7
745 sides its duct there is a distinct hepatic duct which receives that of the pancreas, and opens into the duodenum. We ob- serve at the termination of the small in- testine in the wide colon, that it enters in such an oblique manner as to leave a pretty considerable blind enlargement or caecum at the commencement of the colon. The parietes of the alimentary canal are strong and muscular throughout. The mucous coat is of great extent, as in other phyto- phagous animals; and although there are yet no valvulse conniventes, this inner tunic forms numerous longitudinal folds and cells in the course of the intestine, by which its secreting surface, and the sur- face for the distribution of the numerous larger lacteal vessels, are greatly extended. The distinction of the small and large in- testine is more marked here than in the inferior reptiles, amphibia, or fishes, and the long and capacious colon of the che- lonia is provided with a distinct valve, and often with a wide and short caecum, so that the alimentary canal has now acquired nearly all those characters and divisions which it presents in higher stages of deve- lopment in the warm-blooded vertebrata. ANATOMY AND PHYSIOLOGY. LECTURES ILLUSTRATED BY THE HUNTERIAN PREPARATIONS IN THE MUSEUM OF THE ROYAL COLLEGE OF SURGEONS, LONDON. Delivered at the College in 1833, by SIR CHARLES BELL, K.G.H., F.R.S. LECTURE X. RELATIONS EXISTING BETWEEN THE NERVOUS AND MUSCULAR SYSTEMS, AND MENTAL AND BODILY EXPRES- SION. GENTLEMEN,—Hitherto you know I have taken sure ground; I have gone as far as it was possible for me to be directed by the preparations and the arrangements of Mr. HUNTER. But now I must either go on alone, and unsupported, or I must move in another circle. Now I believe that you would rather that I prosecuted the subject of muscular action a little further. May I observe, then, that the muscular system may be considered as that part of the organiza- tion of the body which is under the direc, tion of the will by volition, and is used in locomotion ; that, again, the muscular system is used in performing all those secret functions which are going on with- out the cognizance of the mind, and all the secret operations which are necessary to the performances of the animal eco- nomy. Now I wish to draw your attention to this, - that the muscular texture which is so directly under the influence of the mind and passions, which is expressive of the condition of the mind, not by volition, but made evident to the eye by certain symp- toms, is brought into action by certain nerves which are intermediate between the internal parts of the body and their external or muscular frame. This may appear to some foreign to our proper sub- ject. Nothing, however, can be foreign on this occasion, which is a fair deduction from the facts presented to us by anatomy, a science which is highly cultivated only when we observe all its relations. If you find an interest in attending even to the number of bones in the wrist and the foot; nay more, if you find that you form as it were another science by an attention to the minutiae of animals, you will not con- sider that time to be lost which is spent in analysing the relation established be- tween the corporeal frame and the mind itself, the moi especially as this is, in fact, laying the foundation of the doctrine of sympathy, or the doctrine of symptoms, as I should more correctly express myself. For how are we to be alive to all the changes in the body, and all the variations of form in disease, unless we are familiar with the condition and relation which are established between the nerves and emo- tions of the body ? I will give you a familiar instance in illustration of my view. I had bought a horse, and driven it to the door pf a pa- tient, who was looking out of the window, and who, on seeing me, said, " How long have vou had that horse?" I told him that I had bought it a fortnight since. Then, said he, " vou have made a bad bargain in it, for he is not sound." " How can you presume," said I, " to say so, for you have only looked at him from a dis- tance ?" " True," he replied, and I pressed him to tell me how he knew the state of the animal. " By its breathing," he said; " by the inflation of the nostrils." I was then satisfied that he was wrong in his opinion, for I found that I had not driven him in his own collar, and that he was only restrained in his respiration, and not unsound in his lungs. But I was well pleased to find that this knowing gentle- man judged of the condition of the lungs. by the action of the nostril. I have seen the same kind of thing in the hospital.

