in length. The general outline of the mass of coils is, as before, cone-shaped. This is accentuated by the increasing complexity of the rectal group, and by the rapidity of growth of the first ])art of the small intestine. The same groups described above can be recognized at this stage. The group .1 has increased consideral)ly in length in Fig. 13 and can be divided into two groups which are marked .1 and B in Fig. 13, 11. These become more distinct in later stages. From B the gut passes over to the right side of the body and forms the group C which is situated entirely on the right side, and makes up* most of the surface coils there. This is shaded in Fig. 13, I. On approaching the cord there are found the three complete loops described in Fig. 12, as making up group D. These are almost identical iu the two stages, auu
  
  
  
DEVELOPMEIST OF THE PIG'S INTESTINE.
+
April-May-Juxe, 1901.]
  
By John Beuce MacCallum, M. T>., Assistant in Anatomy, Johns Hopkins University.
 
  
  
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JOHNS HOPKINS HOSPITAL BULLETIN.
  
By the work of Henke' and of AVeinberg' it was first shown that the various parts of the human intestine hold a definite relative position in the body. But it was not until 1897, when the researches of Mall' were published, that this subject was put on a satisfactory basis. Professor Mall described in detail the development of the human intestine, the protrusion of loops into the cosloni of the umbilical cord and their return to the general body-cavity. He traced the various loops through different stages in their development and showed that in the human adult these loops are massed together into definite groups, which maintain a constant position in the abdominal cavity.
 
  
Merkel,' in his handbook, has considered all the literature on the subject and has given a description of his own work, the results of which are in accord with those of Mall.
 
  
Dexter " has lately described the development of the intestine of the cat. He finds no definite arrangement of the intestinal loops to be present in this animal.
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105
  
The following notes were made in the study of a considerable number of pig's embryos:
 
  
Methods and Material.
 
  
In this study there was used a series of pig's embryos varying in length from IS mm. to 13 cm. An attempt was made to obtain embryos with each stage, showing only the least possible advance on the one preceding it. In some stages several embryos from the same uterus were examined in order to determine the constancy of the loops of intestine in individuals of the same age. Types chosen from the various large groups of lower animals were also studied.
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extend into the ccrloniie cavity of tlie cord, which has become gradually more shallow. TIic rectal group is more complex than in the preceding stages and forms a conspicuous mass of coils whose calibre is noticealily smaller than in the rest of the intestine. Its position also has altered. Instead of lying between groups .1 and (', it is to tlie right of C, having rotated on an axis corresponding ap]u-oximately with that of the cord. Figs. 14 and 15 represent the dissection and model resjiectively of the intestine nf an endiryo 4.S nun. in length. At this stage all the coils are within the main liody-eavity. The
  
The only method used was one of direct dissection. The embryos were hardened in formalin or alcohol, which rendered the intestines firm and not easily displaced. The abdominal cavity was opened and the liver carefully lifted away and dissected out under water. The Wolfiian body and kidney were similarly removed. The umbilical cord was then laid open to expose that part of the coelom which it contained. In this way the intestines could be well isolated without disturbing them in the least. Starting, then, with the stomach the various loops were followed and modeled with copper wire. Tliis could be bent so as to accurately represent the direction of each loop, and the general position of the loops of wire could be constantly compared with that of the intestinal loops, so that very little error could arise. On reaching the anus
 
  
  
 +
large intestine begins on the right side of group D, a short distance from its a])ex. The coecum corresponds fairly well in position with that in Fig. 13. On leaving the eoecum, liowever, the large intestine passes obliquely down on the right surface of group C, and is coiled to form the rectal group, posterior to groups .1 and B. Fig. 14 does not justly rejtresent the regularity of the looj)s nuiking up group C. They form a series lying transversely from right to left, and can be easily separated in a mass from group D on the one hand, and croups A and B on the other.
  
'Henke; Arch. f. Anat. uud Pliys. Anat. Abtb., IS'.M, S."89. 5 Weinberg; Internat. Monatsch. f. Anat. und Pliys., xiii Bd., 1896. 2 Mall, F. P. ; Arch. f. Anat. und Entwickeluug. Anat. Abth. Supplementbaud, S. 403, 1807; and Anatom. Anz. Bd. 10, S. 4!)3, 1899. ■•Merkel; Handbuch der Topographischen Anatomic, ii Bd., 1899. 5 Dexter, F. ; Arch. f. Anat, und Phys., Anat. Abth., 1899.
 
  
  
  
the whole intestine was gone over again starting with the rectum and ending in the stomach. In this way any error could be well controlled. The whole model was then compared again with the emljryo to see that the surface coils corresponded. To aid in drawing and studying these models the various groups of coils were painted in different colors. The same method was employed in the study of the lower animals. In the simpler types, however, the wire models were unnecessary. In the earliest embryos also the arrangement could be made out perfectly well without modeling.
+
X
  
Description of Dissections.
 
  
Until the embryonic pig has reached a length of about 10 mm. there is in every case some part of the intestine in the umbilical cord. The portion nearest the stomach develops entirely outside the cord; while what corresponds with the lower end of the ileum, together with the coecum and a short stretch of the large intestine, remain in the cord until the stage mentioned above. The part in the neighborhood of the coecum is the last to leave the cord. All the loops which develop within the cord belong to the part of the intestine corresponding in position with the lower end of the ileum. This develops more slowly than the intra-abdominal portion of the gut.
 
  
In the following descriptions the terms " right " and " left " refer to the pig's body and not to the figures tlicmselves. "Anterior" and "posterior" refer to the head and tail ends respectively; while the terms "dorsal" and "ventral" are used in their ordinary sense. The figures are all drawn from the right side of the embryo's body unless otherwise indicated.
 
  
Figure 1 represents an early stage in the development of the pig's embryo, in which tlie intestine consists of a single loop extending out into the umbilical cord. The embryo itself is 13 mm. long and the loop in the cord is slightly less than 3 mm. in length. This loop is somewhat curved with the concave surface towards the head. As represented in Fig. 1 the intestine is sharply bent on itself in the cord, and on its return to the main body-cavity it turns at an acute angle to form the rectum. I can discover no trace of a ccecum at this stage other tlian a slight enlargement of the tube just after it bends in the cord. The arm of the loop which extends from the stomach into the cord is destined to give rise to the small intestine; while the arm returning from the cord to tlie rectum is, roughly speaking, the forerunner of the large intestine. Several embryos of this size were examined, and the condition described above found to be constant.
+
w
  
In Fig. 2 there is shown the dissection of a pig's embryo, 18 mm. in length. The loop of intestine extending into the cord is much like that represented in Fig. 1. A distinct coecum, however, can be made out in the rectal arm of the
 
  
  
  
Ai'ril-.May-,Ii-.ve, 1901.]
+
M
  
  
  
JOHNS HOPKINS HOSPITAL BULLETIN.
+
TV
  
  
  
103
 
  
  
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smr'
  
loop, a short distance from where the intestine bends on itself. This coecum is a short blind sac having an appearance very much like that shown in the iigurc. It will be noticed tliat a considerable part of the body-cavity is, in this stage, in tlie umbilical cord. Fully luilf the length of tlie intestine is contained in this extra-abdominal cielom. Just inside the main body-cavity a loop is beginning to 1)e formed in the small intestine. Its bends are marked 1, 'i and .'5. From the stomach it extends dorsally and to the right. Turning sharply it runs ventrally and to the left, and lieforo entering the cord it ))roceeds again posteriorly. On cumparing Figs. 1 and 2, there is seen a greater change in this part of the intestine near the stomach than in the part contained in the cord. The large intestine beginning at tliu cnn-um turns and passes into the rectum as before. Several enibryos of this size showed an identical structure.
 
  
Fig. 3 represents a pig 21 mm. long. The portion of the intestine in the cord is still unchanged, while that in the body-cavity jirojier .shows a further development of the same loops seen in Fig. 2. In comparing the numbers on the two figures there is no ditficulty in recognizing the corresponding parts. The ca?eum holds the same relative position as in Fig. 2. After entering the cord at the loo]) 3 in Fig. 3 the intestine l)ends in a curve with the concave side towards the head. It then turns abruptly backward and to the left, and returns to the main body-cavity by almost the same path. This is represented i)lainly in Fig 3, and it will lie noticed in the succeeding stages that this particular arrangement of the intestine as it turns is quite characteristic.
 
  
Fig. 4 shows a somewhat more advanced stage in the develojnnent. It is drawn from the dissection of a pig 23 mm. long. The general position of the intestine is very similar to that just described. The loops, however, have increased in number; and instead of one entire loop, as represented in Fig. 3, there are three, indicated by the letters a. h and c in Fig. 4, B. In Fig. 3 the stomach narrows into the small intestine, which bends rather aliruptly, and forms one complete loop overlying the large intestine. In Fig. 4 the same thing occurs, but following this tirst loop are two others. As shown in the figures there is a tendency for the loops to grow around the large intestine from the right side. The large intestine is on the left side of the small intestine and somewhat anterior. The part of the small intestine contained in the cord is less changed, and its growth is apparently somewhat slower. There is, however, to be seen the beginning of a new coil marked x in Fig. 4, B. This is an incompletelyformed loop and shows well the way in which the loops develop. It is simply a bending, as though the intestine had grown too long for the space it was obliged to occupy. Before reaching the ccecum the small intestine turns on itself in the characteristic way described in Fig. 3. The large intestine is unchanged.
 
  
In Fig. 5 the same loops are seen in the first part of the small intestine, and those marked a, b and c correspond fairly wtII. In the cord, however, there are here too loops instead of the one shown in Fig. 4. These occur in the small
+
Fin. 18. — A series of diagrams to indicate tlie formation of groups of coils in the intestine. These represent the intestines of embryos, 13, 21, 2."), 32, 40, 48 and 8.5 mm. in length respectively. The groups are lettered in correspondence with the preceding ligiires. T/// shows the direction in which the groups have rotated, their course being marked by curved arrows.
  
  
  
intestine ojipositc the ccecum and have relatively the same position as the bending of the tube marked .v in Fig. 4. They are lettered .v and // in Fig. -5. The remainder of the intestine is the same as in Fig. 4. The length of this pig was 25 mm.
+
groups described above can be readily recognized, but a considerable change in their position has taken place. The surface coils near the stomath are derived from group A instead of group C, as in the stage represented in Fig. 13. Group A is on the right side of the body, and group B on the left, (rroup C has moved in a ventral direction and somewhat to the left, until it lies transversely between group D and groups A and B. Group D enters the main body-cavity and the regularity of its coils is lost. Instead of being complete and regular, as in Fig. 13, the loops are distorted and flattened by their association with the other abdominal viscera. The more or less pointed extremity of this group is still directed towards the cord, as shown in Fig. 14. The
  
Fig. (i represents the intestine of a pig of approximately the same length a? that shown in Fig. 5. The small intestine in the main body-cavity, however, is slightly more advanced in develo])ment. The various loops can be readily recognized and niiuli more easily so on the wii'c model than on the drawing. A very slight change in the general position of a loop causes a most decided dilference in a flat drawing. The main difference, for example, between Figs. .5 and t), is the dislocation of the loop z towards the stomach. By comjjaring the lettering in the two figures this can be easily understood. The part of the intestine in the cord is practically the same in the two figures.
 
  
Thus far the large intestine is a simple lube bending shar])ly near the stomach to form the rectum. 11 will be noticed that the small intestine has grown much more rapidly than the large iiitestiiu'; and also that the part of the small intestine neai' the stomach has increased in length uu:ire rajv idly than the part in the cord. Several jiigs, the same size as these last two described, were examined, ami their intestines fomid to be similar in every way. Endiryos tiiken from the same uterus did not seem to resemble one another in this respect more closely than pigs of the same length from different uteri.
 
  
Fig. 7 represents a dissection of a pig's embryo 28 mm. in length, and Fig. 8 is a drawing of the wire model made from this intestine. The stomach, it will be seen, occupies the same position and narrows into the small intestine in the same way as before The small intestine here forms a distinct mass of loops in the nuiin body-cavity, and then extends out into the cord in a manner identical with that shown in earlier endiryos. The loops form a cone-shaped mass with the base of the cone towards the stomach and its apex in the umbilical cord. This is due to the more rapid growth of that part of the small intestine near the stomach. This arrangement will be noticed in all the older embryos as well until after all the coils have returned to the main body-cavity. It is a little unsatisfactory to attempt to follow the individual coils of the intestine, and to trace them from one endjryo to another after their arrangement has reached a complexity as great as that shown in Fig. 8 and the figures following. But if the two models represented in Figs 6 and 8 be compared, there will be seen a certain correspondence which can hardly be overlooked. The identity of the two loops in the cord marked .r and // is recognized at first glance. In this part of the intestine there seems to have been very little if any change. The coils near the stomach, however, are distiiutly more complicated in Fig. 8 than in Fig. 6. The slight bend in Fig. 6 marked e is accentuated into the loop marked r in Fig. 8. The letters a and z mark corresponding parts in the two figures; and the loop b can be readily derived in Fig. 8 from the b in Fig. 6. Following this, however, there are in Fig. 8 three distinct loops, c, d and
+
Fig. IG represents the surface coils of the intestine of a pig's embryo 85 mm. long. Fig. 16, / is drawn from the ajiimal's right side; Fig. IG, II from its ventral surface; and Fig. 16, /// from its left side. The various groups of coils are lettered in correspondence with those pictured in Fig. 17, which is drawn from a wire model of this intestine. The surface coils on the right side are formed by groups A and D. On the ventral surface groups B and C are present; while the left side is occupied by parts of B and D and the whole of group E. In this stage the same five main groups, that have been described, can be made out. It will be noticed, however, that their relative position is somewhat different. Group D has rotated posteriorly, dorsally and to the right, so
  
  
  
104
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106
  
  
Line 9,269: Line 9,276:
  
  
[Nos. 121-132-133.
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[Nos. 121-122-123.
  
  
  
f, without counting x and y; wliile in Fig. 6 there is only one without considering x and y. At d in Fig. 6 there is the beginning of a new loop, as yet only a slight bending in the tube, and c corresponds with one of the three loops spoken of in Fig. 8. There is then in Fig. 6 only one entirely new loop not indicated in Fig. 6.
+
that it takes up a position to (he right of, ami posterior to, group C. It thus moves ]iast group C and earrios the coecuni with it, so that tlie beginning of the large intestine lies dorsally, and posterior to grouj) />. The gr(iu|i E is pushed still farther in the sauie direction until it is finally situated in the left dorsal region of the mass of intestines. This group in the beginning lies on the left anteroventral surface. As it becomes more coni])lex it moves around to the right initil it reaches the left dorsal ]iosition. It therefore rotates througii three-quarters of a circle. The axis of this rotation is a line drawn from the beginning of the duodenum to a point somewhat posterior to the umbilical cord.
  
The copcum maintains the same position in Fig. 8 as in Fig. 6. The bend in the large intestine, however, where it passes into the rectum, shows quite a distinct alteration. It no longer forms a simi^le acute angle with the rectum, but is bent in two directions as shown in Fig. 8. This is the beginning of the formation of a very distinct group of convolutions which is perfectly constant and will be descrilu'd below.
+
l*"ig. 18 consists of a number of diagrams of the different stages, showing this rotation of the groups. The straight dotted line in each diagram represents the junction of the main body-cavity and the coelom of the cord. Diagram VI corresponds with Fig. 15, and VII with Fig. 17. The younger stages can be easily recognized. Diagram VIII shows the direction in which the groups rotate. The letters in all the diagrams correspond with those used in the description of the groups; and in VIII these letters, associated with the curved arrows, indicate the direction in which those groups have moved from their original positions.
  
The general tendency in the formation of new loops in the small intestine is for the tube to become slightly bent on itself and to grow around an axis which is represented by the large intestine. The characteristic shape of the loops is shown iu Fig. 8, d and /. The loops do not meet above (on the surface towards the head of the embryo); for the large intestine is situated between the bends of the loops. in such a way that it could be lifted away from the small intestine by drawing it towards tlie head, but not by drawing it towards the tail of the embryo. The arrangement becomes less regular the nearer it is to the stomach, for the gi-owth in this rc'gion is more rapid and the pressure exerted on the coils greater than in other jiarts.
+
An appearance which is characteristic of the older embryos is shown in Fig. 16, /, D and C; and in Fig. 16, II, C. The regular loops, which have been described, become flattened by pressure against the abdominal walls, giving rise to the peculiar coiled appearance represented.
  
Fig. 9 represents tlie dissection and Fig. 10 the model of the intestines of a pig 30 mm. long. The general position of the various parts is much like that in Fig. 8. By following the letters on Figs. S and 10 the corresponding loops can be made out. There are yet no groups of coils to be distinguished. Tlie small intestine can be roughly compared with a hollow^ cone whose axis is represented by tlie large intestine. The loops ;r and ?/ have become more fully developed and grow around the large intestine in the characteristic fashion. The loops in the figures arc lettered only on the right side, since they arc in a certain sense duplicated on the left side of the large intestine. A loop, however, is a fold which begins and ends somewhere in the same neighborhood; and it might be possible to take the median line as the starting point, and make loops on either side; but it is much simpler to treat as complete loops only those folds which start on one side and return to that side.
+
The intestines of several embryos older than those represented in Figs. 16 and 17 were studied. The groups were found to correspond with those already described; and an accoimt of these later embryos would not add any essentials to the above description. It is possible in these to tell with considerable accuracy to what group any one surface looj) belongs.
  
The large intestine in Fig. 10 holds a straight course from the ccecuin until it reaches the stomach. It then makes a complete Ijeiid on itself and enters the rectum as shown in Fig. 10, g.
+
It will lie noticed that in the older stages, «hich have been described, the large intestine grows more rapidly than it does in earlier embryos. In those represented by the first eight figures there is practically no change in the large intestine. After this, however, there gradually appears a consideralde mass of coils to form the rectal group. The part of the small intestine which is at first present in the cord grows more rapidly after its return to the general body-cavity. For this reason as well as on account of the pressiire exerted by the other viscera, the cone-shaped mass of intestines becomes more or less spherical after it is entirely intra-abdominal. The growth, which in earlier stages was almost solely in the region of group .4, is in the older embryos more uniform throughout the gut. The younger the embryo, the more noticeable is this rapid growth in the region of group /i. This fact was observed by Dr. Mall and indicated in his paper by means of tables of measurements. In connection with this it is of interest to note an observation made by Berry," who found that the villi appear first in the upper part of the
  
Fig. 11 is the dissection of a pig 32 mm. long, and Fig. 12 is a drawing of the model made from its intestinal canal. A certain general resemblance in outline is seen between Figs. 10 and 12. The intestine is a cone-shaped mass in each with the apex extending a short distance into the cord and the large intestine forming an axis for the cone. The arrangement of the small intestine in relation to the large intestine is the same as that spoken of before. The loops
 
  
  
 +
« Berry, J. M. ; Anatomisclier Anzeijier, xvii Bd., S. 242, 1900.
  
are bent around the axis of the large intestine, especially near the apex of the cone, i. e. near the cord. At the stomach end the gut has become so twisted that the individual loops cannot be traced with any satisfaction. Certain landmarks, however, can be recognized. For example, the loops .r, y, f and d correspond fairly well in the two stages, and it is not difficult to conceive of the transformation of the loop c in Fig. 10 to the same loop in Fig. 12. This transformation takes place by a flattening of the loop which will be spoken of later. It gives rise to a figure which is often seen in the intestines of pig's embryos.
 
  
Although the loops can no longer be individually followed with ease, there begins at this stage to arise a grouping of the coils. In Fig. 12 four fairly distinct groups can be made out. Starting with the stomach end the intestine forms a mass of loops which are situated mainly on the left side of the body. In no place does a whole coil of this grouji reach the surface of the intestinal cone on the right side. Thi.s will be called group A. After bending in five or six loops, as represented in the more liglitly shaded part of Fig. 13 near the stomach, the gut reaches the right side and forms a group of more or less flattened coils, which form all the surface coils of the right side up to nearly the beginning of the cord. This group is shaded darkly in Fig. 12 and ends after the loop marked d. It includes the coil c described above and will be designated group C. The intestine leaves this region at the termination of loop d, and forms three complete loops of the type described in earlier embryos. These are unshaded in Fig. 13 and include /, x and //. They form the group />. These coils are associated more closely than the rest of the intestine with the cadoni of the c(n'd. At the end of this group the small intestine takes a straight path for a short distance and turns on itself in the way seen in all the embryos so far pictured, and enters the large intestine at the cn?cuiii. The large intestine is straight as before until it reaches the region whei'e it turns to form the rectum. Here it is thrown into irregular twists, as shown in Fig. 13, E. The convolutimis formed in this region will be spoken of as the rectal group or group E, and will be followed through the various embryos. At this stage it is directly anterior (towards the head) and lies partly between the groups A and C.
 
