or inilindibula, according to the manner in which they aro.
examined; thus, if we look to them as running upwards,
pad! part will resemble the calyx of a flower, but if we
fake them in another view, they will appear as little fun-:
uels.
The structure of the kidney differs much in certain classes
of animals, from that of the human body. In the kidney of
the sheep, there is a very close resemblance to that of man ;
bat in the lion, dog, cat, &c. the kidney is never tabulated,
but has only one papilla, whence it is called a single kid-
ney. In the ox it continues tabulated through the whole life
of the animal : but the best examples of the tabulated kid-
ney, are those of animals which occasionally inhabit tha
water, as the bear, seal, &c.
The capsula renalis, or, as it has been called by the an-
cients, glandula atrabilaris, is of very curious structure, re-
sembling a piece of fat : in the foetus, it is large, in propor-
tion to the kidney ; but in old age, it is hardly possible to,
discover it; the only thing observable in it, is a cavity, iu
which there is occasionally a thick blackish fluid.
I trust that this short sketch of the manner of investigat-
ing the minute structure of the viscera, will be considered as
only an endeavour to induce the student to prosecute this
subject, which, though difficult, is highly interesting and
important.
SOME OBSERVATIONS ON THE MANNER OF
EXAMINING A BODY TO DISCOVER THE
SEAT OF 'DISEASE..
When called upon to make a private examination of the
state of the abdomen of a person who has died inconse-
quence of visceral disease, we should endeavour, in open-
ing the body, to disfigure it as little as possible, The best-
65
manner of proceeding is, to cut through the skin only, in the
line of the linea alba, beginning a little above the middle of
the sternum, down to the pubes. The skin may be
quickly dissected from the muscles, and pulled over to-
wards each side : the muscles may then be cut in any direc-
tion.
If the body is not very fat, this longitudinal cut in the
skin will give us sufficient room for our examination ; but
we may be obliged to make a transverse incision below the
umbilicus. When the dissection is finished, and the skin is
sewed up, the incision should be concealed by strips of
strongly adhesive plaster.
The morbid anatomy of the viscera is a subject so exten-
sive, that it is not possible for me to enter into it fully here.
All that the limits of this work will permit, is, to endeavour
to point out a few of the circumstances which are liable to
lead those who are not conversant with anatomy, to make
erroneous statements of the appearances which they see in
making the examination of a body.
It is not unusual to see a minute description given of
: a very curious displacement of the viscera ;" but the posi-
tion of the viscera in the dead body depends on such a varie-
ty of circumstances, that we ought not to attach importance
to any trifling change from that which is considered natural.
The bmentum is frequently described as extra sedem : but,
if I were to take the description of the omentum from the
common appearance which it has in bodies after they have
been moved, I should, have great difficulty in saying what its
natural situation really is. I have observed, that if there
has been any inflammation in any one of the viscera, at any
period, that the omentum is found attached to it : thus, the
most common appearance of disease in the abdomen of the
female, is adhesion of the omentum to the uterus.
It is a very common mistake to describe the loaded state
of the vessels as an appearance denoting previous inflamma-
tion : the state of the true inflamed intestine is so distinct,
that it can hardly be forgotten after it has been once sees,
In the first stage, there are numerous small vessels segn
upon the gut, Tike those on the eye in ophthalmia, with a
suffusion around them ; in the second stage, there is matter,
or lymph, effused ; and in the more advanced state, adhe-
sions are formed between the surfaces of the intestines. But
there are many different lands of peritonitis. In that which
is called idiopathic, the peritoneum will be found coated with
lymph ; but after inflammation in consequence of strangulated
hernia, the substance of the intestine will appear more affect-
ed than the proper peritoneum. I cannot enter farther on
66
this important subject; but shall refer to a very early work,
by Mr. Bell, in which much interesting matter on the mor-
bid anatomy of all the viscera will be found.
We must not fall into the mistake of supposing-, that the
air which rushes out when the abdomen is opened, has been
formed during- the life of the patient ; for though there may
be cases of true tympanitis, still the most probable cause of
the formation of this air, is the change produced after death
by putrefaction. In some cases of gangrene of the intes-
tines, air may have escaped .into the general cavity immedi-
ately before death. The great distention of the stomach
and intestines, is also commonly produced by the change
which takes place in their contents after death; though
there is always more or less air within the intestines during
life.