LECTURES ILLUSTRATED BY THE HUNTERIAN PREPARATIONS IN THE MUSEUM OF THE ROYAL COLLEGE OF SURGEONS, LONDON

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745

sides its duct there is a distinct hepaticduct which receives that of the pancreas,and opens into the duodenum. We ob-serve at the termination of the small in-testine in the wide colon, that it enters insuch an oblique manner as to leave a prettyconsiderable blind enlargement or caecumat the commencement of the colon. The

parietes of the alimentary canal are strongand muscular throughout. The mucouscoat is of great extent, as in other phyto-phagous animals; and although there areyet no valvulse conniventes, this innertunic forms numerous longitudinal foldsand cells in the course of the intestine, bywhich its secreting surface, and the sur-face for the distribution of the numerouslarger lacteal vessels, are greatly extended.The distinction of the small and large in-testine is more marked here than in theinferior reptiles, amphibia, or fishes, andthe long and capacious colon of the che-lonia is provided with a distinct valve, andoften with a wide and short caecum, so thatthe alimentary canal has now acquirednearly all those characters and divisionswhich it presents in higher stages of deve-lopment in the warm-blooded vertebrata.

ANATOMY AND PHYSIOLOGY.LECTURES

ILLUSTRATED BY THE

HUNTERIAN PREPARATIONS

IN THE MUSEUM OF THE ROYAL COLLEGE

OF SURGEONS, LONDON.

Delivered at the College in 1833, by

SIR CHARLES BELL, K.G.H., F.R.S.

LECTURE X.

RELATIONS EXISTING BETWEEN THE

NERVOUS AND MUSCULAR SYSTEMS,AND MENTAL AND BODILY EXPRES-

SION.

GENTLEMEN,—Hitherto you know Ihave taken sure ground; I have gone asfar as it was possible for me to be directedby the preparations and the arrangementsof Mr. HUNTER. But now I must either

go on alone, and unsupported, or I mustmove in another circle.Now I believe that you would rather

that I prosecuted the subject of muscularaction a little further. May I observe,then, that the muscular system may beconsidered as that part of the organiza-tion of the body which is under the direc,tion of the will by volition, and is used in

locomotion ; that, again, the muscular

system is used in performing all thosesecret functions which are going on with-out the cognizance of the mind, and allthe secret operations which are necessaryto the performances of the animal eco-

nomy.Now I wish to draw your attention to this,

- that the muscular texture which is so

directly under the influence of the mindand passions, which is expressive of thecondition of the mind, not by volition, butmade evident to the eye by certain symp-toms, is brought into action by certainnerves which are intermediate betweenthe internal parts of the body and theirexternal or muscular frame. This mayappear to some foreign to our proper sub-ject. Nothing, however, can be foreignon this occasion, which is a fair deductionfrom the facts presented to us by anatomy,a science which is highly cultivated onlywhen we observe all its relations. If youfind an interest in attending even to thenumber of bones in the wrist and the foot;nay more, if you find that you form as itwere another science by an attention tothe minutiae of animals, you will not con-sider that time to be lost which is spentin analysing the relation established be-tween the corporeal frame and the minditself, the moi especially as this is, infact, laying the foundation of the doctrineof sympathy, or the doctrine of symptoms,as I should more correctly express myself.For how are we to be alive to all thechanges in the body, and all the variationsof form in disease, unless we are familiarwith the condition and relation which areestablished between the nerves and emo-tions of the body ?

I will give you a familiar instance inillustration of my view. I had bought ahorse, and driven it to the door pf a pa-tient, who was looking out of the window,and who, on seeing me, said, " How longhave vou had that horse?" I told himthat I had bought it a fortnight since. Then,said he, " vou have made a bad bargainin it, for he is not sound." " How can

you presume," said I, " to say so, for youhave only looked at him from a dis-tance ?" " True," he replied, and I pressedhim to tell me how he knew the state ofthe animal. " By its breathing," he said;" by the inflation of the nostrils." I wasthen satisfied that he was wrong in hisopinion, for I found that I had not drivenhim in his own collar, and that he wasonly restrained in his respiration, and notunsound in his lungs. But I was well

pleased to find that this knowing gentle-man judged of the condition of the lungs.by the action of the nostril. I have seenthe same kind of thing in the hospital.