  
Fig. 13 represents the model of the intestine of an embryo 40 mm. in length. The general outline of the mass of coils is, as before, cone-shaped. This is accentuated by the increasing complexity of the rectal group, and by the rapidity of growth of the first ])art of the small intestine. The same groups described above can be recognized at this stage. The group .1 has increased consideral)ly in length in Fig. 13 and can be divided into two groups which are marked .1 and B in Fig. 13, 11. These become more distinct in later stages. From B the gut passes over to the right side of the body and forms the group C which is situated entirely on the right side, and makes up* most of the surface coils there. This is shaded in Fig. 13, I. On approaching the cord there are found the three complete loops described in Fig. 12, as making up group D. These are almost identical iu the two stages, auu
+
intestine. Whether or not the number of villi increases more rapidly in this region than hnver down, has not been determined.
  
 +
In reviewing a considerable numlier of embryos in this way and modeling their intestines Ijy a method in which errois can be easily controlled, one cannot help being struck by the remarkable constancy of the appearances met with. At first glance it is more noticeable in the earlier embryos. This fact is due to the greater simplicity of the loo]is and to the smaller chance f(u- distortion of the coils by pressure. It will be noticed that there is practically no variation in the portion of the intestine contained within the cord. In that part of the body-cavity there are no other viscera to interfere by ])ressurc with the growth. If it were possible to isolate an organ during its development, its form would undoubtedly be difTereut from what it is when it develops a contact with many other growing organs. The portion of the intestiiie which develo])S in the ccu'd is to a certain extent isolated. The j'npidly-growing viseeia, such as the liver and urinary organs, can in no way intcrfci'e with lis growth; and it is seen from the above descriptions that it is this part of the intestine in particular, which is entirely constant in its appearance. Here the intestine increases in length by the formation of regular loops which grow up and surround the large intestine, as already stated. At first sight it woidd appear that this manner of growth might be caused by the confinement of the intestine in the cylindrical cavity of the cord; but the same method of formation of loops takes place in the general liodycavity before any loops whatever appear in the intestine of the cord. Since it thus takes jilace in two parts of the intestine under difl'erent conditions, it is fair to assume that this is the natural tendency in the growth of loops in the intestine of the pig.
  
 +
Dr. Mall, in the publication already referred to, has discussed the entry of the intestinal loojis into the ccclom of the cord, and their return to the general body-cavity. He inclines to the belief that the gut is forced into the cord liy the pressure exerted on it by the other rapidly-growing viscera; and that it returns to the main body-cavity on account of a twisting of the loops already contained in tlie abdomen. The dissections of the pig's embryos, which have been described, throw no new light on this subject. The ca?lom of the cord in early pig's embryos is of considerable size and the intestine is at first only a single loop. Hence it is not hard to imagine its being pushed into this easily available space in the cord. Here it remains until the secondary loops are formed, which make up group D. This group is more or less cone-sha]ied and fits into the cavity of the cord which has a similar form. The passing of this group to tlie main body-cavity does not take place one loop at a time. The group returns ajiparently by a gradual obliteration of the cone-shaped cavity of the cord fi'oni its apex to its base.
  
April-May-Juxe, 1901.]
+
It can hardly be said that the coils enter the abdominal cavity from the cord in any regular order. The order of their entry is dependent on their position in the mass of coils which projects into the cord. The apex of this mass is formed by
  
  
  
JOHNS HOPKINS HOSPITAL BULLETIN.
+
April-Mat-June, 1901.]
  
  
  
105
+
JOHNS HOPKINS HOSPITAL BULLETIN.
  
  
  
extend into the ccrloniie cavity of tlie cord, which has become gradually more shallow. TIic rectal group is more complex than in the preceding stages and forms a conspicuous mass of coils whose calibre is noticealily smaller than in the rest of the intestine. Its position also has altered. Instead of lying between groups .1 and (', it is to tlie right of C, having rotated on an axis corresponding ap]u-oximately with that of the cord. Figs. 14 and 15 represent the dissection and model resjiectively of the intestine nf an endiryo 4.S nun. in length. At this stage all the coils are within the main liody-eavity. The
+
107
  
  
  
large intestine begins on the right side of group D, a short distance from its a])ex. The coecum corresponds fairly well in position with that in Fig. 13. On leaving the eoecum, liowever, the large intestine passes obliquely down on the right surface of group C, and is coiled to form the rectal group, posterior to groups .1 and B. Fig. 14 does not justly rejtresent the regularity of the looj)s nuiking up group C. They form a series lying transversely from right to left, and can be easily separated in a mass from group D on the one hand, and croups A and B on the other.
+
the lower end of the ileum where it turns on itself to join the large intestine. The apex leaves the cord last, and hence the lower end of the ileum is the last part to enter the ahdominal cavity. In the same way the coecum enters a short distance in front of this part of the ileum, simply because it is so situated in the group of coils.
  
 +
In connection with the development of the mammalian intestine. I wish to call attention very briefly to the intestines of the various lower vertebrates. In Amphioxus the alimentary canal consists of a simple straight tube with no convolutions whatever (Fig. 19, A). In the shark the intestine is straight, but the stomach is bent on itself so as to form a descending, and an ascending part (Fig. 19, B). In the jierch, as in most Teleosteans, there is one distinct loop in
  
  
  
X
 
  
 +
Fio. 19. — Diagrams reiireseuting the intestines of -■!, Ampliinxus; B, Sliarl< ; C, Percli ; I), Frog; E, Turtle; F, Sparrow.
  
 +
tlie intestine, as shown in Fig. 19, C. There are two methods in these animals l)y which the digestive surface is increased in extent, namely, by the so-called spiral v.-dve and by the pyloric coeca. The spiral valve consists of a longitudinal fold extending into the cavity of the intestine. It is present in all Klasjnobranchs, Dipnoi and Ganoidei, hut not usually in the Teleostei. The pyloric cceea may be very numerous and form a large mass of processes just below the stomach. The spiral valve and the pyloric cceea are seldom both highly develo])ed in the same animal.
  
 +
In the Amphibia the intestine is, as a rule, much more conijilex than in the fishes. As shown in Iig. 19, D, the frog's intestine is considerably coiled. In a ninn1)er of frogs anil toads which were dissected, tlie intestines were found to be ai-ranged according to a general type which is I'cpicscntcil
  
w
 
  
  
 +
in Fig. 19, D. In some cases, however, the coils assumed a much more complicated mass than that shown in the figure. It is interesting to note here that in some stages of the tadpole's life the intestine is a much more complex organ than in the adult frog. The intestine of Necturus shows a coiling which is usually not so great as in the frog.
  
 +
In the Eei)tilia the form of the alimentary canal is considerably modified by the shape of the body. In Fig. 19, E, is represented the stomach and intestine of a turtle. This is an arrangement which was found to be very constant. In snakes the coils are not so numerous and are somewhat obliterated by the narrowness of the body. In lizards the intestine is coiled more than in either the turtle or the snake. Thus it is seen that in reptiles, and amphibians there is a much more complex arrangement of the coils of intestines than in fishes.
  
M
+
In birds there is a still greater complexity in the form of the intestine. Birds of the same species show very little variation in the arrangement of the coils. In a number of sparrows, robins and blackbirds the arrangement was found to be according to a type represented in Fig. 19, F. There was very little divergence from this type in any of the specimens examined. In the chicken, however, there is a far greater coiling. In several chickens examined there was found a noticeable constancy in the arrangement of the loops. A long duodenal fold extends from the gizzard backward and to the left side of the body. Turning on itself it passes to the right side of the body, where the small intestine is thrown into a number of coils which resolve themselves into two main groups. From the rectum two long coeca extend forward.
  
 +
In the study of these few lower vertebrates two main points are to be observed: (1) the constancy in the arrangement of the loops in nearly related animals; and (2) the gradual increase in complexity of the coils as we pass from the lowest vertebrates to those higher up in the scale. It is interesting to note also a certain relation which seems to exist between the ontogeny of the intestinal canal in mammals, and its phylogeny. Beginning with a straight tube in the early mammalian embryo the intestine is thrown into a gradually increasing number of loops. Beginning in the same way with Amphioxus we may jiass from the fishes, which possess but a single loop, to the amphibians, whose intestine is much more complex; and fiom these to the birds and mammals, where the alimentary canal is a very much coiled organ.
  
 +
Recapitulation.
  
TV
+
The intestine of a pig's embryo at an early stage consists of an uncoiled tube which sends a single loop out into the ccelom of the cord. The first half of the loop is on the right side and gives rise to the small intestine. From the other half is formed the large intestine. The gut increases in length by the formation of regular loops which grow around an axis corresponding with that of the cord and the large intestine. 'I'hese loops form first in the part which is to become the small intestine. They also develoj) in that part of the small inlesliiie near the stomach before they a]ipear in
  
  
  
 +
108
  
  
smr'
 
  
 +
JOHNS HOPKINS HOSPITAL BULLETIN.
  
  
  
Fin. 18. — A series of diagrams to indicate tlie formation of groups of coils in the intestine. These represent the intestines of embryos, 13, 21, 2."), 32, 40, 48 and 8.5 mm. in length respectively. The groups are lettered in correspondence with the preceding ligiires. T/// shows the direction in which the groups have rotated, their course being marked by curved arrows.
+
[Nos. 131-122-123.
  
  
  
groups described above can be readily recognized, but a considerable change in their position has taken place. The surface coils near the stomath are derived from group A instead of group C, as in the stage represented in Fig. 13. Group A is on the right side of the body, and group B on the left, (rroup C has moved in a ventral direction and somewhat to the left, until it lies transversely between group D and groups A and B. Group D enters the main body-cavity and the regularity of its coils is lost. Instead of being complete and regular, as in Fig. 13, the loops are distorted and flattened by their association with the other abdominal viscera. The more or less pointed extremity of this group is still directed towards the cord, as shown in Fig. 14. The
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the cord. Up to a certain stage the further growth in complexity is greatest near the stomach. After tlie small intestine has become considerably coiled, a mass of loops is formed in the large intestine. In embryos between 3.5 mm. and -10 mm. in length the group of coils which has formed in the ccelom of the cord, enters the general body-cavity by a mechanism which is not clearly understood. In embryos of the same size the coils are constant in arrangement and definite in their position. Tliey can be followed through various stages of the early development. In older embryos, when tlie individual coils cannot be recognized with ease, they are found to be arranged in distinct groups which have definite situations in the body-cavity. The loops in a certain region of the body-cavity, tliongh they may vary in form, always belong to the same group. These groups arrive at their final situation by a rotation which takes place posteriorly and to the right around an axis, running from the beginning of the duodenum to a point a short distance posterior to the opening of the cord. It is not at all claimed that the surface coils hold always the same position with regard to one another, or that the coils always have the same relation to one another in the group; but it is to be emphasized that the groups always do hold the same relative position in the body.
  
 +
In lower vertelirates the intestine increases in complexity as we ascend the scale. The intestinal coils are very similar in nearly related animals; and a certain amount of constancy is noticed in their arrangement.
  
 +
I regret that I have had no opportunity of confirming Dexter's work on the cat's intestine, in which he finds no constancy in the position of the loops. However, from the researches, already referred to, of Henke, Weinberg, ilall and Merkel, as well as from the present study of pig's embryos and the intestines of lower vertebrates, it seems plain that the intestinal canal is an organ which is situated in the body in a definite position, and that its different parts hold a constant relation to one another.
  
Fig. IG represents the surface coils of the intestine of a pig's embryo 85 mm. long. Fig. 16, / is drawn from the ajiimal's right side; Fig. IG, II from its ventral surface; and Fig. 16, /// from its left side. The various groups of coils are lettered in correspondence with those pictured in Fig. 17, which is drawn from a wire model of this intestine. The surface coils on the right side are formed by groups A and D. On the ventral surface groups B and C are present; while the left side is occupied by parts of B and D and the whole of group E. In this stage the same five main groups, that have been described, can be made out. It will be noticed, however, that their relative position is somewhat different. Group D has rotated posteriorly, dorsally and to the right, so
 
  
  
 +
DESCKII'TKIN OF PLATES .XIX-XX.
  
106
+
Fio. 1 Pig's embryo 13 mm. long, showing a single loop of iiitustiu
  
 +
extending into the umbilical cord.
  
 +
Fig. 3. — Pig's embryo IS mm. long, showing a loop of intestine iu the cord with a distinct ccecum. The small intestine shows the begining of coils inside the main body-cavity. The dotted line indicates the original outlines of the body before the removal of the liver.
  
JOHNS HOPKINS HOSPITAL BULLETIN.
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Fig. 3. — Pig's embryo 31 mm. long, showing a slightly more convoluted small intestine. The numbers 1, 3 and '•> correspond with those on Fig. 3.
  
 +
Fig. 4. — .1. Dissection of pig's embryo 33 mm. in length. B. Wire model of the intestine of this embryo.
  
 +
Fig. .'i. — Wire model of intestine of pig's embryo 3.5 mm. long. The lettering corresponds with that iu Fig. 4, B.
  
[Nos. 121-122-123.
+
Fig. C Wire model of intestine of pig's embryo 3.5 mm. long.
  
 +
Fig. 7. — Dissection of pig's embryo 38 ram. long.
  
 +
Fig. S. — Wire model of intestine of the embryo represented in Fig. T.
  
that it takes up a position to (he right of, ami posterior to, group C. It thus moves ]iast group C and earrios the coecuni with it, so that tlie beginning of the large intestine lies dorsally, and posterior to grouj) />. The gr(iu|i E is pushed still farther in the sauie direction until it is finally situated in the left dorsal region of the mass of intestines. This group in the beginning lies on the left anteroventral surface. As it becomes more coni])lex it moves around to the right initil it reaches the left dorsal ]iosition. It therefore rotates througii three-quarters of a circle. The axis of this rotation is a line drawn from the beginning of the duodenum to a point somewhat posterior to the umbilical cord.
+
Fig. 9. — Dissection of a pig's embryo 30 mm. long.
  
l*"ig. 18 consists of a number of diagrams of the different stages, showing this rotation of the groups. The straight dotted line in each diagram represents the junction of the main body-cavity and the coelom of the cord. Diagram VI corresponds with Fig. 15, and VII with Fig. 17. The younger stages can be easily recognized. Diagram VIII shows the direction in which the groups rotate. The letters in all the diagrams correspond with those used in the description of the groups; and in VIII these letters, associated with the curved arrows, indicate the direction in which those groups have moved from their original positions.
+
Fig. 10. — Wire model of intestine of embryo represented iu Fig. 9.
  
An appearance which is characteristic of the older embryos is shown in Fig. 16, /, D and C; and in Fig. 16, II, C. The regular loops, which have been described, become flattened by pressure against the abdominal walls, giving rise to the peculiar coiled appearance represented.
+
Fig. 11. — Dissection of a pig's embryo 33 mm. long. C, superficial group of coils on right side of body. The small letters correspond with those used above.
  
The intestines of several embryos older than those represented in Figs. 16 and 17 were studied. The groups were found to correspond with those already described; and an accoimt of these later embryos would not add any essentials to the above description. It is possible in these to tell with considerable accuracy to what group any one surface looj) belongs.
+
Fig. 13. — Wire model made from the intestines of the embryo represented in Fig. 11. .4, C, D and E, iudicate the formation of groups of coils. The group C is shaded.
  
It will lie noticed that in the older stages, «hich have been described, the large intestine grows more rapidly than it does in earlier embryos. In those represented by the first eight figures there is practically no change in the large intestine. After this, however, there gradually appears a consideralde mass of coils to form the rectal group. The part of the small intestine which is at first present in the cord grows more rapidly after its return to the general body-cavity. For this reason as well as on account of the pressiire exerted by the other viscera, the cone-shaped mass of intestines becomes more or less spherical after it is entirely intra-abdominal. The growth, which in earlier stages was almost solely in the region of group .4, is in the older embryos more uniform throughout the gut. The younger the embryo, the more noticeable is this rapid growth in the region of group /i. This fact was observed by Dr. Mall and indicated in his paper by means of tables of measurements. In connection with this it is of interest to note an observation made by Berry," who found that the villi appear first in the upper part of the
+
Fig. 13. — Wire model of intestine of an embryo 40 mm. iu length. The groups are lettered as in Fig. 13.
  
 +
Fig. 14. — Dissection of a pig's embryo 48 mm. long. The letters as before iudicate the groups of coils.
  
 +
Fig. 15. — Wire model of intestines of embryo represented in Fig. 14. Groups are indicated by shading.
  
« Berry, J. M. ; Anatomisclier Anzeijier, xvii Bd., S. 242, 1900.
+
Fig. 16. — Dissection of a pig's embryo 85) mm. long, /shows the intestines from the right side; //from the ventral surf.ace; and/// from the left side. The lettering corresponds with that in the previous figures.
  
 +
Fig. 17. — Wire model of intcstiue of embryo represented iu Fig. Ifl.
  
 +
Note: — No attempt has been made to retain the relative size of the embryos iu these figures. The actual measurements are giveu iu each case.
  
intestine. Whether or not the number of villi increases more rapidly in this region than hnver down, has not been determined.
 
  
In reviewing a considerable numlier of embryos in this way and modeling their intestines Ijy a method in which errois can be easily controlled, one cannot help being struck by the remarkable constancy of the appearances met with. At first glance it is more noticeable in the earlier embryos. This fact is due to the greater simplicity of the loo]is and to the smaller chance f(u- distortion of the coils by pressure. It will be noticed that there is practically no variation in the portion of the intestine contained within the cord. In that part of the body-cavity there are no other viscera to interfere by ])ressurc with the growth. If it were possible to isolate an organ during its development, its form would undoubtedly be difTereut from what it is when it develops a contact with many other growing organs. The portion of the intestiiie which develo])S in the ccu'd is to a certain extent isolated. The j'npidly-growing viseeia, such as the liver and urinary organs, can in no way intcrfci'e with lis growth; and it is seen from the above descriptions that it is this part of the intestine in particular, which is entirely constant in its appearance. Here the intestine increases in length by the formation of regular loops which grow up and surround the large intestine, as already stated. At first sight it woidd appear that this manner of growth might be caused by the confinement of the intestine in the cylindrical cavity of the cord; but the same method of formation of loops takes place in the general liodycavity before any loops whatever appear in the intestine of the cord. Since it thus takes jilace in two parts of the intestine under difl'erent conditions, it is fair to assume that this is the natural tendency in the growth of loops in the intestine of the pig.
 
  
Dr. Mall, in the publication already referred to, has discussed the entry of the intestinal loojis into the ccclom of the cord, and their return to the general body-cavity. He inclines to the belief that the gut is forced into the cord liy the pressure exerted on it by the other rapidly-growing viscera; and that it returns to the main body-cavity on account of a twisting of the loops already contained in tlie abdomen. The dissections of the pig's embryos, which have been described, throw no new light on this subject. The ca?lom of the cord in early pig's embryos is of considerable size and the intestine is at first only a single loop. Hence it is not hard to imagine its being pushed into this easily available space in the cord. Here it remains until the secondary loops are formed, which make up group D. This group is more or less cone-sha]ied and fits into the cavity of the cord which has a similar form. The passing of this group to tlie main body-cavity does not take place one loop at a time. The group returns ajiparently by a gradual obliteration of the cone-shaped cavity of the cord fi'oni its apex to its base.
+
BILATERAL RELATIONS OF THE CEREBRAL CORTEX.
  
It can hardly be said that the coils enter the abdominal cavity from the cord in any regular order. The order of their entry is dependent on their position in the mass of coils which projects into the cord. The apex of this mass is formed by
+
By E. Lindon Mellus, M. D.
  
 +
(From the Aiititotnirnl Ltfbvratonj, Jn/nm Ifttpkhix I'/tift'rxlty.)
  
  
April-Mat-June, 1901.]
 
  
 +
In the study of the central nervous system it becomes more and more apparent that the statement that each cerebral hemisphere controls the opposite half of the body must be still further modified. It has long been recognized that certain movements were more or less bilateral; that is, equally controlled by each hemisphere. This is easily demonstrated by electrical stimulation of the cortex and, to a certain extent, the anatomical relations have been worked out. The bilateral representation of most facial movements would appear at first thought to be quite essential and anatomists held, long l)efore it was demonstrated, that each of the motor nuclei in the pons and medulla was connected with its fellow of the oiiposite side by decussating filires. Bilateral movement
  
  
JOHNS HOPKINS HOSPITAL BULLETIN.
 