From the variety of appearances of inflammation, from
the black spots, and from the ulceration and corrosion,
which, in the course of my dissections, I have seen in the
stomachs of those who have died without any marked symp^
toms of affection of that viscus, and from the close resem-
blance which many of these have had to the stomachs of
those persons who have swallowed poison, and from the
similarity of the appearances produced by gastritis, and
other diseases, to those caused by poison, I have come to
the conviction, that the appearance of the stomach or int^s-
. tines alone, in a question of poison, is not to be depended on*
In the last book that has been written on poisons, (that of Or-
filia,) the list of appearances which is given, as to be expect-
ed, where poison has been taken, corresponds exactly with
those which I have found in stomachs where I was certain
no deleterious matter had been taken. I am happy to think,
that this degree of uncertainty will prevent the anatomist
from being called On to decide a question which may involve
the life of a fellow creature.
In examining the abdomen of children w r ho have died in
consequence of irritation in the bowels, we shall frequently
find one portion of the gut invaginated in the other. This
is introsusceptio ; but in the child it is seldom the cause of
death, while in the adult it is generally attended with such
inflammation as to produce strangulation and death. If a .
patient has died with symptoms of hernia, and no external
tumour be discovered, we may expect to find an introsus-
ceptio, or a portion of the intestine strangulated, by a noose
formed of cojidensed omentum, or mesentery ; in these ca-
ses, the portion of gut above the point of strangulation will
be red, thickened, and distended, while the portion
*-vi'j be nale and emptv.
67
If a patient has long suffered from chronic inflammation
of the abdomen, we may expect to find the intestines com-
pletely glued together : this is a common appearance in the
abdomen of those who have been repeatedly tapped. In the
scrophulous child we shall probably find the mesenteric
glands enlarged and cheesy ; in such a case, the lacteals
will be often found filled with scrophulous matter.
In the greater number of those who die of fever, the
mtestines appear gorged with blood not inflamed ; but on
opening the lower part of the small mtestines, we shall ge-
nerally discover small ulcers, with thickened edges : this
appearance is almost always found in the great intestines of
those who have died of dysentery. I may here remark, that
a small pouch occasionally projects from the side of the
ileon ; but this is considered only a lusus, it is called diver-
ticulum ilii.
The most common appearance of disease in the liver, is
the tubercle ; and this occasionally suppurates. When we
look to the proximity of the colon to the liver, and know,
that in the previous inflammation they generally adhere,
we cannot be surprised, that an abscess of the liver should
occasionally communicate with the colon, and the matter be
discharged by the rectum. If there be gall stones in the
gall bladder, or ducts, we must not be surprised to find the
coats thickened, for this is a natural consequence of the
irritation..
It is hardly possible to say, whether the softening of the
spleen is to be considered as a mark of disease, for it is ge-
nerally softened, in all old subjects. The peritoneal coat is
very frequently thickened, and particularly in those who
have suffered from intermittent fever, as the Walcheren.
The pancreas is naturally very firm, whence it is not
imfrequently described, by those not familiar with anatomy,
as scirrhous ; but I suspect, that, like the other salivary
glands, it is very seldom diseased. A softening and tabula-
ted form of the kidney, is the first appearance of disease in-
this viscus. The kidney may be the seat of primary dis-
ease, as of schrophula or stone^but we should always expect
to find it more or less altered in structure, when there has
been disease or irritation in. the bladder. We should not
forget, that there is occasioimlly a yery curious variety in the
natural form of the kidney, for, sometimes, the two kidneys
are united with each other, sa as to present the form of a
crescent, whence this lusus is called the horse shoe kidney.
In such cases, I have sometimes found three ureters, but ge-
nerally only one. It is not unusual to find two ureters corne
from one of the kidneys, whichj in other respects, is of the:
common form,
68
DISSECTION
OF THE
PARTS IN THE PERINEUM.