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Going into the hospital, and finding no-thing amiss, nothing to do amongst tiie

patients, I have inquired if they were allgoing on well, and have been told thateverything was right. But, on looking tosome one man, I have found that although Ihe was almost totally enveloped in bed-clothes, yet that there was an unusual ex-pression observable in his nostrils, and onlooking to him more narrowly, I found atrembling of the lips. I have then said tomyself, " Why, this man cannot be well ; Ithis is not the condition of a person in re- ipose ; he has nothing to alarm his mind, i

therefore this must b3 an indication or asymptom of something wrong." If you go ’,up to the man on such an occasion, andask him how he is, you find that the voice Iis affected,-that he cannot speak to you.If you make him draw in his breath, youfind at once where is the seat of com-

plaint ; you put your finger to the place,and discover that condition in which thelungs are going rapidly into a state of

hepatization, in which they are fast be-coming to resemble liver. Now 1 cer-

tainly believe that the course of reflectionwe are upon to-day, although it may take

us, apparently, a circuitous route, will leadthe mind to be more alive to little circum-stances which would otherwise escape ob-servation.We find that some men are observers,

as it -were intuitively; that they can mimictheir fellows; that some can depict thepassions, and others describe them inwords. You must have found some, who,apparently without particular attentionor study, have the power of mimicry; so

that when a person goes out of the room,the mimic can throw himself into his veryattitude, assume his manner of speaking,and almost his manner of thinking. Justin the same way vou find another manwith genius (we call it " genius," as if itwere something intuitive), who does notappear to be a more accurate observerthan others, who ,yet, with the pencil inhis hand, represents on canvass the na-ture, the form, the attitude, and the ex-pression of another, so faithfully as toarouse the sympathies within you, and

compel you to say that that man hasthe same talent as the first, but a differentmode of showing it. So, again, whileothers cannot mimic, cannot use the pen-cil, know nothing of drawing, yet theycan in words, with a pen, represent thingsas naturally as they are exhibited on thestage, and thus call forth the sympathy ofall mankind.Now this is not intuitive; this ought

not to be called the effect of genius ; it isthe result of a close, minute, reiterated ob-servation, and the only difference is, that

it is not labour to the man who can ac-complish it. He likes the pursuit, he in-dulges in it, he repeats it. That is thedifference between such a man and a manwho does not readily effect such results.Now I conceive that something artificialmay be done towards communicating toyou the right principle, as it were, for un-veiling the powers of your mind, towardsmaking you observant of all that passesin your own circle, the very expression,the very attitude of others, and leadingyou to that sort of acumen at last, whichmakes you better physicians, better ob-servers of the influence of disease on thebody. This is my excuse for taking upthis subject, which seems to lead us fromthe common course of observation, but inthe present course I trust I shall be ableto show the influence of the bodily frameupon the mind, as well as the influence of

the mind upon the bodily frame.This, on a superficial view, would ap-pear to be something like supporting ma-terialism, and therefore I conceive mysafest course is to draw your attention, inthe first instance, to the influence of thecommon organs of sense. You will find,by attending to this subject, that an ideais produced in the mind by a certain coti-

dition, or a certain change in the organsof sense,--that is to say, when an objectis visible, when the rays of light have beenreflected from an object to the eye, thereis nothing conveyed into the nerve itself,but an impression only is made upon it.Now the common idea is, that somethingis carried along the nerve, as if somethinghad been actually received there, and yetthose who have studied this cnhinnl- mnaf

carefully, who have been great discoverersin science, and on that account must bedepended on for their accuracy, have saidthat the nerves are unhandy engines forcarrying ideas, that there is, in fact, no-thing received when the outward organ isimpressed, and therefore that the occur-rence of an idea in the mind results froma relation established in nature, by theAuthor of our being, betwixt the intel-lectual principle within us, the brain, thenerve, the outward organ of sense, andthe qualities of things externally. Wecan come to no other conclusion than

this, that there is a relation establishedbetween certain things, but what the na-tire of that relation is we cannot say.

i Yet of this we are certain, that nothing is, received. Well, then, if nothing be re-f ceived, there must be a change in the or-

gan, in the nerve, in the brain itself, andt an influence at least produced upon the; intellectual principle itself. If, then, every- impression upon the hand, every impres-t sion upon the eye, every impression upon

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the ear, though seeming to us at first tobe something received from without, beproved only to be a change in the organ!itself, we shall be less surprised at findingthat a certain condition or emotion of themind results from the state of the body,and that the corporeal frame is, as it

were, a great organ influencing the mind,and intimately influenced by it.The first step, then, of this demonstra-

tion, if I may give it that important cha-racter, is to show how the vital organsare sustained together, and to show theinfluence of these vital internal organs,first upon the exterior muscular appara-tus, and then the mind., and .