  
 +
could thus be accounted for by simultaneous stimulation of the nuclei of both sides, but the results of some of the more recent investigations show that projection fibres run directly from the cortex of each hemisphere to the nuclei of both sides. This provides for simultaneous stimulation, while the fibres passing directly from one nucleus to the other may conserve the symmetrical discharge of energy.
  
 +
The necessity for bilateral control of the limbs is not so evident, but the fibres of the so-called direct or uncrossed pyramidal tract in man and the finding of bilateral degeneration in the cord after unilateral lesion of the brain seemed to make it probable. For some time it was not possible to trace tlie cdurse of this homolateral deoeneration from the
  
107
 
  
  
 +
THE JOHNS HOPKINS HOSPITAL BULLETIN. APRIL-MAY-JUNE, 1901.
  
the lower end of the ileum where it turns on itself to join the large intestine. The apex leaves the cord last, and hence the lower end of the ileum is the last part to enter the ahdominal cavity. In the same way the coecum enters a short distance in front of this part of the ileum, simply because it is so situated in the group of coils.
 
  
In connection with the development of the mammalian intestine. I wish to call attention very briefly to the intestines of the various lower vertebrates. In Amphioxus the alimentary canal consists of a simple straight tube with no convolutions whatever (Fig. 19, A). In the shark the intestine is straight, but the stomach is bent on itself so as to form a descending, and an ascending part (Fig. 19, B). In the jierch, as in most Teleosteans, there is one distinct loop in
 
  
 +
PLATE ^IX.
  
  
  
Fio. 19. — Diagrams reiireseuting the intestines of -■!, Ampliinxus; B, Sliarl< ; C, Percli ; I), Frog; E, Turtle; F, Sparrow.
 
  
tlie intestine, as shown in Fig. 19, C. There are two methods in these animals l)y which the digestive surface is increased in extent, namely, by the so-called spiral v.-dve and by the pyloric coeca. The spiral valve consists of a longitudinal fold extending into the cavity of the intestine. It is present in all Klasjnobranchs, Dipnoi and Ganoidei, hut not usually in the Teleostei. The pyloric cceea may be very numerous and form a large mass of processes just below the stomach. The spiral valve and the pyloric cceea are seldom both highly develo])ed in the same animal.
+
Fig. 11,
  
In the Amphibia the intestine is, as a rule, much more conijilex than in the fishes. As shown in Iig. 19, D, the frog's intestine is considerably coiled. In a ninn1)er of frogs anil toads which were dissected, tlie intestines were found to be ai-ranged according to a general type which is I'cpicscntcil
 
  
  
 +
MacCallum del.
  
in Fig. 19, D. In some cases, however, the coils assumed a much more complicated mass than that shown in the figure. It is interesting to note here that in some stages of the tadpole's life the intestine is a much more complex organ than in the adult frog. The intestine of Necturus shows a coiling which is usually not so great as in the frog.
 
  
In the Eei)tilia the form of the alimentary canal is considerably modified by the shape of the body. In Fig. 19, E, is represented the stomach and intestine of a turtle. This is an arrangement which was found to be very constant. In snakes the coils are not so numerous and are somewhat obliterated by the narrowness of the body. In lizards the intestine is coiled more than in either the turtle or the snake. Thus it is seen that in reptiles, and amphibians there is a much more complex arrangement of the coils of intestines than in fishes.
 
  
In birds there is a still greater complexity in the form of the intestine. Birds of the same species show very little variation in the arrangement of the coils. In a number of sparrows, robins and blackbirds the arrangement was found to be according to a type represented in Fig. 19, F. There was very little divergence from this type in any of the specimens examined. In the chicken, however, there is a far greater coiling. In several chickens examined there was found a noticeable constancy in the arrangement of the loops. A long duodenal fold extends from the gizzard backward and to the left side of the body. Turning on itself it passes to the right side of the body, where the small intestine is thrown into a number of coils which resolve themselves into two main groups. From the rectum two long coeca extend forward.
+
THE JOHNS HOPKINS HOSPITAL BULLETIN, APRIL-MAY-JUNE, 1901.
  
In the study of these few lower vertebrates two main points are to be observed: (1) the constancy in the arrangement of the loops in nearly related animals; and (2) the gradual increase in complexity of the coils as we pass from the lowest vertebrates to those higher up in the scale. It is interesting to note also a certain relation which seems to exist between the ontogeny of the intestinal canal in mammals, and its phylogeny. Beginning with a straight tube in the early mammalian embryo the intestine is thrown into a gradually increasing number of loops. Beginning in the same way with Amphioxus we may jiass from the fishes, which possess but a single loop, to the amphibians, whose intestine is much more complex; and fiom these to the birds and mammals, where the alimentary canal is a very much coiled organ.
 
  
Recapitulation.
 
  
The intestine of a pig's embryo at an early stage consists of an uncoiled tube which sends a single loop out into the ccelom of the cord. The first half of the loop is on the right side and gives rise to the small intestine. From the other half is formed the large intestine. The gut increases in length by the formation of regular loops which grow around an axis corresponding with that of the cord and the large intestine. 'I'hese loops form first in the part which is to become the small intestine. They also develoj) in that part of the small inlesliiie near the stomach before they a]ipear in
+
PLATE XX.
  
  
  
108
 
  
 +
Fig. 12.
  
  
JOHNS HOPKINS HOSPITAL BULLETIN.
 
  
  
  
[Nos. 131-122-123.
+
Fig. 14.
  
  
  
the cord. Up to a certain stage the further growth in complexity is greatest near the stomach. After tlie small intestine has become considerably coiled, a mass of loops is formed in the large intestine. In embryos between 3.5 mm. and -10 mm. in length the group of coils which has formed in the ccelom of the cord, enters the general body-cavity by a mechanism which is not clearly understood. In embryos of the same size the coils are constant in arrangement and definite in their position. Tliey can be followed through various stages of the early development. In older embryos, when tlie individual coils cannot be recognized with ease, they are found to be arranged in distinct groups which have definite situations in the body-cavity. The loops in a certain region of the body-cavity, tliongh they may vary in form, always belong to the same group. These groups arrive at their final situation by a rotation which takes place posteriorly and to the right around an axis, running from the beginning of the duodenum to a point a short distance posterior to the opening of the cord. It is not at all claimed that the surface coils hold always the same position with regard to one another, or that the coils always have the same relation to one another in the group; but it is to be emphasized that the groups always do hold the same relative position in the body.
+
Fig. 1:J.
  
In lower vertelirates the intestine increases in complexity as we ascend the scale. The intestinal coils are very similar in nearly related animals; and a certain amount of constancy is noticed in their arrangement.
 
  
I regret that I have had no opportunity of confirming Dexter's work on the cat's intestine, in which he finds no constancy in the position of the loops. However, from the researches, already referred to, of Henke, Weinberg, ilall and Merkel, as well as from the present study of pig's embryos and the intestines of lower vertebrates, it seems plain that the intestinal canal is an organ which is situated in the body in a definite position, and that its different parts hold a constant relation to one another.
 
  
  
 +
Fig. 15.
  
DESCKII'TKIN OF PLATES .XIX-XX.
 
  
Fio. 1 Pig's embryo 13 mm. long, showing a single loop of iiitustiu
 
  
extending into the umbilical cord.
 
  
Fig. 3. — Pig's embryo IS mm. long, showing a loop of intestine iu the cord with a distinct ccecum. The small intestine shows the begining of coils inside the main body-cavity. The dotted line indicates the original outlines of the body before the removal of the liver.
 
  
Fig. 3. — Pig's embryo 31 mm. long, showing a slightly more convoluted small intestine. The numbers 1, 3 and '•> correspond with those on Fig. 3.
+
MacCallum del.
  
Fig. 4. — .1. Dissection of pig's embryo 33 mm. in length. B. Wire model of the intestine of this embryo.
 
  
Fig. .'i. — Wire model of intestine of pig's embryo 3.5 mm. long. The lettering corresponds with that iu Fig. 4, B.
 
  
Fig. C Wire model of intestine of pig's embryo 3.5 mm. long.
+
Fig. 17.
  
Fig. 7. — Dissection of pig's embryo 38 ram. long.
 
  
Fig. S. — Wire model of intestine of the embryo represented in Fig. T.
 
  
Fig. 9. — Dissection of a pig's embryo 30 mm. long.
+
Fig. 16.
  
Fig. 10. — Wire model of intestine of embryo represented iu Fig. 9.
 
  
Fig. 11. — Dissection of a pig's embryo 33 mm. long. C, superficial group of coils on right side of body. The small letters correspond with those used above.
 
  
Fig. 13. — Wire model made from the intestines of the embryo represented in Fig. 11. .4, C, D and E, iudicate the formation of groups of coils. The group C is shaded.
+
Apkil-May-June, 1901.]
  
Fig. 13. — Wire model of intestine of an embryo 40 mm. iu length. The groups are lettered as in Fig. 13.
 
  
Fig. 14. — Dissection of a pig's embryo 48 mm. long. The letters as before iudicate the groups of coils.
 
  
Fig. 15. — Wire model of intestines of embryo represented in Fig. 14. Groups are indicated by shading.
+
JOHNS HOPKINS HOSPITAL BULLETIN.
  
Fig. 16. — Dissection of a pig's embryo 85) mm. long, /shows the intestines from the right side; //from the ventral surf.ace; and/// from the left side. The lettering corresponds with that in the previous figures.
 
  
Fig. 17. — Wire model of intcstiue of embryo represented iu Fig. Ifl.
 
  
Note: — No attempt has been made to retain the relative size of the embryos iu these figures. The actual measurements are giveu iu each case.
+
109
  
  
  
BILATERAL RELATIONS OF THE CEREBRAL CORTEX.
+
brain to the cord, and various theories were brought forward to explain it. It was considered probable by some anatomists that the pyramidal tract divided at the decussation, some fibres passing to the lateral column of each side, while a portion remained in the anterior column as the direct tract; but in the absence of confirmation Sherrington's theory of " recrossed " fibres was generally accepted. Sherrington's conclusions were based upon experimental unilateral lesions on the brain of the monkey, in which he claimed that immediately below the decussation the degeneration was all on the opposite side of the cord, while at a still lower level degenerated fibres were fomid in botii lateral columns. He thereupon assumed that all the degeneration crossed over in the decussation to the oj)posite side of the cord, but a portion crossed back at a lower level to the lateral column of the same side. The probable explanation of his mistake is that at the time of his observations the delicate methods in use in recent years were not known. Still the fact that he reported at the same time that fibres from the upper limb area of the cortex passed down the entire length of the cord, while fibres from the leg areas disappeared from the cord in the cervical and upper dorsal regions, would indicate that his preparations were handled or studied somewhat carelessly. It is rather curious that no one seems to have suggested that he had mixed up those cords.
  
By E. Lindon Mellus, M. D.
+
Soon after the publication of Marchi's method of staining degenerated nervous tissue by osmie acid, Muratow undertool' the study, by that method, of degenerations following lesions of the brain in the dog. He published the results of his observations in 1893 ' and clearly showed that in the dog the ]iyramidal tract divided at the decussation and a portion ]iassed directly to the lateral column of the same side. I had been working with the same method tracing degenerations in the central nervous system of the monkey after very minute lesions of the cerebral cortex, and at the time of the appearance of Muratow's publication I had already accomplished the same results on the monkey, but to him undoubtedly belongs the credit of priority. These results have since been confirmed by other investigators, and Dejerine and Thomas " and Eisien Eussell' have proved the existence of the same conditions in man.
  
(From the Aiititotnirnl Ltfbvratonj, Jn/nm Ifttpkhix I'/tift'rxlty.)
+
At the same time I was able to demonstrate the passage of fibres from the pyramid of one side directly to the motor nuclei of both sides in the pons and medulla.'
  
 +
The following experiment enlarges still further the scope of bilateral representation and adds another to those paths already demonstrated l)y wliich one hemisphere may control more or less both halves of the body. It by no means stands alone, but is presented as the type of a considerable group which will be considered individually in a later publication.
  
 +
On September 20, 1898, I operated in ]\Ir. Victor ITors
  
In the study of the central nervous system it becomes more and more apparent that the statement that each cerebral hemisphere controls the opposite half of the body must be still further modified. It has long been recognized that certain movements were more or less bilateral; that is, equally controlled by each hemisphere. This is easily demonstrated by electrical stimulation of the cortex and, to a certain extent, the anatomical relations have been worked out. The bilateral representation of most facial movements would appear at first thought to be quite essential and anatomists held, long l)efore it was demonstrated, that each of the motor nuclei in the pons and medulla was connected with its fellow of the oiiposite side by decussating filires. Bilateral movement
 
  
  
 +
■ ArchtT fur Anatomic und Entwickelungsgescbkbte. 1893. 5 Dejerine and Thomas. Archives, de pliysiol. norm, et patholog. 18%, No. 3. Review in Neurologisehes Centralblatt, 1897, p. 503. sRisien Russell. Brain. Summer, 1898. ' Proo. Roy. Soc. vol. .58.
  
could thus be accounted for by simultaneous stimulation of the nuclei of both sides, but the results of some of the more recent investigations show that projection fibres run directly from the cortex of each hemisphere to the nuclei of both sides. This provides for simultaneous stimulation, while the fibres passing directly from one nucleus to the other may conserve the symmetrical discharge of energy.
 
  
The necessity for bilateral control of the limbs is not so evident, but the fibres of the so-called direct or uncrossed pyramidal tract in man and the finding of bilateral degeneration in the cord after unilateral lesion of the brain seemed to make it probable. For some time it was not possible to trace tlie cdurse of this homolateral deoeneration from the
 
  
 +
ley's laboratory at University College, London, on a small but apparently healthy bonnet monkey (Macacus sinicus). The animal being etherized, the cortex of the left hemisphere was exposed under strict aseptic precautions, the centre for thumb movements determined by electrical stimulation and that portion of the cortex carefully excised. Care was taken not so much to remove every portion of cortical substance as to avoid injury to the underlying white matter. I therefore passed the knife under the cortex with the flat surface of the knife parallel to the convexity of the hemisphere, bringing it out at a right angle to the line of incision. Then lifting the cut edge with a pair of small forceps the excision was easily completed. The slight hemorrhage was controlled with hot saline solution, the wound closed with horsehair sutures and dressed with borated cotton smeared with collodion. This monkey got dian-hoea and died on the tenth day after the operation (September 30) of marasmus. The wound in the scalp had healed well and there was no trace of sepsis. The brain and cord were removed, kept for four days in formalin and then transferred to Miiller. The brain was cut into thin segments in a plane nearly parallel to Lhe occipital sulcus (Aft'enspalte), as shown in Figs. 1 and 3, and stained by the Marehi method. It was my endeavor to make the plane of section correspond as nearly as possible to the course of the projection fibres through the internal capsule.
  
 +
Description of the Lesion*.
  
THE JOHNS HOPKINS HOSPITAL BULLETIN. APRIL-MAY-JUNE, 1901.
+
Tlie portion of cortex removed was circular and about one cm. in diameter. About one-third of the area of the lesion was in the ascending parietal convolution and the other twothirds in the ascending frontal. Its posterior extremity was about midway between the lowest portion of the interparietal sulcus and the fissure of Rolando, while its anterior boundary was the superior angle of the sulcus precentralis. The lowest portion of the lesion was very nearly opposite the lower extremity of the interparietal sulcus, and it extended upward to the superior frontal sulcus.'* The lesion in the ascending frontal was much more shallow than in the ascending parietal and the entire cortical substance was removed only at that portion of the ascending parietal convolution nearest the centre of the lesion, close to the fissure of Rolando. It was at this point that uncomplicated flexion of the thumb was obtained on stimulation with a weak faradic current. The portion of cortex removed became thinner from the centre" to the periphery of the lesion. In the hardened brain there' was evidence of slight cerebral hernia, i. e. bulging of the brain into the opening in the skull, which accounts for the irregularity of contour in Fig. 3.
  
 +
In Figs. 1 and 3 I have eiuleavored to show the distribution of association fibres to the external surface of the two hemispheres, the proximity of the oblique parallel lines to each other corresponding to the amount of degeneration found in the various convolutions. It was impossible to
  
  
PLATE ^IX.
 
  
 +
■>» In Fig. 1 the lesion does not extend upward as far as it should. It is better represented in Fig. 3.
  
  
  
Fig. 11,
+
110
  
  
  
MacCallum del.
+
JOHNS HOPKINS HOSPITAL BULLETIN.
  
  
  
THE JOHNS HOPKINS HOSPITAL BULLETIN, APRIL-MAY-JUNE, 1901.
+
[Nos. 131-122-123.
  
  
  
PLATE XX.
+
represent the comparative amount of degeneration so accurately in the outline drawings of transverse sections of the brain (Figs. 3 to 7 inclusive), because in so small a figure, in order to have the degeneration show at all, it was necessary to exaggerate. Degenerated fibres can be seen crossing in the corpus callosnm in all the segments except " E," the most posterior. The distribution of association fibres to the convolutions of the two hemispheres is very nearly equal and quite sj'mmetrical. It extends also upon the internal (mesial)
  
  
  
  
Fig. 12.
+
Fig. 1.
  
 +
surface of both hemispheres as far as the calloso-marginal fissure.
  
 +
In two segments, C and D, the degeneration extends to the superior temporal convolution of licith sides. The route taken by the degenerated fibres to reach the temporal lobe is the same in botli hemispheres and is interesting. In section " B " (Fig. 4) a few degenerated fibres appear among the fibres passing to the superior temporal convolution just external to the thickened lower edge of the claustrum on both
  
  
  
Fig. 14.
 
  
 +
Fig. 2.
  
 +
sides. In the segment posterior to this (Fig. 5) many degenerated fibres can be seen leaving the internal capsule, breaking through the thin inferior edge of the lenticular nucleus and passing below the claustrum to reach the superior temporal convolution. Some of these fibres probably terminate in the lateral geniculate body. Although no continuous fibres could be traced from the internal capsule into the lateral geniculate body, it lies directly in the path of those running to the lemporal lolie and there is considerable degen
  
Fig. 1:J.
 
  
 +
eration in this nucleus in both liemispheres. Still posterior to this (Fig. 6) degenerated fibres are passing between the islets of gray matter representing the prolongations of the putamen, while many others may be seen passing down among the fibres of the external capsule. The degenerated fibres in the superior temporal convolution are apparently continuous with both these tracts, the course of which is the same in both hemispheres.
  
 +
Taking into consideration the movements represented in
  
  
Fig. 15.
 
  
  
 +
Fig. 3.
  
 +
that portion of the cortex removed, the distribution of association fibres is of especial interest. While the centre for uncomplicated movement of the thumb occupies but a small portion of the area removed, movements of the thumb as part of some associated movement or march may be obtained not only from every portion of that area but also from points considerably removed therefrom — even as far down the convexity of the brain as the lower extremity of the fissure of Rolando. It is a question of much interest whether this is
  
  
MacCallum del.
 
  
  
 +
Fig. 4.
  
Fig. 17.
+
Ijrought about by means of association fibres or projection fibres passing directly from each of tlie widely separated cortical areas to the system of secondary neurons in the cervical region of the cord. It is quite possible that complicated movements may be brought about in either or both ways. The great increase in cortical association tracts between monkey and man suggests the possibility of inconceivable degrees of association.
  
 +
Looking upon the motor cortex as representing the centres
  
  
Fig. 16.
 
  
 +
April-Mat-Juxe, 1901.]
  
  
Apkil-May-June, 1901.]
 
  
 +
JOHNS HOPKINS HOSPITAL BULLETIN.
  
  
JOHNS HOPKINS HOSPITAL BULLETIN.
 
  
 +
Ill
  
  
109
 
  
 +
for associated movements one would naturally expect to find projection fibres passing directly down through the capsule from that part of the cortex, giving rise to the movement. As I understand the significance of excitation experiments upon the cortex, the finding of a <?entre for the imcomplicated movement of the thumb only means that in the movement represented at that spot, the movement of the thumb (flexion or otherwise) is the first or initial movement of the march. If the stimulation is continued or increased the
  
  
brain to the cord, and various theories were brought forward to explain it. It was considered probable by some anatomists that the pyramidal tract divided at the decussation, some fibres passing to the lateral column of each side, while a portion remained in the anterior column as the direct tract; but in the absence of confirmation Sherrington's theory of " recrossed " fibres was generally accepted. Sherrington's conclusions were based upon experimental unilateral lesions on the brain of the monkey, in which he claimed that immediately below the decussation the degeneration was all on the opposite side of the cord, while at a still lower level degenerated fibres were fomid in botii lateral columns. He thereupon assumed that all the degeneration crossed over in the decussation to the oj)posite side of the cord, but a portion crossed back at a lower level to the lateral column of the same side. The probable explanation of his mistake is that at the time of his observations the delicate methods in use in recent years were not known. Still the fact that he reported at the same time that fibres from the upper limb area of the cortex passed down the entire length of the cord, while fibres from the leg areas disappeared from the cord in the cervical and upper dorsal regions, would indicate that his preparations were handled or studied somewhat carelessly. It is rather curious that no one seems to have suggested that he had mixed up those cords.
 