AFTER the student has finished the dissection of the mus-
cles and of the viscera of the abdomen, he should, in union
with his companion, dissect the parts in the perineum ; but
if the body be that of a female, he had better proceed to
the dissection of the muscles of the thigh. It is almost need-
less to remark, that before the muscles of the perineum can
be shown, that the students who are dissecting the upper
half, and to whom all the muscle's of the back belong, must
either permit the body to be cut through at the loins, or to
be put into a certain position. Although some of the mus-
cles of the back must be cut in dividing the body, still it
will be to the advantage of all parties that the division should
be made, for the four dissectors must now necessarily in-
terfere very much with each Qther.
When we consider the operations which we may be called
upon to perform on the parts in the perineum, we shall have
a just notion of the necessity of the study of the anatomy of
this part, to the surgeon who proposes to be an operator.
But when it is known, that a common abscess in the peri-
neum has not unfrequently been the cause of death, in con-
sequence of the peculiar formation of these parts, it will be
allowed, that the study of the minute anatomy of the peri-
neum, should not be confined to the operating surgeon only.
No one will assert that he can safely manage even the slight-
est obstruction in the urethra, unless he knows every turn of
the passage : and if he cannot be confident in his treatment
of a most common case, how can he possibly understand the
proper and safe treatment of those complicated fistulse which
are now so frequent, and which require such nice opera-
tions ? It might be thought that such observations were quite
unnecessary, were it not a common opinion among students,
that even the operation of lithotomy may be performed, by
one who is not conversant with the anatomy of the parts, if
lie makes use of instruments which are nicely adapted t
i other-
69
Though much has been written on the perineum, and
though many valuable observations have been made on par-
ticular parts, still the anatomy of it is so complicated, that I
have found very few students who were capable of making
themselves masters of the many points of interest, unless
they went through a regular series of dissections. I shall,
therefore, endeavour to describe such a course of dissections
of the perineum, as will enable the student to comprehend
the simple anatomy, and also the manner of examining the
parts, so as to discover the causes of difficulty in the seve-
ral operations.
In such a complicated structure as the outlet of the pelvis,
it will be absolutely necessary to dissect the parts many
times : I shall, therefore, in pointing out what I conceive to
be the best plan of proceeding, endeavour to describe it,
that the student may make the most of each body which he
dissects.
I shall first show the method of performing the dissection
so as to enable the student to acquire a general idea of the
muscles, and of those parts which are connected with, tho
passage of the semen, the urine, and the fceces.
POSITION OF THE BODY.
Tie the hands and feet so as to put the body in the same
position in which a patient is placed for the operation of lith-
otomy ; then put a block under the sacrum introduce a
sound into the bladder tie the glans penis to the upper part
of the sound, and then fix it in the centre, by tying it to
both knees.
Before commencing the dissection, the rectum should be
desired of its contents, by throwing in water forcibly with a
syringo ; a little baked hair is then to be pushed into the
rectum, and a round cork, with a string tttttichud to it, should
bo passed just within the sphincter : this will be found useful
in bringing the sphincter forwards.
Place a pelvis in the same position as the body, and com-
pare the ramus of the pubes and ischium, and the tuberosity
of the ischium, with the same parts in the subject ; then
make the first incision along the ramus of the pubes and
ischium, down to tho tuberosity of the ischium. Make a
second through the skin only, along the Raphe, in the mid-
dle of the pern's, to within of an inch of the anus ; and
then a third, from the one on the tuberosity of the ischium,
to the termination of the cut on the Raphe. Make stilif
another incision through the skin round the anus, beginning
te union of the cross and. longitudinal incisions; and.
70
lastly, feal for the os coccygis, and make a cut from it to the
circular one around the anus. (a)
These incisions will enable us to expose the principal mus-
i-les. The cut along- the ramus of the pubes and ischium,
vill show the course of the erector penis : the cross cut,
that of the transversalis ; the incision along the Raphe will
show the union of the two ejaculators ; and the circular cut
will be in the line of the fibres of the sphincter ani. It is
better to make these incisions on both sides ; for I have al-
ways found that the student got a very imperfect idea of the
anatomy of the perineum, from the examination of one side
only.