Accordingly I have before me a demon-stration sufficiently minute for that pur-pose, and you cannot think how anxiouslya person in my situation desires to have,as it were, a point, a rest for the mind, inthe shape of a demonstration. But I muchfear, after all, notwithstanding the nicetyof the present dissection, that I shall make Ilittle of it ; that is to say, I am not con-vinced that you will see it well. There- Ifore, however nicely the dissection hasbeen prepared, I must ask you in placeof it to look upon the rude sketches be-fore you. You will understand that wehave here a representation of the visceraof the thorax, the heart, the lungs, thestomach, the trachea, the larynx, and thepharynx. Now what I particularly wish todraw your attention to, is the eighth pair.We ought, indeed, in the first place, instudying this nerve, to consider its justrelation to the viscera. Here comparativeanatomy comes to our aid, to prevent usfrom forming incorrect notions. I say itis an incorrect notion to suppose that thenerve leads off from the brain, and con-veys all the energy of that organ to the

parts led to, because I know full well, bytracing from the lower animals to the morecomplex, the powerful operation of thecirculation and of respiration, where thereis no such nerve, no such source of nerv-ous energy in the head, in fact, at all.The reflection naturally occurring from

this (and we shall have occasion to recurto it more than once) is, thit in the loweranimals the nervous energy lies in the

part or organ itself excited, and there isno reason to suppose that the fact is muchotherwise in the higher animals. We na-turally say, therefore, " Why this chord-the spinal marrow?" This leads to the

supposition that there is an establishedrelation between certain parts, betweenwhich this is the agent of communication.In fact, the great engines of circulationand respiration, the great organ for thefirst step of assimilation, are all connectedtogether; not grouped together, not united

by juxtaposition, but connected throughnervous energy. I believe I ought to! verify this statement, though I know withregard to most of you, that it is Liiineees-sary for me to do so. The best way toestablish the point is, to consider the caseof a person apparently drowned. The per-son is taken out of the water withoutbreath, without action of the parts con-cerned in breathing, without pulse: themere dilatation of the lung, its repeatedaction, will bring on the action of theheart. Were it not so, there would be nopossibility of resuscitation, because thisfirst action of the heart does not cause adecarbonization of the blood, does not

bring arterial blood into the heart throughthe body. All that it does at first is torestore a sympathy between the action ofthe heart and the lungs, when, by repeating,for a certain time the inflation and com-pression of the lung, the pulse returns.We find other instances of the heart com-ing into action after the lungs. Youknow the common experiment with a frog.If it be rendered apparently insensible andmotionless, on being immersed in a respi-ratory gas the heart, being pricked withthe point of a needle, begins to act, and,according to its nature, acts two or three

times, when, being again pricked, it re-

news its action, and presently, after it has

so acted, the breath returns, and respira-tion takes place, and when the animalhas respired once or twice, it turns overfrom its back to its belly and leaps. Hereyou see the sympathetic action of thelungs drawing after it the action of theheart, and then again the action of the; heart drawing after it the action of the; lungs.

_ _

The experiments of Mr. COLEMAN inhis earlv life tended to show that if a nar-cotic medicine were in the stomach duringthe attempt to perform such experiments,the attempt did not succeed, implying thatthose three organs, the lungs, the heart,and the stomach, are closely connected, notmerely by proximity of situation, but bybeing supplied by the same pair, the parvagum, which lies by the side of the pha-

-

rynx, giving off the pharyngeal branches.Coming to the larynx, it gives off the laryn-geal branches. Coming down to the thorax, --

it sends down the recurrent under the archof the thorax, which course removes theparticular interest attaching to it, becauseso long as it continues to run from itssource, distributing its branches, there isno intricacy about it, nor is there any callfor its minute study. But you next findthe nerve taking a circuitous course, thebranches running up together, and it nowbecomes a fair subject for close examina-tion, a fair subject for inference. Here we