  
Soon after the publication of Marchi's method of staining degenerated nervous tissue by osmie acid, Muratow undertool' the study, by that method, of degenerations following lesions of the brain in the dog. He published the results of his observations in 1893 ' and clearly showed that in the dog the ]iyramidal tract divided at the decussation and a portion ]iassed directly to the lateral column of the same side. I had been working with the same method tracing degenerations in the central nervous system of the monkey after very minute lesions of the cerebral cortex, and at the time of the appearance of Muratow's publication I had already accomplished the same results on the monkey, but to him undoubtedly belongs the credit of priority. These results have since been confirmed by other investigators, and Dejerine and Thomas " and Eisien Eussell' have proved the existence of the same conditions in man.
 
  
At the same time I was able to demonstrate the passage of fibres from the pyramid of one side directly to the motor nuclei of both sides in the pons and medulla.'
+
Fig. 5.
  
The following experiment enlarges still further the scope of bilateral representation and adds another to those paths already demonstrated l)y wliich one hemisphere may control more or less both halves of the body. It by no means stands alone, but is presented as the type of a considerable group which will be considered individually in a later publication.
+
march is continued or completed unless interrupted by a .general convulsion. Thus, if the anaesthesia is at just the right stage the gentlest stimulus only excites the first or initiatory movement of the march. In opposition to such a theory it may be urged that only one centre has been found in any single animal for such uncomplicated or initial movement, while many combinations are possible beginning with such movement. This woiild hardly render an entirely separate centre for each movement necessary, as they might ali be grouped about the common centre.
  
On September 20, 1898, I operated in ]\Ir. Victor ITors
 
  
  
  
■ ArchtT fur Anatomic und Entwickelungsgescbkbte. 1893. 5 Dejerine and Thomas. Archives, de pliysiol. norm, et patholog. 18%, No. 3. Review in Neurologisehes Centralblatt, 1897, p. 503. sRisien Russell. Brain. Summer, 1898. ' Proo. Roy. Soc. vol. .58.
+
Fig. li.
  
  
  
ley's laboratory at University College, London, on a small but apparently healthy bonnet monkey (Macacus sinicus). The animal being etherized, the cortex of the left hemisphere was exposed under strict aseptic precautions, the centre for thumb movements determined by electrical stimulation and that portion of the cortex carefully excised. Care was taken not so much to remove every portion of cortical substance as to avoid injury to the underlying white matter. I therefore passed the knife under the cortex with the flat surface of the knife parallel to the convexity of the hemisphere, bringing it out at a right angle to the line of incision. Then lifting the cut edge with a pair of small forceps the excision was easily completed. The slight hemorrhage was controlled with hot saline solution, the wound closed with horsehair sutures and dressed with borated cotton smeared with collodion. This monkey got dian-hoea and died on the tenth day after the operation (September 30) of marasmus. The wound in the scalp had healed well and there was no trace of sepsis. The brain and cord were removed, kept for four days in formalin and then transferred to Miiller. The brain was cut into thin segments in a plane nearly parallel to Lhe occipital sulcus (Aft'enspalte), as shown in Figs. 1 and 3, and stained by the Marehi method. It was my endeavor to make the plane of section correspond as nearly as possible to the course of the projection fibres through the internal capsule.
+
In experimental destruction of small cortical areas in tlio monkey I have often traced projection filires into the cervicil region of the cord from portions of the facial area far removed from arm centres. Such fibres probably represent the conduction paths for impulses, giving rise to movi'ments in which the arm is associated with facial movement. Such movements or actions are numerous in the monkey and increase as we go u]) in the scale. For example, in feeding, the monkey stretches out his arm, opens the hand Id lay hold
  
Description of the Lesion*.
 
  
Tlie portion of cortex removed was circular and about one cm. in diameter. About one-third of the area of the lesion was in the ascending parietal convolution and the other twothirds in the ascending frontal. Its posterior extremity was about midway between the lowest portion of the interparietal sulcus and the fissure of Rolando, while its anterior boundary was the superior angle of the sulcus precentralis. The lowest portion of the lesion was very nearly opposite the lower extremity of the interparietal sulcus, and it extended upward to the superior frontal sulcus.'* The lesion in the ascending frontal was much more shallow than in the ascending parietal and the entire cortical substance was removed only at that portion of the ascending parietal convolution nearest the centre of the lesion, close to the fissure of Rolando. It was at this point that uncomplicated flexion of the thumb was obtained on stimulation with a weak faradic current. The portion of cortex removed became thinner from the centre" to the periphery of the lesion. In the hardened brain there' was evidence of slight cerebral hernia, i. e. bulging of the brain into the opening in the skull, which accounts for the irregularity of contour in Fig. 3.
 
  
In Figs. 1 and 3 I have eiuleavored to show the distribution of association fibres to the external surface of the two hemispheres, the proximity of the oblique parallel lines to each other corresponding to the amount of degeneration found in the various convolutions. It was impossible to
+
of the object, which he grasps and carries toward his already opening mouth. In this instance the extension of the arm is the initial movement, followed by extension of the thumb and fingers, then flexion, etc. Such a movement or marcli is 'of course much more complicated than any movement obtained by electrical stimulation of the cortex. But it must be assumed that the normal discharge of energy from the cells concerned in the cortical reflex, as a result of incoming sensations, is a very different affair from our experimental stimulation. Stimulation of the motor cortex with a weak faradic current gives rise to certain movements. Cut away the cortical cells and stimulate the cut ends of the projection fibres immediately beneath and you get the same result. Who can say these results are or are not brought about in the same way? Does the former experiment induce a discharge of energy from the cell or does the current passing through the cell to the axis cylinder act exactly as in the other instance? However this may be we cannot safely assume that stimulation experiments disclose more than a hint of the functional activity of the cortex.
  
 +
A study of the excitation experiments of Beevor and Horsley° on the bonnet monkey shows that they obtained from
  
  
■>» In Fig. 1 the lesion does not extend upward as far as it should. It is better represented in Fig. 3.
 
  
  
 +
the cortical area corresponding to the lesion in this experiment:
  
110
+
Movements of thumb of the opposite side: flexion, extension and adduction:
  
 +
Flexion and extension of the fingers, opposite side;
  
 +
Movements of wrist, elbow and shoulder, opposite side;
  
JOHNS HOPKINS HOSPITAL BULLETIN.
+
( 'losure of opposite eyelids;
  
 +
Turning of the head to the opposite side;
  
 +
Retraction and elevation of the corner of the moutli, opiiosite side;
  
[Nos. 131-122-123.
+
Pouting, pursing and rolling in of the lips, more of the opposite side, but often bilateral;
  
 +
Ojieuing of both eyes and
  
 +
Eetraction of the head.
  
represent the comparative amount of degeneration so accurately in the outline drawings of transverse sections of the brain (Figs. 3 to 7 inclusive), because in so small a figure, in order to have the degeneration show at all, it was necessary to exaggerate. Degenerated fibres can be seen crossing in the corpus callosnm in all the segments except " E," the most posterior. The distribution of association fibres to the convolutions of the two hemispheres is very nearly equal and quite sj'mmetrical. It extends also upon the internal (mesial)
+
The last two were each observed only once in fifteen ex|)eriments. These movements were obtained from various points within the given area but in no single animal were they all observed, nor was any one of these movements obtained from exactly the same point in all the animals experimented upon. Most were primary, though sometimes secondary or tertiary.
  
  
  
 +
■Beevor ami Ilcirsley, Phil. Trans. Royal Society, B. 1887 ami 1S94.
  
Fig. 1.
 
  
surface of both hemispheres as far as the calloso-marginal fissure.
 
  
In two segments, C and D, the degeneration extends to the superior temporal convolution of licith sides. The route taken by the degenerated fibres to reach the temporal lobe is the same in botli hemispheres and is interesting. In section " B " (Fig. 4) a few degenerated fibres appear among the fibres passing to the superior temporal convolution just external to the thickened lower edge of the claustrum on both
+
112
  
  
  
 +
JOHNS HOPKINS HOSPITAL BULLETIN.
  
Fig. 2.
 
  
sides. In the segment posterior to this (Fig. 5) many degenerated fibres can be seen leaving the internal capsule, breaking through the thin inferior edge of the lenticular nucleus and passing below the claustrum to reach the superior temporal convolution. Some of these fibres probably terminate in the lateral geniculate body. Although no continuous fibres could be traced from the internal capsule into the lateral geniculate body, it lies directly in the path of those running to the lemporal lolie and there is considerable degen
 
  
 +
[Nus. 131-122-123.
  
eration in this nucleus in both liemispheres. Still posterior to this (Fig. 6) degenerated fibres are passing between the islets of gray matter representing the prolongations of the putamen, while many others may be seen passing down among the fibres of the external capsule. The degenerated fibres in the superior temporal convolution are apparently continuous with both these tracts, the course of which is the same in both hemispheres.
 
  
Taking into consideration the movements represented in
 
  
 +
No purely piimaiT movcincnt was ol)t:i'r\(.'i1 (iT tlio elliow or tlio fintjcrs.
  
 +
On stiimilation of the cortex of tlie orang outaiig the same investigators ° observed opening of the eyes and turning the head and eyes to the opposite side represented in the same area, or ratlier in that part of it anterior to tlie fissure of Rolando. This march, it will be seen, is also represented within this area in the Bonnet, though not so clearly brought out as in the latter. It is of especial interest in connection with the considerable degree of degeneration found, in the experiment here described, in the superior temporal convolution, now well established as the auditory centre. The association of this cenlre with that jiortion of the cortical area which controls the opening of the eyes followed by synchronous movement of the head and eyes would seem to be the anatomical basis of a cortical reflex of primary importance to self-preservation in all wild animals. It is also to be noted that the distribution of these fibres is quite bilateral. The fact that in this ease they degenerate toward the auditory centre, instead of from it, may be urged against the supposition that these fibres are a link in this reflex, but the anatomical relations of the two centres are certainly intimate and direct.
  
 +
The feature of special interest in this group of experiments is the large nundier of degenerate fibres passing from the area of the cortical lesion over the middle line in the corpus callosum and down the internal capsule of the opposite side.' With the exception of those fibres going to tlie superior tem]ioral convolution of the opposite side, tlu\se fil)res, in this ex]ierimont, all pass into the thalamus. In a few animals, in which practically the same area was extirpated, some of the degenerated fibres found in the internal capsule of the opposite side can be followed through the ])ons and medulla into the eei'vical region of the cord where they disapj)ear.
  
Fig. 3.
+
Nerve fibres within the central nervous system usually functionate in the direction of degeneration, but there is nothing in the character of the degeneration to suggest the character of the function. This can only be guessed at by the origin, course and termination of the fibres and what
  
that portion of the cortex removed, the distribution of association fibres is of especial interest. While the centre for uncomplicated movement of the thumb occupies but a small portion of the area removed, movements of the thumb as part of some associated movement or march may be obtained not only from every portion of that area but also from points considerably removed therefrom — even as far down the convexity of the brain as the lower extremity of the fissure of Rolando. It is a question of much interest whether this is
 
  
  
 +
«Beevor and Horsley, Phil. Trans. Royal Society, B. 1890.
  
 +
' The writer lias found the same thing — degeneration in the internal capsule of both sides after unilateral lesion in the brain, in the dog. In the dog all the degenenatiou in the internal capsule of the opposite side ends in the thalamus.
  
Fig. 4.
 
  
Ijrought about by means of association fibres or projection fibres passing directly from each of tlie widely separated cortical areas to the system of secondary neurons in the cervical region of the cord. It is quite possible that complicated movements may be brought about in either or both ways. The great increase in cortical association tracts between monkey and man suggests the possibility of inconceivable degrees of association.
 
  
Looking upon the motor cortex as representing the centres
+
we know of tlie function of the areas and structures thus anatomically associated. Some of the projection fibres passing inward from the motor cortex clearly carry motor impulses, but it cannot be assumed that all do. A vast number of projection fibres arising in the motor cortex end in the thalamus; I think I may say in the thalamus of both sides. A careful study of the brains of a large number of animals, mostly monkeys, the subjects of experimental lesions of the cortex, leads me to conclude that this anatomical connection of each thalamus with the cortex of both hemispheres is most evident in those instances in which the area excised was that in wliich movements more or less bilateral are represented. These movements are mostly facial; such as are calleil into play in the expression of the emotions. May not this have some bearing on the fuiution of the thalamus? It has been suggested that the thalamus is the centre for reflex or emotional movements.' In unilateral facial palsy the escape of the emotional paths has long been a puzzle. According to present conceptions the cortex is concerned in all reflexes involving consciousness. Many cortical refle.xes are purely voluntary. The part played by volition in those cortical reflexes termed emotional, such as the play of the features in facial expression, is open to discussion, but it can hardly be doubted that they are as much cortical reflexes as any of the so-called voluntary movements. The interposition of the thalamus in such an arc and the anatomical connection of each hemisphere with both thalami, as here demonstrated, may explain the play of the features as the result of emotion when voluntary movement is impossible. In many extensive lesions of the internal capsule fibres passing into the thalamus, even on the side of the lesion, might easily escape injury, even if bilateral control of the thalami were improbable.
  
 +
As to the functions, other than motor, of projection fibres from the motor cortex, it is at least possible that some serve the purposes of inhibition, voluntary or otherwise. It seems altogether reasonable that voluntary inhibition of certain visual reflexes might be essential to holding the eyes fixed upon a given object. This is suggested as a possible explanation of the presence of degenerated fibres in the lateral geniculate bodies in this case (Figs. 5 and 6). There is certainly no reason why the reflex might not be inhibited in the geniculate body before it reaches the motor oculi nuclei.
  
  
April-Mat-Juxe, 1901.]
 
  
 +
8 Bechterew. Leitungsbalmeu im Gehiru uud Riiolienmark. Zweite A ullage.
  
  
JOHNS HOPKINS HOSPITAL BULLETIN.
 
  
 +
A NEW CARBON-DIOXIDE FREEZING MICROTOME.
  
 +
liv ClI.VRLES EUSSELL BaEDEEN, M. D.,
  
Ill
+
Assnciale in Anatoiiii/, The Johns Hopl-ins Universili/. Bnlliiiiore.
  
  
  
for associated movements one would naturally expect to find projection fibres passing directly down through the capsule from that part of the cortex, giving rise to the movement. As I understand the significance of excitation experiments upon the cortex, the finding of a <?entre for the imcomplicated movement of the thumb only means that in the movement represented at that spot, the movement of the thumb (flexion or otherwise) is the first or initial movement of the march. If the stimulation is continued or increased the
+
The carbon-dioxide freezing microtomes in common use in pathological laboratories have several drawbacks. Of these the most serious are those due to the use of a rubber tube to connect the tank with the freezing stage. In addition to the
  
  
  
 +
annoyances due to the rubber tube the microtomes are so constructed as to utilize but a slight fraction of the heat absorption due to the expansion of the liquid earlKm-iliiixido. Ill order to oliviale these drawbacks the microtome described
  
Fig. 5.
 
  
march is continued or completed unless interrupted by a .general convulsion. Thus, if the anaesthesia is at just the right stage the gentlest stimulus only excites the first or initiatory movement of the march. In opposition to such a theory it may be urged that only one centre has been found in any single animal for such uncomplicated or initial movement, while many combinations are possible beginning with such movement. This woiild hardly render an entirely separate centre for each movement necessary, as they might ali be grouped about the common centre.
 
  
 +
April-May-June, 1901.]
  
  
  
Fig. li.
+
JOHNS HOPKINS HOSPITAL BULLETIN.
  
  
  
In experimental destruction of small cortical areas in tlio monkey I have often traced projection filires into the cervicil region of the cord from portions of the facial area far removed from arm centres. Such fibres probably represent the conduction paths for impulses, giving rise to movi'ments in which the arm is associated with facial movement. Such movements or actions are numerous in the monkey and increase as we go u]) in the scale. For example, in feeding, the monkey stretches out his arm, opens the hand Id lay hold
+
113
  
  
  
of the object, which he grasps and carries toward his already opening mouth. In this instance the extension of the arm is the initial movement, followed by extension of the thumb and fingers, then flexion, etc. Such a movement or marcli is 'of course much more complicated than any movement obtained by electrical stimulation of the cortex. But it must be assumed that the normal discharge of energy from the cells concerned in the cortical reflex, as a result of incoming sensations, is a very different affair from our experimental stimulation. Stimulation of the motor cortex with a weak faradic current gives rise to certain movements. Cut away the cortical cells and stimulate the cut ends of the projection fibres immediately beneath and you get the same result. Who can say these results are or are not brought about in the same way? Does the former experiment induce a discharge of energy from the cell or does the current passing through the cell to the axis cylinder act exactly as in the other instance? However this may be we cannot safely assume that stimulation experiments disclose more than a hint of the functional activity of the cortex.
+
below was devised. In the designing of the original machine I had tJie assistance of Mr. E. F. Xorthrup. In the construction of the present machine I am indebted to Bausch and Lomb, who manufacture it, for several modifications which have simplified tlie instrument and rendered it more useful. Figure 1 shows the machine as it stands ready for use. It is made to screw directly npon the nozzle of the carbondioxide tank. The valve of the latter is utilized to control tlie escape of the gas into the freezing stage. When the microtome is screwed directly upon the carbon-dioxide tank it is necessary that the tank should lie in a horizontal position, on a table for instance, where it may be held in place by some simple clamp. On the other hand, if it is desired to connect the microtome to a tank placed in some other than the horizontal ]iosition an L-'shaped piece of tubing may be screwed on the nozzle of the tank and the microtome on the other end of the L tube. The tank may then be placed in any position desired.
  
A study of the excitation experiments of Beevor and Horsley° on the bonnet monkey shows that they obtained from
 
  
  
  
 +
Fig. 1.
  
the cortical area corresponding to the lesion in this experiment:
+
A. Cover of freezing stage.
  
Movements of thumb of the opposite side: flexion, extension and adduction:
+
B. Glass track for carrying kuife.
  
Flexion and extension of the fingers, opposite side;
+
E. Spiral spring.
  
Movements of wrist, elbow and shoulder, opposite side;
+
F. Tubal base of knife-stage. 1. Wheel.
  
( 'losure of opposite eyelids;
+
J. Nut for attachiug axial tube to tank. M. Handle of tank-valve. N. Pointer.
  
Turning of the head to the opposite side;
+
The axis and main support of the machine consists of a solid tube with a narrow himen {K-D, Fig. 2). This axial tube is united by a nut (.7, Fig. 1 and Fig. 2) either to tlie nozzle of the tank or to the L-shaped tube mcntidiu'd above.
  
Retraction and elevation of the corner of the moutli, opiiosite side;
+
The machine is thus very readily attached.
  
Pouting, pursing and rolling in of the lips, more of the opposite side, but often bilateral;
+
On the top of the axial tube the freezing stage (.1, Fig. 1, A-C, Fig. 2) is screwed. This stage piece consists of two parts, a base and a cover. The base is the part screwed into the upper end of the axial tube (C, Fig. 2). To this base the cover-piece is .screwed (.1. Fig. 2). Between the base of the stage and the axial tube is placed a thin brass plate
  
Ojieuing of both eyes and
 
  
Eetraction of the head.
 
  
The last two were each observed only once in fifteen ex|)eriments. These movements were obtained from various points within the given area but in no single animal were they all observed, nor was any one of these movements obtained from exactly the same point in all the animals experimented upon. Most were primary, though sometimes secondary or tertiary.
+
(D, Fig. 2) with a very narrow aj)erture at its centre. Through this narrow aperture the carbon-dioxide escapes into the lumen of the stage piece (C, Fig. .2). The difference in pressure on the two sides of the brass plate causes a very rapid expansion of gas between the cover and base of the freezing stage. The passage open for the escape of gas from the lumen of the base {C, Fig. 2) to the external world is in the form of a s])iral passage which finally opens out through the side of the cover, as shown in (Fig. 1, .1). Between tlie cover and base of the freezing stage an asljestus washer is ]i]aced. The exjianding gas therefore can absorb little heat from the base of the stage. Almost all heat absor]ition must take place from the cover. This heat absorption is greatly facilitated by the metallic spiral which projects down from the cover so as to give rise to the spiral passage through which the gas escajies.
  
