Anatomy, descriptive and surgical / by Henry Gray ; with an introduction on general anatomy and development by T. Holmes ; the drawings by H.V. Carter ; with additional drawings in later editions ; ed. by T. Pickering Pick.

  • Henry Gray
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: Anatomy, descriptive and surgical / by Henry Gray ; with an introduction on general anatomy and development by T. Holmes ; the drawings by H.V. Carter ; with additional drawings in later editions ; ed. by T. Pickering Pick. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    joint at the bottom of tlie tabatiere aDatomique (140). Supposing, however, there be much swelling, the knife introduced at the angle between the lirst and second metacarpal bones readily finds the joint if the blade be directed out- wards. 154. Sesamoid Bones.—The sesamoid bones of the thumb can be distinctly felt. Just above them—that is, nearer to the wrist—lies the joint between the metacarpal bone and the first phalanx. We should remember the position of these bones in amputation at this joint. Mutatis mutandis the same observa- tions apply to the sesamoid bones of the great toe. The extensor tendon of the last joint of the thumb crosses the apex of the first interosseous space. Under the tendon, and in the angle between the bones, we feel the radial artery just before it sinks into the palm. 155. Subcutaneous Veins.—The veins on the back of the hand, and their arrangement in the form of arches which receive the digital veins, is sufficiently obvious. The number and arrangement of the arches may vary, but in all hands it is interesting to notice that the veins from the fingers run up between the knuckles and out of harm's way. 156. Interosseous Arteries.—Since the dorsal interosseous arteries, like the palmar, run along the interosseous spaces, incisions to let out pus should always be made along the lines of the metacarpal bones. 157. Digital Bursas.—Small subcutaneous burste are sometimes developed over the knuckles and the backs of the joints of the fingers. They often be- come enlarged and unseemly in persons of a rheumatic or gouty tendency. 158. Knuckles and Digital Joints.—The three rows of projections called the knuckles are formed by the proximal bones of the several joints: thus the first row is formed by the ends of the metacarpals; the second by the ends of the first phalanges, and so forth. In amputations of the fingers it is well to remember that in all cases the line of the joints is a little in advance of the knuckles, that is, nearer the end of the fingers. Long and graceful fingers, coupled with thickness and breadth of the sentient pulp at their ends, and too great arching of the nails, have been regarded, ever since the days of Hippocrates, as not unlikely indications of a tendency to pul- monary disease. [Staining the nails (e. g.^ by nitric acid) affords a means of determining the fact and the rate of their growth, and, therefore, of the nutritive processes in the corresponding arm or leg.] PALPATION BY THE RECTUM. The following report is from Mr. Walsham, of St. Bartholomew's Hospital, who, having a small hand (somewhat less than seven and a half inches round), has had opportunities of introducing it up the rectum, in the living subject, for the purpose of diagnosis :— It is possible to introduce the hand (if small) into the rectum; in manj^ cases into the sigmoid flexure, and in rare instances into the descending colon. Once beyond the sphincter, the hand enters a capacious sac, and the follow- ing important parts can be felt through its walls:— Through the anterior wall the hand first recognizes the prostate, which feels like a moderately large chestnut. Immediately behind the prostate, the vesi- cul^e seminales may be distinguished as two softish masses situated one on either side of the middle line. Internal to them, the whipcord-like feel of the vasa deferentia can be readily traced over the bladder to the sides of the pelvis. The bladder is easy recognized, when moderately distended, as a soft fluctu- ating tumour behind the prostate ; when empty it cannot be distinguished from the intestines, which then descend between the rectum and the pubes. The arch of the pubes can be well defined when the bladder is empty.