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have occasion to speak of a point which Ihave already once made the subject of re-mark, viz., the action of the trapeziusmuscle. We had reason to conclude thatthis muscle acted in the process of respi-ration, and in restoring exhausted respira-tion ; but no part of it acts without beingstimulated, or without some relation beingestablished between it and other parts.Well, then, here is the nerve running downto the root of the lungs, about to expandon the lungs, but not before it sendscircuitous branches back to supply thoseparts which are necessarily drawn in inthe regular act of breathing; the frame,were they not so drawn in, (one branchbeing kept irregularly or imperfectly ex-cited,) suffering spasm, and suffocation be-ing the effect. Now the nerve comes downinto the chest, and passes to the lungs,where it throws out little branches, whichunite again, and so are distributed to the ’iheart. Some persons formerly said thatthe lungs were not sensible bodies. No,they are not very sensible. So again hasit been said that the heart is not sensible,nor is it so in the common acceptation ofthe term. We know full well that whenHARVEY put his hand to the heart of ayoung nobleman which an injury had laidbare, the youth did not know that theorgan was touched; he did not know thatthey were handling him at all unless theytouched the external integuments. Thus Iit appears, in a common parlance view of !the matter, that the heart is insensible. IBut is that the fact? We know that wecannot rise from our seat without a cer-tain increase of the pulsating artery, norcan you accelerate your pace homewardswithout a corresponding acceleration ofthe action of the heart itself. In short,knowing that the heart is connected withevery important vital organ, and affectedby every condition of the body, you mustbe prepared to understand that the heartis acutely sensible to the influence of themind, when labouring under passion andwhen in motion.The parts within the thorax being thus

connected with the stomach, they have arelation to the parts external, to the mov-ing parts, and yet there are no nerves

going out from the centre straight to thecircumference, - no nerves strictly inunion between the lungs, the heart, thestomach, and the exterior muscles. Wemust therefore go back to where the parvagum reached the throat, and see whatother nerres there may be coming downfrom the neck, deviating only so far as

they go to the muscles externally, insteadof the parts internally. Here is a sketchwhich will bring to your recollection thenumber of powerful muscles that act in

moving the chest. We have here, forexample, the sterno-cleido-mastoideus,which is a muscle of the head; but ifthe head be fixed, it is a powerful musclefor raising the sternum and dilating thechest. We come down here again to thepectoralis major, a powerful muscle of thearm. Change the origin to the insertion;make the insertion the fixed point, andthen the origin becomes the insertion,-that is to say, instead of moving the armit dilates the thorax. Then we come roundto this powerful muscle, the serratus majoranticus, spreading like a hand upon all theribs, taking its digitations from the move-able ribs, then forming a fleshy belly whichruns under the shoulder and scapula, tobe inserted into the basis of the scapula,

and is a muscle of the scapula and shoul-der ; but if the shoulder be fixed, it is amuscle of the thorax. Thus you will ob-

serve that if the two parts be fixed, that is,the head above and the shoulder at the

lower part, all those muscles which are

muscles of volition and ordinary motion of

the extremities, become muscles of respi-ration..

I beg your attention next to the tra-pezius. If we require the head to bethrown back and fixed, this is a powerfulmuscle for that purpose. If we requirethe scapula to be thrown back and fixed,that is the direct office of this muscle.So, then, this muscle, though it is not amuscle of the head, yet by fixing the headand shoulder it makes those parts thepoints from which the other muscles gooff as from an origin, and this becomes apowerful muscle of inspiration. Indeedit is very much worth your observation,that nature, both by the distribution ofthe nerves and the application of powerfulmuscles, seems more anxious, if I may sospeak, to give freedom and fulness to in-spiration than to expiration. Your ownfeelings and observation point out this,that in all anxious states of breathing, inall excited conditions of the lungs in in-spiration, the act of difficulty is the dilata-tion of the lungs. The elasticity of the parts,the compressibility of the whole, seemssufficient to expel the air.Now, reviewing these muscles, let us

attend to their action. The jockey is wellaware that if he wish to ascertain the

healthy condition of the lungs of thei horse, he must give the animal a smartblow, when an immediate and powerfulinspiration is made, so that inspiration inthat case is the immediate effect of alarm.