 +
Througli the mechanism here descrilicd far the greater part of the heat-absorbing power of the expanding gas is utilized
  
 +
A B
  
■Beevor ami Ilcirsley, Phil. Trans. Royal Society, B. 1887 ami 1S94.
 
  
  
  
112
+
G l^
  
  
  
JOHNS HOPKINS HOSPITAL BULLETIN.
 
  
 +
A. B. C. D. E. F. <i. H. I. J. K.
  
  
[Nus. 131-122-123.
 
  
 +
Fig. 3.
  
 +
Cover of freezing stage.
  
No purely piimaiT movcincnt was ol)t:i'r\(.'i1 (iT tlio elliow or tlio fintjcrs.
+
Glass track for carrying-knife.
  
On stiimilation of the cortex of tlie orang outaiig the same investigators ° observed opening of the eyes and turning the head and eyes to the opposite side represented in the same area, or ratlier in that part of it anterior to tlie fissure of Rolando. This march, it will be seen, is also represented within this area in the Bonnet, though not so clearly brought out as in the latter. It is of especial interest in connection with the considerable degree of degeneration found, in the experiment here described, in the superior temporal convolution, now well established as the auditory centre. The association of this cenlre with that jiortion of the cortical area which controls the opening of the eyes followed by synchronous movement of the head and eyes would seem to be the anatomical basis of a cortical reflex of primary importance to self-preservation in all wild animals. It is also to be noted that the distribution of these fibres is quite bilateral. The fact that in this ease they degenerate toward the auditory centre, instead of from it, may be urged against the supposition that these fibres are a link in this reflex, but the anatomical relations of the two centres are certainly intimate and direct.
+
Aperture in base of freezing stage.
  
The feature of special interest in this group of experiments is the large nundier of degenerate fibres passing from the area of the cortical lesion over the middle line in the corpus callosum and down the internal capsule of the opposite side.' With the exception of those fibres going to tlie superior tem]ioral convolution of the opposite side, tlu\se fil)res, in this ex]ierimont, all pass into the thalamus. In a few animals, in which practically the same area was extirpated, some of the degenerated fibres found in the internal capsule of the opposite side can be followed through the ])ons and medulla into the eei'vical region of the cord where they disapj)ear.
+
Aperture in thin brass plate.
  
Nerve fibres within the central nervous system usually functionate in the direction of degeneration, but there is nothing in the character of the degeneration to suggest the character of the function. This can only be guessed at by the origin, course and termination of the fibres and what
+
Spiral spring.
  
 +
Tubal base of knife stage.
  
 +
Check for limiting movements of knife-stage.
  
«Beevor and Horsley, Phil. Trans. Royal Society, B. 1890.
+
Groove for G.
  
' The writer lias found the same thing — degeneration in the internal capsule of both sides after unilateral lesion in the brain, in the dog. In the dog all the degenenatiou in the internal capsule of the opposite side ends in the thalamus.
+
Wheel.
  
 +
Nut for attaching axial tube to tank.
  
 +
Opening into lumen of axial tube.
  
we know of tlie function of the areas and structures thus anatomically associated. Some of the projection fibres passing inward from the motor cortex clearly carry motor impulses, but it cannot be assumed that all do. A vast number of projection fibres arising in the motor cortex end in the thalamus; I think I may say in the thalamus of both sides. A careful study of the brains of a large number of animals, mostly monkeys, the subjects of experimental lesions of the cortex, leads me to conclude that this anatomical connection of each thalamus with the cortex of both hemispheres is most evident in those instances in which the area excised was that in wliich movements more or less bilateral are represented. These movements are mostly facial; such as are calleil into play in the expression of the emotions. May not this have some bearing on the fuiution of the thalamus? It has been suggested that the thalamus is the centre for reflex or emotional movements.' In unilateral facial palsy the escape of the emotional paths has long been a puzzle. According to present conceptions the cortex is concerned in all reflexes involving consciousness. Many cortical refle.xes are purely voluntary. The part played by volition in those cortical reflexes termed emotional, such as the play of the features in facial expression, is open to discussion, but it can hardly be doubted that they are as much cortical reflexes as any of the so-called voluntary movements. The interposition of the thalamus in such an arc and the anatomical connection of each hemisphere with both thalami, as here demonstrated, may explain the play of the features as the result of emotion when voluntary movement is impossible. In many extensive lesions of the internal capsule fibres passing into the thalamus, even on the side of the lesion, might easily escape injury, even if bilateral control of the thalami were improbable.
 
  
As to the functions, other than motor, of projection fibres from the motor cortex, it is at least possible that some serve the purposes of inhibition, voluntary or otherwise. It seems altogether reasonable that voluntary inhibition of certain visual reflexes might be essential to holding the eyes fixed upon a given object. This is suggested as a possible explanation of the presence of degenerated fibres in the lateral geniculate bodies in this case (Figs. 5 and 6). There is certainly no reason why the reflex might not be inhibited in the geniculate body before it reaches the motor oculi nuclei.
 
  
 +
to lower the temperature of the surface of the cover of the freezing stage. The temperature of the rest of the machine is but little altered. Good control of the temperature of the freezing stage can be thus maintained. This control is farther rendered possible by the valve of the tank. If this valve is turned on full the temperature of tlie cover nf the freezing stage is quickly reduced to a very low point. Tissue placed
  
  
8 Bechterew. Leitungsbalmeu im Gehiru uud Riiolienmark. Zweite A ullage.
 
  
 +
lU
  
  
A NEW CARBON-DIOXIDE FREEZING MICROTOME.
 
  
liv ClI.VRLES EUSSELL BaEDEEN, M. D.,
+
JOHNS HOPKINS HOSPITAL BULLETIN.
  
Assnciale in Anatoiiii/, The Johns Hopl-ins Universili/. Bnlliiiiore.
 
  
  
 +
[Nos. 121-122-123.
  
The carbon-dioxide freezing microtomes in common use in pathological laboratories have several drawbacks. Of these the most serious are those due to the use of a rubber tube to connect the tank with the freezing stage. In addition to the
 
  
  
 +
on it is quickly frozen. On the other hand, if the gas is not allowed to escajie from the tank with full force the difference in pressure in the two sides of the brass plate is less and heat absorption from the cover is less marked. In this way tissues placed on the cover may be slowly frozen without suljjecting them to severe cold. Thus, too, a constant low temperature may be maintained by opening the tank-valve to the required point.
  
annoyances due to the rubber tube the microtomes are so constructed as to utilize but a slight fraction of the heat absorption due to the expansion of the liquid earlKm-iliiixido. Ill order to oliviale these drawbacks the microtome described
+
The mechanism for controlling the thickness of the sections is equally simple. On the lower end of the axial tube a movable wheel {I, Fig. 1 and Fig. 2) is placed. This wheel moves up and down the axial tube on a screw thread cut twenty-five threads to the inch. A complete revolution of the wheel therefore raises or lowers it a millimeter. The margin of the wheel is divided into fifty spaces, each of which therefore represents twenty microns. A pointer (iV. Fig. 1) serves to indicate the number of spaces passed in a partial revolution of the wheel and thus to show the thickness of the sections cut.
  
 +
The knife-stage {F-B, Fig. 1 and Fig. 2) consists of a tubal
  
  
April-May-June, 1901.]
 
  
 +
base (F). whii-li surrounds the axial tube and rests on the mova1)le wheel; and of two flanges {B) which extend above the freezing stage on each side for the support of the cutting blade. The base of the knife-stage is moved up the axial tube by screwing the wheel ujiwards. It is forced down the axial tube by the spring (E, Fig. 1 and Fig. 2) whenever the wheel is turned so as to be carried downwards. Tlie flanges of the knife-stage support parallel glass tracks upon which the cutting blade is carried to and fro.
  
 +
For cutting sections a razor or a plane or almost any good steel blade with a straight edge may be used.
  
JOHNS HOPKINS HOSPITAL BULLETIN.
+
The advantages of the machine are as follows:
  
 +
1. But little carbon-dioxide is wasted.
  
 +
2. The temperature of the freezing stage can be controlled.
  
113
+
3. Owing to the nature of its attachment to the tank it can be readily carried about. This should render it of especial value to surgeons.
  
 +
4. Above all it is simple in design, strong, and unlikely to get out of order.
  
  
below was devised. In the designing of the original machine I had tJie assistance of Mr. E. F. Xorthrup. In the construction of the present machine I am indebted to Bausch and Lomb, who manufacture it, for several modifications which have simplified tlie instrument and rendered it more useful. Figure 1 shows the machine as it stands ready for use. It is made to screw directly npon the nozzle of the carbondioxide tank. The valve of the latter is utilized to control tlie escape of the gas into the freezing stage. When the microtome is screwed directly upon the carbon-dioxide tank it is necessary that the tank should lie in a horizontal position, on a table for instance, where it may be held in place by some simple clamp. On the other hand, if it is desired to connect the microtome to a tank placed in some other than the horizontal ]iosition an L-'shaped piece of tubing may be screwed on the nozzle of the tank and the microtome on the other end of the L tube. The tank may then be placed in any position desired.
 
  
 +
NOTES ON CERVICAL RIBS.
  
  
  
Fig. 1.
+
(Froii) the Aniitninii'id Luhoratorij
  
A. Cover of freezing stage.
+
Altliough nianv cervical ribs have been described hereto
  
B. Glass track for carrying kuife.
 
  
E. Spiral spring.
+
fore, the following description of three cases is given because of variations presented which, while most of them have already been recorded, are somewhat rare.
  
F. Tubal base of knife-stage. 1. Wheel.
+
(Jase I. Fig. 1. The dissection of this subject was nearly completed before the cervical rib was noticed, so that most of the soft parts had already been removed before it came to my hands.
  
J. Nut for attachiug axial tube to tank. M. Handle of tank-valve. N. Pointer.
+
There was a cervical rib on each side, the left being much better developed tl-an the right. Each rib was made up of head, neck, tubercle and shaft. Each articulated with the seventh cervical vertebra on the body and on the transverse process. There was a simple stellate ligament at the costocentral articulation, and a capsular ligament at the articulation of tlie tubercle with the transverse process.
  
The axis and main support of the machine consists of a solid tube with a narrow himen {K-D, Fig. 2). This axial tube is united by a nut (.7, Fig. 1 and Fig. 2) either to tlie nozzle of the tank or to the L-shaped tube mcntidiu'd above.
+
The left rib extended down to the upper liorder of the first thoracic rib, witli which it articulated, lieing held in position by a capsular ligament. There was a slight articular eminence or facet on the first thoracic rib at the point of articulation, the facet apparently corresponding to the scalene tubercle of a normal first thoracic rib. The left cervical v\h projected a distance of 2.3 cm. beyond the body of the seventh cervical vertebra and then curved sharply downwards. The extreme width of the rib was at this point, where it measured !.(! cm. The shaft of the rib was triangular in cross-section and measured .4 cm. in thickness.
  
The machine is thus very readily attached.
+
The sevcntli cervical nerve on the left side crossed the middle cif tlu' livoad up]ier half of the rili in a well marked groove.
  
On the top of the axial tube the freezing stage (.1, Fig. 1, A-C, Fig. 2) is screwed. This stage piece consists of two parts, a base and a cover. The base is the part screwed into the upper end of the axial tube (C, Fig. 2). To this base the cover-piece is .screwed (.1. Fig. 2). Between the base of the stage and the axial tube is placed a thin brass plate
 
  
  
 +
By Clinton E. Brush, Jr.
  
(D, Fig. 2) with a very narrow aj)erture at its centre. Through this narrow aperture the carbon-dioxide escapes into the lumen of the stage piece (C, Fig. .2). The difference in pressure on the two sides of the brass plate causes a very rapid expansion of gas between the cover and base of the freezing stage. The passage open for the escape of gas from the lumen of the base {C, Fig. 2) to the external world is in the form of a s])iral passage which finally opens out through the side of the cover, as shown in (Fig. 1, .1). Between tlie cover and base of the freezing stage an asljestus washer is ]i]aced. The exjianding gas therefore can absorb little heat from the base of the stage. Almost all heat absor]ition must take place from the cover. This heat absorption is greatly facilitated by the metallic spiral which projects down from the cover so as to give rise to the spiral passage through which the gas escajies.
+
of file Jiihiis Iliipktns Unlfersili/.)
  
Througli the mechanism here descrilicd far the greater part of the heat-absorbing power of the expanding gas is utilized
+
At a point 2.G cm. from the distal end of the rib was the superior border of a sharply defined groove, .9 cm. in width. Across this jiassed the lower trunk of the brachial plexus (1), the eighth cervical and first thoracic nerves uniting before crossing the rib. As the truid'; of the brachial plexus was
  
A B
 
  
  
  
 +
YlG. 1.
  
G l^
+
C.^SE I. — 1. Lower cord of brachial plexus. 3. Sui)pleineiitar_v iutereostal uerve. 3. Fibrous cord.
  
 +
but .4 cm. in diameter, it is probable that the subclavian artery also crossed iu this groove.
  
 +
In the supplementary interspace there were some well developed muscle fibres, but their condition was such that it was impossible to decide wliether or not tliere had been both an inner and an outer set. ,lust before crossing the upper border of the first tiuu'acic rib, the eightli cervical nerve
  
  
A. B. C. D. E. F. <i. H. I. J. K.
 
  
 +
Ai'iai.-MAY-JrM-;, lOdl.]
  
  
Fig. 3.
 
  
Cover of freezing stage.
+
JOHNS PIOPKINS HOSPITAL BULLETIN.
  
Glass track for carrying-knife.
 
  
Aperture in base of freezing stage.
 
  
Aperture in thin brass plate.
+
115
  
Spiral spring.
 
  
Tubal base of knife stage.
 
  
Check for limiting movements of knife-stage.
+
<iave off a small branch (2), which divided into several smaller twigs to innervate the supplementary intercostal muscle.
  
Groove for G.
+
The right cervical rib corresponded very closely in size and shape to the upper half of the left rib. It extended 1.7 cm. beyond the body of the seventh cervical vertolira and was 1.4 cm. wide. The upper border curved sharply downwards and met the lower border 2.6 cm. below tlip tuliercle. so that the rib ended in a point. From this pointed end a round, lihrous cord (3) extended to the first thoracic ril). meetiui;- it al a point corresponding to the place of articulation of tlie left cervical i-ib with the first thoracic rib (ui tlie left side. l'"r(ini bere the fibrous cord was continued along tlie superidr liin-ilcr of the first thoracic rib to the stcrntnn.
  
Wheel.
+
On the riglit side also the supplementary inlers|iace C(intained well developed muscle filires, the nerve suiiply lieing similar to that on the left side.
  
Nut for attaching axial tube to tank.
+
'I'he distribution of the arteries that were still on the subject was normal, except that nn buth sides the verteljial arteries passed up to enter the foramina of the transverse processes of the fifth cervical vertebra.
  
Opening into lumen of axial tube.
 
  
  
  
to lower the temperature of the surface of the cover of the freezing stage. The temperature of the rest of the machine is but little altered. Good control of the temperature of the freezing stage can be thus maintained. This control is farther rendered possible by the valve of the tank. If this valve is turned on full the temperature of tlie cover nf the freezing stage is quickly reduced to a very low point. Tissue placed
+
Fig. 3.
  
 +
Case II. 1. Groove for subclavian artery and lower cord of brachial
  
 +
plexus. 3. Groove for VII cervical uervc. 3. Ligament. 4. Capsular liijauient. 5, (I, 7 and 8. Liijaraeuts.
  
lU
+
Case II. Negro woman. Age, a1)out GO years. Fig. 2. Vertebral formula— C, 7; T, 12; L, 5; ,S', 5.
  
 +
This subject possessed two well developed cer\ieal ribs, that on the left side being much better developed tliau that on the right. Each rib consisted of head, neck, tubercle and shaft. Each articulated with the seventh cervical vertebra in two places — the liody and the transverse process. The right rib articulated with the superior border of the first thoracic rib, G.9 cm. from the head of the latter. The left rib was ankylosed with the superior border of the first thoracic ril), the central point of the ankylosis being 5.5 cm. from the head of the thoracic rib.
  
 +
The general shape of the two ribs was the same, the upper part of the shaft being broad and flat and then rapidly narrowing down to a shaft which was triangular in cross-section.
  
JOHNS HOPKINS HOSPITAL BULLETIN.
 
  
  
 +
Each rib presented two grooves. One (1) which was very well defined, was on the anterior surface of the narrnw pail of the shaft for the }ias.sage of the lower trunk of the brachial plexus and the sid'clavian artery. The other groove (2) was very slight and extended outward across the broad upper part of the sliaft for the ]mssage of the seventh cervical nerve.
  
[Nos. 121-122-123.
+
The dianieier of tlie first thoracic rib on the left side from its lu'ad to the ankylosis with the cervical rib, liu( more especially in llw nock, was much less than tbat of tbe right thoracic rib in tbe same part. Beyond the ankylosis it was nbdnt the same width as the right rib was lievmid its articnla'tion with the cervical rib.
  
 +
From the ti|> of the right t'ci'vical rib a round lilu'ous coi-il extended to Ihe sternum along the superior bordei' (if Ihe first thoracic rib, being closely adherent to the latter. A similar cord was present on the superior border of the left thoracic rib, being continued from the ankylosis.
  
 +
The ]n'iiu-ipal measurements of the ribs were as follows:
  
on it is quickly frozen. On the other hand, if the gas is not allowed to escajie from the tank with full force the difference in pressure in the two sides of the brass plate is less and heat absorption from the cover is less marked. In this way tissues placed on the cover may be slowly frozen without suljjecting them to severe cold. Thus, too, a constant low temperature may be maintained by opening the tank-valve to the required point.
+
Right. Lett.
  
The mechanism for controlling the thickness of the sections is equally simple. On the lower end of the axial tube a movable wheel {I, Fig. 1 and Fig. 2) is placed. This wheel moves up and down the axial tube on a screw thread cut twenty-five threads to the inch. A complete revolution of the wheel therefore raises or lowers it a millimeter. The margin of the wheel is divided into fifty spaces, each of which therefore represents twenty microns. A pointer (iV. Fig. 1) serves to indicate the number of spaces passed in a partial revolution of the wheel and thus to show the thickness of the sections cut.
+
Head, neck and tubercle 3.6 cm 2..S cm.
  
The knife-stage {F-B, Fig. 1 and Fig. 2) consists of a tubal
+
Straight line from back of tubercle to
  
 +
end of rib 4.7 " 4. .5 "
  
 +
Length along' concave border .5.7 " O.ti "
  
base (F). whii-li surrounds the axial tube and rests on the mova1)le wheel; and of two flanges {B) which extend above the freezing stage on each side for the support of the cutting blade. The base of the knife-stage is moved up the axial tube by screwing the wheel ujiwards. It is forced down the axial tube by the spring (E, Fig. 1 and Fig. 2) whenever the wheel is turned so as to be carried downwards. Tlie flanges of the knife-stage support parallel glass tracks upon which the cutting blade is carried to and fro.
+
Breadth of upjier part of shaft l.o " I. .5 "
  
For cutting sections a razor or a plane or almost any good steel blade with a straight edge may be used.
+
Diameter of lower part of shaft 4 .6 "
  
The advantages of the machine are as follows:
+
Diameter of neck of first thoracic rib 1
  
1. But little carbon-dioxide is wasted.
+
cm. from its head 9.5 " .5.5 **
  
2. The temperature of the freezing stage can be controlled.
+
On the right side, the scalenus anticus had a. normal origin, but was inserted on the tip of the cervical rili anil on the sitperior border of the first thoracic rib for 1 cm. anterior to the articulation of the two ribs. The scalenus medius was inserted along the superior border of the cervical rib from the tubercle to the upper border of the groove for the subclavian artery and lower cord of the brachial plexus, 2.3 cm. from the distal end of the rib. At the lower end of the insertion some of the filn'cs were prolonged downwards across the inner surface of the supplementary interspace to be inserted on the upper border of the first thoracic rib for l.l cm. jjosterior to the articulation with the cervical rib. The scalenus posticus was inserted on the outer border of the cervical rib at a point l.t! cm. from the tubercle, in connection with the scalenus medius, and thence by a fibrous band, .3 cm. wide, backward and downward to the superior boi-der of the first thoracic rib for a distance of .5 em. on that rib.
  