The dissection is to be begun by cutting on the line of
the ramus of the pubes and ischium, so as to expose the fibres
of the erector, which will be found to form a tendinous ex-
pansion that spreads upon the crus of the penis. But we
must be particularly careful in dissecting the origin of this
muscle, for the transversalis is connected with it. The same
dissection should be made on the other side, and then there
will be a distinct view of the crura of the penis, and the at-
tachment of the erectors.
The next step will be, to dissect, in the line of the cross
cut, as far as to the union with that in the line of the Raphe,
with the intention of laying bare the fibres of the transver-
salis. But the student is very liable to be foiled in his first
attempt to dissect this muscle, because its fibres are not
only frequently very indistinct, but its place is often supplied
l>y a set of fibres from the levatur ani. Sometimes, indeed,
we may discover two transversales ; while in other bodies
there is no proper transversalis, but a set of fibres which,
though they may have the same origin, take a direction ob-
liquely upwards. This slip of fibres has been called the
transversalis alter. The transversalis is considered regular.
figure ; the two obtuse angles of
are inward from the tuberosities of the iechia : consequently,
it has an anterior acute angle at the arch of the pubis :
the posterior acute angle being in the situation of the apex
of the sacrum, from which the os coccygis is seen stand-
ing forward, this bone having its motion within the
apace of the outlet. By reason of the more depending
situation of the tuberosities of the ischia, the boundarie^
of the outlet are not on a plain ; but are to be considered
collectively as forming an obtuse angle at an imaginary line
^tending- from one tubcrosity of the ischium to the other.
71
when it is inserted with the other muscles into the condens-
ed cellular membrane on the lower part of the bulb.
The ejaculator seminis may now be shown by dissecting
carefully from the cut in the Raphe, towards the erector pe-
rn's and cms of each side. After the fibres of this muscle are
exposed, the loose skin should be taken off from the penis>
so that a more distinct view of the parts may be given.
We may now proceed with the dissection of the lower
part, by cutting in the line of the incision which has been
made round the verge of the anus, so as to expose the fibres
of the sphincter. In doing this, the dissector will discover,
that the most superficial set of fibres is attached to the skin
in the line of the Raphe, but that the greater mass of the
muscle is inserted into that point at which the two transver-
sales and ejaculators unite ; indeed, this point is often called
the " common centre of union."
When the dissection of the sphincter is continued up for
about an inch upon the rectum, some of the fibres of the
levatur ani will be seen ; but, to expose the whole of this
muscle, it will be necessary to remove a large quantity of fat
and cellular membrane from the side of the rectum. This
may be done very boldly, if we keep below the level of the
trans versalis, for we may, without fear, set our knife on the
edge of the tuber ischii, and carry it full of an inch in-
wards and downwards, without the risk of cutting any fi-
bres, except some of the gluteus maximus.
The object of this first dissection being only to acquire a
general knowledge of the relative situation of the principal
parts, we ought not at present to attend to the vessels, but
proceed to remove the superficial muscles.
It will not be necessary to remove the erectors, for the
erura penis are sufficiently distinct while they are attached to
them ; but the fibres of the ejaculator and of the transversa-
lis, are to be carefully raised, so as to expose the spongy
body and its bulb. After removing the fibres of the ejacula-
tor, which arise from between the erector and bulb, the fas/-
cia, or ligament, which is called triangular, will be seen ; or
by pushing in the finger, the ligament will be felt.
After studying the appearance of the parts now presen-
ted, a dissection of the pelvis should be made, so as to
show the penis, bladder, &c. in their mutual relation to
each other.
The penis and bladder should be left attached to the right
limb, that there may be a view of that side which is cut in
the operation of lithotomy. The first step, in making the
section, is to cut the left crus of the corpus cavernosum
from the ramua of the pubes and ischium, and through tl;e
72
skin of the pubes and muscles of the abdomen; taking care
to avokl the spermatic cord and testicle. The body is then
to be untied and laid upon its back, the staff is to be taken
out of the bladder, and the hair from the rectum. The hand
is to be introduced into the pelvis (it is presumed that the
muscles of the abdomen are already dissected ; and all the
viscera, except the rectum and bladder removed), and the
rectum and bladder are to be pulled over towards the right
side ; taking care that the peritoneum be not torn from them*
nor the ureter injured.