It is the same with man; if we are startledby anything, an instantaneous extensionand dilatation of the chest takes place. Nowthis surely is notanaccidental thing; foryouwill see at once that if there be a condition

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of alarm, and a state of preparation of the’body for avoiding the object of alarm, orfor struggling against it, or defendingourselves, this is necessary to the force ofthe extremities. You may remind me,perhaps, that if a man cut his throat, themoment he has opened the trachea belowthe muscles of the glottis, the thorax sub-sides, and he feels as if struck with death,so feeble are his motions. Experimentsof this kind have been made upon animals.If you open the trachea of a dog andthrow him into a ditch, he will try toswim across, but he cannot do so, andsinks. But there is a preparation foraction; the chest is dilated, and, beingdilated, the muscles of the glottis keep itso, and give freedom to all the muscles ofthe cliest, so that they are not, for thetime, muscles of respiration, but musclesof the arm. The thorax is full, themuscles are placed in a position for thegreatest possible action at the furtherextremity, and the whole animal is there-fore in a state prepared for exertion.What is the condition of a person in a

state of asphyxia? See a man labour-ing under asthma, and at once youare led to understand his position. Hedoes not stand upright, but leans uponthe table, or rests his elbows there. Heseeks in some way to make the shoulderthe fixed point, because his alarm has oh-structed respiration, and he calls in thewhole muscular system to assist in effec-tively aiding the dilatation of the chest.The next point that I would advert to-

and this is purely professional-is theagency of the arteries. You know that thelungs and the arteries are occupied in oneoffice, to produce and convey vital arterialblood into the system, to supply all thedifferent functions, powers, and endow-ments of life. These are but two parts ofone object,-the one the preparation ofthe blood, and the other its propulsion.When, therefore, a person is losing blood,he labours often under a symptom as if hewould suffocate ; he labours in his breath-ing ; he heaves the chest; he has all thecharacters of anxious breathing; you seeit in the workings of the chest, the eleva-tion of the shoulder, the action of theheart, and the inflation of the nostrils.He exhibits extraordinary paleness, not

merely becoming colourless because he islosing red blood fast, but because he isobviously labouring under the influence ojdifficult and alarmed respiration. TherEis a natural excitement of the respirator)organs attendant on the draining away o:blood. Call to mind the figure of the dyingladiator. There we have the action of aman who is wounded, and from whenthere is a draining of blood. The instru

ment which has wounded him is at hisside. I beg your attention to the parti-cular manner in which he lies. This sta-tue is indeed true to nature, the best proofof which is, that it has been spared in allages, as well by those savage nations thatmade inroads upon Rome, as by the re-fined nations and citizens of our own age.There must be something very true to na-ture where every one acknowledges thebeauty of expression. The gladiator lieshalf recumbent, resting upon one hand,with the other upon his knee. Notice thecondition of the shoulder; he feels that in

the draining of blood there is a call uponthe act of respiration. If it have ever; been your lot to see a man dying in thisf condition, you must have observed that heclings to his assistants, hangs upon those3who are really holding him up, and theshoulder is raised; all the muscles are in,violent action, the chest is greatly dilated,rand in that condition he labours untildeath actually takes place, and he falls,

relaxed from his hold.Look, again, at the group known by the

name of the Laocoon. The artist, a manof fine and sensible imagination, has con-trived to make the Laocoon restrain the

expression of his pain, and with what ad-mirable propriety ! The whole group, in-deed, has met with admiration. The true

explanation of the restraint is to be foundin the relation which the muscles have tothe arm and the chest; they continually actin such manner that you cannot dilate thechest and move the arm at the same time.

You must have observed that in wrestlingor in any other condition of great exertion,it is impossible for a man to breathe dur-ing the action, nor is the voice audible.It is in the intervals of powerful actiononly that the voice is to be heard. TheLaocoon has been entwined by the serpent,and is endeavouring by the most powerfulexertion to tear the serpent from him.During the period that the arm is pushingoff the offensive animal, it is impossiblethat he can speak, on account of the ne-cessity to which I have before alluded;namely, because the powerful muscleswhich dilate the chest are now engagedin moving the arm. Hence the conditiongiven to the figure. The artist, you per-ceive, is rigidly true to nature, and mostpowerful in the expression of character.The most surprising thing in the consi-

deration of this subject is the accuracywhich we all display in judging of what isnatural in portraiture,-in judging of whatwe see, and acknowledging it to be rightlyexpressed, without knowing how. It re-minds one of an actor in a tragedy. Someof you perhaps may recollect Mrs. Sid-.dons in some of her finer scenes, where