3. Owing to the nature of its attachment to the tank it can be readily carried about. This should render it of especial value to surgeons.
+
The supplementary interspace on the right side was fillett by two well developed intercostal muscles, an outer and an inner. The external intercostal arose from the outer inferior border of the cervical rib from the head to the extreme end of the rib. The fibres extended downward and forward to be inserted along the superior border of the first thoracic rib. The fibres arising from the end of the cervical rib spread out in a fan-shaped insertion along the anterior face of the first thoracic rib for a distance of 2.5 cm.
  
4. Above all it is simple in design, strong, and unlikely to get out of order.
+
The internal intercostal muscle arose from the inner border nC the infi'i-idi- sni-face of the rib, the fibres running downward and backward to be inserted along the inner border of the first thoracic rib for a similar distance. This muscle was
  
  
  
NOTES ON CERVICAL RIBS.
+
116
  
  
  
(Froii) the Aniitninii'id Luhoratorij
+
JOHNS HOPKINS HOSPITAL lUTLLETIN.
  
Altliough nianv cervical ribs have been described hereto
 
  
  
fore, the following description of three cases is given because of variations presented which, while most of them have already been recorded, are somewhat rare.
+
[Nos. 121-132-123.
  
(Jase I. Fig. 1. The dissection of this subject was nearly completed before the cervical rib was noticed, so that most of the soft parts had already been removed before it came to my hands.
 
  
There was a cervical rib on each side, the left being much better developed tl-an the right. Each rib was made up of head, neck, tubercle and shaft. Each articulated with the seventh cervical vertebra on the body and on the transverse process. There was a simple stellate ligament at the costocentral articulation, and a capsular ligament at the articulation of tlie tubercle with the transverse process.
 
  
The left rib extended down to the upper liorder of the first thoracic rib, witli which it articulated, lieing held in position by a capsular ligament. There was a slight articular eminence or facet on the first thoracic rib at the point of articulation, the facet apparently corresponding to the scalene tubercle of a normal first thoracic rib. The left cervical v\h projected a distance of 2.3 cm. beyond the body of the seventh cervical vertebra and then curved sharply downwards. The extreme width of the rib was at this point, where it measured !.(! cm. The shaft of the rib was triangular in cross-section and measured .4 cm. in thickness.
+
innervatoil liy (ibrcs from the interfostal ln-aiu-h of tlie first tliorMcic iKTVt'. This branch ran ahiii<>- tlie superior border of tlie second tlun-acic rib and sent its fibres across the first rib io the su|)plcmeutary intercostal muscle.
  
The sevcntli cervical nerve on the left side crossed the middle cif tlu' livoad up]ier half of the rili in a well marked groove.
+
Tlie eifihtli cervical and first thoracic nerves united at the inner boi'der cd' the cervical rib to form the lower trunk of the brachial plexus, which crossed the rib above the subclavian artery. Just i)efore uniting with the eighth cervical nerve, the first thoracic gave off a slender blanch which descended along the inner border of the rib, behind the suljdavian artery, to the lower end of the rib, where it turned upward to gain the surface, wound around the end of the rib and was distributed to the articular ligament.
  
 +
The right rib articulated freely with the seventh cervical vertebra and also with the first thoracic rilj. A stellate ligament held the head of the cervical rib to the vertebra. Besides this ligament there was a superior costocentral ligament (3) passing from the superior surface of the neck of the rib mainly to the lower outer border of the body of the sixth vertebra, a small slip being continued upward and outward to the anterior inferior border of the transverse process of the same vertebra. A capsular ligament (4) held the tubercle of the rib to the transverse process of the seventh vertebra.
  
 +
The disposition of the soft parts of the left side' was very similar to that of the right. The scalenus anticns was inserted by a fan-shaped set of tendinous fibres to the lower half centimeter of the cervical rib, and was continued along the superior border of the first thoracic rib for 1.6 cm. anteriorly. The scalenus medins was inserted along the superior external border of the cervical rib from its head to the upper margin of the groove for the subclavian artery, 2.3 cm. from the central point of the ankylosis. The scalenus posticus was inserted on the superior border of the first rib. The iliocostalis dorsi sent a sliiJ of insertion to the external border of the cervical rib and also one to the tubercle. On the right side the slip to the tubercle alone was jjresent.
  
By Clinton E. Brush, Jr.
+
The external intercostal muscle in the supplementary interspace was well developed. It arose from the outer border of the inferior surface of the cervical rilj from its head to the ankylosis. The fibres, running downward and forward, were inserted along the superior border and external surface of the first thoracic rib for a somewhat longer distance. The internal intercostals arose from the inner inferior border of the cervical rib, from the ankylosis to the tubercle, and extended downward and slightly backward to l)e inserted for a similar distance along the superior inner border of the first thoracic rib. The innervation of the supplementary intercostals was similar to that on the right side — l.iy branches from the first intercostal nerve.
  
of file Jiihiis Iliipktns Unlfersili/.)
+
The left cervical rib articulated freely with the seventh cervical vertebra, but was firmly ankylosed with the superior border of the first thoracic rib, the ankylosis covering a distance of 2.2 cm. The tubercle articulated with the transverse process of the seventh vertebra, the joint being effected by a capsular ligament, no distinct division into smaller indi
  
At a point 2.G cm. from the distal end of the rib was the superior border of a sharply defined groove, .9 cm. in width. Across this jiassed the lower trunk of the brachial plexus (1), the eighth cervical and first thoracic nerves uniting before crossing the rib. As the truid'; of the brachial plexus was
 
  
 +
vidual l)ands being noticeable. From the ui'ck of the rib. .just within the tubercle, a filirous band (5) .•"> em. in width extended upwai'd, backward and slightly inward to the lower ])osterior border of the transverse process of the sixth vertebra, and to the anterior face of the transverse process of the seventh. A small ligament (fi) connected the superior external margin of the liead with the lower, outer border of the body of the sixth vertebra. Just internally to this, and arising friuu the middle of the superior surface of the lu'ad. a band .3 cm. wide (7) extended u})ward ami inward to the lower outer border of the sixth vertebra, the insertion being under and inside of that of the smaller slip. Posteriorly to these, another ligament, .G cm. wide, connected the superior posterior surface of the head with the lower border of the body of the sixth vertebra. A shoi't, tough, fibrous cord (8) extended from the inferior surface of the head of the cervical rib to the superior surface of the head of the first thoracic rib. From the upper half of the head of the cervical ril) a stellate ligament extended to the body of the seventh vertelira.
  
 +
The arterial distribution on both sides was normal except for the origin of the left common carotid from the innominate artery immediately after the latter left the aorta.
  
 +
There was a distinct skoliosis to the left side in the upper thoracic region.
  
YlG. 1.
+
Case III. This was simply a cleaned specimen of a rib from the anatomical museum. Nothing was known about the subject from which it came.
  
C.^SE I. — 1. Lower cord of brachial plexus. 3. Sui)pleineiitar_v iutereostal uerve. 3. Fibrous cord.
+
The specimen was that of a left first thoracic rib, having a cervical rib ankylosed with it. The ankylosis was so complete and the free part of the cervical rib so shoi't that it would be better to class this as a bicipital first thoracic rib. Its morphology is very similar to that of the bicipital ribs described by Turner.' The rib presented two heads, two necks, two tubercles; and, for a distance of l.G cm. beyond the tubercle of the upper division, there were two shafts. That point marked the posterior limit of the ankylosis, which extended forward a distance of 4 em. On account of the ankylosis, the rib was very broad at this part, being 2.(i cm., while the true shaft of the first thoracic rib beyond the fusion was hut 1.7 cm. The two necks were separated by n space .6 cm. wide.
  
but .4 cm. in diameter, it is probable that the subclavian artery also crossed iu this groove.
+
The principal uieasui'cments of the rib were as foUow's:
  
In the supplementary interspace there were some well developed muscle fibres, but their condition was such that it was impossible to decide wliether or not tliere had been both an inner and an outer set. ,lust before crossing the upper border of the first tiuu'acic rib, the eightli cervical nerve
+
From tip of lie.ad to outer border o£ tubercle, (upiier divisiou). .'3.4 em.
  
 +
II '• " ■' " " (lower division). S.li "
  
 +
Widtli of necl<, (upper division) S "
  
Ai'iai.-MAY-JrM-;, lOdl.]
+
" " (lower division) ... .7 "
  
 +
Straight line from head of lower division to dist;il end of rib. S..") " Length along convex margin from head of lower division to
  
 +
distal end of rib 1'.>.3 >■
  
JOHNS PIOPKINS HOSPITAL BULLETIN.
+
The U]ipcr border of the rib ])resented two grooves, one crossing just anterior to the central point of the ankylosis and the other .7 cm. anterior to this. In the recent state the subclavian artery and lower cord of the brachial plexus undoubtedly crossed by the former, while the latter was prob
  
  
 +
' Journ. Anat. and Physiol., 1883, vol. xvii, pt. ill.
  
115
 
  
  
 +
Ai'Ril-May-June, 1901.]
  
<iave off a small branch (2), which divided into several smaller twigs to innervate the supplementary intercostal muscle.
 
  
The right cervical rib corresponded very closely in size and shape to the upper half of the left rib. It extended 1.7 cm. beyond the body of the seventh cervical vertolira and was 1.4 cm. wide. The upper border curved sharply downwards and met the lower border 2.6 cm. below tlip tuliercle. so that the rib ended in a point. From this pointed end a round, lihrous cord (3) extended to the first thoracic ril). meetiui;- it al a point corresponding to the place of articulation of tlie left cervical i-ib with the first thoracic rib (ui tlie left side. l'"r(ini bere the fibrous cord was continued along tlie superidr liin-ilcr of the first thoracic rib to the stcrntnn.
 
  
On the riglit side also the supplementary inlers|iace C(intained well developed muscle filires, the nerve suiiply lieing similar to that on the left side.
+
JOHNS HOPKINS HOSPITAL BULLETIN.
  
'I'he distribution of the arteries that were still on the subject was normal, except that nn buth sides the verteljial arteries passed up to enter the foramina of the transverse processes of the fifth cervical vertebra.
 
  
  
 +
117
  
  
Fig. 3.
 
  
Case II. 1. Groove for subclavian artery and lower cord of brachial
+
ably for the passage of the subclavian vein. Between these two grooves there was a very prominent pointed process, projecting 1 cm. beyond the upper border of the rib. The anterior margin of its base was also the anterior limit of the ankylosis. From its general direction and from the fact tliat there was a visible groove along the line of ankylosis, it seems probable that this represented the tip of an originally free cervical rib. In the recent state there was probably a tibrous (Mird extending from the tip of the process to the slernnni.
  
plexus. 3. Groove for VII cervical uervc. 3. Ligament. 4. Capsular liijauient. 5, (I, 7 and 8. Liijaraeuts.
+
SOMMAKT.
  
Case II. Negro woman. Age, a1)out GO years. Fig. 2. Vertebral formula— C, 7; T, 12; L, 5; ,S', 5.
+
Of tliese three cases, the first two present some uiicoiiinion \ariations. In the first case the innervation of the supploiiiciitary intercostals by a direct intercostal branch from the eiglith cervical nerve has been described only once." The second ease shows a peculiar insertion of the serratns posticus on the first thoracic rib. This has also been described by Grubcr,' but it is not mentioned as a variation in the standard
  
This subject possessed two well developed cer\ieal ribs, that on the left side being much better developed tliau that on the right. Each rib consisted of head, neck, tubercle and shaft. Each articulated with the seventh cervical vertebra in two places — the liody and the transverse process. The right rib articulated with the superior border of the first thoracic rib, G.9 cm. from the head of the latter. The left rib was ankylosed with the superior border of the first thoracic ril), the central point of the ankylosis being 5.5 cm. from the head of the thoracic rib.
 
  
The general shape of the two ribs was the same, the upper part of the shaft being broad and flat and then rapidly narrowing down to a shaft which was triangular in cross-section.
 
  
 +
Mem. de 1' Acad, des Sc. de St. Petersbourg, 1869.
  
  
Each rib presented two grooves. One (1) which was very well defined, was on the anterior surface of the narrnw pail of the shaft for the }ias.sage of the lower trunk of the brachial plexus and the sid'clavian artery. The other groove (2) was very slight and extended outward across the broad upper part of the sliaft for the ]mssage of the seventh cervical nerve.
+
text-books, nor is it spoken of by Le Double.^ This case also presents the following variations, wliich, so far as I can find, liave not been reported heretofore: a minute brancli from the right first tlioracic nerve to the articidar ligament l>etween tlie cervical and first tlioracic ribs; a ligament connecting tlic licad of tlic left cervical rib witli the head of the left first thoracic rib, and a ligament from the neck of the cervical ril) to the lower border of the transverse process of the si.xth vertebra (Fig. 3, 5). I^or a full list of references to the subject of cervical I'ibs the recent article by I'hillips' may bo consulted.
  
The dianieier of tlie first thoracic rib on the left side from its lu'ad to the ankylosis with the cervical rib, liu( more especially in llw nock, was much less than tbat of tbe right thoracic rib in tbe same part. Beyond the ankylosis it was nbdnt the same width as the right rib was lievmid its articnla'tion with the cervical rib.
+
In conclusion 1 wish to express my thanks to Dr. K. (). Harrison, at whose suggestion the work was originally undertaken, for his advice and assistance in my work.
  
From the ti|> of the right t'ci'vical rib a round lilu'ous coi-il extended to Ihe sternum along the superior bordei' (if Ihe first thoracic rib, being closely adherent to the latter. A similar cord was present on the superior border of the left thoracic rib, being continued from the ankylosis.
 
  
The ]n'iiu-ipal measurements of the ribs were as follows:
 
  
Right. Lett.
+
■' Traite des variations desSystcme masculaire de 1' liommo. Paris ISltT. Tome I.
  
Head, neck and tubercle 3.6 cm 2..S cm.
+
Jouru. Aiiat. and Physiol., l',)00, vol. xx.\iv, D. s. xiv, pt. iv.
  
Straight line from back of tubercle to
 
  
end of rib 4.7 " 4. .5 "
+
ON THE PRESERVATION OF ANATOMICAL MATERIAL IN AMERICA BY MEANS
  
Length along' concave border .5.7 " O.ti "
+
OF COLD STORAGE.
  
Breadth of upjier part of shaft l.o " I. .5 "
 
  
Diameter of lower part of shaft 4 .6 "
 
  
Diameter of neck of first thoracic rib 1
+
By Abram T. K Assialaiit Profc.tsor of Anaiumij,
  
cm. from its head 9.5 " .5.5 **
+
The pi'cservaliun of the dead body and its pre}iaration for dissection ha\e always been problems to the teacher of anatomy. The methods of preservation are different according 1(1 the object in view; certain methods being employed when it is only desired to keep the body for the ordinary dissection; others, when special parts, systems, or regions are to be worked out; and still different methods when it is desired to store material for months or years. One great step was made in the process of preservation of anatomical material for dissection when Frederic Euysch, the Dutch anatomist, introduced the method of embalming by means of injection. This was further developed by William Harvey and has been brouglit to great perfection at the present day both by the anatomists and the professional embalmers. The various methods employed in most of the principal European schools have been carefully described by Dr. Iljalniar Gronoos in the Auatoniischer Anzeigcr for September 28, 1898; and a report upon the various methods employed in America was jirepared by a committee of the Association of American Anatomists and ]iublished in Science January 17, 189G.
  
On the right side, the scalenus anticus had a. normal origin, but was inserted on the tip of the cervical rili anil on the sitperior border of the first thoracic rib for 1 cm. anterior to the articulation of the two ribs. The scalenus medius was inserted along the superior border of the cervical rib from the tubercle to the upper border of the groove for the subclavian artery and lower cord of the brachial plexus, 2.3 cm. from the distal end of the rib. At the lower end of the insertion some of the filn'cs were prolonged downwards across the inner surface of the supplementary interspace to be inserted on the upper border of the first thoracic rib for l.l cm. jjosterior to the articulation with the cervical rib. The scalenus posticus was inserted on the outer border of the cervical rib at a point l.t! cm. from the tubercle, in connection with the scalenus medius, and thence by a fibrous band, .3 cm. wide, backward and downward to the superior boi-der of the first thoracic rib for a distance of .5 em. on that rib.
+
The ra]iid development of medical education has called for the introduction of more lalioratory work in the first two years of the course, and this, together with the increased tendency to concentrate medical teaching in the larger colleges, has made it necessary to collect dissecting material during the whole year and to develop methods which shall preserve it in good condition until wanted.
  
The supplementary interspace on the right side was fillett by two well developed intercostal muscles, an outer and an inner. The external intercostal arose from the outer inferior border of the cervical rib from the head to the extreme end of the rib. The fibres extended downward and forward to be inserted along the superior border of the first thoracic rib. The fibres arising from the end of the cervical rib spread out in a fan-shaped insertion along the anterior face of the first thoracic rib for a distance of 2.5 cm.
+
The method of pickling, that is, placing the body after it
  
The internal intercostal muscle arose from the inner border nC the infi'i-idi- sni-face of the rib, the fibres running downward and backward to be inserted along the inner border of the first thoracic rib for a similar distance. This muscle was
 
  
  
 +
ERR, B. S., M. D..
  
116
+
Cornell Uiiircrsili/. Il/nira, N. Y.
  
 +
is embalmed and injected into a large vat of brine or some other fluid, is being quite generally abandoned. It is replaced in some institutions by enclosing the bodies in tightly sealed boxes, in which there is an inch or more of alcohol on the bottom and the body is surrounded by alcohol vapor. In other places the use of cold is employed to keep the bodies until they are needed.
  
 +
Cold is produced according to the well known law of physics, that heat is required to change a solid into a liquid, or liquid into a gas. This heat is abstracted from surrounding substances. For the preservation of cadavers the cold was produced until the past few years by the melting of ice. either alone or combined with salt. But within recent years refrigerating machinery has been so well perfected, and the cost of these machines has been so much reduced, that to-day there are ten medical colleges in the United States whicli have installed refrigerating plants. The principle on whicli these machines work is very simple. It is well known that it requires much more heat to vaporize a liquid than to li([ucfy a solid; thus to liquefy 1 gram of ice_ it requires 80 heat units, but to vaporize 1 gram of water it takes 537 heat units. Therefore in the freezing machine a volatile li(|iiid such as ammonia or ether is used. The machines on the market to-day are mostly ammonia machines.
  
JOHNS HOPKINS HOSPITAL lUTLLETIN.
+
The first ice machine to be used to preserve dissecting material was installed by the College of Physicians and Surgeons, Columbia University, New York, and when it had been in operation long enough to show the practicability and advan
  
  
 +
118
  
[Nos. 121-132-123.
 
  
  
 +
JOHNS HOPKINS HOSPITAL BULLETIN.
  
innervatoil liy (ibrcs from the interfostal ln-aiu-h of tlie first tliorMcic iKTVt'. This branch ran ahiii<>- tlie superior border of tlie second tlun-acic rib and sent its fibres across the first rib io the su|)plcmeutary intercostal muscle.
 
  
Tlie eifihtli cervical and first thoracic nerves united at the inner boi'der cd' the cervical rib to form the lower trunk of the brachial plexus, which crossed the rib above the subclavian artery. Just i)efore uniting with the eighth cervical nerve, the first thoracic gave off a slender blanch which descended along the inner border of the rib, behind the suljdavian artery, to the lower end of the rib, where it turned upward to gain the surface, wound around the end of the rib and was distributed to the articular ligament.
 
  
The right rib articulated freely with the seventh cervical vertebra and also with the first thoracic rilj. A stellate ligament held the head of the cervical rib to the vertebra. Besides this ligament there was a superior costocentral ligament (3) passing from the superior surface of the neck of the rib mainly to the lower outer border of the body of the sixth vertebra, a small slip being continued upward and outward to the anterior inferior border of the transverse process of the same vertebra. A capsular ligament (4) held the tubercle of the rib to the transverse process of the seventh vertebra.
+
LN,
  
The disposition of the soft parts of the left side' was very similar to that of the right. The scalenus anticns was inserted by a fan-shaped set of tendinous fibres to the lower half centimeter of the cervical rib, and was continued along the superior border of the first thoracic rib for 1.6 cm. anteriorly. The scalenus medins was inserted along the superior external border of the cervical rib from its head to the upper margin of the groove for the subclavian artery, 2.3 cm. from the central point of the ankylosis. The scalenus posticus was inserted on the superior border of the first rib. The iliocostalis dorsi sent a sliiJ of insertion to the external border of the cervical rib and also one to the tubercle. On the right side the slip to the tubercle alone was jjresent.
 