The division of the bones are now to be made, by cutting
with the saw, not exactly through the symphysis, but
father to the left of it ; but in doing this, we must take care
that we do not cut the origin of the gracilis muscle, on the
inside of the thigh.
The bone having been sawed through, and the viscera of
the pelvis held aside, and the fibres of the levator arii being
carefully cut, the knife (without regarding the pyriformis,
great nerve, &c.) is to be carried through the parts, up to
the notch of the ilium ; and then the thighs being forcibly
pulled asunder, the left leg will be separated from the trunk,
at its union with the sacrum. Tire muscles on the back part
are then to be cut, and the left limb removed. In making
this section, some of the arteries and nerves, with certain
muscles of the left side, will be necessarily destroyed ; but
they may be preserved if we make the division more in the
middle of the pelvis ; to do this, we must pull the viscera
quite over to the right side, so that we may saw through the
middle of the sacrum and the symphysis of the pubes ; but
in doing it, we must carefully avoid the urethra. By pro-
ceeding in this manner, the muscles of the hip will be saved,
but still the deep muscles of the back must be cut through
by a cross incision ; however, these muscles are of little im-
portance, compared to the parts seen in the lateral view of
the pelvis : indeed the body should be divided immediately
above the sacrum, before the perpendicular section is made.
This last method may be sufficient to give a general idea of
the bladder, rectum, and urethra ; but to form an accurate
notion of the relation of these viscera to each other, we
must make the section according to the manner first de-
scribed.
The view which is now given, will seem somewhat confu-
sed to a dissector, in his first essay; for he will not, ae yet,
be able to distinguish the bladder or rectum : but to make
them distinct, it is only necessary to distend them. By in-
troducing a, blow-pipe into the urethra, the bladder may be
blown up ; but if the staff has been passed into the urethra,
73
*h' bladder may be distended by blowing into one of the uiv
t ers. A small quantity of hair is again to he put into the rec-
turn. The form and situation of the bladder will now 1 <
distinct ; but as the surface will still he obscured by the pe-
ritoneum which covers a great part of it, it may be useful,
even in a first dissection, to pay some attention to the fold*
of this membrane.
The peritoneum will be seen passing from the muscles of
the abdomen to the fundus of the bladder, and from that,
continued down upon the back and lateral parts. It then ri-
ses on the front of the rectum, so as to form, a bag. or pouch.
between the bladder and rectum : the lateral boundaries of
which are sometimes called the posterior ligaments of the
bladder. If the lower part of the muscles of the abdomen be
still entire, we may see the remains of the umbilical arteries
running up along the- lateral parts of .the bladder to the um-
bilicus, and, between them, the urachus passing from the
fundus. These parts will appear like three thickened lines
upon the peritoneum.
The peritoneum may now be raised ; it is so loosely con-
nected with the bladder at the fundus, that, with the fingers
only, w r e may tear it from the muscular coat of the bladder ;
but we must remove it more cautiously from the lower pait,
or we may destroy the ducts of the testicle, which run on
each side of the bladder ; but these ducts are so thick and
dense, that, though they may not be seen, they will be easilv
felt. If we put small bougies into the ureters, as a guard
against wounding them, we may proceed more boldly in re-
nioving the peritoneum from the lower part.
TLe muscular fibres of the upper part of the bladder will
now be seen ; but a great deal of dissection is required to
make the parts below, distinct. Part of the rectum is still
Covered by the levator ani, whicji ought now to be dissected
away, and then a quantity of cellular membrane will be seen
between the rectum and bladder. In removing this, the
knife, must be used cautiously, until a portion of the vesicu-
la seminalis, which lies between the rectum and bladder, is
exposed ; it will be known by its dark glistening appearance.
If we follow the vesicula forwards, we shall discover the
lateral part of the prostrate gland. The bulb should now be
made distinct by removing any muscular fibres that may be