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the poet leaves her to her own concep. ]tions and depiction of a character whileasleep, in which seeming state she con-tinued to move the hearts of every onebeholding her. In the deepest character-istics of sleep there is occasionally, andwas expressed by Mrs. Siddons, the con-vulsive throb through the whole frame,the action of the platysma myoides of theneck, a swelling of the nostrils, a movement of the lips, and a little obvious re-spiratory action. It was not so remark-able that she represented these effects, butthat every one of the thousands who be-held her should feel the chord of sympathyvibrating in his own heart. It is remark-able that mankind should be so held to-

gether by sympathy. In the Laocoon,again, how evidently silent is the victim !The artist is in this, too, still true to na-ture, for who could cry out in receiving amortal wound? The whole of the partsare in agony; and under the influence of

approaching death it would be highly un-natural for an actor, who had reasoned onnature, to cry out at such a time.

So far with regard to the mere muscles,- the connexion simply between the mus-cles of the thorax and the muscles of the Iarm; but those muscles, which are an

outward apparatus, though an organ ofrespiration and expression, have no directconnexion with the ribs, with the partsbelow. If, however, you trace back thepar vagum to its source, you will find thatthere are other nerves coming down fromthe medulla oblongata.

Here is the phrenic nerve, acknow-ledged to be a nerve of respiration, whichexcites the diaphragm, the most import-ant muscle in all the vital economy, intocontraction, just at the moment of the di-latation of the chest in respiration. Thereis another nerve very near it, the externalthoracic, which passes across the other

nerves, but has nothing to do with them,and there are the intercostal nerves, run-

ning to the muscles. One would naturallysay, why should there be two sources ofnerves ? Here are two, one running fromthe intercostal spaces to these muscles, andanother running down from the neck, forthe purpose, I should allege, of bringingthis powerful muscle the serratus magnusinto combination with the diaphragm. Iobserved that this was a powerful muscleof inspiration when the head was fixed,the sterno-cleido-nastoideus muscle draw-ing up the sternum and dilating the chest.These muscles, connected -with the neck,have no power unless they are inverted,and their insertion is made their fixed

point. Now if there be a stimulus actingon the trapezius, it draws back the head,draws back the shoulder, and gives a fixed

point for the insertion of these othermuscles, and therefore throws them all atonce powerfully on the ribs as muscles ofrespiration. These nerves run down theircourse, the other nerves also uniting attheir roots, both for the purpose of unitingthese muscles into one combined action,and connecting those muscles with the in-ternal viscera and their sensations.

But, perhaps, you have been thinking,how can this affect the process of respira-tion, such various actions being assumedin various conditions of the lungs ? Thecondition of the heart and lungs is one

thing, and produced by certain distinctnerves, but how is all this external part tobe put into action ? There must some-where be a relation established betweenthe external part and the internal, bywhich means the impressions felt withinhold correspondence with the action with-out. Take an example from the passions,whether of grief, laughter, or fear. Thereis a species of expression of which youcan easily comprehend the phenomena,that,for instance, of terror. When a manis terrified, you comprehend a great dealfrom his expression. You see that hisI eyes are fixed on the object of his alarm,you understand why his eyes roll and arelargely uncovered, you know by his mo-tions that he is in a condition of fright,and anxious to run from the object of it.All this is easy to the comprehension; itexhibits the direct influence of the mindon the body; the man is intent upon theobject before him, he is prepared to escapeor to defend himself, which is naturalenough, but you probably do not knowwhy his shoulder is so elevated, or his chestis so dilated that he cannot breathe,-why e

there is that awful condition of all the re-

spiratory organs which prevents him frompropelling his breath freely,-why he iscut in his speech and cannot utter a word,- why there is that extraordinary pale-ness, that blanched cheek and livid lip,- and far less why there is that convul-sion of the neck and throat, that inflationof the lips and nostrils, so peculiar on anoccasion of terror. But if you observe the ,

knocking at his side, if you notice that thecondition of his mind is obviously influen-cing the action of his heart, obviously in-fluencing all those viscera that are groupedtogether, you discover that they must havean influence on these muscles, and thatan excitement is first produced internally,and then reflected on the muscles of respira-tion, by which he is thrown into all the ap-parent agony during which the respiration

is obstructed, and the speech is checked.You have another proof of the source

from which this expression arises in thecirculation, evidenced by paleness andt

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coldness of the surface. By thus follow-ing up the appearances presented by thepassions, and studying their source and

relations, you acquire not only a new in-terest in an old subject, but you really havenew means afforded you of increasing youracumen in discriminating the symptomsof disease. I will go on with this subjecta little farther at the next lecture.