  
The external intercostal muscle in the supplementary interspace was well developed. It arose from the outer border of the inferior surface of the cervical rilj from its head to the ankylosis. The fibres, running downward and forward, were inserted along the superior border and external surface of the first thoracic rib for a somewhat longer distance. The internal intercostals arose from the inner inferior border of the cervical rib, from the ankylosis to the tubercle, and extended downward and slightly backward to l)e inserted for a similar distance along the superior inner border of the first thoracic rib. The innervation of the supplementary intercostals was similar to that on the right side — l.iy branches from the first intercostal nerve.
 
  
The left cervical rib articulated freely with the seventh cervical vertebra, but was firmly ankylosed with the superior border of the first thoracic rib, the ankylosis covering a distance of 2.2 cm. The tubercle articulated with the transverse process of the seventh vertebra, the joint being effected by a capsular ligament, no distinct division into smaller indi
+
iai-122-123.
  
  
vidual l)ands being noticeable. From the ui'ck of the rib. .just within the tubercle, a filirous band (5) .•"> em. in width extended upwai'd, backward and slightly inward to the lower ])osterior border of the transverse process of the sixth vertebra, and to the anterior face of the transverse process of the seventh. A small ligament (fi) connected the superior external margin of the liead with the lower, outer border of the body of the sixth vertebra. Just internally to this, and arising friuu the middle of the superior surface of the lu'ad. a band .3 cm. wide (7) extended u})ward ami inward to the lower outer border of the sixth vertebra, the insertion being under and inside of that of the smaller slip. Posteriorly to these, another ligament, .G cm. wide, connected the superior posterior surface of the head with the lower border of the body of the sixth vertebra. A shoi't, tough, fibrous cord (8) extended from the inferior surface of the head of the cervical rib to the superior surface of the head of the first thoracic rib. From the upper half of the head of the cervical ril) a stellate ligament extended to the body of the seventh vertelira.
 
  
The arterial distribution on both sides was normal except for the origin of the left common carotid from the innominate artery immediately after the latter left the aorta.
+
tages of this method plants were installed 1\y the Johns Hopkins and by the University of Pennsylvania and later by Syraense University, Long Island College Hospital, the University of Buffalo, Jefferson Medical College, the University and Bellevne Hospital Medical College, Cornell University Medical College, New York City, and a iilaiit is to be liuill this year by the Cornell I'liiversity Medical College at Ithaca, N."y.
  
There was a distinct skoliosis to the left side in the upper thoracic region.
+
Last A])ri], at the siigge.Midn (d' Dr. .Mnll. I |iiesi'nted before the Association of American Anatomists at Washington a very brief account of the plant installed at the University of Buffalo. At this time 1 wrote to the pnifessors of anatomy in all the institutions where 1 knew that they had cold storage plants and askeil for certain statistics in order to compare their residts with those obtained by me at the University of Buffalo. From some of these which I am permitted to use, and from the articles of Dr. iMall ' on the cold storage plant at the Johns Hopkins, and of Hr. Ibilnies' on that at the University of Penn.«ylvauia, I wish to call attention to those things which it is desirable to incorporate in a plant and those which slunild be avoided. I desire at this I'.dint to express my thanks to the professors in the institutions named above for furnishing me with data regarding the ice machines and vaults employed by them.
  
Case III. This was simply a cleaned specimen of a rib from the anatomical museum. Nothing was known about the subject from which it came.
+
There are two systems in use at the present day. In the ammonia-absorption system a solution of ammonia in water is heated, the ammonia gas passes off into a condenser where the constant distillation raises the pressure and the heat being absorbed by a stream of cold water, the ammonia becomes liquid. The liquid ammonia is conducted to the refrigerating coils, where it again becomes a gas and by thus vaporizing produces cold. The gas then passes to another chamber, where it is absorbed by a weak solution of ammonia in water, and the strong solution resulting is returned to be heated again. This type of apparatus is said to have some advantages over the other system, as its relative cheapness and lack of complicated machinery, but it is also deficient in several respects. The Long Island C(dlege Hospital is, I believe, the only medical school which has an apparatus of this kind.
  
The specimen was that of a left first thoracic rib, having a cervical rib ankylosed with it. The ankylosis was so complete and the free part of the cervical rib so shoi't that it would be better to class this as a bicipital first thoracic rib. Its morphology is very similar to that of the bicipital ribs described by Turner.' The rib presented two heads, two necks, two tubercles; and, for a distance of l.G cm. beyond the tubercle of the upper division, there were two shafts. That point marked the posterior limit of the ankylosis, which extended forward a distance of 4 em. On account of the ankylosis, the rib was very broad at this part, being 2.(i cm., while the true shaft of the first thoracic rib beyond the fusion was hut 1.7 cm. The two necks were separated by n space .6 cm. wide.
+
The ammonia compression machine is the one most generally used to-day. This consists essentially of three parts, as shown in the figure of the plan at the Johns Hopkins University. The evaporating coils arc the inpes in which the liquid ammonia changes to a gas and absorbs heat from its surroundings. The compressor is a combined suction and compression pump which draws the ammonia vapor from the evaporating coils and forces it under pressure into the cooling coils. These are long lines of pipes immersed in running water, and under the combined action of the ])rcssure from the pumj) and cold from the water the ammonia gas is here reconverted into a liquid and passes again into the evaporat
  
The principal uieasui'cments of the rib were as foUow's:
 
  
From tip of lie.ad to outer border o£ tubercle, (upiier divisiou). .'3.4 em.
+
ing coils. The lldw is of course regulated l)y valves and pres
  
II '• " ■' " " (lower division). S.li "
 
  
Widtli of necl<, (upper division) S "
+
' Franklin P. Mall, The .Anatomical course and Laboratory of the .Johns Hopkins University, Bulletin of the .Johns Hopkins Hospital, Baltimore, May and June, 18!)6, vol. vii, Nos. 62-63.
  
" " (lower division) ... .7 "
+
• E. W. Holmes, Refrigeration as a means ol preservation of Bodies for use iu the Dissecting room, Internal. M. Mag. Phil., ISIIT, vi, 747-741).
  
Straight line from head of lower division to dist;il end of rib. S..") " Length along convex margin from head of lower division to
 
  
distal end of rib 1'.>.3 >■
 
  
The U]ipcr border of the rib ])resented two grooves, one crossing just anterior to the central point of the ankylosis and the other .7 cm. anterior to this. In the recent state the subclavian artery and lower cord of the brachial plexus undoubtedly crossed by the former, while the latter was prob
 
  
 +
NV.^^ \\\\\\\ \vCv
  
' Journ. Anat. and Physiol., 1883, vol. xvii, pt. ill.
 
  
  
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Q
  
Ai'Ril-May-June, 1901.]
 
  
  
  
JOHNS HOPKINS HOSPITAL BULLETIN.
 
  
  
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ably for the passage of the subclavian vein. Between these two grooves there was a very prominent pointed process, projecting 1 cm. beyond the upper border of the rib. The anterior margin of its base was also the anterior limit of the ankylosis. From its general direction and from the fact tliat there was a visible groove along the line of ankylosis, it seems probable that this represented the tip of an originally free cervical rib. In the recent state there was probably a tibrous (Mird extending from the tip of the process to the slernnni.
 
  
SOMMAKT.
+
■/,
  
Of tliese three cases, the first two present some uiicoiiinion \ariations. In the first case the innervation of the supploiiiciitary intercostals by a direct intercostal branch from the eiglith cervical nerve has been described only once." The second ease shows a peculiar insertion of the serratns posticus on the first thoracic rib. This has also been described by Grubcr,' but it is not mentioned as a variation in the standard
 
  
 +
X
  
  
Mem. de 1' Acad, des Sc. de St. Petersbourg, 1869.
+
O
  
  
text-books, nor is it spoken of by Le Double.^ This case also presents the following variations, wliich, so far as I can find, liave not been reported heretofore: a minute brancli from the right first tlioracic nerve to the articidar ligament l>etween tlie cervical and first tlioracic ribs; a ligament connecting tlic licad of tlic left cervical rib witli the head of the left first thoracic rib, and a ligament from the neck of the cervical ril) to the lower border of the transverse process of the si.xth vertebra (Fig. 3, 5). I^or a full list of references to the subject of cervical I'ibs the recent article by I'hillips' may bo consulted.
 
  
In conclusion 1 wish to express my thanks to Dr. K. (). Harrison, at whose suggestion the work was originally undertaken, for his advice and assistance in my work.
 
  
  
  
■' Traite des variations desSystcme masculaire de 1' liommo. Paris ISltT. Tome I.
 
  
Jouru. Aiiat. and Physiol., l',)00, vol. xx.\iv, D. s. xiv, pt. iv.
 
  
 +
m
  
ON THE PRESERVATION OF ANATOMICAL MATERIAL IN AMERICA BY MEANS
 
  
OF COLD STORAGE.
+
a
  
  
  
By Abram T. K Assialaiit Profc.tsor of Anaiumij,
 
  
The pi'cservaliun of the dead body and its pre}iaration for dissection ha\e always been problems to the teacher of anatomy. The methods of preservation are different according 1(1 the object in view; certain methods being employed when it is only desired to keep the body for the ordinary dissection; others, when special parts, systems, or regions are to be worked out; and still different methods when it is desired to store material for months or years. One great step was made in the process of preservation of anatomical material for dissection when Frederic Euysch, the Dutch anatomist, introduced the method of embalming by means of injection. This was further developed by William Harvey and has been brouglit to great perfection at the present day both by the anatomists and the professional embalmers. The various methods employed in most of the principal European schools have been carefully described by Dr. Iljalniar Gronoos in the Auatoniischer Anzeigcr for September 28, 1898; and a report upon the various methods employed in America was jirepared by a committee of the Association of American Anatomists and ]iublished in Science January 17, 189G.
+
o
  
The ra]iid development of medical education has called for the introduction of more lalioratory work in the first two years of the course, and this, together with the increased tendency to concentrate medical teaching in the larger colleges, has made it necessary to collect dissecting material during the whole year and to develop methods which shall preserve it in good condition until wanted.
 
  
The method of pickling, that is, placing the body after it
+
^
  
  
 +
'-s
  
ERR, B. S., M. D..
 
  
Cornell Uiiircrsili/. Il/nira, N. Y.
+
.,
  
is embalmed and injected into a large vat of brine or some other fluid, is being quite generally abandoned. It is replaced in some institutions by enclosing the bodies in tightly sealed boxes, in which there is an inch or more of alcohol on the bottom and the body is surrounded by alcohol vapor. In other places the use of cold is employed to keep the bodies until they are needed.
 
  
Cold is produced according to the well known law of physics, that heat is required to change a solid into a liquid, or liquid into a gas. This heat is abstracted from surrounding substances. For the preservation of cadavers the cold was produced until the past few years by the melting of ice. either alone or combined with salt. But within recent years refrigerating machinery has been so well perfected, and the cost of these machines has been so much reduced, that to-day there are ten medical colleges in the United States whicli have installed refrigerating plants. The principle on whicli these machines work is very simple. It is well known that it requires much more heat to vaporize a liquid than to li([ucfy a solid; thus to liquefy 1 gram of ice_ it requires 80 heat units, but to vaporize 1 gram of water it takes 537 heat units. Therefore in the freezing machine a volatile li(|iiid such as ammonia or ether is used. The machines on the market to-day are mostly ammonia machines.
+
f
  
The first ice machine to be used to preserve dissecting material was installed by the College of Physicians and Surgeons, Columbia University, New York, and when it had been in operation long enough to show the practicability and advan
 
  
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118
 
  
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JOHNS HOPKINS HOSPITAL BULLETIN.
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fcti
  
  
  
LN,
 
  
  
  
iai-122-123.
 
  
  
  
tages of this method plants were installed 1\y the Johns Hopkins and by the University of Pennsylvania and later by Syraense University, Long Island College Hospital, the University of Buffalo, Jefferson Medical College, the University and Bellevne Hospital Medical College, Cornell University Medical College, New York City, and a iilaiit is to be liuill this year by the Cornell I'liiversity Medical College at Ithaca, N."y.
 
  
Last A])ri], at the siigge.Midn (d' Dr. .Mnll. I |iiesi'nted before the Association of American Anatomists at Washington a very brief account of the plant installed at the University of Buffalo. At this time 1 wrote to the pnifessors of anatomy in all the institutions where 1 knew that they had cold storage plants and askeil for certain statistics in order to compare their residts with those obtained by me at the University of Buffalo. From some of these which I am permitted to use, and from the articles of Dr. iMall ' on the cold storage plant at the Johns Hopkins, and of Hr. Ibilnies' on that at the University of Penn.«ylvauia, I wish to call attention to those things which it is desirable to incorporate in a plant and those which slunild be avoided. I desire at this I'.dint to express my thanks to the professors in the institutions named above for furnishing me with data regarding the ice machines and vaults employed by them.
+
oi
  
There are two systems in use at the present day. In the ammonia-absorption system a solution of ammonia in water is heated, the ammonia gas passes off into a condenser where the constant distillation raises the pressure and the heat being absorbed by a stream of cold water, the ammonia becomes liquid. The liquid ammonia is conducted to the refrigerating coils, where it again becomes a gas and by thus vaporizing produces cold. The gas then passes to another chamber, where it is absorbed by a weak solution of ammonia in water, and the strong solution resulting is returned to be heated again. This type of apparatus is said to have some advantages over the other system, as its relative cheapness and lack of complicated machinery, but it is also deficient in several respects. The Long Island C(dlege Hospital is, I believe, the only medical school which has an apparatus of this kind.
 
  
The ammonia compression machine is the one most generally used to-day. This consists essentially of three parts, as shown in the figure of the plan at the Johns Hopkins University. The evaporating coils arc the inpes in which the liquid ammonia changes to a gas and absorbs heat from its surroundings. The compressor is a combined suction and compression pump which draws the ammonia vapor from the evaporating coils and forces it under pressure into the cooling coils. These are long lines of pipes immersed in running water, and under the combined action of the ])rcssure from the pumj) and cold from the water the ammonia gas is here reconverted into a liquid and passes again into the evaporat
+
O
  
  
ing coils. The lldw is of course regulated l)y valves and pres
+
^_,
  
  
' Franklin P. Mall, The .Anatomical course and Laboratory of the .Johns Hopkins University, Bulletin of the .Johns Hopkins Hospital, Baltimore, May and June, 18!)6, vol. vii, Nos. 62-63.
 
  
• E. W. Holmes, Refrigeration as a means ol preservation of Bodies for use iu the Dissecting room, Internal. M. Mag. Phil., ISIIT, vi, 747-741).
 
  
  
  
  
NV.^^ \\\\\\\ \vCv
 
  
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sure gauges. The compression machines are utilized in two
  
  
  
 +
Apkil-May-June, 1901.]
  
  
  
 +
JOHNS HOPKINS HOSPITAL BULLETIN.
  
  
  
 +
119
  
  
  
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ways. In the one the evaporating or expansion pipes are distributed directly in the room which it is wished to cool; in the other these coils arc distributed through calcium chloride brine and the cold brine is pumped througli the
  
  
  
 +
Jfachines are rated in two ways, according to their icemaking capacity, and their refrigerating capacity. The latter is usually taken as twice the former. The unit of ice-making capacity is one Ion of ice at 32 degrees F. frozen from water
  
  
  
a
 
  
 +
Insulation
  
M
 
  
  
a
+
^Tine tartK
  
  
Bq
 
  
 +
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Fig. 2. — Outline of the cold storasje vault at the Uuiversity of Penusylvania. The brick wall ou the outside is striated.
  
  
  
  
 +
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 +
vy
  
  
  
05
+
Fiu. '■'). Section of the cold storas;e vault at the I'liiversity of Bullalci
  
 +
rooms which it is desired to refrigerate. The first of these is known as the direct-e.xpansion method, the other as the indirect. Johns Hopkins and Syracuse have the indirect and Pennsylvania and Buffalo the direct.
  
Ch
 
  
  
  
 +
Fig. 4. — Section of the wall and insulation of the vault at the University of Pennsylvania. BP, one layer of building paper; A, half-inch'air space.
  
  
  
O
+
at 32 degrees F., and is equivalent to 281,000 heat units per 24 hours.
  
 +
It is quite imjiortant to get a machine large enough for the work required of it. The size will be influenced greatly
  
  
  
 +
120
  
  
  
 +
JOHNS HOPKINS HOSPITAL BULLETIN.
  
  
  
c
+
[Nos. 131-133-133.
  
  
o f^'
 
  
 +
by location, insulation, and so fortli. Very satisfactory work is being done at Syracuse by a macbinc of 3 tons refrigerating capacity for a vanlt of about 3(100 culjic feet. At Buffalo a 3-ton machine for about 1.500 cubic feet, at Johns Hopkins a 4-ton machine for 3300 cubic feet, at Pennsylvania a G-ton is used for about 4300 cubic feet. The cost of such a plant varies from $3000 to $3000.
  
 +
AVhetlicr the machine works on the plan of direct radiation or indirectly by means of brine, it is a very great advantage to have within the vault a considerable body of brine which is cooled when the machine is running and which holds the cold, giving it out gradually and keeping the temperature of the vault from rising rapidly when the machine is not running. These brine tanks are cooled by coils of ammonia expansion ])ii)es running through them. In the Johns Hopkins plant, where this device was first introduced, there is
  
2 * o
 
  
  
 +
around the sides of the upper jiart of the vaidt or along the ceiling, or botli. This also heljis the circulation and })revents a warmer stratum of air from collecting above and a cold stratum Ijelow. The circidation of the air in the vault is only maintained during the running of the machine, as the temjierature of the e.xpansion pipes soon becomes the same as that of tlie surrounding air when the machine is shut down.
  
 +
The size of the machine rc(|uired is of course influenced greatly by the size of the vault and its insulation, and the number of hours per day which the machine is in operation. In all of the above-named plants there is more than enough cold produced. The excess of cold can be used to cool some of the dissecting rooms in summer, as is done at Columbia and at Cornell, N. Y.
  
 +
The construction of the vault is one of the most important
  
  
sure gauges. The compression machines are utilized in two
 
  
  
 +
Fig. .5. — Section of the iusulatlou of the ceiling of tlie vault at the University of Buffalo, li, BoarJs space one-inch wide; /', buihiiug paper.
  
Apkil-May-June, 1901.]
 
  
  
 +
-inch thick ; .1, air
  
JOHNS HOPKINS HOSPITAL BULLETIN.
 
  
  
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sw
  
119
 
  
  
  
ways. In the one the evaporating or expansion pipes are distributed directly in the room which it is wished to cool; in the other these coils arc distributed through calcium chloride brine and the cold brine is pumped througli the
+
Fio. 6. — Section of the insulation of the side walls of the vault at the University of Buffalo. ,S'ir, stone wall; P, building p.iper.
  
  
  
Jfachines are rated in two ways, according to their icemaking capacity, and their refrigerating capacity. The latter is usually taken as twice the former. The unit of ice-making capacity is one Ion of ice at 32 degrees F. frozen from water
+
one large tank situated in one corner of the vault. Since they use the indirect method tiiis tank alone is cooled by ammonia expansion coils and the cold brine is taken from the tank and pumped througji the pipes in the vaidt. At tlie University of Pennsylvania there are two long, narrow tanks situated on each side of the door. The brine is ntit ]>umi)ed from these, but they simply act as a reservoir for cold brine. At the University of P)ufl'alo there are two long, shallow brine tanks, which are susjiendod, covering the whole top of the vault. The advantage in this 'arrangement is that the large mass of chilled brine cools the air above; this falls to the bottom of the vault replacing the warmer and lighter air there, and in this way a constant circulation is kept up (Figs. 1, 3 and 3).
  
 +
Besides the expansion pipes in the brine, there is a considerable amount of pipe in the vault to cool the air directly. The arrangement of ammonia expansion coils is usually
  
  
  
Insulation
+
things and the aim should be to get the insulation as jierfect as possible. Willi a perfect insulation there will be al)solutely no loss of cold and a temperature once obtained will be retained indefinitely. Of course a perfect insulation cannot be secured, but a little extra expense in the construction of the vault at the start is a saving in the end, as the machine will have to be in operation for a much shorter time. The illustrations show the method of insulation employed at the University of Pennsylvania and the University of Buffalo. These consist of a number of dead air spaces se])arated by boards and building, or tar pajier. Some of these air spaces may be iilled with cork or mineral wool. With the considerable changes in temperature and consequent expansion and contraction the insulation is liable to be destroyed. This may be partly overcome by having around' the outside a strongly braced wall, or one of brick or stone, as at the University of Pennsylvania and the University of Buffalo. It is
  
  
  
^Tine tartK
+
April-Mat-Junjj, 1901.]
  
  
  
/
+
JOHNS HOPKINS HOSPITAL BULLETIN.
  