CLINICAL OBSERVATIONS

ON

VARIOUS DISEASES,

BY

MR. WARDROP.

CASES OF RETENTION OF LTRINE. BWHENEVER there is a retention of urine,the first endeavour of the surgeon usuallyis to introduce a catheter, to procure theevacuation of the retained fluid, thus dis-regarding the immediate cause which hasprevented the bladder from performing itsnatural function. Now there are, in par-ticular, two states of disease, either ofwhich predisposes to retention of urine ;these are, an enlarged prostate, and astrictured urethra, and in both these affec- Itions, if inflammation supervene, the re- Itention follows. It is such cases of reten-tion as arise from the one or the other ofthese two causes, that the following in-stances are designed to illustrate.

Case 1.—I was sent for early one morn-ing to draw off the water of an old ge-neral officer who was suffering from re-tention of urine. Sir GILBERT BLANEhad previously visited him, and had pro- Iposed the use of the catheter. The uri-

nary bladder was considerably distended,no water having passed since the previousevening. The prostate gland was en-

larged, and the temperature of the internalsurface of the rectum was much increased.The patient’s pulse was not sensibly af-fected, and his skin was hot. He was notaware of ever having had any disease inthe affected parts, although he had longfelt a difficulty in voiding his urine afterfree drinking, and he attributed the pre-sent attack to having drunk freely thenight previously.

In place of endeavouring to introducean instrument into the bladder in orderto withdraw the urine, I proposed first tosubdue the inflamed state of the prostateand parts around the neck of the bladder.For this purpose blood was immediately

taken from the arm, while he was in thehorizontal position, and the current wasallowed to flow until the pulse was quitesubdued. He was by this measure relievedvery quickly from all pain, and in a fewhours the urine began to ooze from the

urethra. Twenty leeches were now ap-plied to the perineum, and in a fewhours more the urine, after having comegutta tim, escaped in a stream, and thebladder was completely evacuated. No-

thing but the antiphlogistic regimen wasafterwards employed, and in a few daysthe functions of the urinary organs werecompletely restored. This patient livedseveral years after, and I had occasionalopportunities of seeing him, and I learntthat he never had a subsequent attack ofthe same kind.

Case 2.-1 visited a gentleman who, inthe eighty -second year of his age, was at-tacked with retention of urine, for therelief of which repeated attempts had beenunsuccessfully made to introduce a cathe-ter. I found the bladder considerably dis-tended. There was great tenderness andpain in the pelvic region, the action of theheart and arteries was much accelerated,the skin was hot, and he suffered greatdisquietude. I endeavoured, without usingany force, to introduce a catheter, but theinstrument stopped at the neck of thebladder. I found the prostate gland en-larged and tender, with increased heat inthe adjacent parts, and I was informed

that he had long had an enlarged pro-state, in consequence of which instruments

had, on several occasions, been used. Per-suaded that the catheter could not be in-troduced with force, and perhaps not with-out more or less injury, and that the re-tention of urine had been caused by anattack of inflammation, I conceived it

expedient to subdue that attack before

again endeavouring to draw off the water,and 1 was also not without hope, that afterthe inflammation was subdued, the urinemight pass along the canal of the urethra,i an event which had occurred in the formercase. Forty ounces of blood were takenfrom the veins of both arms before syn-cope supervened. After the faintness hadpassed off he rose from the bed, and pass-ed a few spoonfuls of urine, and duringthe subsequent eight hours he remainedtranquil and undisturbed, though no moreurine escaped. 1 therefore now endea--

voured to introduce a catheter, whenthe instrument passed without difficultyor pain, and continued to be passed withperfect ease, as long as the bladder wasunable to perform its functions.

Case 3.-1 visited Colonel--, whohad not voided his urine for ten hours.His countenance expressed great anxiety,.