  
  
Fig. 2. — Outline of the cold storasje vault at the Uuiversity of Penusylvania. The brick wall ou the outside is striated.
+
121
  
  
  
 +
important that the Audi- sIkuiIJ lie well insulated and covered on tlio inside with a layer ot Portland cement, asphalt or, better still, sheet zinc, which should extend up for a toot or so on the side walls of the vault. It is desirable also tluit the floor should slope toward the entrance, so that wlien the machine is shut down and the vault is being cleaned, the water will flow through the door to a drain placed in the room outside.
  
K^
+
With a vault of a given size the capacity in bodies varies according to the method of storing them. There are three methods in general use in the different universities. The most popular is to have the vault arranged with a series of shelves. This is the method employed at the Universities of Buffalo, Pennsylvania, Syracuse and Long Island College Hospital. At the Johns Hopkins the bodies were first stored on shelves but in order to increase the capacity of the vault the shelves were removed and the bodies piled one upon an
  
  
 +
^
  
vy
 
  
  
 +
c
  
Fiu. '■'). Section of the cold storas;e vault at the I'liiversity of Bullalci
 
  
rooms which it is desired to refrigerate. The first of these is known as the direct-e.xpansion method, the other as the indirect. Johns Hopkins and Syracuse have the indirect and Pennsylvania and Buffalo the direct.
 
  
 +
JaL
  
  
  
Fig. 4. — Section of the wall and insulation of the vault at the University of Pennsylvania. BP, one layer of building paper; A, half-inch'air space.
+
J^
  
  
  
at 32 degrees F., and is equivalent to 281,000 heat units per 24 hours.
 
  
It is quite imjiortant to get a machine large enough for the work required of it. The size will be influenced greatly
 
  
  
 +
JK
  
120
 
  
  
 +
(( m
  
JOHNS HOPKINS HOSPITAL BULLETIN.
 
  
  
 +
UL
  
[Nos. 131-133-133.
 
  
  
 +
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by location, insulation, and so fortli. Very satisfactory work is being done at Syracuse by a macbinc of 3 tons refrigerating capacity for a vanlt of about 3(100 culjic feet. At Buffalo a 3-ton machine for about 1.500 cubic feet, at Johns Hopkins a 4-ton machine for 3300 cubic feet, at Pennsylvania a G-ton is used for about 4300 cubic feet. The cost of such a plant varies from $3000 to $3000.
 
  
AVhetlicr the machine works on the plan of direct radiation or indirectly by means of brine, it is a very great advantage to have within the vault a considerable body of brine which is cooled when the machine is running and which holds the cold, giving it out gradually and keeping the temperature of the vault from rising rapidly when the machine is not running. These brine tanks are cooled by coils of ammonia expansion ])ii)es running through them. In the Johns Hopkins plant, where this device was first introduced, there is
 
  
 +
^
  
  
around the sides of the upper jiart of the vaidt or along the ceiling, or botli. This also heljis the circulation and })revents a warmer stratum of air from collecting above and a cold stratum Ijelow. The circidation of the air in the vault is only maintained during the running of the machine, as the temjierature of the e.xpansion pipes soon becomes the same as that of tlie surrounding air when the machine is shut down.
 
  
The size of the machine rc(|uired is of course influenced greatly by the size of the vault and its insulation, and the number of hours per day which the machine is in operation. In all of the above-named plants there is more than enough cold produced. The excess of cold can be used to cool some of the dissecting rooms in summer, as is done at Columbia and at Cornell, N. Y.
+
"r
  
The construction of the vault is one of the most important
 
  
  
 +
"T
  
  
Fig. .5. — Section of the iusulatlou of the ceiling of tlie vault at the University of Buffalo, li, BoarJs space one-inch wide; /', buihiiug paper.
 
  
 +
Fiii. 7. — Side of vault showiiiiic the arrangement of the expansion pipes at the University of Kiiti'alo.
  
 +
other. At Columbia and Cornell, N. Y., they are suspended. There are certain advantages in each system. The method of shelving the l)odics-takes up the most room, but it has the advantage that each body is easily accessible. The shelves may be divided into sections and each shelf numbered, then when a body is placed in the vault the record of its position can be added to the department history and it can readily be found when desired for a particular purpose. In actual practice tliis works out very nicely, as employed at the University of Pennsylvania, and a body which has been stored for months and is then claimed by relatives is easily located. The slielves may be either made of slats or solid boards. The latter are used at the University of Buffalo. AVIiere the subjects are piled one upon the other there are several advantages as well as disadvantages. First of all there is great economy of space, and the subjects being packed closely tend to prevent evaporation, but on the other hand there is a tendency for the bodies to become frozen together, causing considerable annoyance when one is to be removed. This
  
-inch thick ; .1, air
 
  
  
 +
has been overcome by Dr. JInll liy placing a layer ol' building lathe between the bodies after they have been vaselined and wrapped. Of course in a great pile of bodies it is very difficult to find any particular one. Bodies packed in this way tend to hold the cold for some time, so after the machine is shut down and the vault thrown open it takes several days for them to thaw out. If these bodies are piled closely around a brine tank it is still more difficult to thaw them with the additional cold from the tank, and this is a great advantage in case of a break-down.
  
sw
+
At Columbia and at Cornell, N. Y., the bodies are suspended and run into the cold storage vaidt on tracks like the carcasses at a slaughter-house. I do not know the advantages and disadvantages of this method.
  
 +
The temperature in the vault should not be allowed to run .above freezing, as this permits thawing, and in consequence a slopj)y condition of the floor. The average maximum temperature usually maintained at the University of Pennsylvania is 24 degrees and the minimum 16 degrees Fahrenheit, and at the University of Buffalo the maximum is 2.5 degrees and the minimum li degrees Fahrenheit. This is computed from (he daily temperatures for June, July and August, 1899. which are given in the appended table. These temperatures are taken at the University of Buffalo by an ordinary thermometer, it being necessary to enter the vault to take the readings. At the University of Pennsylvania a self-recording thermometer takes the temperature variations.
  
 +
All of the vaults are lighted by electricity, which may be turiuHl on by a switch from the outside Ijefore entering the vault. The cost of operating a plant varies greatly, depending on the size, number of hours a day it is run, number of subjects, and also the motive pow'er.
  
 +
Steam is employed to operate the machine at the Johns Hopkins and at the Long Island College Hospital, and steam with electricity as reserve at Syracuse University. Electricity alone is used at the University of Pennsylvania, and a gas engine at the University of Buffalo. As the steam is also used for heating and the electricity for lighting it is difficult to estimate the exact amount of either used for running the machine. At the University of Buffalo and at the Johns Hopkins an estimate of the cost for one year was below $100.
  
Fio. 6. — Section of the insulation of the side walls of the vault at the University of Buffalo. ,S'ir, stone wall; P, building p.iper.
+
In all the cases before the body is placed in the cold room it is endialmed and the arteries filled with colored plaster, starch or at the Johns Hopkins with shellac. When wanted the body has only to be taken from the vault to the dissecting room and upon thawing it is ready for work. When a body is kept in cold storage for a time there is considerable drying of the hands and feet, face and genitals, and when kept for a long time there is a general mummification of the body. To overcome this the body is covered at tlie Johns Hopkins with a layer of vaseline, over which is wrapped a layer of toilet paper, and the whole is covered with cheese-cloth. The same method is employed at the University of Pennsylvania. At the University of Buffalo and at Syracuse L^uiversity only the head, limbs and genitals are w-rapped.
  
 +
Although there are other methods of preserving the body
  
  
one large tank situated in one corner of the vault. Since they use the indirect method tiiis tank alone is cooled by ammonia expansion coils and the cold brine is taken from the tank and pumped througji the pipes in the vaidt. At tlie University of Pennsylvania there are two long, narrow tanks situated on each side of the door. The brine is ntit ]>umi)ed from these, but they simply act as a reservoir for cold brine. At the University of P)ufl'alo there are two long, shallow brine tanks, which are susjiendod, covering the whole top of the vault. The advantage in this 'arrangement is that the large mass of chilled brine cools the air above; this falls to the bottom of the vault replacing the warmer and lighter air there, and in this way a constant circulation is kept up (Figs. 1, 3 and 3).
 
  
Besides the expansion pipes in the brine, there is a considerable amount of pipe in the vault to cool the air directly. The arrangement of ammonia expansion coils is usually
+
122
  
  
  
things and the aim should be to get the insulation as jierfect as possible. Willi a perfect insulation there will be al)solutely no loss of cold and a temperature once obtained will be retained indefinitely. Of course a perfect insulation cannot be secured, but a little extra expense in the construction of the vault at the start is a saving in the end, as the machine will have to be in operation for a much shorter time. The illustrations show the method of insulation employed at the University of Pennsylvania and the University of Buffalo. These consist of a number of dead air spaces se])arated by boards and building, or tar pajier. Some of these air spaces may be iilled with cork or mineral wool. With the considerable changes in temperature and consequent expansion and contraction the insulation is liable to be destroyed. This may be partly overcome by having around' the outside a strongly braced wall, or one of brick or stone, as at the University of Pennsylvania and the University of Buffalo. It is
+
JOHNS HOPKINS HOSPITAL BULLETIN.
  
  
  
April-Mat-Junjj, 1901.]
+
[Nos. 121-122-123.
  
  
  
JOHNS HOPKINS HOSPITAL BULLETIN.
+
for dissection, it would seem that a well embalmed body properly wrapped and kept in cold storage furnishes the cleanest, best preserved and most satisfactory dissecting material. Besides being used to preserve cadavers the refrigerating plants in the different medical schools are used to keep such material from the slaughter-house as is used for dissection. Fresh organs from post mortems are also preserved^ in the vault until wanted, or a sepai-ate compartment, cooled by the same machine, is built to contain them.
  
 +
From the study of the various cold storage apparatuses for the preservation of anatomical material it appears that the system at the Johns Hopkins is the most economical, as it does not require continuous operation of the machine. This system is further improved at the ITnivcrsity of Pennsylvania and at the University of Buffalo for the direct system of cooling the vault at the same time the brine tank within the vault is chilled makes the pumping of brine unnecessary.
  
 +
TABLES OF RESULTS OBTAINED DURING JUNE, JULY AND AUGUST, 1899 AT THE UNIVERSITY OF BUFFALO.
  
121
+
The machiue was operated only durins; the day, the uumbers below 13 are A. M., and those after 13 are P. M. The temperature is given in degrees Fahrenheit.
  
  
  
important that the Audi- sIkuiIJ lie well insulated and covered on tlio inside with a layer ot Portland cement, asphalt or, better still, sheet zinc, which should extend up for a toot or so on the side walls of the vault. It is desirable also tluit the floor should slope toward the entrance, so that wlien the machine is shut down and the vault is being cleaned, the water will flow through the door to a drain placed in the room outside.
 
  
With a vault of a given size the capacity in bodies varies according to the method of storing them. There are three methods in general use in the different universities. The most popular is to have the vault arranged with a series of shelves. This is the method employed at the Universities of Buffalo, Pennsylvania, Syracuse and Long Island College Hospital. At the Johns Hopkins the bodies were first stored on shelves but in order to increase the capacity of the vault the shelves were removed and the bodies piled one upon an
 
  
  
^
 
  
  
  
c
 
  
  
 +
Maximum
  
JaL
 
  
  
  
J^
+
M inimura
  
  
 +
Date.
  
  
 +
Duration of Run.
  
  
JK
+
Time.
  
  
 +
Temp.
  
(( m
 
  
 +
Time.
  
  
UL
+
Temp.
  
  
  
ifQ
+
i899.
  
  
  
^
 
  
  
  
"r
 
  
  
  
"T
 
  
  
  
Fiii. 7. — Side of vault showiiiiic the arrangement of the expansion pipes at the University of Kiiti'alo.
 
  
other. At Columbia and Cornell, N. Y., they are suspended. There are certain advantages in each system. The method of shelving the l)odics-takes up the most room, but it has the advantage that each body is easily accessible. The shelves may be divided into sections and each shelf numbered, then when a body is placed in the vault the record of its position can be added to the department history and it can readily be found when desired for a particular purpose. In actual practice tliis works out very nicely, as employed at the University of Pennsylvania, and a body which has been stored for months and is then claimed by relatives is easily located. The slielves may be either made of slats or solid boards. The latter are used at the University of Buffalo. AVIiere the subjects are piled one upon the other there are several advantages as well as disadvantages. First of all there is great economy of space, and the subjects being packed closely tend to prevent evaporation, but on the other hand there is a tendency for the bodies to become frozen together, causing considerable annoyance when one is to be removed. This
+
June 1
  
  
 +
4 hrs.
  
has been overcome by Dr. JInll liy placing a layer ol' building lathe between the bodies after they have been vaselined and wrapped. Of course in a great pile of bodies it is very difficult to find any particular one. Bodies packed in this way tend to hold the cold for some time, so after the machine is shut down and the vault thrown open it takes several days for them to thaw out. If these bodies are piled closely around a brine tank it is still more difficult to thaw them with the additional cold from the tank, and this is a great advantage in case of a break-down.
 
  
At Columbia and at Cornell, N. Y., the bodies are suspended and run into the cold storage vaidt on tracks like the carcasses at a slaughter-house. I do not know the advantages and disadvantages of this method.
+
10
  
The temperature in the vault should not be allowed to run .above freezing, as this permits thawing, and in consequence a slopj)y condition of the floor. The average maximum temperature usually maintained at the University of Pennsylvania is 24 degrees and the minimum 16 degrees Fahrenheit, and at the University of Buffalo the maximum is 2.5 degrees and the minimum li degrees Fahrenheit. This is computed from (he daily temperatures for June, July and August, 1899. which are given in the appended table. These temperatures are taken at the University of Buffalo by an ordinary thermometer, it being necessary to enter the vault to take the readings. At the University of Pennsylvania a self-recording thermometer takes the temperature variations.
 
  
All of the vaults are lighted by electricity, which may be turiuHl on by a switch from the outside Ijefore entering the vault. The cost of operating a plant varies greatly, depending on the size, number of hours a day it is run, number of subjects, and also the motive pow'er.
 
  
Steam is employed to operate the machine at the Johns Hopkins and at the Long Island College Hospital, and steam with electricity as reserve at Syracuse University. Electricity alone is used at the University of Pennsylvania, and a gas engine at the University of Buffalo. As the steam is also used for heating and the electricity for lighting it is difficult to estimate the exact amount of either used for running the machine. At the University of Buffalo and at the Johns Hopkins an estimate of the cost for one year was below $100.
 
  
In all the cases before the body is placed in the cold room it is endialmed and the arteries filled with colored plaster, starch or at the Johns Hopkins with shellac. When wanted the body has only to be taken from the vault to the dissecting room and upon thawing it is ready for work. When a body is kept in cold storage for a time there is considerable drying of the hands and feet, face and genitals, and when kept for a long time there is a general mummification of the body. To overcome this the body is covered at tlie Johns Hopkins with a layer of vaseline, over which is wrapped a layer of toilet paper, and the whole is covered with cheese-cloth. The same method is employed at the University of Pennsylvania. At the University of Buffalo and at Syracuse L^uiversity only the head, limbs and genitals are w-rapped.
+
24°
  
Although there are other methods of preserving the body
 
  
 +
1
  
  
122
+
16°
  
  
 +
3
  
JOHNS HOPKINS HOSPITAL BULLETIN.
 
  
 +
3
  
  
[Nos. 121-122-123.
+
10
 +
 
  
  
  
for dissection, it would seem that a well embalmed body properly wrapped and kept in cold storage furnishes the cleanest, best preserved and most satisfactory dissecting material. Besides being used to preserve cadavers the refrigerating plants in the different medical schools are used to keep such material from the slaughter-house as is used for dissection. Fresh organs from post mortems are also preserved^ in the vault until wanted, or a sepai-ate compartment, cooled by the same machine, is built to contain them.
+
33
  
From the study of the various cold storage apparatuses for the preservation of anatomical material it appears that the system at the Johns Hopkins is the most economical, as it does not require continuous operation of the machine. This system is further improved at the ITnivcrsity of Pennsylvania and at the University of Buffalo for the direct system of cooling the vault at the same time the brine tank within the vault is chilled makes the pumping of brine unnecessary.
 
  
TABLES OF RESULTS OBTAINED DURING JUNE, JULY AND AUGUST, 1899 AT THE UNIVERSITY OF BUFFALO.
+
1
  
The machiue was operated only durins; the day, the uumbers below 13 are A. M., and those after 13 are P. M. The temperature is given in degrees Fahrenheit.
 
  
 +
14
  
  
 +
3
  
  
 +
3)4
  
  
 +
9
  
  
  
  
Maximum
+
22
 +
 
 +
 
 +
13
  
  
 +
13 •
  
  
M inimura
+
4
  
  
Date.
+
3
  
  
Duration of Run.
+
9
  
  
Time.
 
  
  
Temp.
+
26
  
  
Time.
+
13
  
  
Temp.
+
16
  
  
 +
.5
  
i899.
 
  
 +
2%
  
  
 +
9
  
  
  
  
 +
24
  
  
 +
13
  
  
 +
14
  
  
June 1
+
6
  
  
4 hrs.
+
3
  
  
10
+
9
  
  
  
  
24°
+
24
  
  
1
+
13
  
  
16°
+
14
  
  
3
+
7
  
  
Line 10,685: Line 10,700:
  
  
10
+
9
  
  
  
  
33
+
24
  
  
1
+
13
  
  
Line 10,699: Line 10,714:
  
  
3
+
8
  
  
3)4
+
2%
  
  
9
+
9.
  
  
 +
15
  
  
22
+
34
  
  
Line 10,716: Line 10,732:
  
  
13 •
+
14
  
  
4
+
9
  
  
3
+
2%
  
  
9
+
9.
  
  
 +
15
  
  
26
+
34
  
  
Line 10,736: Line 10,753:
  
  
16
+
15
  
  
.5
+
10
  
  
2%
+
4
  
  
9
+
s'
  
  
  
  
24
+
33
  
  
Line 10,756: Line 10,773:
  
  
14
+
13
  
  
6
+
11
  
  
3
+
Sunday.
  
  
9
 
  
  
  
  
24
 
  
  
13
 
  
  
14
+
1
  
  
7
+
12
  
  
3
+
ax
  
  
9
+
8.
  
  
 +
45
  
  
24
+
28
  
  
Line 10,796: Line 10,811:
  
  
14
+
17
 +
 
 +
 
 +
13
  
  
8
+
2Ji
  
  
2%
+
8.
  
  
9.
+
45
  
  
15
+
26
  
  
34
+
11
  
  
Line 10,818: Line 10,836:
  
 
14
 
14
 +
 +
 +
3
  
  
Line 10,823: Line 10,844:
  
  
2%
 
  
  
9.
+
26
  
  
15
+
13
  
  
34
+
16
 
 
 
 
13
 
  
  
Line 10,841: Line 10,858:
  
  
10
+
3)i
  
  
4
+
8.
  
  
s'
+
50
  
  
 +
26
  
  
33
+
13
  
  
13
+
Ifi
  
  
13
+
16
  
  
11
+
3
  
  
Sunday.
+
8.
  
  
 +
45
  
  
 +
26
  
  
 +
13
  
  
 +
16
  
  
1
+
17
  
  
12
+
43^
  
  
ax
+
8
  
  
8.
 
  
  
45
+
24
  
  
28
+
11
  
  
Line 10,896: Line 10,917:
  
  
17
+
18
  
  
13
+
Sunday.
  
  
2Ji
 
  
  
8.
 
  
  
45
 
  
  
26
 
  
  
11
 
  
  
13
+
19
 
 
 
 
14
 
  
  
Line 10,931: Line 10,944:
  
  
26
+
29
  
  
Line 10,937: Line 10,950:
  
  
16
+
17
  
  
15
+
20
  
  
3)i
+
3X
  
  
8.
+
9
  
  
50
 
  
  
26
+
36
  
  
Line 10,958: Line 10,970:
  
  
Ifi
+
16
  
  
16
+
21
  
  
3
+
SH
  
  
8.
+
ii
  
  
45
 
  
  
26
+
25
  
  
Line 10,979: Line 10,990:
  
  
16
+
17
  
  
17
+
23
  
  
43^
+
SH
  
  
8
+
9
  
  
  
  
24
+
36
  
  
11
+
13
  
  
13
+
17
  
  
18
+
33
  
  
Sunday.
+
SM
  
  
 +
9
  
  
  
  
 +
34
  
  
 +
13
  
  
 +
14
  
  
19
+
24
  
  
Line 11,024: Line 11,039:
  
  
9
+
8
  
  
  
  
29
+
34
  
  
Line 11,035: Line 11,050:
  
  
17
+
14
  
  
20
+
25